人工授精及继用体外受精-胚胎移植助孕临床结局分析

Analysis on the pregnancy outcome of the artificial insemination and the subsequent in vitro fertilization and embryo transfer

目的:分析宫腔内人工授精(IUI)助孕及继用体外受精-胚胎移植(IVF-ET)助孕的临床结局。方法:回顾性分析本中心接受夫精人工授精(AIH)助孕1038例患者(年龄<40岁)的1657周期资料以及继用IVF-ET助孕的384例临床资料。结果:接受AIH患者临床妊娠率13.88%(230/1657),年龄、单侧或双侧输卵管通畅及助孕周期各组间妊娠率无差异(P>0.05),继发不孕妊娠率高于原发不孕(P<0.05),注入精子数量(10～20)×106组妊娠率最高(P<0.05)。继用IVF-ET助孕妊娠率52.34%(201/384),根据AIH助孕失败次数分组,各组内Gn用量、获卵数、移植胚胎数、优质胚胎数、受精率、临床妊娠率无差异(P>0.05)。结论:对于<40岁患者行AIH时,其不孕类型、注入精子数量是影响治疗妊娠的重要因素。根据患者年龄和不孕年限行AIH治疗不宜超过3周,年龄较大、不孕年限较长患者可提前继用IVF-ET助孕治疗。

Objective： To study the clinical pregnancy of artificial insemination with husband sperm （ AIH - IUI）, and the clinical outcome of the in vitro fertilization and embryo transfer （IVF - ET） following the failure of the AIH - IUI. Methods：The related data of 1,657 cycles of AIH - IUI conducted in this centre for 1,038 infertile couples were collected. The clinical outcomes of the AIH - IUI cycles and those of IVF - ET subsequent to the failure of AIH - IUI were retrospectively analyzed.Results： The clinical pregnancy rate of AIH- IUI cycles was 13.88% （230/1,657）. With the increase in age of female patients, the pregnancy rate was decreased. There was no significant difference in pregnancy rate between the patients with single or double unobstructed oviducts or between the patients with different cycles of AIH - IUI. The pregnancy rate of the patients with secondary infertility was significantly higher than that of the patients with primary infertility （P 〈 O. 05）. The pregnancy rate was the highest in the patients inseminated with 10 ～ 20 × 10^6 sperm （ P 〈 0.05 ）. The pregnancy rate of IVF - ET following the failed AIH -IUI was 52.34% （201/384）. There was no significant difference in Gn dose, number of retrieved oocytes, fertilization rate, high - quality embryo rate, number of embryos transferred, or clinical pregnancy rate among the patients with different failed AIH - IUI cycles. Conclusion： The age of female patients, type of infertility and the quantity of sperm inseminated can affect the pregnancy rate of AIH - IUI. The patients may receive the treatment of up to 3 cycles of AIH - IUI. For the elder patients or those with longer duration of infertility, it is suggested that IVF - ET be conducted earlier.