Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Pittsburgh, Pittsburg, PA, USA.
J Assist Reprod Genet. 2020 Oct;37(10):2435-2442. doi: 10.1007/s10815-020-01918-z. Epub 2020 Aug 15.
We aimed to define intrauterine insemination (IUI) cycle characteristics associated with viable birth, identify thresholds below which IUI treatments are consistent with very poor prognosis and futile care, and develop a nomogram for individualized application.
This retrospective cohort study evaluated couples using fresh partner ejaculate for IUI from January 2005 to September 2017. Variables included female age, semen characteristics, and ovarian stimulation type. Using cycle-level data, we evaluated the association of these characteristics with the probability of viable birth by fitting generalized regression models for a binary outcome with a logit link function, using generalized estimating equation methodology to account for the correlation between cycles involving the same patient.
The cohort consisted of 1117 women with 2912 IUI cycles; viable birth was achieved in 275 (9.4%) cycles. Futile care (viable birth rate < 1%) was identified for women age > 43, regardless of stimulation type or inseminate motility (IM). Very poor prognosis (viable birth rate < 5%) was identified for women using oral medications or Clomid plus gonadotropins who were (1) age < 35 with IM < 49%, (2) age 35-37 with IM < 56%, or (3) age ≥ 38, and (4) women age ≥ 38 using gonadotropins only with IM < 60%. A clinical prediction model and nomogram was developed with an optimism-corrected c-statistic of 0.611.
The present study highlights the impact of multiple clinical factors on IUI success, identifies criteria consistent with very poor prognosis and futile care, and provides a nomogram to individualize counseling regarding the probability of a viable birth.
本研究旨在定义与活产相关的宫腔内人工授精（IUI）周期特征，确定低于何种阈值的 IUI 治疗与极差预后和无效护理相符，并制定用于个体化应用的列线图。
本回顾性队列研究评估了 2005 年 1 月至 2017 年 9 月期间使用新鲜配偶精液进行 IUI 的夫妇。变量包括女性年龄、精液特征和卵巢刺激类型。使用周期水平数据，我们通过拟合具有对数链接函数的二项式结果广义回归模型，使用广义估计方程方法来考虑涉及同一患者的周期之间的相关性，评估这些特征与活产概率的关联。
该队列包括 1117 名女性的 2912 个 IUI 周期；275 个（9.4%）周期实现了活产。无论刺激类型或授精精子活力（IM）如何，年龄>43 岁的女性被确定为无效护理（活产率<1%）。对于使用口服药物或克罗米芬加促性腺激素的年龄<35 岁且 IM<49%、年龄 35-37 岁且 IM<56%或年龄≥38 岁且 IM<60%的女性，或仅使用促性腺激素的年龄≥38 岁且 IM<60%的女性，被确定为预后极差（活产率<5%）。制定了一个临床预测模型和列线图，经矫正后的 c 统计量为 0.611。
本研究强调了多种临床因素对 IUI 成功的影响，确定了与极差预后和无效护理相符的标准，并提供了一个列线图，以个性化咨询活产概率。
