卵巢过度刺激综合征的临床处理

卵巢过度刺激综合征（ovarian hyperstimulation syndrome，OHSS）是由于患者对外源性促性腺激素高反应而造成，发生于促排卵后黄体阶段或妊娠早期的一种医源性并发症。     

IVF-ET中促性腺激素释放激素激动剂的超促排卵应用与剂量研究

促性腺激素释放激素激动剂(GnRH-a)是体外受精-胚胎移植(IVF-ET)技术中重要用药。GnRH-a与GnRH受体结合后,早期"突发"作用可刺激垂体促性腺激素急剧释放,持续应用后使垂体受抑制,内源性促性腺激素(Gn)水平下降,即所谓的降调节作用。利用这种生物学特性,GnRH-a联合Gn超促排卵可预防早发黄体生成素(LH)峰,避免卵泡过早黄素化。另外,GnRH-a代替人绒毛膜促性腺激素诱发排卵可降低卵巢过度刺激综合征(OHSS)发生率。探索既能有效抑制LH峰,又不使垂体过度抑制的GnRH-a有效低剂量对于超促排卵有重要意义。     

限制性促排卵方案预防卵巢过度刺激综合征的探索性研究

目的研究提前注射绒促性素（hCG）的促排卵方案,即限制性促排卵（LOS）方案,在预防卵巢过度刺激综合征（OHSS）发生中的作用。方法对10例OHSS高危的不孕患者,其中8例为多囊卵巢综合征（PCOS）患者,采用促性腺激素释放激素激动剂（GnRHa）长方案超排卵,当最大卵泡直径达到12．0～14．5mm时注射hCG10000U,36h后取卵,行常规体外受精或单精子卵母细胞质内注射及胚胎移植。结果10例患者均无OHSS发生,获卵11～35个,其中成熟卵4～28个,均在取卵周期行胚胎移植。胚胎移植后妊娠8例,其中输卵管妊娠1例。结论LOS方案可以使PCOS不孕患者在获得足够多的成熟卵、有效防止OHSS发生的同时不降低妊娠率。     

下丘脑-垂体轴外GnRH—R研究现状

促性腺激素释放激素（GnRH）是下丘脑神经内分泌细胞合成的十肽激素，以脉冲形式分泌，通过垂体门脉系统进入垂体，与垂体前叶促性腺细胞上的特异性高亲和力促性腺激素释放激素受体（GnRH—R）结合，刺激黄体生成素（LH）和卵泡刺激素（FSH）的合成与分泌，作用于性腺，从而维持正常的内分泌和生殖系统功能。GnRH—R是介导GnRH功能必不可少的物质，主要分布于垂体，20世纪70年代始下丘脑-垂体轴外GnRH及GnRH—R相继被发现，在下丘脑-垂体轴外许多正常组织和病变组织发现有GnRH—R的表达，     

卵巢过度刺激综合征的补液治疗

卵巢过度刺激综合征（ovarian hyperstimulation syndrome，OHSS）是促超排卵过程中发生的自限性疾病。患者的生存质量可因此受到影响，严重者危及生命。其病理生理改变为毛细血管通透性增加，致大量体液外渗，体液由血管内转移到组织间隙使血液浓缩，胸、腹水，少尿，肝肾功能损害，血栓形成，急性呼吸窘迫综合征（ARDS）等。OHSS多见于使用外源性促性腺激素者，少数可发生于使用氯米芬促排卵者，几乎均为医源性促排卵所致，极个别发生于自然周期妊娠，是内、外源性促性腺激素共同作用所致的一种综合征。因发病机制不清，目前无针对病因的特异治疗方法，一般均根据病情轻重分类对症处理。     

GnRH-a的临床应用进展

促性腺激素释放激素（gonadotropin releasing hormones，GnRH）是由下丘脑神经元细胞体合成并由其末端直接分泌入垂体门脉系统的一种十肽化合物。GnRH选择性的刺激促性腺细胞释放促性腺激素LH和FSH，接下来LH和FSH分别刺激性腺细胞产生性激素并促进配子形成。GnRH具有以下几个显著的生理特征：     

