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。     

宫腔内人工授精的临床应用进展

宫腔内人工授精（ＩＵＩ）避免了不良宫颈因素对精子游动的影响,缩短了精子游动的距离,增加了受孕机会,ＩＵＩ结合超排卵技术,Ｐｅｒｃｏｌｌ法或上游法处理精液是治疗不明原因不孕,男性因素,宫颈因素,排卵功能障碍和子宫内膜异位症所致不孕的有效治疗方法。     

影响宫腔内人工授精临床妊娠率的相关因素分析

目的:探讨影响宫腔内人工授精(IUI)临床妊娠率的各种相关因素。方法:回顾性分析本生殖中心实施IUI治疗的2011个周期。对女方年龄、不孕年限、授精时机及次数、方案、输卵管因素与妊娠结局的关系进行分析。结果:夫精人工授精(AIH)-IUI治疗1508个周期,临床妊娠率11.74%。供精人工授精(AID)-IUI治疗503个周期,临床妊娠率27.83%。二者比较有显著差异(P<0.05)。随着女性年龄增长,不孕年限延长,IUI的妊娠率逐渐降低。单次排卵前、单次排卵后和双次授精妊娠率无统计学差异;AIH诱导排卵的妊娠率高于自然周期。原发或继发不孕、单侧或双侧输卵管通畅间,妊娠率无统计学差异。结论:IUI中女方年龄、不孕年限、精子数量和用药方案是影响妊娠的重要因素。     

使用促性腺激素释放激素激动剂中发现妊娠26例分析

目的：研究在控制性超排卵(COH)使用促性腺激素释放激素激动剂(GnRH—a)的过程中发现妊娠的原因及妊娠结局。方法：回顾性分析1993年2月至2001年11月体外受精或卵母细胞浆内单精于显微注射受精与胚胎移植(IVF／ICSI—ET)超排卵周期使用GnRH—a过程中发现妊娠的临床资料。结果：在5180个IVF／ICSI—ET超排卵周期使用GnRH—a的过程中发现妊娠26例，发生率为0．50％，其中在输卵管因素、男方因素、子宫内膜异位症、盆腔粘连和不明原因各种不孕中的发生率分别为0．33％、0．37％、2．30％、0．97％和0．64％。26例妊娠中宫内妊娠20例，其中15例分娩17个健康新生儿，1例正在妊娠，流产2例，失访2例；异位妊娠6例，发生率为23．08％(6/26)，输卵管因素中异位妊娠发生率最高速55．56％(5/9)。结论：在超排卵周期使用GnRH—a的过程中应注意发生妊娠的可能。宫内妊娠给予安胎治疗，可分娩正常新生儿；此种妊娠在子宫内膜异位症患者中发生率较高，而异位妊娠发生率则在输卵管因素中最高，临床应严密监测异位妊娠的发生情况。     

子宫内膜异位症与自然流产的相关性分析

目的:探讨子宫内膜异位症(EMs)与自然流产的相关性。方法:回顾性分析行IVF-ET妊娠的周期,其中EMs患者903个周期、单纯男性因素者643个周期及单纯输卵管因素者720个周期,比较分析基础FSH值、β-hCG检测阳性率(临床妊娠前)、稽留流产率和自然流产率(临床妊娠后)等指标。结果:基础FSH值EMs组高于男性因素组和输卵管因素组;平均年龄EMs组略大于输卵管因素组及男性因素组,平均不孕年限3组间无统计学差异;临床妊娠率EMs组(32.1%)与输卵管因素不孕组(33.6%)无统计学差异(P>0.05),但显著低于男性因素组(45.7%);稽留流产率、异位妊娠率妊娠率3组间无统计学差异(P>0.05);EMs组自然流产率(9.1%)高于男性因素不孕组(1.0%)和输卵管因素组(4.5%),差异显著(P<0.05)。结论:EMs患者自然流产率高于输卵管因素不孕及单纯男性因素不孕的患者。     

