影响夫精宫腔内人工授精妊娠成功率相关因素分析
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摘要
目的探讨临床因素对夫精宫腔内人工授精妊娠成功率的影响。方法 256例不孕症患者行421个周期夫精宫腔内人工授精治疗,分析年龄、不孕类型、不孕时间、治疗方式及授精时机等对夫精宫腔内人工授精妊娠成功率的影响。结果 421个人工授精周期中,48个周期获临床妊娠,临床妊娠率为11.4%;继发不孕者妊娠成功率(21.2%)高于原发不孕者(8.4%)(P<0.05),不孕时间<3 a者(17.3%)高于不孕时间3～5 a者(9.0%)和>5 a者(6.7%)(P<0.05),排卵前后双次授精者(18.3%)高于排卵前单次授精者(6.2%)和排卵后单次授精者(13.4%)(P<0.05),在不同年龄和不同治疗方式上差异无统计学意义(P>0.05);继发不孕和排卵前后双次授精是夫精宫腔内人工授精妊娠成功的影响因素(OR=2.85,95%CI:1.48～5.47,P=0.002;OR=3.31,95%CI:1.54～7.15,P=0.002)。结论不同不孕类型和接受授精的时机影响夫精宫腔内人工授精妊娠成功率,继发不孕和排卵前后双次人工授精临床妊娠成功率较高。
Objective To analyze the clinical influencing factors for the success rate of intrauterine insemination(IUI) with the husband's sperm. Methods Totally 256 patients with infertility received 421 cycles of IUI. The influences of age, type of infertility, duration of infertility, treatment method and IUI timing on the success rate of IUI were analyzed. Results Of 421 IUI cycles, pregnancy was achieved after 48 cycles, with a clinical pregnancy rate of 11.4%. The pregnancy rate was significantly higher in patients with secondary infertility(21.1%) than that in patients with primary infertility(8.4%)(P<0.05), in patients with <3-year infertility(17.3%) than that in patients with 3-to 5-year infertility(9.0%) and >5-year infertility(6.7%)(P<0.05), and in patients with double insemination(18.3%) than that in patients with single pre-ovulation insemination(6.2%) and single post-ovulation insemination(13.4%)(P<0.05). There was no significant difference in clinical pregnancy rate between patients with different ages and treatment methods(P>0.05). Secondary infertility and double insemination before and after ovulation were the influencing factors for the success rate of IUI(OR=2.85, 95%CI: 1.48-5.47, P=0.002; OR=3.31, 95%CI: 1.54-7.15, P=0.002). Conclusion Different types of infertility and timing of IUI affect the success rate of IUI. The patients with secondary infertility and double insemination before and after ovulation have high success rate of IUI.
Objective To analyze the clinical influencing factors for the success rate of intrauterine insemination(IUI) with the husband's sperm. Methods Totally 256 patients with infertility received 421 cycles of IUI. The influences of age, type of infertility, duration of infertility, treatment method and IUI timing on the success rate of IUI were analyzed. Results Of 421 IUI cycles, pregnancy was achieved after 48 cycles, with a clinical pregnancy rate of 11.4%. The pregnancy rate was significantly higher in patients with secondary infertility(21.1%) than that in patients with primary infertility(8.4%)(P<0.05), in patients with <3-year infertility(17.3%) than that in patients with 3-to 5-year infertility(9.0%) and >5-year infertility(6.7%)(P<0.05), and in patients with double insemination(18.3%) than that in patients with single pre-ovulation insemination(6.2%) and single post-ovulation insemination(13.4%)(P<0.05). There was no significant difference in clinical pregnancy rate between patients with different ages and treatment methods(P>0.05). Secondary infertility and double insemination before and after ovulation were the influencing factors for the success rate of IUI(OR=2.85, 95%CI: 1.48-5.47, P=0.002; OR=3.31, 95%CI: 1.54-7.15, P=0.002). Conclusion Different types of infertility and timing of IUI affect the success rate of IUI. The patients with secondary infertility and double insemination before and after ovulation have high success rate of IUI.
引文
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[7] 徐慧芳,朱依敏.不同病因不孕症宫腔内人工授精1 640周期疗效分析[J].中国优生与遗传杂志,2010,18(10):94-96.
[8] 马延敏,贾婵维,兰永连,等.自然周期夫精宫腔内人工授精的相关因素分析[J].中国优生与遗传杂志,2011,19(8):114-115.
[9] 周巧艳,郭凤月,李兴华.9 865例女性不孕的临床病因分析[J].中国计划生育学杂志,2011,19(6):376-378.
