女性的人体质量指数对夫精人工授精助孕妊娠结局的影响

Influence of body mass index on pregnancy outcomes of women underwent artificial insemination by husband

目的探讨女性的人体质量指数(BMI)对夫精人工授精(AIH)助孕妊娠结局的影响。方法选择2009年6月至2016年12月,于苏北人民医院生殖医学中心采用AIH助孕的3 243例女性不孕患者为研究对象。将4种具有相同子宫内膜准备方案及相同年龄段情况下的女性不孕患者,均分别按照BMI值分为正常体重组(BMI为18.5~22.9 kg/m2),超重组(BMI为23.0~24.9kg/m2)和肥胖组(BMI≥25.0kg/m2)。具体为:(1)采用自然周期并且年龄≤35岁者,3组分别为1 366例、347例及233例;(2)采用自然周期并且年龄>35岁者,3组分别为155例、71例及36例;(3)采用诱导排卵周期并且年龄≤35岁者,3组分别为529例、208例及191例;(4)采用诱导排卵周期并且年龄>35岁者,3组分别为59例、32例及16例。回顾性分析所有受试者的临床病例资料,分别比较4种相同条件下,3组患者的基本临床资料和妊娠结局,以评估女性不孕患者的BMI对AIH治疗结局的影响。对于3组受试者临床妊娠率及自然流产率的比较,采用χ~2检验。结果 (1)按照正常体重组、超重组及肥胖组的顺序:采用自然周期并且年龄≤35岁者,3组受试者的临床妊娠率分别为14.6%、10.1%及10.7%,自然流产率分别为25.0%、22.9%及32.0%;采用自然周期并且年龄>35岁者,3组受试者的临床妊娠率分别为14.2%、9.9%及8.3%,自然流产率分别为31.8%、42.9%及33.3%;采用诱导排卵周期并且年龄≤35岁者,3组受试者的临床妊娠率分别为17.0%、13.0%及10.0%,自然流产率分别为23.3%、29.6%及36.8%;采用诱导排卵周期并且年龄>35岁者,3组受试者的临床妊娠率分别为15.3%、9.4%及6.3%,自然流产率分别为44.4%、33.3%及100.0%。(2)上述4种相同条件下,分别对3组受试者进行临床妊娠率和自然流产率比较的结果显示:采用自然周期并且年龄≤35岁者,正常体重组的临床妊娠率分别较超重组及肥胖组高,并且差异均有统计学意义(χ~2=4.850,P=0.028;χ~2=11.859,P=0.001);采用诱导排卵周期并且年龄≤35岁者,正常体重组的临床妊娠率较肥胖组高,并且差异有统计学意义(χ~2=5.453,P=0.020)。其余条件下受试者的临床妊娠率和自然流产率分别进行3组间比较,差异均无统计学意义(P>0.05)。结论对于采用AIH助孕并且年龄≤35岁的女性不孕患者,无论采用自然周期还是诱导排卵周期子宫内膜准备方案,其BMI值高可能降低临床妊娠率,但是对自然流产率无影响。而对于年龄>35岁者,BMI值对妊娠结局无明显影响。

To explore the influence of the body mass index(BMI)on pregnancy outcomes of women underwent artificial insemination by husband(AIH).Methods A total of 3 243 cases of barren women underwent AIH in Reproductive Medical Center of Northern Jiangsu People′s Hospital from June 2009 to December 2016,were chosen as study subjects.Four kinds of patients with same endometrial preparation scheme and same age group were all divided into following 3 groups according to BMI value,respectively,including normal body weight group(BMI of 18.5-22.9 kg/m 2),overweight group(BMI of 23.0-24.9 kg/m 2)and obesity group(BMI≥25.0 kg/m 2).More details were as follows.①For women with natural cycles and age≤35 years old,there were 1 366 cases,347 cases and 233 cases in 3 groups,respectively.②For women with natural cycles and age>35 years old,there were 155 cases,71 cases and 36 cases in 3 groups,respectively.③For women with induced ovulation cycles and age≤35 years old,there were 529 cases,208 cases and 191 cases in 3 groups,respectively.④For women with induced ovulation cycles and age>35 years old,there were 59 cases,32 cases and 16 cases in 3 groups,respectively.Case informations of all subjects were analyzed retrospectively.Compared the general clinical data and pregnancy outcomes among 3 groups of women in 4 identical conditions,respectively,to evaluate the influence of BMI of barren women on outcomes of AIH treatments.Chi-square test was used to compare the clinical pregnancy rate and spontaneous miscarriage rate among 3 groups.Results①In accordance with the order of normal body weight group,overweight group and obesity group:for women with natural cycles and age≤35 years old,the clinical pregnancy rates of 3 groups were 14.6%,10.1%and 10.7%,respectively;the spontaneous miscarriage rates were 25.0%,22.9%and 32.0%,respectively.For women with natural cycles and age>35 years old,the clinical pregnancy rates of 3 groups were 14.2%,9.9%and 8.3%,respectively;the spontaneous miscarriage rates were 31.8%,42.9%and 33.3%,respectively.For women with induced ovulation cycles and age≤35 years old,the clinical pregnancy rates were 17.0%,13.0%and 10.0%,respectively;the spontaneous miscarriage rates were 23.3%,29.6%and 36.8%,respectively.For women with induced ovulation cycles and age>35 years old,the clinical pregnancy rates were 15.3%,9.4%and 6.3%,respectively;the spontaneous miscarriage rates were 44.4%,33.3%and 100.0%,respectively.②The comparison results of clinical pregnancy rates and spontaneous miscarriage rates among 3 groups of subjects under the same 4 conditions showed that:the clinical pregnancy rates of women with natural cycles and age≤35 years old in normal body weight group were higher than those of overweight group and obesity group,and the differences were statistically significant(χ2=4.850,P=0.028;χ2=11.859,P=0.001).The clinical pregnancy rate of women with induced ovulation cycles and age>35 years old in normal body weight group was higher than that of obesity group,and the difference was statistically significant(χ2=5.453,P=0.020).There were no significant differences among 3 groups of women under other conditions in clinical pregnancy rates and spontaneous miscarriage rates(P>0.05).Conclusions For barren women with the age≤35 years old and AIH treatment,no matter using natural cycles or induced ovulation cycles for endometrial preparation,the higher BMI value may decrease clinical pregnancy rate,but no effect on spontaneous miscarriage rate.For women with the age>35 years old,BMI value may have no effect on pregnancy outcomes.