Double versus single homologous intrauterine insemination for male factor infertility： a systematic review and meta-analysis

Male factor infertility affects 30%-50% of infertile couples worldwide, and there is an increasing interest in the optimal management of these patients. In studies comparing double and single intrauterine insemination （IUI）, a trend towards higher pregnancy rates in couples with male factor infertility was observed. Therefore, we set out to perform a meta-analysis to examine the superiority of double versus single IUI with the male partner＇s sperm in couples with male factor infertility. An odds ratio （OR） of 95% confidence intervals （CIs） was calculated for the pregnancy rate. Outcomes were analysed by using the ManteI-Haesel or DerSimonian-Laird model accordingto the heterogeneity of the results. Overall, five trials involving 1125 IUI cycles were included in the meta-analysis. There was a two-fold increase in pregnancies after a cycle with a double IUI compared with a cycle with a single IUI （OR. 2.0; 95% CI. 1.07-3.75; P〈O.03）. Nevertheless, this result was mainly attributed to the presence of a large trial that weighted as almost 50% in the overall analysis. Sensitivity analysis, excluding this large trial, revealed only a trend towards higher pregnancy rates among double IUI cycles （OR. 1.58; 95% CI. 0.59-4.21）, but without statistical significance （P=0.20）. Our systematic review highlights that the available evidence regarding the use of double IUI in couples with male factor infertility is fragmentary and weak. Although there may be a trend towards higher pregnancy rates when the number of IUIs per cycle is increased, further large and well-designed randomized trials are needed to provide solid evidence toide current clinical practice.

Clinical pregnancy rate of women with unexplained infertility with or without cervical mucus aspiration before intrauterine insemination: A randomized controlled trial

Objective:To detect effect of removing cervical mucus before performing intrauterine insemination(IUI)on pregnancy rate in patients with unexplained infertility.Methods:The randomized controlled trial was conducted in Infertility Division of Department of Obstetrics and Gynaecology of a tertiary care hospital.Totally 80 patients of unexplained infertility were recruited.By computer generated block randomization in block size of 4 and 6,patients were randomly allocated at time of starting ovarian stimulation into the cervical mucus removal group or the non-removal of cervical mucus group before IUI,40 in each group.Ovarian stimulation with clomiphene 100 mg from day 2-6 of menstrual cycle along with human menopausal gonadotropin 150 IU was given alternate day starting from day 7.Follicular monitoring was done and further doses given as per response;trigger was planned when 1-3 follicle reach a diameter of>18 mm.IUI was planned after trigger.IUI was done as per the group allocated.Mucus cleaning was done in the cervical mucus removal group by aspirating mucus with IUI syringe and sterile cotton swab before IUI.The primary outcome was clinical pregnancy rate.Number of difficult IUIs and cycle cancellation due to ovarian hyperstimulation were also noted.Results:IUI was not done in 4 patients due to hyperstimulation.Pregnancies per IUI cycle occurred in 7.9%(3/38)in the cervical mucus removal group and 21.1%(8/38)in the non-removal of cervical mucus group.There was no statistically significant difference in clinical pregnancy rate between two groups(P=0.19).Conclusions:There is a trend towards a lower clinical pregnancy rate with removal of cervical mucus before IUI in women of unexplained infertility though the difference is not statistically significant.Further studies with large sample size need to be done on this intervention.

Timed Intercourse versus Intrauterine Insemination with Mild Ovarian Stimulation for Unexplained Infertility

Background: Infertility is unexplained in about 22% - 28% of infertile couples. Spontaneous pregnancy may occur in them. If did not happen, Expectant management will be via clomiphene citrate (CC) administration, intrauterine insemination (IUI), and IVF & ICSI. Aim: to assess the effectiveness of intrauterine insemination with mild controlled ovarian stimulation compared with expectant management in couples with unexplained infertility more than one year. Methods: 160 couples with unexplained infertility were selected, The couples were randomly divided into two groups: Group (A) “80 couples”: Intrauterine insemination (IUI) with mild controlled ovarian stimulation (combination of CC + hMG) using prepared semen and was performed 36 hours after hCG injection, Group (B) “80 couples”: Couples had no ovulation induction. They encouraged for timed intercourse in the most fertile days of female cycle guided by folliculometry for 6 months. Data were collected quantitatively, coded and analyzed using SPSS. The power of study is 80% and 95% confidence interval. Result: The pregnancy rate was calculated in both groups: In group (A) (IUI/COS): OPR (Ongoing pregnancy rates) was 27.5% and PR (pregnancy rates)/cycle was 8.6%. In group (B) (Expectant management): OPR was 25% and PR/cycle was 5.3%. Conclusion: Mild controlled ovarian stimulation CC + hMG with IUI offers no statistical significance in terms of pregnancy outcomes over expectant management in this study however significance in the response to stimulation.

