Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Endocrinol (Lausanne). 2022 Aug 22;13:922605. doi: 10.3389/fendo.2022.922605. eCollection 2022.
Polycystic ovary syndrome (PCOS) is one of the most common reasons for infertility. The consensus of the treatment of infertile women with PCOS is ovulation induction (OI) for six to nine attempts before fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Nowadays, more attention was paid to a rising, noninvasive treatment, intrauterine insemination (IUI), as some experts claimed IUI could benefit PCOS patients with infertility. Our study means to investigate the outcomes of IUI for PCOS patients and if patients' previous OI cycles can be a predictive factor for IUI outcomes.
A total of 1,086 PCOS patients was included and 1,868 IUI cycles were performed between January 2007 and July 2021 in the department of assisted reproduction in Shanghai Ninth People's Hospital. All included patients underwent IUI treatments with letrozole+human menopausal gonadotropin (LE+hMG) for ovarian stimulation.
The pregnancy outcomes were not associated with the attempts of failed OI cycles previously. Specifically, the clinical pregnancy rate was 21.14% for PCOS patients without previous OI cycles, 21.95% for PCOS patients with 1-2 previous OI cycles and 23.64% for PCOS patients with 3 or more previous OI cycles (p=0.507). The corresponding live birth rate was 16.64%, 18.06%, and 18.68%, respectively, of which the difference was not statistically significant (p=0.627). The cumulative rate per patient was 38.59% for clinical pregnancy and 31.03% for live birth, and approximately 98% of the pregnancies occurred in the first 3 cycles of IUI.
PCOS women with different attempts of OI cycles had similar pregnancy outcomes after IUI, thus a history of repeated failures of OI treatments was not a predictive factor for the pregnancy outcomes in IUI cycles. Most pregnancies occurred in the first three cycles of IUI, so we strongly recommended three attempts of IUI for PCOS women before they switched to IVF/ICSI. Generally, IUI might be an assist for infertile women with PCOS before IVF/ICSI and might accelerate pregnancy for target women without invasive manipulations.
多囊卵巢综合征（PCOS）是导致不孕的最常见原因之一。对于患有 PCOS 的不孕女性，共识是在体外受精（IVF）/卵胞浆内单精子注射（ICSI）之前进行六到九次排卵诱导（OI）尝试。如今，更多的注意力集中在一种新兴的非侵入性治疗方法——宫腔内人工授精（IUI）上，因为一些专家声称 IUI 可以使患有不孕的 PCOS 患者受益。我们的研究旨在调查 IUI 对 PCOS 患者的结果，以及患者之前的 OI 周期是否可以作为 IUI 结果的预测因素。
共纳入 1086 例 PCOS 患者，于 2007 年 1 月至 2021 年 7 月在上海第九人民医院辅助生殖科进行了 1868 个 IUI 周期。所有纳入的患者均接受来曲唑+人绝经促性腺激素（LE+hMG）进行卵巢刺激的 IUI 治疗。
妊娠结局与之前失败的 OI 周期的尝试无关。具体而言，无先前 OI 周期的 PCOS 患者的临床妊娠率为 21.14%，有 1-2 次先前 OI 周期的 PCOS 患者为 21.95%，有 3 次或更多先前 OI 周期的 PCOS 患者为 23.64%（p=0.507）。相应的活产率分别为 16.64%、18.06%和 18.68%，差异无统计学意义（p=0.627）。每个患者的累积率为 38.59%的临床妊娠和 31.03%的活产，约 98%的妊娠发生在 IUI 的前 3 个周期。
接受不同 OI 周期尝试的 PCOS 女性在接受 IUI 后具有相似的妊娠结局，因此重复 OI 治疗失败的病史不是 IUI 周期妊娠结局的预测因素。大多数妊娠发生在 IUI 的前三个周期，因此我们强烈建议 PCOS 女性在转向 IVF/ICSI 之前进行三次 IUI 尝试。一般来说，IUI 可能是 PCOS 不孕女性在 IVF/ICSI 之前的一种辅助手段，并且可以在没有侵入性操作的情况下加速目标女性的妊娠。
