精液处理前和精子优化处理后孵育时间对夫精宫腔内人工授精临床结局的影响

目的探讨精液处理前孵育时间和精子优化处理后孵育时间与夫精宫腔内人工授精(IUI-AIH)临床结局的相关性。方法回顾性分析2018年10月至2019年3月在我院生殖医学中心接受IUI治疗的107对夫妇(授精次数共173次)的临床资料,女方年龄≤35周岁。按有无临床妊娠分为妊娠组和非妊娠组,比较两组间女方年龄、原发不孕占比、正常精子率、授精次数、注入前向运动精子总数;按精液处理前孵育时间分为A1(0～15 min,n=6)、A2(15～45 min,n=37)、A3(>45 min,n=130)三组,按精子优化处理后孵育时间分为B1(0～15 min,n=27)、B2(15～45 min,n=102)、B3(>45 min,n=44)三组,比较各组间的临床妊娠率差异,并对女方年龄、原发不孕占比、正常精子率、授精次数、注入前向运动精子总数、精液处理前孵育时间和优化处理后孵育时间与临床妊娠结局进行Logistic多因素回归分析。结果妊娠组和非妊娠组在女方年龄、原发不孕占比、正常精子率、授精次数以及注入前向运动精子总数的差异均无统计学意义(P>0.05)。精液处理前A1、A2和...     

精液参数对宫腔内人工授精结局的预测价值

目的探讨处理前精液参数对宫腔内人工授精(IUI)结局的预测价值。方法根据处理前精子浓度分为15×109/L、(15~30)×109/L、30×109/L 3组,根据处理前精子活力分为30%、30%~50%、50%3组,根据处理前活动精子总数(total mobile sperm,TMS)分为10×106、10×106~20×106、20×106~50×106、50×1064组,根据处理前精子正常形态率分为4%、4%~10%、10%3组,分别比较各组间的周期妊娠率。结果 355个IUI周期共获得53例妊娠,总周期妊娠率14.9%,处理前精子浓度、精子活力与妊娠率无明显相关性,处理前TMS各组妊娠率依次为6.6%、19.0%、15.9%及17.6%,后面3组与第1组差异有统计学意义(P0.05),处理前精子正常形态率各组间妊娠率依次为4.6%、16.9%及19.0%,后两组明显高于第1组(P0.05)。结论处理前TMS和精子正常形态率对IUI妊娠率有一定的预测价值,当处理前TMS10×106或正常形态率4%时,难以获得满意的IUI妊娠率,故不建议IUI治疗。     

夫精宫腔内人工授精临床妊娠率影响因素的分析

目的 探讨影响夫精宫腔内人工授精(IUI)临床妊娠率的各种因素.方法 回顾性分析402例患者进行的726个IUI周期.对女性患者年龄、输卵管条件、子宫内膜厚度、卵泡直径,处理前、后精子密度,精子活力(a级 b级)和活动精子总数(PTMS)与临床妊娠率的关系进行分析.结果 IUI共获89个临床妊娠周期,每周期临床妊娠率12.26%,每例临床妊娠率为22.14%.女方年龄>40岁、子宫内膜厚度＜9mm且输卵管通畅而盆腔造影剂弥散差者,临床妊娠率降低.处理前精子密度＜10×106/ml,PTMS＜10×106;处理后精子密度＜30×106/ml,精子活力<30%,活动精子总数＜5×106的患者临床妊娠率明显降低.治疗周期数对临床妊娠率无影响.结论 IUI中女性的年龄、子宫内膜厚度、输卵管情况和处理前后精子各项参数,尤其是PTMS是影响IUI临床妊娠率的直接因素.     

620个宫腔内人工授精周期临床妊娠结局探讨

目的 探讨患者年龄,周期数和注入宫腔内前向运动精子总数（NMSI）对宫腔内人工受精（IUI）临床妊娠率的影响.方法 339对夫妇的620个IUI周期,按年龄分为：≤35、35～40、≥40岁组;按周期数分为：第1个、第2个、第3及〉第3个周期;按处理后NMSI分为：〈2、2～5、5～10、10～20及〉20×106组,分别比较各组间的临床妊娠率差别,分析各因素对IUI临床妊娠结局的影响.结果 年龄≤35、35～40及≥40岁组临床妊娠率分别为14.52、17.85及0.00%;第1、第2、第3及〉3个周期临床妊娠率分别为13.86%、18.82%、12.64%及0.00%;NMSI〈2、2～5、5～10、10～20及〉20×106 组临床妊娠率分别为3.13%、18.18%、13.21%、14.83%及16.00%.结论 年龄＞40岁,处理后前向运动精子总数低于2×106,以及3～4次IUI尝试仍未成功的患者,不适合继续尝试IUI治疗.     

