尿黄体生成素试纸在自然及促排卵周期中预测排卵的应用

应用尿黄体生成素 (L H)试纸对 48例不育患者的自然周期、克罗米芬 (CC)和人绝经期促性腺激素 (HMG)共 1 0 2个周期监测排卵 ,以评价其预测排卵的效果 ,并比较 3组尿 L H峰值时优势卵泡大小和子宫内膜厚度的差异。一、资料与方法1 .研究对象 :不育患者 48例 ,年龄 30±2 .8岁 (2 1～ 35岁 )。监测 1 0 2个周期均为已排卵或黄素化不破裂卵泡 (L UF)。其中自然周期37个、CC周期 45个、HMG周期 2 0个。2 .L H试纸为日本基因株式会社会生产的喜可妮排卵试纸 ,它参用单克隆抗体技术 ,敏感度为尿 L H≥ 5 0 IU/ L。3.方法及观察指标 :C…     

自然周期体外受精取卵前卵母细胞提早排出的预测因素分析

目的分析卵巢低反应患者自然周期体外受精(IVF)方案中发生取卵前卵母细胞提早排出的相关因素,探讨预测和预防卵母细胞在取卵前提早排出的相关指标。方法实施自然周期IVF/卵胞浆内单精子注射(ICSI)治疗的患者共378个周期,自月经第3天B超监测窦卵泡直径,基础卵泡刺激素(FSH)、黄体生成索(LH)、雌二醇(E_2)值;第8¹1天B超监测卵泡直径;当卵泡直径>14 mm时,监测血LH、E_2、孕酮(P)水平,当E_2≈1,100 pmol/L时,肌注0.2 mg促性腺激素释放激素激动剂(GnRH-a)诱发排卵(trigger),3411天B超监测卵泡直径;当卵泡直径>14 mm时,监测血LH、E_2、孕酮(P)水平,当E_2≈1,100 pmol/L时,肌注0.2 mg促性腺激素释放激素激动剂(GnRH-a)诱发排卵(trigger),34³6 h后取卵。分析各项临床指标与卵母细胞在取卵前提早排出发生的相关性。结果取卵前卵母细胞提早排出与基础E_2值、"trigger"日P、LH值有关,与患者年龄、基础LH、FSH值和卵泡直径无关。结论自然周期取卵时机的选择应根据患者基础E_2值及监测P、LH水平进行预测和监控。     

LH半定量试纸在异常子宫出血诊断中的应用价值探讨

目的动态监测生育期无器质性病变、异常子宫出血(AUB)患者的尿黄体生成素(LH)水平变化,以期为LH检测在AUB临床诊断中的应用提供参考。方法收集无器质性病变的生育期AUB患者200例,B超监测卵泡发育及排卵情况,同时动态监测患者尿LH水平变化特点,分析常见的不同原因AUB患者尿LH水平的波动情况。结果 200例患者中正常排卵22例(11.0%),排卵障碍者178例(89.0%),以多囊卵巢综合征(PCOS)患者最为常见(62.5%),其次为未破裂卵泡黄素化综合征(LUFS)患者(19.0%)。正常排卵者,LH水平波动变化正常,出现峰值后排卵;PCOS患者无排卵时尿LH波动范围为10~25U/L,无周期改变或峰值形成;LUFS患者尿LH波动范围为10~40U/L,波动曲线呈现为一缓慢上升、缓慢下降的抛物线,无真正峰值出现。结论尿LH半定量试纸可预测有无排卵和排卵时间,可根据LH水平动态变化的特点,评估AUB患者是否存在排卵障碍,为排卵障碍类型的判断提供信息,以期指导临床诊断和治疗。     

