不同体质量指数女性自然周期和促排卵周期供精人工授精的妊娠结局比较
|
摘要
目的:比较不同体质量指数(BMI)女性进行自然周期和促排卵周期供精人工授精(artificial insemination by donor,AID)的妊娠结局。方法:回顾性分析2011年3月—2017年4月于安徽医科大学第一附属医院生殖中心行AID助孕的1 707例女性患者资料,按BMI分为正常组1 314例(其中自然周期1 162例,促排卵周期152例,18.5 kg/m~2≤BMI<24 kg/m~2)、超重组320例(其中自然周期270例,促排卵周期50例,24 kg/m~2≤BMI<28 kg/m~2)和肥胖组73例(其中自然周期54例,促排卵周期19例,BMI≥28 kg/m~2),评估3组自然周期和促排卵周期AID的生化妊娠率、临床妊娠率、流产率和活产率。结果:正常组中促排卵周期AID的流产率高于自然周期,差异有统计学意义(29.03%,9/31 vs. 11.45%,30/262,χ~2=0.589,P=0.014),而生化妊娠率、临床妊娠率和活产率差异无统计学意义(P>0.05)。超重组中自然周期AID的临床妊娠率和活产率(分别为23.33%,63/270和21.48%,58/270)高于促排卵周期(分别为10%,5/50和8%,4/50),差异有统计学意义(χ~2=4.482,P=0.034;χ~2=4.908,P=0.027),促排卵周期生化妊娠率和流产率与自然周期比较差异无统计学意义(P>0.05)。肥胖组中自然周期AID的妊娠结局与促排卵周期比较差异无统计学意义(P>0.05)。结论:自然周期AID临床结局可能优于促排卵周期AID;尤其是超重女性,自然周期AID可能获得更高的妊娠结局。对条件合适的患者,应积极提倡自然周期AID。
Objective:To compare the pregnancy outcomes of artificial insemination in natural cycle and ovulation cycle for women with different body mass index. Methods:This retrospective study included 1 707 female patients undergoing artificial insemination by donor from March 2011 to April 2017. There were 1 314 cases in normal weight group(Among them,there were 1 162 natural cycle and 152 artificial cycles, 18.5 kg/m~2≤BMI<24 kg/m~2),320 cases in excess weight group(Among them,there were 270 natural cycle and 50 artificial cycles, 24 kg/m~2≤BMI<28 kg/m~2) and 73 cases in obesity group(Among them,there were 54 natural cycle and 19 artificial cycles, BMI ≥28 kg/m~2). The biochemical pregnancy rate,clinical pregnancy rate,abortion rate and live birth rate of AID were compared in women with different body mass index, and between two different cycles.Results:In normal weight group, the abortion rate of AID in artificial cycles was significantly higher than that in natural cycles(29.03%,9/31 vs. 11.45%,30/262,χ~2=0.589,P=0.014),however there were significant differences in the biochemical pregnancy rate, clinical pregnancy rate and live birth rate when compared between two different cycles(all P>0.05). In excess weight group, the clinical pregnancy rate and live birth rate in natural cycles(23.33%,63/270:21.48%,58/270)were significantly higher than those in artificial cycles(10%,5/50:8%,4/50,χ~2=4.482,P =0.034;χ~2=4.908,P =0.027),however there were no significant differences in the biochemical pregnancy rate and the abortion rate when compared between two different cycles(both P>0.05),so as. However,in obesity group,the difference of pregnancy outcomes was no significant when compared between natural cycles and ovulation cycles(P>0.05). Conclusions:Some parameters of clinical outcomes of natural cycles may be better than those of ovulatory cycles in those women undergoing AID treatment. Especially, the pregnancy outcome of natural cycles is better than that of ovulatory cycles in those women with excess weight. The natural cycle should be advocated for those suitable women.
Objective:To compare the pregnancy outcomes of artificial insemination in natural cycle and ovulation cycle for women with different body mass index. Methods:This retrospective study included 1 707 female patients undergoing artificial insemination by donor from March 2011 to April 2017. There were 1 314 cases in normal weight group(Among them,there were 1 162 natural cycle and 152 artificial cycles, 18.5 kg/m~2≤BMI<24 kg/m~2),320 cases in excess weight group(Among them,there were 270 natural cycle and 50 artificial cycles, 24 kg/m~2≤BMI<28 kg/m~2) and 73 cases in obesity group(Among them,there were 54 natural cycle and 19 artificial cycles, BMI ≥28 kg/m~2). The biochemical pregnancy rate,clinical pregnancy rate,abortion rate and live birth rate of AID were compared in women with different body mass index, and between two different cycles.Results:In normal weight group, the abortion rate of AID in artificial cycles was significantly higher than that in natural cycles(29.03%,9/31 vs. 11.45%,30/262,χ~2=0.589,P=0.014),however there were significant differences in the biochemical pregnancy rate, clinical pregnancy rate and live birth rate when compared between two different cycles(all P>0.05). In excess weight group, the clinical pregnancy rate and live birth rate in natural cycles(23.33%,63/270:21.48%,58/270)were significantly higher than those in artificial cycles(10%,5/50:8%,4/50,χ~2=4.482,P =0.034;χ~2=4.908,P =0.027),however there were no significant differences in the biochemical pregnancy rate and the abortion rate when compared between two different cycles(both P>0.05),so as. However,in obesity group,the difference of pregnancy outcomes was no significant when compared between natural cycles and ovulation cycles(P>0.05). Conclusions:Some parameters of clinical outcomes of natural cycles may be better than those of ovulatory cycles in those women undergoing AID treatment. Especially, the pregnancy outcome of natural cycles is better than that of ovulatory cycles in those women with excess weight. The natural cycle should be advocated for those suitable women.
