供精人工授精多胎妊娠的多因素分析

Multivariate analysis of multiple pregnancies after artificial insemination with donor sperm

目的:探讨供精人工授精(AID)多胎妊娠的影响因素。方法:回顾性分析2011年1月-2020年12月在本所生殖中心治疗的6171个AID妊娠周期,对女性因素、供精精液质量以及周期相关因素与术后多胎妊娠结局进行分析。结果:优势卵泡数2个或≥3个组妇女多胎妊娠风险分别是1个优势卵泡组的6.467倍。枸橼酸氯米芬(CC)、促性腺激素(Gn)、枸橼酸他莫昔芬(TMX)和来曲唑(LE)组多胎妊娠风险分别是自然周期组的5.752倍、6.023倍、5.021倍和4.206倍。优势卵泡数≥3个且年龄<35岁组的妇女,采用LE促排,多胎率(5.6%)低于CC(19.2%)、Gn(18.7%)和TMX(29.5%);在≥35岁组12例多胎中,6例为Gn促排产生,占比最高;在FSH和hMG+FSH两种治疗方案中,启动剂量>75 U组的多胎率最高。结论:在AID中,治疗方案和优势卵泡数是影响多胎妊娠的重要因素。在AID治疗过程中,为了降低多胎率,对<35岁的妇女宜采用LE促排卵治疗;对≥35岁的妇女,Gn是造成多胎妊娠的重要因素,应适当降低启动剂量。

Objective:To analyze the influence factors of multiple pregnancies after artificial insemination with donor sperm(AID).Methods:A total of 6,171 pregnancy cycles of the women after AID from January 2011 to December 2020 were analyzed retrospectively.The relationship between the multiple pregnancies and the women's character,donor sperm quality,and cycle related factors was analyzed byX2 and generalized estimated linear equation.Results:The risk of multiple pregnancies of the women with 2 dominant follicles was 6.467 times of that of women with 1 dominant follicle,and the risk of multiple pregnancies of the women with≥3 dominant follicles was10.638 times of that of women with 1 dominant follicle.The risk of multiple pregnancies of the women after clomiphene(CC)treatment was 5.752 times of the women with natural cycle,that after gonadotropin(Gn)treatment was 6.023 times of the women with natural cycle,that after tamoxifen(TMX)treatment was 5.021 times of the women with natural cycle,and that after letrozole(LE)treatment was 4.206 times of the women with natural cycle.The multiple fetal rate(5.6%)of the women with≥dominant follicles and age<35 years old after ovulation induction by LE was significantly lower than that(19.2%)by CC,that(18.7%)by Gn,or that(29.5%)by TMX.Among 12 women with multiple pregnancies and≥35 years old,6 cases were given ovulation induction by Gn,accounting for the highest proportion.In the women were given FSH protocol or hMG combined with FSH protocol,the highest multiple pregnancise rates was observed in the women with Gn starting dose>75 IU.Conclusion:In AID,the treatment protocols and the numbers of dominant follicles of the women are the major factors of their multiple pregnancies.During AID,the women<35 years old should be given ovulation induction by LE to reduce their multiple pregnancies rate.For the women≥35 years old,Gn is an important factor to cause their multiple pregnancies,so the starting dose of Gn should be reduced appropriately.