子宫腔内人工授精成功率的精子参数影响因素的研究

doi:10.13418/j.issn.1001-165x.2019.04.015

中国临床解剖学杂志 ›› 2019, Vol. 37 ›› Issue (4): 436-441.doi: 10.13418/j.issn.1001-165x.2019.04.015

子宫腔内人工授精成功率的精子参数影响因素的研究

李青¹，　胡少飞¹，　王丽华²，　黄毅¹，　邓诸秀¹，　朱茂灵¹

1.南宁市妇幼保健院生殖医学中心，南宁 530011；　2.田林县医院儿科，广西百色 533300

收稿日期:2019-04-28 出版日期:2019-07-25 发布日期:2019-08-01
通讯作者: 朱茂灵，主任医师，E-mail：3152284326@qq.com
作者简介:李青（1965-），博士，研究方向：精子形态对男性生育力的影响，Tel：（0771）2418456
基金资助:
南宁市科学研究与技术开发项目（20183038-1）

Impact of sperm parameters on the outcome of intrauterine insemination cycles

LI Qing¹, HU Shao-fei¹, WANG Li-hua², HUANG Yi¹, DENG Zhu-xiu¹, ZHU Mao-ling¹

1. Reproductive Medicine Center, Nanning Maternal and Child Health Care Hospital, Nanning 530011; 2. Department of Paediatrics, Tianlin People's Hospital, Baise 533300, Guangxi Province, China

Received:2019-04-28 Online:2019-07-25 Published:2019-08-01

摘要/Abstract

摘要： 目的　探讨精液浓度、活力、前向运动精子总数和精子形态等参数对子宫腔内人工授精（intrauterine insemination，IUI）临床妊娠率的影响。方法　回顾性分析696个周期由于男性因素或不明原因行IUI治疗的临床资料，按精液检查阶段和行IUI当天优化处理前后对各精液参数进行分组，比较各组间临床妊娠率。结果　优化处理前精液浓度达到30×106/mL时，IUI临床妊娠率高于＜15.0×106/mL组和15.0×106~29.9×106/mL组（15.2% vs 6.1%，8.3%），P＜0.05；精子活力在21%~30%时，行IUI后获得的临床妊娠率最好，高于11%~20%组和＞30%组（21.6% vs 4.2%，12.6%），P＜0.05；优化处理前、后的前向活动精子总数显著影响IUI的临床妊娠率，其阈值分别为10×106和5×106。不同检测者对精子形态评估的一致率为42.9%。精液检查阶段的各个参数如精子形态、精液总量、精液浓度、精子活力和前向运动精子总数与IUI临床妊娠率均无相关关系。多因素Logistic回归分析提示，优化处理前精液浓度、成熟卵泡数和子宫内膜厚度显著影响IUI妊娠率。结论　优化处理前精液浓度、成熟卵泡数和子宫内膜厚度是影响IUI临床妊娠率的独立因素。而精液检查阶段各精液参数对IUI的成功率没有影响。精子形态检测结果可能受个人因素影响。

关键词: 精液浓度, 　精子活力, 　精子形态正常率, 　子宫腔内人工授精, 　临床妊娠率

Abstract: Objective　To evaluate the sperm parameters in semen analysis and before/after preparation that can affect the clinical pregnancy rate after intrauterine insemination (IUI).　Methods　A single centre retrospective observational cohort study included 696 IUI cycles among couples in unexplained and male subfertility treated with gonadotrophins. Results　The clinical pregnancy rate in women inseminated with 30×106/mL in the native semen was higher than those inseminated with＜15.0×106/mL or 15.0×106~29.9×106/mL (15.2% vs 6.1%, 8.3%, respectively)(P<0.05). When the motility in the native semen was 21%~30%, the clinical pregnancy rate after IUI was noted higher than those inseminated with semen motility of 11%~20% or＞30% (21.6% vs 4.2%, 12.6%, respectively)(P<0.05). The clinical pregnancy rate was influenced by total motile spermatozoa count in the native semen (TMSC) and inseminating motile count after washing (IMC), with the cut-off value of 10 million and 5 million, respectively. And 42.9% of sperm was evaluated with the same result in its morphology by 4 andrologists. There were no strong correlations between sperm parameters at the time of semen analysis and clinical pregnancy rates after IUI. By multivariate logistic regression analysis three factors were identified to be associated significantly with clinical pregnancy rate: the sperm concentration in the native semen, the number of preovulatory follicles (≥18 mm), and the endometrial thickness.　Conclusions　The concentration in the native semen is significantly associated with the clinical pregnancy rate after IUI and is an independent factor to affect IUI outcome. Various sperm parameters in semen analysis are not correlated with IUI outcome.

Key words: Sperm concentration, 　Sperm motility, 　Sperm morphology, 　Intrauterine insemination, Clinical pregnancy rate

中图分类号:

R321.1

李青, 胡少飞, 王丽华, 黄毅, 邓诸秀, 朱茂灵. 子宫腔内人工授精成功率的精子参数影响因素的研究[J]. 中国临床解剖学杂志, 2019, 37(4): 436-441.

LI Qing, HU Shao-fei, WANG Li-hua, HUANG Yi, DENG Zhu-xiu, ZHU Mao-ling. Impact of sperm parameters on the outcome of intrauterine insemination cycles [J]. Chinese Journal of Clinical Anatomy, 2019, 37(4): 436-441.

