在常见不孕病因中，宫内授精时机与排卵的关系以及授精次数对周期妊娠率的影响。

The effects of timing of intrauterine insemination in relation to ovulation and the number of inseminations on cycle pregnancy rate in common infertility etiologies.

机构信息

Mansoura Integrated Fertility Center, Mansoura, Egypt.

出版信息

Hum Reprod. 2011 Mar;26(3):576-83. doi: 10.1093/humrep/deq362. Epub 2010 Dec 21.

DOI:10.1093/humrep/deq362

PMID:21177312

Abstract

BACKGROUND

Controlled ovarian hyperstimulation with intrauterine insemination (COH/IUI) is an established tool in medically assisted conception for many infertility factors. However, the proper timing of IUI after hCG trigger and the frequency of IUI are still debated. We aimed to examine the association between the cycle pregnancy rate (CPR) and: (i) single IUI timed at 36 ± 2 h post-hCG (pre- or post-ovulation) (ii) the number of IUI (single or double) for pre-ovulatory cases both aims in male, anovulatory and unexplained infertility.

METHODS

The study included a total 1146 first-stimulated cycles in infertile couples due to male factor, anovulation or unexplained infertility. Cycles were stimulated by clomiphine citrate (CC) or sequential CC-hMG or hMG and monitored by transvaginal ultrasound. When the leading follicle reached ≥ 18 mm mean diameter, 10000 IU hCG was given to trigger ovulation and IUI was timed for 36 ± 2 h later. Semen was processed and ovulation was checked at the time of IUI. Post-ovulatory cases received single IUI, while pre-ovulatory cases were sequentially randomized to receive either single or double IUI. The end-point of the cycle was CPR.

RESULTS

Overall CPR in the whole cohort was 10.1%. When ovulation was present before IUI, CPR was 11.7% compared with 6.7% when ovulation was absent [OR (95% CI): 1.85 (1.12-3.06), P = 0.015]. When this OR was computed according to infertility etiology, it was 1.26 (0.52-2.95) (P = 0.82) for male factor infertility and 2.24 (1.23-4.08) (P = 0.007) for non-male factor infertility. Comparing the CPR for double versus single IUI in pre-ovulatory cases, the OR for all cycles was 1.9 (0.76-4.7) (P = 0.22), but according to etiology, it was 4.667 (0.9-24.13) (P = 0.06) in male factor and 1.2 (0.43-3.33) (P = 0.779) for non-male factors.

CONCLUSIONS

Single IUI timed post-ovulation gives a better CPR when compared with single pre-ovulation IUI for non-male infertility, whereas for male factors, pre-ovulation, double IUI gives a better CPR when compared with single IUI.

摘要

背景

在许多不孕因素的医学辅助受孕中，控制性卵巢超刺激与宫腔内人工授精（COH/IUI）是一种既定的工具。然而，hCG 触发后 IUI 的适当时间和 IUI 的频率仍存在争议。我们旨在研究周期妊娠率（CPR）与以下因素之间的关系：（i）在 hCG 触发后 36±2 小时进行的单次 IUI（排卵前或排卵后）（ii）排卵前病例的 IUI 次数（单次或双次），均针对男性因素、排卵障碍和不明原因不孕。

方法

该研究共纳入了 1146 个因男性因素、排卵障碍或不明原因不孕而接受首次刺激的不孕夫妇的周期。通过枸橼酸氯米芬（CC）或序贯 CC-hMG 或 hMG 进行周期刺激，并通过经阴道超声进行监测。当主导卵泡达到≥18mm 平均直径时，给予 10000IU hCG 以触发排卵，并在 36±2 小时后进行 IUI。在 IUI 时处理精子并检查排卵。排卵后病例接受单次 IUI，而排卵前病例则按顺序随机接受单次或双次 IUI。周期终点为 CPR。

结果

整个队列的总 CPR 为 10.1%。当 IUI 前有排卵时，CPR 为 11.7%，而无排卵时为 6.7%[OR（95%CI）：1.85（1.12-3.06），P=0.015]。当根据不孕病因计算此 OR 时，对于男性因素不孕，其为 1.26（0.52-2.95）（P=0.82），对于非男性因素不孕，其为 2.24（1.23-4.08）（P=0.007）。比较排卵前病例中双次与单次 IUI 的 CPR，所有周期的 OR 为 1.9（0.76-4.7）（P=0.22），但根据病因，对于男性因素，其为 4.667（0.9-24.13）（P=0.06），对于非男性因素，其为 1.2（0.43-3.33）（P=0.779）。