输卵管因素对夫精人工授精妊娠率的影响

Effect of tubal factors on pregnancy rate of artificial insemination by husband

目的通过研究女性输卵管因素对夫精人工授精(IUI)妊娠成功率的影响,探讨输卵管异常的不孕症患者助孕方式的选择。方法统计2010年12月1日-2015年5月31日行IUI治疗的311例不孕症患者共557个周期,根据女方输卵管情况分为3组。A组80例,一侧或双侧输卵管通而不畅及单侧输卵管阻塞组;B组18例,双侧或单侧输卵管炎行腹腔镜下输卵管整形术;C组213例为对照组:双侧输卵管通畅。分别对3组不孕类型、年龄、治疗结局、IUI日处理后前向运动精子总数>5×106治疗周期的治疗结局及不同治疗方案的治疗结局进行比较。结果 3组女方年龄、不孕类型、IUI日处理后前向运动精子总数>5×106治疗周期临床妊娠率差异无统计学意义(P>0.05);A组临床妊娠率高于B组与C组(14.0%vs 10.3%,11.0%),但无统计学差异(P>0.05);A组与B组促排卵周期所占比例分别为45.0%、44.8%,明显高于C组的27.6%(P<0.05);A组促排卵周期临床妊娠率高于C组(P>0.05)。结论对于轻度输卵管异常且女方年龄较轻者,建议先行输卵管通畅侧IUI,必要时促排卵治疗3个周期,若不成功,再考虑转IVF助孕治疗。

Objective To explore the choice of assisted pregnancy modes of infertile patients with Fallopian tube abnormalities through researching the effect of female tubal factors on sucessful pregnancy rate of artificial insemination by husband（ AIH）.Methods A total of311 infertile patients（ 557 cycles） receiving AIH in the hospital from December 1st,2010 to May 31 st,2015 were analyzed statistically,then the patients were divided into group A（ 80 patients with unilateral or bilateral unsmooth tubes and unilateral tube block）,group B（ 80 patients with bilateral or unilateral salpingitis,undergoing laparoscopic salpingoplasty）,and group C（ 213 patients with smooth tubes,control group） according to tube situations.The infertile types,age,outcomes,the outcomes during treatment cycle with the number of forward movement sperms〉5×106after AIH,outcomes of different therapeutic regimens in the three groups were compared.Results There was no statistically significant difference in maternal age,infertile types,and clinical pregnancy rate during treatment cycle with the number of forward movement sperms〉5×106after AIH among the three groups（ P〉 0.05）;the clinical pregnancy rate in group A（ 14.0%） was higher than those in group B and group C（ 10.3%,11.0%）,but there was no statistically significant difference（ P〉0.05）;the proportion of ovarian stimulant cycles in group A and group B were 45.0% and 44.8%,respectively,which were statistically significantly higher than that in group C（ 27.6%）（ P〈0.05）;the clinical pregnancy rate in ovarian stimulant cycles in group A was statistically significantly higher than that in group C（ P〉0.05）.Conclusion For the young patients with mild Fallopian tube abnormalities,AIH of smooth side of tubes is recommended,ovulation induction can be carried out for three courses if necessary,but if fail,ICF assisted pregnancy can be considered.