1525例不孕症患者病因分析

目的探讨不孕症的主要病因分布及影响因素.方法对1525例不孕症患者临床资料进行分析.结果女性因素不孕占59.67%,男方因素24.59%,男女双方因素12.13%.女性不孕的病因中输卵管因素占53.85%,其中继发不孕输卵管因素占72.02%,明显高于原发不孕组(33.02%),两者比较差异有显著性(P＜0.05);PCOS的发病率为25.27%,其中原发不孕(38.82%)明显高于继发不孕(13.37%),两者比较差异有显著性.结论不孕症中以女性因素为主,而女性不孕的首要原因是不同程度的输卵管阻塞,其可由生殖道炎症引起,但流产、分娩及盆腔手术创伤也是导致输卵管阻塞的重要原因;PCOS居女性不孕病因的第二位,不容忽视.     

女性不孕症合并盆腔粘连腹腔镜诊治临床分析

目的探讨盆腔粘连与女性不孕症的关系，以及腹腔镜在诊治盆腔粘连相关的女性不孕症中的意义。方法回顾性分析2003年6月至2005年6月在我院因不孕症行腹腔镜诊治的481例不孕患者。其中原发不孕175例，继发不孕306例。分析腹腔镜下不孕症患者盆腔粘连、盆腔粘连合并输卵管阻塞发生率和盆腔粘连腹腔镜术后妊娠情况。结果腹腔镜检查发现原发和继发不孕患者盆腔粘连发生率分别为45．7％和65％，差异有显著性（P〈0．05）。盆腔粘连合并输卵管阻塞在原发不孕中发生率为65．0％，在继发不孕中发生率为58．7％。原发不孕盆腔粘连患者腹腔镜术后宫内自然妊娠率为32．5％（26／80），其中术后6个月内自然妊娠占76，9％（20／26）；继发不孕盆腔粘连患者腹腔镜术后宫内自然妊娠率为27.1％（54／199），其中术后6个月内自然妊娠占66．7％（36／54）。结论盆腔粘连是引起女性不孕症最常见盆腔病变之一。腹腔镜可及时准确地发现不孕症患者的盆腔粘连情况，并同时行镜下盆腔粘连的分离，是诊治不孕患者较为理想的方法。     

伴发腰骶椎隐性脊柱裂女性不孕症的内分泌研究

目的:探讨腰骶椎隐性脊柱裂对女性不孕症内分泌状态的影响。方法:回顾性分析1681例女性不孕症患者的临床资料,依照是否伴发隐性脊柱裂分为伴发隐性脊柱裂1242例(SBO组)和不伴有隐性脊柱裂439例(NSBO组),同时选择相同年龄阶段进行了基础内分泌功能检测的180例生殖健康的女性作为正常对照组(分别在卵泡期、排卵期、黄体期检测各60例),对3组基础内分泌功能(包括FSH、LH、E2、P、PRL、T)在卵泡期、排卵期和黄体期的情况进行比较,同时对SBO组中原发不孕和继发不孕患者的以上6项指标进行对照分析。结果:正常对照组和NSBO组在卵泡期、排卵期和黄体期的6项基础内分泌功能测定指标比较,差异均无统计学意义(P>0.05)。SBO组在卵泡期、排卵期和黄体期的6项基础内分泌功能检测结果与正常对照组和NSBO组比较,差异均有统计学意义及高度统计学意义(P<0.05,P<0.01)。SBO组内原发不孕组中除卵泡期和排卵期的P值与继发不孕组比较,差异无统计学意义(P>0.05),其余各项指标在卵泡期、排卵期和黄体期的比较,差异均有统计学意义及高度统计学意义(P<0.05,P<0.01)。结论:腰骶椎隐性脊柱裂可能会引发女性不孕症患者的内分泌状态失常。     

宫腔镜下输卵管口插管疏通术在不孕症诊治中的应用

目的 探讨宫腔镜下输卵管口插管疏通术在不孕症患者诊治中的应用价值。方法 2001年9月至2003年1月对122例原发性不孕患者(原发组)和185例继发性不孕患者(继发组)行宫腔镜检查及镜下输卵管口插管疏通术，记录输卵管疏通情况。结果 与术前比较，术后两组的输卵管通畅病例增加；术后原发组左侧输卵管通畅的病例较右侧多。而继发组左侧和右侧输卵管间的通畅性的差异无显著性意义；两组术前为输卵管阻塞的病例，术后输卵管双侧通畅与一侧通畅病例分别达60．0％和47．0％，而术后仍双侧阻塞的病例分别减少至30．0％和37．8％。结论 宫腔镜下输卵管口插管疏通术对不孕症患者的诊治效果非常理想，原发性不孕患者的左侧输卵管较右侧输卵管的疏通效果好。     

