供精人工授精与供精体外受精胚胎移植的临床结局

The clinical pregnancy outcome of artificial insemination by donor(AID) and in vitro fertilization with donor semen (IVF-D) treatment

目的总结供精人工授精（AID）及供精体外受精（IVF—D）的临床结局，探讨其最佳治疗方案。方法总结我院2004年11月～2006年6月686例接受供精人工授精（AID）及93例接受供精体外受精（IVF—D）胚胎移植患者的临床结局，分析其相关影响因素。结果686例接受供精人工授精（AID）患者共行1309个人工授精周期，均采用宫颈管内人工授精（ICI），周期临床妊娠率16．88％（221／1309）。单次排卵前授精周期妊娠率19．89％（37／186）；单次排卵后授精周期妊娠率14．46％（134／927）；双次授精周期妊娠率25．51％（50／196）。3种授精时机相比妊娠率有统计学差异（X^2=15．49，P=0．001），双次授精妊娠率最高，单次排卵前授精妊娠率次之，单次排卵后授精妊娠率较低。3个周期累积成功率60．2％（153／254）。接受供精IVF患者93例，共135个移植周期。新鲜移植周期妊娠率53．76％（50／93），解冻移植周期妊娠率50％（21／42）。平均周期妊娠率52.59％（71／135）。AID单胎妊娠率高于IVF—D（91．86％与60．56％；X^2=39．65，P=0．001），AID多胎妊娠率低于IVF—D（1．36％与26．77％；X^2：68．4，P=0．001），AID宫外孕率与IVF—D组相比无统计学差异（0与1．41％，Fisher检验，P=0．24），AID自然流产率与IVF—D组相比无统计学差异（6．79％与11．27％；X^2=1．49，P=0．22）。AID妊娠率低于IVF—D（16．88％与52．59％；X^2=96、73，P=0．001）。结论采用双次宫颈管内供精人工授精（ICI）方法简单，妊娠率满意，供精体外受精（IVF—D）妊娠率高，但多胎率高于AID。

Objective： To analyze the clinical pregnancy outcome of artificial insemination by donor （AID） and in vitro fertilization with donor semen （IVF- D） treatment and investigate the best treatment for infertility by frozen donor semen. Methods： To analyze the clinical pregnancy outcome of AID treatment for 686 patients and IVF - D treatment for 93 patients from November 2004 to June 2006 in our hospital and to investigate the factors affecting the pregnancy rates of AID and IVF - D treatment. Results ： We gave 686 patients AID treatment by intracervical insemination （ICI） for 1309 cycles. The clinical pregnancy rate per cycle was 16. 88% （221/1309）. The pregnancy rate per cycle of AID treatment was 19. 89% （37/186） when we gave patients one time insemination before ovulation. The pregnancy rate per cycle of AID treatment was 14. 46% （134/927） when we gave patients one time insemination after ovulation. The pregnancy rate per cycle of AID treatment was 25. 51% （50/196） when we gave patients two times insemination after and before ovulation. There was a significant difference between the three kinds of insemination timing （ X^2 = 15. 49, P = 0. 001 ）. The pregnancy rate per cycle of AID treatment by two times insemination treatment was best. The pregnancy rate of one time insemination before ovulation was better. The pregnancy rate of one time insemination after ovulation was lower. The cumulative pregnancy rate at the third AID cycles was 60. 2% （153/254）. We gave the 686 patients IVF - D treatment for 135 cycles. The pregnancy rate of fresh IVF -D cycles was 53.76% （50/93）, the pregnancy rate of frozen IVF- D cycles was 50% （21/42）, the average pregnancy rate per IVF -D cycle was 52. 59% （71/135）. The singleton pregnancy rate was higher in AID cycles than that in IVF - D cycles （91.86% versus 60. 56% ; X^2 =39. 65, P =0. 001 ）. The multiple pregnancy rate in AID cycles was lower than that in IVF - D cycles （ 1.36% versus 26. 77% ; X^2 =68. 4, P =0. 001 ）. There was no significant difference in ectopic pregnancy rate between AID and IVF - D cycles （0 versus 1.41%, Fisher exact test, P =0. 24）. There was no significant difference in spontenous abortion pregnancy rate between AID and IVF - D cycles （6. 79% versus 11.27% ; X^2 = 1.49, P =0. 22）. The pregnancy rate in AID cycles was lower than that in IVF - D cycles （ 16. 88% versus 52. 59% ; X^2 = 96. 73, P = 0. 001 ）. Conclusion： Two times insemination treatment in AID cycles by ICI was simple and pregnancy rate was satisfactory. There was a higher pregnancy rate and higher multiple pregnancy rate in IVF - D cycles than that in AID cycles.