不明原因不孕人群宫腔内夫精人工授精妊娠结局分析及预测模型构建

Reproductive outcomes of unexplained infertile couples following intrauterine insemination and construction of prediction models

目的探索真实临床世界中不明原因不孕夫妇宫腔内夫精人工授精(intrauterine insemination,IUI)妊娠结局的影响因子,构建妊娠结局的预测模型。方法回顾性分析本中心进行IUI的不明原因不孕夫妇(女方年龄<40岁且抗缪勒氏管激素(anti-Müllerian hormone,AMH)≥1.1 pg/mL)。研究主要终点是周期活产率,次要终点是周期临床妊娠率。采用logistic回归及受试者工作特征曲线构建妊娠结局预测模型。结果本研究纳入2601个不明原因不孕IUI周期,活产率组和非活产率组,以及临床妊娠组和非临床妊娠组的临床特征中,单因素分析显示,AMH水平(活产:OR=1.06,95%CI:1.02~1.11;临床妊娠:OR=1.05,95%CI:1.01~1.09)和是否促排卵(活产:OR=4.74,95%CI:3.48~6.46;临床妊娠:OR=4.35,95%CI:3.31~5.72)与妊娠结局有显著影响。是否促排卵周期+AMH联合预测活产率和临床妊娠率的AUC分别为:0.70(95%CI:0.66~0.74),0.68(95%CI:0.65~0.72)。结论联合是否促排卵周期和AMH水平能够较好地预测不明原因不孕夫妇IUI的周期活产率和周期临床妊娠率,高AMH结合促排卵治疗能帮助患者获得更好的妊娠结局。

Objective To investigate the influencing factors affecting the reproductive outcomes of unexplained infertile couples following intrauterine insemination(IUI),and construct prediction models of their reproductive outcomes.Methods The clinical data of the unexplained infertile couples((female,less than 40 years old)and the anti-Mullerian hormone(AMH)levels≥1.1 pg/mL)were retrospectively analysed The primary and secondary outcomes of this study were the live birth rate per cycle and the clinical pregnancy rate per cycle,respectively.The predictive models of live birth rate and clinical pregnancy rate were constructed using logistic regression,and their accuracies were determined by areas under the receiver operating characteristic curve(AUC).Results The study included 2601 cycles of IUI for unexplained infertile couples.Univariable regression analyses of the clinical data from the live birth group vs.non live birth group,and from clinical pregnancy group vs.non clinical pregnancy group found that,AMH levels(live birth:OR=1.06,95%CI:1.02~1.11,and clinical pregnancy,OR=1.05,95%CI:1.01~1.09)and ovarian stimulation(live birth:OR=4.74,95%CI:3.48~6.46,and clinical pregnancy,OR=4.35,95%CI:3.31~5.72)had significant impacts on the reproductive outcomes.Prediction models with AMH levels and ovulation stimulation could predict the live birth rate and clinical pregnancy rate per cycle with AUC at 0.70(95%CI:0.66~0.74)for the live birth and at 0.68(95%CI:0.65~0.72)for the clinical pregnancy.Conclusion Prediction models with ovulation stimulation and AMH levels can predict live birth rate and clinical pregnancy rate of unexplained infertile couples following IUI.Those with high AMH levels and the help of ovarian stimulation could end up with better reproductive outcomes.