不孕妇女卵巢血供彩色多普勒特点与卵巢功能的相关性研究

目的:研究不孕妇女卵巢血供彩色多普勒特点与卵泡发育及卵巢功能的相关性,为不孕症的诊治提供依据.方法:经阴道彩超监测68例不孕妇女和60例正常育龄妇女的排卵情况,测量卵泡发育期、围排卵期、黄体期卵巢血流,同期测定血激素并对比分析.结果:①不孕妇女卵巢干动脉、卵巢基质动脉、卵泡壁动脉、黄体血流收缩期最大血流速度(S)、舒张期最低血流速度(D)均显著低于正常育龄妇女,而阻力指数(RI)则相反(P＜0.05);②优势卵泡壁动脉血流S、D与卵泡直径、血雌二醇(E2)正相关,RI则负相关(P＜0.05);③黄体血流S、D与血孕酮(P)和黄体功能正相关,RI则负相关(P＜0.05).结论:不孕妇女不孕与其卵巢血供显著降低有关,观察不孕妇女卵巢血供可提示并预测卵巢功能状态,利于诊治.     

窦卵泡计数及卵巢动脉血流变化与助孕术治疗结局的关系探讨

目的:探讨助孕术前子宫、卵巢的血流动力学变化及窦卵泡数与IVF-ET治疗后妊娠结局的关系。方法:129例拟采用IVF-ET助孕技术治疗的不育症患者,经阴道彩色多谱勒分别检测子宫体积、内膜厚度、血液动力学变化和卵巢体积、血液动力学以及窦卵泡数,比较分析上述指标与IVF-ET后成功妊娠的关系。结果:妊娠成功组的卵巢基质血流PI及RI、S/D指标显著小于妊娠失败组,而卵巢体积、窦卵泡数显著大于妊娠失败组,但是妊娠与否与子宫的相关参数无关。结论:卵巢动脉的PI、RI、S/D、卵巢体积和窦卵泡数数与妊娠结局有密切的关系。     

不同促排卵方案排卵结局和不同受精方式妊娠结局的相关因素探讨

目的:探讨不同促排卵方案的排卵结局和不同受精方式妊娠结局的相关因素。方法:100例需诱发排卵或行宫腔内人工受精(IUI)治疗的不孕症患者,随机分为两组,分别采用hp-hMG或hMG促排。用化学发光法测量基础及治疗各期血清中的性激素水平。结果:两组患者应用促性腺激素的时间和剂量、卵泡数、排卵率、妊娠率无统计学意义。但hCG注射日大卵泡数(1.8±1.3vs2.5±1.9)、E2水平在hp-hMG组显著低于hMG组(577.77vs925.23pmol/ml),而P/E2水平无明显差别。合并两组后LH<4IU/L组的排卵率(100%)、妊娠率(27.5%)明显较LH>4IU/L组(90%和10.0%)增高,当hCG日子宫内膜厚度在8-12mm时妊娠率最高(21.3%);IUI患者hCG注射日E2水平、卵泡数(>14mm)和卵泡破裂数在妊娠组显著高于非妊娠组(E2:1324.00±971.52vs733.97±724.87pmol/L;卵泡数:3.28±2.39vs2.19±1.55;卵泡破裂数:2.2±1.1vs1.2±0.5),而P/E2在妊娠组显著低于非妊娠组(1.25±1.20vs2.62±2.05)。结论:hMG和hp-hMG在促排卵治疗中无论是排卵率、妊娠率均无明显差异,但hp-hMG更为有效;基础LH水平在促排卵治疗中对排卵率和妊娠率有重要作用;hCG注射日的E2和P/E2水平与妊娠率明显相关。     

输卵管切除术对超排卵的影响

目的:探讨单侧输卵管切除,切除侧卵巢对超排卵的反应性。方法:以因输卵管妊娠行单侧输卵管切除后不孕接受IVF-ET治疗的患者45例共52个周期为研究组,并以同期因输卵管阻塞(无输卵管积水)不孕行IVF-ET治疗的患者875例共913个周期为对照,分析输卵管切除侧卵巢与对侧卵巢对超排卵的反应性。结果:①两组的促性腺激素(Gn)用量、用药天数、hCG日E_2水平、卵裂率、平均移植胚胎数、种植率、临床妊娠率、流产率、异位妊娠率差异无统计学意义(P>0.05)。但单侧输卵管切除组的获卵数减少,差异有统计学意义(P<0.05)。②研究组卵泡晚期(注射hCG日)两侧卵巢大小(分别为35.1±6.5mm、38.2±5.9 mm)有差异,P<0.05。取卵日两组卵泡数(个)分别为6.7±4.5、8.6±3.3(P<0.05),回收卵子数(个)分别为4.9±3.7、6.4±3.6,P<0.05。结论:单侧输卵管切除者切除侧卵巢在行超排卵时,其卵泡晚期(注射hCG日)卵巢较小,取卵日的卵泡数和回收卵子数明显减少,手术可能影响卵巢的血液供应和超排卵效果。     

