切换至 "中华医学电子期刊资源库"
高级检索
中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2018, Vol. 14 ›› Issue (01) : 92 -98. doi: 10.3877/cma.j.issn.1673-5250.2018.01.015

所属专题： 文献；

论著

女性的人体质量指数对夫精人工授精助孕妊娠结局的影响
许琳1, 于鲁华1, 李雪丽2, 张晓梅2,†()   
  1. 1. 116000　辽宁，大连医科大学
    2. 225001　江苏，扬州大学临床医学院/苏北人民医院生殖医学中心
  • 收稿日期:2017-08-24 修回日期:2017-12-07 出版日期:2018-02-01
  • 通信作者: 张晓梅

Influence of body mass index on pregnancy outcomes of women underwent artificial insemination by husband

Lin Xu1, Luhua Yu1, Xueli Li2, Xiaomei Zhang2,†()   

  1. 1. Dalian Medical University, Dalian 116000, Liaoning Province, China
    2. Reproductive Medicine Center, Clinical Medical School of Yangzhou University· Northern Jiangsu People′s Hospital, Yangzhou 225001, Jiangsu Province, China
  • Received:2017-08-24 Revised:2017-12-07 Published:2018-02-01
  • Corresponding author: Xiaomei Zhang
  • About author:
    Corresponding author: Zhang Xiaomei, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

许琳, 于鲁华, 李雪丽, 张晓梅. 女性的人体质量指数对夫精人工授精助孕妊娠结局的影响[J/OL]. 中华妇幼临床医学杂志(电子版), 2018, 14(01): 92-98.

Lin Xu, Luhua Yu, Xueli Li, Xiaomei Zhang. Influence of body mass index on pregnancy outcomes of women underwent artificial insemination by husband[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2018, 14(01): 92-98.

目的

探讨女性的人体质量指数(BMI)对夫精人工授精(AIH)助孕妊娠结局的影响。

方法

选择2009年6月至2016年12月，于苏北人民医院生殖医学中心采用AIH助孕的3 243例女性不孕患者为研究对象。将4种具有相同子宫内膜准备方案及相同年龄段情况下的女性不孕患者，均分别按照BMI值分为正常体重组(BMI为18.5～22.9 kg/m2)，超重组(BMI为23.0～24.9 kg/m2)和肥胖组(BMI≥25.0 kg/m2)。具体为：①采用自然周期并且年龄≤35岁者，3组分别为1 366例、347例及233例；②采用自然周期并且年龄>35岁者，3组分别为155例、71例及36例；③采用诱导排卵周期并且年龄≤35岁者，3组分别为529例、208例及191例；④采用诱导排卵周期并且年龄>35岁者，3组分别为59例、32例及16例。回顾性分析所有受试者的临床病例资料，分别比较4种相同条件下，3组患者的基本临床资料和妊娠结局，以评估女性不孕患者的BMI对AIH治疗结局的影响。对于3组受试者临床妊娠率及自然流产率的比较，采用χ2检验。

结果

①按照正常体重组、超重组及肥胖组的顺序：采用自然周期并且年龄≤35岁者，3组受试者的临床妊娠率分别为14.6%、10.1%及10.7%，自然流产率分别为25.0%、22.9%及32.0%；采用自然周期并且年龄>35岁者，3组受试者的临床妊娠率分别为14.2%、9.9%及8.3%，自然流产率分别为31.8%、42.9%及33.3%；采用诱导排卵周期并且年龄≤35岁者，3组受试者的临床妊娠率分别为17.0%、13.0%及10.0%，自然流产率分别为23.3%、29.6%及36.8%；采用诱导排卵周期并且年龄>35岁者，3组受试者的临床妊娠率分别为15.3%、9.4%及6.3%，自然流产率分别为44.4%、33.3%及100.0%。②上述4种相同条件下，分别对3组受试者进行临床妊娠率和自然流产率比较的结果显示：采用自然周期并且年龄≤35岁者，正常体重组的临床妊娠率分别较超重组及肥胖组高，并且差异均有统计学意义(χ2＝4.850，P＝0.028；χ2＝11.859，P＝0.001)；采用诱导排卵周期并且年龄≤35岁者，正常体重组的临床妊娠率较肥胖组高，并且差异有统计学意义(χ2＝5.453，P＝0.020)。其余条件下受试者的临床妊娠率和自然流产率分别进行3组间比较，差异均无统计学意义(P>0.05)。

结论

对于采用AIH助孕并且年龄≤35岁的女性不孕患者，无论采用自然周期还是诱导排卵周期子宫内膜准备方案，其BMI值高可能降低临床妊娠率，但是对自然流产率无影响。而对于年龄>35岁者，BMI值对妊娠结局无明显影响。

关键词: 授精，人工(丈夫供体), 人体质量指数, 妊娠结局, 妊娠率, 女(雌)性
Objective

To explore the influence of the body mass index (BMI) on pregnancy outcomes of women underwent artificial insemination by husband (AIH) .

