宫内人工授精并非次数越多越好？几次更合适？

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OBJECTIVE

目的

To calculate the cumulative incidence of first clinical pregnancy after IUI in three representative patient groups pursuing fertility treatment.

计算三个代表性患者群体在接受人工授精（IUI）后的首次临床妊娠的累计发生率。

MATERIALS AND METHODS

材料和方法

All heterosexual couples (HCs), same-sex female couples (SSFCs), and unpartnered female patients (UFPs) undergoing their first IUI cycle from January 1, 2017 to December 31, 2021 at a large US academic fertility center were included. Demographics and cycle data were collected from medical records. The primary outcome was number of IUI cycles to first clinical pregnancy. The cumulative incidence of first clinical pregnancy was calculated following up to 10 IUI cycles, which was the maximum number undergone by our patient population.

本研究包括2017年1月1日至2021年12月31日在美国大型学术生育中心接受第一次人工授精周期的所有异性夫妇(HCs)、女性同性夫妇(SSFCs)和未婚女性患者(UFPs)。人口统计数据和周期数据从医疗记录中收集。主要结果是实现首次临床妊娠所需的IUI周期数。根据我们的患者群体接受的最大IUI周期数（最多10个周期），计算了首次临床妊娠的累计发生率。

RESULTS

结果

A total of 4,200 HCs, 795 SSFCs, and 355 UFPs completed 9,870, 2,713, and 1,160 IUI cycles, respectively. While the UFP group had a higher mean age at first IUI (37.4 years) compared to the HC (33.6 years) and SSFC (32.9 years) groups, patients in all three groups were similar with regards to mean body mass index (27.7-28.8 kg/m2) and anti-Müllerian hormone (2.4-3.7 ng/ml). Ovarian stimulation/ovulation induction medications were utilized in 92.4%, 45.9%, and 53.6% of IUI cycles in HCs, SSFCs, and UFPs, respectively. After up to 10 IUI cycles, clinical pregnancies were achieved in 736 HCs (17.5%) compared to 236 SSFCs (29.7%) and 74 UFPs (20.8%). Among patients with a clinical pregnancy, 97.1% of HCs, 85.6% of SSFCs, and 87.8% of UFPs achieved their first clinical pregnancy within four IUI cycles (Table 1).

总共有4200个HCs、795个SSFCs和355个UFPs分别完成了9870、2713和1160个IUI周期。虽然与HC（33.6岁）和SSFC（32.9岁）组相比，UFP组在首个IUI时的平均年龄较高（37.4岁）但是三组患者在平均体重指数(27.7-28.8 kg/m2)和AMH水平(2.4-3.7 ng/ml)方面相似。92.4%的HCs、45.9%的SSFCs和53.6%的UFPs在IUI周期中采用了卵巢刺激/诱导排卵药物。在最多进行10个IUI周期后，HCs中有736例临床妊娠（17.5%），SSFCs中有236例（29.7%），UFPs中有74例（20.8%）。在临床妊娠的患者中，97.1%的HCs，85.6%的SSFCs和87.8%的UFPs在前四个IUI周期内实现了首次临床妊娠（表1）。

CONCLUSIONS

结论

Same-sex female couples and unpartnered female patients have superior clinical pregnancy rates after IUI compared to heterosexual couples. However, in all three groups, there was a dramatic decrease in the likelihood of success after four cycles.

与异性夫妇相比，同性女性夫妇和未婚女性患者在IUI的临床妊娠率更高。在所有三个组别中，经过四个周期后成功的可能性显著降低。

IMPACT STATEMENT

影响说明

While IUI can result in a successful pregnancy in up to 30% of patients, it is important to counsel patients about the low likelihood of success after four IUI cycles and that proceeding to in vitro fertilization (IVF) at that point may be prudent.

虽然人工授精可使多达30%的患者成功怀孕，但重要的是告知患者，在经过四个IUI周期后成功的可能性较低，此时进行体外受精（IVF）可能是明智的选择。

文章来源：

INTRAUTERINE INSEMINATION (IUI): MORE IS NOT ALWAYS BETTER Heyward, Quetrell et al.Fertility and Sterility, Volume 120, Issue 4, e53