3178周期宫腔内夫精人工授精临床结局及其影响因素分析

目的:评估宫腔内夫精人工授精(IUI)的临床结局及其影响因素。方法:回顾性分析行IUI治疗的1 646对夫妇共3 178个周期的临床资料,分析临床妊娠率及其与女方年龄、不孕类型、不孕病因、是否促排卵治疗、IUI时机、IUI周期次数的关系。结果:IUI临床妊娠率为12.4%(394/3 178);对临床妊娠率有统计学意义的影响因素是女方年龄、不孕病因、是否促排卵治疗;而不孕类型、IUI时机、IUI周期次数不影响临床妊娠率。结论:女方年龄、不孕病因、是否促排卵治疗均可影响妊娠率,治疗时应综合考虑多种因素的影响。     

自然月经周期供精人工授精临床妊娠率的影响因素

目的:探讨如何提高自然月经周期宫颈内人工授精(AID)妊娠率。方法:回顾性分析AID986个周期的女方年龄、解冻精子复苏率、卵泡直径、子宫内膜厚度、同一周期授精次数与周期临床妊娠率的关系。结果:周期临床妊娠率为18.15%。多因素Logistic回归分析显示女方年龄、同一周期授精次数是影响自然周期供精人工授精妊娠率的主要因素。按年龄分为<30岁组、30-35岁组和>35岁组,各组周期临床妊娠率分别为21.86%、13.04%和6.15%,两两比较有显著差异(P=0.000)。同一周期单次授精周期临床妊娠率(16.3%)低于双次授精者(27.85%),P=0.000;排卵前授精者(20.87%)略高于排卵后授精临床妊娠率(15.57%),但二者无统计学差异(P=0.165)。结论:女方年龄和同一周期授精次数是影响自然月经周期宫颈内AID临床妊娠率的主要因素,30岁以后临床妊娠率明显下降,同一周期双次授精可提高临床妊娠率。     

授精时机和次数对夫精宫腔内人工授精临床结局的影响

目的:探讨授精时机和次数对夫精宫腔内人工授精(IUI)妊娠结局的影响。方法:选择在本中心行IUI的195例不孕患者共379个IUI周期,随机分成4组:于h CG注射后24 h行IUI,即排卵前单次授精组(A组,n=93)和排卵后单次授精组(B组,n=102);于h CG注射后48 h再次行IUI,即排卵前、后各行1次IUI的双次授精组(C组,n=84)和均在排卵前行IUI的双次授精组(D组,n=100)。分析精液处理后活动精子总数(processed total motile sperm,PTMS)、授精时机和次数与各组IUI周期妊娠率之间的关系。结果:当PTMS5×106时,仅B组妊娠1例,其余各组未妊娠;当PTMS≥5×106时,各组妊娠率均有显著提高,B组周期妊娠率(32.22%)显著高于A组(14.12%)、C组(20.00%)和D组(17.39%)(P0.05),A组、C组和D组之间周期妊娠率无统计学差异(P0.05)。结论:PTMS≥5×106是IUI获得理想妊娠率的首要条件,h CG注射后24 h排卵后行单次授精可获得理想周期妊娠率,若此时仍未排卵患者行双次授精亦不能显著提高周期妊娠率。     

超排卵对宫腔内人工授精周期妊娠率的影响

目的分析超排卵对人工授精结局的影响，探讨超排卵对不同人群治疗的有效性。方法回顾性分析我院生殖科2000年3月-2007年12月期间女方有自发排卵的739个人工授精周期，比较不孕原因、女方年龄、有无子宫内膜异位症等因素下超排卵与自然周期妊娠率。结果739个人工授精周期中，超排卵周期233个，自然周期506个，妊娠率分别为21．6％和13．5％（P〈0.05），不孕因素中，宫颈因素为378个，男性因素为100个，盆腔输卵管因素44个，子宫内膜异位症85个，不明原因132个，其中宫颈因素和不明原因不孕周期超排卵周期妊娠率明显高于自然周期（22．40％，14．62％；27．03％，12．63％ P〈0.05）；男性因素、输卵管因素、子宫内膜异位症、女方年龄大于37岁周期，超排卵与自然周期妊娠率差异无显著性（P〉0.05）。超排卵周期中，氯米芬与促性腺素周期临床妊娠率无显著差异（P〉0.05）。结论因宫颈因素、不明原因不孕行人工授精夫妇超排卵周期妊娠率高，而男性因素、子宫内膜异位症、盆腔输卵管因素或年龄大于37岁妇女进行人工授精时慎重选择排卵诱导。     

