Satwik Ruma, Kochhar Mohinder
Centre of IVF and Human Reproduction Institute of Obstetrics and Gynaecology Sir Ganga Ram Hospital New Delhi India.
Reprod Med Biol. 2021 Feb 1;20(2):190-198. doi: 10.1002/rmb2.12368. eCollection 2021 Apr.
To determine how subcategorizing unexplained infertility based on female laparoscopy and total-motile-sperm-count assessment would impact cumulative live-births after one in-vitro fertilization (IVF) cycle.
Seven hundred twenty one IVF cycles from Jan 2014-April 2019 performed at a single-center were retrospectively analyzed. Couples with unexplained infertility having normal uterine and endometrial morphology were subcategorized into three cohorts, UI (1): those with no tuboperitoneal pathology on laparoscopy and total-motile-sperm-count (TMSC) ≧20 million: n = 103; UI (2): tuboperitoneal pathology on laparoscopy or TMSC <20 million, n = 86; and UI(3): tuboperitoneal status not known: n = 114. Controls were severe male factor, bilateral tubal block, and grade 3/4 endometriosis: n = 418. Primary Outcome was cumulative-live-birth-per-initiated-IVF cycle (CLBR). Odds ratio for live-births were adjusted for confounding factors.
The CLBR in UI1 cohort was significantly lower than controls (29.1% vs 39; OR = 0.62; 95%CI = 0.39-0.98; = .04); but similar in UI2 and UI3 vs. controls. (37.2% vs 39.95%; OR = 0.89, 95%CI = 0.55-1.44; = .89) and (38.6% vs 39.95%; OR = 0.98, 95%CI = 0.64-1.55; = .98). After adjusting for age, infertility duration, past live-births, and AMH, the adjusted odds for CLBR in UI1 was 0.48 (95%CI = 0.28-0.82; = .007).
Unexplained infertility when defined after a normal laparoscopy and TMSC significantly lowered cumulative-live-births-per-initiated-IVF cycle when compared with traditional diagnosis of tubal, endometriosis, or male factor infertility. In UI subcategory with abnormal laparoscopy or TMSC, CLBR remained unaffected. This information could be useful for counseling couples prior to IVF. Large-scale prospective studies are needed to confirm this observation.
确定根据女性腹腔镜检查和总活动精子计数评估对不明原因不孕症进行亚分类如何影响一个体外受精（IVF）周期后的累积活产率。
回顾性分析了2014年1月至2019年4月在单一中心进行的721个IVF周期。将子宫和子宫内膜形态正常的不明原因不孕症夫妇分为三个队列，UI（1）：腹腔镜检查无输卵管腹膜病变且总活动精子计数（TMSC）≥2000万的夫妇：n = 103；UI（2）：腹腔镜检查有输卵管腹膜病变或TMSC<2000万的夫妇，n = 86；UI（3）：输卵管腹膜状况未知的夫妇：n = 114。对照组为严重男性因素、双侧输卵管阻塞和3/4级子宫内膜异位症：n = 418。主要结局是每个启动的IVF周期的累积活产率（CLBR）。对活产的优势比进行混杂因素调整。
UI1队列中的CLBR显著低于对照组（29.1%对39%；OR = 0.62；95%CI = 0.39 - 0.98；P =.04）；但UI2和UI3队列与对照组相似。（37.2%对39.95%；OR = 0.89，95%CI = 0.55 - 1.44；P =.89）和（38.6%对39.95%；OR = 0.98，95%CI = 0.64 - 1.55；P =.98）。在调整年龄、不孕持续时间、既往活产情况和抗缪勒管激素（AMH）后，UI1队列中CLBR的调整优势比为0.48（95%CI = 0.28 - 0.82；P =.007）。
与传统的输卵管、子宫内膜异位症或男性因素不孕症诊断相比，在腹腔镜检查正常和TMSC后定义的不明原因不孕症显著降低了每个启动的IVF周期的累积活产率。在腹腔镜检查或TMSC异常的UI亚分类中，CLBR不受影响。该信息可能有助于在IVF前为夫妇提供咨询。需要大规模前瞻性研究来证实这一观察结果。
