影响宫腔内人工授精成功的相关因素分析

Investigation of Correlative Factors Affecting Successful Intrauterine Insemination

目的 :通过对 186例患者 2 16个周期宫腔内人工授精 (IUI)的总结 ,分析影响IUI妊娠率的主要相关因素。方法 :从不孕症的原因、自然周期与促排卵周期、不同的促排卵方案 [克罗米酚 (CC)组、CC +人绝经期促性腺激素(hMG)组、hMG组 ]、上游法与梯度离心 2种精子处理方法以及授精时机 [注射人绒毛膜促性腺激素 (hCG)日子宫内膜的厚度 ,雌二醇E2的水平 ,IUI的次数 ]5个方面 ,分别进行妊娠率的比较。 结果 :男方因素、宫颈因素的妊娠率 (2 9.82 %、2 5 .0 0 % )明显高于其他因素 ;促排卵周期和自然周期之间 (19.5 4 %vs 16 .6 7% )、促排卵的 3组方案之间 (CC组 6 .5 0 %、CC +hMG组 14 .2 8%、hMG组 2 2 .30 % ) ;梯度离心法和上游法之间 (2 0 .13%vs 16 .13% ) ,2次IUI和 1次IUI之间 (19.73%vs 17.39% ) ,妊娠率差异均无显著性 (P均 >0 .0 5 )。而注射hCG日的子宫内膜不同厚度之间 ,每个直径≥ 14mm卵泡的不同E2水平之间 ,妊娠率差异有显著性 (P <0 .0 5 )。 结论 :IUI更适用于男方因素、宫颈因素引起的不孕。在此基础上选择最恰当的授精时机是影响妊娠率的关键。

Objective: To investigate the main correlative factors affecting the pregnancy rate of intrauterine insemination (IUI) by means of analyzing 186 patients and 216 cycles of IUI. Methods: Comparisons were made between different pregnancy rates from five respects: infertility reasons,stimulation and natural cycles,different protocols for stimulating ovulation (CC group,CC +hMG group,hMG group),two methods for semen treatment( swim-up and gradient centrifugal),and insemination time (endometrial thickness and E2 levels at the day of hCG injection,and times of IUI). Results: The pregnancy rates resulting from male and cervix factors ( 29.82 %, 25.00 %) were significantly higher than those from other factors. There were few statistical differences in the pregnancy rates between stimulation and natural cycles ( 19.54 % vs 16.67 %),between the three different protocols for stimulating ovulation (CC 6.50 %,CC+hMG 14.28 %,hMG 22.30 %),between gradient centrifugal and swim-up methods( 20.13 % vs 16.13 %) and between one-time IUI and two-time IUI( 19.73 % vs 17.39 %) ( P > 0.05 ). However,the pregnancy rates were statistically correlated with the endometrial thickness at the day of hCG injection and different E2 levels of the follicles over 14 mm in diameter( P < 0.05 ).Conclusion: IUI is of more applied value for infertility caused by male and cervix factors. With these factors in view,to choose the most suitable insemination time is the key to increasing pregnancy rate.