Treatment of Infertile Women with Unilateral Tubal Occlusion Diagnosed by Hysterosalpingography:The Role of Intrauterine Insemination

Summary:The optimal assisted reproductive treatment strategy for infertile women with unilateral tubal obstruction remains uncertain.To investigate the role of intrauterine insemination(IUI)in the treatment of infertile women with unilateral tubal occlusion,the data of 148 couples were retrospectively collected and analyzed.Seventy-eight infertile women with unilateral occlusion diagnosed by hysterosalpingography(HSG)were categorized as the study group and 70 others with unexplained infertility as the control group.The study group was divided into a proximal occlusion subgroup and a mid-distal occlusion subgroup for further analysis.The main outcomes,namely the clinical pregnancy rate(CPR),ongoing pregnancy rate(OPR),and live birth rate(LBR)per cycle,were analyzed.Our results showed a tendency of lower CPR,OPR,and LBR in the study group than in the control group,without statistical significance.Further investigations revealed that the unilateral proximal occlusion subgroup had similar CPR,OPR,and LBR as the control group,while the unilateral mid-distal occlusion subgroup had significantly lower CPR(5.1%vs.20.0%,P=0.035),OPR(5.1%vs.20.0%,P=0.035),and LBR(5.1%vs.20.0%,P=0.035)than the control group.In conclusion,the clinical outcomes of IUI were worse in patients with unilateral tubal occlusion than in those with unexplained infertility.This might be primarily caused by the worse outcome of patients with unilateral mid-distal tubal occlusion instead of proximal occlusion.

Intrauterine Insemination—Our Results between the Years 2008-2012

The purpose of this retrospective study was to determine whether or not there was a significant relationship between women’s age as a cause of sterility and pregnancy after IUI. Furthermore, we evaluated the effect of stimulation of antiestrogens and time of hCG administration on the success of IUI in relation to the age of women. During the period between 2008 and 2012, we performed a total number of 793 IUI. Patients were prepared for IUI in the natural cycle and stimulation with antiestrogens (clomiphene citrate-CC). Ovulation was induced by hCG (Ovitrelle) 40 hours before IUI or immediately after the procedure. Sperm was processed through density gradients. The average success rate of IUI was 10.2% of pregnant women per cycle. Significantly the highest number of pregnant women 16.3% was women with a diagnosis of anovulation. Significantly the lowest success rate of IUI was at the immunological cause of infertility and endometriosis. There was no evidence of age dependence for women on the success of IUI. Stimulation of CC did not significantly increase the chance of becoming pregnant. There was also no statistically significant difference in hCG before and after IUI pregnancy success. The most important group of women for whom IUI is a suitable form of assisted reproduction consists of patients of 35 years old with anovulation cause of sterility. Those patients with an immunological cause of infertility and endometriosis have significantly lower chances of conceiving after IUI and it is preferable for them to choose other techniques of assisted reproduction and embryo transfer.

加用中药周期疗法改善IUI患者妊娠结局的临床研究

[目的]观察加用中药周期疗法改善宫腔内人工授精(IUI)患者妊娠结局的临床效果。[方法]将40例行诱导排卵联合IUI的脾肾两虚型排卵障碍性不孕患者,分为中药周期疗法联合诱导排卵组(治疗组)20例,单纯诱导排卵组(对照组)20例,比较两组临床疗效、扳机日子宫内膜厚度和形态、排卵率及妊娠率。[结果]治疗组总有效率为95%,对照组为60%,两组差异有统计学意义(P<0.05)。治疗组扳机日子宫内膜厚度、A型内膜比例较对照组显著增加(P<0.05)。治疗组和对照组患者的排卵率相当(P>0.05)。治疗组妊娠率为45%,对照组为15%,两组差异有统计学意义(P<0.05)。[结论]在宫腔内人工授精周期中,使用中药周期疗法能使子宫内膜增厚,改善子宫内膜容受性,从而提高妊娠率。