供精人工授精周期妊娠率相关因素及妊娠结局分析

目的:探讨影响供精人工授精周期妊娠率的相关因素及其妊娠结局.方法:对2005年11月至2007年10月在本中心治疗的594对不孕夫妇行1088个供精人工授精(AID)治疗周期.并分析不孕妇女的年龄、授精次数、治疗周期、促排卵等因素对AID治疗妊娠率的影响,并对AID治疗后妊娠结局进行统计分析.结果:①≥36岁组的周期妊娠率18.30%,与≤25岁组(30.37%)、26～30岁组(32.99%)、31～35岁组(27.10%)比较,差异有统计学意义(P<0.05);各年龄组自然流产率比较,差异无统计学意义(P>0.05),但有随年龄增高的趋势.②促排卵组与自然周期组行AID治疗,其周期妊娠率比较差异无统计学意义(P>0.05).③双次授精的周期妊娠率(34.34%)高于单次授精(20.05%)(P<0.05).④行AID治疗,不同治疗周期的周期妊娠率之间比较,差异无统计学意义(P>0.05).结论:供精人工授精周期妊娠率与多种因素有关,其中不孕妇女的年龄是影响AID成功率的重要因素.同一周期行两次人工授精能更有效控制授精时机,有较高周期妊娠率.     

影响人工授精妊娠率的多因素分析

目的:探讨影响夫精人工授精妊娠率的相关因素。方法:选取2013年3月至2014年9月在南通大学附属医院生殖医学中心行宫腔内人工授精(IUI)治疗的夫妇146对,共277个周期。分析女性年龄、不孕年限、IUI治疗周期数、促排卵方案,扳机方法及扳机日相关指标等与临床妊娠率的关系。结果:年龄25岁组的妊娠率明显高于年龄30岁组(25.8%vs 11.2%,P0.05);妊娠组的扳机日促黄体生成素(LH)水平高于非孕组[(29.7±8.44)vs(16.6±1.52),P0.05]。子宫内膜分型为A型者的妊娠率显著高于非A型者(P0.05)。GnRH-a扳机后排卵率优于HCG(P0.05);4个治疗周期内随着周期数的增加累计妊娠率上升,卵泡期为10~16天妊娠率最高。结论:夫精人工授精治疗中,患者年龄、HCG日LH值、子宫内膜分型与妊娠率相关,GnRH-a扳机后排卵率优于HCG。     

单次及双次宫腔内人工授精的临床结局分析

官腔内人工授精(intrauterine insemination，IUI)是治疗不孕症的有效手段，适用于一侧或双侧输卵管通畅、有自发或促排卵后排卵的不孕妇女。IUI的受精过程较接近自然受孕过程，操作简单，如何提高IUI的妊娠率是人们共同关心的问题。本研究旨在分析行单次IUI和行双次IUI的妊娠率及授精时机的选择。     

供精人工授精结局分析及临床应用价值

目的:探讨供精人工授精(AID)成功的影响因素及临床应用价值。方法:回顾性分析在本中心实施AID的2 467对不孕夫妇共5 470个周期的临床资料,分析影响AID临床妊娠率的相关因素及妊娠结局。结果:①年龄35岁和≥35岁的临床妊娠率分别为21.49%和12.27%,差异有统计学意义(P0.05);②不孕年限≤5年和5年者比较,妊娠率有统计学差异(22.09%vs 16.45%,P0.05);③自然周期和控制性促排卵周期的临床妊娠率分别为21.92%和17.46%,差异有统计学意义(P0.05);④不同授精方式宫颈内授精(ICI)、宫腔内授精(IUI)及ICI/IUI组的临床妊娠率分别为20.61%、16.52%和18.56%,差异无统计学意义(P0.05);⑤每周期授精次数对AID的妊娠率有显著影响,1次和2次授精的成功率分别为10.64%和21.26%(P0.05);⑥注入前向运动精子总数40~60×106和60×106的妊娠率有统计学差异(19.32%vs26.07%,P0.05);⑦第1、第2、第3、第4周期的累计妊娠率分别为20.02%、33.40%、41.06%、43.70%,随着授精次数的增加,累计妊娠率显著升高(P0.05);⑧1 110例妊娠者中33例(11.98%)流产,13例(1.17%)发生宫外孕,多胎率为3.15%,出生缺陷发生率为0.67%。结论:①在AID治疗中女方年龄、不孕年限、治疗方案、授精次数及注入前向运动精子总数均是影响成功妊娠的相关因素;②AID技术安全有效,患者至少应进行3~4个周期的AID治疗,未成功者应及时求助于试管婴儿等其他辅助生殖技术。     