子宫内膜异位症不孕患者辅助生殖技术治疗结局分析

目的:探讨子宫内膜异位症(EMs)不孕患者应用辅助生殖技术(ART)的治疗结局。方法:回顾性分析2006.01-2008.02期间在我中心行ART治疗的EMs患者。比较以下各组的治疗结局:行常规体外受精-胚胎移植/卵胞浆内单精子显微注射(IVF/ICSI-ET)的EMs患者(n=42,48个周期)与单纯输卵管因素患者(n=1060,1211个周期);采用3种超排卵方案的EMs患者(n=42,48个周期);行卵巢囊肿穿刺术后,病理结果确诊为EMs的患者(n=16,16个周期)与非EMs单纯囊肿患者(n=79,79个周期);接受夫精人工授精(AIH)治疗,采用自然周期(51个周期)和诱导排卵周期(31个周期)的EMs患者。结果:EMs患者的临床妊娠率(12.5%)比单纯输卵管因素患者(36.2%)明显降低,P<0.05;3种超排卵方案的临床妊娠率无统计学差异,P>0.05;卵巢囊肿穿刺术后确诊的EMs患者与非EMs单纯囊肿患者的治疗结局无统计学差异,P>0.05;EMs患者采用诱导排卵周期AIH的妊娠率(29.0%)明显高于自然周期(9.8%),P<0.05。结论:由于EMs引起不孕的机制复杂,EMs患者接受IVF/ICSI-ET治疗后的临床妊娠率明显低于单纯输卵管因素患者。EMs患者行AIH治疗时,建议采用诱导排卵方案。     

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。     

轻度子宫内膜异位症患者供精人工授精治疗方案的比较

目的:探讨轻度子宫内膜异位症患者在腹腔镜诊治术后2年内,自然周期和促排卵周期供精人工授精(AID)的妊娠结局。方法:回顾性分析303周期(168例)无排卵障碍的轻度子宫内膜异位症患者AID情况,比较在腹腔镜诊治术后2年内,自然周期(78例,195周期)与促排卵周期(90例,108周期)AID助孕后的周期妊娠率;同时比较在促排卵周期中,单卵泡排卵与多卵泡排卵的周期妊娠率。结果:在所有研究患者中,妊娠47例,其中自然周期妊娠率为16.9%(33/195),促排卵周期妊娠率为13.0%(14/108),二者比较差异无统计学意义(P=0.362)。在促排卵周期中,单卵泡排卵周期妊娠率13.5%(7/52),多卵泡排卵周期妊娠率12.5%(7/56),二者比较差异无统计学意义(P=0.882)。结论:对于排卵正常的轻度子宫内膜异位症患者,在助孕方式的选择中,可以优先选择自然周期人工授精。     

自然周期准备内膜在子宫内膜异位症患者冻融胚胎移植中的结局分析

目的:研究以自然周期作为子宫内膜准备方式对子宫内膜异位症(EMS)患者冻融胚胎移植(FET)妊娠结局的影响。方法:回顾性分析EMS患者353个FET周期,按EMS严重程度分组,A组:I~II期,120个周期;B组:III~IV期,233个周期;另将B组中囊肿复发的47个周期设为D组;而将输卵管因素不孕患者的300个FET周期纳入为对照组(C组),比较A、B、C组患者自然周期准备内膜的妊娠结局。结果:A、B、C组患者的种植率、活产率、继续妊娠率、流产率、妊娠期并发症率无统计学差异(P0.05),且妊娠结局与EMS的分期无关。A、B、C组均没有出生缺陷儿。当高质量的胚胎移植时,卵巢内膜异位囊肿并不影响妊娠结局。B组较C组低出生体质量儿和早产儿的发生率高。结论:EMS患者自然周期准备内膜与输卵管性因素不孕患者有相似的妊娠结局,且与EMS严重程度无关,妊娠结局不受内膜异位囊肿的影响,是经济、高效的内膜准备方法。     

子宫内膜异位症患者术后不孕原因分析

目的 :分析子宫内膜异位症伴不孕患者腹腔镜术与开腹手术后仍然不孕的原因。方法 :选择 10 3例有手术指征的子宫内膜异位症伴不孕患者 ,分为腹腔镜与开腹手术两组进行手术治疗 ,术后口服孕三烯酮 3～ 6个月 ,随访患者 2年内妊娠情况 ,分析术后不孕的原因。结果 :子宫内膜异位症伴不孕患者腹腔镜术后 2年内妊娠率为 5 5 .2 0 % ,开腹手术 5 0 .0 0 % ,总妊娠率为5 2 .74 % ,两组妊娠率差异无显著性 (P >0 .0 5 ) ;子宫内膜异位症分期程度与输卵管通畅程度差异无显著性 (P >0 .0 5 )。术后不孕原因中 ,输卵管不通占 37.2 1% (16 / 4 3) ,子宫腺肌病 13.95 % (6 /4 3) ,子宫内膜异位症复发 9.30 % (4/ 4 3) ,子宫内膜异位症合并子宫肌瘤 6 .98% (3/ 4 3) ,既往有两次开腹史者 4 .6 5 % (2 / 4 3)。另外还有 2 7.91% (12 / 4 3)输卵管通畅但不孕原因未明。结论 :治疗子宫内膜异位症伴不孕应选手术治疗 ,有条件首选腹腔镜手术 ;术后不孕与输卵管不通关系密切 ,子宫内膜异位症合并子宫肌瘤及腺肌病等也是不孕的原因。     

Intrauterine insemination after ovarian stimulation as a treatment for subfertility because of subnormal semen: a prospective randomized controlled trial.