精子形态对宫腔内人工授精妊娠率的影响

目的探讨正常形态精子比率对宫腔内人工授精（IUI）临床妊娠率的影响。方法回顾分析328个周期宫腔内人工授精临床资料,根据男方精子形态学检查结果分为三组：正常形态精子百分率≥4%、2%～〈4%、〈2%,比较各组间精液处理前后精子浓度、活力、前向运动精子总数以及IUI临床妊娠率。结果处理前精子浓度、活力及前向运动精子总数各组间比较无显著性差异（P〉0.05）,处理后精子浓度、活力、前向运动精子总数各组间比较有显著性差异（P〈0.05）,≥4%、2%～〈4%、〈2%各组临床妊娠率分别为19.5%、17.9%、2.6%,有显著性差异（P〈0.05）。结论正常形态精子比率影响IUI临床妊娠率,正常形态精子百分率≥2%可获得较满意的临床妊娠率。     

宫腔内人工授精临床妊娠率的影响因素分析

目的:分析影响宫腔内人工授精(IUI)临床妊娠率的相关因素。方法:回顾性分析611个周期IUI者的临床资料,探讨女方年龄、不孕年限、不孕类型、所行周期数、周期方案、子宫内膜厚度及形态、处理前精液参数等因素与IUI妊娠率的关系。结果:促排卵周期妊娠率显著高于自然周期(23.03%vs 11.03%,P0.01),第4周期以上的妊娠率较第1、2、3周期明显下降(2.04%vs 21.03%、18.13%、12.67%,P0.01),当女方年龄≥40岁、处理前前向运动精子总数(TPMSC)10×106、前向运动精子百分率20%、正常形态精子百分率2%时,IUI临床妊娠率明显下降(P均0.05)。Logistic回归分析提示周期方案、所行周期数、前向运动精子百分率显著影响IUI临床妊娠率(P0.05)。结论:周期方案、所行周期数、前向运动精子百分率、女方年龄、TPMSC以及精子形态是影响IUI临床妊娠率的重要因素,而不孕年限、不孕类型、子宫内膜厚度及形态对IUI成功率没有明显影响。     

精子优化处理后孵育时间与夫精宫腔内人工授精临床妊娠率的相关性研究

目的:研究精子优化处理后孵育时间对夫精宫腔内人工授精(AIH-IUI)临床妊娠率的影响。方法:相同促排卵方案的191个AIH-IUI周期,男方精液经密度梯度离心优化处理后,将孵育时间分为0~19、20~39、40~59、60~80 min 4组;根据优化处理后前向运动精子总数(TPMC)分为(0~9)×106、(10~20)×106、(21~30)×106、>30×1064组,分析孵育时间和优化处理后TPMC与临床妊娠率的关系,并对患者年龄、不孕年限、孵育时间、优化处理后TPMC与临床妊娠率进行Logistic多因素回归分析。结果:不同孵育时间临床妊娠率分别为12.7%、18.3%、11.4%、9.1%,孵育20~39 min组显著高于其他3组(P均<0.05);优化处理后4组TPMC临床妊娠率分别为0%、16.7%、11.4%、8.3%,(10~20)×106组显著高于其他3组(P均<0.05);Logistic多因素回归结果显示,女方年龄的增加会导致临床妊娠率显著下降(OR 0.89,95%CI 0.83~0.94),而孵育时间20~39 min(OR 2.11,95%CI 1.34~3.13)和处理后TPMC(10~20)×106(OR 2.06,95%CI 1.32~3.46)均可显著增加临床妊娠率。结论:精子优化处理后的孵育时间是AIH-IUI临床妊娠率的重要影响因素。     