仿生物电疗法在人工授精中的应用价值

目的 探讨仿生物电疗法在人工授精周期治疗中的应用价值。 方法 中山市人民医院生殖专科将仿生物电疗法应用于宫腔内人工授精（intrauterine insemination ,IUI）治疗,自2012年3月至2013年5月共完成34例42周期为研究组,选择同期条件相似的普通人工授精62例104周期为对照组。比较两组的妊娠情况。 结果 研究组女方平均年龄(31.6±4.5)岁,临床周期妊娠率28.6%。对照组女方平均年龄(29.3±4.4)岁,临床周期妊娠率10.6%。两组间促排周期比、不孕病因构成比、精液处理后精子情况、精子回收率等情况比较,差异无统计学意义（P＞0.05）。研究组女方平均年龄及不孕年限均显著高于对照组（P＜0.05）,研究组临床周期妊娠率显著高于对照组（P＜0.05）,差异有统计学意义。结论 在双侧输卵管通畅的人工授精治疗中应用仿生物电疗法可提高周期妊娠率。     

促排卵对不同病因宫腔内人工授精的结局分析

目的:探讨促排卵对不同病因不孕患者人工授精的影响。方法:回顾性分析因男性因素、输卵管盆腔因素、子宫内膜异位症(EMS)和不明原因进行人工授精患者的资料,根据患者进行自然周期或促排卵周期分组,比较不同周期组的临床妊娠率和活产率。采用多元回归分析模型校正患者年龄、不孕年限、不同因素构成比、基础FSH、LH、E_2、子宫内膜厚度、类型、宫腔内人工授精(IUI)日卵泡直径及男性前向运动精子总数。评估在男性因素、输卵管盆腔因素、EMS和不明原因中促排卵周期与临床妊娠率的关系。结果:①促排卵组患者平均年龄、不孕年限以及不孕因素构成比(男性因素、输卵管盆腔因素、EMS和不明原因)与自然周期比较,无统计学差异(P0.05),而临床妊娠率和活产率均高于自然周期,但无统计学差异(P=0.08);②通过多元因素回归分析校正了年龄、基础内分泌水平、不孕因素、内膜厚度和类型及前向运动精子总数等混杂因素后,促排卵周期相对于自然周期依然有显著优势(OR=1.607;95%CI=1.115~2.316);③在不同因素不孕患者中,促排卵周期可提高输卵管盆腔因素患者的活产率(OR=4.56;95%CI=1.53~13.53)。结论:促排卵周期可提高输卵管盆腔因素患者宫腔内人工授精的临床妊娠和活产率。     

Impact of Semen Characteristics on the Success of Intrauterine Insemination

PURPOSE: To evaluate the influence of sperm characteristics on the outcome of infertility treatment using intrauterine insemination (IUI). METHODS: Retrospective study of 431 infertility couples who underwent 1007 IUI treatment cycles from June 1999 to October 2002. Sperm parameters before and after preparation for IUI were evaluated and correlated with pregnancy outcome. RESULTS: Clinical pregnancy occurred in 12% of cycles and 28% of patients. Initial sperm motility and processed forward progression were independently associated with pregnancy after IUI. The mean number of cycles per patient was 4.3. Although pregnancy rate per cycle did not differ from cycle to cycle, the cumulative pregnancy rate approached plateau after five cycles. CONCLUSIONS: Sperm motility is an independent factor influencing IUI-related pregnancy. A forward progression score of 3 to 4 in a processed specimen is necessary for IUI success. The number of IUI attempts per patient should be individualized depending upon the needs of patients.     

A comparative analysis of the cycle fecundity rates associated with combined human menopausal gonadotropin (hMG) and intrauterine insemination (IUI) versus either hMG or IUI alone

