Department of Gynecology and Obstetrics, Centre for Reproductive Medicine, Zhongshan City People's Hospital, No. 2, Sunwen East Road, Shiqi District, Zhongshan, 528400, Guangdong Province, China.
Reprod Biol Endocrinol. 2021 Mar 19;19(1):45. doi: 10.1186/s12958-021-00730-3.
Some studies have stated that intrauterine insemination (IUI) with controlled ovarian stimulation (COS) might increase the pregnancy rate, while others suggest that IUI in the natural cycle (NC) should be the first line of treatment. It remains unclear whether it is necessary to use COS at the same time when IUI is applied to treat isolated male factor infertility. Thus, we aimed to investigate efficacy of IUI with COS for isolated male factor infertility.
A total of 601 IUI cycles from 307 couples who sought medical care for isolated male factor infertility between January 2010 and February 2020 were divided into two groups: NC-IUI and COS-IUI. The COS-IUI group was further divided into two subgroups according to the number of pre-ovulatory follicles on the day of HCG: cycles with monofollicular development (one follicle group) and cycles with at least two pre-ovulatory follicles (≥ 2 follicles group). The IUI outcomes, including clinical pregnancy, live birth, spontaneous abortion, ectopic pregnancy, and multiple pregnancy rates were compared.
The clinical pregnancy, live birth, spontaneous abortion, and ectopic pregnancy rates were comparable between the NC-IUI and COS-IUI group. Similar results were also observed among the NC-IUI, one follicle, and ≥ 2 follicles groups. However, with respect to the multiple pregnancy rate, a trend toward higher multiple pregnancy rate was observed in the COS-IUI group compared to the NC-IUI group (8.7% vs. 0, P = 0.091), and a significant difference was found between the NC-IUI and ≥ 2 follicles group (0 vs. 16.7%, P = 0.033).
In COS cycles, especially in those with at least two pre-ovulatory follicles, the multiple pregnancy rate increased without a substantial gain in overall pregnancy rate; thus, COS should not be preferred in IUI for isolated male factor infertility. If COS is required, one stimulated follicle and one healthy baby should be the goal considering the safety of both mothers and foetuses.
一些研究表明，宫腔内人工授精（IUI）联合控制性卵巢刺激（COS）可能会提高妊娠率，而另一些研究则认为自然周期 IUI（NC-IUI）应该是一线治疗方法。目前仍不清楚在治疗单纯男性因素不育症时，是否有必要同时进行 COS。因此，我们旨在探讨 COS 在治疗单纯男性因素不育症中的作用。
回顾性分析 2010 年 1 月至 2020 年 2 月因单纯男性因素不育就诊的 307 对夫妇的 601 个 IUI 周期，将其分为两组：NC-IUI 和 COS-IUI。COS-IUI 组根据 HCG 日子宫内单个优势卵泡（1 卵泡组）和至少 2 个优势卵泡（≥2 卵泡组）的数量进一步分为两组。比较两组的 IUI 结局，包括临床妊娠率、活产率、自然流产率、异位妊娠率和多胎妊娠率。
NC-IUI 组和 COS-IUI 组的临床妊娠率、活产率、自然流产率和异位妊娠率相似。NC-IUI 组、1 卵泡组和≥2 卵泡组的结果也相似。然而，就多胎妊娠率而言，COS-IUI 组的多胎妊娠率呈上升趋势，与 NC-IUI 组相比差异有统计学意义（8.7%比 0，P=0.091），与≥2 卵泡组相比差异有统计学意义（0 比 16.7%，P=0.033）。
在 COS 周期中，尤其是至少有 2 个优势卵泡的周期中，多胎妊娠率增加，而总妊娠率无明显增加；因此，在治疗单纯男性因素不育症时，不应首选 COS。如果需要进行 COS，应考虑母亲和胎儿的安全，以获得一个刺激的卵泡和一个健康的婴儿为目标。
