非输卵管性不孕症中宫腔内人工授精与输卵管内精子灌注的比较
Intrauterine insemination versus fallopian tube sperm perfusion in non-tubal infertility.
作者信息
Shekhawat G S
机构信息
Professor, Dept of Obst & Gynae, Smt Kashibai Navale Medical College, Narhe, Pune 411041, India.
出版信息
Med J Armed Forces India. 2012 Jul;68(3):226-30. doi: 10.1016/j.mjafi.2012.02.013. Epub 2012 May 12.
BACKGROUND
Controlled ovarian hyperstimulation (COH) combined with intrauterine insemination (IUI), using a volume of 0.5 ml of inseminate is commonly offered to couples with non-tubal sub fertility. Another method is Fallopian tube sperm perfusion (FSP) which is based on a pressure injection of 4 ml of sperm suspension while attempting to seal the cervix to prevent semen reflux. This technique ensures the presence of higher sperm density in the fallopian tubes at the time of ovulation than standard IUI. The aim of this study was to compare the efficiency of standard intrauterine insemination (IUI) and Fallopian tube sperm perfusion (FSP) in the treatment of non-tubal infertility.
METHODS
200 consecutive patients with infertility in 404 stimulated cycles were included in the study. Those randomized to standard IUI included 100 patients in 184 cycles [158 clomiphene citrate/human menopausal gonadotrophin cycles and 26 Letrozole/FSH cycles exclusively for polycystic ovarian disease patients] (group A). Patients subjected to FSP included 100 patients in 220 cycles (193 clomiphene citrate/human menopausal gonadotrophin cycles and 27 Letrozole/FSH cycles exclusively for polycystic ovarian disease patients] (group B). Swim up semen preparation technique was used in all cases. Insemination was performed in both groups 34-37 h after hCG administration. Standard IUI was performed using 0.5 ml of inseminate. In FSP 4 ml inseminate was used.
RESULTS
In group A (184 IUI cycles in 100 patients), 22 clinical pregnancies (presence of gestational sac with fetal cardiac activity) occurred (11.95% per cycle over four cycles). In group B, (220 cycles of FSP in 100 patients), 48 clinical pregnancies occurred (21.81% per cycle over four cycles) and this difference was statistically significant (p < 0.05).
CONCLUSIONS
For non-tubal sub fertility, the results indicate clear benefit for FSP (Fallopian tube sperm perfusion) over IUI (Intrauterine insemination).
背景
对于非输卵管性亚生育夫妇，通常采用控制性卵巢过度刺激（COH）联合宫腔内人工授精（IUI），授精体积为0.5ml。另一种方法是输卵管精子灌注（FSP），该方法基于在试图封闭宫颈以防止精液反流的同时，压力注射4ml精子悬液。与标准IUI相比，该技术可确保排卵时输卵管内精子密度更高。本研究的目的是比较标准宫腔内人工授精（IUI）和输卵管精子灌注（FSP）治疗非输卵管性不孕的疗效。
方法
本研究纳入了404个促排卵周期中连续的200例不孕患者。随机分配至标准IUI组的有100例患者，共184个周期[158个枸橼酸氯米芬/人绝经期促性腺激素周期和26个仅针对多囊卵巢疾病患者的来曲唑/FSH周期]（A组）。接受FSP的患者有100例，共220个周期（193个枸橼酸氯米芬/人绝经期促性腺激素周期和27个仅针对多囊卵巢疾病患者的来曲唑/FSH周期]（B组）。所有病例均采用上游精液制备技术。两组均在注射hCG后34 - 37小时进行授精。标准IUI使用0.5ml授精液。FSP使用4ml授精液。
结果
A组（100例患者的184个IUI周期）发生22例临床妊娠（有胎心搏动的妊娠囊）（四个周期内每个周期发生率为11.95%）。B组（100例患者的220个FSP周期）发生48例临床妊娠（四个周期内每个周期发生率为21.81%），差异具有统计学意义（p < 0.05）。
结论
对于非输卵管性亚生育，结果表明输卵管精子灌注（FSP）比宫腔内人工授精（IUI）有明显优势。
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