Page 16 - 南京医科大学自然版

第46卷第5期
·638 · 南 京 医 科 大 学 学 报 2026年5月

regression analyses were applied to evaluate the effect of endometrial thickness on clinical pregnancy outcomes. Results：There were
no statistically significant differences between the two groups in body mass index（BMI），basal follicle⁃stimulating hormone（FSH），

duration of infertility，number of IUI cycles，IUI protocols，number of IUI，or total number of progressive motility（PR）sperm（all P >
0.05）. However，there was a statistically significant difference in the type of infertility between the two groups（P < 0.05）. Compared
with the endometrial thickness < 8 mm group，the group with endometrial thickness ≥ 8 mm had a lower average age for both the
female and male patients，and significantly higher levels of anti⁃Müllerian hormone（AMH）and antral follicle count（AFC）（all P <
0.05）. The clinical pregnancy rate and live birth rate in the IUI cycles with endometrial thickness ≥ 8 mm were higher than those in
the < 8 mm group（P < 0.05）. There was no statistically significant difference in the early spontaneous abortion rate between the two
groups（P > 0.05）. After propensity score matching，endometrial thickness was found to have a significant effect on the live birth rate of
IUI（P < 0.05）. Univariate analysis indicated that factors such as female age，male age，female BMI，basal FSH，AMH，AFC，duration of
infertility，endometrial thickness，and total number of PR sperm were significantly associated with the clinical outcomes of IUI（all P <
0.05）. After adjusting for the significant confounding factors identified in the univariate analysis（except for basal FSH），multivariate
logistic regression analysis revealed that endometrial thickness was not significantly associated with clinical pregnancy（OR=1.933，
95%CI：0.929-4.022，P=0.078）or live birth（OR=1.838，95%CI：0.850-3.971，P=0.122）. Conclusion：The endometrial thickness
during the IUI cycle does not affect the clinical pregnancy outcome. The predictive value of endometrial thickness as a single
ultrasound indicator in the IUI population is limited. Clinical decisions should comprehensively consider factors such as age，ovarian
function，sperm factors，and uterine cavity factors. The decision on whether to cancel or terminate IUI should not be made solely based
on endometrial thickness. However，when it comes to IUI cycles with too low endometrial thickness，clinical decisions still need to be
made with caution.
［Key words］ intrauterine insemination；endometrial thickness；clinical pregnancy rate；live birth rate
［J Nanjing Med Univ，2026，46（05）：637⁃643］

不孕症已经成为当今社会不可忽视的一个社
1 对象和方法
会问题。全球有8%~12%的生育年龄夫妇受到不孕
［1］
症的困扰 。不孕症对患者、家庭及社会造成的负 1.1 对象
面影响一直备受关注，已成为公共卫生领域的核心 回顾性分析 2016—2022 年在南京鼓楼医院生
议题 ［2-3］ 。辅助生殖技术（assisted reproductive tech⁃ 殖医学中心进行的 4 764 个 IUI 周期的临床资料。
nology，ART）已成为解决不孕不育问题的主要方案 根据人绒毛膜促性腺激素（human chorionic gonad⁃
［4］
之一 。宫腔内人工授精（intrauterine insemination， otropin，hCG）诱导排卵当日经阴道超声监测子宫内膜
IUI）作为 ART 的重要组成部分，因操作简便、并发 厚度，将患者分为2组：内膜厚度< 8 mm组（n=395例）
症发生率低、经济成本较低且更接近自然受孕 ， 和内膜厚度≥ 8 mm 组（n=4 369 例）。入组标准：女
［5］
在辅助生殖临床工作中被广泛应用，因此其妊娠 方20~40岁；输卵管至少一侧通畅；妇科盆腔超声正
成功率及影响因素也成为临床关注的焦点。在探 常。排除标准：染色体异常；子宫或内膜病变；中重
讨临床妊娠结局时，子宫内膜厚度是一个常用的 度子宫内膜异位症；数据缺失或治疗周期取消。本
参考指标，目前关于子宫内膜厚度对妊娠结局影 研究经南京大学医学院附属鼓楼医院医学伦理委

响的研究多集中于体外受精⁃胚胎移植（in vitro fer⁃ 员会批准（伦理号：2021⁃384⁃01）。
tilization⁃embryo transfer，IVF⁃ET）周期，而针对 IUI 1.2 方法
周期的相关研究相对较少，缺乏大样本数据，尚未 所有入组患者在治疗前均已完成妇科超声、输
形成统一结论 ［6-7］ 。因此，探讨子宫内膜厚度对 IUI 卵管通畅性检查及精液分析等常规检查。根据患
妊娠结局的影响，对于优化 IUI 患者的个性化治疗 者月经周期及排卵等情况采用自然周期或促排卵
方案具有重要的临床指导意义。本研究回顾性分 周期。自然周期方案：月经规律有排卵患者于月经
析南京鼓楼医院生殖医学中心的相关数据，探讨子 第 10~12 天开始超声动态监测卵泡和内膜生长情
宫内膜厚度与 IUI 临床妊娠结局的相关性，以期为 况，并同步检测外周血性激素水平。促排卵周期方
临床决策提供参考依据。 案：月经不规律无排卵或卵泡发育异常患者于月经