不同治疗方案对卵巢储备功能正常年轻女性夫精人工授精妊娠结局的影响

Effect of different treatment protocols on pregnancy outcomes of AIH in young women with normal ovarian reserve function

目的探讨不同治疗方案对年龄<35岁卵巢储备功能正常女性夫精人工授精(AIH)妊娠结局的影响。方法回顾性分析2015年1月至2021年8月在本中心行AIH助孕的年龄<35岁卵巢储备功能正常女性的3024个周期的临床资料。根据治疗方案分为6组:自然周期组(NC组,n=380)、克罗米芬组(CC组,n=57)、CC联合促性腺激素(Gn)组(CC+Gn组,n=78)、Gn组(n=1712)、来曲唑组(LE组,n=430)以及LE联合Gn(LE+Gn组,n=367),比较各组患者的一般情况和妊娠结局,并采用多因素Logistic回归分析影响AIH临床妊娠率及活产率的相关因素。结果一般情况比较:6组间体质量指数(BMI)、窦卵泡数(AFC)、基础卵泡刺激素(FSH)水平、优势卵泡数、不孕因素整体比较有统计学差异(P<0.05),而女方年龄、不孕年限、不孕类型及精液处理方式比较均无统计学差异(P>0.05)。妊娠结局比较:6组患者间临床妊娠率和活产率整体比较有统计学差异(P<0.05),其中LE+Gn组的临床妊娠率和活产率显著高于NC组(分别为20.7%vs.9.5%;16.3%vs.7.4%)(P<0.05);6组间流产率、异位妊娠率及多胎率比较无统计学差异(P>0.05)。多因素Logistic回归分析结果显示,矫正混杂因素后,LE+Gn治疗方案和优势卵泡数均是临床妊娠和活产的保护因素(OR>1,P<0.05),而不孕年限是临床妊娠和活产的危险因素(OR<1,P<0.05)。结论LE联合Gn方案可显著提高AIH的临床妊娠率和活产率,可作为年龄<35岁卵巢储备功能正常女性AIH助孕的首选治疗方案。

Objective:To investigate the effect of different treatment protocols on pregnancy outcomes of artificial insemination with husband sperm(AIH)in the women under 35 years old with normal ovarian reserve function.Methods:The clinical data of 3024 AIH cycles in women under 35 years old with normal ovarian reserve function in our center from January 2015 to August 2021 were analyzed in this retrospective study.According to the treatment protocols,the patients were divided into 6 groups:natural cycle group(NC,n=380),clomiphene group(CC,n=57),CC combined with Gn group(CC+Gn,n=78),gonadotropin group(Gn,n=1712),letrozole group(LE,n=430),and LE combined with Gn group(LE+Gn,n=367).The patients’general characteristics and pregnancy outcomes in each group were compared,and multivariate logistic regression was used to analyze the relevant factors that affect the clinical pregnancy rate and live birth rate of AIH.Results:In general comparison,there were significant differences in the number of cycles,body mass index(BMI),antral follicle count(AFC),basic FSH level,dominant follicle number and infertility factors among 6 groups(P<0.05),but there were no significant differences in the woman’s age,infertility years,infertility types and semen processing methods(P>0.05).There were significant differences in clinical pregnancy rate and live birth rate among 6 groups(P<0.05).The clinical pregnancy rate(20.7%vs.9.5%)and live birth rate(16.3%vs.7.4%)in the LE+Gn group were significantly higher than those in NC group(P<0.05).There were no significant differences in abortion rate,ectopic pregnancy rate and multiple birth rate among 6 groups(P>0.05).After adjusting confounding factors,multivariate logistic regression showed that LE combined with Gn protocol and dominant follicle number were all protective factors for clinical pregnancy and live birth(OR>1,P<0.05),whereas infertility duration was a risk factor for clinical pregnancy and live birth(OR<1,P<0.05).Conclusions:LE combined with Gn protocol significantly improves the clinical pregnancy rate and live birth rate of AIH,and it can be used as preferred protocol for AIH in the women under 35 years old with normal ovarian reserve function.