供精人工授精临床结局影响因素分析

The Influential Factors on Clinical Outcomes of Artificial Insemination with Donor Sperm

目的:探讨供精人工授精(AID)临床结局的影响因素。方法:回顾性分析2012年1月—2017年4月1810对夫妇共4067个AID周期的临床资料,分析女方年龄、女方不孕因素、治疗方案、授精时机及治疗周期数与临床结局的相关性。结果:①临床妊娠率、活产率随年龄增长均有下降趋势(均P<0.05)。②女方合并排卵障碍、盆腔子宫内膜异位症术后及盆腔炎性疾病后遗症者AID临床结局与单纯男方因素者相比,差异均无统计学意义(均P>0.05)。③自然周期、氯米芬、来曲唑及单纯促性腺激素(Gn)促排卵周期的临床妊娠率、宫内妊娠流产率和活产率差异均无统计学意义(均P>0.05);氯米芬和来曲唑促排卵周期的多胎妊娠率显著高于自然周期(均P<0.001)。④无论自然周期还是促排卵周期,排卵前与排卵后授精的临床结局比较,差异均无统计学意义(均P>0.05)。⑤前4个治疗周期随着治疗周期数的增加,累计妊娠率与累计活产率显著升高(均P<0.05),第5个治疗周期开始累计妊娠率与累计活产率均无明显增长(均P>0.05)。结论:女性年龄是影响AID临床结局的重要因素;未发现其他女性不孕因素及授精时机显著影响AID临床结局。实施3个或4个AID周期仍未孕者或女性年龄超过40岁建议行供精体外受精助孕。

Objective:To investigate the influential factors on the clinical outcomes of artificial insemination with donor sperm (AID). Methods: The data of 4 067 AID cycles from 1 810 couples between January 2012 and April 2017 were retrospectively analyzed, to investigate the effects of women′ s age, female infertility factors, therapeutic regimen, insemination timing and the numbers of treatment cycle on the AID outcomes. Results:①Both clinical pregnancy rates and live birth rates were decreased with women′s age (both P<0.05).②Women with ovulation failure, postoperative pelvic endometriosis or pelvic inflammatory disease had comparable clinical outcomes to those infertile women with pure male factors of husbands (all P>0.05).③There were no significant differences in clinical pregnancy rate, abortion rate or live birth rate among natural cycle, clomiphene cycle, letrozole cycle and pure Gn cycle (both P>0.05), while the rates of multiple pregnancy in clomiphene and letrozole cycle were significantly higher than that in natural cycle (both P<0.001).④Insemination before or after ovulation didn′t affect the clinical outcomes of AID in both natural cycle and ovulation induction cycle (both P>0.05).⑤Both cumulative pregnancy rate and cumulative live birth rate were significantly increased with the numbers of treatment cycle within the first 4 cycles (both P<0.05), but no longer increased visibly since the fifth cycle (both P>0.05). Conclusions: Women′s age was an important factor of the success of AID. We found in this paper that other factors of female infertility and insemination timing could not significantly affect the clinical outcomes of AID. IVF treatment should be considered for those women who did not get pregnancy after 3 or 4 AID treatment cycles, or those women aged over 40 years.