[10] 邢冠琳,王芳,柳胜贤.宫腔内人工授精时机及授精日男方精液质量对妊娠结局的影响[J].中国实用医刊,2015,42(19):29-30.
[11] 乔攀峰,申小静,张丽.人工授精联合腹腔镜治疗输卵管伞端粘连闭锁性不孕的临床观察[J].医药论坛杂志,2013,34(3):104-105.
[12] ZAHIRI SOROURI Z, RASHID SHOMALI R, POURMARZI D. Single versus double intrauterine insemination in controlled ovarian hyperstimulation cycles: a randomized trial[J]. Arch Iran Med,2016,19(7):465-469.
[13] ZAVOS A, DAPONTE A, GARAS A, et al. Double versus single homologous intrauterine insemination for male factor infertility: a systematic review and meta-analysis[J]. Asian J Androl,2013,15(4):533-538.
[14] 李道云,高红艳,孔祥.对1 395个夫精人工授精治疗周期的临床分析[J].实用妇科内分杂志,2018,5(5):31-33.
[15] 李冬兰,杨丽娟,胥杜娟,等.自然周期与促排卵周期供精人工授精妊娠结局的比较[J].生殖与避孕,2011,31(11):776-779.
[16] HUANG S, WANG R, LI R, et al. Ovarian stimulation in infertile women treated with the use of intrauterine insemination: a cohorts from China[J]. Fertil Steril,2018,109(5):872-878.
[17] 徐景岭.正常形态精子百分率对宫腔内人工授精妊娠率的影响[J].中华实用诊断与治疗杂志,2014,28(3):273-274.
[2] HEDIGER M L, BELL E M, DRUSCHEL C M, et al. Assisted reproductive technologies and children's neurodevelopmental outcomes[J]. Fertil Steril,2013,99(2):311-317.
[3] GHAFFARI F, SADATMAHALLEH S J, AKHOOND M R, et al. Evaluating the effective factors in pregnancy after intrauterine insemination: a retrospective study[J]. Int J Fertil Steril,2015,9(3):300-308.
[4] 徐仰英,王海燕,乔杰,等.影响宫腔内人工授精妊娠率的临床因素分析[J].北京大学学报(医学版),2013,45(6):887-891.
[5] LAKA D, BLANDINE C, VINCENT A, et al. Prognosis factors of pregnancy after intrauterine insemination with the husband' s sperm: conclusions of an analysis of 2 019 cycles[J]. Fertil Steril,2014,101(4):994-1000.
[6] 王琼.高龄妇女与生殖助孕[J].中国实用妇科与产科杂志,2006,22(10):791-793.
[7] 徐慧芳,朱依敏.不同病因不孕症宫腔内人工授精1 640周期疗效分析[J].中国优生与遗传杂志,2010,18(10):94-96.
[8] 马延敏,贾婵维,兰永连,等.自然周期夫精宫腔内人工授精的相关因素分析[J].中国优生与遗传杂志,2011,19(8):114-115.
[9] 周巧艳,郭凤月,李兴华.9 865例女性不孕的临床病因分析[J].中国计划生育学杂志,2011,19(6):376-378.
[10] 邢冠琳,王芳,柳胜贤.宫腔内人工授精时机及授精日男方精液质量对妊娠结局的影响[J].中国实用医刊,2015,42(19):29-30.
[11] 乔攀峰,申小静,张丽.人工授精联合腹腔镜治疗输卵管伞端粘连闭锁性不孕的临床观察[J].医药论坛杂志,2013,34(3):104-105.
[12] ZAHIRI SOROURI Z, RASHID SHOMALI R, POURMARZI D. Single versus double intrauterine insemination in controlled ovarian hyperstimulation cycles: a randomized trial[J]. Arch Iran Med,2016,19(7):465-469.
[13] ZAVOS A, DAPONTE A, GARAS A, et al. Double versus single homologous intrauterine insemination for male factor infertility: a systematic review and meta-analysis[J]. Asian J Androl,2013,15(4):533-538.
[14] 李道云,高红艳,孔祥.对1 395个夫精人工授精治疗周期的临床分析[J].实用妇科内分杂志,2018,5(5):31-33.
[15] 李冬兰,杨丽娟,胥杜娟,等.自然周期与促排卵周期供精人工授精妊娠结局的比较[J].生殖与避孕,2011,31(11):776-779.
[16] HUANG S, WANG R, LI R, et al. Ovarian stimulation in infertile women treated with the use of intrauterine insemination: a cohorts from China[J]. Fertil Steril,2018,109(5):872-878.
[17] 徐景岭.正常形态精子百分率对宫腔内人工授精妊娠率的影响[J].中华实用诊断与治疗杂志,2014,28(3):273-274.