人工授精前实时三维子宫输卵管超声造影对输卵管通畅性评估的有效性

Validity of real-time three-dimensional hysterosalpingocontrast sonography in evaluating hysterosalpingo patency before intrauterine insemination

目的探讨宫腔内人工授精(intrauterine insemination,IUI)前实时三维子宫输卵管超声造影(real-timethree-dimensional hysterosalpingocontrast sonography,RT-3D-HyCoSy)对不孕患者输卵管通畅性评估的临床价值。方法回顾性分析2017年1—12月期间在南通大学附属医院生殖医学中心进行夫精人工授精助孕的242例患者,共364个周期。根据行IUI前输卵管通畅性检查方法的不同分为RT-3D-HyCoSy组(A组,105例,161个周期)和X线子宫输卵管造影(hysterosalpingography,HSG)组(B组,137例,203个周期)。分析患者的临床基本资料、治疗方案和IUI妊娠结局。结果在364个IUI治疗周期中,A组和B组的自然周期和促排卵周期比例差别无统计学意义(P>0.05);两组患者排卵前子宫内膜厚度、排卵前最大卵泡直径、输卵管检查距离IUI的时间、处理后精子活力和前向精子总数,差异均无统计学意义(P>0.05);A组和B组的临床妊娠率分别为18.01%和16.26%,差异亦无统计学意义(P>0.05)。结论RT-3D-HyCoSy能实时、快速、动态地评价输卵管通畅性,显影清晰、安全无辐射、空间感强,有较高的准确性,用于IUI助孕前输卵管通畅性的评价,安全有效。

Objective To explore the clinical value of real-time three-dimensional hysterosalpingocontrast sonography(RT-3D-HyCoSy)in evaluating hysterosalpingo patency before intrauterine insemination(IUI).Methods Totally 364 cycles(242 cases)of IUI were retrospectively analyzed in Center for Reproductive Medicine of Affiliated Hospital of Nantong University from January to December 2017.According to the method used for evaluating hysterosalpingo patency before IUI,these patients were divided into RT-3D-HyCoSy group(group A,105 cases,161 cycles)and hysterosalpingography(HSG)group(group B,137 cases,203 cycles).The basic clinical data,the treatment protocol and the pregnancy rate of IUI were analyzed.Results In 364 cycles of IUI,the ratio of natural cycle vs.ovulation induction cycle was not significantly different between the two groups(P>0.05).There were no differences in endometrial thickness on the day of human chorionic gonadotropin(hCG)injection,the follicle size before ovulation and the time gap between tube patency check to the date of IUI.The sperm motility and the total fast progressive sperms between the two groups were also not different(P>0.05).There was no difference in clinical pregnancy rate between group A(18.01%)and group B(16.26%)(P>0.05).Conclusion RT-3D-HyCoSy has many advantages as in real time,quickly and dynamically in tubal patency evaluation.It is also clear,safe,free of radiation and with high accuracy.RT-3D-HyCoSy is a safe and effective way in evaluating the tubal patency before IUI.