不孕年限对宫腔内夫精人工授精成功率的影响  

Effect of infertility duration on the success rate of intrauterine insemination by husband sperm

作　　者：董辰悦 王雪 田沛哲 张翠莲 DONG Chen-yue;WANG Xue;TIAN Pei-zhe;ZHANG Cui-lian(Reproductive Medicine Center of Henan Provincial People’s Hospital,Zhengzhou University People’s Hospital,Zhengzhou 450003)

机构地区：[1]郑州大学人民医院河南省人民医院生殖医学中心,郑州450003

出　　处：《生殖医学杂志》2024年第10期1295-1300,共6页Journal of Reproductive Medicine

摘　　要：目的探讨不孕年限对宫腔内人工授精妊娠结局的影响。方法采用回顾性队列研究,分析2016年9月至2023年6月期间在河南省人民医院生殖医学中心行宫腔内夫精人工授精(AIH)的患者临床资料,共3465个周期。通过多因素Logistic回归分析、曲线拟合以及按年龄、抗苗勒管激素(AMH)水平、是否促排卵、周期内是否二次授精等分层分析探讨不孕年限对AIH临床结局的影响。结果纳入的AIH周期中,女方平均年龄为(30.64±4.00)岁,平均不孕年限为(3.19±1.94)年,临床妊娠率为13.25%(459/3465)。多元Logistic回归分析显示,不孕年限是AIH临床妊娠率的独立影响因素[OR=0.94,95%CI(0.88,0.99),P=0.0267],且不孕年限每增加1年,临床妊娠率下降6%。曲线拟合结果显示,随着不孕年限增加,临床妊娠率降低,该效应近似于直线,无显著拐点。分层分析结果显示,在高卵巢储备、使用促排卵周期、周期内二次授精的人群中,不孕年限对临床妊娠率影响不显著(P>0.05)。结论随着不孕年限增加,AIH临床妊娠率下降,但不孕年限长的患者接受AIH仍有妊娠的可能,尤其在卵巢高储备人群中;另外,采用促排卵周期AIH和排卵前后两次人工授精可能有助于提高临床妊娠率。Objective:To investigate the effect of infertility duration on pregnancy outcomes of intrauterine artificial insemination with husband semen(AIH).Methods:A retrospective cohort study was conducted to analyze the clinical data of patients who underwent AIH in Henan Provincial People’s Hospital from September 2016 to June 2023,with a total of 3465 cycles.Multivariate logistic regression analysis,curve fitting,and stratified analysis according to age,anti-Müllerian hormone(AMH)level,ovulation induction,and the second insemination in the cycle were used to explore the effect of infertility duration on the clinical outcomes of AIH.Results:In AIH cycles recruited,the average age of women was(30.64±4.00)years,the average duration of infertility was(3.19±1.94)years,and the clinical pregnancy rate was 13.25%(459/3465).Multivariate logistic regression analysis showed that the duration of infertility was an independent influencing factor of clinical pregnancy rate[OR=0.94,95%CI(0.88,0.99),P=0.0267],and the clinical pregnancy rate decreased by 6%for each additional year of the duration of infertility.The results of curve fitting showed that the clinical pregnancy rate decreased with the increase of infertility duration,and the effect was approximately a straight line without an inflection point.The results of stratified analysis showed that the effect of infertility duration on clinical pregnancy rate was not significant in women with high ovarian reserve,using ovarian stimulation cycle,and the second insemination in the cycle(P>0.05).Conclusions:With the increase of infertility duration,the clinical pregnancy rate after AIH decreases.However,patients with a long history of infertility still have the possibility of pregnancy after AIH,especially in patients with high ovarian reserve.In addition,AIH and two cycles of artificial insemination before and after ovulation may help to improve the clinical pregnancy rate.

关 键 词：不孕年限 宫腔内人工授精 临床妊娠率 

分 类 号：R711.6[医药卫生—妇产科学]