回顾性分析影响不明原因不孕患者行人工授精妊娠率的相关因素

Factors affecting pregnancy rate of artificial insemination in patients with unexplained infertility

目的探讨影响不明原因不孕(Unexplained infertility,UI)患者行宫腔内人工授精(Intrauterine insemination,IUI)临床结局的相关因素.方法回顾性分析2011年1月至2017年11月因UI到本中心行IUI的142例患者,共352周期.根据“原发、继发不孕”分成2组,比较两组临床妊娠率、生化妊娠率、多胎率、流产率、宫外孕发生率.再根据用药方案分为3组[组1:自然周期;组2:氯米芬+尿促性腺激素针(Human urnary gonadotropin,HMG);组3:单纯用HMG].比较上述妊娠结局指标.结果原发不孕患者自然流产率显著高于继发不孕患者(P<0.05);两组临床妊娠率、多胎率、宫外孕率、生化妊娠率差异无统计学意义(均P> 0.05).按用药方案分组,促排卵方案的妊娠率显著高于自然周期(P<0.05).促排卵方案中> 16mm的卵泡数均显著大于自然方案(均P<0.05).Gn用量方面,组3>组2>组1,三者间两两比较差异均有统计学意义(均P< 0.05).处理后前向运动精子,组2>组3>组1,组1与组2和组2与组3之间差异均有统计学意义(均P< 0.05).结论对于UI患者,原发不孕较继发不孕流产率高.建议使用促排卵方案,但是随着成熟卵泡数目(n>3)的增加,临床妊娠率并不会随之增加.女方年龄对UI夫妇临床妊娠有预测意义.

Objective To explore the factors that may affect the clinical outcomes of intrauterine insemination (IUI) in patients with unexplained infertility (UI).Methods The clinical data of 352 cycles of 142 UI patients undergoing IUI from January,2011 to November,2017 at our center were analyzed retrospectively.The patients were divided into a primary infertility group (P) and a secondary infertility group (S) according to the characteristics of infertility.The clinical pregnancy rate,biochemical pregnancy rate,multiple pregnancy rate,miscarriage rate,and ectopic pregnancy rate were compared between these two groups.According to the medication protocols,the patients were divided into group 1,taking natural protocol,group 2,taking clomiphene and human urinary gonadotropin (HMG),and group 3,taking HMG only;and the above pregnancy outcomes were compared among the 3 groups.Results The spontaneous pregnancy loss in group P was significantly higher than that in group S (P < 0.05);and there were no statistical differences in the clinical pregnancy rate,biochemical pregnancy rate,multiple pregnancy rate,and ectopic pregnancy rate between these two groups (all P > 0.05).The pregnancy rate and the number of over 16 mm folliculus were higher in the ovulation induction than in the natural protocol (P < 0.05).The dosage of Gn was higher in group 3 than in group 2 and than in group 1,with statistical differences (P < 0.05).After the treatment,the ratio of forward mobile sperm was higher in group 2 than in group 3 and than in group 1,with statistical differences between group 1 and group 2 and between group 2 and group 3 (P < 0.05).Conclusions The miscarriage rate of UI patients with primary infertility(PI) is higher than that of secondary infertility(SI).An ovulation-promoting regimen is recommended,but as the number of mature follicles increases(n > 3),the clinical pregnancy rate does not increase.As the women's age increases,the clinical pregnancy rate drops.