子宫腔内人工授精成功率的精子参数影响因素的研究

Impact of sperm parameters on the outcome of intrauterine insemination cycles

目的探讨精液浓度、活力、前向运动精子总数和精子形态等参数对子宫腔内人工授精(intrauterine insemination,IUI)临床妊娠率的影响。方法回顾性分析696个周期由于男性因素或不明原因行IUI治疗的临床资料,按精液检查阶段和行IUI当天优化处理前后对各精液参数进行分组,比较各组间临床妊娠率。结果优化处理前精液浓度达到30×10^6/mL时,IUI临床妊娠率高于<15.0×10^6/mL组和15.0×10^6~29.9×10^6/mL组(15.2%vs 6.1%,8.3%),P<0.05;精子活力在21%~30%时,行IUI后获得的临床妊娠率最好,高于11%~20%组和>30%组(21.6%vs 4.2%,12.6%),P<0.05;优化处理前、后的前向活动精子总数显著影响IUI的临床妊娠率,其阈值分别为10×10^6和5×10^6。不同检测者对精子形态评估的一致率为42.9%。精液检查阶段的各个参数如精子形态、精液总量、精液浓度、精子活力和前向运动精子总数与IUI临床妊娠率均无相关关系。多因素Logistic回归分析提示,优化处理前精液浓度、成熟卵泡数和子宫内膜厚度显著影响IUI妊娠率。结论优化处理前精液浓度、成熟卵泡数和子宫内膜厚度是影响IUI临床妊娠率的独立因素。而精液检查阶段各精液参数对IUI的成功率没有影响。精子形态检测结果可能受个人因素影响。

Objective To evaluate the sperm parameters in semen analysis and before/after preparation that can affect the clinical pregnancy rate after intrauterine insemination(IUI). Methods A single centre retrospective observational cohort study included 696 IUI cycles among couples in unexplained and male subfertility treated with gonadotrophins. Results The clinical pregnancy rate in women inseminated with 30 × 10^6/mL in the native semen was higher than those inseminated with<15.0 × 10^6/mL or15.0×10^6~29.9×10^6/mL(15.2% vs 6.1%, 8.3%, respectively)(P<0.05). When the motility in the native semen was 21%~30%, the clinical pregnancy rate after IUI was noted higher than those inseminated with semen motility of 11%~20% or>30%(21.6% vs 4.2%, 12.6%, respectively)(P<0.05). The clinical pregnancy rate was influenced by total motile spermatozoa count in the native semen(TMSC) and inseminating motile count after washing(IMC), with the cut-off value of 10 million and 5 million, respectively. And 42.9% of sperm was evaluated with the same result in its morphology by 4 andrologists. There were no strong correlations between sperm parameters at the time of semen analysis and clinical pregnancy rates after IUI. By multivariate logistic regression analysis three factors were identified to be associated significantly with clinical pregnancy rate: the sperm concentration in the native semen, the number of preovulatory follicles(≥18 mm), and the endometrial thickness. Conclusions The concentration in the native semen is significantly associated with the clinical pregnancy rate after IUI and is an independent factor to affect IUI outcome. Various sperm parameters in semen analysis are not correlated with IUI outcome.