1907个夫精人工授精周期妊娠结局的女方影响因素分析

Analysis of female influencing factors of pregnancy outcome in 1907 artificial insemination by husband cycles

目的通过回顾性分析1907个夫精人工授精(artificial insemination by husband,AIH)周期,明确影响AIH成功率的关键因素,从而指导临床实践。方法回顾性分析2014年1月至2019年10月于福建省妇幼保健院行AIH的819对夫妇,采用COOK导管行宫腔内人工授精,共进行1907个周期。分析女方的年龄、不孕年限、优势卵泡直径、授精周期数、AIH指征、助孕方式、AIH日内膜厚度、AIH次数对妊娠结局的影响。结果女方平均年龄(31.07±4.04)岁,平均不孕年限(3.83±2.31)年,共181例妊娠,妊娠率9.49%,活产122例,活产率6.40%。因子宫内膜异位症行AIH者,其妊娠率、活产率均显著低于因其他因素行AIH者(P<0.05)。促排卵周期妊娠率显著高于自然周期(P=0.04)。同一周期AIH 2次的妊娠率显著高于AIH 1次(P=0.02)。多因素Logistic回归分析结果显示,子宫内膜异位症是影响AIH活产率的主要危险因素(P<0.05)。结论子宫内膜异位症合并不孕者不建议采用AIH作为首选助孕方式;药物诱导排卵可提高AIH妊娠率;授精24h后未排卵者,再次授精可提高妊娠率。

Objective A retrospective analysis of 1907 artificial insemination by husband(AIH)cycles was conducted in order to identify the key factors affecting the success rate of AIH,so as to guide clinical practice.Methods A total of 819 couples who underwent AIH in Fujian Provincial Maternity and Children’s Hospital from January 2014 to October 2019 were retrospectively analyzed,and a total of 1907 cycles were performed.COOK catheter was used for intrauterine insemination.The effects of female age,infertility years,dominant follicle diameter,number of insemination cycles,AIH indication,methods of pregnancy assistance,AIH intimal thickness and AIH frequency on pregnancy outcome were analyzed.Results The average age of the woman was(31.07±4.04)years old,and the average length of infertility was(3.83±2.31)years.There were 181 pregnancies,the pregnancy rate was 9.49%.A total of 122 live births,with a live birth rate of 6.40%.The pregnancy rate and live birth rate of AIH due to endometriosis were lower than those due to non-endometriosis(P<0.05).The pregnancy rate of ovulation induction cycle was significantly higher than that of natural cycle(P=0.04).The pregnancy rate of double AIH in the same cycle was higher than that of once(P=0.02).The results of multivariate Logistic regression analysis showed that endometriosis was the main risk factor of AIH live birth rate(P<0.05).Conclusion AIH is not recommended as the first method of assisted fertility for patients with endometriosis.Drug-induced ovulation can increase the AIH pregnancy rate.For those who have not ovulated after 24 hours of insemination,re-insemination can increase the pregnancy rate.