促性腺激素释放激素激动剂触发排卵的临床观察

目的:探讨促性腺激素释放激素激动剂(GnRH-a)触发排卵的疗效。方法:对应用氯米芬(CC)、来曲唑(LE)和/或人绝经期促性腺激素(hMG)促排卵治疗的不孕患者,卵泡成熟时给与GnRH-a(A组)或人绒毛膜促性腺激素(hCG)(B组)触发排卵,卵巢过度刺激综合征(OHSS)高危周期则给予GnRH-a,观察比较其临床结局。结果:共分析了81例患者132个促排卵周期,A、B组周期数分别为75和57,组间周期排卵率、多胎率、流产率相似(P>0.05)。周期临床妊娠率、OHSS发生率A组高于B组(P<0.05),无重度OHSS发生。结论:GnRH-a触发排卵临床妊娠率高,可有效预防重度OHSS的发生。     

GnRH脉冲治疗与男性低促性腺激素性性腺功能减退症生育力保护

<正>低促性腺激素性性腺功能减退(hypogonadotropic hypogonadism, HH)是由于下丘脑促性腺激素释放激素(gonadotropin-releasing hormone, GnRH)神经元功能受损,GnRH合成、分泌或作用障碍,导致垂体分泌促性腺激素减少,进而引起性腺功能不足导致的一组疾病。HH造成性激素合成减少,青春期前起病的患儿表现为青春期延迟或缺失,成年生育期的患者则表现为性腺功能减退和不育。     

女性特发性低促性腺激素性性腺功能减退症诊疗新进展

特发性低促性腺激素性性腺功能减退症(IHH)是由于先天性GnRH合成、分泌或功能障碍所致的促性腺激素水平低下、性腺功能不足的一组遗传异质性疾病,因一个或多个基因突变致病。既往认为女性患者表现为原发闭经及第二性征不发育;但新的研究发现,部分患者可有自主第二性征发育,少数患者可为继发性闭经。嗅觉检测有助于明确疾病分类,伴嗅觉障碍者称为Kallmann综合征。IHH需终身监测,患者可能出现逆转及复发现象。治疗方面,青春期启动激素补充治疗,有生育要求者促排卵治疗后生育结局良好。     

促性腺激素释放激素(GnRH)或乙炔雌二醇(EE)的短期治疗影响垂体对GnRH的反应性

许多研究已清楚证实性腺类固醇调节垂体对GnRH的反应性。在人类正常月经周期中的不同时期、垂体对GnRH的反应明显不同。促性腺激素对GnRH的反应在周期的中期最大。这和滤泡成熟过程中雌激素分泌增加有关。用外源性雌激素同样可见到它使垂体对GnRH的敏感性增强。用GnRH快速治疗可引起垂体释放促性腺激素,并使促性腺激素对随后GnRH的调节敏感而释放。实验也证实GnRH或其超效能类似物长期持久刺激却使垂体反应性显著下降,随之垂体前叶的LH和FSH排出量减少。因此,作者们设计一项研究观察     

Anonymous and non-anonymous gamete and embryo donations: pros and cons

Consequences of legal restrictions concerning gamete and embryo donation have been increasingly discussed during the last three decades, partly dependent upon the fact that assisted reproductive technologies have opened up new medico-technical possibilities. In the present communication we want to elucidate some of the problems and consequences of a Swedish law from 1985 requiring that all sperm donors should be non-anonymous. A similar law was passed in 2003 for oocyte donation. Such legal restrictions do not seem to be in the interest of the infertile couple who, to a large extent, seek treatment abroad where the laws are more liberal or non-restrictive (reproductive tourism). Whether or not the Swedish law is in the best interest for the offspring remains to be seen.     

