影响宫腔内人工授精妊娠率的临床及精液因素分析

目的探讨促排卵方案、子宫内膜因素、处理后前向运动精子总数和活动率、受精次数对人工授精妊娠率的影响。方法回顾性分析本中心2009-2010年收治的677对病人促排卵方案,子宫内膜类型及厚度,受精次数,将前向运动精子总数分为7组,即A:(4～9)×106,B:(10～12)×106,C:(13～15)×106,D:(16～20)×106,E:(21～25)×106,F:(26～30)×106,G:>30×106,分别比较各组患者年龄、不孕年限、活动率对临床妊娠率的影响。结果 677个周期共获得88例生化妊娠,79例临床妊娠,平均生化妊娠率为13.15%,临床妊娠率为11.81%。促排卵方案以HMG组最好,子宫内膜类型为三线征及内膜厚度大于8mm是妊娠达到10%以上的必要条件。双次人工授精妊娠率(15.27%)明显高于单次(7.57%)。各活动精子数量组妊娠率分别为0、14.37%、11.92%、15.09%、8.33%、20.34%、6.06%,A组临床妊娠率最低,与其余组比较差异有统计学意义,F组活动率和妊娠率最高,与其余组比较差异有统计学意义。结论促排卵方案以HMG组最好;三线征子宫内膜且厚度大于8mm、(26～30)×106精子密度和84%以上的活动率是获得高妊娠率的先决条件;双次人工授精优于单次。

Analysis of clinical factors affecting intrauterine insemination

Objective To assess the relationship between ovulation induction, the thickness of endometrium, total motile sperm count,sperm motility and times of insemination on the outcome of intrauterine insemination (IUI). Methods Clinical data of 677 infertile couples were analyzed by a retrospective study. According to the A+B sperm count, the patients were divided into 7 groups: (4-9)×106 (group A),(10-12)×106 (group B), (13-15)×106(group C), (16-20)×106(group D),(21-25)×106(group E),(26-30)×106 (group F) and >30×106 (group G). The difference of pregnancy rate and motility rate per treatment cycle among the subgroups was analyzed. The number of insemination on IUI,different ovulation induction and endometrium were analyzed. Results A total of 79 clinical pregnancies were obtained and the overall pregnancy rate was 11.81% per cycle. The pregnancy rate in group A to G was 0, 14.37%, 11.92%, 15.09%, 8.33%, 20.34% and 6.06%, respectively. There was no statistical difference about age and imfertility duration. The pregnancy rate per cycle in groups A was significantly lower than the other groups. The pregnancy rate per cycle in group F was higher than the other groups (P<0.05). Subjects receiving 2 cycles of IUI had a higher pregnant rate (15.27%) than the subjects receiving one cycle of IUI (7.57%). It was best that human menopausal gonadotropin(HMG) was used to induce ovulate than clomiphene citrate(CC) and clinical pregnant rate should higher when the thickness of endometrium was over 8 mm. Conclusion IUI treatment is recommended for the subjects when the A+B sperm is (26-30)×106 and the motility rate was over 84%. Two cycle of IUI is better than the one cycle IUI. The method is especially suitable for the subjects with trilaminar edometrium and with the endometrial thickness of ≥8 mm.