赠卵试管婴儿1例分娩报告

198 4年世界首例赠卵试管婴儿诞生 ,为缺乏正常卵子的妇女提供了获得生育的途径。目前这一技术在国外常应用于治疗多种生殖疾患。我院自 1998年末开始开展ＩＶＦ -ＥＴ(体外受精与胚胎移植 )项目 ,于 1999年 8月首次为一名 48岁绝经前期妇女实施赠卵试管婴儿技术 ,获妊娠成功 ,并于 2 0 0 0年 5月 7日剖宫产分娩一健康男婴。1　病历摘要患者 48岁 ,2 0年前曾生育 1子 ,之后一直置环避孕。 1年前其子夭折后取环 ,但一直未孕。近 1年月经不规律 ,2～3个月行经 1次 ,经量正常 ,经Ｂ超监测证实无排卵。月经周期第 5天抽血做内分泌检验 :ＦＳＨ 4…     

人类卵体外受精与胚胎移植—“试管婴儿”研究现状

据美国1983年生殖与不育杂志报道,至1982年底世界上约有20个临床诊所具有产生“实验室胚胎”的能力,当这些胚胎移植入不育妇女子宫后,能继续发育足月分娩。约10个诊所于1983年初已出生100名以上的“试管婴儿”。预期再有一年时间全世界将有50个临床诊所会获得成功,300名以上“试管婴儿”会出生。最近,在澳大利亚已有一名不育妇女一次分娩4名“试管婴儿”,在美国成功地进行了人类异体胚胎移植实验,使一名丧失排卵功能的不育妇女顺利地生出世界上第一个异体胚胎移植的“试管婴儿”。这些标志着人类在调节和控制生育研究中的     

辅助生殖技术方式的选择

人类辅助生殖技术主要有人工授精、体外受精-胚胎移植、卵胞浆内单精子显微注射、冷冻相关技术、胚胎植入前遗传学诊断及赠卵试管婴儿等。近年来,辅助生殖技术取得了长足的发展。在此对辅助生殖技术方式的选择逐一评述。     

受卵体外受精-胚胎移植治疗结局分析

目的:探讨受卵体外受精-胚胎移植(IVF-ET)治疗结局和疗效。方法:回顾分析2004年9月至2005年11月在本中心接受卵子赠送IVF-ET的患者共21周期的临床资料。赠卵组(20例)均采用长方案控制性超排卵行IVF-ET。受卵组(21例)采用激素替代治疗准备子宫内膜。赠卵者所赠卵子与受卵者丈夫精液行IVF-ET。选择同期常规IVF-ET患者55例做对照。结果:赠卵组种植率和临床妊娠率(7.3%,15.79%)明显低于受卵组(34.9%,52.38%)和同期IVF-ET组(21.19%,34.55%),P<0.05。结论:受卵IVF-ET是治疗卵巢功能不良和遗传原因不能生育健康后代妇女的有效方法;激素替代周期的种植率和临床妊娠率高于控制性超排卵周期。     

接受赠卵妊娠患者24例产科结局

近年来随着辅助生殖技术的实施,一些丧失卵巢功能的患者能够通过接受赠卵(oocyte donation,OD)得以妊娠,但由于这些患者的年龄和特殊的内分泌状况,使之妊娠过程有其特殊性,现将我院2001年1月至2004年4月治疗的24例接受赠卵妊娠患者的孕期、分娩及产褥期经过情况总结如下.     

赠卵相关伦理问题的思考

赠卵-IVF(in vitro fertilization)技术的发展为卵巢储备功能低下或卵巢功能衰竭的不孕症患者带来了生育的希望,然而该技术的实施过程中遇到不少新的伦理问题,日渐受到关注,如何面对和解决赠卵相关的伦理问题是确保该技术合理应用的必要前提。现就赠卵相关的伦理学热点问题(卵子来源、赠卵者补偿、赠受者条件、赠受匿名以及子代告知等)进行系统回顾和深入思考,并提出自己的观点和建议。     

肾移植后抗免疫疗法条件下妊娠分娩的几个问题

肾移植比血液透析对慢性肾功能不全患者在生活素质方面有显著提高,特别是女性患者的妊娠分娩在血液透析非常困难,由于进行肾移植则较容易。1963年Murray等报告肾移植后的首次分娩。产妇是不给免疫抑制剂的一卵性双胎儿间的肾移植。此后是以血缘者作为供者的给予免疫抑制剂的肾移植妇女分娩,供者为     

