718周期夫精宫腔内人工授精临床因素分析

Analysis of clinical factors affecting pregnancy rate of intrauterine artificial insemination from 718 cycles

目的：探讨影响夫精宫腔内人工授精（intrauterine inseminatio，IUI）成功率的各种临床因素。方法：回顾性分析526例患者进行718周期的IUI。对患者年龄、自然周期或超排卵周期、IUI次数、IUI活性精子数量、输卵管条件、子宫内膜厚度与妊娠率的关系进行分析。结果：718周期的IUI中妊娠109周期，其中双胎妊娠率9．2％，三胎妊娠率为2．8％，流产率为22．2％，每周期临床妊娠率为15．2％。自然周期或超排卵周期、单侧或双侧输卵管通畅病人间，妊娠率无显著性差异（19〉0．05）。就女方年龄，〈30岁、30。40岁和〉40岁妊娠率分别为17．24％、14．40％和3．22％，年龄越大受孕率越低，〉40岁组妊娠率明显低于前两组（19〈0，05））。第3次IUI的妊娠率明显高于第2次IUI（妊娠率分别为25．00％、10．39％，19〈0．05）。当IUI活性精子数量低于1×10^6时，妊娠率为3．33％，明显低于活性精子数为1～10×10^6，10～50×10^6，和〉50×10^6组（妊娠率分别为15．82％、16．67％和27．27％，P〈0．05）。LH峰或注射HCG时，子宫内膜厚度〈7mm和〉16mm时，妊娠率分别为7．14％和3．23％，明显低于7～12mm和13～16mm组（妊娠率为16．86％和14．18％，P〈0．05）。结论：IUI中女方的年龄、IUI活性精子数量和子宫内膜厚度是影响IUI妊娠率的直接因素。

Objective： To study the various clinical factors affecting the pregnancy rate of the intrauterine artificial insemination （IUI） with husband sperm. Methods ：718 cycles of 526 patients with IUI were analyzed retrospectively. The study focused on the relationships of the age of female patient, natural and stimulant cycles, times of IUI, the numbers of the moving sperm, the oviduct condition and endometrium thickness with the pregnancy rate. Results： There were totally 109 pregnancy cycles in 718 cycles of IUI, of these twin pregnancy rate was 9.2%, triplet pregnancy rate was 2.8% ,miscarriage rate was 22.2%, and clinical pregnancy rate （CPR） per cycle was 15.2%. There was no significant difference in the pregnancy rate （P〉0.05） between natural and stimulant cycles, single and double unobstructed oviduct. When the female patients were divided into three groups （age〈=30, age30〈age〈=40, and age〉40）, their pregnancy rates were 17.24%,14.40% and 3.22% respectively, and the group （age〉40） was significantly lower than the others （P〈0.05）. The pregnancy rate was 25% and 10.39% respectively in the third and second IUI. There was significant difference in the pregnancy rate （P〈0.05）. When the total numbers of the moving sperm after the treatment were 〈1×10^6, 1～10×10^6, 10～50×10^6 and 〉50×10^6 respectively, the pregnancy rates were 3.33%,15.82%,16.67% and 27.27% respectively, and the first group （〈1×10^6） was significantly lower than the others （P〈0.05）.When the endometrial thicknesses were 〈7 mm, 7～12 mm,13～16 mm and 〉16 mm respectively at the day of hCG injection or LH surge, the pregnancy rates were 7.14%, 16.86%, 14.18% and 3.23% respectively. The group （〈7 mm） and the group （〉16 mm） were significantly lower than the others （P〈0.05）. Conclusion： The direct factors affecting the pregnancy rate of IUI were the age of female patient,the numbers of moving sperm and the endometrium thickness.