Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
Shady Grove Fertility, Rockville, Maryland.
Fertil Steril. 2021 Mar;115(3):638-645. doi: 10.1016/j.fertnstert.2020.08.1430. Epub 2020 Oct 17.
To compare clinical and ongoing pregnancy after natural cycle (NC) intrauterine insemination (IUI) versus ovarian stimulation (OS) IUI in ovulatory women undergoing therapeutic donor insemination (TDI).
Retrospective cohort.
Single infertility center.
PATIENT(S): A total of 76,643 IUI cycles in patients treated with intrauterine insemination were examined. Women undergoing TDI in the absence of diagnosed female factor infertility were included.
INTERVENTION(S): NC TDI or OS TDI with either clomiphene citrate or letrozole.
MAIN OUTCOME MEASURE(S): Clinical and ongoing pregnancies were analyzed by generalized estimating equations adjusting for age, body mass index, total motile sperm at time of insemination and cycle number. Ongoing multiple gestations were examined as a secondary outcome.
RESULT(S): Six thousand one hundred ninety-two TDI cycles from 2,343 patients (711 patients without repeated IUI cycles) met inclusion criteria and were available for analysis (3,837 NC and 2,355 OS). There was no difference in mean age between the two groups (NC, 34.2 years vs. OS, 34.3 years). Probability of clinical and ongoing pregnancy was higher in the OS cohort compared with the NC cohort (OS, 22.4% vs. NC, 18.7% and OS, 15.4% vs. NC, 14.9%, respectively). However, OS significantly increased ongoing multiple gestations (OS, 10.8% vs. NC, 2.4%).
CONCLUSION(S): Ovarian stimulation in TDI cycles resulted in a <4% increase in clinical and <1% increase in ongoing pregnancy, and more than fourfold increase in ongoing multiple gestations. Natural cycle IUI should be considered as a first-line treatment for ovulatory women who need donor insemination.
比较行治疗性供精人工授精（TDI）的排卵障碍妇女中行自然周期（NC）宫腔内人工授精（IUI）与卵巢刺激（OS）IUI 的临床妊娠和持续妊娠。
回顾性队列研究。
单不孕中心。
共检查了 76643 个人工授精周期的患者，这些患者接受了 IUI 治疗。包括无诊断为女性因素不孕而接受 TDI 的患者。
NC-TDI 或 OS-TDI，分别使用枸橼酸氯米酚或来曲唑。
通过广义估计方程，调整授精时的年龄、体重指数、总活动精子数和周期数，分析临床妊娠和持续妊娠。将持续多胎妊娠作为次要结局进行检查。
符合纳入标准且可用于分析的 TDI 周期有 6192 个，来自 2343 名患者（711 名患者无重复 IUI 周期）（3837 例 NC 和 2355 例 OS）。两组间平均年龄无差异（NC 组 34.2 岁，OS 组 34.3 岁）。与 NC 组相比，OS 组的临床妊娠和持续妊娠的概率更高（OS 组分别为 22.4%和 15.4%，NC 组分别为 18.7%和 14.9%）。然而，OS 显著增加了持续多胎妊娠（OS 组 10.8%，NC 组 2.4%）。
在 TDI 周期中进行卵巢刺激可使临床妊娠率增加<4%，持续妊娠率增加<1%，持续多胎妊娠率增加 4 倍以上。对于需要供精人工授精的排卵障碍妇女，自然周期 IUI 应作为一线治疗。