黄素化未破裂卵泡综合征病因及治疗探讨

黄素化未破裂卵泡综合征(luteinizedunrup turedfolliclesyndrome,LUFS)是导致女性不育的原因之一。现就2000～2004年我院不孕症门诊就诊的LUFS患者22例进行分析。一、资料1.一般资料:我院不孕症门诊就诊LUFS22例,其中继发不育10例,原发不育12例;年龄25～41岁、平均31.4岁,不育年限2～19年、平均6.7年。2.诊断标准:B超监测显示有卵泡生长无排卵,结合基础体温(BBT)、宫颈粘液评分、黄体生成素(LH)峰进行评价。阴道B超自月经第8天开始隔日或每日监测卵泡生长,自月经第10天每日留晨尿查尿LH,如在尿LH峰出现后24h,预测的排卵日无排卵,…     

药物去势和手术去势对前列腺癌患者性激素的影响

目的比较药物去势与手术去势对前列腺癌患者血清性激素水平的影响。方法对40例行手术去势、22例药物去势(黄体生成素释放激素类似物,LHRH-A;每4周皮下注射1次)的前列腺癌患者治疗前及治疗后1、3个月血清睾酮(T)、雌二醇(E2)、孕激素(P)、卵泡刺激素(FSH)、黄体生成素(LH)、泌乳素(PRL)水平进行检测,统计学分析比较2组患者去势后性激素变化情况。结果手术去势组治疗前及治疗后1、3个月T为(19.3±10.6)、(1.1±0.8)、(0.9±0.7)nmol/L,E2为(104.3±58.4)、(53.4±36.9)、(50.7±37.5)pmol/L,P为(2.6±1.6)、(1.8±1.3)、(1.7±1.4)nmol/L,FSH为(10.8±6.5)、(73.8±31.4)、(75.1±28.7)IU/L,LH为(11.2±7.5)、(38.3±20.6)、(37.4±30.5)IU/L,PRL为(14.5±8.9)、(12.8±7.6)、(13.2±7.9)μg/L;药物去势组治疗前及治疗后1、3个月T为(21.1±11.7)、(1.2±0.7)、(1.0±0.6)nmol/L,E2为(110.5±62.7)、(36.5±30.4)、(34.7±28.6)pmol/L,P为(2.7±1.4)、(0.8±0.6)、(0.7±0.6)nmol/L,FSH为(11.2±7.0)、(5.5±4.3)、(5.8±4.0)IU/L,LH为(12.0±6.7)、(0.8±0.4)、(0.7±0.4)IU/L,PRL为(15.2±7.6)、(13.8±8.2)、(14.2±9.4)μg/L。2组治疗1个月后,T值均显著下降。药物去势治疗后FSH、LH明显下降,而手术去势后FSH、LH明显上升。药物去势组治疗后E2、P下降程度大于手术去势组。结论药物去势与手术去势对前列腺癌患者的性激素水平可产生不同影响。     

冻融胚胎移植周期中未破裂卵泡黄素化综合征发生的相关因素分析

目的探讨冻融胚胎移植(FET)周期中未破裂卵泡黄素化综合征(LUFs)发生的相关因素。方法回顾性分析2015年1月至2018年5月在我院采用自然周期或者促排周期内膜准备方案的FET460例患者的临床资料,采用Logistic回归分析患者发生LUFs的相关风险因素。根据卵泡是否正常排卵,分为LUFs组(57例)和排卵组(403例)。结果子宫内膜异位症[OR=9.509,95%CI(2.689,33.630)]及盆腔结核史[(OR=3.847,95%CI(1.705,8.682)为FET周期患者发生LUFs的主要相关因素;尿LH峰延迟[OR=1.167,95%CI(1.060,1.286)可以有效预测LUFs的发生,HCG诱导排卵[OR=5.889,95%CI(2.377,14.592)会促进LUFs的发生。结论子宫内膜异位症及盆腔结核史是发生LUFs的高危因素,尿LH峰延迟可能预测LUFs的发生,而HCG不能改善LUFs的结局,不适用于FET排卵方案。     