同期体外受精-胚胎移植(IVF-ET)赠卵的临床应用

目的:探讨当前形势下中国赠卵的可行性、赠卵数、影响因素及存在的问题。方法:行IVF-ET并自愿捐卵的21例患者及同期接受赠卵并完成IVF-ET周期的23例患者,分析供、受双方的受精率、妊娠率和种植率。结果:23例患者共接受赠卵135枚,平均每周期接受卵子5.6±1.5枚,29个移植周期,12例妊娠,周期妊娠率为41.4%。供卵的21例患者,9个新鲜胚胎移植周期,2例妊娠;32个解冻胚胎移植周期,12例妊娠,冷冻移植周期的妊娠率为37.5%。供、受双方受精率、冷冻胚胎移植周期的妊娠率、累积妊娠率均无统计学差异(P>0.05)。结论:供卵者提供6个左右的卵子既不影响供卵者的妊娠,也能为受卵者提供一个良好的妊娠机会。     

华裔与非亚裔女性不孕症患者体外受精疗效研究

目的针对有关华裔女性比以白种人为主的非亚裔女性体外受精(IVF)成功率较低的报道,本研究对在美国明明试管婴儿生育医学中心接受体外受精治疗的华裔女性和以白种人为主的非亚裔女性的治疗效果进行了比较。方法临床病历回顾性研究。华裔患者是男女双方均为来自中国大陆,港澳台或定居海外的、会讲中文的华人。非亚裔患者是以白人为主的、男女双方均为来自欧美非或地中海地区的非黄种人。研究对象为接受体外受精治疗的女性不孕症患者,包括接受己卵体外受精治疗的、41岁以下华裔和非亚裔女性患者,以及接受同族裔赠卵体外受精治疗的华裔和非亚裔女性患者。所研究的体外受精治疗周期均为鲜胚移植周期。结果在赠卵体外受精供卵者年龄、己卵体外受精女性患者年龄、以及疾病类型之间差异无统计学意义(P0.05)的前提下,华裔组与非亚裔组体外受精采卵取消率、胚胎移植取消率、平均采卵数、平均成熟卵子数、体外受精率、第3天优质胚胎率、平均移植鲜胚数、胚胎着床率、临床妊娠率及婴儿活产率等指标间的差异均无统计学意义(P0.05)。结论华裔女性体外受精治疗成功率与以白人为主的非亚裔女性相比差异无统计学意义(P0.05)。     

种植期单次给予GnRHa增加胚胎的发育潜能

为 证 实黄 体 期 由 于疏 忽 给 予 G nRH 激 动 剂 (G nRH a)对于辅 助 生 育 的继 续 妊 娠 并无 影 响 ,对 产 妇 进 行前 瞻 性 对 照 研究探 讨 GnRH a 的 影 响。 276个 赠 卵周 期。赠 卵者 为 年龄 19～27岁 ,卵 巢储 备 良好的年 轻妇 女 。用自 己 的卵 子多 次 助孕 失败 的 有排 卵的 受 卵者147例 ,提 前或 生 理性 闭经 的 无排 卵的 受 卵者 129例 ,年龄 范围在 31～50岁 。每 位 赠卵 者的 卵 子随 机平 均 分给 生理 特 征尽量 接 近的 2例 受 卵者 ,GnR H a 组 和 对照 组 各 1例 。 分 配 采用随 机 的 方 法 。 …     

Successful pregnancy in an ovarian agenesis patient after modified natural cycle IVF oocyte donation

The recovery of a mature oocyte from a modified natural cycle followed by in-vitro fertilization (nIVF) is an attractive alternative to conventional IVF, involving ovarian stimulation, in the treatment of female infertility. Ovarian agenesis is a rare disorder resulting in primary amenorrhoea and infertility in affected females. A couple sought help for infertility due to ovarian agenesis of the female partner and decided to pursue treatment utilizing oocyte donation. Modified natural-cycle egg retrieval was carried out on the donor; one mature oocyte was retrieved and underwent IVF using a sperm sample from the male partner. A good-quality embryo was transferred. A viable pregnancy was confirmed by ultrasound scan and resulted in the delivery of a healthy baby boy at 36 weeks' gestation. This is the second published report of an ongoing clinical pregnancy and subsequent birth resulting from oocyte donation recovered during a modified natural cycle. The use of less invasive assisted reproduction techniques such as nIVF can be used in oocyte donation cycles successfully.     

