Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Front Endocrinol (Lausanne). 2022 May 4;13:880538. doi: 10.3389/fendo.2022.880538. eCollection 2022.
To date, no consensus has been reached on whether to wait for spontaneous luteinizing hormone (LH) surge to occur or to trigger ovulation regardless of the presence of an LH surge for achieving higher success rate in intrauterine insemination (IUI) cycles. Therefore, we hope to investigate the effect of the presence of a spontaneous LH surge on pregnancy outcomes in letrozole-human menopausal gonadotropin (LE-HMG) IUI cycles.
In this retrospective cohort study, a total of 6,285 LE-HMG IUI cycles were included between January 2010 and May 2021. Cycles were categorized into three groups: the trigger + LH surge group, the trigger only group, and the LH surge only group. The primary outcome measure was the clinical pregnancy rate. A logistic regression analysis was performed to explore other risk factors affecting the clinical pregnancy rate.
No significant differences were observed in biochemical pregnancy rate ( =0.640), clinical pregnancy rate ( =0.702), ongoing pregnancy rate ( =0.842), and live birth rate ( =0.951) among the three groups. The binary logistic regression analysis also confirmed that the existence of an LH surge was not associated with clinical pregnancy. There was a difference in ectopic pregnancy rates ( =0.045), but logistic regression showed that the presence of a spontaneous LH surge has no association with ectopic pregnancy. Nonetheless, patients with lead follicles within 18.1-20.0 mm/20.1-22.0 mm and a long duration of LE treatment were less likely to get ectopic pregnant compared with patients with 14.1-16.0 mm lead follicles and shorter LE treatment (OR: 0.142, 95% CI: 0.023-0.891, =0.037; OR: 0.142, 95% CI: 0.022-0.903, =0.039; OR: 0.445, 95% CI: 0.235-0.840, = 0.013).
The presence of a spontaneous LH surge in triggered LE-HMG IUI cycles does not appear to improve pregnancy rates. Thus, we suggest that waiting for an LH surge to occur is not necessary in triggered LE-HMG IUI cycles.
迄今为止，对于是否应该等待自发的黄体生成素 (LH) 激增发生，还是无论是否存在 LH 激增都进行排卵触发，以提高宫腔内人工授精 (IUI) 周期的成功率，尚无共识。因此，我们希望研究在来曲唑-人绝经期促性腺激素 (LE-HMG) IUI 周期中自发 LH 激增对妊娠结局的影响。
在这项回顾性队列研究中，纳入了 2010 年 1 月至 2021 年 5 月期间的 6285 个 LE-HMG IUI 周期。这些周期被分为三组：触发+LH 激增组、仅触发组和仅 LH 激增组。主要观察指标是临床妊娠率。采用逻辑回归分析探讨影响临床妊娠率的其他危险因素。
三组间生化妊娠率（=0.640）、临床妊娠率（=0.702）、持续妊娠率（=0.842）和活产率（=0.951）均无显著差异。二元逻辑回归分析也证实 LH 激增的存在与临床妊娠无关。异位妊娠率存在差异（=0.045），但逻辑回归显示自发 LH 激增与异位妊娠无关。然而，与 14.1-16.0mm 主导卵泡和较短 LE 治疗的患者相比，18.1-20.0mm/20.1-22.0mm 主导卵泡和较长 LE 治疗的患者异位妊娠的可能性较小（OR：0.142，95%CI：0.023-0.891，=0.037；OR：0.142，95%CI：0.022-0.903，=0.039；OR：0.445，95%CI：0.235-0.840，=0.013）。
在触发的 LE-HMG IUI 周期中存在自发的 LH 激增似乎并未提高妊娠率。因此，我们建议在触发的 LE-HMG IUI 周期中等待 LH 激增发生是不必要的。