OBJECTIVE: To determine whether intrauterine insemination (IUI) after ovarian stimulation with human menopausal gonadotropin (hMG) gives a better pregnancy rate (PR) than natural intercourse in couples with subfertility because of subnormal semen. DESIGN: Prospective randomized controlled trial. SETTING: University based subfertility clinic. PATIENTS: Couples with subnormal semen as the only identifiable cause of subfertility. INTERVENTIONS: In control cycles, the couples had natural intercourse. In IUI cycles, IUI was performed after ovarian stimulation with hMG and human chorionic gonadotropin. MAIN OUTCOME MEASURE: The clinical PRs and complications of IUI cycles and control cycles were compared. RESULTS: There were six clinical pregnancies in the 42 IUI cycles, whereas there was no clinical pregnancy in the 42 control cycles. The clinical PR in IUI cycles (14.3% per cycle) was significantly higher than that in control cycles (0%). Six patients (14.3%) developed moderate degree of ovarian hyperstimulation syndrome in IUI cycles. CONCLUSION: Intrauterine insemination after ovarian stimulation with hMG is useful in treatment of subfertile couples with subnormal semen.     

Case series of a single centre's treatment of ovulatory infertility with clomiphene citrate and intrauterine insemination in 2002

The present paper reports a single department's retrospective case series of all clomiphene citrate (CC) combined with intrauterine insemination (IUI) treatment cycles for ovulatory infertility performed during 2002. Thirty-eight couples with unexplained, endometriosis, male or unilateral tubal factor infertility had undergone 71 cycles of CC and IUI. The clinical and ongoing cycle pregnancy rates were 20 and 17%, respectively. Seven percent of the clinical pregnancies were multiple pregnancies, with all multiple pregnancies being twin gestations. The current use of CC and IUI is an effective early treatment option in couples with ovulatory infertility presenting to our department.     

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.     

Seminal hyperviscosity is associated with poor outcome of controlled ovarian stimulation and intrauterine insemination: a prospective study

OBJECTIVE: To determine the relationship between seminal hyperviscosity and pregnancy outcome in patients undergoing ovarian hyperstimulation and intrauterine insemination (IUI). METHODS: Patients were enrolled in the study between October 2002 and December 2003 at the Toronto Centre for Advanced Reproductive Technology. This was a prospective trial that included 37 infertile couples with abnormal seminal viscosity who underwent 57 insemination cycles as treatment for infertility (group I) and 37 couples undergoing 51 IUI cycles during the same time period, with normal semen viscosity, who served as controls (group II). Cycles were stimulated using either gonadotropin (FSH) only or FSH combined with an aromatase inhibitor, and raw semen processed for intrauterine insemination using swim-up or density gradient. Results-The mean number (+/-SD) of IUI cycles was 1.93 +/- 1.42 per patient (range 1 to 7 cycles) in group I and 2.4 +/- 1.05 (range 1 to 4) in group II. The overall pregnancy rate (PR) was 14% (8/57) and 11.8% (6/51) per cycle, and 21.6% (8/37) and 16.2% (6/37) per patient in group I and in group II, respectively. Among patients where the male had seminal hyperviscosity, five (62.5%) pregnancies miscarried in the first trimester; there was no miscarriage in the control group. Conclusion: The high miscarriage rate in couples with semen hyperviscosity may be attributed to biophysical alterations or chemical changes of the ejaculate that could impact sperm quality despite normal sperm parameters on semen analysis.     

A prospective randomized study of pregnancy rates following intrauterine and intracervical insemination using frozen donor sperm

Cryopreserved sperm have lowered fertility when compared with fresh sperm in artificial insemination by donor programs. The purpose of this study was to compare pregnancy rates following intrauterine insemination (IUI) and intracervical insemination (ICI) with cryopreserved sperm in a prospective trial using the patient as her own control. A total of 154 patients were randomized into alternating treatment cycles and underwent 238 cycles of IUI and 229 cycles of ICI. The pregnancy rate per treatment cycle was 9.7% following IUI and 3.9% following ICI. Treatment outcome was influenced by patient age, ovulatory status, and endometriosis. Pregnancy success correlated well with the post-thaw survival of sperm and the number of motile cells inseminated. In spite of having normal semen parameters, some donors were found to have markedly reduced sperm fecundity. We conclude that IUI with cryopreserved sperm can be an effective treatment for couples with infertility, genetic indications, or other reasons.     

Insemination data on men with varicoceles.

