Vitthala S, Gelbaya T A, Hunter H, Roberts S A, Nardo L G
Department of Reproductive Medicine, Saint Mary's Hospital, Whitworth Park, Manchester M13 0JH, UK.
J Assist Reprod Genet. 2008 Sep-Oct;25(9-10):431-6. doi: 10.1007/s10815-008-9251-0. Epub 2008 Oct 1.
The objective of our study is to investigate the optimum number of stimulated intrauterine insemination (SIUI) or donor insemination (DI) cycles that can be offered to the couples prior to in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) in a tertiary referral unit for assisted reproduction.
This is a retrospective analysis of 408 SIUI and 704 DI cycles performed in a tertiary referral unit for assisted reproduction. SIUI's were performed by controlled ovarian hyperstimulation and ovulation induction followed by insemination 36 h later. DI's were performed in natural or stimulated cycles after thawing frozen donor sperm. The main outcome measured was cumulative live birth rate (CLBR) per couple.
A maximum CLBR of 26.1% was achieved after the fourth cycle of SIUI. The CLBR of DI increased to 60.1% in the sixth cycle.
This study, in line with a number of other studies, is unable to demonstrate unequivocally whether increasing numbers of IUI or DI cycles are justified clinically or financially. There is a need for larger datasets from multiple centres along with rigorous randomised trials to compare treatment pathways. Until then, the resources spent on the provision of extra SIUI cycles may be better utilized by early referral to IVF.
我们研究的目的是调查在一家三级辅助生殖转诊单位中，在进行体外受精（IVF）或卵胞浆内单精子注射（ICSI）之前，可以为夫妇提供的最佳刺激子宫内授精（SIUI）或供体授精（DI）周期数。
这是一项对一家三级辅助生殖转诊单位进行的408个SIUI周期和704个DI周期的回顾性分析。SIUI通过控制性卵巢过度刺激和排卵诱导进行，36小时后进行授精。DI在解冻冷冻供体精子后的自然或刺激周期中进行。主要测量结果是每对夫妇的累积活产率（CLBR）。
在第四个SIUI周期后，CLBR最高达到26.1%。DI的CLBR在第六个周期增加到60.1%。
本研究与其他一些研究一致，无法明确证明增加IUI或DI周期在临床或经济上是否合理。需要来自多个中心的更大数据集以及严格的随机试验来比较治疗途径。在此之前，将用于提供额外SIUI周期的资源尽早转诊至IVF可能会得到更好的利用。
