人绒毛膜促性腺激素触发或黄体生成素峰后宫腔内人工授精：一项荟萃分析。
Intrauterine Insemination After Human Chorionic Gonadotropin Trigger or Luteinizing Hormone Surge: A Meta-analysis.
机构信息
Department of Obstetrics and Gynecology, Galter Health Sciences Library, and Department of Preventive Medicine, Biostatistics Collaboration Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
出版信息
Obstet Gynecol. 2023 Jul 1;142(1):61-70. doi: 10.1097/AOG.0000000000005222. Epub 2023 Jun 7.
OBJECTIVE
To assess the odds of pregnancy after intrauterine insemination (IUI) timed by ultrasound monitoring and human chorionic gonadotropin (hCG) administration compared with monitoring luteinizing hormone (LH) levels.
DATA SOURCES
We searched PubMed (MEDLINE), EMBASE (Elsevier), Scopus (Elsevier), Web of Science (Clarivate Analytics), ClinicalTrials.gov (National Institutes of Health), and the Cochrane Library (Wiley) from the inception until October 1, 2022. No language limitations were applied.
METHODS OF STUDY SELECTION
After deduplication, 3,607 unique citations were subjected to blinded independent review by three investigators. Thirteen studies (five retrospective cohort, four cross-sectional, two randomized controlled trials, and two randomized crossover studies) that enrolled women undergoing natural cycle, oral medication (clomid or letrozole), or both for IUI were included in the final random-effects model meta-analysis. Methodologic quality of included studies was assessed with the Downs and Black checklist.
TABULATION, INTEGRATION, AND RESULTS: Data extraction was compiled by two authors, including publication information, hCG and LH monitoring guidelines, and pregnancy outcomes. No significant difference in odds of pregnancy between hCG administration and endogenous LH monitoring was observed (odds ratio [OR] 0.92, 95% CI 0.69-1.22, P =.53). Subgroup analysis of the five studies that included natural cycle IUI outcomes also showed no significant difference in odds of pregnancy between the two methods (OR 0.88, 95% CI 0.46-1.69, P =.61). Finally, a subgroup analysis of 10 studies that included women who underwent ovarian stimulation with oral medications (clomid or letrozole) did not demonstrate a difference in odds of pregnancy between ultrasonography with hCG trigger and LH-timed IUI (OR 0.88, 95% CI 0.66-1.16, P =.32). Statistically significant heterogeneity was noted between studies.
CONCLUSION
This meta-analysis showed no difference between pregnancy outcomes between at-home LH monitoring and timed IUI.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42021230520.
目的
评估超声监测和人绒毛膜促性腺激素（hCG）给药指导的宫内授精（IUI）与监测促黄体生成激素（LH）水平相比，妊娠的几率。
数据来源
我们在 PubMed（MEDLINE）、EMBASE（Elsevier）、Scopus（Elsevier）、Web of Science（Clarivate Analytics）、ClinicalTrials.gov（美国国立卫生研究院）和 Cochrane Library（Wiley）上进行了检索，检索时间截至 2022 年 10 月 1 日。未应用任何语言限制。
研究选择方法
在重复项消除后，3607 个独特的引文由三位研究人员进行了盲法独立审查。纳入了 13 项研究（5 项回顾性队列研究、4 项横断面研究、2 项随机对照试验和 2 项随机交叉研究），这些研究纳入了接受自然周期、口服药物（氯米芬或来曲唑）或两者联合进行 IUI 的女性。使用 Downs 和 Black 清单评估纳入研究的方法学质量。
列表、综合和结果：两位作者汇编了数据提取信息，包括出版物信息、hCG 和 LH 监测指南以及妊娠结局。未观察到 hCG 给药与内源性 LH 监测之间妊娠几率的显著差异（优势比 [OR] 0.92，95%CI 0.69-1.22，P =.53）。对包括自然周期 IUI 结局的 5 项研究的亚组分析也显示，两种方法之间妊娠几率无显著差异（OR 0.88，95%CI 0.46-1.69，P =.61）。最后，对包括接受口服药物（氯米芬或来曲唑）卵巢刺激的 10 项研究的亚组分析也表明，超声引导 hCG 扳机与 LH 指导的 IUI 之间妊娠几率无差异（OR 0.88，95%CI 0.66-1.16，P =.32）。研究之间存在显著的异质性。
结论
本荟萃分析显示，家庭 LH 监测与定时 IUI 之间的妊娠结局无差异。
系统评价注册
PROSPERO，CRD42021230520。
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