影响人工授精妊娠率的多因素分析

Analysis on factors related to the pregnancy rate of artificial insemination with husband sperm

目的：探讨影响夫精人工授精妊娠率的相关因素。方法：选取2013年3月至2014年9月在南通大学附属医院生殖医学中心行宫腔内人工授精（IUI）治疗的夫妇146对,共277个周期。分析女性年龄、不孕年限、IUI治疗周期数、促排卵方案,扳机方法及扳机日相关指标等与临床妊娠率的关系。结果：年龄〈25岁组的妊娠率明显高于年龄〉30岁组（25.8%vs 11.2%,P〈0.05）;妊娠组的扳机日促黄体生成素（LH）水平高于非孕组[（29.7±8.44）vs（16.6±1.52）,P〈0.05]。子宫内膜分型为A型者的妊娠率显著高于非A型者（P〈0.05）。GnRH-a扳机后排卵率优于HCG（P〈0.05）;4个治疗周期内随着周期数的增加累计妊娠率上升,卵泡期为10-16天妊娠率最高。结论：夫精人工授精治疗中,患者年龄、HCG日LH值、子宫内膜分型与妊娠率相关,GnRH-a扳机后排卵率优于HCG。

Objective： To investigate the related factors affect pregnancy rate of intrauterine insemination（ IUI）. Methods： 146 infertile couples（ 277 cycles）,who received IUI in Affiliated Hospital of Nantong University from March 2013 to Sep. 2014,were included in this study. The relationship between female age,duration of infertility,cycles of intrauterine insemination,ovulation induction protocol and triggering methods with pregnancy rate was analyzed.Results： The overall pregnancy rate was 14. 4% per cycle. The pregnancy rate of women older than 30 years old decreased significantly comparing to those younger than 25 years old（ 11. 2%vs 25. 8%,P〈0. 05）. Women with endometrium triple-line（ type A）,pregnancy rate was higher than non-type A（ 17. 6% vs 5. 6%,P〈0. 05）. Serum LH level on triggering day was higher in pregnant group compared to non-pregnant group（ 29. 7 ± 8. 44 vs 16. 6 ± 1. 52,P〈0.05）. The ovulation rate induced by GnRH-a was higher than HCG（ 96. 2% vs 85. 0%,P〈0.05） with similar pregnancy rate. The accumulated pregnancy rate of IUI increased with the number of IUI cycles within four cycles. The follicular phase between 10 to 16 days had higher pregnancy rate compared to other groups,but there was no statistical significance. Conclusion：The female age,LH level and the type of endometrium on the day of triggering significantly affect IUI pregnancy rate. GnRh-a triggering results in higher ovulation rate than HCG.