低剂量人绝经期促性腺激素与自然周期在宫内授精治疗月经规律的不孕夫妇中的应用比较。
Low-dose human menopausal gonadotrophin versus natural cycles in intrauterine insemination for subfertile couples with regular menstruation.
机构信息
Department of Reproductive Medicine, the Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, Guangdong, China.
Key Laboratory of Reproductive Medicine of Guangdong Province, Guangzhou, Guangdong, China.
出版信息
J Ovarian Res. 2020 Apr 4;13(1):36. doi: 10.1186/s13048-020-00638-3.
BACKGROUND
Women with irregular menstruation should be considered to benefit from the ovarian stimulation. However, most literature did not separate ovulatory disorders from normal menstrual cycles. Our purpose was to assess the superiority of ovarian mild stimulation compared with the natural cycle in IUI for subfertile couples when the women with regular menstruation.
METHODS
A retrospective study in a single medical center in which 2413 couples with 3573 IUI cycles were studied from 2013 to 2018. The results of IUI in natural cycles versus low-dose HMG induced cycles were analyzed.
RESULTS
For young women (age < 35 years) with normal menstrual cycle, HMG induced ovulation combined with IUI can improve clinical pregnancy outcome (13.55% in two follicular induced cycles vs. 7.23% in natural cycles, p < 0.01); even if only one follicle was induced, the clinical pregnancy rate was increased to 10.32% (p < 0.01). When two growth follicles were induced in HMG cycles, a remarkable improvement of the live birthrate (10.28% vs. 5.91% in natural cycles, p < 0.05) was noted. Simultaneously, twin pregnancy rates were increased to 20.69% (p < 0.01). Twin pregnancies showed significantly increased risk of both ectopic pregnancy and preterm birth (p = 0.00 for both). For advanced women (age ≥ 35 years) with regular menstrual cycle, ovulation induction didn't improve clinical pregnancy and live birthrates, while age was the only relevant factor.
CONCLUSIONS
Combining HMG induced ovulation and IUI can improve pregnancy outcome in young women with normal menstrual cycles. 1-2 follicles with diameter ≥ 14 mm served as the purpose of ovulation induction. Further, both twin and ectopic pregnancy rate in HMG cycles with two growth follicles were significantly higher than those in natural cycles were. Therefore, doctors must evaluate the risk before making choices and inform the patients to achieve the best results. For advanced women with normal menstrual cycles, natural IUI cycles were optional.
背景
不规则月经的女性应被认为受益于卵巢刺激。然而，大多数文献没有将排卵障碍与正常月经周期分开。我们的目的是评估在有规律月经的不孕夫妇中，与自然周期相比，卵巢轻度刺激在 IUI 中的优势。
方法
这是一项在一家医疗中心进行的回顾性研究，该研究纳入了 2013 年至 2018 年期间的 2413 对夫妇的 3573 个 IUI 周期。分析了自然周期与低剂量 HMG 诱导周期中 IUI 的结果。
结果
对于年轻（年龄<35 岁）有规律月经的女性，HMG 诱导排卵联合 IUI 可以提高临床妊娠结局（两个卵泡诱导周期为 13.55%，自然周期为 7.23%，p<0.01）；即使只有一个卵泡被诱导，临床妊娠率也提高到 10.32%（p<0.01）。当 HMG 周期中诱导两个生长卵泡时，活产率显著提高（10.28%比自然周期的 5.91%，p<0.05）。同时，双胎妊娠率提高到 20.69%（p<0.01）。双胎妊娠显著增加异位妊娠和早产的风险（两者均为 p=0.00）。对于有规律月经的高龄（年龄≥35 岁）女性，排卵诱导并不能提高临床妊娠和活产率，而年龄是唯一相关因素。
结论
在有规律月经周期的年轻女性中，HMG 诱导排卵联合 IUI 可以提高妊娠结局。1-2 个直径≥14mm 的卵泡可作为排卵诱导的目的。此外，HMG 周期中两个生长卵泡的双胎和异位妊娠率明显高于自然周期。因此，医生在做出选择前必须评估风险，并告知患者以达到最佳效果。对于有规律月经的高龄女性，自然 IUI 周期是可选的。
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