摘要
目的探讨处理后精液参数对男性不育自然周期(natural cycle,NC)宫腔内人工授精(intrauterine insemination,IUI)的预测价值。方法回顾性分析了181例(299个周期)因男方因素行NC-IUI助孕治疗患者的临床资料,将299个周期分为妊娠组(n=31)和无妊娠组(n=268),比较两组之间的差异,并采用ROC曲线分析其预测价值。结果两组间比较,处理后正常形态精子百分比妊娠组显著高于无妊娠组[(8.3±3.3)%比(6.8±3.3)%],差异具有统计学意义(P<0.05);其余指标包括女方年龄、男方年龄、不孕年限、不孕类型、IUI日子宫内膜厚度以及处理后前向运动精子总数(postwashed total progressively motile sperm count,TPMSC)在两组间比较,差异均无统计学意义。ROC曲线分析结果显示处理后正常形态精子百分比用于预测男性不育NC-IUI妊娠结局有显著意义[曲线下面积为0.656(95%CI:0.563-0.749,P=0.004)]。进一步将所有周期按TPMSC≥10×106和<10×106进行分层分析。在TPMSC≥10×106组(n=191)中妊娠组处理后正常形态精子百分比(8.9±3.4)%高于无妊娠组(7.4±3.4)%,差异有统计学意义(P<0.05);在TPMSC<10×106组(n=108)中,处理后正常形态精子百分比在妊娠组与无妊娠组中比较,差异无统计学意义(P>0.05)。TPMSC在两组间比较,妊娠组显著高于无妊娠组,差异有统计学意义(7.3±1.4比6.1±1.9,P<0.05)。ROC曲线分析结果亦提示当TPMSC<10×106,处理后正常形态精子百分比用于预测男性不育NC-IUI妊娠结局无意义;而TPMSC却有意义[ROC曲线下面积为0.702(95%CI:0.565-0.839,P=0.029)]。结论当TPMSC>10×106,处理后正常形态精子百分比是预测男性不育NCIUI妊娠结局的决定因素;但当TPMSC<10×106,处理后正常形态精子百分比与妊娠结局无关,TPMSC才是影响妊娠结局的重要参数。
Objective To investigate the efficacy of post-wash normal sperm morphology percentage in predicting of intrauterine insemination（IUI） for male subfertility in natural cycle（NC）. Methods Methods The data of 299 cycles performed in 181 couples with male subfertility were retrospectively analyzed. The differences between pregnancy group and no pregnancy group were compared. The ROC curve was used to evaluate the ability of a variable to predict pregnancy after an IUI cycle. Results Results Pregnancy occurred in 31 IUI cycles. Post-wash normal sperm morphology percentage of pregnancy group（n=31） was higher than that of no pregnancy group（n=268） [（8.3±3.3）% vs（6.8±3.3）%, P =0.004]. Other parameters including female age, male age, duration of infertility, type of infertility, the thickness of endometrium on the day of IUI and the postwashed total progressively motile sperm count（TPMSC）, showed no differences between these two groups. The ROC curve revealed that post-wash normal sperm morphology percentage had better prognostic potency for predicting pregnancy of IUI for male subfertilty in NC（the area under the curve was 0.656（95% CI： 0.563-0.749,P =0.004）. Further analyses between pregnancy group and no pregnancy group were done in group of TPMSC≥10×106 and 10×106. In the group of TPMSC≥10×106, similar results were observed（post-wash normal sperm morphology percentage： pregnancy group vs. no pregnancy group： [（8.9±3.4）% vs.（7.4±3.4）%, P =0.028]. However, in the group of TPMSC 10×106, no difference were observed in post-wash normal sperm morphology percentage between pregnancy group and no pregnancy group（P 0.05）, while with regard to TPMSC, significant difference was showed. The TPMSC was higher in the pregnancy group（7.3±1.4 vs. 6.1±1.9, P =0.029）. The ROC curve also revealed that when TPMSC 10×106, the TPMSC had better prognostic potency for predicting pregnancy（the area under the curve was 0.702（95%CI： 0.565-0.839, P =0.029） rather tha
作者
唐妍
黄立光
张汉奎
赵晋
何茜冬
张婷婷
郑妍
Tang Yan Huang Liguang Zhang Hankui Zhao Jin He Qiandong Zhang Tingting Zheng Yan(Center of Reprodvctive Medicine, Department of Gynecology and Obsterics, Zhongshan City People＇s Hospital, Zhongshan 528403, Chin)
出处
《中国男科学杂志》
CAS
CSCD
2017年第4期24-28,共5页
Chinese Journal of Andrology
关键词
不育
男性
授精
人工
正常精子形态
妊娠结局
infertility, male
Insemination, Artificial
normal sperm morphology
pregnancy outcome