参考文献 22

[1]	Cohlen B, Bijkerk A, Van der Poel S, et al. IUI: review and systematic assessment of the evidence that supports global recommendations[J]. Hum Reprod Update, 2018, 24(3): 300-319.
[2]	Van Voorhis BJ, Barnett M, Sparks AE, et al. Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization[J]. Fertil Steril, 2001, 75(4): 661-668.
[3]	Merviel P, Heraud MH, Grenier N, et al. Predictive factors for pregnancy after intrauterine insemination (IUI): an analysis of 1038 cycles and a review of the literature[J]. Fertil Steril, 2010 , 93(1): 79-88.
[4]	Ombelet W, Dhont N, Thijssen A, et al. Semen quality and prediction of IUI success in male subfertility: a systematic review[J]. Reprod Biomed Online, 2014, 28(3): 300-309.
[5]	Gatimel N, Moreau J, Parinaud J, et al. Sperm morphology: assessment, pathophysiology, clinical relevance, and state of the art in 2017[J]. Andrology, 2017, 5(5): 845-862.
[6]	世界卫生组织编, 谷翊群, 陈振文, 卢文红, 等译. 世界卫生组织人类精液检查与处理实验室手册[M]. 5版. 北京: 人民卫生出版社, 2011.
[7]	Kruger TF, Menkveld R, Stander FS, et al. Sperm morphologic features as a prognostic factor in in vitro fertilization[J]. Fertil Steril, 1986, 46(6): 1118-1123.
[8]	Van Waart J, Kruger TF, Lombard CJ, et al. Predictive value of normal sperm morphology in intrauterine insemination (IUI): a structured literature review[J]. Hum Reprod Update, 2001, 7(5): 495-500.
[9]	Akl LD, Oliveira JB, Petersen CG, et al. Efficacy of the motile sperm organelle morphology examination (MSOME) in predicting pregnancy after intrauterine insemination[J]. Reprod Biol Endocrinol, 2011, 9(1): 120.
[10]	Sun Y, Li B, Fan LQ, et al. Does sperm morphology affect the outcome of intrauterine insemination in patients with normal sperm concentration and motility[J]. Andrologia, 2012, 44(5): 299-304.
[11]	Deveneau NE, Sinno O, Krause M, et al. Impact of sperm morphology on the likelihood of pregnancy after intrauterine insemination[J]. Fertil Steril, 2014, 102(6): 1584-1590.
[12]	Lemmens L, Kos S, Beijer C, et al. Predictive value of sperm morphology and progressively motile sperm count for pregnancy outcomes in intrauterine insemination[J]. Fertil Steril, 2016, 105(6): 1462-1468.
[13]	Dickey RP, Pyrzak R, Lu PY, et al. Comparison of the sperm quality necessary for successful intra-uterine insemination with World Health Organization threshold values for normal sperm[J]. Fertil Steril, 1999, 71(4): 684-689.
[14]	Stone BA, Vargyas JM, Ringler GE, et al. Determinants of the outcome of intrauterine insemination: analysis of outcomes of 9963 consecutive cycles[J]. Am J Obstet Gynecol, 1999, 180(6): 1522-1534.
[15]	Dorjpurev U, Kuwahara A, Yano Y, et al. Effect of semen characteristics on pregnancy rate following intrauterine insemination[J]. J Med Invest, 2011, 58(1-2): 127-133.
[16]	Wainer R, Albert M, Dorion A, et al. Influence of the number of motile spermatozoa inseminated and of their morphology on the success of intrauterine insemination[J]. Human Reprod, 2004, 19(9): 2060-2065.
[17]	Badawy A, Elnashar A, Eltotongy M. Effect of sperm morphology and number on success of intrauterine insemination[J]. Fertil Steril, 2009, 91(3): 777-781.
[18]	Miller DC, Hollenbeck BK, Smith GD, et al. Processed total motile sperm count correlates with pregnancy outcome after intrauterine insemination[J]. Urology, 2002, 60(3): 497-501.
[19]	Horvath PM, Bohrer M, Shelden RM, et al. The relationship of sperm parameters to cycle fecundity in superovulated women undergoing intrauterine insemination[J]. Fertil Steril, 1989, 52(2): 288-294.
[20]	Ombelet W, Vandeput H, Van de Putte G, et al. Intrauterine insemination after ovarian stimulation with clomiphene citrate: predictive potential of inseminating motile count and sperm morphology[J]. Hum Reprod, 1997, 12(7): 1458-1463.
[21]	Cao S, Zhao C, Zhang J, et al. A minimum number of motile spermatozoa are required for successful fertilisation through artificial intrauterine insemination with husband's spermatozoa[J]. Andrologia, 2014, 46(5): 529-534.
[22]	Honda T, Tsutsumi M, Komoda F, et al. Acceptable pregnancy rate of unstimulated intrauterine insemination: a retrospective analysis of 17, 830 cycles[J]. Reprod Med Biol, 2015, 14(1): 27-32.

子宫腔内人工授精成功率的精子参数影响因素的研究

Impact of sperm parameters on the outcome of intrauterine insemination cycles

可视化

摘要/Abstract

引用本文

使用本文

参考文献 22

相关文章 1

Metrics

本文评价

推荐阅读 0