低体质指数不利于不明原因原发不孕患者人工授精诱导排卵周期妊娠结局

【目的】探索女方体质指数(BMI)对不明原因原发不孕女性人工授精诱导排卵周期(OI-IUI)妊娠结局的影响。【方法】回顾性分析2016年1月至2022年12月于中山大学孙逸仙纪念医院生殖中心行OI-IUI助孕的不明原因原发不孕夫妻共764个周期的临床资料。按照女方患者BMI分为3组,低BMI组(消瘦,BMI<18.5 kg/m^(2))、正常BMI组(正常体质量,18.5 kg/m^(2)≤BMI<23.0 kg/m^(2))、高BMI组(超重、肥胖,BMI≥23.0 kg/m^(2)),比较各组间一般资料以及妊娠结局。采用单因素分析和Logistic回归分析矫正混杂因素,探讨BMI与OI-IUI活产率的相关性。【结果】三组HCG阳性率(7.08%、9.74%、13.19%)、宫内妊娠率(5.51%、7.91%、13.19%)和活产率(4.72%、6.90%、12.50%)由低BMI组到高BMI组依次递增,早期流产率(14.28%、10.26%、5.26%)则是由低BMI组至高BMI组依次递减,其中高BMI组活产率明显高于低BMI组及正常BMI组,差异有统计学意义(P=0.034)。根据二元Logistic回归分析显示,BMI是影响活产的独立影响因素,与低BMI相比,高BMI可提高活产率(OR=3.15,95%CI=1.191,8.329,P=0.021)。【结论】低BMI不利于不明原因原发不孕女性OI-IUI妊娠结局,对该部分患者鼓励以健康方式进行合理增重。

影响宫腔人工授精妊娠率的临床因素分析

目的探讨影响宫腔内人工授精(IUI)妊娠率的相关因素。方法回顾性分析2017年12月至2022年9月恩施土家族苗族自治州中心医院生殖医学中心收治的行IUI治疗的不孕不育夫妇的615个周期的临床资料,分析影响IUI妊娠率的相关因素。结果共纳入615个IUI周期,其中71个周期获得妊娠,妊娠率为11.54%(71/615);65个周期获得临床妊娠,临床妊娠率为10.57%(65/615)。消瘦、正常体重、超重、肥胖女性的临床妊娠率比较,差异具有统计学意义(P<0.05);排卵数≥2个的妊娠率、临床妊娠率与排卵数为1个比较,差异具有统计学意义(P<0.05)。排卵个数(OR=1.970,95%CI:1.155~3.359)是影响妊娠率的独立因素(P<0.05)。结论排卵个数是影响IUI妊娠率的相关因素。

子宫内膜厚度对宫腔内人工授精活产率的影响

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。

Intrauterine insemination with donor sperm:only the number of motile spermatozoa inseminated influences both pregnancy and live-birth rates

Intrauterine insemination with donor sperm(IUI-D)is an assisted reproductive technology(ART)offered to couples with definitive male infertility or risk of genetic disease transmission.Here,we sought to evaluate our practice in IUI-D and identify factors that influenced the success rate.We performed a retrospective,single-center study of all IUI-D procedures performed at Lille University Medical Center(Lille,France)between January 1,2007,and December 31,2017.Single and multivariate analyses with a mixed logistic model were used to identify factors associated with clinical pregnancies and live births.We included 322 couples and 1179 IUI-D procedures.The clinical pregnancy rate was 23.5%,and the live birth rate was 18.9%per IUI-D.In a multivariate analysis,the women’s age was negatively associated with the live birth rate.The number of motile spermatozoa inseminated was the only factor associated with both clinical pregnancies and live births,with a chosen threshold of 0.75 million.The clinical pregnancy and live birth rates were,respectively,17.3%and 13.0%below the number of motile spermatozoa inseminated threshold and 25.9%and 21.0%at or above the threshold(all P=0.005).The number of motile spermatozoa inseminated was the only factor that significantly influenced both pregnancies and live-birth rates after IUI-D.Indeed,below a threshold of 0.75 million motile spermatozoa inseminated,those rates were significantly lower.Application of this number of motile spermatozoa inseminated threshold may help centers to allocate donations more effectively while maintaining reasonable waiting times for patients.

