Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, MUHC Reproductive Center, McGill University, 888, Blvd. de Maisonneuve East, Suite 200, Montreal, QC, H2L 4S8, Canada.
J Assist Reprod Genet. 2020 Dec;37(12):3103-3107. doi: 10.1007/s10815-020-01976-3. Epub 2020 Oct 26.
The aim of this study was to determine how female age at the end of the reproductive spectrum effects success of natural cycle intrauterine insemination (IUI) or IUI in combination with ovarian stimulation.
We performed a retrospective cohort study of women 43 years of age and older at the time of IUI in a single academic fertility center between January 2011 and March 2018. Primary outcomes were both pregnancies and live births per cycle of IUI. Data are presented as percentage or mean ± SD. Fisher exact and chi-squared analyses were performed.
There were 9334 IUI cycles conducted during the study period. Of these cycles, 325 IUIs (3.5%) were for women aged 43 years and over at the time of insemination (43.6 ± 0.8, range 43 to 47 years). Analysis of these 325 IUI cycles revealed 5 biochemical pregnancies (1.5%) and only 1 live birth (0.3%). The pregnancy rate did not differ between IUIs using donor sperm (N = 1/49, 2.0%) compared to IUIs with partner sperm (N = 4/276, 1.4%). The pregnancy rate did not differ between IUIs with gonadotropins (N = 2/211, 0.9%), clomiphene or letrozole (N = 2/78, 2.6%), or natural cycle (N = 1/36, 2.8%).
The use of intrauterine inseminations in women 43 years of age and older is an ineffective treatment strategy. This is irrespective of the use of ovarian stimulation or donor sperm. Costly gonadotropin injections did not increase the chance of pregnancy nor did oral medication when compared to natural cycle IUIs.
本研究旨在确定女性在生殖末期的年龄如何影响自然周期宫腔内人工授精（IUI）或 IUI 联合卵巢刺激的成功率。
我们对 2011 年 1 月至 2018 年 3 月期间在一家学术生育中心进行的年龄在 43 岁及以上的女性进行了回顾性队列研究。主要结局是每周期 IUI 的妊娠和活产数。数据以百分比或均值±标准差表示。采用 Fisher 确切检验和卡方检验进行分析。
研究期间共进行了 9334 个 IUI 周期。其中，325 个 IUI（3.5%）用于授精时年龄在 43 岁及以上的女性（43.6±0.8，范围 43 至 47 岁）。对这 325 个 IUI 周期进行分析显示，有 5 例生化妊娠（1.5%），仅有 1 例活产（0.3%）。使用供精的 IUI（N=1/49，2.0%）与使用配偶精子的 IUI（N=4/276，1.4%）的妊娠率无差异。使用促性腺激素（N=2/211，0.9%）、克罗米酚或来曲唑（N=2/78，2.6%）或自然周期（N=1/36，2.8%）的 IUI 妊娠率无差异。
对于 43 岁及以上的女性，使用宫腔内人工授精是一种无效的治疗策略。这与使用卵巢刺激或供精无关。与自然周期 IUI 相比，昂贵的促性腺激素注射并不能增加妊娠机会，也不能增加口服药物的妊娠机会。
