子宫内膜厚度对宫腔内人工授精活产率的影响

The effect of endometrial thickness on live birth rates in intrauterine insemination

目的探讨宫腔内人工授精(IUI)助孕时子宫内膜厚度与活产率的关系。方法回顾性分析2014年1月1日至2021年12月31日期间在西北妇女儿童医院生殖中心接受夫精宫腔内人工授精(AIH-IUI)且符合纳入标准的不孕症患者进行的8739个助孕周期。根据进行IUI治疗后不孕症患者是否活产将其分为活产组(1239例)与非活产组(7500例)。根据人工授精助孕周期中排卵前最后一次B超时测量的子宫内膜厚度,将不孕症患者分为五组:3~6mm组(106例)、7~9mm组(3011例)、10~12mm组(4420例)、13~15mm组(1103例)、≥16mm组(99例)。比较各组间早期流产率、临床妊娠率、活产率的差异;在调整女性不孕症患者年龄及治疗方案对IUI活产率的影响后,采用多因素Logistic回归分析子宫内膜厚度对IUI活产率的影响。结果①患者子宫内膜厚度从3mm至≥16mm时,IUI助孕均有妊娠发生。②患者子宫内膜厚度为7~15mm时(7~9mm组、10~12mm组、13~15mm组),IUI临床妊娠率均高于子宫内膜厚度为3~6mm组和≥16mm组,但差异无统计学意义(χ^(2)=8.475,P=0.750);子宫内膜厚度为7~15mm时(7~9mm组、10~12mm组、13~15mm组),IUI活产率均高于子宫内膜厚度为3~6mm组和≥16mm组,但差异无统计学意义(χ^(2)=7.822,P=0.098)。③多因素Logistic回归分析显示,与子宫内膜厚度为3~6mm相比,患者子宫内膜厚度为7~9mm、10~12mm、13~15mm、≥16mm的IUI活产率分别是3~6mm的2.0倍(OR=2.048,95%CI:0.982~4.271)、1.8倍(OR=1.808,95%CI:0.855~3.826)、1.8倍(OR=1.820,95%CI:0.824~4.021)、1.0倍(OR=1.007,95%CI:0.345~3.208),但活产率的增加并未达到统计学上的显著性(P>0.05)。结论薄型子宫内膜(<7mm)或者子宫内膜过厚(≥16mm)时较正常子宫内膜厚度的IUI活产率降低,但无显著性差异。不同子宫内膜厚度均有活产发生,子宫内膜厚度3~6mm并不是取消IUI助孕的指标。

Objective To study the association between endometrial thickness and live birth rates in intrauterine insemination(IUI)assisted pregnancy.Methods A retrospective analysis was conducted on 8739 assisted reproductive cycles performed on infertile patients who received artificial insemination by husband-intrauterine insemination(AIH-IUI)and met the inclusion criteria at the Reproductive Center of Northwest Women s and Children s Hospital from January 1,2014,to December 31,2021.Infertility patients were categorized into a live birth group(1239 cases)and a non-live birth group(7500 cases)based on whether they had a live birth following IUI treatment.Patients were categorized into five groups according to endometrial thickness measured during the last ultrasound before ovulation in the assisted reproductive cycles:3-6mm group(106 cases),7-9mm group(3011 cases),10-12mm group(4420 cases),13-15mm group(1103 cases),≥16mm group(99 cases).The differences in early miscarriage rates,clinical pregnancy rates,and live birth rates among the five groups were compared.Multivariate logistic regression analysis was used to investigate the effect of endometrial thickness on IUI live birth rates after adjusting for the effects of female age and treatment regimen on IUI live birth rates.Results①Pregnancy occurred in IUI assisted conception in patients when the endometrial thickness ranged from 3mm to≥16mm.②When the endometrial thickness was 7-15mm(7-9mm group,10-12mm group,13-15mm group),the clinical pregnancy rates in IUI were higher than those in the 3-6mm group and≥16mm group,but the difference was not statistically significant(χ^(2)=8.475,P=0.750).When the endometrial thickness was 7-15mm(7-9mm group,10-12mm group,13-15mm group),the live birth rates in IUI were higher than those in the 3-6mm group and≥16mm group,but the difference was not statistically significant(χ^(2)=7.822,P=0.098).③Multifactorial logistic regression analysis showed that compared with an endometrial thickness of 3-6mm,the live birth rates in IUI for patients with an endometrial thickness of 7-9mm,10-12mm,13-15mm,and≥16mm were 2.0 times(OR=2.048,95%CI:0.982-4.271),1.8 times(OR=1.808,95%CI:0.855-3.826),1.8 times(OR=1.820,95%CI:0.824-4.021),and 1.0 times(OR=1.007,95%CI:0.345-3.208),that of the 3-6mm group,respectively.However,the increase in live birth rates did not reach statistical significance(P>0.05).Conclusion The IUI live birth rates were lower when the endometrium is thin(<7mm)or excessively thick(≥16mm)compared to normal endometrial thickness,but the difference was not statistically significant.Live births occurred across various endometrial thicknesses,and an endometrial thickness of 3-6mm is not an indicator to cancel IUI-assisted conception.