不同正常精子形态百分率对宫腔内人工授精临床妊娠率的影响

目的探讨不同正常精子形态百分率对宫腔内人工授精(IUI)临床妊娠率的影响。方法回顾性分析2019年12月至2022年12月于我院生殖中心进行的2637个IUI治疗周期[控制女方年龄<40岁、前向运动精子总数(TPMSC)≥500万]的患者临床资料。按照正常精子形态百分率分为3组(分别为<1.0%、≥1.0%~<4.0%及≥4.0%),比较各组间的患者临床特征及临床妊娠率;并采用Logistic回归模型来分析精子形态与IUI临床妊娠率的关系。结果纳入的2637个IUI治疗周期中,321个周期(12.17%)获得临床妊娠。在严格按照精子形态学分类分析中,正常精子形态百分率<1.0%、≥1.0%~<4.0%及≥4.0%组的临床妊娠率分别为12.87%、11.63%和12.62%,组间比较无统计学差异(P>0.05)。在多变量Logistic分析中,不同程度的精子形态不能独立预测IUI的临床妊娠结局[OR(95%CI)=1.016(0.973,1.061),P=0.470],而性功能障碍[OR(95%CI)=2.809(1.415,5.578),P=0.003]及促排卵方案[OR(95%CI)=1.480(1.058,2.072),P=0.022]可以独立预测IUI的临床妊娠结局。结论在控制女方年龄及TPMSC的前提下,不同正常精子形态百分率的患者(包括严重畸形精子症患者)的临床妊娠率并无明显差异。

Th1/Th2免疫失衡与PCOS不孕症患者IUI治疗后临床结局的关系

目的 研究辅助性T淋巴细胞亚群比值(Th1/Th2)免疫失衡与多囊卵巢综合征(PCOS)不孕症患者宫腔内人工授精(IUI)治疗后临床结局的关系。方法 前瞻性选取2019年2月至2020年12月在咸宁市中心医院进行IUI治疗的120例PCOS不孕症患者作为研究对象,根据治疗效果分为成功组(n=29),失败组(n=91)。比较两组性激素及Th1/Th2,并分析Th1及Th2水平的相关性。结果 成功组Th1、Th2、Th1/Th2显著低于失败组(P<0.05),成功组补体C3、补体C4、免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)水平显著高于失败组(P<0.05)。相关性分析结果显示,患者的IUI治疗不良结局与Th1、Th2、Th1/Th2呈正相关。结论 Th1/Th2免疫失衡与PCOS不孕症患者IUI治疗后临床结局有显著相关性。

不明原因不孕的期待治疗与助孕

排卵监测、输卵管通畅度及男方精液分析均正常的不孕症称为不明原因不孕。针对不明原因不孕患者,应根据患者的年龄、不孕年限、卵巢功能状态和生育愿望等制定个体化、阶梯式助孕方案;其中,避免过多医疗干预的期待治疗是年轻、卵巢功能正常患者的首选。来曲唑联合促性腺激素方案是宫腔内人工授精的可选方案。体外授精-胚胎移植可发现隐匿性不孕因素,是更进一步的助孕方式。诊断性宫腹腔镜因具有创伤性导致应用受到限制。本文就不明原因不孕的期待治疗与助孕进行综述,以期提供相对合理的助孕方案。

