李颖，王慧春，刘慧文，习艳霞，张庆

(北京市海淀区妇幼保健院生殖中心，北京　100080)

夫精人工授精影响因素分析

李颖，王慧春*，刘慧文，习艳霞，张庆

(北京市海淀区妇幼保健院生殖中心，北京100080)

【摘要】目的分析影响夫精宫腔内人工授精(IUI)妊娠率的相关因素。方法回顾性分析2 172例不孕患者在我院行4 630个夫精IUI周期的临床资料。比较女方年龄、不孕时间、子宫内膜厚度、授精时机、促排卵和不孕原因对妊娠率的影响。结果4 630个IUI周期共获得534例临床妊娠，周期妊娠率11.5%。(1)年龄≥40岁的患者IUI妊娠率为5.1%，显著低于年龄<30岁的患者(13.3%)(P<0.05)；(2) HCG日子宫内膜厚度>7 mm的患者IUI妊娠率为12.5%，显著高于HCG日子宫内膜≤7 mm者(8.5%)(P<0.01)；(3)自然周期IUI妊娠率显著低于促排卵周期(9.1% vs.12.6%，P<0.01)；当排卵数为1、2和3时，IUI妊娠率分别为10.0%、15.1%和17.0%，排卵数≥2时临床妊娠率显著增加(P<0.01)；(4) 当排卵数为1时，授精时机即排卵前和/或排卵后授精与妊娠率无显著相关性(P>0.05)；(5)在具有单一不孕原因的患者中，排卵障碍患者的妊娠率显著高于单侧输卵管梗阻者(13.9% vs.7.5%，P<0.05)；(6)多因素logistic回归分析显示，IUI妊娠率与促排卵、HCG日子宫内膜厚度、排卵障碍和子宫内膜异位症有关(P<0.05)。结论女方年龄、促排卵及排卵个数、HCG日子宫内膜厚度及不孕原因是影响本组不孕患者夫精IUI成功的主要因素，而不孕时间、授精时机与IUI妊娠无明显相关。

【关键词】宫腔内人工授精；年龄；促排卵；子宫内膜厚度；不孕原因

Methods： The clinical data of 4 630 intrauterine insemination cycles in 2 172 infertile patients were retrospectively analyzed. The maternal age，infertile duration，endometrial thickness，insemination time，ovulation induction and cause of infertility etc. were compared to explore the correlations between the pregnancy rate and other factors.

Results： There were 534 clinical pregnancies in 4 630 IUI cycles with a clinical pregnancy rate of 11.5% per treatment cycle. The clinical pregnancy rate was significantly higher in patients less than 30 years old compared with the patients ≥40 years old (13.3% vs. 5.1%，P<0.05). The clinical pregnancy rate of patients with endometrial thickness>7 mm on the day of HCG injection was significantly higher than that of the patients with endometrial thickness ≤7 mm (12.5% vs. 8.5%，P<0.01).The clinical pregnancy rate was higher in ovulation induction cycles than that in natural cycles (12.6% vs. 9.1%，P<0.01).The clinical pregnancy rate was 10.0%，15.1% and 17.0% respectively in the patients with 1，2 and 3 dominant follicles. The clinical pregnancy rate was significantly increased when the dominant follicles were ≥2 (P<0.01).In the patients with single dominant follicle，the insemination timing and frequency was not associated with the pregnancy rate(P>0.05). The clinical pregnancy rate of the patients with ovulation dysfunction was significantly higher than that of the patients with unilateral obstruction of fallopian tube (13.9% vs. 7.5%，P<0.05). Multivariate logistic regression analysis revealed that the factors of endometrial thickness，ovulation induction and causes of infertility were associated with the pregnancy rate of IUI (P<0.05).

Conclusions： The major influence factors of success rate of insemination were maternal age，ovulation induction，numbers of dominant follicles，endometrial thickness，and infertility cause. The infertile duration and insemination timing are not associated with pregnancy rate of IUI.

(JReprodMed2016，25(6)：499-504)

宫腔内人工授精(IUI)是一项常用的辅助生殖技术，是指将精液在体外处理后以非性交的方式送入女性子宫腔内从而达到受孕目的。该技术操作简单，创伤性小，费用低，并发症少，因而较易被患者接受，在临床中应用得非常广泛。文献报道IUI妊娠率在8%～22%之间[1]，影响成功的因素也较多[1-11]。本文回顾性分析我院生殖医学中心4 630个IUI周期的临床资料，分析其影响因素，以指导临床应用。

资料与方法

一、研究对象

回顾性分析2007年1月至2015年10月在我院生殖医学中心施行的IUI周期资料。患者夫妻双方在IUI前均进行不育病因筛查，女方检查包括输卵管通畅性试验、阴道超声下排卵监测、月经周期第2～5天性激素检查；……