Biochemical pregnancy outcomes following dual versus human chorionic gonadotropin-only trigger in gonadotropin-stimulated intrauterine insemination cycles for unexplained infertility: a retrospective cohort study.
Mehtap Akin Efe, Ozlem Dural, Hevra Ekin Ulusoy, Atacem Mert Aytekin, Cemil Akgül
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引用次数: 0
Abstract
Background: Unexplained infertility remains a diagnostic and therapeutic challenge. Dual trigger, combining gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (hCG), has been proposed to more closely mimic the physiological mid-cycle gonadotropin surge than hCG alone in gonadotropin-stimulated intrauterine insemination (IUI) cycles.
Objectives: To evaluate whether dual trigger improves biochemical pregnancy outcomes compared with hCG-only trigger in gonadotropin-stimulated IUI cycles.
Patients and methods: Between April 2021 and September 2022, 96 patients underwent IUI after ovarian stimulation with gonadotropins (53 hCG-only, 43 dual trigger). Baseline demographic and clinical characteristics included female age (29.5±2.5 vs. 27.2±3.5 years), male age (33.3±4.0 vs. 31.6±3.5 years), body mass index (BMI) (24.0 vs. 25.0 kg/m2), gonadotropin dose (median 675 IU), treatment duration (median 9 days), dominant follicle size (18 mm vs. 17 mm), and endometrial thickness (9 mm vs. 8 mm).
Main outcome measures: Biochemical pregnancy, defined as serum β-hCG ≥5 mIU/mL.
Results: Biochemical pregnancy occurred in 18.6% of the dual trigger group and 11.3% of the hCG-only group (P=.315). The odds of biochemical pregnancy were higher with dual trigger but not statistically significant (OR=1.8, 95% CI: 0.6-5.6). Subgroup analysis revealed a significant association between infertility duration and biochemical pregnancy (P=.04), with 76.9% of conceptions occurring in women with 2-3 years of infertility.
Conclusions: Dual trigger did not significantly improve biochemical pregnancy rates compared with hCG-only trigger (OR=1.8, 95% CI: 0.6-5.6). Infertility duration was the only significant predictor of treatment success. Larger multi-center trials are required due to the current study's limited power.
Limitations: Retrospective design, single-center setting, and limited sample size may restrict generalizability.
背景：不明原因的不孕症仍然是诊断和治疗的挑战。双触发，结合促性腺激素释放激素（GnRH）激动剂和人绒毛膜促性腺激素（hCG），已被提出更接近模拟生理中期促性腺激素激增比hCG单独在促性腺激素刺激的宫内人工授精（IUI）周期。目的：评价在促性腺激素刺激的IUI周期中，双触发与单触发hcg相比是否能改善生化妊娠结局。设计：回顾性队列研究。设置：单中心，三级转诊中心。患者和方法：在2021年4月至2022年9月期间，96例患者在使用促性腺激素刺激卵巢后接受了IUI（53例仅使用hcg， 43例双触发）。基线人口统计学和临床特征包括女性年龄（29.5±2.5 vs. 27.2±3.5岁）、男性年龄（33.3±4.0 vs. 31.6±3.5岁）、体重指数（BMI） （24.0 vs. 25.0 kg/m2）、促性腺激素剂量（中位675 IU）、治疗持续时间（中位9天）、优势卵泡大小（18 mm vs. 17 mm）和子宫内膜厚度（9 mm vs. 8 mm）。主要结局指标：生化妊娠，定义为血清β-hCG≥5 mIU/mL。样本量：96例患者（53例仅hcg， 43例双触发）。结果：双触发组生化妊娠发生率为18.6%，单触发组生化妊娠发生率为11.3% （P=.315）。双触发的生化妊娠几率较高，但无统计学意义（OR=1.8, 95% CI: 0.6-5.6）。亚组分析显示，不孕持续时间与生化妊娠之间存在显著相关性（P= 0.04）， 76.9%的妊娠发生在不孕2-3年的妇女中。结论：双触发与单触发hcg相比，未显著提高生化妊娠率（OR=1.8, 95% CI: 0.6-5.6）。不孕持续时间是治疗成功的唯一显著预测因子。由于目前研究的能力有限，需要更大规模的多中心试验。局限性：回顾性设计、单中心设置和有限的样本量可能会限制推广。
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