引文
[1]乐杰.妇产科学[M].9版.北京:人民卫生出版社,2018:361-365.
[2]Botchan A,Hauser R,Gamzu R,et al.Results of 6139 artificial insemination cycles with donor spermatozoa[J].Hum Reprod,2001,16(11):2298-2304.
[3]Thijssen A,Creemers A,Van der Elst W,et al.Predictive factors influencing pregnancy rates after intrauterine insemination with frozen donor semen:a prospective cohort study[J].Reprod Biomed Online,2017,34(6):590-597.
[4]Zhang T,Dai P,Cheng D,et al.Obesity occurring in apolipoprotein E-knockout mice has mild effects on fertility[J].Reproduction,2013,147(2):141-151.
[5]DagZ,Dilbaz B.Impact of obesity on infertility in women[J].JTurk Ger Gynecol Assoc,2015,16(2):111-117.
[6]Brewer CJ,Balen AH.The adverse effects of obesity on conception and implantation[J].Reproduction,2010,140(3):347-364.
[7]Bellver J,Pellicer A,García-Velasco JA,et al.Obesity reduces uterine receptivity:clinical experience from 9,587 first cycles of ovum donation with normal weight donors[J].Fertil Steril,2013,100(4):1050-1058.
[8]王兴玲,冯涵琪,刘芳,等.供精人工授精助孕结局相关影响因素[J].中国妇幼保健,2014,29(3):396-401.
[9]Veleva Z,Tiitinen A,Vilska S,et al.High and low BMI increase the risk of miscarriage after IVF/ICSI and FET[J].Hum Reprod,2008,23(4):878-884.
[10]Hancke K,More S,Kreienberg R,et al.Patients undergoing frozenthawed embryo transfer have similar live birth rates in spontaneous and artificial cycles[J].J Assist Reprod Genet,2012,29(5):403-407.
[11]Malchau SS,Loft A,Henningsen AK,et al.Perinatal outcomes in6,338 singletons born after intrauterine insemination in Denmark,2007 to 2012:the influence of ovarian stimulation[J].Fertil Steril,2014,102(4):1110-1116.e2.
[12]赵华,王兴玲,管一春,等.影响供精人工授精临床结局多因素分析[J].中国妇幼保健,2011,26(5):711-714.
[13]李秀芳,范华蕊,盛燕,等.供精人工授精成功率影响因素分析[J].中华男科学杂志,2015,21(3):234-238.
[14]刘莹,刘新宇,王冰松,等.供精人工授精妊娠结局的影响因素及子代安全性分析[J].中华男科学杂志,2016,22(3):229-232.
[15]Chavarro JE,Ehrlich S,Colaci DS,et al.Body mass index and short-term weight change in relation to treatment outcomes in women undergoing assisted reproduction[J].Fertil Steril,2012,98(1):109-116.(收稿日期:)
[2]Botchan A,Hauser R,Gamzu R,et al.Results of 6139 artificial insemination cycles with donor spermatozoa[J].Hum Reprod,2001,16(11):2298-2304.
[3]Thijssen A,Creemers A,Van der Elst W,et al.Predictive factors influencing pregnancy rates after intrauterine insemination with frozen donor semen:a prospective cohort study[J].Reprod Biomed Online,2017,34(6):590-597.
[4]Zhang T,Dai P,Cheng D,et al.Obesity occurring in apolipoprotein E-knockout mice has mild effects on fertility[J].Reproduction,2013,147(2):141-151.
[5]DagZ,Dilbaz B.Impact of obesity on infertility in women[J].JTurk Ger Gynecol Assoc,2015,16(2):111-117.
[6]Brewer CJ,Balen AH.The adverse effects of obesity on conception and implantation[J].Reproduction,2010,140(3):347-364.
[7]Bellver J,Pellicer A,García-Velasco JA,et al.Obesity reduces uterine receptivity:clinical experience from 9,587 first cycles of ovum donation with normal weight donors[J].Fertil Steril,2013,100(4):1050-1058.
[8]王兴玲,冯涵琪,刘芳,等.供精人工授精助孕结局相关影响因素[J].中国妇幼保健,2014,29(3):396-401.
[9]Veleva Z,Tiitinen A,Vilska S,et al.High and low BMI increase the risk of miscarriage after IVF/ICSI and FET[J].Hum Reprod,2008,23(4):878-884.
[10]Hancke K,More S,Kreienberg R,et al.Patients undergoing frozenthawed embryo transfer have similar live birth rates in spontaneous and artificial cycles[J].J Assist Reprod Genet,2012,29(5):403-407.
[11]Malchau SS,Loft A,Henningsen AK,et al.Perinatal outcomes in6,338 singletons born after intrauterine insemination in Denmark,2007 to 2012:the influence of ovarian stimulation[J].Fertil Steril,2014,102(4):1110-1116.e2.
[12]赵华,王兴玲,管一春,等.影响供精人工授精临床结局多因素分析[J].中国妇幼保健,2011,26(5):711-714.
[13]李秀芳,范华蕊,盛燕,等.供精人工授精成功率影响因素分析[J].中华男科学杂志,2015,21(3):234-238.
[14]刘莹,刘新宇,王冰松,等.供精人工授精妊娠结局的影响因素及子代安全性分析[J].中华男科学杂志,2016,22(3):229-232.
[15]Chavarro JE,Ehrlich S,Colaci DS,et al.Body mass index and short-term weight change in relation to treatment outcomes in women undergoing assisted reproduction[J].Fertil Steril,2012,98(1):109-116.(收稿日期:)