Methods

A total of 3 243 cases of barren women underwent AIH in Reproductive Medical Center of Northern Jiangsu People′s Hospital from June 2009 to December 2016, were chosen as study subjects. Four kinds of patients with same endometrial preparation scheme and same age group were all divided into following 3 groups according to BMI value, respectively, including normal body weight group (BMI of 18.5-22.9 kg/m2), overweight group (BMI of 23.0-24.9 kg/m2) and obesity group (BMI≥25.0 kg/m2). More details were as follows. ① For women with natural cycles and age≤35 years old, there were 1 366 cases, 347 cases and 233 cases in 3 groups, respectively. ② For women with natural cycles and age>35 years old, there were 155 cases, 71 cases and 36 cases in 3 groups, respectively. ③ For women with induced ovulation cycles and age≤35 years old, there were 529 cases, 208 cases and 191 cases in 3 groups, respectively. ④ For women with induced ovulation cycles and age>35 years old, there were 59 cases, 32 cases and 16 cases in 3 groups, respectively. Case informations of all subjects were analyzed retrospectively. Compared the general clinical data and pregnancy outcomes among 3 groups of women in 4 identical conditions, respectively, to evaluate the influence of BMI of barren women on outcomes of AIH treatments. Chi-square test was used to compare the clinical pregnancy rate and spontaneous miscarriage rate among 3 groups.

Results

① In accordance with the order of normal body weight group, overweight group and obesity group: for women with natural cycles and age≤35 years old, the clinical pregnancy rates of 3 groups were 14.6%, 10.1% and 10.7%, respectively; the spontaneous miscarriage rates were 25.0%, 22.9% and 32.0%, respectively. For women with natural cycles and age>35 years old, the clinical pregnancy rates of 3 groups were 14.2%, 9.9% and 8.3%, respectively; the spontaneous miscarriage rates were 31.8%, 42.9% and 33.3%, respectively. For women with induced ovulation cycles and age≤35 years old, the clinical pregnancy rates were 17.0%, 13.0% and 10.0%, respectively; the spontaneous miscarriage rates were 23.3%, 29.6% and 36.8%, respectively. For women with induced ovulation cycles and age>35 years old, the clinical pregnancy rates were 15.3%, 9.4% and 6.3%, respectively; the spontaneous miscarriage rates were 44.4%, 33.3% and 100.0%, respectively. ② The comparison results of clinical pregnancy rates and spontaneous miscarriage rates among 3 groups of subjects under the same 4 conditions showed that: the clinical pregnancy rates of women with natural cycles and age≤35 years old in normal body weight group were higher than those of overweight group and obesity group, and the differences were statistically significant (χ2=4.850, P=0.028; χ2=11.859, P=0.001). The clinical pregnancy rate of women with induced ovulation cycles and age>35 years old in normal body weight group was higher than that of obesity group, and the difference was statistically significant (χ2=5.453, P=0.020). There were no significant differences among 3 groups of women under other conditions in clinical pregnancy rates and spontaneous miscarriage rates (P>0.05).

Conclusions

For barren women with the age≤35 years old and AIH treatment, no matter using natural cycles or induced ovulation cycles for endometrial preparation, the higher BMI value may decrease clinical pregnancy rate, but no effect on spontaneous miscarriage rate. For women with the age>35 years old, BMI value may have no effect on pregnancy outcomes.

