Taerk Evan, Hughes Edward, Greenberg Cassandra, Neal Michael, Amin Shilpa, Faghih Mehrnoosh, Karnis Megan
- Division of Gynecologic Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.
J Reprod Infertil. 2017 Jul-Sep;18(3):316-322.
The purpose of this study was to evaluate whether clinical pregnancy rate is affected by timing intrauterine insemination (IUI) according to serum LH surge, r-hCG trigger, or a combination of LH surge and r-hCG trigger in controlled ovarian hyperstimulation (COH) cycles for patients with a variety of infertility etiologies.
The last 365 consecutive COH-IUI cycles performed at ONE Fertility Burlington in 2014 were reviewed and categorized according to method of IUI timing. Associations between categorical variables were analyzed using a combination of Chi-square and Fisher's Exact tests, and between continuous variables using independent sample t-tests and logistic regression to a level of significance of p<0.05.
The overall clinical pregnancy rate in this sample was 18.1% (66/365). Administration of r-hCG prior to IUI resulted in a higher clinical pregnancy rate compared with spontaneous serum LH surge: 18.2% . 5.8%, p=0.012. Patients in whom r-hCG was administered concomitantly with a serum LH surge had a higher clinical pregnancy than the r-hCG trigger group (30.8% . 18.2%, p=0.004) and LH surge group (30.8% . 5.8%, p<0.001). A sub-group analysis revealed that patients receiving r-FSH, rather than clomiphene or letrozole, had a significantly higher clinical pregnancy rate after r-hCG trigger as compared to the LH surge group (21.7% . 2.1%, p=0.01).
In subfertile couples undergoing COH-IUI, r-hCG administration was associated with an increased clinical pregnancy rate compared with spontaneous serum LH surge. When r-hCG was administered concomitantly with a serum LH surge, this benefit was amplified. The effect appears to be of particular importance in r-FSH-medicated cycles.
本研究旨在评估在接受控制性卵巢刺激（COH）的不同病因不孕症患者的周期中，根据血清促黄体生成素（LH）峰、重组人绒毛膜促性腺激素（r-hCG）扳机或LH峰与r-hCG扳机联合使用来确定宫内人工授精（IUI）时间，是否会影响临床妊娠率。
回顾了2014年在ONE Fertility Burlington进行的最后365个连续的COH-IUI周期，并根据IUI时间确定方法进行分类。分类变量之间的关联使用卡方检验和费舍尔精确检验进行分析，连续变量之间的关联使用独立样本t检验和逻辑回归分析，显著性水平为p<0.05。
该样本的总体临床妊娠率为18.1%（66/365）。与自发血清LH峰相比，在IUI前给予r-hCG导致更高的临床妊娠率：18.2%对5.8%，p=0.012。r-hCG与血清LH峰同时给予的患者的临床妊娠率高于r-hCG扳机组（30.8%对18.2%，p=0.004）和LH峰组（30.8%对5.8%，p<0.001）。亚组分析显示，与LH峰组相比，接受重组促卵泡素（r-FSH）而非克罗米芬或来曲唑治疗的患者在r-hCG扳机后的临床妊娠率显著更高（21.7%对2.1%，p=0.01）。
在接受COH-IUI的不育夫妇中，与自发血清LH峰相比，给予r-hCG与临床妊娠率增加相关。当r-hCG与血清LH峰同时给予时，这种益处会放大。这种效应在r-FSH治疗的周期中似乎尤为重要。
