多因素对宫腔内供精人工授精临床妊娠率的影响分析

Multiple factors influencing clinical pregnancy rate of intrauterine insemination

目的:探究多种因素与宫腔内供精人工授精(AID-IUI)临床妊娠率的相关性,寻求进一步提高中心妊娠率的方法。方法:回顾性分析本中心2015年1月至2022年12月257对夫妇在本中心行AID-IUI的440个治疗周期,按女方年龄分为<30岁、30~35岁、>35岁三组;按女方体重指数(BMI)分为<18.5、18.5~24、24~28、≥28四组;输卵管分为单侧通畅和双侧通畅两组;按治疗方案分为自然周期组和促排周期组;处理后前向运动精子总数(PTMS)分为(10~30)×106、(30~40)×106、≥40×106三组;按精液处理后孵育时间分为0~10min、10~40min、≥40min三组;分别对各因素进行单因素和多因素回归分析。结果:女方年龄<30岁、30~35岁、>35岁三组临床妊娠率分别是33.62%、27.11%、26.19%(P>0.05)。单侧输卵管通畅组临床妊娠率33.7%高于双侧输卵管通畅组的29.6%(P>0.05)。促排周期组临床妊娠率32.16%高于自然周期组的27.39%(P>0.05)。体重指数(BMI):<18.5、18.5~24、24~28、≥28四组临床妊娠率分别为35.48%、31.27%、30.26%、15.38%(P>0.05)。PTMS各组临床妊娠率差异无统计学意义(P>0.05)。精液处理后孵育时间10~40min组妊娠率33.82%高于0~10min组的23.53%和≥40min组的28.57%(P>0.05)。Logistic回归分析BMI是AID-IUI临床妊娠率的重要影响因素。结论:建议行AID-IUI治疗的女方将BMI控制在28以内有利于提高临床妊娠率;无论输精1次或2次只要PTMS超过10×106即可获得良好的成功率;人工授精妊娠结局一定程度上受到精液优化处理后孵育时间影响,提倡优化处理后孵育时间10~40min内进行手术,利于提高妊娠率。

Objective:To explore the correlation between multiple factors and clinical pregnancy rate of intrauterine insemination(AID-IUI),and to seek a method to further improve the central pregnancy rate.Methods:A total of 440 cycles of AID-IUI were performed in 257 couples from 2014 to December 2022 in our center.The women were divided into three groups according to their age:<30,30~35,>35;according to their body mass index(BMI):<18.5,18.5~24,24~28,≥28;The patients were divided into natural cycle group and ovulation promoting cycle group,and the total number of sperm with forward motion after treatment(PTMS)were divided into(10~30)×106,(30~40)×106,≥40×106 groups According to the incubation time after semen treatment,the rats were divided into three groups:0~10 min,10~40 min,≥40 min;Single factor and multi-factor regression analysis were carried out for each factor.Results:The clinical pregnancy rates of the women aged<30,30~35 and>35 were 33.62%,27.11%and 26.19%respectively(P>0.05).The clinical pregnancy rate was 33.7%in the unobstructed group and 29.6%in the unobstructed group(P>0.05).The clinical pregnancy rate(32.16%)in the ovulation-promoting group was higher than that(27.39%)in the natural group(P>0.05).Body mass index(BMI):<18.5,18.5~24,24~28 and≥28 were 35.48%,31.27%,30.26%and 15.38%respectively(P>0.05).There was no significant difference in clinical pregnancy rate among PTMS groups(P>0.05).The pregnancy rate was 33.82%in the group of 10~40 min after semen treatment,higher than 23.53%in the group of 0~10 min and 28.57%in the group of≥40 min(P>0.05).Logistic regression analysis showed that BMI was an important factor influencing clinical pregnancy rate in AID-IUI.Conclusion:It is suggested that the BMI of women treated with AID-IUI should be controlled within 28 to improve the clinical pregnancy rate;A good success rate could be achieved with a PTMS of more than 10×106,regardless of whether the sperm was inseminated once or twice;The pregnancy outcome of artificial insemination is affected by the incubation time after sperm optimal treatment to some extent.The operation within 10~40 minutes after sperm optimal treatment is advocated to improve pregnancy rate.