彝族地区不孕妇女与衣原体感染关系的研究

本文对87例原发不孕及53例继发不孕彝族妇女宫颈细胞沙眼衣原体（CT）抗原进行了检测,结果表明,原发、继发不孕组CT抗原阳性发生率分别为32．2％和35．8％,组间CT阳性检出率无显著性意义（P＞0．05）,但与生育组相比分别存在着显著差异（P＜0．01）。不孕年限长短与CT发生率之间无明显差异（P＞0．05）。研究结果提示,生殖道CT感染与女性不孕之间存在着明显的关系,而与不孕时间的长短无关。研究中还发现CT抗原阳性检出率与抗精子抗体、子宫颈炎严重程度之间存在着高度相互依存关系,宫颈炎越严重,CT阳性率越高。     

生殖道病原微生物与不孕不育的关系研究分析

目的 探讨生殖道病原微生物与不孕不育的关系。方法 选取300例原发性不孕症患者、300例继发性不孕症患者作为观察组;另选取同期300例正常妊娠妇女作为对照组。应用导流杂交低密度芯片检测生殖道感染,确定淋病奈瑟菌（NG）、沙眼衣原体（CT）、解脲脲原体（Uu）、微小脲原体（Up）1/3/6/14、人型支原体（Mh）、生殖支原体（MG）和单纯疱疹病毒（HSV）Ⅱ在两组中的单独和协同感染率。研究不同感染状态与女性不孕症的关系。结果 不孕症组生殖道病原体感染率明显高于对照组,差异有统计学意义（P<0.05）。18～30岁不孕症患者中CT、Uu及协同感染率分别为19.6%、15.9%、17.6%,均分别高于31～42岁不孕症患者的1.6%、10.2%、9.9%,31～42岁不孕症患者中Up3、Up6感染率分别为22.0%、16.8%,均分别高于18～30岁不孕症患者的7.8%、10.1%(P<0.05)。原发性不孕症组的CT+Uu、Uu+Up3、Uu+Up6、Uu+Up3+Up6、Uu+Mh协同感染率与继发性不孕症组比较,差异无统计学意义（P>0.05）。结论 不孕症女性中（包...     

生殖道解脲支原体与沙眼衣原体感染和女性不孕的相关性

目的:了解生殖道解脲支原体(UU)、沙眼衣原体(CT)感染和女性不孕是否存在相关性。方法:选择进行UU、CT检查的158例不孕妇女为研究对象,观察其感染的发生率,根据有无感染情况设置病例组和对照组,对两组间结果进行临床分析。结果:UU、CT感染率分别为45.6%、7.6%,病例组上生殖道炎症及输卵管病变的发生率较对照组显著增高,差异有统计学意义(P<0.05)。结论:UU、CT感染与女性不孕高度相关。     

不明原因原发不孕症患者黄体中期血清蛋白质谱研究

目的探讨不明原因原发不孕症患者血清蛋白质谱特征，寻找女性不孕症血清生物学标志物。方法采用表面增强激光解离飞行时间质谱技术（SELDI-TOFMS），运用WCX2蛋白质芯片检测2005-01-11卫生部北京医院妇产科、北京大学第三临床医院生殖中心、北京妇产医院的29例不明原因原发不孕患者（原发不孕组）和30例健康育龄妇女（对照组）黄体中期血清蛋白质谱，建立并测试不明原因原发不孕症患者血清蛋白质指纹图谱模型。结果筛出差异显著的5种蛋白质组成不明原因原发木孕患者血清的蛋白质谱最佳优化模型，其中质荷比（m／z）分别为8690、8715、8634、8826的4种蛋白质表达下降，质荷比（m／z）6628的蛋白质表达上调。结论不明原因原发不孕患者与正常育龄妇女黄体期血清蛋白质谱存在明显差异，深入研究可能为女性不明原因不孕的病因学提供基础，同时有助于不孕症生物标志物的筛查和发现。     

胎膜早破与解脲支原体、沙眼衣原体感染及细菌性阴道病的关系探讨

目的探讨胎膜早破与孕产妇下生殖道解脲支原体（UU）感染、沙眼衣原体（CT）感染及细菌性阴道病（BV）之间的关系。方法对120例胎膜早破产妇及同期120例正常足月孕妇的宫颈分泌物用PCR技术对UU和CT进行检测及取阴道分泌物对BV进行快速检测。结果胎膜早破组UU—DNA阳性率38．3％，CT—DNA阳性率31．7％，BV阳性率15．0％；正常足月孕妇组UU—DNA阳性率13．3％，CT—DNA阳性率11．7％，BV阳性率5．0％，两组比较差异均有显著性（P〈0．05）。结论孕妇下生殖道UU、CT及BV感染与胎膜早破密切相关。     

