女性体质量指数对排卵障碍不孕患者夫精人工授精妊娠结局的影响  

The effect of female body mass index on pregnancy outcomes in anovulatory patients with intrauterine artificial insemination with husband sperm

作　　者：李岚新 武世勋 谢青贞[1] 漆倩荣[1] LI Lan-xin;WU Shi-xun;XIE Qing-zhen;QI Qian-rong(Reproductive Medical Center,Renmin Hospital of Wuhan University,Wuhan 430060)

机构地区：[1]武汉大学人民医院生殖医学中心,武汉430060

出　　处：《生殖医学杂志》2024年第4期458-465,共8页Journal of Reproductive Medicine

基　　金：湖北省重点研发计划(2021BCA107)。

摘　　要：目的探讨女性体质量指数(BMI)对排卵障碍不孕患者行夫精人工授精(AIH)助孕妊娠结局的影响。方法回顾性分析2018年1月至2022年5月在我中心因排卵障碍因素行AIH助孕的不孕患者共1240个周期的临床资料,根据女性不同BMI值分为4组:BMI<19 kg/m^(2)为低体重组(n=154)、19 kg/m^(2)≤BMI<24 kg/m^(2)为正常体重组(n=799)、24 kg/m^(2)≤BMI<27 kg/m^(2)为超重组(n=197)、BMI≥27 kg/m^(2)为肥胖组(n=90),比较各组患者的一般情况、促排卵及AIH治疗、妊娠结局及新生儿情况;采用多因素Logistic回归分析临床妊娠率和活产率的影响因素。结果各组间女方年龄、不孕年限、既往妊娠和促排卵次数、及基础FSH水平比较均无显著差异(P>0.05),超重组和肥胖组基础雌二醇(E 2)水平显著高于正常体重组(P<0.05),与正常体重组比较,低体重组、超重组和肥胖组患者抗苗勒管激素(AMH)水平显著降低(P<0.05)。与正常体重组比较,超重组和肥胖组促排卵方案中使用尿促性腺激素(HMG)所占比例显著升高(P<0.05),各组间优势卵泡数、授精日内膜厚度、精液参数、授精时机和次数比较均无显著差异(P>0.05)。低体重组临床妊娠率显著低于正常体重组(P<0.05),各组间多胎妊娠率、流产率、异位妊娠率、活产率、新生儿出生体重和性别比比较无显著差异(P>0.05),低体重组早产率显著高于正常体重组(P<0.05),超重组和肥胖组剖宫产比例显著高于正常体重组(P<0.05)。多因素Logistic回归分析结果显示,排除年龄和卵巢储备功能等混杂因素后,女性BMI对AIH临床妊娠率和活产率无显著影响(P>0.05)。结论对于排卵障碍性超重和肥胖患者,BMI的升高并未降低其AIH临床妊娠率和活产率,而低体重可能潜在降低患者AIH的临床妊娠率。Objective:To analyze the effect of female body mass index(BMI)on pregnancy outcomes in anovulatory patients with intrauterine artificial insemination with husband sperm(AIH).Methods:Data from anovulatory patients who received AIH assisted pregnancy in Reproductive Medicine Center of People’s Hospital of Wuhan University from January 2018 to May 2022 were retrospectively analyzed.According to the female BMI,the included participants were divided into low BMI group(BMI<19 kg/m^(2),n=154),normal weight group(19 kg/m^(2)≤BMI<24 kg/m^(2),n=799),overweight group(24 kg/m^(2)≤BMI<27 kg/m^(2),n=197),and obesity group(BMI≥27 kg/m^(2),n=90).The cycle characteristics,induced ovulation and AIH treatment,pregnancy outcomes and newborn situation were compared among the four groups.Multi-factor logistic regression analysis was performed to analyze the risk factors for live birth.Results:There was no significant difference in female age,infertility years,previous number of pregnancies and induced ovulation treatment as well as the baseline level of follicular stimulating hormone among the four groups(P>0.05).The baseline estradiol level was significantly increased in overweight and obesity groups(P<0.05)when compared to the normal group,while the anti-Müllerian hormone level was remarkably decreased in low BMI,overweight,and obesity groups than that in the normal group(P<0.05).The proportion of human menopausal gonadotropin use during ovarian induction was significantly increased in overweight and obesity groups when compared to the normal group(P<0.05).The number of dominant follicles,endometrium thickness on the insemination day,sperm parameters,insemination timing and frequency were comparable among the four groups(P>0.05).The clinical pregnancy rate was significantly decreased in low BMI group when compared with normal groups(P<0.05),The rates of multiple pregnancy,pregnancy loss,ectopic pregnancy,live birth,newborn weight and gender ratio were comparable among the four groups(P>0.05).The rate of premature labor was

关 键 词：体质量指数 夫精人工授精 肥胖 妊娠结局 

分 类 号：R711.6[医药卫生—妇产科学]