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对于无法解释的不孕症进行IUI刺激的最小剂量范式:以莱特醇启动的晚期淋巴腺激素协议
Evren Yeşildağer1, Ufuk Yeşildağer1, Sefa Arlıer2
1Department of Obstetrics and Gynecology, Afyonkarahisar State Hospital, 03030 Afyonkarahisar, Turkey.
Journal of clinical medicine
|February 13, 2026
概括
使用莱特醇和复合FSH (rFSH) 的顺序刺激提供了与常规rFSH用于宫内授精 (IUI) 的怀孕率相似的怀孕率. 这种节约性腺激素的协议减少了药物需求,特别是对于PCOS患者.
科学领域:
- 生殖内分泌学 生殖内分泌学
- 不孕症治疗方法 不孕症治疗方法
- 临床试验分析
背景情况:
- 在卵巢诱导中优化妊娠结果对于子宫内授精 (IUI) 是至关重要的,特别是对于患有多囊性卵巢综合征 (PCOS) 或高卵巢储备的患者.
- 尽量减少淋巴激素暴露和治疗负担是IUI协议的关键目标.
- 将莱特醇与晚发性复合FSH (rFSH) 结合的顺序方案旨在提高效率并减少药物使用,但现实数据有限.
研究的目的:
- 为了比较顺序列列列醇加上晚期发作的rFSH刺激与IUI的常规rFSH刺激的有效性和效率.
- 为了评估两个刺激方案之间的怀孕率,淋巴激素剂量和安全结果.
- 在IUI周期中识别妊娠的独立预测因子.
主要方法:
- 764个IUI周期的回顾性比较队列研究 (传统rFSH:n=372;莱特醇+晚期rFSH:n=392).
- 主要结局:每个周期的怀孕 (阳性血清β-hCG). 二次结果:临床怀孕,淋巴激素剂量,子宫内膜厚度,周期取消,产科结果.
- 使用多变量逻辑回归,倾向得分匹配 (PSM) 和治疗权重反向概率 (IPTW) 解决的混因素.
主要成果:
- 在顺序组 (14.8%) 与传统rFSH (9.9%) 相比,原始怀孕率更高,p=0.042.
- 顺序组的AMH,毛囊数和PCOS患病率都较高 (32.4%对16.3%).
- 在调整后,刺激方案与怀孕没有独立关联 (aOR1.09,p=0.657);女性年龄是最强的预测因素 (aOR0.70/年). 顺序性协议显著降低了淋巴激素剂量 (中位数为375 IU与750 IU,p<0.001),安全性可比.
结论:
- 顺序列列列醇加上晚发的rFSH可以实现与IUI常规rFSH相比的妊娠结果,同时显著降低淋巴激素需求.
- 调整后的分析表明,结果的粗略差异是由于基线失衡 (PCOS,卵巢储备),而不是协议本身.
- 这种节约性腺激素的序列协议是IUI的临床有效选择,特别是对于有过度卵巢反应风险的患者.
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