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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 predictive value of post-processing semen parameters in intrauterine insemination (IUI) in male infertility cycle (NC). Methods The clinical data of 181 patients (299 cycles) who underwent NC-IUI assisted pregnancy with male factors were retrospectively analyzed. The 299 cycles were divided into pregnancy group (n = 31) and non-pregnancy group (n = 268) The differences between the two groups were compared and their predictive value was analyzed using ROC curves. Results After treatment, the percentage of normal spermatozoa in normal pregnant women was significantly higher than that of non-pregnant women [(8.3 ± 3.3)% vs (6.8 ± 3.3)%], the difference was statistically significant (P <0.05) The age of the woman, the age of the man, the age of infertility, the type of infertility, the endometrial thickness of IUI, and the post-treatment total motility motile sperm count (TPMSC) were not significantly different between the two groups . ROC curve analysis showed that the percentage of normal morphology sperm after treatment was significant for predicting pregnancy outcomes in male infertility NC-IUI [area under the curve 0.656 (95% CI: 0.563-0.749, P = 0.004)]. All cycles were further stratified by TPMSC ≧ 10 × 10 6 and <10 × 10 6. The percentage of normal spermatozoa (8.9 ± 3.4)% in pregnancy group after TPMSC≥10 × 106 group (n = 191) was higher than that in non - pregnancy group (7.4 ± 3.4%), the difference was statistically significant (P <0.05). In TPMSC <10 × 106 group (n = 108), the percentage of normal morphology sperm after treatment was no significant difference between pregnancy group and non-pregnancy group (P> 0.05). TPMSC was significantly higher in the pregnancy group than in the non-pregnancy group (7.3 ± 1.4 vs 6.1 ± 1.9, P <0.05). ROC curve analysis also suggested that when TPMSC <10 × 106, the percent of normal-shaped spermatozoa treated for predicting pregnancy outcomes for male infertility NC-IUI was meaningless, whereas TPMSC was of interest [area under the ROC curve was 0.702 (95% CI: 0.565-0.839, P = 0.029)]. Conclusion When the percentage of normal spermatozoa treated with TPMSC> 10 × 106, the percentage of sperm in normal morphology after treatment is the predictor of pregnancy outcome in male infertile NCIUI. However, TPMSC is not affected by pregnancy outcome when TPMSC is less than 10 × 106 The outcome of the important parameters.