经阴道彩色多普勒评价促排卵时卵泡质量的研究

目的 探讨经阴道彩色多普勒超声检测卵泡周围血流情况,在评价控制性超促排卵（COH）周期卵泡发育成熟及妊娠结局中的价值。方法 接受IVF或卵胞浆内精子注射治疗的66个周期,在注射HCG日行阴道彩色多普勒超声测量双侧卵巢内每一个直径≥12mm的卵泡周围血流的各项参数。结果 未妊娠组卵泡周围血流阻力指数（RI）、收缩期峰流速/舒张末期血流速度（S/D）值显著高于妊娠组。当RI〈0.49时妊娠率、受精率、卵裂率、MⅡ卵细胞数均显著较高。卵泡周围动脉RI与卵泡直径无相关性。结论 检测卵泡周围血流有助于评价辅助生育技术促排卵治疗时卵泡的质量,是预测妊娠结局的有效指标。     

使用GnRH-a超促排卵时卵泡发育数与妊娠相关血浆蛋白-A的关系

目的:探讨超排卵周期卵泡发育数与卵泡颗粒细胞妊娠相关血浆蛋白-A(PAPP-A)的关系。方法:根据取卵时卵泡发育数不同,将卵巢对超排卵药物的反应分为低反应型(卵泡数≤3个,A组,n=5)、中反应型(卵泡数4-13个,B组,n=20)和高反应型(卵泡数≥14个,B组,n=14)。采用RT-PCR法和ELISA法测定卵泡颗粒细胞PAPP-A mRNA的表达量及其蛋白含量。结果:A组PAPP-A mRNA表达量显著低于B、C组(分别为0.368±0.084、0.572±0.187、0.605±0.188,P<0.05和P<0.01)。A组与B、C组相比,PAPP-A蛋白含量减少,差异有显著性(分别为0.371±0.111mIU/ml、0.531±0.181mIU/ml、0.503±0.154mIU/ml,P<0.05)。结论:颗粒细胞中的PAPP-A含量可能影响超排卵周期卵泡发育数。     

超声卵泡监测在无排卵性不孕症治疗中的应用

目的探讨超声卵泡监测治疗无排卵性不孕症中的疗效。方法选择2013年1月~2014年12月我院门诊收治的不孕症患者65例,所有患者均在我科多次行超声检查,无成熟卵泡形成或成熟卵泡不排,自愿选择药物治疗促进卵泡发育及排卵,同时行超声监测卵泡发育情况,并根据卵泡发育情况指导临床。结果65例患者共促排治疗210个周期,共排卵125次,妊娠28例,流产5例,卵巢过度刺激综合征5例,无成熟卵泡发育45次,卵泡黄素化30次,取消周期10次。结论超声监测卵泡发育可以指导临床用药及受孕时机,在无排卵性不孕症治疗中起着重要作用。     

超排卵周期卵巢的反应性与卵泡颗粒细胞中卵泡刺激素受体表达的关系

目的探讨超排卵周期卵巢的反应性与颗粒细胞中卵泡刺激素受体(FSHR)表达的关系。方法采用蛋白印迹法,测定因输卵管性不孕或者男性因素不孕的60例不孕症患者的卵泡颗粒细胞FSHR蛋白的水平;采用电化学发光法测定血清雌二醇峰值。根据超排卵周期中发育卵泡数,将60例患者分为卵巢低反应组(20例)、卵巢中反应组(20例)及卵巢高反应组(20例),比较各组FSHR蛋白表达水平,并分析FSHR表达水平与卵泡数、雌二醇峰值的相关性。结果(1)卵巢低反应组、卵巢中反应组及卵巢高反应组的FSHR蛋白表达分别为0·19±0·07、0·34±0·16及0·45±0·18,3组比较,差异均有统计学意义(P<0·001);卵泡数分别为(2·5±0·5)、(7·9±1·9)及(21·6±3·8)个,3组比较,差异均有统计学意义(P<0·01);雌二醇峰值分别为3441、7864及22486pmol/L,3组比较,差异有统计学意义(P<0·01)。(2)3组患者超排卵周期颗粒细胞FSHR表达水平与卵泡数及雌二醇峰值均呈显著正相关关系(rs=0·52及0·71,P<0·01)。结论超排卵周期中,卵巢的反应性与颗粒细胞FSHR蛋白表达有关,FSHR表达水平的高低反映不同的卵巢反应类型。     

