供精人工授精临床妊娠率影响因素分析

摘要

目的 探讨多种因素对供精人工授精(AID)临床妊娠率的影响. 方法 回顾性分析2010年1月至2016年12月因男方因素于国家卫计委科研所计划生育生殖健康技术服务中心接受AID手术治疗的患者2 040例,共3 889个治疗周期.探讨AID临床妊娠率与女方年龄、不孕年限、不孕类型、治疗周期数、治疗方案、手术方式的关系. 结果 <30岁组与30~<35岁组AID妊娠率(分别为25.23%、23.91%)显著高于35~<40岁组和40岁以上组(分别为17.61%、9.38%)(P<0.05);不孕≤5年的女性AID妊娠率(25.15%)显著高于不孕>5年女性的妊娠率(20.90%)(P<0.01);继发不孕女性的AID妊娠率(30.18%)显著高于原发不孕女性(22.75%)(P<0.01).AID实施第1至第4周期,每周期妊娠率比较无显著性差异(分别为24.88%、23.26%、20.92%和23.12%,P>0.05).促排周期组的妊娠率稍高于自然周期组(分别为24.15%和22.71%),但无显著性差异(P>0.05).促排周期组的多胎率显著高于自然周期组(分别为5.36%和1.39%)(P<0.01).4种手术方式中宫颈管内人工授精+宫腔内人工授精(ICI+IUI)组、2次IUI组和1次IUI组的妊娠率分别为25.01%、22.33%和22.75%,组间比较无显著性差异(P>0.05),1次ICI组的妊娠率(4.44%)最低,显著低于其他3种手术方式组(P<0.01). 结论 AID是一种安全、有效的助孕方式;女方年龄、不孕年限、不孕类型是影响AID临床妊娠率的重要因素;促排卵并不增加AID的妊娠率,但会增加多胎妊娠的风险;AID治疗4个周期仍未妊娠者可寻求供精IVF-ET技术助孕.%Objective: To explore the influence factors on the clinical pregnancy rate in artificial insemination with donor sperm (AID). Methods: The data of 3 889 AID cycles of 2 040 infertile couples undergone AID in our center from January 2010 to December 2016 were retrospectively analyzed. The influencing factors of the clinical pregnancy outcome of AID including age,infertile duration,infertile type of female,and number of AID cycles,treatment protocol,and AID operative approaches were evaluated. Results: The clinical pregnancy rate of AID in the women younger than 30 years (25.23%) group and 30-34 years group (23.91%) was significantly higher than that in 35-39 years group (17.61%) and older than 40 years group (9.38%) (P<0.05). The clinical pregnancy rate in the women with infertile duration ≤5 years was significantly higher than that of more than 5 years (25.15% vs. 20.90%,P<0.01).The pregnancy rate of secondary infertility group (30.18%) was significantly higher than that in the primary infertility group (22.75%) (P<0.01). The pregnancy rate in the 1st,2nd,3rd and 4th AID cycle was 24.88%,23.26%,20.92% and 23.12% respectively,and there was no significant difference (P>0.05). The pregnancy rate in ovulation induction cycles was slightly higher than that in the natural cycles (24.15% vs. 22.71%),but it was not significantly different (P>0.05). The multiple pregnancy rate in ovulation induction cycles was significantly higher than that in the natural cycles (5.36% vs. 1.39%,P<0.01). There was no significant difference in pregnancy rate among the intracervical insemination (ICI)+intrauterine insemination (IUI) group (25.01%),2 times of IUI group (22.33%),and 1 time of IUI group (22.75%) (P>0.05). The pregnancy rate in the one time of ICI group (4.44%) was the lowest,which was significantly lower than that in the other three groups (P<0.01). Conclusions: AID is a safe and effective assisted reproductive technique. The age,infertile duration and infertile type of the infertile women are important factors affecting the clinical pregnancy rate of AID. Ovulation induction increases the pregnancy rate of AID,while it also increases the risk of multiple pregnancies. In vitro fertilization with donor sperm can be advised to the patients who failed to pregnant after 4 times of AID cycles.