宫腔内人工授精每周期授精次数、周期数与妊娠率的关系

目的探讨宫腔内人工授精(IUI)每周期授精次数与周期数对妊娠率的影响。方法分析1056例不育不孕患者共1368个IUI治疗周期,检测记录每个周期精液处理后活动精子总数及妊娠结果。根据IUI实施方式分成2组:单次IUI与双次IUI,比较两组的精子活动总数和妊娠率;纵向分析IUI的累积妊娠概率,比较各周期的妊娠率,了解IUI周期数对妊娠率的影响。结果1368个IUI周期共获得201例妊娠,总周期妊娠率是14.7%,总病例妊娠率是19.0%。单次IUI与双次IUI相比,活动精子总数分别是(18.86±9.54)和(38.60±18.21),前者明显少于后者(P<0.05);获得的妊娠率分别是10.3%和16.5%,两者有显著性差异(P<0.05)。结论(1)单次IUI妊娠率明显少于双次IUI;(2)适应于IUI治疗的不育患者,至少应进行3~4次IUI治疗,未成功者,才需考虑其他精卵结合障碍等问题,或求助于试管婴儿等其他辅助生殖技术。     

男性精液质量与宫腔内人工受精妊娠率的关系

目的：探讨处理前后的精液特征与宫腔内人工受精（IUI）妊娠率的影响。方法：收集分析819例不育不孕患者共1060个IUI治疗周期,检测记录每个周期精液处理前后的各精液参数。根据妊娠结果分成妊娠组与非妊娠组;根据处理后精子活动总数（PTMS）分成PTMS〈5×10^6,5×10^6～〈10×10^6,10×10^6～〈20×10^6,20×10^6～〈30×10^6,≥30×10^6五组;根据处理前精子密度分为3组：少精子症、弱精子症、正常精子组。分别比较各组间的各精液参数及妊娠率。结果：1060个IUI周期共获得156例妊娠,总周期妊娠率是14．7％,总病例妊娠率是19．0％。妊娠组与非妊娠组相比,各精液参数无明显差别;上述PTMS各组妊娠率依次为2．4％、9．2％、16．4％、16．7％和18．9％,各组间差异有统计学意义（P〈0．05）。少精子症、弱精子症、正常精子组妊娠率分别是7．0％、14．3％和18.1％,后两组明显高于第1组（P〈0．05）。结论：当PTMS≥10×10^6以上时,IUI治疗才有可能获得较为理想的妊娠率;少精子症患者IUI妊娠率明显低于弱精子症、正常精子组的患者。     

两种精子优选方法效果比较

目的　探讨精子经王氏管和密度梯度离心法处理后精子参数的变化 ,比较两者在宫内人工授精 (IUI)的临床效果。　方法　选择不育男性精液 15 7份 ,采用两种方法进行配对处理 ,比较两种分离方法前后精子活力、正常形态率、精子顶体形态和精子染色质等变化 ;分离后的精子用于IUI的临床妊娠率。　结果　两种方法处理后的精子活力 (a +b级 )、正常精子形态率、精子顶体完整率、正常染色质率与处理前比较有显著差异 (P <0 .0 1) ;但两种方法分离的精子用于IUI的临床妊娠率无显著差异 (P >0 .0 5 )。　结论　王氏管法和密度梯度离心法处理精子后均获得质量较好的精子 ,但用于IUI后临床妊娠率无明显差异     

The outcomes of artificial insemination by cryopreserved donor semen and analysis of its affecting factors

Objective:To analyze the outcomes of artificial insemination by frozen-thawed donor's semen(AID)and its affecting factors.Methods:Retrospective analysis of the results of 412 AID cycles performed in 173 couples be-tween February 2002 and December 2003 was presented,to evaluate the influence of female age,methods of insemination,therapeutic regime,post-thaw semen motility and number of treatment cycles on the fecundity of women undergoing AID.Results.Overall pregnancy rate of 31.6%(130/412)and delivery rate of 27.2%(112/412)per cycle and cumulative pregnancy rate of 72.3%(125/173)were achieved,with abortion rate of 13.9%(18/130)and multiple pregnancy rate of 2.68%.In 125 pregnant women,inseminations were performed 1-5 cycles,and 89.2% pregnant women conceived within three treatment cycles with twice AID in each cycle.Some factors such as ovarian stimulation(OS),female age(under 38 years),methods of insemination and luteal phase support bear no significant relations to preg-nancy rate,but the motility of post-thaw semen was significantly related to pregnancy rate.A-mong 115 neonates with weight 2,750～5,000 g,one was found congenital ventricular septal de-fect.Conclusions:Insemination with frozen-thawed semen is safe and effective.In women less than 38 years with normal reproductive function,satisfactory pregnancy rate could be achieved when AID was performed twice per cycle before and after ovulation within 4 consecutive sponta-neous cycles.     