潮汕地区4123对不孕不育夫妇病因及治疗效果

目的分析潮汕地区不孕不育的病因以及各因素下的临床妊娠结局,旨在为不孕症的治疗和预防提供依据。方法选取2014年1月1日至2019年12月30日在广东省揭阳爱维艾夫医院生殖医学中心就诊进行辅助生殖技术的4123对不孕不育夫妇的资料进行回顾性分析。行体外受精-胚胎移植(IVF-ET)治疗3715例,其中原发性不孕1992例(53.62%),继发性不孕1723例(46.38%);女性不孕2934例,男性不育512例,双方因素269例。行宫腔人工授精408例。分析不孕不育因素的构成以及不同治疗方法的妊娠率。结果4123对夫妇中,患病年限1~<4年者占比最高,为43.17%。3715例行IVF-ET治疗患者中,原发性不孕的多囊卵巢综合征(PCOS)、子宫因素占比均高于继发性不孕,差异均有统计学意义(P<0.05)。原发性不孕的输卵管因素和卵巢储备功能减退占比低于继发性不孕,差异均有统计学意义(P<0.05)。行IVF-ET治疗女性不孕患者中,输卵管因素为主要原因,占比为61.05%。行IVF-ET治疗男性不育患者中,畸形精子症的占比较高,为30.39%。PCOS因素不孕行IVF-ET治疗患者的妊娠率高于输卵管因素,子宫因素、子宫内膜异位症、卵巢储备功能减退、其他排卵异常不孕行IVF-ET治疗患者的妊娠率均低于输卵管因素,差异均有统计学意义(P<0.05)。PCOS因素不孕行IVF-ET治疗患者的妊娠率最高(81.43%)。弱精子症不育行IVF-ET治疗患者的妊娠率低于无精子症,差异有统计学意义(P<0.05)。畸形精子症不育行IVF-ET治疗患者的妊娠率较高(72.22%)。不同原因的不孕不育患者选择宫腔人工授精的妊娠率比较,差异无统计学意义(P>0.05)。结论不孕不育原因涉及男女双方,其中女方不孕病因复杂,辅助生殖技术针对不同的不孕不育病因具有不同的成功率。

不明原因不孕症患者HSG术后IUI治疗效果分析

目的:探讨子宫输卵管造影(HSG)术后不同时间对不明原因不孕症(UI)患者行宫腔内人工授精(IUI)助孕的妊娠结局影响。方法:回顾性分析弋矶山医院生殖医学科2016年1月~2021年6月UI患者行IUI共333周期,根据其行HSG与IUI的间隔时间分为2组,A组为HSG术后3个月内行IUI助孕,共157个周期,B组为HSG术后3个月以上行IUI助孕,共176个周期,分析其术后妊娠情况。结果:A组单周期妊娠率及活产率分别低于B组(14.01%vs. 22.73%,11.46%vs. 19.89%)(P<0.05),但两组间流产率(18.18%vs. 12.50%)差异无统计学意义(P>0.05)。结论:UI患者HSG术后何时行IUI均不增高其流产率,HSG术后过早行IUI助孕并不能提高UI患者单周期妊娠率及活产率。

夫精宫腔内人工授精临床妊娠率的相关影响因素分析

目的:探讨夫精宫腔内人工授精(intrauterine insemination,IUI)临床妊娠率的相关影响因素。方法:选取2019年1月-2022年2月安徽省第二人民医院生殖医学中心施行IUI治疗的129对夫妇,共183个周期,比较IUI患者的排卵方案、不孕因素、妊娠率等的差异性。结果:女方年龄<35岁组的妊娠率高于≥35岁组(P<0.05),促排卵方案的妊娠率高于自然排卵方案(P<0.05),体质量指数(BMI)<24 kg/m^(2)组的妊娠率高于BMI≥24~<28 kg/m^(2)组及BMI≥28 kg/m^(2)组(P<0.05),各不孕因素间妊娠率比较,差异有统计学意义(P<0.05);临床妊娠组与临床未妊娠组优势卵泡个数相比较,差异有统计学意义(P<0.05);多因素Logstic回归分析显示,优势卵泡个数可以作为提高临床妊娠率的独立临床因素(P<0.05)。结论:女方年龄<35岁、促排卵方案、体质量指数<24 kg/m^(2)组可提高IUI临床妊娠成功率,优势卵泡个数可以作为提高临床妊娠率的独立临床因素。

小剂量阿司匹林联合宫腔内夫精人工授精治疗不明原因不孕症患者的效果

目的:观察小剂量阿司匹林联合宫腔内夫精人工授精治疗不明原因不孕症(UI)患者的效果。方法:选取2018年1月至2020年1月该院收治的124例UI患者进行前瞻性研究,按照随机数字表法分为观察组与对照组各62例。对照组采用宫腔内夫精人工授精治疗,观察组在对照组基础上联合小剂量阿司匹林治疗,比较两组促卵泡生成素(FSH)水平、黄体生成素(LH)水平、雌激素(E2)水平、术后4周临床妊娠率、≥15 mm卵泡个数、流产率和抱婴率。结果:观察组术后4周临床妊娠率为24.19%,明显高于对照组的9.68%,差异有统计学意义(P<0.05);授精术当日,观察组≥15 mm卵泡个数为(2.68±0.67)个,明显多于对照组的(1.65±0.63)个,差异有统计学意义(P<0.05);治疗前后,两组FSH、LH、E2水平组间比较,差异无统计学意义(P>0.05);观察组抱婴率为19.35%,明显高于对照组的6.45%,差异有统计学意义(P<0.05);两组流产率比较,差异无统计学意义(P>0.05)。结论:小剂量阿司匹林联合宫腔内夫精人工授精治疗不明原因不孕症患者可提高其临床妊娠率、抱婴率和≥15 mm卵泡个数,效果优于单纯宫腔内夫精人工授精治疗。

