卵泡发育不良女性氯米芬与来曲唑诱导排卵的助孕结局比较

Comparison of Clinical Outcomes in Women with Follicular Dysplasia Treated with Clomiphene Citrate and Letrozole

目的:探讨卵泡发育不良女性氯米芬(CC)与来曲唑(LE)诱导排卵后供精人工授精(AID)周期的助孕结局。方法:回顾性分析我院生殖医学科2012年1月—2019年8月卵泡发育不良女性CC、LE诱导排卵后AID周期的临床资料,包括小卵泡排卵女性的320个周期、卵泡发育停滞或闭锁女性的286个周期;分别按诱导排卵方案分为CC组和LE组,采用单因素及多因素Logistic回归分析比较2种方案的AID助孕结局。结果:与CC组相比,LE组小卵泡排卵女性宫内妊娠率差异无统计学意义(27.68%vs.21.68%,P=0.196),妊娠丢失率降低约0.72倍(10.20%vs.29.03%,OR=0.278,P=0.038),活产率增加约0.88倍(24.86%vs.15.38%,OR=1.875,P=0.031)。与LE组相比,CC组卵泡发育停滞或闭锁女性宫内妊娠率略高(32.22%vs.22.45%),但优势未达显著水平(OR=1.679,P=0.071);妊娠丢失率差异无统计学意义(10.34%vs.18.18%,OR=1.926,P=0.366),活产率增加约0.89倍(28.89%vs.18.37%,OR=1.886,P=0.035)。结论:AID助孕周期小卵泡排卵女性采用LE诱导排卵的助孕结局优于CC;卵泡发育停滞、闭锁女性采用CC诱导排卵的助孕结局优于LE。

Objective:To compare the clinical outcomes of artificial insemination with donor sperm(AID)in those women with follicular dysplasia who treated with clomiphene citrate(CC)and letrozole(LE).Methods:The data of AID cycles performed between January,2012 and August,2019 were retrospectively analyzed,including 320 cycles by women with small follicle ovulation and 286 cycles by women with follicle growth arrest or atresia.The cycles were respectively grouped according to ovulation induction protocol with CC or LE.Univariate and multivariate logical regression analyses were used to compare the intrauterine pregnancy rate(IPR)and live birth rate(LBR)between CC group and LE group.Results:Women with small follicle ovulation had a comparable IPR(27.68%vs.21.68%,P=0.196),a significantly lower pregnancy loss rate(PLR)(10.20%vs.29.03%,OR=0.278,P=0.038)and a significantly higher LBR(24.86%vs.15.38%,OR=1.875,P=0.031)in the LE group when compared with CC group.Women with follicle growth arrest or atresia had a higher IPR(32.22%vs.22.45%)without significant difference(OR=1.679,P=0.071),a comparable PLR(10.34%vs.18.18%,OR=1.926,P=0.366)and a significantly higher LBR(28.89%vs.18.37%,OR=1.886,P=0.035)in the CC group when compared with LE group.Conclusions:In AID procedure,LE protocol can lead to better clinical outcomes than CC for women with small follicle ovulation,while CC protocol can get better clinical outcomes than LE for women with follicle growth arrest or atresia.