单侧输卵管阻塞合并男性不育患者行未促排卵宫腔内人工授精的妊娠结局。
Pregnancy outcomes of intrauterine insemination without ovarian stimulation in couples affected by unilateral tubal occlusion and male infertility.
机构信息
Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Zhongshan City People's Hospital, Zhongshan, 528403, Guangdong Province, China.
Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong Province, China.
出版信息
BMC Pregnancy Childbirth. 2023 May 24;23(1):376. doi: 10.1186/s12884-023-05705-3.
BACKGROUND
Information available to date regarding the pregnancy outcomes of intrauterine insemination (IUI) without ovarian stimulation (OS) in infertile patients with unilateral tubal occlusion remains scarce. The objectives of this study were to investigate for couples affected by unilateral tubal occlusion (diagnosed via hysterosalpingography (HSG)/transvaginal real-time three-dimensional hysterosalpingo-contrast sonography (TVS RT-3D-HyCoSy)) and male infertility: (1) whether significant differences exist in pregnancy outcomes between IUI with or without OS cycles, and (2) whether the pregnancy outcomes of IUI without OS in women with unilateral tubal occlusion were similar to those of women with bilateral patent tubes.
METHODS
258 couples affected by male infertility completed 399 IUI cycles. The cycles were divided into three groups: group A, IUI without OS in women with unilateral tubal occlusion; group B, IUI with OS in women with unilateral tubal occlusion; and group C, IUI without OS in women with bilateral patent tubes. The main outcome measures, including clinical pregnancy rate (CPR), live birth rate (LBR), and first trimester miscarriage rate, were compared between either groups A and B or groups A and C.
RESULTS
Although the number of dominant follicles > 16 mm were significantly higher in group B than that in group A (group B vs. group A: 1.6 ± 0.6 vs. 1.0 ± 0.2, P < 0.001), the CPR, LBR, and first trimester miscarriage rate were comparable between these two groups. When comparing group C to group A, the duration of infertility was significantly longer in group C than that in group A (group A vs. group C: 2.3 ± 1.2 (year) vs. 2.9 ± 2.1 (year), P = 0.017). Except for the first trimester miscarriage rate, which was significantly higher in group A (42.9%, 3/7) than that in group C (7.1%, 2/28) (P = 0.044), no significant differences were observed in the CPR and LBR in these two groups. After adjusting for female age, body mass index, and the duration of infertility, similar results were obtained between groups A and C.
CONCLUSIONS
In couples affected by unilateral tubal occlusion (diagnosed via HSG/TVS RT-3D-HyCoSy) and male infertility, IUI without OS might be an alternative treatment strategy. However, when compared to patients with bilateral patent tubes, the patients with unilateral tubal occlusion showed a higher first trimester miscarriage rate following IUI without OS cycles. Further studies are warranted to clarify this relationship.
背景
目前关于单侧输卵管阻塞不孕患者未经卵巢刺激（OS）的宫腔内人工授精（IUI）的妊娠结局的信息仍然很少。本研究的目的是调查单侧输卵管阻塞（通过子宫输卵管造影术（HSG）/经阴道实时三维子宫输卵管造影超声检查（TVS RT-3D-HyCoSy）诊断）和男性不育症的夫妇：（1）IUI 有无 OS 周期的妊娠结局是否存在显著差异，（2）单侧输卵管阻塞妇女的无 OS IUI 的妊娠结局是否与双侧通畅管的妇女相似。
方法
258 对患有男性不育症的夫妇完成了 399 次 IUI 周期。这些周期分为三组：A 组，单侧输卵管阻塞妇女无 OS 的 IUI；B 组，单侧输卵管阻塞妇女有 OS 的 IUI；C 组，双侧通畅管妇女无 OS 的 IUI。比较各组 A 和 B 或 A 和 C 之间的主要结局指标，包括临床妊娠率（CPR）、活产率（LBR）和早期流产率。
结果
虽然 B 组优势卵泡>16mm 的数量明显高于 A 组（B 组比 A 组：1.6±0.6 vs. 1.0±0.2，P<0.001），但两组之间的 CPR、LBR 和早期流产率相当。与 A 组相比，C 组不孕持续时间明显较长（A 组比 C 组：2.3±1.2（年）比 2.9±2.1（年），P=0.017）。除了 A 组的早期流产率（42.9%，3/7）明显高于 C 组（7.1%，2/28）（P=0.044）外，两组之间的 CPR 和 LBR 没有明显差异。调整女性年龄、体重指数和不孕持续时间后，A 组和 C 组也得到了类似的结果。
结论
在单侧输卵管阻塞（通过 HSG/TVS RT-3D-HyCoSy 诊断）和男性不育的夫妇中，无 OS 的 IUI 可能是一种替代治疗策略。然而，与双侧通畅管的患者相比，单侧输卵管阻塞患者在无 OS 周期的 IUI 后早期流产率较高。需要进一步的研究来阐明这种关系。
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