Influences of the intrauterine insemination times and ovulation induction program on the clinical pregnancy rate and medical cost
10.3760/cma.j.cn101441-20210830-00380
- VernacularTitle:授精次数、促排卵方案对宫腔内人工授精临床妊娠率和医疗花费的影响
- Author:
Haiqin ZHANG
1
;
Hongbin CHI
;
Rong LI
Author Information
1. 西藏自治区人民医院妇产科，拉萨 850000
- Publication Type:Journal Article
- Keywords:
Ovulation induction;
Intrauterine insemination times;
Clinical pregnancy rate;
Medical cost
- From:
Chinese Journal of Reproduction and Contraception
2022;42(11):1176-1181
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the economical and effective strategies for patients treated with intrauterine insemination (IUI).Methods:We retrospectively analyzed in a cohort study the clinical data of the first IUI cycle of 2266 couples who were treated from January 1, 2020 to December 31, 2020 in Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital. According to the times of insemination in one IUI treatment cycle, patients were divided into two groups: single IUI group (2158 cycles) and double IUI group (108 cycles). The differences in clinical pregnancy rate and cost-effectiveness were analyzed. According to the whether treated with ovulation induction and ovulation induction medicines, patients were divided into two groups: natural cycle group (1163 cycles) and ovulation induction cycle group (1103 cycles). The ovulation induction cycle group were further divided into three subgroups according to ovulation induction medicines: clomiphene (CC)/CC+human menopausal gonadotropin (hMG) subgroup ( n=324), letrozole (LE)/LE+hMG subgroup ( n=670) and hMG subgroup ( n=109). IUI outcomes were compared and analyzed in these groups. Results:1) There were no significant differences in age, body mass index (BMI), duration of infertility, endometrial thickness and clinical pregnancy rate between single IUI group and double IUI group (all P>0.05). The medical expenses of the double IUI group was significantly higher than that of the single IUI group [(1 786.06±173.80) yuan vs. (3 172.99±174.91) yuan, P<0.001]. 2) There was no statistically significant difference in the clinical pregnancy rate between single IUI and double IUI group with female factor, male factor, unexplained infertility, natural cycle and ovulation induction cycle (all P>0.05). For single IUI, there was a significant difference in the clinical pregnancy rate among the three different causes of infertility ( P=0.012), and the difference between the female infertility and the unknown cause of infertility was statistically significant ( P=0.003). For double IUI, there was no significant difference in the clinical pregnancy rate among the three groups ( P=0.477). The clinical pregnancy rate of ovulation induction cycle [14.0% (145/1039)] was higher than that of natural cycle [7.8% (87/1119), P<0.001]. There was no significant difference in clinical pregnancy rate between ovulation induction cycle group and natural cycle group in patients with double IUI ( P=0.774). 3) After ovulation induction, the clinical pregnancy rates of CC/CC+hMG and LE/LE+hMG subgroups [13.9% (45/324),14.6% (98/670)] were significantly higher than that of the natural cycle group [7.9% (92/1163); P=0.001, P<0.001]. Ovulation induction with CC/CC+hMG or LE/LE+hMG was an independent factor improving the clinical pregnancy rate of IUI by multivariate logistic regression analysis [ OR(95% CI)=1.794(1.216-2.647), P=0.003; OR(95% CI)=1.892(1.382-2.589), P<0.001]. Conclusion:Double IUI had similar clinical pregnancy rate with the single IUI, but the treatment cost was higher. So the double IUI is not recommended. Ovulation induction therapy could improve the clinical pregnancy rate. Ovulation induction with LE/LE+hMG had the highest clinical pregnancy rate and good security as well.
