夫精宫腔内人工授精周期妊娠成功率相关因素分析

目的探讨影响夫精宫腔内人工授精(IUI)周期妊娠成功率(PPR)相关因素。方法回顾性分析2004年1月至2005年12月在我院生殖中心收治的168例女性不育症患者,接受夫精IUI治疗286个周期。从女方年龄、不育年限、病因、促排卵方案、不育类型I、UI时间及次数、精液洗涤后a+b级精子计数进行分析。结果PPR在年龄21~25岁组为26.3%、25~30岁组为25.2%、30~35岁组为22.2%、>35岁组为8.9%;不育年限在1~2年为29.4%、2~3年为26.3%、3~4年为16.0%、>4年为10.9%;不育因素男性因素为28.1%、宫颈因素为28.6%、排卵障碍为25.8%、免疫因素为15.6%、不明原因为17.9%及有≥2个不育因素者为9.8%;自然周期IUI为10.8%、枸橼酸氯米芬(CC)周期为11.0%、CC+人绝经期促性腺激素(HMG)周期为23.1%、HMG周期为37.5%;原发不育为17.2%、继发不育为26.3%;排卵前1次IUI为17.8%、排卵后1次为26.5%;精液洗涤后a+b级精子计数(1~<5)×106为6.1%,(5~<10)×106为25.0%、(10~20)×106为25.7%、>20×106为25.2%。结论影响IUI PPR的主要因素是:女性年龄、不育年限、不育类型、促排卵方案及精子活动力。

Analysis of the factors relevant to pregnancy rate of intra-uterine insemination with husband's semen

Objective: To study the factors affecting the pregnancy rate per intra-uterine insemination(IUI) cycle in order to improve the outcome of IUI.Methods: The data from 168 infertility couples who underwent IUI cycles in our reproductive medicine center during January,2004 and December,2005 were retrospectively analyzed.A total of 286 cycles were recorded.Multiple indices were analyzed,including the age of the patient,duration of infertility,causes and types(primary or secondary) of infertility,methods for ovulation induction,IUI procedure,sperm count and grade.Results: The pregnancy rate per IUI cycle for the women aged over 35 years was significantly lower than that of others(8.9% vs.26.3%,25.2% and 22.2% for the women aged 21-25 years,25-30 years and 30-35 years,respectively,P<0.05).The pregnancy rate per IUI cycle in the women with 3-4 years(16.0%) or more than 4 years of infertility(10.9%) was significantly reduced when compared with that in women with 1-2 years(26.3%) or 2-3 years of infertility(25.2%)(P<0.05).IUI tended to have a better pregnancy rate per cycle for the couples with male factors(28.1%),cervical problem(28.6%),ovulation problem(25.8%) than those with immune factors(15.6%) or unexplained infertility(17.9%).The couples with two or more infertility factors had a significantly lower pregnancy rate per cycle of 9.8%. HMG induced ovulation improved the pregnancy rate per IUI cycle(37.5% vs.10.8% for natural ovulation).The pregnancy rate per IUI cycle for the women with primary infertility and secondary infertility was 17.2% and 26.3%,respectively.The pregnancy rate per cycle in the women with IUI once a cycle was 17.8%(performed before ovulation) and 26.5%(performed after ovulation).The pregnancy rate per IUI cycle in the couples with grade a+b sperm count(1-5)×106,(5-10)×106,(10-20)×106,and >20×106 was 6.1%,25.0%,25.7% and 25.2%,respectively.Conclusions: Many factors have their effects on the pregnancy rate per IUI cycle,and a comprehensive evaluation should be performed before the procedure to achieve the optimal outcome.