精液处理后活动精子总数对宫腔内人工授精妊娠率的影响

目的:探讨精液处理后活动精子总数(PTMS)对宫腔内人工授精(IUI)妊娠成功率的影响。方法:回顾性分析372例不孕患者共816个IUI周期的临床资料。按照PTMS数量将IUI周期分成4个区间组:PTMS<3×106(A组),3×106-5×106(B组),5×106-10×106(C组),>10×106(D组),分别比较各组间的IUI周期妊娠率。结果:816个IUI周期共获得110例妊娠,总周期妊娠率为13.5%。不同PTMS分组的周期妊娠率分别为3.8%,4.2%,14.8%和14.3%。其中A组、B组的周期妊娠率均显著低于C组和D组(P<0.05)。结论:PTMS是男性生育力评估及助孕方式选择的重要参考依据。当PTMS超过5×106时,可首选IUI治疗。     

宫颈管内与宫腔内供精人工授精妊娠结局的比较

目的比较分析宫颈管内和宫腔内供精人工授精(AID)妊娠结局的影响。方法对548个AID治疗周期进行回顾性分析,其中宫颈管内人工授精(ICI)200例360个周期,宫腔内人工授精(IUI)125例188个周期,对2种授精部位的AID妊娠结局进行比较。结果 ICI组的周期妊娠率为14.74%(51/346),其中自然周期妊娠率为18.54%(33/178),促排卵周期妊娠率为10.71%(18/168),流产率为11.76%(6/51);IUI组的周期妊娠率为28.49%(51/179),其中自然周期的妊娠率为32.04%(33/103),促排卵周期妊娠率为23.68%(18/76),流产率为5.88%(3/51);组间差异均有统计学意义(P0.05)。结论授精部位可能是影响AID成功妊娠的关键因素之一,采用IUI法可能会提高AID的妊娠率。     

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。     

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。     

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.     

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。     

影响供精人工授精成功率的多因素分析

目的:探讨多种因素对供精人工授精(AID)治疗效果的影响。方法:回顾性分析2004.12-2005.11期间在本中心579位妇女实施的1033个AID治疗周期,探讨AID治疗成功率与妇女年龄、输卵管治疗史、每周期AID治疗次数、AID实施周期数和授精方式的关系。结果:①35岁以上的不孕妇女AID治疗成功率明显下降(P<0.05);②有输卵管治疗史的妇女AID实施成功率低于正常妇女(P<0.05);③每周期施行2次人工授精的成功率高于单次的妇女(P<0.05);④AID实施1个直至5个周期每周期间的成功率无差异(P>0.05);⑤宫颈内和宫腔内人工授精的成功率无差异(P>0.05)。结论:不孕妇女的年龄、输卵管治疗史是影响AID治疗成功率的重要因素,同一周期进行2次宫颈内授精优于单次授精,无输卵管因素妇女的AID治疗在改用供精体外受精-胚胎移植前应至少可实施5个周期。在无宫颈因素的妇女中,同一周期2次宫颈内人工授精较宫腔内人工授精操作更简便,且成功率相似,可作为AID的首选。     

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。     

供精人工授精10690个周期妊娠结局的多因素分析

目的分析探讨多种因素对供精人工授精(AID)妊娠结局的影响。方法回顾性分析2013年1月-2015年12月期间在本中心治疗的10 690个AID周期,对女方年龄、不孕年限、治疗方案、输卵管通畅程度、子宫内膜厚度、每周期排卵数、每周期A I D授精次数、精子冻融复苏后浓度、精子冻融复苏后活动率、精子冻融复苏后前向运动精子总数与术后妊娠结局进行χ~2和多因素Logistic回归分析。结果年龄≤30岁妇女的妊娠机会是年龄35岁者的1.934倍(OR=1.934,P0.001)、年龄31~35岁妇女的妊娠机会是35岁者的1.511倍(OR=1.511,P0.001),自然周期妇女妊娠机会是促排卵周期者的1.307倍(OR=1.307,P0.001),每周期AID授精2次的妇女妊娠机会是1次组的1.486倍(OR=1.486,P=0.001),每周期AID授精3次的妇女妊娠机会是1次组的1.338倍(OR=1.338,P=0.020),每周期排卵2个的妇女妊娠机会是排1个卵组的1.362倍(OR=1.362,P=0.001),每周期排卵3个的妇女妊娠机会是排卵1个组的1.499倍(OR=1.499,P=0.004),精子冻融复苏后活动率60%的妇女妊娠机会是≤60%组的1.211倍(OR=1.211,P=0.038),精子冻融复苏后前向运动精子总数≥35×10~6的妇女妊娠机会是≤25×10~6组的1.319倍(OR=1.319,P=0.011)。结论女方年龄≤35岁、每周期排卵2~3个、每周期AID授精2~3次、精子冻融复苏后活动率60%和精子冻融复苏后前向运动精子总数≥35×10~6能提高授精妇女的妊娠几率;在患者无明显排卵障碍的情况下,应首选自然周期。     