1236对不孕夫妇病因探讨

目的 :探讨不孕症的病因 ,从而指导临床治疗。方法 :对 12 36对不孕夫妇进行病史询问、体检及相应的辅助检查 ,对其不孕的原因进行总结分析。结果 :①单纯女方异常者 5 34对 ,占 4 3 2 0 % ;单纯男方异常者 2 5 8对 ,占2 0 87% ;双方均异常者 4 4 4对 ,占 35 92 %。②女方继发性不孕因素高于原发性不孕 ,两组差异有非常显著性 (P <0 0 1) ;男方原发不育因素高于继发组 ,差异有非常显著性 (P <0 0 1)。③女性不孕 978例中 ,排卵障碍原发不孕组高于继发组 ,差异有非常显著性 (P <0 0 1)。输卵管阻塞 5 70例 ,占 5 8 2 8% ,继发不孕组明显高于原发组 ,差异有非常显著性(P <0 0 1)。④男性不育因素 6 96例中 ,发病因素高低依次为弱精子症、少精子症、免疫学病因、男性副性腺感染。其中原发组精液异常高于继发性不育组 ;而继发性不育组男性副性腺感染、免疫学病因高于原发组。结论 :①重视生殖系统感染对不育的影响 ,且应警惕泌尿生殖系统的特殊感染。②男性因素导致的不育不容忽视。不论原发或继发不孕症 ,均应强调男女双方的检查和治疗 ,并应同步进行。③内分泌和免疫学因素对不育的影响值得进一步认识。     

Bacterial vaginosis and infertility: cause or association?

Objectives

To estimate the prevalence of bacterial vaginosis (BV) in infertile women and evaluate the effect of treatment of BV on the pregnancy rate in patients with polycystic ovarian disease (PCOD) and unexplained infertility.

Study design

Cohort study conducted at the Department of Obstetrics and Gynecology in collaboration with the Microbiology Department of Sohag University Hospital, Egypt. All eligible women with female factor infertility (n = 874) were enrolled and all asymptomatic fertile women (n = 382) attending the family planning clinic of the study hospital were recruited as a control group. The study was in two phases: the first included screening all participants for BV after Gram-staining of the vaginal discharge. The second phase was concerned with evaluating the effect of treatment of BV on the cumulative pregnancy rate (CPP) in patients with PCOD (group I; n = 278) and unexplained infertility (group II; n = 170). Each group was divided into three sub-groups: groups Ia (n = 129) and IIa (n = 73) were BV positive and treated for BV; groups Ib (n = 61) and IIb (n = 49) were BV positive and did not receive treatment for BV, and groups Ic (n = 88) and IIc (n = 48) were BV negative. The prevalence of BV was compared using the Chi-square. The long rank test of Kaplan-Meier life table analysis was used to compare the CPR. A multivariate regression model was designed to define the most significant variable which affected the pregnancy rate in patients with PCOD.

Results

The prevalence of BV was significantly higher in infertile than fertile women (45.5% vs 15.4%). The highest prevalence was found in patients with PCOD (60.1%) and unexplained infertility (37.4%). The CPR in both patients with PCOD and unexplained infertility were significantly higher in the patients who were treated for BV. Regression model showed that BV was one of the significant factors interfering with pregnancy.

Conclusions

BV is strongly implicated in female infertility and is probably an underestimated cause of unexplained infertility. Screening and treatment of BV in patients with PCOD and unexplained infertility improved the pregnancy rate considerably.     