Key words: Insemination, artificial, homologous, Body mass index, Pregnancy outcome, Pregnancy rate, Female
表1 采用自然周期并且年龄≤35岁的3组受试者一般临床资料及妊娠结局比较
组别 例数 年龄(岁，±s ) 不孕年限(年，±s) 血清FSH水平(IU/L, ±s) 血清雌二醇浓度(pmol/L, ±s)
正常体重组 1 366 28.8±3.1 3.4±2.1 15.7±1.6 105.7±9.5
超重组 347 28.9±3.0 3.4±2.1 6.7±2.5 92.2±5.5
肥胖组 233 28.9±3.1 3.6±2.3 6.0±1.6 75.6±8.6
检验值 ? F＝0.145 F＝1.910 F＝0.938 F＝9.689
P值 ? 0.865 0.148 0.392 <0.001
组别 例数 血清LH水平(IU/L, ±s ) 移植日子宫内膜厚度(mm, ±s ) 临床妊娠[例数(%)] 自然流产[例数(%)]
正常体重组 1 366 4.9±2.1 8.2±2.2 200(14.6) 50(25.0)
超重组 347 4.5±2.7 7.9±2.2 35(10.1) 8(22.9)
肥胖组 233 3.8±2.0 8.3±2.2 25(10.7) 8(32.0)
检验值 ? F＝26.366 F＝2.829 χ2＝6.542 χ2＝0.711
P值 ? <0.001 0.059 0.038 0.701
表2 采用自然周期并且年龄>35岁的3组受试者一般临床资料及妊娠结局比较
组别 例数 年龄(岁，±s) 不孕年限(年，±s) 血清FSH水平(IU/L, ±s) 血清雌二醇浓度(pmol/L, ±s)
正常体重组 155 38.7±5.0 5.8±4.7 7.9±3.5 100.6±3.7
超重组 71 39.4±5.4 6.2±4.7 7.5±1.9 78.6±5.7
肥胖组 36 39.5±4.0 5.3±3.7 6.5±2.2 96.3±3.8
检验值 ? F＝0.766 F＝0.483 F＝1.887 F＝0.659
P值 ? 0.466 0.618 0.154 0.518
组别 例数 血清LH水平(IU/L, ±s) 移植日子宫内膜厚度(mm, ±s) 临床妊娠[例数(%)] 自然流产[例数(%)]
正常体重组 155 4.9±1.8 8.3±2.2 22(14.2) 7(31.8)
超重组 71 4.3±2.2 8.5±2.3 7(9.9) 3(42.9)
肥胖组 36 3.8±2.1 7.8±1.9 3(8.3) 1(33.3)
检验值 ? F＝5.961 F＝1.403 χ2＝1.439 －
P值 ? 0.003 0.248 0.487 0.866
表3 采用诱导排卵周期并且年龄≤35岁的3组受试者一般临床资料及妊娠结局比较
组别 例数 年龄(岁，±s) 不孕年限(年，±s) Gn用量(g, ±s) 血清FSH水平(IU/L, ±s) 血清雌二醇浓度(pmol/L, ±s)
正常体重组 529 28.9±3.3 3.8±2.6 1.6±0.8 7.4±2.3 99.0±15.1
超重组 208 28.7±3.2 3.8±2.2 2.2±0.9 6.7±2.4 65.2±1.3
肥胖组 191 28.7±2.9 4.1±2.4 3.2±3.1 6.7±1.8 87.5±1.3
检验值 ? F＝0.343 F＝1.359 F＝70.290 F＝11.455 F＝4.459
P值 ? 0.710 0.257 <0.001 <0.001 0.012
组别 例数 血清LH水平(IU/L, ±s) 移植日子宫内膜厚度(mm, ±s) 临床妊娠[例数(%)] 自然流产[例数(%)]
正常体重组 529 5.4±3.3 8.0±2.1 90(17.0) 21(23.3)
超重组 208 4.8±2.9 8.0±2.1 27(13.0) 8(29.6)
肥胖组 191 5.3±3.1 8.0±2.2 19(10.0) 7(36.8)
检验值 ? F＝2.472 F＝0.033 χ2＝6.202 χ2＝1.644
P值 ? 0.085 0.967 0.045 0.440
表4 采用诱导排卵周期并且年龄>35岁的3组受试者一般临床资料及妊娠结局比较
组别 例数 年龄(岁，±s) 不孕年限(年，±s) Gn用量(g, ±s) 血清FSH水平(IU/L, ±s) 血清雌二醇浓度(pmol/L, ±s)
正常体重组 59 38.0±2.0 6.1±4.7 2.2±0.6 7.9±2.7 100.1±1.5
超重组 32 38.7±2.1 5.5±3.9 2.5±0.7 18.7±11.7 63.6±1.3
肥胖组 16 38.1±3.1 3.6±0.8 5.5±3.9 8.0±3.2 86.1±1.3
检验值 ? F＝1.093 F＝1.476 F＝26.609 F＝1.476 F＝6.440
P值 ? 0.339 0.800 <0.001 0.233 0.002
组别 例数 血清LH水平(IU/L, ±s) 移植日子宫内膜厚度(mm, ±s) 临床妊娠[例数(%)] 自然流产[例数(%)]
正常体重组 59 5.3±3.2 10.6±2.8 9(15.3) 4(44.4)
超重组 32 4.7±2.8 10.1±2.5 3(9.4) 1(33.3)
肥胖组 16 5.2±3.1 9.4±2.0 1(6.3) 1(100.0)
检验值 ? F＝3.010 F＝1.569 χ2＝1.285 －
P值 ? 0.049 a 0.213 0.526 0.503
[1]
Brewer CJ, Balen AH. The adverse effects of obesity on conception and implantation[J]. Reproduction, 2010, 140(3):347-364.
[2]
Metwally M, Saravelos SH, Ledger WL, et al.Body mass index and risk of miscarriage in women with recurrent miscarriage[J]. Fertil Steril, 2010, 94(1):290-295.
