女性超重对宫腔内夫精人工授精妊娠结局的影响

The effect of female overweight on the pregnancy outcome of intrauterineartificial insemination by husband

目的探讨女性超重对宫腔内夫精人工授精(artificial insemination by husband,AIH)妊娠结局的影响。方法回顾性分析2015年3月至2020年12月深圳市人民医院生殖医学中心年龄<40岁,因不明原因不孕或男性因素不孕行AIH治疗的1389个周期775例患者的临床资料,根据女方体质量指数(body mass index,BMI)值(WHO标准)分为3组:偏瘦组(BMI<18.5 kg/m^(2))184个周期、正常组(18.5 kg/m^(2)≤BMI≤24.99 kg/m^(2))1056个周期、超重组(25.0 kg/m^(2)≤BMI≤29.99 kg/m^(2))149个周期,再根据促排卵方案将3组分为自然周期和促排卵周期两个亚组。比较3组患者的临床妊娠率、活产率。结果①单因素分析结果显示超重组临床妊娠率和活产率(24.1%,19.4%)显著高于偏瘦组(11.9%,10.3%)和正常组(14.8%,11.9%)(P均<0.05);超重组促排卵周期临床妊娠率(27.4%)显著高于偏瘦组(12.6%)和正常组(16.8%)(P均<0.05),活产率(22.0%)高于偏瘦组(11.6%)和正常组(14.2%),但差异无统计学意义(P均>0.05);超重组自然周期临床妊娠率和活产率(18.9%,15.5%)高于偏瘦组(11.2%,8.9%)和正常组(12.1%,8.7%),但差异均无统计学意义(P均>0.05)②排除混杂因素:女方因素(年龄、不孕年限、不孕因素、促排卵方案)、男方因素[处理后前向活动精子总数(total progressive motile sperm count,TPMSC)],多因素Logistic回归分析结果显示:校准后女方超重组AIH临床妊娠率、活产率显著高于正常组(P均<0.05)。③以分类变量女方年龄(<40岁)、BMI、不孕因素、促排卵方案,连续变量不孕年限、处理后TPMSC为自变量,活产率为因变量的广义估计方程结果显示,女方超重组活产率显著高于正常组(P=0.017,OR=1.741);女方促排卵周期活产率显著高于自然周期(P=0.002,OR=1.735)。结论对由于不明原因不孕或男性因素不孕的女性超重患者,超重并未降低其AIH临床妊娠率和活产率,同时超重患者促排卵方案能获得更高的临床妊娠率和活产率,这有助于减轻患者减肥的心理压力,指导AIH助孕咨询和治疗。

Objective To explore the impact of women overweight on pregnancy outcome of intrauterine artificial insemination by husband(AIH)treatment.Methods Retrospective analysis on the data of 1389 AIH cycles of 775 cases who were younger than 40 years of age with infertility due to unknown causes or male factors received treatment in Reproductive Medicine Center of Shenzhen People's Hospital from March 2015 to December 2020.The cycles were divided into three groups according to female body mass index(BMI)(WHO standard):The underweight group(BMI<18.5 kg/m^(2))with 184 cycles,the normal BMI group(18.5 kg/m^(2)≤BMI≤24.99 kg/m^(2))with 1056 cycles,and the overweight group(25.0 kg/m^(2)≤BMI≤29.99 kg/m^(2))with 149 cycles.According to the types of ovulation induction,the three groups were divided into natural cycles and ovulation induction cycles.Clinical pregnancy rates and live birth rates across the three groups of women were compared.Results①Univariate analysis showed that the clinical pregnancy rates and live birth rates of the overweight group(24.1%,19.4%)were higher than that of the underweight group(11.9%,10.3%)and normal BMI group(14.8%,11.9%)(all P<0.05);the clinical pregnancy rate of the overweight group ovulation induction cycles(27.4%)was significantly higher than that of the underweight group(12.6%)and normal weight group(16.8%)(all P<0.05),the live birth rate(22.0%)was also higher than that of the underweight group(11.6%)and normal BMI group(14.2%),but there was no statistical difference(all P>0.05);the natural cycle clinical pregnancy rates and live birth rates(18.9%,15.5%)of the overweight group were higher than that of the underweight group(11.2%,8.9%)and normal BMI group(12.1%,8.7%),but there was no significant difference(all P>0.05).②Excluding confounding factors:female factors(age,years of infertility,infertility factors,types of ovulation induction),male factors[(total progressive motile sperm count,TPMSC)after treatment],the results of multivariate logistic regression analysis showed that after calibration,the AIH clinical pregnancy rate and live birth rate of women with overweight were significantly higher than those with normal weight(all P<0.05).③The results of the generalized estimating equation with categorical variables female age(<40 years old),BMI,infertility factors,ovulation induction,continuous variables infertility years,TPMSC after treatment as independent variables,and live birth rate as dependent variables show that,the live birth rate of the overweight group was significantly higher than that of the normal BMI group(P=0.017,OR=1.741)and live birth rate of ovulation induction cycle was significantly higher than that of natural cycle(P=0.002,OR=1.735).Conclusion For overweight female patients with infertility due to unknown causes or male factors,overweight did not reduce the clinical pregnancy rate and live birth rate of AIH.Meanwhile,ovulation induction cycles for overweight patients could achieve higher live birth rate which could help relieve the psychological pressure of the patients to loss weight and guide the counseling and treatment of AIH.