Pregnancy outcomes after superovulation-intrauterine insemination (SO-IUI) using gonadotropins versus letrozole in the obese population.

IF 3.2 3区医学 Q2 GENETICS & HEREDITY Journal of Assisted Reproduction and Genetics Pub Date : 2024-10-01 Epub Date: 2024-08-22 DOI:10.1007/s10815-024-03205-7

Joanna J Kim, Livia Renaud, Samantha Torrance, Doron Shmorgun, Jenna Gale, Clara Q Wu

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Abstract

Purpose: To compare fertility outcomes of obese patients (body mass index [BMI] ≥ 30 kg/m²) undergoing superovulation and intrauterine insemination (SO-IUI) using gonadotropins versus letrozole.

Methods: A single centre retrospective cohort study of obese patients undergoing SO-IUI using gonadotropins or letrozole between January/2019 and June/2022. Primary outcome was clinical pregnancy rate (intrauterine pregnancy with positive fetal heart rate). Secondary outcomes included rates of multifollicular development, multiple pregnancy, spontaneous abortion and cycle cancellation. Subgroup analysis was done stratifying by obesity class. A multivariate logistic regression model was used for primary/secondary outcomes, adjusting for clinically determined covariates.

Results: Out of 802 total identified SO-IUI cycles, 715 cycles were completed (518-gonadotropins and 197-letrozole cycles). The clinical pregnancy rates were not significantly different in obese patients undergoing SO-IUI with gonadotropins versus letrozole when adjusted for age, gravidity, parity, cause of infertility, IUI cycle number, endometrial thickness, sperm source and post-wash motile sperm count (adjusted odds ratio [aOR] 1.37, 95% confidence interval [CI] 0.72-2.59). Similarly, no significant associations were found in spontaneous abortion (aOR1.46, 95%CI 0.42-5.08), multiple pregnancy (aOR1.33, 95%CI 0.20-8.88) or cancellation rates (OR0.89, 95%CI 0.55-1.45) between the two groups. The rates of multifollicular development were also comparable between the two groups (aOR0.51, 95% CI 0.19-1.38). For cycles involving gonadotropins, higher BMI classes required higher total gonadotropin dose (p < 0.001).

Conclusion: After adjusting for patient and cycle factors, gonadotropins and letrozole led to comparable odds of achieving pregnancy in obese patients undergoing SO-IUI. Future research in the obese population will help to better understand how to optimize fertility treatments for this growing population.

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肥胖人群使用促性腺激素与来曲唑进行超排卵-宫腔内人工授精（SO-IUI）后的妊娠结局。

目的：比较使用促性腺激素和来曲唑进行超排卵和宫腔内人工授精（SO-IUI）的肥胖患者（体重指数[BMI]≥30 kg/m2）的生育结果：对2019年1月至2022年6月期间使用促性腺激素或来曲唑进行超排卵和宫腔内人工授精（SO-IUI）的肥胖患者进行单中心回顾性队列研究。主要结果为临床妊娠率（胎心率呈阳性的宫内妊娠）。次要结果包括多卵泡发育率、多胎妊娠率、自然流产率和周期取消率。根据肥胖程度进行了分组分析。对主要/次要结果采用了多变量逻辑回归模型，并对临床确定的协变量进行了调整：在802个已确定的SO-IUI周期中，有715个周期完成（518个促性腺激素周期和197个来曲唑周期）。经调整年龄、孕酮、奇偶数、不孕原因、人工授精周期数、子宫内膜厚度、精子来源和洗涤后活动精子计数后，使用促性腺激素和来曲唑进行SO-人工授精的肥胖患者的临床妊娠率没有明显差异（调整赔率[aOR]1.37，95%置信区间[CI]0.72-2.59）。同样，两组之间在自然流产（aOR1.46，95%CI 0.42-5.08）、多胎妊娠（aOR1.33，95%CI 0.20-8.88）或流产率（OR0.89，95%CI 0.55-1.45）方面也没有发现明显的关联。两组的多卵泡发育率也相当（aOR0.51，95%CI 0.19-1.38）。在使用促性腺激素的周期中，BMI 等级越高，所需的促性腺激素总剂量也越高（p 结论：BMI 等级越高，所需的促性腺激素总剂量也越高）：在对患者和周期因素进行调整后，促性腺激素和来曲唑使接受SO-IUI的肥胖患者获得妊娠的几率相当。未来对肥胖人群的研究将有助于更好地了解如何为这一日益增长的人群优化生育治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Assisted Reproduction and Genetics 医学-妇产科学

CiteScore

5.70

自引率

9.70%

发文量

286

审稿时长

1 months

期刊介绍： The Journal of Assisted Reproduction and Genetics publishes cellular, molecular, genetic, and epigenetic discoveries advancing our understanding of the biology and underlying mechanisms from gametogenesis to offspring health. Special emphasis is placed on the practice and evolution of assisted reproduction technologies (ARTs) with reference to the diagnosis and management of diseases affecting fertility. Our goal is to educate our readership in the translation of basic and clinical discoveries made from human or relevant animal models to the safe and efficacious practice of human ARTs. The scientific rigor and ethical standards embraced by the JARG editorial team ensures a broad international base of expertise guiding the marriage of contemporary clinical research paradigms with basic science discovery. JARG publishes original papers, minireviews, case reports, and opinion pieces often combined into special topic issues that will educate clinicians and scientists with interests in the mechanisms of human development that bear on the treatment of infertility and emerging innovations in human ARTs. The guiding principles of male and female reproductive health impacting pre- and post-conceptional viability and developmental potential are emphasized within the purview of human reproductive health in current and future generations of our species. The journal is published in cooperation with the American Society for Reproductive Medicine, an organization of more than 8,000 physicians, researchers, nurses, technicians and other professionals dedicated to advancing knowledge and expertise in reproductive biology.