[3]
Shirazian T, Raghaven S. Obesity and pregnancy: implications and management strategies for providers[J]. Mt Sinai J Med, 2009, 76(6):539-545.
[4]
Dagǧ, ZÖ, Dilbaz B. Impact of obesity on infertility in women[J]. J Turk Ger Gynecol Assoc, 2015, 16(2):111-117.
[5]
梁明懿，朱国平，任君华，等. 肥胖性不孕症的血清性激素变化[J]. 邯郸医学高等专科学校学报，2004, 17(5):444-445.
[6]
Zeng X, Pang H, Li X, et al. Impact of obesity on endometrial blood flow in women without polycystic ovarian syndrome during intracytoplasmic sperm injection[J]. Reprod Biol Endocrinol, 2013, 11:57.
[7]
Souter I, Baltagi LM, Kuleta D, et al. Women, weight, and fertility: the effect of body mass index on the outcome of superovulation/intrauterine insemination cycles[J]. Fertil Steril, 2011, 95(3):1042-1047.
[8]
Zhang D, Zhu Y, Gao H, et al. Overweight and obesity negatively affect the outcomes of ovarian stimulation and in vitro fertilisation: acohort study of 2 628 Chinese women[J]. Gynecol Endocrinol, 2010, 26(5):325-332.
[9]
Li Y, Yang D, Zhang Q. Impact of overweight and underweight on IVF treatment in Chinese women[J]. Gynecol Endocrinol. 2010, 26(6):416-422.
[10]
Bellver J, Ayllón Y, Ferrando M，et al. Female obesity impairs in vitro fertilization outcome without affecting embryo quality[J]. Fertil Steril, 2010, 93(2):447-454.
[11]
Orvieto R, Meltcer S, Nahum R, et al. The influence of body mass index on in vitro fertilization outcome[J]. Int J Gynaecol Obstel, 2008, 104(1):53-55.
[12]
Buyuk E, Seifer DB, Illions E, et al. Elevated body mass index is associated with lower serum anti-mullerian hormone levels in infertile women with diminished ovarian reserve but not with normal ovarian reserve[J]. Fertil Steril, 2011, 95(7):2364-2368.
[13]
Pasquali R, Pelusi C, Genghini S, et al. Obesity and reproductive disorders in women[J]. Hum Reprod Update, 2003, 9(4):359-372.
[14]
Pasquali R, Casimirri F, Venturoli S, et al. Body fat distribution has weight-independent effects on clinical, hormonal, and metabolicfeatures of women with polycystic ovary syndrome[J]. Metab Clin Exp, 1994, 43(6):706-713.
[15]
Morales AJ, Laughlin GA, Bützow T, et al. Insulin, somatotropic, and luteinizing hormone axes in lean and obese women with polycystic ovary syndrome: common and distinct features[J]. J Clin Endocrinol Metab, 1996, 81(8):2854-2864.
[16]
Morán C, García-Hernández E, Cortés MA, et al. Estradiol and progesterone endometrial receptors and body fat distribution inobese women[J]. Gynecol Obstet Invest, 1996, 42(2):117-119.
[17]
