Huang Shuo, Du Xiaoguo, Wang Rui, Li Rong, Wang Haiyan, Luo Li, O'Leary Sean, Qiao Jie, Mol Ben Willem J
Center of Reproductive Medicine, Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China.
Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, Australia.
Eur J Obstet Gynecol Reprod Biol. 2018 Dec;231:117-121. doi: 10.1016/j.ejogrb.2018.08.002. Epub 2018 Aug 3.
To study the effectiveness of different ovulation induction protocols in infertile women with polycystic ovary syndrome (PCOS) undergoing intrauterine insemination (IUI).
Retrospective cohort study.
Infertile women with PCOS undergoing IUI had ovulation induced with clomiphene citrate (CC), letrozole, or gonadotropins.
Live birth and multiple pregnancy rates.
We performed 1068 IUI cycles in 765 couples. Live birth rates were comparable in CC-stimulated cycles (13.9%), letrozole-stimulated cycles (13.5%, OR 0.96 [95% CI, 0.63, 1.47]), and gonadotropins-stimulated cycles (13.2%, OR 0.94[95% CI, 0.62, 1.43]). Multiple pregnancy rates were 8.3%, 4.1% (OR 0.47 [95% CI, 0.09, 2.42]), and 3.3% (OR 0.34 [95% CI, 0.07, 1.95]) in CC, letrozole and gonadotropins stimulated cycles, respectively. Compared to CC, letrozole generated more often mono-follicular growth (75.9% versus 67.0%; OR 1.55 [95% CI, 1.11, 2.15]) but not more often after gonadotropins (72.9%, OR 1.17 [95% CI, 0.82, 1.66]. Cycles with multi-follicular growth did not result in statistically higher live birth rates than cycles with mono-follicular growth (15.8% vs. 12.7%, OR 1.29 [95% CI 0.89, 1.89]), but more often in multiple pregnancies (15.5% versus 0.8%, OR 22.4 [95% CI, 2.8, 181.6]).
In women with PCOS undergoing stimulated IUI, CC, letrozole and gonadotropins were equally effective and safe. Since multi-follicular growth increased the multiple pregnancy rates without increasing the overall live birth rate, ovulation induction would strictly aim for mono-follicular growth. Since letrozole had the highest mono-follicular growth rate, we recommend this drug as the treatment of first choice in infertile women undergoing ovulation induction and IUI.
研究不同的促排卵方案对接受宫腔内人工授精（IUI）的多囊卵巢综合征（PCOS）不孕女性的有效性。
回顾性队列研究。
接受IUI的PCOS不孕女性采用枸橼酸氯米芬（CC）、来曲唑或促性腺激素进行促排卵。
活产率和多胎妊娠率。
我们对765对夫妇进行了1068个IUI周期。CC刺激周期的活产率（13.9%）、来曲唑刺激周期的活产率（13.5%，OR 0.96[95%CI，0.63，1.47]）和促性腺激素刺激周期的活产率（13.2%，OR 0.94[95%CI，0.62，1.43]）相当。CC、来曲唑和促性腺激素刺激周期的多胎妊娠率分别为8.3%、4.1%（OR 0.47[95%CI，0.09，2.42]）和3.3%（OR 0.34[95%CI，0.07，1.95]）。与CC相比，来曲唑更常出现单卵泡生长（75.9%对67.0%；OR 1.55[95%CI，1.11，2.15]），但在促性腺激素刺激后则不然（72.9%，OR 1.17[95%CI，0.82，1.66]）。多卵泡生长的周期与单卵泡生长的周期相比，活产率在统计学上没有显著提高（15.8%对12.7%，OR 1.29[95%CI 0.89，1.89]），但多胎妊娠更常见（15.5%对0.8%，OR 22.4[95%CI，2.8，181.6]）。
在接受刺激IUI的PCOS女性中，CC、来曲唑和促性腺激素同样有效且安全。由于多卵泡生长增加了多胎妊娠率而未提高总体活产率，促排卵应严格以单卵泡生长为目标。由于来曲唑的单卵泡生长率最高，我们推荐将该药作为接受促排卵和IUI的不孕女性的首选治疗药物。