自然周期与促排卵周期供精人工授精妊娠结局的比较

目的:探讨供精人工授精(AID)应用自然周期的妊娠结局。方法:回顾性分析1 100个AID周期的临床资料,其中自然周期736个,促排卵周期364个,比较两者的妊娠率和早期流产率及多胎率。结果:①自然周期妊娠率为24.45%(180/736),与促排卵周期妊娠率为23.9%(87/364),两者比较差异无统计学意义(P>0.05);②自然周期早期流产率为9.4%(17/180),而促排卵周期早期流产率为19.54%(17/87),显著高于自然周期,差异有统计学意义(P<0.05);③促排卵周期多胎率为13.8%(12/87)。结论:促排卵周期与自然周期供精人工授精的妊娠率相当,但其早期流产率和多胎率较自然周期明显升高。     

The impact of the total motile sperm count on the success of intrauterine insemination with husband's spermatozoa

Purpose: The purpose of this study was to evaluate the relationship between the total motile sperm count and the success of IUI treatment cycles with postwashed husband spermatozoa in couples with infertility in a large patient population. Patients: When 939 couples underwent 1375 cycles of IUI with varying etiologies of infertility which included male factor, endometriosis, tubal factor, ovulatory dysfunction, uterine factor, cervical factor, and unexplained infertility, the results were 207 pregnancies. Results: The overall pregnancy rate per cycle was 15.1% (207/1375). The total motile sperm count were significantly increased in the pregnant group than the nonpregnant group (38.7×10⁶ versus 28.6 × 10⁶;P<0.001). There was a trend toward an increased success rate with increased total motile sperm count. Significance was reached when the total motile sperm count exceeded 5×10⁶. Life table analysis was performed and the curve representing a cumulative chance of pregnancy calculated from our data reached 72%. Conclusions: Our findings suggest that a final postwashed total motile sperm count used for IUI may be considered predictive of the success for pregnancy and allow couples to be informed of the chances of success.     

Percutaneous vasal sperm aspiration and intrauterine insemination in the treatment of obstructive azoospermia

Objective: To treat obstructive azoospermia by using sperm recovered from percutaneous vasal sperm aspiration in IUI.

Design: Clinical study.

Setting: Institutional clinic in Jinan.

Patient(s): Six men with obstructive azoospermia, three of whom were treated with percutaneous vasal sperm aspiration and IUI; sperm recovered from this procedure were used for IUIs.

Intervention(s): Spermatozoa used for intrauterine injection were retrieved by percutaneous vasal sperm aspiration and incubated at 37°C for 40 to 60 minutes.

Main Outcome Measure(s): Normal pregnancy.

Result(s): Intrauterine insemination was performed in three patients for one or two cycles, with motile spermatozoa. There was one successful term delivery.

Conclusion(s): Percutaneous vasal sperm aspiration can be used successfully to recover sperm in men with obstructive azoospermia for use in IUI. The technique is simple and less traumatic than an open surgical procedure.     