腹腔镜检查不育症盆腔疾病916例分析

目的应用腹腔镜诊断技术,评价腹腔镜诊断不育症的价值。方法采用德国Storz型腹腔镜,对916例不育症妇女的盆腔疾病和不育的影响进行分析。结果916例妇女中837例(91．37％)找到了盆腔疾病的病因。盆腔粘连、子宫内膜异位症和输卵管炎是引起不育症的主要盆腔疾病。除宫内膜异位症外,原发不孕症中,又以内生殖器官发育异常、盆腔结核、多囊卵巢多见。继发不孕症以盆腔粘连、输卵管炎多见。继发不孕组中,有宫腔操作史占98．40％。结论应用腹腔镜诊断技术对不育症的诊断价值在于能早期明确不育症盆腔病因,可在直视下通液,动态观察输卵管通畅度和形态,并对由于盆腔疾病所引起的不育症的预后影响作出一定判断。     

人工流产术后继发输卵管性不孕的相关因素分析

目的：探讨人工流产术后继发输卵管性不孕的可能因素。方法：选择2008年12月—2010年10月因输卵管性不孕于武警后勤学院附属医院妇产科行宫腹腔镜联合手术且有人工流产史的患者170例作为病例组,以原发性输卵管性不孕患者171例作为对照组。对2组进行访问性问卷调查,询问其一般情况、月经史、生育史等与不孕相关因素,所有信息录入ACCESS数据库,进行校对整理。结果：病例组初次性生活年龄＜21岁和性伴侣数≥2个的患者比例均高于对照组,差异有统计学意义（P＜0.05）;病例组盆腔炎的发生率显著高于对照组（χ2=5.62,P=0.02;OR=1.95,95%CI：1.12～3.40）;病例组有2次以上人工流产史的患者子宫内膜薄的发生率显著高于对照组（χ2=4.86,P=0.03;OR=2.37,95%CI：1.06～5.31）;病例组腔镜下输卵管阻塞、积水、扭曲、系膜囊肿和盆腔粘连的发生率与对照组相比差异无统计学意义（P＞0.05）。结论：未发现人工流产史与继发输卵管性不孕之间有直接联系,但人工流产与术后盆腔炎、子宫内膜薄等不孕因素有关,性生活史与人工流产的发生有直接关系。     

Primary cesarean section and subsequent fertility

The incidence of infertility after primary cesarean section (study group) was compared to an age- and parity-matched control group who underwent vaginal delivery during 1978 at The New York Hospital. Secondary infertility occurred in 17/291 (5.8%) of the study group and 5/279 (1.8%) of the control group (p less than 0.03). Excluding those who practiced contraception and those who underwent sterilization, this difference is still significant (p less than 0.02). Excluding those patients with a history of infertility prior to the 1978 birth, there was still a trend to increased subsequent infertility in the cesarean section group although this difference did not reach statistical significance (p less than 0.06). The patients with infertility did not have a higher incidence of postpartum endomyometritis, prolonged rupture of the membranes, or abnormal placentation. The causes of the secondary infertility could not always be directly related to cesarean section; the concept of an "infertility threshold" will be discussed.     

宫颈糜烂患者细菌性阴道病病原的检测

目的 :了解细菌性阴道病 (BV)与宫颈糜烂的关系。方法 :采用Amsel常用的诊断标准检测BV病原 ,对宫颈糜烂 112 1例和健康对照者 30 0名的BV患病状态进行对照研究 ,并根据宫颈糜烂患者发病年龄及病程进行分组研究。结果 :宫颈糜烂患者BV患病率明显高于对照组。患者年龄超过 4 0岁 ,病程超过 12个月及宫颈糜烂程度重者BV患病率明显升高 (P <0 .0 1)。宫颈糜烂合并BV患者加德菌 (GV)检出率达 10 0 % ,患者胚胎停止发育、人流后腹痛出血等发生率也高。结论 :BV特别是合并加德菌感染在宫颈糜烂发病中起一定作用 ;年龄越大、宫颈糜烂病程越长、糜烂程度越重 ,BV患病率越高 ;宫颈糜烂并BV可能导致胚胎停止发育和人流后腹痛出血     

Relationship of abnormal vaginal flora, proinflammatory cytokines and idiopathic infertility in women undergoing IVF

OBJECTIVE: To investigate the prevalence of bacterial vaginosis (BV) and abnormal bacterial vaginal flora in an infertile population and correlate with cervical cytokine production and in vitro fertilization (IVF) outcome. STUDY DESIGN: In a blinded study, 331 asymptomatic IVF patients were evaluated for BV, abnormal vaginal flora and cervical cytokine production (interleukin 1 beta [IL-1 beta] and IL-8) on the day of oocyte retrieval. All patients received tetracycline prophylaxis at the time of oocyte retrieval. RESULTS: BV was identified in 4.2% (14/331) of the patients. Patients with idiopathic infertility were more likely to have BV than were women with other causes of infertility (P = .02 vs. male factor, P = .03 vs. tubal factor and P < .01 vs. endometriosis-associated infertility). Patients with abnormal vaginal flora had higher cervical IL-1 beta and IL-8 cytokine levels as compared to patients with normal vaginal flora. IL-1 beta and IL-8 levels in the study subjects correlated highly. No differences were detected in IVF outcome parameters based on the vaginal flora determined at the time of retrieval. CONCLUSION: Abnormal vaginal flora, including that causing BV, is associated with elevated cervical levels of IL-1 beta and IL-8. The induction of proinflammatory cytokines by an altered vaginal ecosystem may be a previously unrecognized cause of idiopathic infertility.     