Adiposity and Endometriosis Severity and Typology

Study ObjectivePrior research has collectively shown that endometriosis is inversely related to women's adiposity. The aim of this study was to assess whether this inverse relationship holds true by disease severity and typology.DesignCross-sectional study among women with no prior diagnosis of endometriosis.SettingFourteen clinical centers in Salt Lake City, UT, and San Francisco, CA.PatientsA total of 495 women (of which 473 were analyzed), aged 18–44 years, were enrolled in the operative cohort of the Endometriosis, Natural History, Diagnosis, and Outcomes (ENDO) Study.InterventionsGynecologic laparoscopy/laparotomy regardless of clinical indication.Measurements and Main ResultsParticipants underwent anthropometric assessments, body composition measurements, and evaluations of body fat distribution ratios before surgery. Surgeons completed a standardized operative report immediately after surgery to capture revised American Society for Reproductive Medicine staging (I–IV) and typology of disease (superficial endometriosis [SE], ovarian endometrioma [OE], and deep infiltrating endometriosis [DIE]). Linear mixed models, taking into account within-clinical-center correlation, were used to generate least square means (95% confidence intervals) to assess differences in adiposity measures by endometriosis stage (no endometriosis, I–IV) and typology (no endometriosis, SE, DIE, OE, OE + DIE) adjusting for age, race/ethnicity, and parity. Although most confidence intervals were wide and overlapping, 3 general impressions emerged: (1) women with incident endometriosis had the lowest anthropometric/body composition indicators compared with those without incident endometriosis, (2) women with stage I or IV endometriosis had lower indicators compared with women with stage II or III, and (3) women with OE and/or DIE tended to have the lowest indicators, whereas women with SE had the highest indicators.ConclusionOur research highlights that the relationship between women's adiposity and endometriosis severity and typology may be more complicated than prior research indicates.     

Pharmacokinetics and endometrial and tubal tissue penetration of cefalotin and cefazolin

The pharmacokinetics and concentrations of the two antibiotics cefazolin and cefalotin were studied during gynecologic operations in endometrial and tubal tissue. The patients received 0.05 g/kg of the antibiotics by intravenous injection. Under the given conditions, pharmacokinetic calculation of the plasma elimination gave half-lives of 24.8 min for cefalotin and of 63 min for cefazolin. Fitting of the tissue levels to the Bateman function showed that the two antibiotics diffuse rapidly into both tubal and endometrial tissue and attain peak concentration levels between 10 and 25 min. In both tissues the concentrations of cefazolin were higher than those of cefalotin. Higher tissue concentrations of cefazolin could also be demonstrated in experiments of longer duration.     

Blood lead and cadmium and birth weight among sub-arctic and arctic populations of Norway and Russia

BACKGROUND: Delivering women and their newborns in the Kola Peninsula of Russia and the neighboring arctic area of Norway were studied to explore relationships between maternal cadmium and lead status and birth weight as a pregnancy outcome. METHODS: Life-style information, maternal blood and cord blood specimens were collected from 50 consecutive mother-infant pairs from hospital delivery departments in three Russian and three Norwegian communities. Pregnancy outcomes were verified by consulting medical records. Lead and cadmium were determined in the blood samples by electrothermal atomic absorption spectrometry. RESULTS: The median blood-cadmium concentration for the Russian mothers was 2.2 nmol/L (n = 148) versus 1.8 nmol/L in the Norwegian group (n = 114, p = 0.55). A weak association was observed between maternal cadmium and amount smoked (r = 0.30, p<0.001); no correlation was found between maternal blood cadmium and birth weight. The corresponding maternal lead values were 0.14 (Russia) and 0.06 micromol/L (Norway), p<0.001. The latter lead concentration constitutes one of the lowest adult population values reported to date. Maternal and cord blood lead levels were strongly correlated (r = 0.88, p<0.001). In a multivariate linear regression model, maternal blood lead was recognized as a negative explanatory variable (p<0.05) for birth weight and child's body mass index (BMIC), with or without adjustment for gestational age. A similar association was suggested by ANOVA-analysis of maternal blood lead by quartiles. CONCLUSION: Maternal blood-lead level as an environmental factor is an apparent predictor of low birth weight and BMIC. It reduced substantially the contribution of a country factor in explaining the observed differences in birth weight.