Department of Regenerative Medicine, Tongji University School of Medicine, Shanghai, China.
Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China.
Front Endocrinol (Lausanne). 2022 Jul 14;13:926183. doi: 10.3389/fendo.2022.926183. eCollection 2022.
Few studies have described the relationship between the type of infertility and live birth in patients treated with intrauterine insemination (IUI). We focused on this issue and attempted to explore it.
This retrospective study enrolled 2,256 infertile patients who underwent their first IUI cycle and were subsequently diagnosed with a clinical pregnancy at Ji'an Women and Child Health Care Hospital between 2007 and 2018. Inductees were divided into primary infertility (1,680 patients) and secondary infertility groups (876 patients). Following 1:1 propensity score matching to obtain balanced data, the COX proportional hazards model, landmark analysis, and subgroup analysis were used to assess the association between infertility types and live birth rates. Subsequently, a sensitivity analysis was employed to evaluate the potential effect of unmeasured confounding on outcomes.
Of the 1,486 patients who were identified as a matched cohort, 743 were in the primary infertility group and the remaining patients were in another group. A total of 1,143 patients had live births during 431,009 person-days of follow-up (average 290.0 days). Throughout the follow-up period, patients with secondary infertility demonstrated more live births than patients with primary infertility (hazard ratio [HR], 1.16; 95% confidence interval [CI], 1.04 to 1.30; = .007). More details were observed in the landmark analysis. Live birth rates were similar in both groups within 316 days of follow-up (HR, 0.84; 95% CI, 0.62 to 1.14; = .269), whereas the opposite was found between 316 days of follow-up and delivery day (HR, 1.19; 95% CI, 1.06 to 1.34; 004). This was also obtained in a subgroup analysis of patients younger than 35 years old and patients treated with natural cycles (NCs) and IUIs.
Among the infertile patients who underwent a single natural or stimulated cycle followed by IUI and had later pregnancies, full-term young secondary infertility mothers (<35 years of age) had a greater chance of having viable babies than the primary infertility ones. The latter may get more benefits when undergoing ovarian stimulation and IUI rather than NC-IUI.
很少有研究描述接受宫腔内人工授精（IUI）治疗的患者的不孕类型与活产之间的关系。我们专注于这个问题并试图对此进行探讨。
这项回顾性研究纳入了 2007 年至 2018 年期间在吉安妇幼保健院接受首次 IUI 周期治疗并随后临床诊断为妊娠的 2256 名不孕患者。纳入者分为原发性不孕（1680 例）和继发性不孕组（876 例）。采用 1:1 倾向评分匹配以获得均衡数据，使用 COX 比例风险模型、 landmark 分析和亚组分析来评估不孕类型与活产率之间的关联。随后进行敏感性分析以评估潜在的未测量混杂因素对结果的影响。
在确定的匹配队列中，有 1486 名患者被纳入，其中 743 名患者为原发性不孕组，其余患者为另一组。在 431009 人天的随访（平均 290.0 天）期间，有 1143 名患者分娩。在整个随访期间，继发性不孕患者的活产数多于原发性不孕患者（风险比[HR]，1.16；95%置信区间[CI]，1.04 至 1.30；=0.007）。landmark 分析中观察到了更多细节。在随访 316 天内，两组的活产率相似（HR，0.84；95%CI，0.62 至 1.14；=0.269），但在随访 316 天至分娩日之间，两组的活产率相反（HR，1.19；95%CI，1.06 至 1.34；=0.004）。在年龄小于 35 岁和接受自然周期（NC）和 IUI 治疗的患者的亚组分析中也得到了同样的结果。
在接受单个自然或刺激周期后进行 IUI 并随后妊娠的不孕患者中，足月年轻的继发性不孕母亲（<35 岁）比原发性不孕患者更有可能生育活产婴儿。后者在接受卵巢刺激和 IUI 治疗时可能会获得更多益处，而不是 NC-IUI。
