反复供精者精液人工授精失败后宫腔镜检查的临床意义

Clinical significance of hysteroscopy after repeated failure in artificial insemination by donor

目的通过宫腔镜检查反复人工授精失败后患者的宫腔情况,评价再次行供精者精液人工授精(artificial insemination by donor,AID)术前宫腔镜检查的临床意义。方法回顾性分析2011年6月至2014年5月于广东省计划生育专科医院就诊的150例既往AID失败≥3次者(观察组)与149例行输卵管插管通液拟AID者(对照组)的宫腔镜检查结果,比较两组宫腔异常检出率和异常类型。结果宫腔异常检出率观察组(30.00%)高于对照组(18.79%)(P<0.05),主要为子宫内膜息肉(分别为22.67%、13.42%);观察组各年龄段宫腔异常检出率均高于对照组,但差异无统计学意义(P>0.05)。Logistics回归分析发现,病例类型、年龄和不孕年限均是宫腔异常的危险因素。结论建议反复AID失败的妇女先行宫腔镜诊治改善宫腔环境,以提高辅助生殖的妊娠率。

Objective To investigate the clinical significance of hysteroscopy after repeated failure in artificial insemination by donor（AID）. Methods The hysteroscopic results of 150 women with failure in AID more than 3 times （observation group） and 149 women undergoing AID semen after hydrotubation （control group） in Guangdong Province Family Planning Hospital from June 2011 to May 2014 were retrospectively analyzed. The incidences and types of abnormal hysteroscopic findings were compared between the two groups. Results The incidence of abnormal hysteroscopic findings in observation group was significantly higher than that in control group （30. 0% vs 18.8% , P 〈0. 05）. The main different type of abnormal hysteroscopic findings in the two groups was endometrial polyp （22.7% vs 13.4%, P 〈 0. 05 ）. The incidence of uterine cavity abnormalities of each age group in observational group was higher than that in control group. But the difference was not statistically significant （ P 〉 0. 05 ）. Logistic regression analysis found that the type of illness, age and infertility were all risk factors for uterine abnormalities. Conclusion Women who have repeated failure in AID are advised to undergo hysteroscopy before receiving a seeond insemination to improve the uterine environment, in order to improve the pregnant rate of assisted reproduction.