Hyperandrogenemia as a cause of primary infertility

A total of 205 female infertility patients were investigated for hormonal causes of infertility after other factors such as tubal dysfunction or andrologic disorders had been ruled out. Increased androgen serum levels were found in 72/205 (35.1%) of females. In 28/205 (13.7%), elevated prolactin serum levels were noted. 119/205 (58%) of patients suffered from primary infertility versus 86/205 (42%) with secondary infertility. The incidence of hyperandrogenemia was higher in the primary infertility group (p less than 0.0015). No differences relative to hyperprolactinemia were noted between the two groups. Computerized tomography and sonographic methods did not reveal tumors in any of the subjects where serum concentrations of testosterone and dehydroepiandrosterone sulfate were greater than 2 ng/ml and 7 micrograms/ml, respectively. Present data combine to suggest that the determination of androgen serum levels is of major importance when investigating infertile patients.     

不孕症患者的自身免疫抗体分析

目的：探讨不孕症与患者自身免疫抗体的相关性。方法：采用酶联免疫吸附实验（ELISA）检测516例不孕症患者的血清抗精子抗体（ASAb）、抗卵巢抗体（AOAb）、抗子宫内膜抗体（EMAb）、抗绒毛膜促性腺激素抗体（hCGAb）及抗心磷脂抗体（ACAb）。选择125例正常妊娠妇女作为对照组．比较不孕症组与对照组5项抗体的阳性率。结果：不孕症组ASAb,AOAb,EMAb,hCGAb和ACAb的阳性率分别为26．7％,24．8％,25．2％,21．7％和21．3％。明显高于正常对照组4．8％,2．4％,1．6％,3．2％和1．6％（P均〈0．001）;5种抗体联合检测阳性率为38．2％,与分别单独检测这5项抗体的阳性率相比,差异均有统计学意义（P均〈0．05）。结论：ASAb,AOAb,EMAb,hCGAb和ACAb与不孕症有密切相关性,是引起不孕的重要原因。检测这5项抗体可作为不孕症病因诊断的一项指标。     

Fimbrio-ovarian relationship in unexplained infertility

INTRODUCTION: The role of defective fimbrio-ovarian relation in cases of unexplained infertility has not been extensively studied. The aim of the study was to assess the role of fimbrio-ovarian relation as an investigative modality in women with unexplained infertility. We also aimed to evaluate the efficacy of superovulation and freeing the fimbria-ovarica in increasing the conception rate of women with unexplained infertility. MATERIALS AND METHODS: This was a prospective study where out of 80 infertile couples, 19 women with unexplained infertility were recruited as study group. Fifteen fertile women were recruited as control group. During laparoscopy the length of the fimbria-ovarica and the ovulation border was measured. The fimbrio-ovarian accessibility test was demonstrated by holding the tubal fimbria by a non-traumatizing grasper and their ability to reach or cover the ovulation site. The freeing of the fimbria-ovarica was done, if its length was less than 2 cm. All cases were given ovulation induction for consecutive six cycles and were followed up to document any conception. RESULTS: The mean length of the fimbria-ovarica was significantly less in patients with unexplained infertility (2.5 +/- 0.6 vs. 3.55 +/- 0.8 cm). The mean length of the ovulation border was not significantly different in cases and controls (2.95 +/- 0.6 vs. 3.55 +/- 0.5 cm). The fimbrio-ovarian accessibility test was positive in 6 (31.5%) cases and in 14 (93%) controls. The fimbrio-ovarian accessibility test was negative in 13 (68.4%) cases and in 1 (7%) control. Out of the 13 cases with negative FOAT, 7 had fimbrial length less than 2 cm and in whom the freeing of fimbria-ovarica was done because of severe resistance during stretching. Out of 7 patients in whom freeing of fimbria-ovarica was done 3 conceived (42.8%). Out of the 12 patients who got only ovulation induction 3 conceived (25%). CONCLUSION: Fimbrio-ovarian accessibility test appears to be a promising investigative modality to assess ovarian pick-up in patients with unexplained infertility. Correcting fimbrio-ovarian relation (freeing short fimbria-ovarica) improves pregnancy rate in women with unexplained infertility.