在家中采集精液对宫腔内人工授精结局的影响。

The effect of semen collection at home on intrauterine insemination outcomes.

机构信息

Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.

出版信息

Andrology. 2022 Jul;10(5):863-870. doi: 10.1111/andr.13176. Epub 2022 Apr 8.

DOI:10.1111/andr.13176

PMID:35332697

Abstract

BACKGROUND

The WHO 2010 guidelines recognize at-home semen collection as an acceptable alternative to standard collection at the clinic in "exceptional circumstances." There is lack of sufficient data to determine the need for revisiting these recommendations for treatment purposes.

OBJECTIVES

To determine whether at-home semen collection has any effect on intrauterine insemination (IUI) cycle outcomes.

MATERIALS AND METHODS

This is a retrospective cohort study of 729 IUI treatment cycles (382 patients) performed at an academic fertility center from September 19, 2019 to December 31, 2020. Semen collected at the "clinic" was used for 343 cycles before the Coronavirus Disease 2019 (COVID-19) pandemic (September 19, 2019 to March 21, 2020), and "at-home" collected specimens were used for 386 cycles following revised protocols with COVID-19-driven changes (May 30, 2020 to December 31, 2020). Logistic regression models were performed to evaluate the effect of "at-home" semen collection on achieving a positive pregnancy test (PPT) and a clinical pregnancy (CP).

RESULTS

Male and female partners' age, ovarian reserve biomarkers, and stimulation regimens used were similar in the "clinic" and "at-home" groups. In unadjusted models, "at-home" collection had no significant effect on the odds for a PPT [OR (95%CI): 0.733 (0.503-1.069)] or CP [0.816 (0.543-1.226)]. These results persisted even when adjusting for maternal age and anti-Müllerian hormone: PPT [0.739 (0.505-1.081)] and CP [0.826 (0.547-1.248)]. Of the semen analysis parameters under evaluation, only motility appeared to significantly impact the odds of achieving a PPT [1.014 (1.004-1.025)] and a CP [1.017 (1.006-1.029)]. This effect was slightly attenuated for samples collected "at-home" [1.012 (0.997-1.027) and 1.015 (0.999-1.031), respectively, for PPT and CP].

DISCUSSION

This study adds important information to the limited literature regarding the effect of at-home semen collection on IUI outcomes. Under adequate protocols, at-home semen collection should be considered a safe alternative. Additional research is needed to optimize such protocols.

CONCLUSION

Our data suggest that at-home semen collection does not negatively impact IUI pregnancy outcomes.

摘要

背景

世界卫生组织（WHO）2010 年的指南承认，在“特殊情况下”，家庭采集的精液可以作为在诊所进行标准采集的可接受替代方法。目前缺乏足够的数据来确定是否需要重新考虑这些建议以进行治疗。

目的

确定家庭采集精液是否会对宫腔内人工授精（IUI）周期的结局产生影响。

材料和方法

这是一项回顾性队列研究，纳入了 2019 年 9 月 19 日至 2020 年 12 月 31 日在一家学术生育中心进行的 729 个 IUI 治疗周期（382 名患者）。在 COVID-19 大流行之前（2019 年 9 月 19 日至 2020 年 3 月 21 日），使用“诊所”采集的精液进行了 343 个周期，在 COVID-19 驱动的修订方案（2020 年 5 月 30 日至 2020 年 12 月 31 日）后使用“家庭”采集的标本进行了 386 个周期。采用逻辑回归模型评估“家庭”采集对实现妊娠试验阳性（PPT）和临床妊娠（CP）的影响。

结果

在“诊所”和“家庭”组中，男性和女性伴侣的年龄、卵巢储备生物标志物和刺激方案相似。在未调整的模型中，“家庭”采集对 PPT[比值比（OR）（95%置信区间[CI]）：0.733（0.503-1.069）]或 CP[0.816（0.543-1.226）]的几率没有显著影响。即使调整了母亲年龄和抗苗勒管激素，这些结果仍然存在：PPT[0.739（0.505-1.081）]和 CP[0.826（0.547-1.248）]。在评估的精液分析参数中，只有活力似乎显著影响实现 PPT[1.014（1.004-1.025）]和 CP[1.017（1.006-1.029）]的几率。对于“家庭”采集的样本，这种影响略有减弱[分别为 1.012（0.997-1.027）和 1.015（0.999-1.031），用于 PPT 和 CP]。