输卵管因素对宫腔内人工授精治疗妊娠结局的影响

Impact of tubal factors on the pregnancy outcomes of intrauterine insemination

目的研究输卵管因素对宫腔内人工授精(intrauterine insemination,IUI)治疗妊娠结局是否存在影响,为不同输卵管通畅情况的不孕症患者选择辅助生育方式提供参考依据。方法回顾性分析2018年1月至2018年12月于本我院生殖医学中心通过子宫输卵管超声造影(hysterosalpingo-contrast sonography,HyCoSy)检查输卵管通畅性,并在检查后接受IUI治疗的不孕症患者372例,680个IUI治疗周期。比较不同输卵管检查结果的患者IUI治疗的妊娠率,并通过多因素分析进一步分析输卵管因素与IUI治疗妊娠结局的关系,以及IUI治疗妊娠结局的影响因素。结果HyCoSy输卵管检查结果为一侧通畅一侧阻塞、一侧通畅一侧通而不畅或双侧均通而不畅的患者与双侧均通畅的四组患者,IUI治疗平均每周期临床妊娠率(8.8%,12.9%,13.6%vs 10.1%)及3个周期累积临床妊娠率(17.4%,24.6%,30.0%vs 28.9%)比较,差异均无统计学意义(P>0.05)。多因素分析显示,女方年龄与IUI治疗妊娠结局相关(P<0.05),而输卵管因素与IUI治疗妊娠结局无关(P>0.05)。结论输卵管因素不是IUI治疗妊娠结局的主要影响因素。仅单侧输卵管通畅或双侧输卵管通而不畅的患者平均每周期及累积IUI治疗妊娠结局与双侧输卵管通畅者相似,因此年轻的单侧输卵管通畅或双侧输卵管通而不畅的不孕症患者可首选进行3个周期IUI治疗。

Objective To investigate whether tubal factor is a predictor of pregnancy outcome after intrauterine insemination(IUI),so as to provide reference for assisted reproductive treatment of infertile patients with different degrees of tubal abnormality.Methods 372 infertile patients who underwent hysterosalpingo-contrast sonography(HyCoSy)from January 2018 to December 2018 before IUI treatment(680 IUI cycles)subsequently were retrospectively analyzed.Pregnancy rate after IUI treatment were compared among the patients with different tubal test findings.The relationship between tubal factors and pregnancy outcome after IUI,and prognostic factors of pregnancy outcome after IUI were assessed by multivariate analysis.Results No statistically significant difference was found in the clinical pregnancy rate(8.8%,12.9%,13.6%vs 10.1%)per IUI cycle,and clinical pregnancy rate after 3 IUI cycles(17.4%,24.6%,30.0%vs 28.9%)between patients with one patent tube and another blocked tube,or with one patent tube and another less-patent tube,or with bilateral less-patent tubes and patients with bilateral patent tubes(P>0.05).Multivariate analysis showed that female age was significantly correlated to pregnancy outcomes of IUI,while tubal factors were not associated with pregnancy outcomes of IUI.Conclusion Tubal factors were not prognostic factors of pregnancy outcome after IUI treatment.Patients with unilateral patent tube or bilateral less-patent tubes have per-cycle and cumulative pregnancy outcomes after IUI treatment similar to those with bilateral patent tubes.Thus,3 cycles of IUI may be considered as the first-line treatment option for those younger infertile patients with unilateral patent tube or bilateral less-patent tubes.