Nikolov Bogoje, Folić Miroslav, Tabs Dunja, Nikolić Romana
Klinika za ginekologiju i akuserstvo, Klinicko-bolnicki centar Kragujevac.
Med Pregl. 2003 Nov-Dec;56(11-12):548-51.
During the period 1996-2000, we investigated 900 couples with infertility. In 71 (7.9%) couples no cause of sterility was revealed. These patients were divided according to age, parity and infertility duration.
We established the cumulative conception rate and cycle fecundity after three months without therapy, after three cycles of intrauterine insemination and after three cycles of in vitro fertilization (eventually intracytoplasmic sperm injection). Among patients with less than three years of infertility, cumulative conception rate was 34.8% after three months without therapy, 27.3% after three cycles of intrauterine insemination and 66.7% after three cycles of in vitro fertilization.
In patients with infertility longer than three years, cumulative conception rate without therapy was 12.5%, with intrauterine insemination 16.1% and with in vitro fertilization 40.5%. Differences regarding the age of patients were significant. Based on these findings, we proposed an optimal therapy regimen: three months therapy delay is desirable in patients under 30 years of age with infertility duration under three years. If there is no pregnancy in that period, intrauterine insemination is performed in three to four cycles. In case of intrauterine insemination failure in these women, in vitro fertilization and embryo transfer should be applied. In the group of women over 30 years of age, with infertility longer than three years, the possibility for occurrence of pregnancy with intrauterine insemination is slightly increased. If more than 4 follicles develop during preparations for intrauterine insemination, it is advisable to change the course to in vitro fertilization. In women older than 35, with primary or secondary infertility, in vitro fertilization should be performed from the very beginning.
在1996年至2000年期间，我们对900对不孕夫妇进行了调查。在71对（7.9%）夫妇中未发现不育原因。这些患者根据年龄、生育史和不孕持续时间进行了分组。
我们确定了在未经治疗三个月后、经三个周期宫腔内人工授精后以及经三个周期体外受精（最终为卵胞浆内单精子注射）后的累积妊娠率和周期受孕力。在不孕时间少于三年的患者中，未经治疗三个月后的累积妊娠率为34.8%，经三个周期宫腔内人工授精后的累积妊娠率为27.3%，经三个周期体外受精后的累积妊娠率为66.7%。
在不孕时间超过三年的患者中，未经治疗的累积妊娠率为12.5%，经宫腔内人工授精的累积妊娠率为16.1%，经体外受精的累积妊娠率为40.5%。患者年龄方面的差异具有显著性。基于这些发现，我们提出了一种最佳治疗方案：对于年龄小于30岁、不孕持续时间少于三年的患者，建议延迟治疗三个月。如果在此期间未怀孕，则进行三到四个周期的宫腔内人工授精。如果这些女性宫腔内人工授精失败，则应进行体外受精和胚胎移植。在年龄超过30岁、不孕持续时间超过三年的女性组中，宫腔内人工授精受孕的可能性略有增加。如果在宫腔内人工授精准备过程中发育出超过4个卵泡，建议改为体外受精。对于年龄超过35岁、原发性或继发性不孕的女性，应从一开始就进行体外受精。
