摘要
目的探讨临床因素对夫精人工授精(AIH)妊娠结局的影响,为提高AIH妊娠率提供理论依据。方法回顾性分析2021年1月至12月于我院生殖中心行AIH的1200个周期的病例资料,比较分析妊娠组(191个周期)和非妊娠组(1009个周期)患者的一般特征及临床资料。在来曲唑(LE)促排卵768个周期中,根据是否加用促性腺激素(Gn)分为LE组(450个周期)和LE+Gn组(318个周期),比较两组的一般情况及临床资料,并采用Logistic回归分析矫正影响妊娠结局的混杂因素。结果1200个周期中,妊娠组和非妊娠组患者的年龄(t=-0.568)、不孕时间(Z=-0.383)、不孕类型(χ^(2)=1.618)、体质指数(BMI)(Z=-0.733)、抗米勒管激素(AMH)(Z=-1.596)、周期类型(χ^(2)=1.357)、是否扳机(χ^(2)=1.320)、扳机药物类型(χ^(2)=2.179)、扳机日子宫内膜厚度(Z=-0.627)、宫腔内人工授精(IUI)时机(χ^(2)=0.094)比较,差异无统计学意义(P>0.05)。318个LE+Gn促排卵周期中妊娠组(64个周期)及未妊娠组(254个周期)的Gn药物类型(χ^(2)=1.442)、用药剂量(Z=-0.827)比较差异无统计学意义(P>0.05)。LE组与LE+Gn组的年龄(t=2.824)、BMI(Z=-4.758)、AMH(Z=-6.018)比较差异有统计学意义(P<0.05)。LE组促排卵时间比LE+Gn组短,子宫内膜厚度比LE+Gn组薄,临床妊娠率和活产率均低于LE+Gn组,差异有统计学意义(t=-18.056,Z=-7.378,χ^(2)=4.303、6.698,P<0.05)。为排除混杂因素的影响,将上述指标纳入Logistic回归分析模型,结果显示LE组与LE+Gn组的BMI(OR=0.928,95%CI:0.876~0.983)、促排卵时间(OR=0.519,95%CI:0.465~0.581)、子宫内膜厚度(OR=0.876,95%CI:0.779~0.985)存在差异(P<0.05)。结论人工授精周期类型、是否扳机及扳机药物类型、手术时机、促排卵Gn类型、剂量均不是影响妊娠结局的关键因素,对于来曲唑促排卵的患者,卵泡生长速度快,子宫内膜偏薄,临床妊娠率及活产率相对偏低,临床工作中需结合患者BMI、月经周期等情况调整来曲唑用药剂量及时间,并根据卵泡大小、内膜厚度、激素水平适时延迟扳机,以期进一步提高AIH妊娠结局。
Objective To explore influence of clinical factors on pregnancy outcome of artificial insemination by husband(AIH),and provide theoretical guidance for improving pregnancy rate of AIH.Methods The clinical data of 1200 AIH cycles in our hospital from January 2021 to December 2021 were retrospectively analyzed.According to pregnancy outcome,the women were divided into pregnancy group(191 cycles)and non-pregnancy group(1009 cycles)and the patient s general information,clinical data were compared between the two groups.Further,768 ovulation induction cycles with letrozole(LE)were divided into LE subgroup(450 cycles)and LE+gonadotropin(Gn)subgroup(318 cycles)according to whether Gn was added.Also,general information and clinical data of the women were compared between the two subgroups.Logistic regression analysis was used to correct for confounding factors affecting pregnancy outcomes.Results In 1200 cycles,there were no statistically significant differences in age(t=-0.568),infertility time(Z=-0.383),infertility type(χ^(2)=1.618),body mass index(BMI)(Z=-0.733),anti-Müllerian hormone(AMH)(Z=-1.596),cycle type(χ^(2)=1.357),trigger or not(χ^(2)=1.320),type of trigger drugs(χ^(2)=2.179),endometrial thickness on the trigger day(Z=-0.627)and intrauterine insemination(IUI)timing(χ^(2)=0.094)between the pregnancy group and the non-pregnancy group(P>0.05).In addition,in 318 ovulation induction cycles with LE+Gn,there were no statistically significant differences in type of medication(χ^(2)=1.442)and Gn dosage(Z=-0.827)between the pregnancy group(64 cycles)and the non-pregnancy groups(254 cycles)(P>0.05).While there were statistically significant differences in age(t=2.824),BMI(Z=-4.758)and AMH(Z=-6.018)between the LE group and the LE+Gn group(P<0.05).The days of ovulation promotion in the former were shorter than those in the latter,and the endometrial thickness was relatively thinner,and there were statistically significant differences(t=-18.056,Z=-7.378,P<0.05).The clinical pregnancy rate and live birth rate in the LE group were lower than those in the LE+Gn group,and the differences were statistically significant(χ^(2)=4.303 and 6.698 respectively,both P<0.05).To eliminate influences of confounding factors,the above indicators were included in Logistic regression analysis model,the results showed that there were differences in BMI(OR=0.928,95%CI:0.876-0.983),ovulation induction time(day)(OR=0.519,95%CI:0.465-0.581)and endometrial thickness(OR=0.876,95%CI:0.779-0.985)between the LE group and the LE+Gn group(P<0.05).Conclusions The type of artificial insemination cycle,trigger or not and type of trigger drug,timing of surgery,Gn type of ovulation induction,and dosage of Gn are all not key factors affecting pregnancy outcomes.For patients who undergo LE induced ovulation,their follicle growth rate is faster,their endometrium is thinner,and the clinical pregnancy rate and live birth rate are relatively lower.In clinical work,it is necessary to adjust dosage and time of LE medication based on the patient s BMI,menstrual cycle and so on,and timely delay the trigger according to follicle size,endometrial thickness,hormone levels,so as to improve pregnancy outcome of AIH.
作者
季晓媛
姜薇
张颂
李德红
凌秀凤
张军强
张娟娟
JI Xiaoyuan;JIANG Wei;ZHANG Song;LI Dehong;LING Xiufeng;ZHANG Junqiang;ZHANG Juanjuan(Center for Reproductive Medicine,The Affiliated Gynecological and Obstetric Hospital of Nanjing Medical University/Nanjing Municipal Maternity and Child Health Hospital,Jiangsu Nanjing 210004,China)
出处
《中国妇幼健康研究》
2025年第8期17-22,共6页
Chinese Journal of Woman and Child Health Research
基金
国家重点研发计划课题(2021YFC2700601)。
关键词
夫精人工授精
排卵诱导
来曲唑
促性腺素类
妊娠结局
artificial insemination by husband
ovulation induction
letrozole
gonadotropins
pregnancy outcome
作者简介
季晓媛(1990-),女,主治医师,主要从事生殖医学研究;通讯作者:张娟娟,副主任医师。
