促排卵对不同病因宫腔内人工授精的结局分析

A retrospective analysis of the outcome of ovulation induction in intrauterine insemination with different etiologies

目的：探讨促排卵对不同病因不孕患者人工授精的影响。方法：回顾性分析因男性因素、输卵管盆腔因素、子宫内膜异位症（EMS）和不明原因进行人工授精患者的资料，根据患者进行自然周期或促排卵周期分组，比较不同周期组的临床妊娠率和活产率。采用多元回归分析模型校正患者年龄、不孕年限、不同因素构成比、基础FSH、LH、E2、子宫内膜厚度、类型、宫腔内人工授精（IUI）Zl卵泡直径及男性前向运动精子总数。评估在男性因素、输卵管盆腔因素、EMS和不明原因中促排卵周期与临床妊娠率的关系。结果：①促排卵组患者平均年龄、不孕年限以及不孕因素构成比（男性因素、输卵管盆腔因素、EMS和不明原因）与自然周期比较，无统计学差异仔，〉0．05），而临床妊娠率和活产率均高于自然周期，但无统计学差异（P=0．08）：②通过多元因素回归分析校正了年龄、基础内分泌水平、不孕因素、内膜厚度和类型及前向运动精子总数等混杂因素后，促排卵周期相对于自然周期依然有显著优势（锨=1．607；95％CI=1．115--2．316）；（D在不同因素不孕患者中，促排卵周期可提高输卵管盆腔因素患者的活产率（OR=4．56；95％CI=1．53～13．53）。结论：促排卵周期可提高输卵管盆腔因素患者宫腔内人工授精的·临床妊娠和活产率。

Objective： To evaluate the effects of ovulation induction in intrauterine insemination （IUI） with different etiologies on the clinical pregnancy rate and live-birth rate in women. Methods： A retrospective study was performed on patients underwent IUI treatment, patients with male factor, tubal pelvic factors, endometriosis and unexplained factor were included in this study. A total of 766 patients receiving ovulation induction cycles （OIC） and 1 172 patients receiving natural cycles （NC） were compared based on the clinical pregnancy rate and live-birth rate. Multivariate regression analysis was performed to determine the effect of ovulation induction on the clinical pregnancy rate of patients underwent IUI treatment for male factor, tubal pelvic factors, endometriosis and unexplained factor. Results： Clinical pregnancy and live-birth rates of patients in OIC were higher than those in NC, but there was no statistical significance （P=0.08）. Through multiple regression analysis adjusted for age, basal hormone level, factors of infertility, endometrial thickness and types, the total number of sperm forward movement and other confounding factors, OIC had a significant advantage （OR=1.607; 95%CI=1.115-2.316） compared with NC in different patients with infertility, and OIC can improve pelvic and tubal factors patients＇ outcome （OR=4.56; 95%CI=1.53-13.53）. Conclusion： OIC can improve the clinical pregnancy and live-birth rate of IUI in patients with pelvic and fallopian tube factors.