男性因素对宫腔内人工授精临床妊娠率的影响

目的：探讨男性因素对宫腔内人工授精（IUI）临床妊娠率的影响。方法：回顾性分析239对不孕夫妇行472个IUI周期的资料，分析男方年龄（＜30岁，30~35岁，≥35岁）、精子正常形态百分率（正常精子形态≥15%，10%~15%，5%~10%，≤4%）及精液处理后前向运动精子总数（PTMS）[＜2×106，（2~15）×106，（5~10）×106，（10~20）×106，≥20×106]对IUI临床妊娠率的影响。结果：472个IUI周期共获得80例临床妊娠，周期妊娠率16.95%，累积妊娠率33.47%。男方年龄≥35岁IUI组临床妊娠率显著下降，仅为10.4%（14/134）；重度畸形精子症组周期临床妊娠率为8.4%（7/83），低于其他各组，差异有统计学意义（P＜0.05）。结论：IUI治疗过程中要充分考虑男方年龄对治疗结果的影响，当精子正常形态百分率＜5%或PTMS＜2×106时，IUI临床妊娠率显著下降，建议行体外受精-胚胎移植/胞浆内单精子注射-胚胎移植治疗以改善妊娠结局。

Effects of Male Factors on Outcomes of Intrauterine Insemination

Objective: To assess the effects of male factors on the clinical pregnancy rate of intrauterine insemination（IUI）. Methods： The data of 472 IUI cycles from January 2012 to April 2013 in our center were retrospectively analyzed. These cycles were divided into three groups according to male age（＜30，30～35，≥35 years），four groups according to the percentage of normal morphological spermatozoa（normal：≥15%；mild，moderate and severe abnormal：10%-15%，5%-10%，≤4%）, or five groups according to the processed total motile sperm count（PTMS）（＜2×106，（2-5）×106，（5-10）×106，（10-20）×106，≥20×106）. Then the clinical pregnancy rates were compared. Results：A total of 80 clinical pregnancies were obtained，for a pregnancy rate per cycle of 16.95% and accumulative rate 33.47%. The clinical pregnancy rate in the ≥35 years old group was 10.4%，in severe abnormal group was 8.4%. These rates were significantly lower than those of other groups（P＜0.05）. Conclusions：Male factors such as age, the percentage of normal morphological spermatozoa, and PTMS should be considered during IUI therapy. Those couples with male age ≥35 years, severe abnormal spermatozoa, or PTMS ＜2×106, should be advised to treat with IVF-ET or ICSI-ET.