体外受精-胚胎移植患者卵子捐赠知识和态度的调查分析

目的调查分析体外受精-胚胎移植(IVF-ET)患者对卵子捐赠的知识和态度现状,为赠、受卵工作提供理论依据。方法采用便利抽样法,抽取郑州市某三级甲等医院行IVF-ET治疗的不孕女性500例,采用《体外受精-胚胎移植患者卵子捐赠知识和态度问卷》对其进行问卷调查。结果卵子捐赠知识回答正确率不高,只有22.76%;条目"并不是只要身体健康就可以进行卵子捐赠"回答正确率最高,为58.54%,答对率最低的条目为"捐赠卵子会导致自身卵子数量不足而影响治疗",回答正确率仅为4.47%;IVF-ET患者对卵子捐赠态度得分为(24.4±5.0)分,处于较低水平,其中,卵子捐赠意愿部分得分最低,为(7.9±3.4)分。结论 IVF-ET患者缺乏对卵子捐赠知识的了解,卵子捐赠态度也不积极,应重视对IVF-ET患者卵子捐赠知识的宣传。     

Les accouchées sont-elles de potentielles donneuses d’ovocytes ?

ObjectivesIn France, oocyte donation program is still underdeveloped because of lack of donors and this situation entails an important wave of cross border medical tourism to different European countries mainly Spain and Greece. In 2011, the General inspection of social affairs report recommended to the biomedicine agency to promote spontaneous oocyte donation via different channels of information to develop this national program. The main objective of this study is to assess the knowledge of women after baby delivery about oocyte donation. The second objective is the identification of ways to assure better information and to promote oocyte donation.Patients and methodsWe conducted a prospective study with anonymous questionnaire distribution to women after delivery at obstetrics/gynecology department of the Regional University Hospital and Maternity-Children Unit “Victor-Pauchet” of Amiens, from December 2012 to January 2013.ResultsTwo hundred and fifty-five questionnaires were distributed and 242 of them were analyzed (94.9%). About oocyte donation knowledge: 28% did not know it was possible, 45% did not know it was legal in France, 54% did not know who was concerned and 36% know that a treatment is necessary, 9% think that oocyte donation is paid and 10% it is non-anonymous. If 67% seems to be favorable to this initiative, only 35% could accept to realize it. About information efficiency, 88% think not to receive enough information, 64% would like to have more information. The health care professional wanted to give this information is an obstetrician (51%), a midwife (37%) and a nurse (12%).Discussion and ConclusionOocyte donation program is misoriented due to a lack of information. Obstetricians and midwives have an important educational and informative role to support oocyte donation. Specific strategy of communication and valuable targeted information are needed to motivate potential donor and achieve the objectives of the program.     

In vitro fertilisation (IVF) with donor eggs in post-menopausal women: are there differences in pregnancy outcomes in women with premature ovarian failure (POF) compared with women with physiological age-related menopause?

Purpose

This study assessed pregnancy rates and obstetric outcomes in women with premature ovarian failure (Group A) with post-menopausal women ≥40 years (Group B) who had IVF ± ICSI using donor eggs.

Methods

This was a retrospective analysis of 54 recipients with either premature ovarian failure or physiological menopause undergoing oocyte donation between 2000 and 2007 at Monash IVF.

Results

The average number of stimulated cycles required for a woman in group A and B to deliver a baby was 1.75 and 1.4 respectively. Both groups had high cumulative pregnancy rates; however, there was a statistically significant difference with regards to rates of complications.

Conclusion

Oocyte donation in both premature ovarian failure and physiological menopause is highly successful and cumulative pregnancy rate is an important statistic which can be used to inform women seeking this technique. High rates of complications, in conjunction with individual risk-factor analysis needs to be considered when counselling post-menopausal women about oocyte donation.     

Maternal anxiety and childbirth

The repercussions of the emotional state of a pregnant woman on the course of her labour and delivery and on the state of health of the newborn have been the subject of numerous researches which have yielded contrasting results. The present inquiry was carried out on a group of 34 pregnant women, with the aim of examining the relationship between the emotional state of a woman during pregnancy, on the one hand and, on the other, the course of her labour and delivery, her psychological reaction to it, and the birth weight of her baby.     

