Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea.
Front Endocrinol (Lausanne). 2021 Apr 15;12:650883. doi: 10.3389/fendo.2021.650883. eCollection 2021.
The aim of this study was to determine predictive factors for pregnancy and assess the cumulative pregnancy rate (CPR) and live birth rate (CLBR) in subfertile couples undergoing timed intercourse (TI) using ultrasound. This retrospective cohort study included 285 women (854 cycles) who started TI with ultrasound between January 2017 and October 2019. The overall clinical pregnancy rate was 28.1% (80/285) per couple and 9.4% (80/854) per cycle. Pregnant women had a higher body mass index (BMI), higher percentage of irregular menstrual cycles, a shorter duration of subfertility, lower serum follicle-stimulating hormone levels, and higher anti-Müllerian hormone levels than non-pregnant women. A longer duration of subfertility (≥24 months <12 months; odds ratio: 0.193; 95% confidence interval: 0.043-0.859) and endometriosis ( ovulatory factors; odds ratio: 0.282; 95% confidence interval: 0.106-0.746) as causes of subfertility were unfavorable factors that independently affected clinical pregnancy. In subgroup analysis, old age ≥ 35 years [ < 35 years; odds ratio: 0.279; 95% confidence interval: 0.083-0.938), a longer duration of infertility ≥24 months ( <24 months; odds ratio: 0.182; 95% confidence interval: 0.036-0.913) and a higher BMI ≥ 25 kg/m( >25 kg/m; odds ratio: 3.202; 95% confidence interval: 1.020-10.046) in couples with ovulatory factor and a longer duration of infertility ≥24 months ( <24 months; odds ratio: 0.185; 95% confidence interval: 0.042-0.819) in couples with non-ovulatory factors were significant independent predictive factors for pregnancy. No significant differences were found in the cycle characteristics between pregnant and non-pregnant women. The CPR substantially increased during the first three cycles and significantly increased until the sixth cycle. No significant increase was observed in the CPR after the sixth cycle. The CLBRs substantially increased during the first three cycles and significantly increased until the fourth cycle. No significant increase was observed in the CLBRs after the fifth cycle. When comparing CPRs and CLBRs according to subfertile causes, CRPs was significantly different and CLBRs was different with borderline significance. Our findings may indicate that women with a longer duration of subfertility or subfertility due to endometriosis have poor outcomes during TI with ultrasound. Women who failed to achieve conception by the fourth or fifth cycle of TI with ultrasound may be encouraged to consider advancing to the next treatment strategy.
本研究旨在确定影响妊娠的预测因素，并评估接受超声指导定时性交（TI）的不孕夫妇的累积妊娠率（CPR）和活产率（CLBR）。这项回顾性队列研究纳入了 285 名女性（854 个周期），她们于 2017 年 1 月至 2019 年 10 月期间开始接受超声指导 TI。总的临床妊娠率为每对夫妇 28.1%（80/285），每个周期为 9.4%（80/854）。与未妊娠女性相比，妊娠女性的体重指数（BMI）更高，不规则月经周期的比例更高，不孕时间更短，血清卵泡刺激素水平更低，抗苗勒管激素水平更高。不孕时间较长（≥24 个月 <12 个月；比值比：0.193；95%置信区间：0.043-0.859）和子宫内膜异位症（排卵障碍；比值比：0.282；95%置信区间：0.106-0.746）作为不孕的原因是影响临床妊娠的不利因素。在亚组分析中，年龄较大（≥35 岁<35 岁；比值比：0.279；95%置信区间：0.083-0.938）、不孕时间较长（≥24 个月 <24 个月；比值比：0.182；95%置信区间：0.036-0.913）和 BMI 较高（≥25 kg/m（>25 kg/m；比值比：3.202；95%置信区间：1.020-10.046）的排卵障碍夫妇，以及不孕时间较长（≥24 个月 <24 个月；比值比：0.185；95%置信区间：0.042-0.819）的非排卵障碍夫妇，是妊娠的显著独立预测因素。妊娠和未妊娠女性的周期特征无显著差异。在前三周期中，CPR 显著增加，并在第六周期显著增加。第六周期后，CPR 无显著增加。在前三个周期中，CLBR 显著增加，并在第四个周期显著增加。第五个周期后，CLBR 无显著增加。根据不孕原因比较 CPR 和 CLBR，CPR 有显著差异，CLBR 有边缘显著差异。我们的研究结果可能表明，不孕时间较长或由子宫内膜异位症引起的不孕的女性在接受超声指导 TI 时预后较差。接受超声指导 TI 后第四个或第五个周期仍未受孕的女性可能会被鼓励考虑进入下一治疗策略。
