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。

Analysis of the clinical outcome of 10 690 artificial insemination cycles with donor sperma

Objective To analyze the effects ofvarious factors on the clinical outcome of artificial insemination with donor sperm (AID).Methods A total of 10 690 AID cycles were analyzed between 2013 and 2015 in our center.The relationship between the clinical outcome and the factors,such as woman's age,duration of infertility,therapeutic regimen,fallopian tube patency,endometrial thickness,number of eggs ovulated per cycle,number of insemination per cycle,sperm concentration after thawing,sperm activity ratio after thawing and the total number of progressively motile sperm was analyzed by x2 and multiple factor Logistic regression.Results The pregnancy opportunity was 1.934 times of women who were younger than or equal to 30 years (OR=1.934,P＜0.001) and 1.511 times of women aged 31-35 years (OR =1.511,P＜0.001) as high as those who were older than 35 years.It was 1.307 times of women received the natural cycle as high as that of women received ovulation induction cycle (OR=1.307,P＜0.001).It was 1.486 times of women received double inseminations per cycle (OR=1.486,P=0.001),and 1.338 times of women received three inseminations per cycle (OR=1.338,P=0.020) as high as that of women received one insemination per cycle.It was 1.362 times of women with 2 eggs ovulated per cycle (OR=1.362,P=-0.001),and 1.499 times of women with 3 eggs ovulated per cycle (OR=1.499,P=0.004) as high as that of women with one egg ovulated per cycle.It was 1.211 times of women received sperm with sperm activity ratio more than 60％ after thawing as high as that of women received sperm with sperm activity ratio less than or equal to 60％ after thawing (OR=1.211,P=0.038).It was 1.319 times of women received the progressively motile sperm more than or equal to 35 × 106 after thawing as high as that of women received the progressively motile sperm less than or equal to 25 × 106 after thawing (OR=l.319,P=-0.011).Conclusion Many factors such as woman's age less than or equal to 35 years,double or three inseminations per cycle,2 or 3 eggs ovulated per cycle,sperm activity ratio more than 60％ after thawing and the progressively motile sperm more than or equal to 35 × 106 after thawing can improve the pregnancy rate.In the case of patients with no obvious ovulation disorders,natural cycle should be preferred.