影响多囊卵巢综合征患者夫精宫腔内人工授精成功率的因素分析

Influencing Factors of the Successful Rate of AIH in Patients with PCOS: A Retrospective Analysis

目的:研究影响多囊卵巢综合征(PCOS)患者夫精宫腔内人工授精(IUI-H)成功率的相关因素。方法:收集2013年1月—2017年6月于石家庄市第一医院生殖医学科行IUI-H助孕PCOS患者的临床资料,共150例226个周期,根据年龄、体质量指数(BMI)、授精时机、处理前精液体外存放时间和成熟卵泡数进行分组,并分析各因素对临床妊娠率的影响。结果:(1)<30岁组、30~35岁组和36~38岁组的妊娠率差异无统计学意义(P>0.05)。(2)按BMI分组的3组妊娠率差异有统计学意义(P<0.05)。<24 kg/m^2组的妊娠率高于24~27kg/m^2组和≥28 kg/m`2组(均P<0.05);24~27 kg/m^2组的妊娠率略高于≥28 kg/m^2组,但差异无统计学意义(P>0.05)。(3)排卵前和排卵后各行1次IUI组的妊娠率高于排卵前行1次IUI组(P<0.05)。(4)精液处理前存放10~30 min组的妊娠率高于>30 min组(P<0.05)。(5)1个成熟卵泡时,前向运动精子总数(TPMC)10×10~6~50×10~6组的妊娠率高于>50×106组(P<0.05);2个成熟卵泡时,2组妊娠率差异无统计学意义(P>0.05)。结论:小于39岁的PCOS患者,年龄对其妊娠率影响较小;超重和肥胖PCOS患者在行IUI治疗前最好先行减重预处理;实验室人员在处理精液时可将体外存放时间控制在10~30 min;优化后的TPMC可根据成熟卵泡数进行适当的调节,1个成熟卵泡时可将TPMC控制在10×10~6~50×10~6注入宫腔,剩余精液可注入阴道后穹窿,2个成熟卵泡时可将全部精液注入宫腔;在患者同意的情况下,可在排卵前后各行1次IUI,以提高临床妊娠率。

Objective：To study the factors influencing the success rate of artificial insemination of husband（AIH） in patients with polycystic ovary syndrome （PCOS）. Methods： The clinical data of PCOS patients undergoingAIH between January 2013 and June 2017 were collected, including a total of 226 cycles of 150 cases. Thosecycles were grouped according to age, body mass index （BMI）, the timing of fertilization, storage time beforetreatment of semen, the number of mature follicles. The clinical pregnancy rate was compared among groups. Results： ①There was no significant difference in the pregnancy rate among three groups of 〈30 years, 30-35years and 36-38 years （P〉0.05）. ②There was significant difference in the pregnancy rate among three groupsrelated to BMI （P〈0.05）. The pregnancy rate in the BMI〈24 kg/m2 group was higher than that in the BMI 24-27kg/m2 group, or that in the BMI ≥28 kg/m2 group （both P〈0.05）. The pregnancy rate in the BMI 24-27 kg/m2group was higher than that in the BMI ≥28 kg/m2 group （but P〉0.05）. ③According to the timing of fertilization,the pregnancy rate of the group with two times of IUI before and after ovulation was significantly higher than thatof another group with one time of IUI before ovulation （P〈0.05）. ④According to the storage time before treatmentof semen, the pregnancy rate in the 10-30 minutes group was higher than that in the 〉30 minutes group （P〈0.05）.⑤When there was one mature follicle, the pregnancy rate of the group with the total progressively motile spermcount （TPMC） 10×10^6-50×10^6 was significantly higher than that of the group with TPMC 〉50×10^6 （P〈0.05）.When there were two mature follicles, there was no significant difference in the pregnancy rate between the abovetwo groups （P〉0.05）. Conclusions： The age has little influence on the pregnancy rate in those PCOS patientsaged 〈39 years. PCOS patients with overweight and obese should be asked to lose weight before IUI treatment.The storage time before treatment of semen should be control within 10-30 minutes. TPMC can be properlyadjusted according to the number of mature follicles. Two times of IUI can be arranged before and after ovulationwith the informed consent, so as to increase the pregnancy rate