探讨女方年龄及血清基础卵泡刺激素(FSH)水平，对夫精人工授精(AIH)妊娠结局的影响。

选择2012年1月至2016年12月，于苏北人民医院生殖医学中心接受AIH治疗的885例不孕女性共计1 835个周期为研究对象，包括738个促排卵周期及1 097个自然周期。根据接受AIH的受试者年龄，分别将1 835个治疗周期纳入<35岁组(n＝1 621)及≥35岁组(n＝214)；此外，根据受试者血清基础FSH水平，将1 835个治疗周期分别纳入FSH<10 IU/L组(n＝1 632)及FSH≥10 IU/L组(n＝203)。回顾性分析受试者临床病例资料。采用t检验及χ²检验，对不同年龄段、不同血清基础FSH水平的2组受试者一般临床资料，如不孕年限、人体质量指数(BMI)、血清雌二醇浓度及移植日子宫内膜厚度等，以及AIH妊娠结局(临床妊娠率、自然流产率)，进行统计学比较。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》要求。所有受试者均知情同意。

①年龄<35岁组不孕女性的AIH临床妊娠率为13.6%(221/1 621)，显著高于≥35岁组的8.4%(18/214)；年龄<35岁组的自然流产率为14.0%(31/221)，显著低于≥35岁组的44.4%(8/18)，并且差异均有统计学意义(χ²＝5.483、11.277，P＝0.019、0.001)。②血清基础FSH<10 IU/L组与≥10 IU/L组不孕女性的AIH临床妊娠率分别为13.4%(218/1 632)、9.9%(20/203)，二者比较，差异无统计学意义(P>0.05)。血清基础FSH<10 IU/L组不孕女性的AIH自然流产率为14.2%(31/218)，显著低于FSH≥10 IU/L组的40.0%(8/20)，并且差异有统计学意义(χ²＝8.964，P＝0.003)。③对于血清基础FSH<10 IU/L的不孕女性，采用促排卵周期的AIH临床妊娠率为15.6%(100/639)，显著高于采用自然周期者的11.9%(118/993)，并且差异有统计学意义(χ²＝4.765，P＝0.029)。对于年龄<35岁，或者年龄≥35岁，或者血清基础FSH≥10 IU/L的不孕女性，采用促排卵周期与采用自然周期的AIH临床妊娠率比较，差异均无统计学意义(P>0.05)。

若不孕女性的年龄越大，或者血清基础FSH水平越高，则其接受AIH的临床妊娠率越低，自然流产率越高；对于高龄(≥35岁)或高血清基础FSH水平(≥10 IU/L)的不孕女性，促排卵周期并不能提高其AIH临床妊娠率；对于血清基础FSH<10 IU/L的不孕女性，采用促排卵周期可能提高其AIH临床妊娠率。

To investigate the effects of female age and serum basal follicle stimulating hormone (FSH) levels on pregnancy outcome of artificial insemination with husbands sperm (AIH).

From January 2012 to December 2016, a total of 1 835 cycles of 885 infertile women who received AIH treatment at the Reproductive Medicine Center of the Northern Jiangsu People′s Hospital were included in the study, including 738 ovulation induction cycles and 1 097 natural cycles. According to the age of the subjects, 1 835 treatment cycles were divided into <35 years old group (n=1 621) and ≥35 years old group (n=214). In addition, according to the serum basal FSH level of the subjects, the treatment cycles were divided into FSH<10 IU/L group (n=1 632) and FSH≥10 IU/L group (n=203). The clinical cases data of the subjects were retrospectively analyzed. The t test and chi-square test were used to compare the general clinical data between two groups of subjects with different ages or different serum basal FSH levels, such as infertility years, body mass index (BMI), serum estradiol concentration and endometrial thickness at transplantation day, etc., as well as AIH pregnancy outcomes including clinical pregnancy rate and spontaneous abortion rate. This study was in line with World Medical Association Declaration of Helsinki revised in 2013, and all subjects obtained informed consents.

① The clinical pregnancy rate of AIH in infertile women in <35 years old group was 13.6% (221/1 621), which was significantly higher than that of 8.4% (18/214) in age ≥35 years old group; the spontaneous abortion rate of AIH in age <35 years old group was 14.0% (31/221), which was significantly lower than that of 44.4% (8/18) in age ≥35 years old group, and the differences were statistically significant (χ²=5.483, 11.277; P=0.019, 0.001). ② The clinical pregnancy rates of AIH in serum basal FSH<10 IU/L group and ≥10 IU/L group were 13.4% (218/1 632) and 9.9% (20/203), respectively, and there was no significant difference between two groups in clinical pregnancy rate (P>0.05). The spontaneous abortion rate of AIH in serum basal FSH<10 IU/L group was 14.2% (31/218), which was significantly lower than that of 40.0% (8/20) in serum basal FSH ≥10 IU/L group, and the difference was statistically significant (χ²=8.964, P=0.003). ③ For infertile women with serum basal FSH <10 IU/L, the clinical pregnancy rate of AIH with ovulation induction cycles was 15.6% (100/639), which was significantly higher than that of 11.9% (118/993) with natural cycles, and the difference was statistically significant (χ²=4.765, P=0.029). For infertile women of age <35 years old, or age ≥35 years old, or serum basal FSH ≥10 IU/L, there were no significant differences between ovulation induction cycles and natural cycles in AIH clinical pregnancy rate (P>0.05).

The older the infertile woman is, or the higher the serum basal FSH level is, the lower the clinical pregnancy rate of AIH and the higher the spontaneous abortion rate are. For the infertile women with advanced age (≥35 years old) or high serum basal FSH levels (≥10 IU/L), the clinical pregnancy rate of AIH cannot be improved with ovulation induction cycle. For infertile women with serum basal FSH <10 IU/L, adoption of ovulation induction cycle measures may increase the clinical pregnancy rate of AIH.