影响促排卵宫腔内人工授精临床妊娠率相关因素分析

目的探讨影响促排卵周期宫腔内人工授精(intrauterine insemination,IUI)临床妊娠率相关因素。方法回顾性分析广州市妇女儿童医疗中心2011年1月至2015年9月行促排卵IUI治疗的805个周期,对女方年龄、不孕年限、授精周期数、授精次数、促排卵方案、优势卵泡数目、是否行人绒毛膜促性腺激素(human chorionic gonadotrophin,HCG)诱导排卵对临床妊娠率的影响进行分析。结果 1年龄30组、31~36岁组、37~40组、40组临床妊娠率分别为17.84%、16.59%、7.77%、0,差异有统计学意义(P0.05)。2不孕年限3年组、3~5年组、5年组临床妊娠率分别为17.88%、14.44%、13.38%,随着不孕年限增加临床妊娠率呈下降趋势,但各组间差异无统计学意义(P0.05)。3授精周期数为1、2、3、3次者临床妊娠率分别为17.07%、15.56%、12.00%、10.34%,授精周期数增加临床妊娠率呈下降趋势,但各组间差异无统计学意义(P0.05);同一周期中授精1次和2次临床妊娠率分别为15.20%、16.06%(P0.05)。4氯米芬、来曲唑、氯米芬+尿促性素、来曲唑+尿促性素、尿促性素5种促排卵方案临床妊娠率分别为12.15%、13.73%、21.74%、19.15%、15.25%,差异无统计学意义(P0.05)。5优势卵泡为1个临床妊娠率为12.17%,低于2个组(19.08%)、3个组(20.88%),(P0.05)。6使用HCG诱导排卵组临床妊娠率为15.59%,略高于未使用HCG诱导排卵组(12.69%),但差异无统计学意义(P0.05)。7 Logistic回归分析显示促排卵IUI妊娠成功率的主要因素是年龄和优势卵泡数目。结论患者年龄、授精周期数、优势卵泡数目是影响促排卵IUI临床妊娠率的主要因素。促排卵方案、授精次数、是否使用HCG诱导排卵等对促排卵IUI临床妊娠无影响。

Analysis of relative factors affecting pregnancy rate of intrauterine insemination with induced ovulation

Objective To discuss the influence factors of clinical pregnancy rate in intrauterine insemination ( IUI) with induced ovulation. Methods A total of 805 IUI cycles with induced ovulation in Guangzhou Women&Children's Medical Center from Jan 2011 to Sep 2015 were analyzed retrospectively. Analyzed the influence of female age, duration of infertility, the number of insemination cycles, the insemination times, the protocol of induced ovulation, the number of dominant follicles, whether use HCG trigger on clinical pregnancy rate. Results ① The pregnancy rate in groups of age <30 y, 31 ~36y, 37 ~40y, >40y were 17. 84%、16. 59%、7. 77%、0 respectively, and the differences were significant among the four groups ( P <0. 05 ) . ② The pregnancy rate in groups of duration infertility <3y, 3 ~5y, >5y, were 17. 88%、14. 44%、13. 38% respectively, though the differences among the groups were not significant(P>0. 05), there was a declining trend with the duration of infertility increasing. ③The groups of number of insemination cycles 1,2,3,>3,the pregnancy rate were 17. 07%、15. 56%、12. 00%、10. 34% respectively, indicated that with the increase of cycle numbers, the pregnancy rate decreased,however, there were no significant differences. The clinical pregnancy rate of insemination once and twice in the same cycle were 15. 20% and 16. 06%, there was no significant difference ( P>0. 05 ) .④ The induced ovulation protocols of CC, LE, CC +HMG, LE +HMG, HMG, and the pregnancy rate were 12. 15%、13. 73%、21. 74%、19. 15%、15. 25% respectively, there was no significant difference ( P >0. 05 ) . ⑤ The pregnancy rate of acquired one dominant follicle was 12. 17%, less than two follicles (19. 08%) and three dominant follicles(20. 88%), and there were significant differences (P<0. 05). ⑥ The group of use HCG trigger, the pregnancy rate was 15. 99%, a litter more than the group without HCG, but there was no significant difference ( P >0. 05 ) . ⑦ Logistic regression analysis indicated that the influence factors of IUI with induced ovulation were female age and the number of dominant follicles. Conclusion The influence factors of clinical pregnancy rate in IUI with induced ovulation were female age, the number of insemination cycles and the number of dominant follicles, and the protocol of induced ovulation, insemination times in the same cycle and whether use HCG trigger seems no impact on the success of IUI.