Ⅱ型排卵障碍女性使用克罗米芬或来曲唑诱导排卵的AID临床结局及妊娠结局比较

目的比较Ⅱ型排卵障碍女性使用克罗米芬(CC)方案或来曲唑(LE)方案诱导排卵后供精人工授精(AID)周期的临床结局和妊娠结局。方法回顾性分析2012年1月至2019年8月578名Ⅱ型排卵障碍妇女在我中心完成的1253个AID周期的超声监测数据及临床资料。比较单用CC或LE或联合促性腺激素(Gn)诱导排卵的AID周期的参数和临床结局。采用单因素和多因素Logistic回归分析,探讨诱导排卵方案与宫内妊娠和活产的关系。比较CC及LE方案的妊娠结局和新生儿出生状况。结果总体上4种方案的宫内妊娠率和活产率无显著差异(P>0.05);校正混杂因素后,与单用CC相比,CC联合Gn及LE联合Gn均显著促进宫内妊娠(分别为OR=1.641,P=0.024;OR=1.543,P=0.019)和活产(分别为OR=1.589,P=0.047;OR=1.508,P=0.034),而单用LE与单用CC相比均无显著差异(P>0.05);各种妊娠结局的发生率及新生儿出生状况在CC及LE方案之间均无显著差异(P>0.05)。结论在宫内妊娠和活产方面,无论单用还是与Gn联用,LE与CC疗效相当,且联用Gn优于单用;LE和CC方案的妊娠结局及新生儿出生状况基本可比。

Clinical outcome and pregnancy outcome of AID in women with typeⅡovulation dysfunction treated with clomiphene citrate or letrozole

Objective:To compare the clinical outcome and pregnancy outcome in women with typeⅡovulation dysfunction who were treated with clomiphene citrate(CC)protocol or letrozole(LE)protocol in artificial insemination with donor sperm(AID).Methods:The data of 578 women(1253 AID cycles)with typeⅡovulation dysfunction treated in our center from January 2012 to August 2019 were retrospectively analyzed.The ultrasonic monitoring data and clinical outcome of AID cycles in which ovulation was induced by CC or LE alone or in combination with gonadotropin(Gn)were compared.Univariate and multivariate logical regression analyses were applied to explore the association of ovulation induction protocol with intrauterine pregnancy and live birth.Pregnancy outcomes and neonatal birth status were compared between CC or LE protocol.Results:No significant difference was found in intrauterine pregnancy rate and live birth rate among the four protocols(P>0.05).After adjusting for confounding factors,compared with CC alone,both CC combined with Gn and LE combined with Gn significantly increased intrauterine pregnancy rate(OR=1.641,P=0.024;OR=1.543,P=0.019)and live birth rate(OR=1.589,P=0.047;OR=1.508,P=0.034).There was no significant difference between LE alone and CC alone(P>0.05).The incidence of various pregnancy outcomes and neonatal birth status were not significantly different between CC or LE protocol(P>0.05).Conclusions:In terms of both intrauterine pregnancy and live birth,no matter single or combined with Gn,LE and CC have the same curative effect,and combined with Gn is better than single use.LE and CC protocols are comparable in pregnancy outcomes and neonatal birth status.