自然周期子宫内人工授精对年龄较大的女性可能会产生更好的效果。
Intrauterine insemination in natural cycle may give better results in older women.
作者信息
Kalu E, Thum M Y, Abdalla H
机构信息
Lister Fertility Clinic, Lister Hospital, Chelsea Bridge Road, London, SW1W 8RH, UK.
出版信息
J Assist Reprod Genet. 2007 Feb-Mar;24(2-3):83-6. doi: 10.1007/s10815-006-9097-2. Epub 2007 Jan 17.
BACKGROUND
Controlled ovarian hyper-stimulation (COH) in combination with intrauterine insemination (IUI) has been shown to result in significantly higher pregnancy rates compared to un-stimulated (natural cycle) IUI. This may however not be true in all ages.
METHODS
We performed a retrospective cohort study and analysed data collected prospectively on 1759 IUI cycles in couples with unexplained infertility. The results were analysed to show the outcome of IUI with COH, and IUI in natural cycle (unstimulated), in younger women compared to their older counterparts.
RESULTS
In women age 37 and younger, COH resulted in a significantly higher pregnancy rate (13.0% vs 6.5%) and live-birth rate (10.7% vs 5.2%) compared to natural cycle IUI (p = 0.025, p = 0.045 respectively). However for older women age >37 years, natural cycle (unstimulated) IUI, resulted in a significantly higher pregnancy rate (12.0% vs 8.5%) live-birth rate (7.5%vs 3.5%) than IUI with COH ((p = 0.0037). This difference is even more significant when COH was performed with clomiphene citrate (7.5% vs 2.1%) (p = 0.0017).
CONCLUSION
COH was associated with a lower live birth rate in older women, irrespective of the agent used, and it seems to be worse when the anti-oestrogenic drug clomiphene citrate was used for COH. Older women may benefit more from natural cycle (unstimulated) IUI. A randomised controlled trial is required to confirm this observation.
背景
与未刺激（自然周期）的宫腔内人工授精（IUI）相比，控制性卵巢过度刺激（COH）联合IUI已显示出显著更高的妊娠率。然而，这在所有年龄段可能并非如此。
方法
我们进行了一项回顾性队列研究，并分析了前瞻性收集的1759例不明原因不孕夫妇的IUI周期数据。分析结果以显示年轻女性与年长女性相比，COH-IUI和自然周期（未刺激）IUI的结果。
结果
在37岁及以下的女性中，与自然周期IUI相比，COH导致显著更高的妊娠率（13.0%对6.5%）和活产率（10.7%对5.2%）（分别为p = 0.025，p = 0.045）。然而，对于年龄>37岁的老年女性，自然周期（未刺激）IUI导致的妊娠率（12.0%对8.5%）和活产率（7.5%对3.5%）显著高于COH-IUI（p = 0.0037）。当使用枸橼酸氯米芬进行COH时，这种差异更为显著（7.5%对2.1%）（p = 0.0017）。
结论
无论使用何种药物，COH与老年女性较低的活产率相关，当使用抗雌激素药物枸橼酸氯米芬进行COH时，情况似乎更糟。老年女性可能从自然周期（未刺激）IUI中获益更多。需要进行一项随机对照试验来证实这一观察结果。
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