自然周期与促排卵周期及授精次数对宫腔内夫精人工授精临床结局的影响

The clinic outcomes of intrauterine artifi cial insemination(AIH) of natural and stimulate ovulation cycles and the different cycle numbers of insemination

目的分析自然周期与促排卵周期及授精次数对宫腔内夫精人工授精(AIH)临床结局的影响,为临床治疗策略提供指导意见。方法回顾性分析本中心2016年1月至2018年6月行AIH治疗的332周期,根据是否促排卵分为:自然周期组86周期(取消8周期),促排卵周期组246周期(取消1周期),分析比较两组患者的一般资料特征及临床妊娠结局;剔除取消9周期后,将323有效治疗周期根据单一周期内的授精次数分为:单次授精组227周期(排卵前行AIH)双次授精组96周期(排卵前后各行一次AIH),分析比较两组患者的一般资料特征及临床妊娠结局。结果 1.将323个有效治疗周期分为妊娠组和非妊娠组,两组中女方平均年龄,不孕年限,原发与继发不孕占比,自然与促排卵周期占比,男性因素占比,单双次AIH占比差异无统计学意义。2.自然周期和促排卵周期组两组比较分析,女方平均年龄,不孕年限,原发与继发不孕占比,男性因素占比,临床妊娠率,自然流产率,异位妊娠率差异无统计学意义。3.单次AIH组和双次AIH组比较分析,女性平均年龄,不孕年限,原发与继发不孕占比,男性因素占比,临床妊娠率,自然流产率,异位妊娠率差异无统计学意义。结论自然周期与促排卵周期对AIH临床妊娠结局影响无差异,其临床妊娠率、流产率、异位妊娠率相似;同一周期单次和双次AIH其临床妊娠结局无差异。故促排卵治疗及双次AIH不能改善AIH的临床妊娠结局,临床治疗中不应盲目过度治疗,增加患者经济负担的同时也浪费医疗资源。

Objective:To analyze the clinic outcomes of intrauterine artificial insemination(AIH) of natural and stimulate ovulation cycles and the different cycle numbers of insemination and provide guidance for clinical treatment strategies.Methods:A retrospective analysis was performed on the 332 cycles of AIH treatment performed by the center from January 2016 to June 2018.The subjects were divided into natural cycle group(86 cycles(cancel 8 cycles)and simulation cycle group(246 cycles(cancel 1 cycle)according to whether stimulating ovulation was performed,and the general data characteristics and clinical pregnancy outcomes of the two groups were analyzed and compared.After eliminating 9 cycles,the effective treatment cycle of 323 was divided into two groups according to the number of insemination within a single cycle:single insemination group 227 cycles and double insemination group 96 cycles,and the general data characteristics and clinical pregnancy outcomes of the two groups were analyzed and compared.Results:1.The 323 effective treatment cycles were divided into pregnancy group and non-pregnancy group.In the two groups,the average age of the woman,the infertility years,the proportion of primary and secondary infertility,the proportion of natural and ovulatory cycles,the proportion of male factors,and the difference of the ratio of single and double AIH were not statistically significant.2.Comparison and analysis of natural cycle and ovulation induction cycle between the two groups showed that there was no statistically significant difference in the average age of the woman,the years of infertility,the proportion of primary and secondary infertility,the proportion of male factors,clinical pregnancy rate,natural abortion rate,and ectopic pregnancy rate.3.Comparison and analysis between single and double AIH groups showed that there was no statistically significant difference in average age of women,infertility years,ratio of primary and secondary infertility,ratio of male factors,clinical pregnancy rate,natural abortion rate and ectopic pregnancy rate.Conclusion:There was no difference in the effect of natural cycle and ovulation induction cycle on the clinical pregnancy outcome of AIH,and the clinical pregnancy rate,abortion rate and ectopic pregnancy rate were similar.There was no difference in clinical pregnancy outcome between single and double AIH at the same cycle.Therefore,the treatment of ovulation induction and double AIH could not improve the clinical pregnancy of AIH.