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

doi:10.3877/cma.j.issn.1673-5250.2018.01.015

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

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

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