体质量指数对夫精人工授精妊娠结局的影响

Impact of body mass index on pregnancy outcomes in artificial insemination by husband

目的探讨不同体质量指数(BMI)患者使用来曲唑联合注射用尿促性素(HMG)诱导排卵宫腔内夫精人工授精(AIH)后妊娠结局的影响。方法对325例接受来曲唑联合HMG诱导排卵宫腔内AIH助孕的不孕患者的临床资料进行回顾性分析,根据BMI 25为分界,将患者分为肥胖组(BMI≥25,n=133)和对照组(BMI<25,n=192),比较患者的年龄、不孕时间、基础性激素水平、窦卵泡数(AFC)、促性腺素(Gn)天数、Gn总量及妊娠结局,评估在诱导排卵周期AIH中BMI与助孕结局的关系。肥胖是多囊卵巢综合征(PCOS)患者的一个重要特征,肥胖组包括PCOS患者68例和非PCOS患者65例,对照组包括PCOS患者83例和非PCOS患者109例,分析PCOS患者对不同BMI引起的助孕结局的影响。结果①肥胖组在诱导排卵AIH周期中Gn的总量和天数均高于对照组(P<0.05);②肥胖组生化妊娠率低于对照组(23.3%vs 29.2%,P=0.242),调整泌乳素(PRL)及是否PCOS后,差异仍无统计学意义(OR=0.671,95%CI:0.399~1.13);③肥胖组临床妊娠率低于对照组(17.3%vs 26.6%,P=0.052),调整PRL及是否PCOS后,差异有统计学意义(OR=0.528,95%CI:0.301~0.928);④肥胖组活产率低于对照组(10.5%vs 24.5%,P=0.002),调整PRL及是否PCOS后,差异有统计学意义(OR=0.331,95%CI:0.172~0.637);⑤肥胖组流产率高于对照组(12.8%vs 4.7%,P=0.011),调整PRL及是否PCOS后,差异有统计学意义(OR=2.82,95%CI:1.2~6.627)。结论在来曲唑联合HMG诱导排卵宫腔内AIH中,超过正常BMI的肥胖患者比非肥胖患者活产率低。不论是否PCOS患者,异常BMI者均应该通过合理膳食、体育运动、药物治疗等方式降低BMI,可以提高妊娠率。

Objective To explore the impact of body mass index(BMI) on pregnancy outcomes of artificial insemination by husband(AIH) in letrozole plus human menopausal gonadotropin(HMG) ovulation cycle. Methods The clinical data of 325 patients who received AIH with letrozole plus HMG ovulation cycle were retrospectively analyzed. According to BMI, the patients were divided into obese group(BMI≥25 kg/m^2, n=133) and control group(BMI<25 kg/m^2, n=192). The clinical baseline parameters and pregnancy outcomes of the two groups were compared, including age, infertility time, basal hormones, antral follicol count(AFC), days and dosage of gonadotropin(Gn), and pregnancy outcomes. In the obese group, 68 patients had polycystic ovary syndrome(PCOS)and 65 had not, while in the control group, 83 had PCOS and 109 had not. The correlation between PCOS and pregnancy outcomes was analyzed. Results The obese group had longer days and higher dosage of Gn than the control group(P<0.05), but lower biochemical pregnancy rate(23.3% vs 29.2%,P=0.242), and there was no significant difference after prolactin(PRL) and PCOS were adjusted(OR=0.671, 95%CI:0.399-1.13). The obese group had lower clinical pregnancy rate than the control group(17.3% vs 26.6%, P=0.052), but there was significant difference after PRL and PCOS were adjusted(OR=0.528, 95%CI:0.301-0.928). The obese group had lower live birth rate than the control group(10.5% vs 24.5%, P=0.002), and there was significant difference after PRL and PCOS were adjusted(OR=0.331, 95%CI:0.172-0.637). The obese group had higher abortion rate than the control group(12.8% vs 4.7%, P=0.011), and there was significant difference after PRL and PCOS were adjusted(OR=2.82, 95%CI:1.2-6.627). Conclusion In AIH with letrozole plus HMG ovulation cycle, obese patients may acquire lower live birth rate than non-obese patients. Obese women with or without PCOS should control BMI by means of diet, sports or drug treatment to improve pregnancy rate.