比较不明原因的原发性不孕患者反复进行同源精液人工授精失败与输卵管性不孕患者在体外受精/卵胞浆内单精子注射及胚胎移植后的预后。

Comparing the prognosis of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer between unexplained primary infertility patients with repeated artificial insemination with homologous semen failure and tubal infertility patients.

作者信息

Ma Wenhong, Zeng Zhonghong, Xie Jiayan, Wang Xi, Li Liuming, Yang Yihua

机构信息

Guangxi Reproductive Medical Center, the First Affiliated Hospital of Guangxi Medical University, Nanning, China.

Reproductive Medicine Center, Liuzhou Municipal Maternity and Child Healthcare Hospital, Liuzhou, China.

出版信息

J Obstet Gynaecol Res. 2023 Apr;49(4):1206-1213. doi: 10.1111/jog.15568. Epub 2023 Feb 3.

DOI:10.1111/jog.15568

PMID:36738078

Abstract

BACKGROUND

Both in vitro fertilization and embryo transfer (IVF-ET) and intracytoplasmic sperm injection and embryo transfer (ICSI-ET) have been recommended for unexplained primary infertility after recurrent artificial insemination with homologous semen failure (UAIHF), but few studies focused on the safety and efficiency of the IVF/ICSI-ET technique for these patients. In this study, we compared the IVF/ICSI-ET outcomes and perinatal and postnatal complications between UAIHF patients and tubal infertility (TI) patients.

METHODS

We conducted a retrospective study of UAIHF and TI patients who underwent IVF/ICSI-ET at Guangxi Reproductive Medical Center, the First Affiliated Hospital of Guangxi Medical University from January 2012 to March 2021. After propensity score matching (PSM), we analyzed the IVF/ICSI-ET outcomes and rates of perinatal and postnatal complications.

RESULTS

PSM analysis revealed that the baselines of age, infertility duration, and body mass index were comparable. The fertilization method was significantly different between the two groups. Through IVF/ICSI-ET, UAIHF patients had a similar clinical outcome compared to TI patients. Regarding perinatal and postnatal complications, the incidence of premature rupture of membranes (PROM) (7.54% vs. 3.17%, p = 0.030) was significantly higher in UAIHF patients.

CONCLUSIONS

UAIHF patients could achieve satisfying pregnancy outcomes by IVF/ICSI-ET. ICSI-ET did not seem to improve the clinical outcomes of UAIHF patients compared to those of TI patients who underwent IVF-ET, which might be related to possible underlying diseases in these patients. In addition, the incidence of PROM was significantly higher in UAIHF patients, which might be related to the ICSI technique used and uncertain potential idiopathic diseases associated with unexplained infertility patients.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR2200057572. Registered 15 March 2022.

摘要

背景

对于在反复进行同种精液人工授精失败（UAIHF）后出现的不明原因原发性不孕，体外受精-胚胎移植（IVF-ET）和卵胞浆内单精子注射-胚胎移植（ICSI-ET）均被推荐使用，但很少有研究关注IVF/ICSI-ET技术对这些患者的安全性和有效性。在本研究中，我们比较了UAIHF患者与输卵管性不孕（TI）患者的IVF/ICSI-ET结局以及围产期和产后并发症。

方法

我们对2012年1月至2021年3月在广西医科大学第一附属医院广西生殖医学中心接受IVF/ICSI-ET的UAIHF和TI患者进行了一项回顾性研究。在倾向评分匹配（PSM）后，我们分析了IVF/ICSI-ET结局以及围产期和产后并发症的发生率。

结果

PSM分析显示，年龄、不孕持续时间和体重指数的基线具有可比性。两组之间的受精方式存在显著差异。通过IVF/ICSI-ET，UAIHF患者与TI患者的临床结局相似。关于围产期和产后并发症，UAIHF患者的胎膜早破（PROM）发生率（7.54%对3.17%，p = 0.030）显著更高。

结论

UAIHF患者通过IVF/ICSI-ET可获得满意的妊娠结局。与接受IVF-ET的TI患者相比，ICSI-ET似乎并未改善UAIHF患者的临床结局，这可能与这些患者潜在的基础疾病有关。此外，UAIHF患者的PROM发生率显著更高，这可能与所使用的ICSI技术以及与不明原因不孕患者相关的不确定潜在特发性疾病有关。