实用医学杂志 ›› 2022, Vol. 38 ›› Issue (24): 3106-3111.doi: 10.3969/j.issn.1006⁃5725.2022.24.015

• 临床研究 • 上一篇    下一篇

不明原因不孕人群宫腔内夫精人工授精妊娠结局分析及预测模型构建 

李斯晨1,2,3,4 刘海英1,2,3,4 曹明珠1,2,3,4 刘见桥1,2,3,4    

  1. 广州医科大学附属第三医院 1 妇产科,2 生殖医学中心(广州510150);3 广东省产科重大疾病重点实验室 (广州510150);4 广东省生殖医学重点实验室(广州510150)

  • 出版日期:2022-12-25 发布日期:2022-12-25
  • 通讯作者: 刘见桥 E⁃mail:liujqssz@gzhmu.edu.cn
  • 基金资助:
    国家自然科学基金委员会项目(编号:81971452);广州市校(院)联合资助项目(编号:202201020212)

Reproductive outcomes of unexplained infertile couples following intrauterine insemination and construc⁃ tion of prediction models

LI Sichen*,LIU Haiying,CAO Mingzhu,LIU Jianqiao.   

  1. Department of Obstetrics and Gynecology,Center for Reproductive Medicine,the Third Affiliated Hospital of Guangzhou Medical University Guangzhou 510150,China;*Guangdong Provincial Key Laboratory of Major Obstetric Diseases,Guangzhou 510150 China;*Key Laboratory for Reproductive Medicine of Guangdong Province,Guangzhou 510150,China

  • Online:2022-12-25 Published:2022-12-25
  • Contact: LIU Jianqiao E⁃mail:liujqssz@gzhmu.edu.cn

摘要:

目的 探索真实临床世界中不明原因不孕夫妇宫腔内夫精人工授精(intrauterine insemina⁃ tion,IUI)妊娠结局的影响因子,构建妊娠结局的预测模型。方法 回顾性分析本中心进行 IUI 的不明原 因不孕夫妇(女方年龄< 40 岁且抗缪勒氏管激素(anti⁃Müllerian hormone,AMH)≥ 1.1 pg/mL)。研究主要 终点是周期活产率,次要终点是周期临床妊娠率。采用 logistic 回归及受试者工作特征曲线构建妊娠结局 预测模型。结果 本研究纳入 2 601 个不明原因不孕 IUI 周期,活产率组和非活产率组,以及临床妊娠组和非临床妊娠组的临床特征中,单因素分析显示,AMH 水平(活产:OR = 1.06,95%CI:1.02 ~ 1.11;临床妊娠:OR = 1.05,95%CI:1.01 ~ 1.09)和是否促排卵(活产:OR = 4.74,95%CI:3.48 ~ 6.46;临床妊娠:OR = 4.35,95%CI:3.31 ~ 5.72)与妊娠结局有显著影响。是否促排卵周期+AMH 联合预测活产率和临床妊娠率的 AUC分别为:0.70(95%CI:0.66 ~ 0.74),0.68(95%CI:0.65 ~ 0.72)。结论 联合是否促排卵周期和 AMH 水平能够较好地预测不明原因不孕夫妇 IUI 的周期活产率和周期临床妊娠率,高 AMH 结合促排卵治疗能帮助患者获得更好的妊娠结局。

关键词:

不明原因不孕, 宫腔内夫精人工授精, 抗抗缪勒氏管激素, 促排卵, 妊娠结局

Abstract:

Objective To investigate the influencing factors affecting the reproductive outcomes of unexplained infertile couples following intrauterine insemination(IUI),and construct prediction models of their reproductive outcomes. Methods The clinical data of the unexplained infertile couples(female,less than 40 years old)and the anti⁃Mullerian hormone(AMH)levels ≥ 1.1 pg/mL)were retrospectively analysed The primary and secondary outcomes of this study were the live birth rate per cycle and the clinical pregnancy rate per cycle respectively. The predictive models of live birth rate and clinical pregnancy rate were constructed using logistic regression,and their accuracies were determined by areas under the receiver operating characteristic curve(AUC). Results The study included 2601 cycles of IUI for unexplained infertile couples. Univariable regression analyses of the clinical data from the live birth group vs. non live birth group,and from clinical pregnancy group vs. non clinical pregnancy group found that,AMH levels(live birth:OR = 1.06,95%CI:1.02 ~ 1.11,and clinical preg⁃ nancy,OR = 1.05,95%CI:1.01 ~ 1.09)and ovarian stimulation(live birth:OR = 4.74,95%CI:3.48 ~ 6.46,and clinical pregnancy,OR = 4.35,95%CI:3.31 ~ 5.72)had significant impacts on the reproductive outcomes. Predic⁃ tion models with AMH levels and ovulation stimulation could predict the live birth rate and clinical pregnancy rate per cycle with AUC at 0.70(95%CI:0.66 ~ 0.74)for the live birth and at 0.68(95%CI:0.65 ~ 0.72)for the clinical pregnancy. Conclusion Prediction models with ovulation stimulation and AMH levels can predict live birth rate and clinical pregnancy rate of unexplained infertile couples following IUI. Those with high AMH levels and the help of ovarian stimulation could end up with better reproductive outcomes.

Key words:

unexplained infertility, intrauterine insemination, anti ? mullerian hormone (AMH), ovarian stimulation, reproductive outcomes