单次大剂量雌激素在氯米芬促排卵前的应用

目的:观察氯米芬(CC)促排卵时,排卵前单次应用大剂量雌激素的效果。方法:选择排卵障碍的不孕症患者60例,随机分为研究组和对照组,各30例。所有患者均于月经第5天开始服用CC,100mg/d,共5天。研究组患者在最大卵泡的平均直径≥18～20mm时,单次口服戊酸雌二醇12mg;对照组患者于月经第9天起每日加服戊酸雌二醇2mg,直至最大卵泡的平均直径≥18～20cm。阴道超声监测卵泡发育及子宫内膜厚度,比较两组患者妊娠情况。结果:两组HCG日≥18～20cm的优势卵泡个数差异无统计学意义(P>0.05)。研究组HCG日子宫内膜平均厚度显著低于对照组[(8.0±1.3)mm vs(9.8±1.4)mm,P<0.05],但排卵率显著高于对照组(86.7%vs 63.3%,P<0.05),临床妊娠率亦显著高于对照组(60.0%vs 33.3%,P<0.05)。研究组中1例患者出现卵泡未破黄素综合征,对照组中5例出现卵泡黄素化未破裂,两组比较差异无统计学意义(P>0.05)。两组患者均未出现卵巢过度刺激综合征。结论:氯米芬促排卵时,应用雌激素能够改善子宫内膜,排卵前单次大剂量雌激素应用,更利于排卵及妊娠。     

来曲唑联合氯米芬对PCOS患者子宫卵巢血流动力学影响

目的:经阴道超声观察来曲唑联合氯米芬(CC)治疗多囊卵巢综合征(PCOS)的血流动力学变化,探讨来曲唑联合CC治疗PCOS的临床价值。方法:来曲唑联合CC治疗49例PCOS患者,经阴道超声观察子宫内膜厚度,优势卵泡个数,子宫动脉和优势侧卵巢基质收缩期血流峰值(PSV)、舒张末期血流速(EDV)、搏动指数(PI)、阻力指数(RI)及卵巢基质血流信号数。结果:来曲唑联合CC治疗PCOS有较高排卵率和妊娠率,使PCOS患者形成了子宫卵巢血流的周期性变化。结论:来曲唑联合CC用药能改善PCOS的子宫卵巢血流,促进PCOS患者排卵,利于妊娠并能减少流产的发生。     

Differential expression of T-helper cytokines in the peritoneal fluid of women with normal ovarian cycle compared with women with chronic anovulation

BACKGROUND: Estrogen and progesterone immunoregulate the genital environment by expression of cytokines and growth factors. OBJECTIVE: To investigate the pattern of expression of T-helper cytokines during the ovarian cycle compared with women with chronic anovulation resistant to clomiphene citrate. HYPOTHESIS: Expression of T-helper cytokines in women with chronic anovulation may be different from the pattern in women with a normal ovarian cycle. METHODS: We evaluated 31 infertile women having laparoscopy for evaluation of tubal patency and evidence of ovulation in two groups during (a) the luteal phase (17 women) and (b) the follicular phase (14 women). A third group was composed of 14 women with polycystic ovarian syndrome, but they were resistant to clomiphene citrate for induction of ovulation and had laparoscopic ovarian cautery. Peritoneal fluid was collected during laparoscopy. Estimation of T-helper cytokine interleukin (IL)-2, tumor necrosis factor (TNF)-alpha, IL-4 and IL-6 in serum, peritoneal fluid and culture of the peritoneal mononuclear cells was performed by ELISA. Serum luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, estradiol and progesterone were evaluated by the Vidas Parametric System. RESULTS: The LH : FSH ratio was significantly higher in the women with polycystic ovaries than in the ovulatory groups. IL-2 and IFN-gamma were more highly expressed in the follicular phase but the T-helper 2 cytokines IL-4 and IL-6 predominated in the luteal phase, serum, peritoneal fluid and culture of the peritoneal mononuclear cells. From the follicular to the mid-luteal phase, IL-6 increased three to fivefold in the serum and peritoneal fluid, but there was low expression with anovulation. CONCLUSIONS: The peritoneal fluid levels of IL-4 and IL-6 are higher in the luteal phase. Low IL-6 levels in chronic anovulation may be a marker of resistance to clomiphene citrate.     

Comparison between transabdominal and transvaginal ultrasound in the evaluation of a multiple follicular growth.