Male Subfertility and the Outcome of Intrauterine Insemination/Der Einfluß männlicher Fertilitätsstörungen auf die Effektivität der intrauterinen Insemination

Seven out of 27 infertile women conceived by intrauterine insemination (IUI, 26%), one of them twice. Three other pregnancies occurred spontaneously after the discontinuation of treatment. A comparison of the data obtained from 65 treatment cycles revealed that the number of motile spermatozoa per ml of ejaculate and per ml of medium after swim-up preparation was higher in the ultimately fertile group as compared to the patients who failed to conceive. It is concluded that male subfertility affects the outcome of IUI unfavorably.     

Conception Rate According to Semen Characteristics in a Series of 15 364 Insemination Cycles: Results of a Multivariate Analysis

The study was undertaken on 1438 ejaculates from 342 donors. The sperm count, volume, prefreeze and postthaw motility were evaluated for each ejaculate and the morphology for the first ejaculate of each donor. The success rate was found to increase steadily with the sperm count, prefreeze and postthaw motility. For the volume and percentage of all abnormal forms, the success rates are stable up to 5,5 ml and 40% respectively and then decrease. Among all the abnormal forms considered, only the microcephalics and irregular heads were found to be linked to the success rate. As most of the studied characteristics are correlated, a multiple stepwise regression was completed in order to determine the proper role of each variable. The most predictive variable is the postthaw motility. The second variable is the percentage of microcephalics. The other variables bring no further information. In particular, at a given postthaw motility, the prefreeze motility and consequently, the loss in motility have no influence on the success rate.     

用上游精子行宫腔内授精的临床评估

本文总结了用上游精子行宫腔内授精治疗不孕症的结果。受试对象为４０对不孕夫妇,年龄２６～４０岁,不孕年限２～１０年。不孕原因为宫颈或宫颈粘液异常,男方精子活力低及不明原因的不孕。共进行１２６个周期,平均授精周期为３．５３±１．０６个（ｘ±ｓ）,共１２例妊娠,其中２例流产,妊娠率３０％,流产率１６．７％。无一例感染及其它并发症发生。该技术涉及到多方面因素,需临床与实验室结合以提高妊娠率。     

精液不同体外处理技术对宫腔内人工授精的临床疗效分析

目的　探讨精液的不同体外处理技术对宫腔内人工授精 (IUI)的疗效。　方法　A组为因女方因素引起的不育 ,采用上游法优选精子。B组为因男性性交和射精障碍 ,精液液化不良 ,免疫学异常 ,精液中有核细胞数目 >5× 10 9/L ,单纯精浆异常等引起的不育 ,采用高速离心法处理精子。C组为少、弱、畸精子症等引起的不育 ,采用双层梯度法处理精子。　结果　妊娠成功率A组 5 0 .5 % ,B组为 4 1.4 % ,C组为 32 .4 %。　结论　对不同的病因采用不同的精液体外处理技术 ,能提高IUI的成功率。     

Successful use of electroejaculation in two multiple sclerosis patients including report of a pregnancy utilizing intrauterine insemination

We report two males with multiple sclerosis who were infertile as a result of failure to ejaculate. Electroejaculation was successfully used to recover semen with motile sperm from both men, and the sperm was used for artificial insemination. One pregnancy was achieved by intrauterine insemination, and a healthy male baby was born.     

