16458个供精人工授精自然周期妊娠结局的多因素分析

Multivariate analysis of the clinical outcome of 16 458 natural artificial insemination cycles with donor sperm

目的探讨多种因素对自然周期供精人工授精(AID)妊娠结局的影响。方法回顾性分析2011年1月至2018年12月期间在广东省计划生育科学技术研究所生殖中心治疗的16458个自然周期,对女性因素、供精精液质量以及周期相关因素与术后妊娠结局进行χ2和广义估计方程多因素分析。结果女方年龄≤30岁(OR=1.865,P<0.001)、年龄31~35岁(OR=1.215,P<0.001)、不孕年限<5年(OR=1.139,P=0.007)、第3日促黄体生成素水平>8.10 IU/L(OR=1.309,P=0.022)、第3日雌激素水平≤77.10 pmol/L(OR=1.301,P=0.012)、第3日雌激素水平77.11~293.60 pmol/L(OR=1.099,P=0.044)、优势卵泡数1个(OR=1.473,P=0.038)、宫颈黏液评分≥10分(OR=1.256,P=0.026)、子宫内膜分型为A型(OR=1.114,P=0.005)、尿促黄体生成素强阳性(OR=1.171,P=0.002)、精子冻融复苏后活力>54%(OR=1.142,P=0.002)、精子冻融复苏后前向运动精子总数≥35×106(OR=1.217,P=0.001)以及每周期AID授精2次(OR=1.376,P=0.001)显著影响授精妇女的妊娠率。结论在自然周期AID中,女方年龄、不孕年限、第3日促黄体生成素水平、第3日雌激素水平、优势卵泡数、宫颈黏液评分、子宫内膜分型、尿促黄体生成素、精子冻融复苏后活力、精子冻融复苏后前向运动精子总数以及每周期授精次数影响女性的妊娠率。

Objective To analyze the effects of various factors on the clinical outcome of artificial insemination with donor sperm(AID)under natural cycles.Methods A total of 16458 natural cycles with donor sperm were analyzed from January 2011 to December 2018 in Reproductive Center of Guangdong Province Family Planning Science and Technology Research Institute.The relationship between the clinical outcome and the factors such as the women's character,donor sperm quality and cycle related factors withχ2 and multiple factor generalized estimating equation.Results Many factors such as women's age≤30 years(OR=1.865,P<0.001),the woman's age from 31 to 35 years(OR=1.215,P<0.001),duration of infertility≤5(OR=1.139,P=0.007),day 3 luteining hormone(LH)level>8.10 IU/L(OR=1.309,P=0.022),day 3 estrogen level≤77.10 pmol/L(OR=1.301,P=0.012),day 3 estrogen level from 77.11 pmol/L to 293.60 pmol/L(OR=1.099,P=0.044),one dominant follicle per cycle(OR=1.473,P=0.038),cervical mucus score≥10(OR=1.256,P=0.026),A type endometrium(OR=1.114,P=0.005),urinary LH strong positive(OR=1.171,P=0.002),sperm activity ratio more than 54%after thawing(OR=1.142,P=0.002),progressively motile sperm number≥35×106 after thawing(OR=1.217,P=0.001)and double inseminations per cycle(OR=1.376,P=0.001)significantly affected the pregnancy rates of AID women under natural cycles.Conclusion Many factors such as the woman's age,duration of infertility,day 3 LH level,day 3 estrogen level,dominant follicle number per cycle,cervical mucus score,endometrial type,sperm activity ratio after thawing,progressively motile sperm number and insemination times per cycle can affect the women’s pregnancy rate under AID natural cycles.