Performance of the postwash total motile sperm count as a predictor of pregnancy at the time of intrauterine insemination: a meta-analysis

OBJECTIVE: To assess the performance and clinical value of the postwash total motile sperm count (postwash TMC) as a test to predict intrauterine insemination (IUI) outcome. DESIGN: Meta-analysis of diagnostic tests. SETTING: Tertiary fertility center. PATIENT(S): Patients undergoing IUI. INTERVENTION(S): None. RESULT(S): We detected 16 studies that reported on postwash TMC at insemination and IUI outcome. Summary receiver operating characteristics (ROC) curves indicated a reasonable predictive performance toward IUI outcome, and, at cut-off levels between 0.8 to 5 million motile spermatozoa, the postwash TMC provided a substantial discriminative performance. At these cut-off levels, the specificity of the postwash TMC, defined as the ability to predict failure to become pregnant, was as high as 100%; the sensitivity of the test, defined as the ability to predict pregnancy, was limited. CONCLUSION(S): The postwash TMC at insemination could potentially be used in counseling patients for either IUI or IVF. However, to enable patient counseling before the start of treatment, further studies are needed to establish the accuracy of a postwash TMC during the fertility workup rather than at insemination.     

子宫内膜微刺激与宫腔内人工授精患者妊娠结局的新研究

卵巢刺激与宫腔内人工授精(IUI)是世界范围内治疗不孕患者经常用到的基本助孕方案,但其临床妊娠率相对较低;相关文献表明内膜微刺激通过提高内膜容受性能改善不明原因反复移植失败患者体外受精-胚胎移植(IVF-ET)的妊娠结局,那么,其是否同样有益于改善IUI的妊娠结局呢?本文就有关内膜微刺激改善子宫内膜容受性的最新作用机制及IUI临床妊娠率能否得到改善的最新研究进行概述。     

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。     

影响男性不育官腔内人工授精妊娠率的因素分析

目的探讨影响男性不育患者行宫腔内人工授精（IUI）临床妊娠的相关因素。方法回顾性分析337对不孕夫妇因男性因素行IUI共667周期的资料,分析男女双方年龄、不孕年限、女方体重指数（BMI）、促排卵方案以及处理后前向运动精子总数（PTMS）对临床妊娠率的影响。结果女方年龄≥35岁者临床妊娠率为12．6％,显著低于年龄〈30岁者;男方年龄≥35岁者临床妊娠率为15．9%,显著低于年龄〈35岁者;克罗米芬联合促性腺激素周期临床妊娠率为25．5％,显著高于自然周期;PTMS〈5×10^6临床妊娠率为8．3％,显著低于PTMS≥10×10^6（P〈0．05）。结论男性不育患者行IUI治疗过程中需要充分考虑男女双方年龄对治疗结局的影响,适时选择促排卵方案,以提高临床妊娠率;当PTMS〈5×10^6,IUI妊娠率显著下降,建议行IVF-ET／ICSI—ET治疗以改善妊娠结局。     

Platelet-activating factor significantly enhances intrauterine insemination pregnancy rates in non-male factor infertility

OBJECTIVE: To determine the efficacy of treating semen specimens with platelet-activating factor (PAF) before IUI. DESIGN: Prospective randomized double-blinded study of PAF treatment of sperm for patients with a history of infertility undergoing IUI. SETTING: Private infertility center. INTERVENTION(S): Patients had ovulation induction therapy with clomiphene citrate (CC) or gonadotropin, two IUIs per month with PAF treatment. MAIN OUTCOME MEASURE(S): Clinical pregnancy rates. RESULT(S): There was a significant difference in IUI pregnancy rates per cycle between control (10/56; 17.9%) and PAF (14/47; 29.8%) treatment groups in the normal male study arm. There was a significant difference in cumulative IUI pregnancy rates between control (10/35; 28.6%) and PAF (14/26; 53.9%) patient groups in the normal male study arm. There was no significant difference in IUI pregnancy rates per cycle between control (12/124; 9.7%) and PAF (14/119; 11.8%) treatment groups in the male factor study arm. There was no significant difference in cumulative IUI pregnancy rates between control (12/46; 26.1%) and PAF (14/38; 36.8%) patient groups in the male factor study arm. There was a significant difference in overall cumulative IUI pregnancy rates between control (21/81; 25.9%) and PAF (27/64; 42.2%) patient groups. CONCLUSION(S): The inclusion of PAF into the IUI sperm wash procedure significantly improves pregnancy rates. However, the significant improvement can only be shown to affect men presenting with normal semen parameters.