| In recent years,the number of infertile patients has increased significantly.Infertile couples account for about 10%~15% of married couples of childbearing age,and male factors account for about 30%~50% of infertile factors.For men with severe oligospermia,asthenospermia,azoospermia,irreversible damage to fertility and severe genetic diseases that are infertile,general drug or surgical treatment has little effect on the improvement of fertility,so the fertility problems of this population need to be solved urgently.With the development of Assisted reproductive Techniques(ART),the use of sperm for Assisted pregnancy treatment brings hope for the above group to bear offspring.Artificial insemination by donor(AID)and in virtro fertilization with donor or intracytoplasmic sperm injection with donor(IVF-D/ ICSI-D)are two of the best methods for sperm fertilization.Frozen semen for sperm donation has been widely used in the field of human assisted reproduction and has been accepted by more and more infertile couples.What are the factors that affect the clinical pregnancy outcome of human sperm donor assisted reproductive technology and whether it will increase the risk of offspring birth defects is a question that needs our attention at present.Objective: The purpose of this study was to analyze the factors influencing the clinical pregnancy outcome of spermatogenic assisted reproductive technology,and to explore the safety of offspring born with spermatogenic semen,so as to provide data support for the safety of clinical treatment of spermatogenic ART.Materials and Methods: 1 Materials: 1.1AID From January 2009 to December 2017,a total of 3,836 infertile couples receiving AID in the reproductive medicine center of the first affiliated hospital of zhengzhou university were selected as the study subjects.Total of 7,785 cycles.All the female preoperative hysteroscopy results showed that at least one oviduct was unobstructed and the results of chromosome examination were normal.All the AID cycles were Intrauterine insemination(IUI).1.2IVF-D/ICSI-D From January 2009 to December 2017,1072 infertile couples who underwent fresh cycle IVF-D/ICSI-D assisted pregnancy treatment in the reproductive medicine center of the first affiliated hospital of zhengzhou university were selected as the study subjects,with a total of 1209 oocyte collection cycles.All female chromosomes were normal.1.3The offsprings A total of 17,343 live births from January 2009 to December 2017 were selected as subjects after receiving artificial insemination or IVF/ICSI treatment at the reproductive medicine center of the first affiliated hospital of zhengzhou university.1.4 Source and principle of sperm donor The donor semen comes from multiple human sperm Banks approved by the ministry of health of the People's Republic of China.To strictly grasp the indications for spermatogenesis and assisted pregnancy treatment and abide by the relevant laws and regulations and ethical principles.2 Methods: 2.1 AID 2.1.1 Grouping Patients were grouped according to their age,infertility type,infertility years,Body Mass Index(BMI),fertility assistance program,number of insemination,number of pregnancy assistance cycles and pregnancy outcome.2.1.2 Clinical indicators Age,infertility type,infertility years,BMI,fertility assistance program,number of insemination,number of pregnancy assistance cycles,clinical pregnancy rate,cycle pregnancy rate,cumulative pregnancy rate,abortion rate,live birth rate,ectopic pregnancy rate and multiple pregnancy rate.2.2 IVF-D/ICSI-D 2.2.1 Grouping Grouping by their age,infertility type,infertility years,BMI,number of oocytes obtained,number of assisted pregnancy cycles and pregnancy outcome.2.2.2 Clinical indicator Age,infertility type,infertility years,BMI,number of oocytes obtained,number of assisted pregnancy cycles,clinical pregnancy rate,cycle pregnancy rate,abortion rate,live birth rate,multiple pregnancy rate,incidence of ovarian overstimulation and whole embryo freezing rate.2.3 The offsprings 2.3.1 Grouping According to different semen sources,there were 1390 neonates in the Artificial insemination by Husband(AIH)group,1718 neonates in the AID group,13776 neonates in the IVF-H/ICSI-H group and 459 neonates in the IVF-D/ICSI-D group? 2.3.2 Clinical indicator According to the 10 th revision of international statistical classification of diseases and health-related issues(ICD-10)regarding congenital malformations,deformities and chromosomal abnormalities(Q00-Q99),the types and number of birth defects in the offspring of different fertility assistance groups were counted.The incidence of birth defects rate(number of defects/number of live births)in each group were compared.3 Statistically: SPSS21.0 software package was used for statistical analysis of all data,t test was used for measurement data,chi-square test was used for counting data,and P < 0.05 was considered statistically significant.Results: 1 AID 1.1 The clinical pregnancy rate of the group ? 