孕前补充小剂量叶酸预防胎儿NTD临床探讨

目的:探讨孕前补充小剂量叶酸(斯利安或福施福)在预防胎儿NTD的临床意义。方法:濮阳市计划生育指导中心及濮阳市妇幼保健院2007年12月31日～2009年12月31日收集全市各区领取生育证的60000例待孕妇女中成功受孕者中随机抽取50000例,并于孕前3个月至孕后前3个月每日增补400ug叶酸,与50000例孕妇未服用叶酸者组成对照组,进行孕期彩超产前筛查及尸解结果进行分析。结果:待孕妇女妊娠前后单纯服用400ug叶酸片,可以降低NTD的发生,预防率达到86%以上。结论:待孕妇女孕前3个月至孕后3个月末每日增补400ug叶酸(北大药业提供),可有效降低胎儿NTD的发生,达到优生优育的目的,进一步提高我市出生人口素质。     

Live delivery following transfer of a single frozen-thawed embryo derived from a 42-year-old woman with marked decreased oocyte reserve

PURPOSE: To determine if live birth is possible in a woman of older reproductive age and who has markedly decreased oocyte reserve following frozen embryo transfer of an oocyte fertilized by intracytoplasmic sperm injection of testicular sperm. METHODS: Ethinyl estradiol followed by ovarian stimulation with gonadotropins was used and a mature follicle was attained. Following oocyte retrieval 34 hours later, intracytoplasmic sperm injection of testicular sperm was performed. The embryo was cryopreserved. RESULTS: A live delivery of a full-term baby ensued. Following subsequent frozen embryo transfer, the baby was diagnosed with Down's syndrome and subsequently died. CONCLUSION: This is the first report of a live delivery following frozen embryo transfer in a woman of advanced reproductive age with marked decreased oocyte reserve.     

孕妇临产前焦虑、抑郁及其影响因素分析

目的:探讨孕妇产前心理状况及影响因素,为产前心理健康教育和心理咨询提供依据。方法:采用焦虑自评量表(SAS)和抑郁自评量表(SDS)作为测评工具,对368名临产前孕妇进行焦虑、抑郁情绪测定,并分析年龄、文化程度、职业和经济收入等因素对孕妇焦虑、抑郁状况的影响。结果:孕妇临产前焦虑发生率为25.54%,抑郁发生率19.84%;与孕妇年龄、文化程度及职业有关(P<0.05);经济水平对孕妇焦虑、抑郁发生率影响无明显关系(P>0.05)。结论:年龄、文化程度和职业对孕妇产前焦虑、抑郁状况有影响;应有针对性地对孕妇开展产前心理卫生健康教育和心理咨询工作。     

孕妇妊娠晚期凝血四项的变化

目的:探讨围生期孕妇、及妊娠高血压综合症(妊高症)患者凝血四项指标变化,预防DIC发生。方法:孕妇组120例、与正常对照组100例进行凝血四项指标检测,采用生物学凝固法。结果:孕妇组与正常对照组进行比较,结果表明孕妇组APTT、PT、TT结果低于对照组,而FIB结果高于对照组,通过t检验APTT、PT、FIB具有统计学意义(P<0.01),TT差异也具有统计学意义(P<0.05)。结论:正常妊娠和妊高症时血液处于高凝状态,以应对分娩这一生理过程,特别是在分娩前期,凝血功能将会发生一定的变化。对孕妇产前进行凝血四项指标检测,特别是妊高症组患者非常必要,孕妇血浆中FIB浓度要比正常组明显升高,所以动态观察凝血四项指标,以便对病理状态下分娩前孕妇进行筛选,预防和及时治疗出血性疾病和血栓疾病。特别是FIB结果有着重要临床价值,能及早发现和预防DIC。     

全程陪护对实施全产程腰硬联合阻滞分娩镇痛孕妇生理及心理影响的临床观察

目的:探讨全程陪护对实施全产程腰硬联合阻滞分娩镇痛孕妇生理及心理的影响。方法:选择住院分娩120例孕妇,按知情同意、自主选择的方法,随机分为观察组和对照组各60例。两组均为全产程腰硬联合阻滞分娩镇痛。观察组实施全程陪护,对照组实施传统服务模式即分段管理,观察两组孕妇的焦虑程度、镇痛效果、产程时间、出血量、分娩方式,新生儿Apgar评分等。结果:两组孕妇的焦虑程度、镇痛效果、产程时间、出血量、剖宫产、新生儿窒息等情况比较差异有显著性(P0.05)。结论:在全产程腰硬联合阻滞分娩镇痛中,全程陪护可缓解孕妇焦虑情绪,提高镇痛效果,缩短产程,减少出血量,降低剖宫产率及新生儿窒息率,是一种理想的以孕妇为中心的产时分娩服务模式,有利于提高产时质量,保证母婴安全。