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目的探讨免疫及环境因素对夫精人工授精(assisted insemination with husband semen,AIH)周期妊娠率的影响。方法 AIH≥3次未妊娠后行体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVFET)79个周期,其中30个周期行IVF-ET后无优质胚胎移植或未妊娠者(A组),49个周期行IVF-ET后成功妊娠者作为对照(B组),比较两组临床资料、获卵、受精及优质胚胎情况;应用酶联免疫吸附试验(ELISA)方法检测两组卵泡液中抗卵巢抗体(antiovarian antibodies,Ao A)的表达。并且,建立Logistic多元回归模型,筛选出对AIH周期妊娠率有独立影响的环境因素。结果 1两组平均获卵数比较差异无统计学差异(P>0.05),但A组受精率和优质胚胎数显著低于B组(P<0.01)。2A组卵泡液中Ao A阳性率(30%)显著高于B组(10.2%)(P<0.05)。3对202份调查问卷进行Logistic回归分析,尚未筛选出对AIH周期妊娠率有独立影响的环境因素。结论卵泡液中Ao A表达影响AIH≥3次未妊娠后行IVF-ET的受精率和优质胚胎数,可能是患者行AIH及IVF-ET均未妊娠的原因之一;但尚未筛选出对AIH周期妊娠率有独立影响的环境因素。
Objective To investigate the effect of immune and environmental factors on the cycle pregnancy rate of assisted insemination with semen (AIH). Methods After AIH≥3 times without pregnancy, 79 cycles of in vitro fertilization and embryo transfer (IVFET) were performed. There were no embryo transfer or non-pregnancy in group A after 30 cycles of IVF-ET, 49 cycles of IVF-ET after successful pregnancy as a control group (B), the clinical data of two groups were compared, the situation of oocyte, fertilization and high quality embryos; enzyme-linked immunosorbent assay (ELISA) Antiovarian antibodies (AoA) expression. In addition, a Logistic multiple regression model was established to screen out the environmental factors that have an independent effect on the pregnancy rate of AIH. Results 1 There was no significant difference in average number of oocytes retrieved between the two groups (P> 0.05), but the fertilization rate and number of high quality embryos in group A were significantly lower than those in group B (P <0.01). The positive rate of AoA in follicular fluid of group 2A (30%) was significantly higher than that of group B (10.2%) (P <0.05). 3 Logistic regression analysis of 202 questionnaires did not screen out the environmental factors that independently influenced the pregnancy rate of AIH. Conclusions The expression of AoA in follicular fluid affects the IVF-ET fertilization rate and the number of high quality embryos after AIH≥3 times of non-pregnancy. It may be one of the reasons that AIH and IVF-ET are not pregnant. However, Cycle pregnancy rate has an independent influence on environmental factors.