The aim of this work is to compare transabdominal and transvaginal ultrasound measurement of ovarian size and follicular number and diameter during cycles of ovulation induction for assisted reproduction technologies. We included in our study fourty patients undergoing a controlled ovarian stimulation: the ultrasound monitoring of multiple follicular growth was performed by the same operator, with both transabdominal and transvaginal route, during the follicular phase of the cycle, until the day of human chorionic gonadotrophin (hCG) administration; in ten women was compared transabdominal and transvaginal evaluation of total number of recruited follicles > 5 mm in size on day -4, on day -2 and on the hCG administration day (day 0); moreover in all the patients transabdominal and transvaginal measurement of the mean follicular diameter of leading follicle and the mean ovarian diameters on hCG injection day was compared.     

Time of initiation of clomiphene citrate and pregnancy rate in polycystic ovarian syndrome.

OBJECTIVE: To investigate whether the timing of clomiphene citrate (CC) administration affects hormonal levels, follicular growth, endometrial thickness, and ovulation and pregnancy rates in women with polycystic ovarian syndrome (PCOS). METHODS: Of the 78 infertile women with PCOS who participated in this prospective, double-blind, randomized clinical trial, 37 collectively underwent 71 cycles of CC (100 mg/day) on days 1 through 5 of the menstrual cycle (group 1) and 41 collectively underwent 73 cycles of CC at the same concentration on days 5 through 9 (group 2). Hormonal levels, follicular growth, endometrial thickness, and ovulation and pregnancy rates were compared. RESULTS: The mean number of follicles and the maximum follicular size were greater in group 2. However, ovulation rates were 72.8% in group 1 and 70.8% in group 2 (P=.78), and pregnancy rates were 40.5% in group 1 and 19.5% in group 2 (P=.04). CONCLUSION: Treatment with CC is associated with higher rates of pregnancy if started early (days 1-5) in the menstrual cycle.     

Gonadotropin induction of ovulation

Gonadotropins have been widely used worldwide for many years to induce ovulation. Three main exogenous gonadotropins are used for ovulation induction—follicle stimulating hormone (FSH), luteinising hormone (LH) and human chorionic gonadotropin (hCG). Currently, these gonadotropins are available in the urinary (with the exception of LH) and recombinant forms. FSH (± LH) is used to stimulate follicular development and hCG is used to trigger ovulation of the mature follicle(s). Indications for gonadotropin ovulation induction include hypogonadotrophic hypogonadism and clomifene-resistant normogonadotrophic anovulation. Gonadotropins are also used for controlled ovarian hyperstimulation in conjunction with intrauterine insemination in ovulatory women treated for unexplained or mild male factor infertility. Two main regimens of gonadotropin ovarian stimulation are used, namely step-up and the step-down protocols. The choice of gonadotropin preparation and treatment regimen depends on the underlying ovarian dysfunction. Strict monitoring of gonadotropin treatment with implementation of strict cancellation criteria are recommended to minimise the risks of ovarian hyperstimulation and multiple pregnancy.     

腹腔镜电凝打孔术治疗耐氯米芬多囊卵巢综合征不孕43例疗效分析

目的:探讨腹腔镜下卵巢表面电凝打孔术对耐氯米芬(CC)多囊卵巢综合征(PCOS)所致不孕症患者的疗效。方法:对耐氯米芬的PCOS不孕患者43例,行腹腔镜下卵巢表面电凝打孔术。术后随访3~12个月。观察手术前后血清黄体生成素(LH)、卵泡刺激素(FSH)、睾酮(T)、雌二醇(E2)、泌乳素(PRL)水平变化,卵巢体积及窦卵泡数的变化,术后月经和排卵情况、妊娠率及流产率。结果:术后LH、T、LH/FSH、PRL水平、卵巢体积、窦卵泡数均较术前明显降低(P<0.01),而FSH、E2术前、术后差异无显著性(P>0.05),月经情况明显改善,术后排卵率为93.0%(40/43),妊娠率为58.1%(25/43),流产率为16.0%(4/25)。结论:腹腔镜下卵巢表面电凝打孔术对于耐CC的PCOS不孕患者具有高排卵率和妊娠率以及低流产率的疗效。同时,具有创伤小、恢复快、并发症少的优点,是治疗耐CC的PCOS不孕患者的有效手段。     

Follicular growth in relation to serum hormonal patterns in adolescent compared with adult menstrual cycles

The purpose of this study was to clarify the endocrine regulation of the adolescent menstrual cycle, especially the relationships between ovarian follicular development, luteal phase progesterone secretion, and function of the hypothalamic-pituitary unit. One menstrual cycle of each of 17 women who were 15 and 16 years of age and 12 women who were 25 to 35 years of age was characterized by ultrasonography and hormone measurements. In both groups there was a close correlation between follicle size and serum estradiol concentrations. In the adolescents, follicle development was slower, and an eventual ovulation took place from a smaller follicle than in the older group. The immediate preovulatory follicle size correlated with the maximal serum progesterone concentration during the luteal phase. Late follicular development in adolescents may be related to the slow increase of serum follicle-stimulating hormone concentrations early in the cycle.     