左卡尼汀联合西地那非对雄性糖尿病大鼠生殖内分泌功能的保护作用

目的:初步探讨左卡尼汀与西地那非片在保护糖尿病(DM)大鼠生殖内分泌功能中的作用。方法:40只体重为200～230 g的雄性SD大鼠随机均分为5组:A组为正常对照组,B组为DM大鼠模型组,C组为DM大鼠给予西地那非[5 mg/(kg.d)]治疗组,D组为DM大鼠给予左卡尼汀[300 mg/(kg.d)]治疗组,E组为DM大鼠给予左卡尼汀[300 mg/(kg.d)]联合西地那非[5 mg/(kg.d)]治疗组。各组大鼠治疗6周后分别进行血睾酮(T)、卵泡刺激素(FSH)、黄体生成素(LH)的检测。结果:糖尿病大鼠治疗6周后,血清T,FSH、LH含量,A组:T为(25.25±2.67)nmol/L,FSH为(5.78±0.61)IU/L,LH为(625.21±43.45)ng/L;B组:T为(9.63±1.71)nmol/L,FSH为(1.98±0.42)IU/L,LH为(479.89±27.62)ng/L:C组:T为(18.98±3.07)nmol/L,FSH为(5.08±0.33)IU/L,LH为(586.57±31.72)ng/L;D组:T为(16.18±2.65)nmol/L,FSH为(4.63±0.30)IU/L;LH为(540.78±25.52)ng/L;E组:T为(23.65±2.66)nmol/L,FSH为(5.59±0.48)IU/L,LH为(621.53±36.40)ng/L。各组血清T,FSH、LH含量之间比较,B组均显著低于A、C、D、E组(P均<0.01);C、D组均显著低于A、E组(P均<0.05),而C、D组之间比较,差异均无显著性(P>0.05);E组与A组比较,差异也均无显著性(P>0.05)。结论:西地那非片与左卡尼汀灌胃6周后均可增加DM大鼠血清T、FSH、LH的水平,而两者联合用药时,T、FSH、LH增加水平比单独用药更明显,显示联合用药在保护雄性DM大鼠生殖内分泌功能方面效果更佳。     

中西医结合治疗排卵障碍型不育临床观察

排卵障碍约占不育症的25%[1]。我站对324个治疗周期进行回顾性分析,观察中西结合治疗对排卵率、妊娠率及流产率的影响。一、资料与方法1.资料:2002年9月至2004年1月因不育在我站就诊的排卵障碍型不育112例,其中月经不调52例、高泌乳素血症14例、多囊卵巢综合征20例、精神神经性不育26例。年龄25～38岁,病程2～12年,原发不育95例、继发不育17例。全部患者经查输卵管通畅,抗精子抗体及抗子宫内膜抗体阴性,丈夫精液正常。2.排卵障碍不育诊断标准:基础体温单相型,B超连续监测无优势卵泡或直径<15mm,宫颈评分<7分,尿黄体生成素(LH)(-)。内分泌…     

控制性促排卵中过早血清孕酮升高的原因

控制性促排卵(COS)中过早血清孕酮升高(PE)是指HCG注射前血清孕酮过早的轻度升高,PE并非颗粒细胞过早黄素化所致。虽然PE的原因和机制目前尚未完全阐明,但过多成熟卵泡/卵母细胞数、大剂量卵泡刺激素(FSH)促排卵、高雌二醇(E2)水平及促黄体生成素(LH)相对不足与PE呈明显相关。大量研究已发现PE明显降低COS鲜胚移植周期的妊娠率,其原因可能是PE负面影响了子宫内膜接受性。目前对PE阈值并无统一标准,通常以HCG注射前或HCG注射日血清孕酮的绝对值作为界定标准。最近Venetis CA等荟萃分析超过60 000个IVF周期结果显示,血清孕酮过早升高至0.8~1.1ng/ml(2.54~3.50nmol/L)即表现为鲜胚移植周期的妊娠率明显降低,且随着血清孕酮水平升高妊娠率下降,但当过早升高的孕酮≥1.2ng/ml(3.82nmol/L),妊娠率则稳定在低水平并未随血清孕酮水平的进一步上升而下降。     

