摘要
目的探讨通过供精人工授精(AID)助孕获得首次单胎活产后患者的二孩生育情况以及活产率影响因素。方法回顾性分析2010年1月至2020年12月于我所临床医学中心接受AID助孕首次妊娠单胎活产后截至2024年9月再次返回该中心AID助孕二孩患者的临床资料,了解AID助孕二孩患者的生育情况,分析影响AID二孩活产率的可能影响因素。结果共160例患者回诊要求AID助孕二孩,回诊率为13.91%。最终纳入153例患者的347个治疗周期进行分析,患者以农村户籍(73.20%)、初中学历(39.87%)为主;一孩男女性别比为0.55(55/99),女孩多于男孩;50.33%的患者年龄在30~<35岁之间;56.21%的患者两孩助孕间隔在2~<5年之间;49.67%的患者使用过一孩精液助孕二孩,50.33%的患者未使用一孩精液助孕二孩。AID二孩助孕结局:AID二孩周期临床妊娠率27.09%(94/347),流产率17.02%(16/94),活产率22.48%(78/347),活单胎分娩率98.72%(77/78),活双胎分娩率1.28%(1/78)。AID患者二孩活产率影响因素分析:随着患者年龄增加AID活产率逐渐下降。<30岁组的活产率(34.33%)显著高于30~<35岁组(21.23%)和35~<40岁组(17.02%)(P<0.05),但与≥40岁组(14.29%)无显著差异(P>0.05);不同两孩助孕间隔、是否使用一孩精液、是否促排卵、不同促排卵方案以及不同手术方式之间的活产率均无显著差异(P均>0.05);3个AID周期的活产率(8.93%)显著低于1个(26.14%)、2个(23.60%)及5个及以上周期(31.25%)(P<0.05)。结论患者年龄是AID二孩活产率的主要影响因素,两孩助孕间隔、是否使用一孩精液、AID治疗方案和手术方式均不影响AID二孩活产率。考虑到供精助孕伦理方面的特殊性,应对患者做好宣教,尽可能为AID助孕二孩患者使用一孩精液助孕提供便利。
Objective:To explore the fertility status of patients who gave birth to their second child after achieving their first singleton live birth through artificial insemination with donor semen(AID)and the factors influencing the live birth rate.Methods:A retrospective analysis was conducted on the clinical data of patients who underwent AID for their first pregnancy and achieved a singleton live birth at the Clinical Medical Center of the National Research Institute for Family Planning from January 2010 to December 2020,and subsequently returned to the center for AID to conceive their second child by September 2024.The fertility status of these patients undergoing AID for their second child was investigated,and potential factors affecting the live birth rate of AID-conceived second children were analyzed.Results:A total of 160 patients returned for a second child,with a return rate of 13.91%.Analysis was conducted on 347 treatment cycles from 153 patients,with the majority of being from rural registered residence(73.20%)and having a junior high school education(39.87%).The gender ratio of first-child males to females was 0.55(55/99),with more girls than boys.About 50.33%of patients were aged not less than 30 and less than 35 years,56.21%of patients had a second-child conception interval not less than 2 and not more than 5 years,49.67%of patients used semen for the conception of their first child,while 50.33%did not.Outcomes of AID assisted conception for a second child showed that the clinical pregnancy rate of AID cycles for a second child was 27.09%(94/347),the abortion rate was 17.02%(16/94),the live birth rate was 22.48%(78/347),the live single birth rate was 98.72%(77/78),and the live twin birth rate was 1.28%(1/78).Analysis results of factors affecting the live birth rate in AID patients conceiving a second child showed that the live birth rate gradually decreased with increasing patient age.The live birth rate in women aged less than 30 years(34.33%)was significantly higher than those of women aged between not less than 30 and less than 35 years(21.23%)as well as between not less than 35 and less than 40 years(17.02%)(both P<0.05),but there was no significant difference compared to the women aged not less than 40 years(14.29%)(P>0.05).There were no significant differences in live birth rates between different intervals for conceiving a second child,whether the same semen as the first child was used,and between different strategies of ovulation induction as well as different surgical methods(all P>0.05).The live birth rate in three AID cycles(8.93%)was significantly lower than that in one(26.14%),two(23.60%),and five or more cycles(31.25%)(P<0.05).Conclusions:The patient’s age is the main influencing factor of the live birth rate of the second child in AID.The time interval between two pregnancies,whether the same semen as that of the first child is used,the treatment regimen,and the surgical method do not affect the live birth rate of the second child conceived through AID.Considering the ethical particularities of donor-assisted fertilization,it is necessary to provide education and guidance to patients,and facilitate the use of the same semen for AID-assisted conception in second-child patients as for first-child patients.
作者
张蔚
张敏
张广志
陈娟
ZHANG Wei;ZHANG Min;ZHANG Guang-zhi;CHEN Juan(Clinical Medical Center,National Research Institute for Family Planning,Beijing 100081;Hospital of Minzu University of China,Beijing 100080)
出处
《生殖医学杂志》
2025年第6期749-756,共8页
Journal of Reproductive Medicine
基金
中央级公益性科研院所基本科研业务费专项(2022GJZD0103)。
关键词
供精人工授精
二孩
活产
生育意愿
Artificial insemination with donor semen
Second child
Live birth
Fertility intention
