Department of Obstetrics and Gynecology Stanford University School of Medicine, Stanford, CA, USA.
Department of Obstetrics and Gynecology Stanford University School of Medicine, Stanford, CA, USA.
Reprod Biol. 2024 Jun;24(2):100886. doi: 10.1016/j.repbio.2024.100886. Epub 2024 Apr 17.
The impact of estrogen supplementation during the follicular/proliferative phase on the endometrial lining thickness (EMT) prior to intrauterine insemination (IUI) remains largely unstudied. Our study examined changes in EMT and rates of clinical pregnancy, miscarriage, and live birth for all patients who completed an IUI cycle at Stanford Fertility Center from 2017-2023 (n = 2281 cycles). Cycles with estradiol supplementation (n = 309) were compared to reference cycles without supplementation (n = 1972), with the reference cohort further categorized into cycles with a pre-ovulatory EMT of < 7 mm ("thin-lining", n = 536) and ≥ 7 mm ("normal-lining", n = 1436). The estradiol group had a statistically significant greater change in EMT from baseline to ovulation compared to the thin-lining reference groups (2.4 mm vs 1.9 mm, p < =0.0001). Similar rates of clinical pregnancy and live birth were observed. After adjusting for age, BMI, race/ethnicity, infertility diagnosis, and EMT at trigger, the estradiol cohort had a significantly increased odds of miscarriage versus the entire reference cohort (2.46, 95 % confidence interval [1.18, 5.14], p = 0.02). Thus, although estradiol supplementation had a statistically significant increase in EMT compared to IUI cycles with thin pre-ovulatory EMT (<7 mm), this change did not translate into improved IUI outcomes such as increased rates of clinical pregnancy and live birth or decreased rate of miscarriage. Our study suggests that supplemental estradiol does not appear to improve IUI outcomes.
在宫腔内人工授精（IUI）前卵泡/增殖期补充雌激素对子宫内膜厚度（EMT）的影响在很大程度上仍未得到充分研究。我们的研究检查了斯坦福生育中心 2017-2023 年期间所有完成 IUI 周期的患者的 EMT 变化以及临床妊娠、流产和活产率（n=2281 个周期）。与未补充雌激素的参考周期（n=1972）相比，有雌激素补充的周期（n=309），参考队列进一步分为排卵前 EMT<7mm（“薄型”，n=536）和≥7mm（“正常型”，n=1436）的周期。与薄型参考组相比，雌激素组 EMT 从基线到排卵的变化具有统计学意义（2.4mm 对 1.9mm，p<0.0001）。临床妊娠率和活产率相似。在调整年龄、BMI、种族/民族、不孕诊断和触发时的 EMT 后，与整个参考队列相比，雌激素组流产的几率明显增加（2.46，95%置信区间[1.18，5.14]，p=0.02）。因此，尽管与排卵前 EMT 较薄（<7mm）的 IUI 周期相比，雌激素补充具有统计学上 EMT 显著增加，但这种变化并未转化为改善 IUI 结局，如临床妊娠率和活产率增加或流产率降低。我们的研究表明，补充雌激素似乎不能改善 IUI 结局。
