促排卵-宫腔内人工授精（SO-IUI）中使用促性腺激素与来曲唑治疗肥胖患者的妊娠结局。
Pregnancy outcomes after superovulation-intrauterine insemination (SO-IUI) using gonadotropins versus letrozole in the obese population.
机构信息
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.
Faculty of Science, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
出版信息
J Assist Reprod Genet. 2024 Oct;41(10):2649-2656. doi: 10.1007/s10815-024-03205-7. Epub 2024 Aug 22.
PURPOSE
To compare fertility outcomes of obese patients (body mass index [BMI] ≥ 30 kg/m) undergoing superovulation and intrauterine insemination (SO-IUI) using gonadotropins versus letrozole.
METHODS
A single centre retrospective cohort study of obese patients undergoing SO-IUI using gonadotropins or letrozole between January/2019 and June/2022. Primary outcome was clinical pregnancy rate (intrauterine pregnancy with positive fetal heart rate). Secondary outcomes included rates of multifollicular development, multiple pregnancy, spontaneous abortion and cycle cancellation. Subgroup analysis was done stratifying by obesity class. A multivariate logistic regression model was used for primary/secondary outcomes, adjusting for clinically determined covariates.
RESULTS
Out of 802 total identified SO-IUI cycles, 715 cycles were completed (518-gonadotropins and 197-letrozole cycles). The clinical pregnancy rates were not significantly different in obese patients undergoing SO-IUI with gonadotropins versus letrozole when adjusted for age, gravidity, parity, cause of infertility, IUI cycle number, endometrial thickness, sperm source and post-wash motile sperm count (adjusted odds ratio [aOR] 1.37, 95% confidence interval [CI] 0.72-2.59). Similarly, no significant associations were found in spontaneous abortion (aOR1.46, 95%CI 0.42-5.08), multiple pregnancy (aOR1.33, 95%CI 0.20-8.88) or cancellation rates (OR0.89, 95%CI 0.55-1.45) between the two groups. The rates of multifollicular development were also comparable between the two groups (aOR0.51, 95% CI 0.19-1.38). For cycles involving gonadotropins, higher BMI classes required higher total gonadotropin dose (p < 0.001).
CONCLUSION
After adjusting for patient and cycle factors, gonadotropins and letrozole led to comparable odds of achieving pregnancy in obese patients undergoing SO-IUI. Future research in the obese population will help to better understand how to optimize fertility treatments for this growing population.
目的
比较肥胖患者（体重指数 [BMI]≥30kg/m）接受促排卵和宫腔内人工授精（SO-IUI）时使用促性腺激素与来曲唑的生育结局。
方法
这是一项单中心回顾性队列研究，纳入 2019 年 1 月至 2022 年 6 月期间接受 SO-IUI 的肥胖患者，使用促性腺激素或来曲唑。主要结局为临床妊娠率（有胎心的宫内妊娠）。次要结局包括多卵泡发育、多胎妊娠、自然流产和周期取消率。通过肥胖分类进行亚组分析。采用多元逻辑回归模型对主要/次要结局进行分析，调整临床确定的协变量。
结果
在 802 个识别出的 SO-IUI 周期中，有 715 个周期完成（518 个促性腺激素周期和 197 个来曲唑周期）。在调整年龄、孕次、产次、不孕原因、IUI 周期数、子宫内膜厚度、精子来源和精子洗涤后活动精子计数后，接受 SO-IUI 的肥胖患者使用促性腺激素与来曲唑的临床妊娠率无显著差异（调整优势比 [aOR]1.37，95%置信区间 [CI]0.72-2.59）。同样，两组之间的自然流产率（aOR1.46，95%CI0.42-5.08）、多胎妊娠率（aOR1.33，95%CI0.20-8.88）或取消率（OR0.89，95%CI0.55-1.45）也无显著关联。两组的多卵泡发育率也相似（aOR0.51，95%CI0.19-1.38）。对于涉及促性腺激素的周期，较高的 BMI 类别需要更高的总促性腺激素剂量（p<0.001）。
结论
在调整患者和周期因素后，促性腺激素和来曲唑使肥胖患者接受 SO-IUI 后妊娠的几率相当。未来在肥胖人群中的研究将有助于更好地了解如何为这一不断增长的人群优化生育治疗。
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