排卵前优势卵泡直径对供精人工授精结局的影响

doi:10.12280/gjszjk.20200513

摘要/Abstract

摘要：

目的:探讨自然排卵周期、氯米芬（CC）及来曲唑（LE）诱导排卵周期的排卵前优势卵泡直径对供精人工授精（AID）助孕结局的影响。方法:回顾性分析2012年1月—2019年8月南京医科大学第一附属医院进行的2 675个自然排卵AID周期、547个CC诱导排卵AID周期、1 566个LE诱导排卵AID周期的超声及临床资料;分别按排卵前优势卵泡直径分组,了解助孕结局随优势卵泡直径的变化特征,并据此设立各排卵方案的卵泡直径优势组及对照组;采用单因素及多因素Logistic回归分析验证优势组在宫内妊娠及持续妊娠方面的相对优势。结果:自然周期卵泡直径16.0~19.9 mm时的宫内妊娠率（23.01% vs. 19.13%,aOR=1.260,P=0.035）及持续妊娠率（20.57% vs. 16.88%,aOR=1.277,P=0.034）均高于卵泡直径≥20.0 mm时;CC诱导排卵周期卵泡直径18.0~21.9 mm时的宫内妊娠率高于卵泡直径<18.0 mm或≥22.0 mm时（26.86% vs. 16.85%,aOR=1.898,P=0.036）;LE诱导排卵周期卵泡直径18.0~20.0 mm时的宫内妊娠率（23.90% vs. 18.08%,aOR=1.405,P=0.013）及持续妊娠率（22.28% vs. 16.35%,aOR=1.449,P=0.009）均高于卵泡直径<18.0 mm或>20.0 mm时。结论:AID助孕中,自然周期、CC及LE诱导排卵周期的排卵前卵泡直径最佳范围分别为16.0~19.9 mm、18.0~21.9 mm及18.0~20.0 mm。

关键词: 排卵诱导, 授精, 人工, 妊娠率, 氯米芬, 芳香酶抑制剂, 排卵前优势卵泡直径

Abstract:

Objective: To investigate the relastionship between preovulatory dominant follicle size (PDFS) and the outcome of artificial insemination with donor sperm (AID) in natural cycle (NC) and the ovulation induction cycles using clomiphene citrate (CC) or letrozole (LE) respectively.Methods: The clinical data of 2 675 natural cycles (NC-AID), 547 CC-induced cycles (CC-AID) and 1 566 LE-induced cycles (LE-AID) in AID procedures performed between January 2012 and August 2019 were retrospectively analyzed. These AID cycles were respectively grouped according to preovulatory dominant follicle size(PDFS) to understand the variation characteristics of AID outcomes, and to group them respectively into two sub-groups: the dominant group and the control group. The relative advantages of the dominant group in terms of intrauterine pregnancy rate (IPR) and ongoing pregnancy rate (OPR) were analyzed by the univariate and multivariate logical regression.Results: In NC-AID, the IPR and OPR in PDFS 16.0-19.9 mm were significantly higher than those in PDFS ≥20.0 mm (23.01% vs. 19.13%, aOR=1.260, P=0.035; 20.57% vs. 16.88%, aOR=1.277, P=0.034). In CC-AID, the IPR in PDFS 18.0-21.9 mm was significantly higher than that in PDFS<18.0 mm or ≥22.0 mm (26.86% vs. 16.85%, aOR=1.898, P=0.036). In LE-AID, the IPR and OPR in PDFS 18.0-20.0 mm were significantly higher than those in PDFS<18.0 mm or≥20.0 mm (23.90% vs. 18.08%, aOR=1.405, P=0.013; 22.28% vs. 16.35%, aOR=1.449, P=0.009).Conclusions: In AID procedure, the optimal ranges of PDFS in the NC, CC or LE cycles were 16.0-19.9 mm, 18.0-21.9 mm and 18.0-20.0 mm, respectively.

Key words: Ovulation induction, Insemination, artificial, Pregnancy rate, Clomiphene, Aromatase inhibitors, Preovulatory dominant follicle size

倪丽莉, 王菁, 刁飞扬, 马翔, 冒韵东, 刘嘉茵, 刘金勇. 排卵前优势卵泡直径对供精人工授精结局的影响[J]. 国际生殖健康/计划生育, 2021, 40(1): 1-5.

NI Li-li, WANG Jing, DIAO Fei-yang, MA Xiang, MAO Yun-dong, LIU Jia-yin, LIU Jin-yong. Relationship between Preovulatory Dominant Follicle Size and the Outcome of Artificial Insemination with Donor Sperm[J]. Journal of International Reproductive Health/Family Planning, 2021, 40(1): 1-5.

