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目的探讨子宫内膜异位症(EMs)不孕患者腹腔镜术后行夫精人工授精妊娠率的影响因素。方法回顾性分析164例腹腔镜术后的EMs不孕患者进行的318个人工授精周期的临床资料。以年龄、不孕年限、腹腔镜术后时间、用药情况、周期数、是否促排卵、r-AFS分期、IUI时机分别进行妊娠率的比较。结果 EMs不孕患者术后人工授精的周期妊娠率为13.21%。年龄≤35岁的周期妊娠率高于35岁以上者(χ2=6.687,P<0.05),不孕年限≤5年的妊娠率高于5年以上者(χ2=5.430,P<0.05),腹腔镜术后1年内行人工授精的妊娠率高于1年以上者(χ2=6.005,P<0.05),Ⅰ～Ⅱ期患者的妊娠率高于Ⅲ～Ⅳ期患者(χ2=8.264,P<0.05),加用促排卵治疗的妊娠率高于自然周期者(χ2=4.569,P<0.05),3周期内人工授精的妊娠率高于3周期以上者(χ2=4.031,P<0.05),双次IUI者妊娠率高于单次者(χ2=4.371,P<0.05),差异均有统计学意义。而术后是否使用GnRH-a则与妊娠率无关。结论 EMs不孕患者腹腔镜术后行人工授精治疗的最佳时间是术后1年内3周期内有较高的妊娠率,建议同时加用促排卵治疗。
Objective To investigate the influencing factors of pregnancy rate of artificial insemination after laparoscopic surgery in infertile women with endometriosis (EMs). Methods A retrospective analysis of 164 cases of laparoscopic infertility patients EMs 318 artificial insemination period of clinical data. Age, duration of infertility, laparoscopic surgery time, drug use, number of cycles, ovulation induction, r-AFS staging, IUI timing pregnancy rates were compared. Results The pregnancy rate of artificial insemination in infertile women with EMs was 13.21%. The pregnancy rate of 35 years old or older was higher than that of 35 years old (χ2 = 6.687, P <0.05). The pregnancy rate of 5 years was higher than that of 5 years (χ2 = 5.430, P <0.05) The pregnancy rate of patients who underwent artificial insemination within 1 year after surgery was higher than 1 year (χ2 = 6.005, P <0.05). The pregnancy rates of stage Ⅰ ~ Ⅱ patients were higher than those of stage Ⅲ ~ Ⅳ patients (χ2 = 8.264, P <0.05 (Χ2 = 4.569, P <0.05). The pregnancy rate of artificial insemination in three cycles was higher than that of three cycles (χ2 = 4.031, P <0.05) The times of IUI were higher than those of single pregnancy (χ2 = 4.371, P <0.05), the differences were statistically significant. And whether to use GnRH-a after surgery has nothing to do with the pregnancy rate. Conclusions The best time of artificial insemination after laparoscopic surgery in patients with infertility due to EMs is the higher pregnancy rate in 3 cycles within 1 year after operation. It is suggested that ovulation induction therapy should be added at the same time.