Human menopausal gonadotropin (hMG) superovulation combined with washed intrauterine insemination (IUI) has been advocated for the treatment of various forms of infertility when more traditional therapy has failed. To assess the relative efficacy of combined treatment with hMG and IUI compared with either hMG or IUI alone, pregnancy outcomes of the three treatment groups were compared in couples having infertility because of male factor, cervical factor, endometriosis, or unexplained. A total of 751 cycles were analyzed from 322 couples. The mean cycle fecundity rate associated with hMG/IUI therapy was significantly higher than either hMG or IUI therapy alone for all patients (hMG/IUI = 19.6%, hMG = 6.3%, IUI = 3.4%). The improvement in cycle fecundity rates with hMG/IUI therapy was also observed when the couples were separated by infertility diagnostic groups: male factor (hMG/IUI = 15.3%, hMG = 4.4%, IUI = 3.0%), cervical factor (hMG/IUI = 26.3%, hMG = 7.9%, IUI = 5.1%), endometriosis (hMG/IUI = 12.85%, hMG = 6.6%), and unexplained infertility (hMG/IUI = 32.6%, hMG = 5.5%, IUI = 0%). Moreover, in patients who had failed to conceive with hMG or IUI alone, the cycle fecundity rate when they were switched to hMG/IUI therapy equaled that of patients who received combined therapy from the onset. We conclude that cycle fecundity rates and cumulative pregnancy rates are significantly greater using a combination of hMG and IUI compared with either modality alone in the treatment of male factor, cervical factor, endometriosis, or unexplained infertility. Indeed, in couples with nontubal related infertility, cycle fecundity rates with hMG/IUI approach the rates seen with in vitro fertilization and gamete intrafallopian tube transfer.     

A prospective trial of intrauterine insemination of motile spermatozoa versus timed intercourse

STUDY OBJECTIVE: The efficacy of intrauterine insemination (IUI) of selected motile sperm. DESIGN: Prospective randomized sequential alternating cycle trial comparing IUI with luteinizing hormone (LH)-timed intercourse. SETTING: Clinical infertility service. PATIENTS: Couples selected included unexplained infertility (n = 73), cervical mucus hostility (n = 24), moderate semen defect (n = 110), and severe semen defect (n = 78). Two hundred eighty-five couples undertook 600 IUI cycles and 505 LH-timed intercourse. RESULTS: Overall, IUI was slightly more effective than LH-timed intercourse with a pregnancy rate of 6.2% versus 3.4% per cycle. When individual categories were considered only, IUI for severe semen defect was significantly better (5.6% versus 1.3%, P less than 0.05). The first IUI cycle was more effective when compared with both subsequent IUI cycles and the initial LH-timed cycle. Overall, 74% (27/37) of IUI pregnancies occurred in the first cycle. CONCLUSIONS: Compared with LH-timed intercourse, IUI provided little or no improved expectation of pregnancy but was beneficial in couples with severe semen defect. The occurrence of pregnancy was limited per cycle and confined essentially to the initial cycle of treatment. Continued IUI is considered to be unrewarding.     

Fallopian tube sperm perfusion versus intrauterine insemination in unexplained infertility: a randomized, prospective, cross-over trial

OBJECTIVE: To compare the results of fallopian tube sperm perfusion (FSP) versus standard intrauterine insemination (IUI) in patients with unexplained infertility undergoing controlled ovarian hyperstimulation (COH). DESIGN: Randomized, prospective, cross-over study. SETTING: Reproductive medicine unit of a university hospital. PATIENT(S): Fifty-six couples with unexplained infertility. INTERVENTION(S): COH was induced by recombinant FSH and monitored by serial transvaginal ultrasound. On the day of hCG administration during the first treatment cycle, patients were randomized to either IUI or FSP. Thereafter, in case no pregnancy was achieved, patients went on being treated with FSP and IUI in alternate cycles. A maximum of four treatment cycles per couple was performed. FSP was performed using a pediatric Foley's catheter inseminating 4 mL of sperm-enriched suspension; a Kremer-Delafontaine catheter delivering 0.5 mL of sperm suspension was used for IUI. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate per cycle. RESULT(S): One hundred twenty-seven cycles (58 FSP, 69 IUI) were performed. The clinical pregnancy rate per cycle was 21.7% for IUI and 8.6% for FSP, respectively. No major adverse effects were recorded for either technique. CONCLUSION(S): After COH, FSP is less effective than IUI in couples with unexplained infertility.     

针灸联合宫内人工授精(IUI)治疗多囊卵巢综合征所致不孕——65例疗效观察

目的:观察针灸与药物促排卵配合宫腔内人工授精(IUI)治疗多囊卵巢综合征(PCOS)所致不孕的临床疗效。方法:125例PCOS患者随机分为2组:治疗组65例,在药物促排卵基础上于IUI术前、后加针灸治疗;对照组60例,在IUI术前单以药物促排卵治疗。结果:治疗组的周期排卵率为83.9%,妊娠率为36.9%,黄素化未破裂卵泡(LUF)发生率为4.1%,周期取消率为6.3%;对照组周期排卵率为69.9%,妊娠率为20%,LUF发生率为23.1%,周期取消率为21.4%,组间比较均有显著差异(P<0.05或P<0.01)。结论:针灸配合IUI治疗PCOS可有效提高临床妊娠率,降低了LUF及卵巢过度刺激综合征(OHSS)等并发症的发生率。     

Predictive factors for pregnancy during the first four intrauterine insemination cycles using gonadotropin

Abstract

Purpose: Although a variety of factors have been reported as affecting pregnancy rates after intrauterine insemination (IUI), there have been conflicting results on prognostic factors. This study aimed to determine predictive factors for pregnancy in patients undergoing the first four IUI cycles.

