自然周期卵泡和子宫内膜发育及供精人工授精结局的影响因素

Influencing factors of follicular and endometrial development and outcome of artificial insemination with donor sperm in natural cycle

目的探讨自然月经周期卵泡、子宫内膜的发育特点和影响因素以及自然周期供精人工授精(AID)结局的影响因素。方法回顾性分析2012年1月至2018年12月于我中心接受AID助孕的1200例妇女(共2555个自然周期)的超声监测资料及AID临床资料,按不同因素(年龄、BMI、排卵时间、优势卵泡个数、是否扳机及宫内妊娠情况)进行分组,比较各组卵泡和子宫内膜发育情况,利用相关分析及多元线性回归分析探索卵泡和子宫内膜发育的影响因素,利用Logistic回归分析寻找自然周期AID助孕后宫内妊娠的预测因子。结果排卵时间与年龄呈线性负相关(B=-0.111,P=8.87E-9),与体重指数(BMI)呈线性正相关(B=0.050,P=0.028);排卵前最大优势卵泡直径与排卵时间呈线性负相关(B=-0.026,P=0.001),发育两枚优势卵泡者最大卵泡直径较单枚优势卵泡大0.443 mm,差异有统计学意义(P<0.05);排卵日子宫内膜厚度与年龄呈线性负相关(B=-0.037,P=0.002),与BMI(B=0.050,P=2.41E-4)、排卵时间(B=0.098,P=2.02E-16)、最大优势卵泡直径(B=0.074,P=0.014)均呈线性正相关。排卵日子宫内膜厚度(OR=1.058,P=0.019)、女方年龄(OR=0.966,P=0.020)、治疗周期数(OR=0.891,P=0.037)显著影响自然周期AID宫内妊娠率。结论年龄和BMI都影响卵泡和子宫内膜发育,排卵日子宫内膜厚度、年龄及治疗周期数是自然周期AID助孕后宫内妊娠的显著预测因子。

Objective:To investigate the influential factors of follicular and endometrial development and clinical outcome of artificial insemination with donor sperm(AID)in natural cycle.Methods:The ultrasonic monitoring data and AID outcome of 2555 AID nature cycles in 1200 couples from January 2012 to December 2018 were retrospectively analyzed.The cycles were grouped according to the different factors including age,body mass index(BMI),ovulation time,number of dominant follicles,trigger or not.The follicular and endometrial developments were compared,correlation analysis and multivariate linear regression analysis were used to explore the influential factors of follicular and endometrial development,and logistic regression analysis was used to find the predictors of intrauterine pregnancy after AID in natural cycle.Results:Ovulation time was negatively correlated with women’s age(B=-0.111,P=8.87E-9),and positively correlated with BMI(B=0.050,P=0.028).Preovulation maximum dominant follicle diameter(PMDFD)was negatively correlated with ovulation time(B=-0.026,P=0.001).The maximum follicular diameter of the two dominant follicles was 0.443 mm larger than that of the single one,the difference was significant(P<0.05).Endometrial thickness on ovulation day was negatively correlated with age(B=-0.037,P=0.002),but was positively correlated with BMI(B=0.050,P=2.41E-4),ovulation time(B=0.098,P=2.02E-16)and maximum dominant follicular diameter(B=0.074,P=0.014).Endometrial thickness(OR=1.058,P=0.019),age(OR=0.966,P=0.020),number of treatment cycles(OR=0.891,P=0.037)significantly affected the intrauterine pregnancy rate of AID in natural cycle.Conclusions:Women’s age and BMI both significantly affect the development of follicles and endometrium.Endometrial thickness on ovulation day,women’s age and the number of AID cycles are significant predictors for intrauterine pregnancy after NC-AID.