摘要
目的分析高龄女性行夫精人工授精(AIH)的相关临床资料,探索改善高龄女性宫腔内人工受精(IUI)助孕结局的方法。方法回顾性分析2015年1月至2021年3月在我院生殖医学中心进行AIH助孕治疗的35岁及以上的不孕症女性临床资料(高龄组,2198周期),并依据促排卵方案的不同分为自然周期组(NC组,814周期)、来曲唑组(LE组,658周期)、来曲唑+尿促性素组(LE+HMG组,726周期)3个亚组,比较分析亚组组间一般资料和临床结局。以同时期年轻女性(<35岁)的AIH助孕临床资料为对照(对照组,2079周期),分析年龄组间的临床结局差异。结果与对照组比较,高龄组临床妊娠率(11.06%vs.17.60%)和活产率(8.46%vs.15.30%)显著下降,而流产率(23.05%vs.10.38%)和早产率(9.05%vs.3.29%)显著上升,差异均有统计学意义(P<0.05)。高龄组内,LE+HMG方案组较NC组和LE组有着更多的成熟卵泡数和更厚的子宫内膜厚度(P<0.001),以及更高的临床妊娠率(13.50%vs.10.32%、9.27%,P<0.05)和更高的活产率(10.61%vs.7.74%、6.99%,P<0.05);而不同方案组间流产率和早产率差异无统计学意义(P>0.05)。结论女性高龄显著降低了AIH临床妊娠率和活产率,增加了流产和早产的发生率;来曲唑联合尿促性素促排卵可增加高龄女性的成熟卵泡数和子宫内膜厚度,提升AIH临床妊娠率和活产率。
Objective:To analyze the clinical data of artificial insemination with husband sperm(AIH)in elderly women,and explore the methods to improve the outcome of assisted pregnancy.Methods:The clinical data of infertile women≥35 years old(elderly group,2198 cycles)who underwent AIH treatment in the reproductive center of our hospital from January 2015 to March 2021 were retrospectively analyzed.The cycles in elderly group were divided into three subgroups:natural cycle(NC group,814 cycles),letrozole(LE group,658 cycles),and letrozole+urinary gonadotropin(LE+HMG group,726 cycles)according to different ovulation induction protocols.The general data and clinical outcomes among the subgroups were compared and analyzed.Clinical data of 2079 AIH cycles were collected from women<35 years of age during the same period as the control group and compared with the elderly group.General data and clinical outcomes were compared and analyzed between the different age groups.Results:The clinical pregnancy rate(11.06%vs.17.60%)and live birth rate(8.46%vs.15.30%)were significantly decreased,while the miscarriage rate(23.05%vs.10.38%)and preterm birth rate(9.05%vs.3.29%)were significantly higher in elderly group than that in control group(P<0.05).In the elderly group,the patients in LE+HMG subgroup had more mature follicles and thicker endometrial thickness(P<0.001),and higher clinical pregnancy rate(13.50%vs.10.32%vs.9.27%,P<0.05)and higher live birth rate(10.61%vs.7.74%vs.6.99%,P<0.05)than that in NC subgroup and LE subgroup.There were no significant differences in abortion rate and premature birth rate among the three subgroups(P>0.05).Conclusions:Female advanced age significantly reduces the clinical pregnancy rate and live birth rate of AIH,and increases the incidence of abortion and premature delivery.Letrozole combined with urinary gonadotropin can increase the number of mature follicles and endometrial thickness,and improve the clinical pregnancy rate and live birth rate of AIH in older women.
作者
朱素芹
姜雯雯
李榕珊
郑备红
陈晓菁
ZHU Su-qin;JIANG Wen-wen;LI Rong-shan;ZHENG Bei-hong;CHEN Xiao-jing(Reproductive Medicine Center of Fujian Maternity&Child Health Hospital,Affiliated Hospital of Fujian Medical University,Fuzhou 350001)
出处
《生殖医学杂志》
CAS
2022年第7期943-947,共5页
Journal of Reproductive Medicine
基金
福建省自然科学基金项目(2019J01511)
福建省妇幼保健院科技创新基金(YCXM18-15)。
关键词
夫精人工授精
高龄女性
活产率
促排卵方案
Artificial insemination with husband sperm
Advanced age women
Live birth rate
Ovulation induction protocol
