Campana A, Gurtner P, Schwarz W, Stamm O
Geburtshilfe Frauenheilkd. 1976 May;36(5):421-9.
This paper is concerned with the causes of spontaneous abortion in a sample of 200 pregnancies induced by artificial insemination. In particular it examines the importance of the following factors: existing disorders in the woman's menstrual cycle, the influence of hormone treatment during the conception cycle, the age of the woman treated, and the type of semen used. Of the 200 pregnancies in our treatment sample 27 terminated in abortions (13.5%). Clinical examination before treatment established the presence of menstrual disorders in 69 of 180 women to be treated: 23.9% exhibited corpus luteum deficiency, 12% anovular cycles, and 2% oligomenorrhea. On the basis of this preliminary examination the principal cause of abortion proved to be an existing corpus luteum deficiency, since 15 of the 27 abortions occurred in women with this type of menstrual disorder. Our observations show that it is important when performing artificial insemination to correct the patient's existing menstrual disorders by means of hormone treatment. This emerges from the following figures: In 26 cases without hormone treatment the incidence of abortion was 35%. In 174 cases that received hormone treatment during the successful cycle only 18 abortions occurred (an incidence of 10.3%). Breaking down hormone treatment into 6 basic types, we get incidences of abortion ranging from 0 to 25% in the different groups. Dividing the treatment sample into age groups reveals an 11 to 14% incidence of abortion in the 30 to 34 age group; in the 35 to 40 group age group the incidence doubles to 26%. Whereas existing menstrual disorders and adequate hormone treatment significantly influence the incidence of abortion, there is no close relationship between incidence of abortion and the type of semen used. The innocuousness of using deep-frozen semen with an admixture of glycerine has been shown by various authors reporting on laboratory and clinical investigations. For 117 pregnancies induced purely with deep-frozen semen we had an incidence of abortion of 13.7%. This figure is of the same order as the incidence of abortion in pregnancies induced by insemination with fresh semen. The results obtained permit one to conclude that incidence of abortion is not significantly dependent on the type of semen used. Our work demonstrates the importance of assessing the patient's genital constitution from both the functional and the organic points of view, not merely in order to achieve conception but also for the purposes of preventing abortion by means of the appropriate hormone treatment. If satisfactory therapeutic results are to be achieved candidates for artificial insemination must therefore be given a thorough diagnostic examination beforehand and, if necessary, adequate hormone treatment during the insemination cycle.
本文关注的是200例人工授精诱导妊娠样本中自然流产的原因。具体而言，它考察了以下因素的重要性：女性月经周期中现有的紊乱情况、受孕周期中激素治疗的影响、接受治疗的女性年龄以及所用精液的类型。在我们的治疗样本中的200例妊娠中，有27例以流产告终（13.5%）。治疗前的临床检查确定，在180名待治疗的女性中，有69名存在月经紊乱：23.9%表现为黄体功能不全，12%为无排卵周期，2%为月经过少。基于这项初步检查，流产的主要原因被证明是现有的黄体功能不全，因为27例流产中有15例发生在患有这种月经紊乱类型的女性身上。我们的观察表明，在进行人工授精时，通过激素治疗纠正患者现有的月经紊乱很重要。这从以下数据可以看出：在26例未接受激素治疗的病例中，流产发生率为35%。在174例在成功周期接受激素治疗的病例中，仅发生了18例流产（发生率为10.3%）。将激素治疗细分为6种基本类型，我们得到不同组的流产发生率在0%至25%之间。将治疗样本按年龄组划分显示，30至34岁年龄组的流产发生率为11%至14%；在35至40岁年龄组，该发生率翻倍至26%。虽然现有的月经紊乱和适当的激素治疗会显著影响流产发生率，但流产发生率与所用精液类型之间没有密切关系。不同作者报告的实验室和临床研究表明，使用添加甘油的冷冻精液是无害的。对于117例纯用冷冻精液诱导的妊娠，我们的流产发生率为13.7%。这个数字与用新鲜精液授精诱导妊娠的流产发生率处于同一水平。所获得的结果使人们可以得出结论，流产发生率并不显著取决于所用精液的类型。我们的工作表明，从功能和器质性角度评估患者的生殖体质很重要，这不仅是为了实现受孕，也是为了通过适当的激素治疗预防流产。因此，如果要取得令人满意的治疗效果，人工授精的候选者必须事先接受全面的诊断检查，如有必要，则在授精周期进行适当的激素治疗。