图/表 8

参考文献 18

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按助孕结局分组	周期数	女方年龄（周岁）	女方BMI（kg/m²）	周期序号	卵泡期天数（d）	内膜厚度（mm）	精子浓度（×10⁶/mL）	PR总数（×10⁶）
宫内妊娠组	588	27.67±3.21	21.68±2.73	1.53±0.85	15.22±3.14	10.52±1.93	50.09±14.81	16.72±6.09
未获宫内妊娠组	2 087	28.20±3.37	21.63±2.90	1.64±0.98	15.34±3.25	10.25±1.97	49.54±13.77	16.69±6.00
t		3.406	0.352	2.731	0.742	2.883	0.848	0.097
P		0.001	0.725	0.006	0.458	0.004	0.397	0.923
持续妊娠组	524	27.59±3.16	21.57±2.65	1.54±0.87	15.19±3.14	10.54±1.95	50.28±15.01	16.76±6.19
未获持续妊娠组	2 151	28.21±3.38	21.66±2.91	1.63±0.97	15.34±3.25	10.25±1.97	49.51±13.75	16.68±5.97
t		3.987	0.698	2.138	0.956	2.962	1.122	0.287
P		<0.001	0.485	0.033	0.339	0.003	0.262	0.774

按助孕结局分组	周期数	女方年龄（周岁）	女方BMI（kg/m²）	周期序号	卵泡期天数（d）	内膜厚度（mm）	精子浓度（×10⁶/mL）	PR总数（×10⁶）
宫内妊娠组	588	27.67±3.21	21.68±2.73	1.53±0.85	15.22±3.14	10.52±1.93	50.09±14.81	16.72±6.09
未获宫内妊娠组	2 087	28.20±3.37	21.63±2.90	1.64±0.98	15.34±3.25	10.25±1.97	49.54±13.77	16.69±6.00
t		3.406	0.352	2.731	0.742	2.883	0.848	0.097
P		0.001	0.725	0.006	0.458	0.004	0.397	0.923
持续妊娠组	524	27.59±3.16	21.57±2.65	1.54±0.87	15.19±3.14	10.54±1.95	50.28±15.01	16.76±6.19
未获持续妊娠组	2 151	28.21±3.38	21.66±2.91	1.63±0.97	15.34±3.25	10.25±1.97	49.51±13.75	16.68±5.97
t		3.987	0.698	2.138	0.956	2.962	1.122	0.287
P		<0.001	0.485	0.033	0.339	0.003	0.262	0.774

按助孕结局分组	周期数	女方年龄（周岁）	女方BMI（kg/m²）	周期序号	卵泡期天数（d）	内膜厚度（mm）	精子浓度（×10⁶/mL）	PR总数（×10⁶）
宫内妊娠组	138	27.67±3.22	21.87±2.73	2.04±1.02	14.27±2.26	9.91±2.12	51.38±14.33	16.41±4.89
未获宫内妊娠组	409	28.38±3.14	21.91±2.74	2.17±1.13	14.12±2.15	9.42±2.23	49.78±13.73	16.62±5.76
t		2.279	0.145	1.203	0.679	2.268	1.165	0.386
P		0.023	0.885	0.230	0.497	0.024	0.245	0.700
持续妊娠组	117	27.50±3.13	21.86±2.76	2.01±1.01	14.22±2.21	9.81±2.07	50.46±14.23	16.16±4.91
未获持续妊娠组	430	28.40±3.16	21.92±2.73	2.18±1.12	14.14±2.17	9.47±2.25	50.11±13.81	16.68±5.71
t		2.740	0.207	1.556	0.353	1.461	0.241	0.903
P		0.006	0.836	0.121	0.724	0.145	0.809	0.367

按助孕结局分组	周期数	女方年龄（周岁）	女方BMI（kg/m²）	周期序号	卵泡期天数（d）	内膜厚度（mm）	精子浓度（×10⁶/mL）	PR总数（×10⁶）
宫内妊娠组	138	27.67±3.22	21.87±2.73	2.04±1.02	14.27±2.26	9.91±2.12	51.38±14.33	16.41±4.89
未获宫内妊娠组	409	28.38±3.14	21.91±2.74	2.17±1.13	14.12±2.15	9.42±2.23	49.78±13.73	16.62±5.76
t		2.279	0.145	1.203	0.679	2.268	1.165	0.386
P		0.023	0.885	0.230	0.497	0.024	0.245	0.700
持续妊娠组	117	27.50±3.13	21.86±2.76	2.01±1.01	14.22±2.21	9.81±2.07	50.46±14.23	16.16±4.91
未获持续妊娠组	430	28.40±3.16	21.92±2.73	2.18±1.12	14.14±2.17	9.47±2.25	50.11±13.81	16.68±5.71
t		2.740	0.207	1.556	0.353	1.461	0.241	0.903
P		0.006	0.836	0.121	0.724	0.145	0.809	0.367

按助孕结局分组	周期数	女方年龄（岁）	女方BMI（kg/m²）	周期序号	卵泡期天数（d）	内膜厚度（mm）	精子浓度（×10⁶/mL）	PR总数（×10⁶）
宫内妊娠组	344	27.72±3.28	21.78±2.82	2.23±0.98	13.71±2.17	9.39±1.99	48.20±11.20	15.99±4.41
未获宫内妊娠组	1222	28.30±3.55	22.10±3.10	2.54±1.14	13.58±1.95	9.39±1.88	48.07±11.64	15.48±4.57
t		2.814	1.745	4.945	1.099	0.026	0.196	1.827
P		0.005	0.081	<0.001	0.272	0.979	0.845	0.068
持续妊娠组	318	27.72±3.23	21.79±2.81	2.24±1.00	13.70±2.19	9.33±1.97	48.15±11.22	15.95±4.37
未获持续妊娠组	1248	28.30±3.55	22.09±3.10	2.53±1.13	13.58±1.96	9.40±1.89	48.08±11.62	15.50±4.57
t		2.822	1.564	4.553	0.873	0.567	0.090	1.572
P		0.005	0.118	<0.001	0.383	0.571	0.928	0.116