OBJECTIVE: To determine possible benefits of sperm processing and intrauterine insemination (IUI) for a group of men with a varicocele history who had not achieved a pregnancy by natural coitus (mean duration of infertility 42.2 months). DESIGN: A retrospective study including infertile men with varicoceles who were classified by their semen analyses and sperm penetration assays (SPAs). SETTING: Private practice of infertility. PATIENTS: Seventy-one infertile couples. The husbands had a varicocele history and were grouped into four clinical categories (14 untreated, 5 medical treatment, 34 varicocelectomies, and 18 varicocelectomies plus medical treatment). The wives were studied or treated before IUI. INTERVENTIONS: Varicocelectomies were performed on the males when indicated. Female studies included laparoscopies as indicated intrauterine insemination with Tomcat catheter (Sherwood Medical, St. Louis, MO) was performed in all cases. MAIN OUTCOME MEASURES: Overall pregnancy rates (PRs) and fecundity rates with sperm processing and IUI. RESULTS: Six pregnancies occurred with 66 cycles of sperm processing and IUI among 28 men with normal SPAs (PR 21%, fecundity rate = 0.09). In contrast, there were no pregnancies with 121 cycles among 43 varicocele patients with abnormal SPA results or with low values for all three semen parameters. CONCLUSIONS: Sperm processing and IUI may be beneficial for selected patients with varicoceles who had not achieved a pregnancy by coitus.     

Intrauterine insemination with controlled ovarian stimulation for treatment of infertility: an audit of a new IUI programme in a low resource setting.

This study is an audit of a new intrauterine insemination (IUI) programme in a low resource private fertility practice in southeast Nigeria. IUI was performed using a Wallace flexible catheter 1 day before or on the day of ovulation after ovarian stimulation with clomiphene citrate. The 18 couples treated had either male (16) or unexplained (2) infertility. The women were between 25 and 49 years and 13 (72.2%) of the couples had primary infertility while the duration of infertility ranged from 3 to 15 years. All the women had tubal patency confirmed by laparoscopy and dye test before undergoing IUI. The pregnancy rates per couple and per insemination cycle and the effect of maternal age and source of semen (partner or donor) were determined. The 18 couples had a total of 48 treatment cycles and five became pregnant (confirmed by early ultrasound scan) giving a pregnancy rate of 27.8% per couple or 10.4% per treatment cycle. The pregnancy rate was 41.7% per couple, 15.6% per treatment cycle for the donor group and 0% for the partner group (p<0.01). Poor sperm quality was responsible for the poor pregnancy outcome in the partner group. The pregnancy rate per couple was 36.5% in women<35 years compared with 14.3% in those>or=35 years (p=0.02). Similarly, the cycle pregnancy rate was significantly higher in women<35 years (16.0% vs 4.4%; p<0.02). There was one (20%) case of twin pregnancy and no miscarriage. Four of the women had a live birth (80%) at term and one had an intrauterine death following severe pre-eclampsia at 29 weeks' gestation. In conclusion, the overall couple and cycle pregnancy rates at our centre is comparable with the rates in many centres. Younger age and good quality semen are good indicators of a successful outcome. Infertile couples should therefore be evaluated early and recommended for this treatment option before advanced female age.     

Effect of diagnosis,age, sperm quality,and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate-intrauterine insemination

OBJECTIVE: To determine how diagnosis, age, sperm quality, and number of preovulatory follicles affect pregnancy rates when multiple cycles of clomiphene citrate (CC)-IUI are performed. DESIGN: Fifteen-year prospective observational study. SETTING: Private infertility clinic. PATIENT(S): Three thousand, three hundred eighty-one cycles of husband or donor IUI. INTERVENTION(S): Ovulation induction with CC and IUI. MAIN OUTCOME MEASURE(S): Per-cycle pregnancy rate (PR), cumulative pregnancy rate (CPR). RESULT(S): Pregnancy rates remained constant through four cycles, then fell significantly for diagnoses other than ovulatory dysfunction. Mean PRs for cycles 1-4 were significantly lower for patients with the following characteristics: age >/=43 years, poor semen quality, single preovulatory follicles, and diagnoses other than ovulatory dysfunction. Additional cycles of CC-IUI compensated for low PRs because of age, semen quality, or number of follicles. After four cycles, CPRs were 46% for ovulatory dysfunction; 38% for cervical factor, male factor, and unexplained infertility; 34% for endometriosis; and 26% for tubal factor. After six cycles, CPRs were 65% for ovulation dysfunction, 35% for endometriosis, and unchanged for other diagnoses. CONCLUSION(S): Clomiphene citrate-intrauterine insemination should be performed for a minimum of four cycles. Additional cycles of CC-IUI can compensate for low pregnancy rates due to age, semen quality, or follicle number in patients with ovulation dysfunction.