Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
BMC Pregnancy Childbirth. 2023 Jul 13;23(1):512. doi: 10.1186/s12884-023-05835-8.
GnRHa and hCG are both used for oocyte maturation and ovulation triggering. However, GnRHa have a shorter half-life than hCG, which leads to luteal phase deficiency. Letrozole (LE) has been found to improve the luteal function. Thus, the choice of triggering strategy can be different in intrauterine insemination (IUI) cycles using LE and human menopausal gonadotropin (HMG). The aim of this study was to compare the pregnancy and neonatal outcomes of patients triggered with GnRHa versus hCG versus dual trigger in LE-IUI cycles.
This retrospective cohort study included 6,075 LE-HMG IUI cycles between January 2010 and May 2021 at a tertiary-care academic medical center in China. All cycles were divided into three groups according to different trigger strategies as hCG trigger group, GnRHa trigger group and dual trigger group. The primary outcome was clinical pregnancy rate. Logistic regression analysis was performed to explore other risk factors for clinical pregnancy rate.
No significant difference was observed in clinical pregnancy rate between hCG, GnRHa and dual trigger cycles in LE-HMG IUI cycles (P = 0.964). The miscarriage rate was significantly lower in the GnRHa trigger group, and higher in the dual trigger group, compared with the hCG group (P = 0.045). Logistic analysis confirmed that triggering strategy was associated with miscarriage (aOR:0.427, 95%CI: 0.183-0.996, P = 0.049; aOR:0.298, 95%CI: 0.128-0.693, P = 0.005). No significant differences were observed regarding neonatal outcomes between the three groups.
Our findings suggested that both GnRHa and dual trigger can be used to trigger ovulation in LE-HMG IUI cycles, but dual trigger must be used with caution.
GnRHa 和 hCG 均用于卵母细胞成熟和排卵触发。然而，GnRHa 的半衰期比 hCG 短，这导致黄体期不足。已经发现来曲唑（LE）可以改善黄体功能。因此，在使用 LE 和人绝经期促性腺激素（HMG）的宫腔内人工授精（IUI）周期中，触发策略的选择可能会有所不同。
本研究比较了 GnRHa、hCG 和 LE-IUI 周期中双重触发对妊娠和新生儿结局的影响。
本回顾性队列研究纳入了 2010 年 1 月至 2021 年 5 月在中国一家三级保健学术医疗中心进行的 6075 例 LE-HMG IUI 周期。根据不同的触发策略，所有周期分为 hCG 触发组、GnRHa 触发组和双重触发组。主要结局是临床妊娠率。采用逻辑回归分析探讨影响临床妊娠率的其他危险因素。
在 LE-HMG IUI 周期中，hCG、GnRHa 和双重触发周期的临床妊娠率无显著差异（P=0.964）。GnRHa 触发组的流产率显著低于 hCG 组，而双重触发组的流产率显著高于 hCG 组（P=0.045）。逻辑分析证实，触发策略与流产有关（aOR：0.427，95%CI：0.183-0.996，P=0.049；aOR：0.298，95%CI：0.128-0.693，P=0.005）。三组新生儿结局无显著差异。
本研究结果表明，GnRHa 和双重触发均可用于 LE-HMG IUI 周期的排卵触发，但必须谨慎使用双重触发。
