Analysis of influencing factors of pregnancy failure after intrauterine insemination during ovulation promoting cycle
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摘要:目的 探讨促排卵周期宫腔内人工授精（IUI）后妊娠失败的影响因素。方法 选择完成促排卵周期IUI的200例患者及其配偶为研究对象。观察患者临床妊娠结局；自制调查问卷，记录患者相关资料；分析促排卵周期IUI后妊娠失败的影响因素。结果 151例患者促排卵周期IUI后妊娠失败，妊娠失败率为75.50%。肥胖、子宫内膜异位症（EMs）、焦虑/抑郁均是促排卵周期IUI后妊娠失败的影响因素（OR>0，P < 0.05）。结论 促排卵周期IUI后患者妊娠失败风险高，可能与肥胖、EMs、焦虑/抑郁等因素有关，临床应及时评估风险因素，并针对性实施干预，提高IUI后妊娠率。Abstract:Objective To explore the influencing factors of pregnancy failure after intrauterine insemination (IUI) during ovulation induction cycle.Methods Two hundred patients and their spouses who completed the ovulation induction cycle IUI were selected as the research subjects. The clinical pregnancy outcomes of patients were observed; self-made questionnaires were used to record relevant data of patients; the influencing factors of pregnancy failure after ovulation induction cycle IUI were analyzed.Results Pregnancy failure after ovulation induction cycle IUI was observed in 151 patients, and the pregnancy failure rate was 75.50%. Obesity, endometriosis (EMs) and anxiety or depression were all the influencing factors of pregnancy failure after IUI during ovulation promoting cycle (OR>0, P < 0.05).Conclusion The risk of pregnancy failure is high after IUI treatment during ovulation promoting cycle, which may be related to obesity, EMs, anxiety or depression and other factors. Clinical evaluation of risk factors should be timely performed, and targeted interventions should be implemented to improve the pregnancy rate after IUI.
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Keywords:
- intrauterine insemination /
- ovulation promoting cycle /
- pregnancy failure /
- obesity /
- endometriosis /
- anxiety /
- depression
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表 1 不同妊娠结局患者的基线资料比较(x±s)[n(%)]
因素 n 失败组(n=151) 成功组(n=49) t/χ2 P 年龄/岁 30.34±5.08 29.76±5.10 0.694 0.489 肥胖 是 61 55(90.16) 6(9.84) 10.203 0.001 否 139 96(69.06) 43(30.94) 妊娠史 有 140 104(74.29) 36(25.71) 0.372 0.542 无 60 47(78.33) 13(21.67) 不孕病程/年 6.26±1.87 5.71±1.86 1.791 0.075 输卵管通畅情况 单侧通畅 28 21(75.00) 7(25.00) 0.004 0.947 双侧通畅 172 130(75.58) 42(24.42) 不孕原因 EMs 46 43(93.48) 3(6.52) 10.439 0.001 其他 154 108(70.13) 46(29.87) 使用促排卵药物 是 139 107(76.98) 32(23.02) 0.539 0.463 否 61 44(72.13) 17(27.87) IUI周期数 1~2次 91 66(72.53) 25(27.47) 0.798 0.372 3~5次 109 85(77.98) 24(22.02) HCG诱导排卵 是 125 98(78.40) 27(21.60) 1.516 0.218 否 75 53(70.67) 22(29.33) 焦虑/抑郁 是 70 62(88.57) 8(11.43) 9.948 0.002 否 130 89(68.46) 41(31.54) IUI: 宫腔内人工授精; EMs: 子宫内膜异位症; HCG: 人绒毛膜促性腺激素。 
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表 2 自变量赋值情况
变量 变量说明 变量赋值 肥胖 分类变量 1=是, 0=否 不孕原因 分类变量 1=EMs, 0=其他 焦虑/抑郁 分类变量 1=是, 0=否 EMs: 子宫内膜异位症。
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表 3 单因素分析结果
因素 B 标准误 Wald P OR值 95%置信区间 肥胖 1.412 0.467 9.129 0.003 4.106 1.642~10.264 EMs 1.809 0.623 8.444 0.004 6.105 1.802~20.683 焦虑/抑郁 1.273 0.4 20 9.163 0.002 3.570 1.566~8.139 EMs: 子宫内膜异位症。
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表 4 多因素分析结果
因素 B 标准误 Wald P OR值 95%置信区间 常量 -2.970 1.355 1.808 0.028 - - 年龄 -0.006 0.034 0.031 0.861 0.994 0.929~1.063 肥胖 2.657 0.580 21.007 0.001 14.257 4.576~44.413 妊娠史 -0.215 0.449 0.229 0.632 0.807 0.335~1.945 不孕病程 -0.132 0.330 0.160 0.690 0.876 0.459~1.674 输卵管通畅情况 -0.040 0.474 0.007 0.934 0.961 0.379~2.436 EMs 1.882 0.650 8.380 0.004 6.569 1.837~23.499 使用促排卵药物 -0.363 0.627 0.336 0.562 0.695 0.204~2.375 IUI周期数 -0.473 0.842 0.315 0.575 0.623 0.120~3.248 HCG诱导排卵 0.665 0.977 0.464 0.496 1.944 0.287~13.188 焦虑/抑郁 1.276 0.421 9.164 0.002 3.581 1.568~8.178 IUI: 宫腔内人工授精; EMs: 子宫内膜异位症; HCG: 人绒毛膜促性腺激素。
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