Rey JM, Pujol P, Dechaud H, et al. Expression of oestrogen receptor-alpha splicing variants and oestrogen receptor-beta in endometrium of infertile patients[J]. Mol Hum Reprod, 1998, 4(7):641-647.
[18]
李星，杨菁，尹太郎，等. 体外受精-胚胎移植者体质量指数对妊娠结局的影响[J]. 中国组织工程研究与临床康复，2010, 14(18):3289-3292.
[19]
Carrell DT, Jones KP, Peterson CM, et al. Body mass index is inversely related to intrafollicular HCG concentrations, embryo quality and IVF outcome[J]. Reprod Biomed Online, 2001, 3(2):109-111.
[20]
Metwally M, Cutting R, Tipton A, et al. Effect of increased body mass index on oocyte and embryo quality in IVF patients[J]. Reprod Biomed Online, 2007, 15(5):532-538.
[21]
Onalan R, Onalan G, Tonguc E, et al. Body mass index is an independent risk factor for the development of endometrial polyps in patients undergoing in vitro fertilization[J]. Fertil Steril, 2009, 91(4):1056-1604.
[22]
Rittenberg V, Sobaleva S, Ahmad A, et al. Influence of BMI on risk of miscarriage after single blastocyst transfer[J]. Hum Reprod, 2011, 26(10):2642-2650.
[1] 张舒沁, 陈练. 产后宫腔内妊娠物残留的诊断和临床处理[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 493-497.
[2] 石皆春, 范子玉, 邢燕. 不同筛查方法预警宫颈原位腺癌的效能[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 575-581.
[3] 唐丹, 姚晓曦, 杨博文, 薛绍龙, 李梦瑶, 韦柳杏, 郄明蓉. 双肾上腺皮质激素样激酶1对子宫内膜样腺癌患者临床特征的影响[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 582-590.
[4] 杜佳丽, 鲍睿, 乔春红, 韩伟. 中孕期宫颈功能不全孕妇经阴道紧急宫颈环扎术后不良妊娠结局预测模型构建[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 403-409.
[5] 魏艺, 周羽西, 杨烨, 凌秀凤, 赵纯. 微小RNA对子宫内膜容受性影响的研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 266-270.
[6] 林琳, 田思萌, 于永华, 徐飞飞, 黄明莉. 干细胞及其外泌体治疗宫腔黏连的研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 271-275.
[7] 李欣, 魏艺, 张娟, 张娟娟, 凌秀凤, 赵纯, 张媔秋. 高龄女性冻胚移植周期临床妊娠结局的影响因素分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 276-283.
[8] 薛静, 孙雅楠, 朱丽丽, 李淑红. 妊娠期急性脂肪肝孕产妇诊疗及其妊娠结局[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 312-321.
[9] 高伟聪, 李丽, 张中华, 朱向辉, 刘素巧. 宫颈癌患者糖调节受损对改良根治术后2年内复发的影响作用[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(02): 231-237.
[10] 鲁珊, 姚蕴珊, 廖色坭, 陈子恩, 张一剑, 蓝健皓, 魏薇, 刘艳杨, 陈艳红, 陈敦金. 妊娠合并急性阑尾炎100例临床研究[J/OL]. 中华产科急救电子杂志, 2024, 13(04): 214-219.
[11] 汪文雁, 郑剑兰, 朱丽慈. 体外受精-胚胎移植术后妊娠患者孕产期风险的临床研究[J/OL]. 中华产科急救电子杂志, 2024, 13(04): 220-226.
[12] 俞慧慧, 尹宗智. 妊娠期胃穿孔[J/OL]. 中华产科急救电子杂志, 2024, 13(04): 209-213.
[13] 胡淼, 杜丽丽, 张丽姿, 林琳, 张瑜亮, 古士锋, 古仲嘉, 赖思莹, 梁景英, 刘雨, 黄敏珊, 黄媛媛, 黄晴晴, 罗世君, 陈敦金. 体外受精/卵胞浆内单精子注射受孕患者胎盘植入分级及围产结局的研究[J/OL]. 中华产科急救电子杂志, 2024, 13(03): 183-189.
[14] 刘文易, 高晓彤, 汤景, 麦卓瑶, 祝丽琼, 陈慧. 体外受精-胚胎移植妊娠合并绒毛膜下血肿患者妊娠结局的临床研究[J/OL]. 中华产科急救电子杂志, 2024, 13(02): 93-99.
[15] 庄旭, 丁立, 许丽, 张宁, 张羽, 林建华. 慢性肾病孕妇肾脏超声异常与不良妊娠结局的相关性研究[J/OL]. 中华产科急救电子杂志, 2024, 13(02): 100-105.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号