Follicular response and pregnancy among infertile women undergoing ovulation induction and intrauterine insemination

OBJECTIVE: To determine the relationship between ovarian follicular response (number and diameter of follicles) to ovulation induction agents and pregnancy. DESIGN: Retrospective cohort study.Hospital-based center of reproductive medicine. PATIENT(S): Three hundred twenty-two clinically diagnosed infertile couples undergoing 1483 cycles of ovulation induction and IUI.Oral and injectable fertility drugs were administered for 2-10 cycles; ultrasound follicular measurements were recorded around time of ovulation; hCG was administered when follicles were 18-20 mm or more in diameter; IUI was performed 36-40 hours after administration of hCG. MAIN OUTCOME MEASURE(S): A first positive pregnancy test as indicative for conception.Women with follicular diameters >or=20 mm were less likely to become pregnant as compared to women with diameters between 15.00 and 19.99 mm (risk ratio [RR] = 0.58, 95% confidence interval [CI] = 0.35, 0.97). Women >or=30 years of age were half as likely to become pregnant as compared to women <30 years (RR = 0.51, 95% CI = 0.30, 0.85). Likelihood of pregnancy increased by 21% for each prior pregnancy (RR = 1.21, 95% CI = 1.00, 1.47). CONCLUSION(S): Maternal age, gravidity, and follicular diameters around the time of insemination are prognostic factors in the likelihood of pregnancy.     

Induction of ovulation with human urinary follicle-stimulating hormone: endocrine pattern and ultrasound monitoring

Nine infertile patients, suffering from polycystic ovaries, were treated with human urinary FSH and hCG (eight cases) to induce ovulation. Oestrone, oestradiol, 17α-hydroxyprogesterone, testosterone and androstenedione serum levels increased during the treatment. A decrease in luteinizing hormone serum levels was noticed, and in five cases a spontaneous peak was observed. No changes were noted in 5α-dihydrotestosterone serum levels. Ultrasound scanning of the ovaries often revealed multiple follicles at different speeds and stages of growth and their marked turnover was observed. The beginning of the LH spontaneous surge was precocious compared to the normal ovulating follicular sizes: it does not appear that an optimum size exists but when the LH peak occurred too prematurely, ovulation did not take place. Administration of hCG seems to be necessary as spontaneous peaks of LH are not always followed by rupture of the follicle. Ultrasound scanning plays an important role in monitoring ovulation induction, while oestradiol and 17α-hydroxyprogesterone serum levels are not good indicators of follicular maturity in multifollicular growth. Ovulation occurred in eight patients; four conceptions were obtained, one of which resulted in abortion. No ovarian hyperstimulations were observed.     

Prediction of the individual follicle-stimulating hormone threshold for gonadotropin induction of ovulation in normogonadotropic anovulatory infertility: an approach to increase safety and efficiency.

OBJECTIVE: To predict the FSH response (threshold) dose in normogonadotropic, anovulatory infertile women undergoing gonadotropin induction of ovulation. DESIGN: Prospective longitudinal clinical study. SETTING: Specialist academic fertility unit. PATIENT(S): Normogonadotropic, oligoamenorrheic, infertile women who were resistant to clomiphene citrate or in whom clomiphene citrate therapy had failed. INTERVENTION(S): Daily exogenous FSH administration in a low-dose, step-up regimen. MAIN OUTCOME MEASURE(S): The FSH dose on the day of ovarian response (follicle growth > 10 mm in diameter). RESULT(S): Multivariate analysis was used to devise the following equation to predict the individual FSH response dose (75 to >187 IU/d) before initiation of therapy: [4 body mass index (in kg/m(2))] + [32 clomiphene citrate resistance (yes = 1 or no = 0)] + [7 initial free insulin-like growth factor-I (in ng/mL)] + [6 initial serum FSH level (in IU/L)] - 51. The SE of the predicted dose is 35 IU. CONCLUSION(S): The individual FSH response dose for gonadotropin induction of ovulation in anovulatory infertile women can be predicted on the basis of initial screening characteristics. The prediction model developed in this study may increase the safety and efficiency of low-dose gonadotropin protocols (step-up and step-down) by correctly determining the appropriate starting dose for a given patient.