Split Ejaculate Insemination with and without the Addition of Kallikrein*

Split-Ejakulat-Insemination mit und ohne Zusatz von Kallikrein 48 Ehepaare mit primärer Ehesterilität und einem therapieresistenten männlichen Faktor (Oligoasthenozoospermie, Asthenozoospermie) wurden einer Inseminationstherapie mit und ohne Kallikreinzusatz bei Verwendung von Splitejakulaten unterzogen. Bei allen Männern war im in-vitro Stimulationstest eine Verbesserung der Spermatozoenmotilität durch Kallikrein möglich. 468 Inseminationen wurden bei 341 Ovulationszyklen unter Verwendung der Basaltemperatur und des Cervixindex durchgeführt. Zur spermatozoenreichen Fraktion des Splitejakulates wurde physiologische Kochsalzlösung oder physiologische Kochsalzlösung mit Pankreas-Kallikrein in einer Endkonzentration von 5 Einheiten/ml zugesetzt und alternierend für ein Jahr inseminiert. Das Konzeptionsoptimum lag um den 7. Inseminationszyklus. 11 Schwangerschaften wurden nach Splitejakulat-Insemination mit Kallikrein und 6 Schwangerschaften nach Splitejakulat-Insemination ohne Kallikreinzusatz beobachtet. Die Konzeptionsrate lag bei 35%, die Abortrate bei 18%. Die Geschlechtsverteilung ergab 8 gesunde Mädchen und 4 gesunde Jungen. Innerhalb der Gruppe mit Oligoasthenozoospermie betrug die Konzeptionsrate 28%, bei der Asthenozoospermiegruppe 43%. Bei letzterer wurde eine mehr als doppelt so große Zahl von Schwangerschaften nach Kallikreinzusatz erzielt. Der Kallikreinzusatz war besonders günstig bei Ejakulaten, die weniger als 30% progressiv bewegliche Samenzellen enthielten. Die Untersuchung zeigt, daß die Splitejakulat-Insemination günstige Ergebnisse aufweist. Weiterhin erscheint der Zusatz von Kallikrein zum Inseminationssperma besonders bei Patienten mit therapieresistenter Asthenozoospermie sinnvoll.     

Does transcervical intra-fallopian insemination improve pregnancy rates in cases of oligoteratoasthenozoospermia? A prospective,randomized study

The relatively low pregnancy rates (PR) after treatment of patients with oligoteratoasthenozoospermia (OTA) result in a search for different treatment modalities. The objective of this study was to assess the efficacy of transcervical intrafallopian insemination (IFI) with husband's semen in comparison to intrauterine insemination (IUI) in couples with OTA. A prospective, randomized study included 30 couples with OTA-related infertility (according to WHO criteria). The female patients underwent individually adjusted controlled ovarian stimulation by gonadotropins. Spermatozoa was prepared using the Percoll 70% technique and insemination was performed 36-40 h after human chorionic gonadotropin (HCG) administration. The Tomcat Catheter was used for IUI and the Jansen-Anderson Catheter for IFI to the fallopian tube leading to the ovary that contained more dominant follicles. The couples were divided according to sperm count, into group A (9 couples): < 10 mill ml-1 and group B (21 couples): > 10 mill ml-1. Within the groups the patients were randomly assigned for IUI or IFI treatment. Among group B couples, two pregnancies out of 15 IUI cycles (13.3% PR) and two pregnancies out of 18 IFI cycles (11.1% PR) were achieved. Group A patients completed 7 IUI and 9 IFI treatment cycles with no pregnancies observed. These data did not demonstrate a statistically significant advantage for either technique.     

抽取附睾精子作人工授精治疗梗阻性无精子症初步报告

本文从５例梗阻性无精子症不育患者输精管收集附睾精子。其中除１例为附睾先天性梗阻，作附睾－输精管吻合术外，余均为远端输精管不通畅或缺如。第二性症发育良好、性激素、睾丸容积等均正常。抽吸附睾液放入术前精浆和精子保养液中冷冻保存，解冻复苏后４例行人工授精。该法对输精管发育不全或炎症、损伤等因素造成的不能手术修复的远端输精管广泛损害梗阻的病人是一种较好的治疗选择     

Intrauterine insemination of washed spermatozoa for treatment of oligozoospermia

Efficacy of intrauterine insemination (IUI) using washed spermatozoa for treatment of oligozoospermia was evaluated by a prospective randomized study in 50 couples, using LH-timed natural intercourse in the alternate menstrual cycles as a control. The quality of spermatozoa in terms of their concentration and motility before and after sperm washing was compared. Sperm motility increased significantly after sperm preparation but the number of sperm was reduced. Eight pregnancies occurred in 253 cycles of IUI with washed spermatozoa and clomiphene citrate-stimulated cycles (3.16% per cycle). Only one patient conceived in 242 LH-timed natural intercourse cycles (0.41% per cycle). Compared with LH-timed natural intercourse, IUI provided a significantly improved pregnancy rate. When the sperm count was <5times10⁶ per ml, no pregnancy occurred with the IUI method. Therefore, IUI is of rather limited usefulness when the sperm quality is very poor. Few complications occurred after IUI, but included slight cervical contact bleeding and mild abdominal discomfort and/or cramps. In conclusion, IUI should be considered as a useful and relatively non-invasive therapeutic modality for treating infertility caused by moderate oligozoospermia (>5times10⁶/ml), when sexual intercourse fails.