Gubert Palma G, Pudwell Jessica, Van Vugt Dean, Reid Robert L, Velez Maria P
Department of Obstetrics and Gynaecology, Division of Reproductive Endocrinology and Infertility, Queen's University, Kingston Health Sciences Centre, 76 Stuart Street, Victory 4, Kingston, ON K7L 2V7 Canada.
Fertil Res Pract. 2019 Sep 2;5:10. doi: 10.1186/s40738-019-0062-z. eCollection 2019.
To determine whether age modifies the effect of the number of motile spermatozoa inseminated (NMSI) as a predictor of success in Intrauterine Insemination (IUI).
This retrospective cohort study included all patients who underwent IUI at an academic infertility center between October 2004 and June 2018. The primary outcome was clinical pregnancy (CP; a gestational sac and fetal heartbeat on ultrasound). Results were analyzed by patient factors including age, NMSI, duration of infertility, and cause of infertility, along with treatment factors such as number of follicles and ovulation induction protocol. Factors associated with the odds of achieving a clinical pregnancy were analyzed using binary logistic generalized estimating equations to control for clustering effects by couple. Female age was categorized as <35 years vs. ≥35 years.
Seven hundred thirty-seven couples that underwent 2062 IUI cycles for heterogeneous indications were included. The overall CP rate was 15.1% per cycle, and the cumulative CP rate per couple was 35.9%. For females < 35 years, the odds of CP per cycle were reduced for NMSI categories (× 10) of < 5.0 vs. ≥10.0 (OR = 0.49; 95% CI 0.29-0.83); the odds of CP per cycle did not differ for NMSI 5.0-9.9 vs. ≥10.0 (OR = 0.66; 0.37-1.18). For those ≥35 years, no difference was seen in the odds of CP per cycle for NMSI categories < 5.0 vs. ≥10.0 (OR = 1.55; 95% CI 0.72-3.31) or 5.0-9.9 vs. ≥10.0 (OR = 1.04; 95% CI 0.48-2.27).
These results suggest that the NMSI can be used as a predictor of success in IUI in couples with women who are < 35 years of age; these patients should be counselled about their lower pregnancy rates when the NMSI is < 5.0 × 10. In patients ≥35 years, the NMSI does not appear to be a useful predictor of success. Further studies with larger sample size should be conducted.
确定年龄是否会改变宫腔内人工授精（IUI）时，输入的活动精子数量（NMSI）作为成功预测指标的作用。
这项回顾性队列研究纳入了2004年10月至2018年6月期间在一家学术性不孕不育中心接受IUI的所有患者。主要结局是临床妊娠（CP；超声检查发现妊娠囊和胎心）。通过患者因素（包括年龄、NMSI、不孕持续时间和不孕原因）以及治疗因素（如卵泡数量和促排卵方案）分析结果。使用二元逻辑广义估计方程分析与实现临床妊娠几率相关的因素，以控制夫妻的聚类效应。女性年龄分为<35岁和≥35岁。
纳入了737对夫妇，他们因各种不同指征接受了2062个IUI周期。总体每个周期的CP率为15.1%，每对夫妇的累积CP率为35.9%。对于<35岁的女性，与NMSI类别（×10）<5.0相比，≥10.0时每个周期的CP几率降低（OR = 0.49；95% CI 0.29 - 0.83）；NMSI为5.0 - 9.9与≥10.0时每个周期的CP几率没有差异（OR = 0.66；0.37 - 1.18）。对于≥35岁的女性，NMSI类别<5.0与≥10.0（OR = 1.55；95% CI 0.72 - 3.31）或5.0 - 9.9与≥10.0（OR = 1.04；95% CI 0.48 - 2.27）时每个周期的CP几率没有差异。
这些结果表明，NMSI可作为<35岁女性夫妇IUI成功的预测指标；当NMSI<5.0×10时，应向这些患者咨询其较低的妊娠率。对于≥35岁的患者，NMSI似乎不是成功的有用预测指标。应进行更大样本量的进一步研究。
