女性体质量指数对排卵障碍不孕患者夫精人工授精妊娠结局的影响OACSTPCD

Objective:To analyze the effect of female body mass index(BMI)on pregnancy outcomes in anovulatory patients with intrauterine artificial insemination with husband sperm(AIH). Methods:Data from anovulatory patients who received AIH assisted pregnancy in Reproductive Medicine Center of People's Hospital of Wuhan University from January 2018 to May 2022 were retrospectively analyzed.According to the female BMI,the included participants were divided into low BMI group(BMI＜19 kg/m2,n=154),normal weight group(19 kg/m2≤BMI＜24 kg/m2,n=799),overweight group(24 kg/m2 ≤BMI＜27 kg/m2,n=197),and obesity group(BMI≥27 kg/m2,n=90).The cycle characteristics,induced ovulation and AIH treatment,pregnancy outcomes and newborn situation were compared among the four groups.Multi-factor logistic regression analysis was performed to analyze the risk factors for live birth. Results:There was no significant difference in female age,infertility years,previous number of pregnancies and induced ovulation treatment as well as the baseline level of follicular stimulating hormone among the four groups(P＞0.05).The baseline estradiol level was significantly increased in overweight and obesity groups(P＜0.05)when compared to the normal group,while the anti-Müllerian hormone level was remarkably decreased in low BMI,overweight,and obesity groups than that in the normal group(P＜0.05).The proportion of human menopausal gonadotropin use during ovarian induction was significantly increased in overweight and obesity groups when compared to the normal group(P＜0.05).The number of dominant follicles,endometrium thickness on the insemination day,sperm parameters,insemination timing and frequency were comparable among the four groups(P＞0.05).The clinical pregnancy rate was significantly decreased in low BMI group when compared with normal groups(P＜0.05),The rates of multiple pregnancy,pregnancy loss,ectopic pregnancy,live birth,newborn weight and gender ratio were comparable among the four groups(P＞0.05).The rate of premature labor was remarkably elevated in low BMI group when compared to the normal group(P＜0.05),while the rate of caesarean section was significantly increased in overweight and obesity groups than that in the normal group(P＜0.05).The results of multi-factor logistic regression analysis showed that the calibrated female BMI was not correlated to clinical pregnancy rate and live birth rate of AIH after excluding confounding factors such as age and ovarian reserve function(P＞0.05). Conclusions:For overweight and obese women with ovulation disorder,the increase of BMI could not reduce the clinical pregnancy rate and live birth rate in AIH cycles,while low BMI may potentially reduce the clinical pregnancy rate in AIH cycles.