35 years,the group aged 35-40 years and the group?40 years decreased successively,and the differences between the groups were statistically significant.The abortion rate of ? 35 years old group was lower than the other two groups,and the live birth rate was higher than the other two groups,the difference was statistically significant.The ectopic pregnancy rate in group? 40 years old was higher than that in group ?35 years old,and the difference was statistically significant.1.2 The clinical pregnancy rate was higher in the group with the infertility ? 5 years than the other two groups,and the abortion rate was lower than the other two groups,the differences were statistically significant.The live birth rate in the ?5 year group was higher than that in the ? 10 year group,and the results were statistically significant.1.3 The abortion rate of the secondary infertility group was higher than that of the primary infertility group,and the live birth rate was lower than that of the primary infertility group,the differences were statistically significant.1.4 The multiple pregnancy rate of ovulation promoting cycle was higher than that of natural cycle.The clinical pregnancy rate of the double IUI insemination group was higher than that of the single IUI group,and the results were statistically significant.1.5 The pregnancy rate in the first cycle was higher than that in the third,fifth and sixth cycles,and the results were statistically different.The cumulative pregnancy rate increased with the repetition of treatment cycle,with a large increase in the first three cycles,and little change in the cumulative pregnancy rate after the fourth cycle.2 IVF-D/ICSI-D 2.1 The clinical pregnancy rate of the group aged? 35 years,the group aged 35-40 years and the group aged? 40 years decreased successively,and the differences between the groups were statistically significant.The live birth rate of the 35 year-old group was higher than that of the 35-40 year-old group,and the whole embryo freezing rate of the? 35 year-old group was higher than that of the other two groups,the differences were statistically significant.2.2 The clinical pregnancy rate was lower in the group with infertility duration ? 10 years than the other two groups,the incidence of ovarian overstimulation was lower in the group with fertility duration ? 5 years than the group with fertility duration ?10 years,and the whole embryo freezing rate was higher in the group with fertility duration ? 5 years than the group with fertility duration ? 10 years,with statistically significant results.2.3 The freezing rate of whole embryos in the low BMI group was higher than that in the other three groups,and the results were statistically significant.2.4 The abortion rate of primary infertility group was lower than that of secondary infertility group,and the live birth rate and whole embryo freezing rate were higher than that of secondary infertility group.2.5 There were significant differences in the incidence of ovarian hyperstimulation between 15 < occytes ? 20 and occytes >20 groups and the other groups,but there was no significant difference between the other groups.2.6 The clinical pregnancy rate was the highest in the second cycle,and gradually decreased after the second cycle,but the results were not statistically significant.3 The safety of offspring 3.1 There was no statistical difference in the incidence of birth defects between AIH group and AID group. 3.2 There was no statistical difference in the rate of offspring birth defects between IVF-D/ICSI-D group and IVF-H/ICSI-H group.Conclusions: 1 The age of infertile women,the number of infertile years,the number of IUI insemination of infertile women are important influencing factors of AID clinical pregnancy outcome.2 The ovulation stimulation program significantly increased the multiple pregnancy rate of AID.3 Women who are still infertile after 3 cycles of pregnancy may be considered for fertility-donor IVF embryo transfer.4 The Age,BMI,type of infertility and number of occytes harvested in infertile women are clinical pregnancy outcomes of IVF-D/ICSI-D.5 As a relatively safe technique,assisted reproduction with sperm supply does not increase the incidence of birth defects in offspring. |
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