诱导排卵能否改善正常排卵妇女AID助孕结局?5066个周期回顾性研究  

Can ovulation induction improve AID outcome in women with normal ovulation?A retrospective study of 5066 cycles

作　　者：倪丽莉[1] 王菁[1] 刁飞扬[1] 马翔[1] 冒韵东[1] 刘嘉茵[1] NI Li-li;WANG Jing;DIAO Fei-yang;MA Xiang;MAO Yun-dong;LIU Jia-yin(Reproductive Medicine Center,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029)

机构地区：[1]南京医科大学第一附属医院生殖医学中心,南京210029

出　　处：《生殖医学杂志》2021年第7期858-865,共8页Journal of Reproductive Medicine

基　　金：国家重点研发计划(2017YFC1001604,2017YFC1001004,2016YFC1000204);国家自然科学基金(81730041,81571403);江苏省卫生厅项目(YXZXB2016001)。

摘　　要：目的探讨诱导排卵(OI)能否改善正常排卵妇女供精人工授精(AID)的助孕结局。方法回顾性分析2012年1月至2019年12月由2201名正常排卵妇女在我院生殖中心完成的5066个AID周期的超声和临床资料。比较单用克罗米芬(CC)、来曲唑(LE),或CC/LE联合促性腺激素(Gn),或单用Gn诱导排卵周期与自然周期(NC)的参数和临床结局。采用单因素分析和多因素Logistic回归探讨周期方案与宫内妊娠、活产、早期妊娠丢失及多胎妊娠的相关性。比较各种OI方案与NC方案的不良妊娠结局和新生儿出生状况。结果整体上,6种周期方案的宫内妊娠率、活产率均无统计学差异(P>0.05),早期妊娠丢失率、多胎妊娠率均有统计学差异(P<0.05);矫正混杂因素后,与NC方案相比,5种OI方案均未显著提高宫内妊娠率(P均>0.05),只有LE联合Gn显著降低早期妊娠丢失率(OR=0.543,P=0.025)并提高活产率(OR=1.235,P=0.025)。单用CC(OR=5.239,P=0.01)、CC联合Gn(OR=8.097,P=0.003)、单用LE(OR=7.15,P=0.002)、LE联合Gn(OR=6.384,P=0.001)这4种OI方案均显著增加多胎妊娠率;与NC方案相比,5种OI方案均未增加不良妊娠结局,也未影响新生儿出生状况(P>0.05)。结论LE联合Gn方案在减少早期妊娠丢失及提高活产率方面有显著优势,可作为正常排卵妇女AID助孕中诱导排卵方案的首选。Objective:To explore whether ovulation induction(OI)can improve the clinical outcomes of artificial insemination with donor sperm(AID)in the women with normal ovulation.Methods:The ultrasonic and clinical data of 5066 AID cycles of 2201 women with normal ovulation completed in our reproductive medicine center from January 2012 to December 2019 were retrospectively analyzed.The cycle parameters and clinical outcomes of AID cycles using clomiphene(CC),letrozole(LE)alone,CC/LE combined with gonadotropin(Gn),Gn alone respectively for ovulation induction and natural cycle(NC)were compared.Univariate analysis and multivariate Logistic regression analysis were applied to explore the association between the ovulation induction protocol and intrauterine pregnancy,live birth,early pregnancy loss&multiple pregnancy.Adverse pregnancy outcomes and neonatal birth status were compared among the different OI protocols and NC.Results:Overall,there was no significant difference in the intrauterine pregnancy rate and live birth rate among the six protocols(P>0.05),but the early pregnancy loss rate and multiple pregnancy rate were significantly different(P<0.05).After adjusted for confounders,none of the five OI protocols significantly increased intrauterine pregnancy rate compared with NC(all P>0.05),only LE combined with Gn significantly reduced early pregnancy loss rate(OR=0.543,P=0.025)and increased live birth rate(OR=1.235,P=0.025).CC(OR=5.239,P=0.010),CC combined with Gn(OR=8.097,P=0.003),LE(OR=7.150,P=0.002)and LE combined with Gn(OR=6.384,P=0.001)significantly increased the multiple pregnancy rate.Compared with NC,none of the five OI protocols increased adverse pregnancy outcomes or affected neonatal birth status(P>0.05).Conclusions:LE combined with Gn protocol has significant advantages in reducing early pregnancy loss and improving live birth rate,which can be used as the first choice of ovulation induction in AID assisted pregnancy for women with normal ovulation.

关 键 词：供精人工授精 诱导排卵 宫内妊娠 早期妊娠丢失 活产 新生儿出生状况 

分 类 号：R711.6[医药卫生—妇产科学]