Methods: A total of 348 IUI cycles using clomiphene citrate or letrozole combined with gonadotropin, or gonadotropin only were analyzed. Baseline clinical characteristics, variables related to ovulation induction and sperm parameters were compared between pregnant (n?=?54) and non-pregnant groups (n?=?294). Logistic regression analysis was performed to identify factors that could predict a pregnancy.

Results: The overall clinical pregnancy rate was 15.5% (54/348) per cycle and 30.0% (54/180) per couple. During the first four IUI cycles, logistic regression analysis revealed that woman who were 39 years or older (OR: 0.263, 95% CI: 0.076–0.906, p?=?0.034), longer duration of infertility (OR: 0.967, 95% CI: 0.942–0.993, p?=?0.012), endometriosis (versus unexplained infertility; OR: 0.177, 95% CI: 0.040–0.775, p?=?0.022) and endometrial thickness below 7?mm (OR: 0.114, 95% CI: 0.015–0.862, p?=?0.035) were unfavorable factors to predict clinical pregnancy.

Conclusions: Women with old age, longer duration of infertility, the presence of endometriosis or thin endometrium in the preovulatory phase may have unfavorable outcomes during the first four IUI cycles.     

Comparison of the effectiveness of single intrauterine insemination (IUI) versus double IUI per cycle in infertile patients

OBJECTIVE: To compare a single periovulatory intrauterine insemination (IUI) with a regimen based on double IUI, performed during preovulatory and periovulatory periods, in patients undergoing controlled ovarian hyperstimulation (COH). DESIGN: Prospective, randomized study. SETTING: Infertility and endocrinology units of a medical university. PATIENT(S): One hundred ten patients with male factor, cervical factor, and unexplained infertility who were undergoing 486 cycles of COH with IUI. INTERVENTION(S): The patients were randomly divided into two groups. One group underwent single IUI in the first cycle and double IUI in the second cycle; this alternating pattern was continued up to six cycles unless pregnancy occurred. For patients in the second group, double IUI was performed in the first cycle and single IUI in the second cycle; this pattern was repeated as in the first group. MAIN OUTCOME MEASURE(S): Relationship of single and double IUI to rates of clinical pregnancy and abortion. RESULT(S): Forty-two women became pregnant, with an overall pregnancy rate per cycle of 8.6% and pregnancy rate per couple of 38.2%. Pregnancy rate per cycle was 7.9% in single IUI cycles and was 9.4% in double IUI cycles; these findings were not statistically significant. CONCLUSION(S): Among patients undergoing COH-IUI, results of single and double IUI do not statistically differ.     

Systematic review of the treatment of ovulatory infertility with clomiphene citrate and intrauterine insemination

BACKGROUND: Controlled ovarian hyperstimulation (COH) with clomiphene citrate (CC) combined with intrauterine insemination (IUI) is often used as treatment for ovulatory infertility which includes unexplained, male, cervical, endometriosis, and tubal infertility. AIMS: To review the effectiveness of CC and IUI in ovulatory infertility. METHODS: Systematic review of pertinent randomised controlled trials (RCT) using the bibliographic databases MEDLINE and EMBASE. References of selected articles identified were hand-searched for additional relevant citations. RESULTS: Six published RCT were included in the overall review. Meta-analysis demonstrated a higher cycle pregnancy rate (CPR) with CC and IUI compared to timed intercourse in the natural cycle (P < 0.001 and odds ratio = 4.6, 95% CI = 1.9-11.3). Treatment with gonadotrophins and IUI results in a higher CPR compared to CC and IUI (P = 0.005 and odds ratio = 2.9, 95% CI = 1.3-6.2). Further RCT are required comparing CC and IUI with IUI or CC alone before one can make firm conclusions. CONCLUSIONS: Clomiphene citrate combined with IUI is more effective than timed intercourse in the natural cycle at achieving pregnancy in couples with ovulatory infertility. However, treatment with gonadotrophins and IUI is superior to CC and IUI.