Objective To explore the prediction value of the infertility time on outcome of intrauterine insemination (IUI) treatment.Methods A retrospective analysis was performed on 947 patients with 1 628 cycles of IUI treatment in Luoyang Central Hospital Affiliated to Zhengzhou University.The patients were divided into ＜ 3 a group,3-5 a group and ＞ 5 a group according to the infertility time.The effect of infertility time on the pregnancy rate were studied in different age,type of infertility,causes of infertility and the different body mass index (BMI) subgroups.Results The first clinical pregnancy rate of patients in the 3 a group,3-5 a group and ＞ 5 a group was 15.67％ (88/561),11.15％ (31/278),8.33％ (9/108) respectively;the cumulative clinical pregnancy rate of patients in the above three groups was 23.71％ (133/561),24.01％ (67/278),16.67％ (14/108)respectively.The first clinical pregnancy rates of patients in the three groups decreased with the increasing of the infertility time,there were statistic difference in the first clinical pregnancy rates among the three groups (P ＜0.05).The cumulative clinical pregnancy rate of patients whose infertility time was ＞ 5 a was significantly lower than that whose infertility time was ＜ 3 a and 3-5 a (P ＜ 0.05);there was no statistic difference in the cumulative clinical pregnancy rate between the whose infertility time was ＜ 3 a and 3-5 a (P ＞ 0.05).Logistic regression analysis showed that infertility time was an independent risk factors for influencing the clinical pregnancy rate of the first treatment cycle (P ＜ 0.05).In the ≤30 years old group,there was no statistic difference in the first clinical pregnancy rate of patients with different infertility time (P ＞ 0.05);the cumulative clinical pregnancy rate of patients whose infertility time was ＜ 3 a and 3-5 a was significantly higher than that whose infertility time was ＞ 5 a (P ＜ 0.05).In the 30-35 years old group,the first clinical pregnancy rate of patients whose infertility time was ＜ 3 a was significantly higher than that whose infertility time was ＞ 5 a (P ＜ 0.05);there was no statistic difference in the cumulative clinical pregnancy rate among patients whose infertility time was ＜ 3 a,3-5 a and ＞ 5 a (P ＞ 0.05).In the ＞ 35 years old group,there was no statistic difference in the first clinical pregnancy rates and cumulative clinical pregnancy rates among patients whose infertility time was ＜3 a,3-5 a and ＞5 a (P ＞0.05).In the primary infertility group,there was no statistic difference in the first clinical pregnancy rates among patients whose infertility time was ＜ 3 a,3-5 a and ＞ 5 a (P ＞ 0.05);the cumulative clinical pregnancy rate of patients whose infertility time was 3-5 a was significantly higher than that whose infertility time was ＞ 5 a (P ＜ 0.05);there was no statistic difference in the cumulative clinical pregnancy rate between the patients whose infertility time was 3-5 a,＞ 5 a and ＜ 3 a (P ＞ 0.05).In the secondary infertility group,the first clinical pregnancy rate of patients whose infertility time was ＜ 3 a was significantly higher than that whose infertility time was 3-5 a (P ＜ 0.05);there was no statistic difference in the first clinical pregnancy rate between the patients whose infertility time was ＜3 a,3-5 a and ＞5 a (P ＞0.05);the cumulative clinical pregnancy rate of patients whose infertility time was ＜ 3 a was significantly higher than that whose infertility time was ＞ 5 a (P ＜ 0.05);there was no statistic difference in the cumulative clinical pregnancy rate between the patients whose infertility time was ＜ 3 a,＞ 5 a and 3-5 a (P ＞ 0.05).In the ovulation disorder group,male factor group and unexplained infertility group,there was no statistic difference in the first clinical pregnancy rates and cumulative clinical pregnancy rates among the patients whose infertility time was ＜3 a,3-5 a and ＞5 a (P ＞0.05).In