剖宫产史对不孕症患者人工授精助孕结局的影响  

The Influence of Cesarean Section History on the Outcome of Artificial Insemination Assisted Pregnancy in Infertile Patients

作　　者：邓冰冰 林津[1,2] 龚秀芳 黄惠 李萍[1,2] DENG Bingbing;LIN Jin;GONG Xiufang;HUANG Hui;LI Ping(Department of Reproductive Medicine,Women and Children′s Hospital,School of Medicine,Xiamen University,Xiamen Fujian 361003,China;Xiamen Key Laboratory of Reproduction and Genetics,Xiamen Fujian 361003,China)

机构地区：[1]厦门大学附属妇女儿童医院(厦门市妇幼保健院)生殖医学科,福建厦门361003 [2]厦门市生殖与遗传重点实验室,福建厦门361003

出　　处：《中国卫生标准管理》2024年第19期15-19,共5页China Health Standard Management

基　　金：厦门市医疗卫生指导性项目(3502Z20209195)。

摘　　要：目的研究剖宫产史对人工授精助孕临床妊娠率的影响。方法回顾性分析2012年2月—2022年6月在厦门大学附属妇女儿童医院生殖医学科接受夫精人工授精(artificial insemination by husband,AIH)治疗的至少有1次活胎分娩史的不孕患者336例,共560个周期,其中瘢痕子宫组203个周期,阴道分娩组357个周期。比较2组年龄、身体质量指数(body mass index,BMI)、输卵管盆腔因素、内膜异位症占比、治疗方案及助孕结果等。结果2组的年龄、高龄占比(>35岁)、不孕年限、输卵管盆腔因素、内膜异位症占比比较,差异无统计学意义(P>0.05)。瘢痕子宫组患者BMI为(22.30±3.27)kg/m^(2),高于阴道分娩组的(21.67±2.76)kg/m^(2)(P<0.05)。瘢痕子宫组BMI>23 kg/m^(2)的比例为36.9%,高于阴道分娩组的29.7%,差异无统计学意义(P=0.078)。瘢痕子宫组诱导排卵方案占比为53.7%(109/203),高于经阴道分娩组的44.3%(158/357),差异有统计学意义(P<0.05)。瘢痕子宫组临床妊娠率为15.3%,阴道分娩组为16.5%,差异无统计学意义(P=0.853)。结论通过适当的干预与筛选,可以提高有剖宫产史妇女的宫腔内人工授精临床妊娠率。Objective To analysis the effect of history of cesarean section on the clinical pregnancy rate of artificial insemination.Methods A retrospective analysis was performed on 336 infertile patients with at least one live birth history who received artificial insemination by husband(AIH)treatment at the department of reproductive medicine,Women and Children′s Hospital,School of Medicine,Xiamen University,from February 2012 to June 2022,with a total of 560 cycles,including 203 cycles in the cesarean section group and 357 cycles in the other group.Age,BMI,tubal and pelvic factors,history of endometriosis,treatment protocol and pregnancy result were compared in the two groups.Results There were no significant differences in age,senior age(>35 years old),infertility duration,tubal-pelvic factors and history of endometriosis between the two groups.Body mass index(BMI)in cesarean section group was significantly higher than that in vaginal 2 delivery group,(22.30±3.27)kg/m and(21.67±2.76)kg/m^(2),respectively(P<0.05).The proportion of patient′s BMI over 23 kg/m^(2)in cesarean section group was higher than that of the vaginal delivery group,36.9%and 29.7%,respectively,the difference was not statistically significant(P=0.078).The proportion of induced ovulation in cesarean section group was significant higher than that in vaginal delivery group(53.7%vs.44.3%,P<0.05).The clinical pregnancy rate of cesarean section group was 15.3%,and that of vaginal delivery group was 16.5%,the difference was not statistically significant(P=0.853).Conclusion Through appropriate intervention and screening,the clinical pregnancy rate of IUI in women with a history of cesarean section can be improved.

关 键 词：剖宫产史 阴道分娩 夫精人工授精 临床妊娠率 诱导排卵 身体质量指数 

分 类 号：R394[医药卫生—医学遗传学]