不明原因原发性不孕者宫腔内人工授精失败后治疗方案的选择

目的 :探讨对不明原因原发性不孕患者行宫腔内人工授精 (IUI)失败后治疗方法的合理选择。 方法 :将6 1例共 6 5个周期的此类患者分为A、B、C、D 4组 ,分别为IUI后体外受精 (IVF)组 37个周期、IUI后卵细胞胞质内单精子注射 (ICSI)组 19个周期、IUI后一半行IVF一半行ICSI组 4个周期、IUI及IVF失败后第 2次改行ICSI组5个周期 ,同时随机选取常规行IVF治疗共 35个周期为E组、常规行ICSI治疗共 2 4个周期为F组作为对照 ,分别比较其正常受精率、完全不受精率、优质胚胎率、妊娠率及种植率。 结果 :A组的正常受精率、完全不受精率 (分别为 5 5 .4 %、2 1.6 % )与E组 (分别为 72 .8%、0 % )相比 ,差异有显著性 (P <0 .0 5 ,P <0 .0 0 5 ) ;与B组 (分别为6 8.4 %、0 % )相比 ,差异有显著性 (P <0 .0 5 ,P <0 .0 1)。D组患者自身对照前 1次IVF及随后的ICSI治疗 ,其正常受精率分别为 12 .2 %、74 .2 % ,差异有显著性 (P <0 .0 0 5 )。 结论 :不明原因原发性不孕患者IUI失败后行IVF有约 2 0 %完全不受精的可能 ,作为充分知情后的选择 ,行ICSI治疗可以获得较高的受精率 ,使患者有供移植的胚胎 ,但ICSI不应为推荐性的选择。

2140例不孕患者夫精宫腔内人工授精的临床效果及其影响因素

目的观察2 140例不孕患者夫精宫腔内人工授精(IUI)的临床效果,并分析其影响因素。方法 2 140例不孕患者,均行IUI治疗,共治疗3 383个IUI周期,采用B超测量HCG日患者子宫内膜厚度,计算直径≥14 mm卵泡数。IUI后第30天计算临床妊娠率、抱婴率、流产率、异位妊娠率、多胎妊娠率。分析IUI的临床妊娠率、抱婴率与不孕症患者年龄、不孕类型、不孕原因、IUI次数的关系。结果 3 383个IUI周期中患者HCG日子宫内膜厚度(9.4±2.0)mm,直径≥14 mm卵泡数(2.6±1.9)个。IUI后第30天时临床妊娠率15.0%(508/3 383),抱婴率11.1%(375/3 383)。流产率16.9%(86/508),异位妊娠率8.9%(45/508),其中宫内妊娠合并宫外妊娠者4例、双胎妊娠58例、三胎妊娠8例、四胎妊娠3例,多胎妊娠率13.6%(69/508)。女性年龄>40岁者临床妊娠率、抱婴率明显低于其余年龄者,P均<0.05。原发不孕与继发不孕患者的临床妊娠率分别为14.8%(285/1 921)、15.3%(223/1 462),抱婴率分别为10.9%(209/1 921)、11.4%(166/1 462),二者比较,P均>0.05。39~40岁原发不孕患者抱婴率明显低于继发不孕者,P<0.05。女性因素不孕患者临床妊娠率、抱婴率均低于混合因素者,P均<0.05。不同IUI周期次数之间临床妊娠率与抱婴率间比较差异无统计学意义。结论 IUI的成功率仍较低,女性年龄<40岁、提高IUI周期次数是提高IUI妊娠结局的重要因素,临床中应综合分析女性年龄、不孕类型、不孕原因选择合适助孕方案。