the tubal factor group,the first clinical pregnancy rate of patients whose infertility time was ＜ 3 a group was significantly higher than that whose infertility time was 3-5 a P ＜ 0.05);there was no statistic difference in the first clinical pregnancy rate between the patients whose infertility time was ＜ 3 a,3-5 a and ＞ 5 a (P ＞ 0.05);there was no statistic difference in the cumulative clinical pregnancy rate among the patients whose infertility time was ＜ 3 a,3-5 a and ＞ 5 a (P ＞ 0.05).In the BMI ＜ 23 kg · m-2 group,the first clinical pregnancy rate of patients patients whose infertility time was ＜ 3 a was significantly higher than that patients whose infertility time was 3-5 a (P ＜ 0.05);there was no statistic difference in the first clinical pregnancy rate between the patients whose infertility time was ＜ 3 a,3-5 a and ＞ 5 a (P ＞ 0.05);there was no statistic difference in the cumulative clinical pregnancy rate among the patients whose infertility time was ＜3 a,3-5 a and ＞5 a (P＞0.05).In the BMI 23-28 kg · m-1 group,the first clinical pregnancy rate of patients whose infertility time was ＜ 3 a was significantly higher than that whose infertility time was ＞ 5 a (P ＜ 0.05);there was no statistic difference in the first clinical pregnancy rate between the patients whose infertility time was ＜ 3 a,＞ 5 a and 3-5 a(P ＞ 0.05);the cumulative clinical pregnancy rate of patients whose infertility time was 3-5 a was significantly higher than that whose infertility time was ＞ 5 a (P ＜ 0.05);there was no statistic difference in the cumulative clinical pregnancy rate between the patients whose infertility time was 3-5 a,＞5 a and ＜3 a (P ＞0.05).In the BMI ≥28 kg · m-2 group,there was no statistic difference in the first clinical pregnancy rates and cumulative clinical pregnancy rates among the patients whose infertility time was ＜ 3 a,3-5 a and ＞ 5 a (P ＞ 0.05).Conclusions When the infertility time is more than 5 years,the pregnancy rate of IUI treatment decrease.When the infertility time of infertile women who is more than 35 year old,and combined with tubal factors,BMI abnormality is over 3 years,the more complex assisted reproductive technology should be considered.%目的 探讨不孕时间对宫腔内人工授精(IUI)结局的预测价值.方法 回顾性分析于郑州大学附属洛阳中心医院行IUI的947例不孕患者(共1 628个周期)的临床资料.将患者按照不孕时间分为＜3a组、3～5a组和＞5a组,分别研究各年龄段、不孕类型、不孕原因及不同体质量指数(BMI)组内不孕时间对其妊娠率的影响.结果 总体上不孕时间＜3a组、3～5a组和＞5a组患者的首次临床妊娠率分别为15.67％(88/561)、11.15％(31/278)、8.33％(9/108),累计临床妊娠率分别为23.71％(133/561)、24.01％ (67/278)、16.67％(14/108),3组患者的首次临床妊娠率随不孕时间增加而降低,组间两两比较差异均有统计学意义(P＜0.05);不孕时间＞5a组患者的累计临床妊娠率明显小于＜3a组和3～5a组(P＜0.05);不孕时间＜3a组和3～5a组患者累计临床妊娠率比较差异无统计学意义(P＞0.05).Logistic回归分析结果显示,不孕时间为影响IUI首个周期临床妊娠的独立危险因素(P＜0.05).≤30岁组不同不孕时间患者的首次妊娠率比较差异均无统计学意义(P＞0.05);不孕时间＜3a和3～5a患者的累计妊娠率高于不孕时间＞5a患者(P＜0.05).30～35岁组不孕时间＜3a患者的首次妊娠率高于不孕时间＞5a患者(P＜0.05);不同不孕时间患者的累积临床妊娠率比较差异无统计学意义(P＞0.05).＞35岁组不同不孕时间患者的首次妊娠率和累计临床妊娠率比较差异均无统计学意义(P＞0.05).原发不孕组不同不孕时间患者的首次临床妊娠率比较差异均无统计学意义(P＞0.05);不孕时间3～5a患者的累计临床妊娠率明显高于不孕时间＞5a患者(P＜0.05);不孕时间3 ～5 a和＞5a患者的累计临床妊娠率与不孕时间＜3a患者比较差异无统计学意义(P＞0.05).继发不孕组不孕时间＜3a患者的首次临床妊娠率明显高于不孕时间3～5a患者(P＜0.05);不孕时间＜3a和3～5a患者的首次临床妊娠率与不孕时间＞5a患者比较差异无统计学意义(P＞0.05).不孕时间＜3a患者的累计妊娠率高于不孕时间＞5a(P＜0.05);不孕时间3～5a患者的累计临床妊娠率与不孕时间＜3a和＞5a患者比较差异均无统计学意义(P＞0.05).排卵障碍组、男方因素组和不明原因组不同不孕时间患者的首次临床妊娠率和累计临床妊娠率比较差异均无统计学意义(P＞0.05).输卵管因素组不孕时间《3a患者的首次临床妊娠率明显高于不孕时间3～5a患者(P＜0.05);不孕时间＞5a患者首次临床妊娠率与不孕时间＜3a和3～5a患者比较差异均无统计学差异(P＞0.05);累计妊娠率3组比较差异均无统计学意义(P＞0.05).BMI＜ 23 kg·m-2组不孕时间＜3a患者的首次临床妊娠率明显高于不孕时间3～5a患者(P＜0.05);不孕时间＞5a患者首次临床妊娠率与不孕时间＜3a和3～5a患者比较差异均无统计学意义(P＞0.05);累计妊娠率3组患者比较差异均无统计学意义(P＞0.05).BMI 23 ～28 kg·m-2组不孕时间＞5a患者的首次临床妊娠率明显低于不孕时间＜3a患者(P＜0.05);不孕时间3～5a患者的首次临床妊娠率与不孕时间＜3a和＞5a患者比较差异均无统计学意义(P＞0.05);不孕时间3～5a患者的累计妊娠率明显高于不孕时间＞5a患者(P＜0.05);不孕时间＜3a患者的累计妊娠率与不孕时间3～5a和＞5a患者比较差异均无统计学意义(P＞0.05).BMI≥28 kg·m-2组各不孕时间组首次临床妊娠率和累计临床妊娠率比较差异均无统计学意义(P＞0.05).结论 当不孕时间＞5a时预示IUI妊娠率下降.不孕时间＞3a时若合并女方大于35岁、输卵管因素、BMI异常的夫妇可考虑接受更为复杂的辅助生殖技术.
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