精液中性激素水平与生殖细胞凋亡的关系

目的:探讨人精液中性激素水平与生殖细胞凋亡的关系。方法:随机选择66例不育患者及30例生育男性,采用ELISA法进行卵泡刺激素(FSH)、黄体生成素(LH)、泌乳素(PRL)和睾酮(T)水平分析,并用脱氧核苷酸末端转移酶(TdT)介导的缺口末端标记(TUNEL)法检测生殖细胞的凋亡。结果:精液中FSH、LH、PRL和T水平30例生育者分别为(1.63±0.15)U/L、(2.18±0.21)U/L、(6.34±0.30)nmol/L、(1.85±0.11)nmol/L,生殖细胞凋亡率为(4.61±1.23)%,而66例不育者4种性激素水平分别为(1.25±0.18)U/L、(1.76±0.32)U/L、(5.86±0.31)nmol/L、(1.45±0.13)nmol/L,生殖细胞凋亡率为(18.36±2.04)%。两者相比各参数差异均有显著性(P<0.01)。不育组FSH、LH、PRL、T水平与生殖细胞的凋亡率呈负相关(r分别为-0.88、-0.93、-0.90、-0.98,P均<0.01)。凋亡的生殖细胞体积缩小,核染色质致密,凝聚在核周形成新月形,或核裂解形成凋亡小体。结论:精液性激素水平与生殖细胞的凋亡有着密切关系,低水平的性激素可能导致睾丸生殖细胞凋亡率增加。     

每周一次服用米非司酮对正常妇女卵巢功能的影响

对９名健康妇女每周服用２５ｍｇ米非司酮，观察并初步探讨其对性激素、卵泡发育、月经的影响。受试妇女分别在月经周期的第３、１０、１７、２４天晚口服米非司酮２５ｍｇ。结果：９名受试者中５名在用药期间黄体生成素（ＬＨ）、卵泡刺激素（ＦＳＨ）、雌二醇（Ｅ２）、孕酮（Ｐ）处于低水平，没有ＬＨ和ＦＳＨ峰，排卵被抑制，其中３名在停药后发生排卵；其余４名用药期间有排卵。所有受试者Ｂ超显示子宫内膜增生缓慢。服药后１０小时米非司酮血药浓度为１１６．１～４４８．３ｎｇ／ｍｌ。血清米非司酮浓度（１０或５８小时）与α１－酸性糖蛋白（ＡＡＧ）浓度显著相关。米非司酮的作用效果并不依赖于其血清的浓度。认为，部分妇女每周服用一次米非司酮（２５ｍｇ）可以抑制卵泡的发育和排卵，但抑制程度并不一致。     

腹腔镜卵巢打孔术和药物治疗多囊卵巢综合征内分泌变化及诱导排卵的疗效观察

目的:探讨持续无排卵多囊卵巢综合征(PCOS)患者使用诱发排卵的疗效及其长期预后。方法:收集氯米芬(CC)抵抗的多囊卵巢综合征患者75例。共238个治疗周期,随机分为3组(1)腹腔镜电凝打孔术组;(2)低剂量促卵泡激素(FSH)缓增方案促排卵治疗组;(3)达英-35组。观察各组治疗前后FSH、LH、T、E2、PRL、LH/FSH及双侧卵巢体积、卵泡数目及卵泡直径的变化;根据基础体温测定(BBT)及B超监测排卵;并随访受孕情况。结果:随访时间4年,腹腔镜电凝打孔术组妊娠率最高,流产率、卵巢过度刺激综合征(OHSS)和多胎发生的情况极低。3组治疗后血清激素水平均恢复正常,各组间无显著性差异(P>0.05)。各组治疗后较治疗前有显著性差异(P<0.05)。3组卵巢体积、直径、卵泡数量治疗后较治疗前有显著性差异(P<0.05)。结论:三种治疗方法均对难治的多囊卵巢综合征有一定的治疗效果,但腹腔镜电凝打孔术具有治疗周期短、花费少、无卵巢过度刺激综合征和多胎妊娠的发生等优点。     

The treatment of anovulatory infertility with domestic human menopausal gonadotrophin (analysis of 110 cases)

IntroductionHumanmenopausalgonadotropin(HMG)havebeenusedsuccessfuIlyinthetreatmentofanovulatoryinfertilityduringthelast2decades.InShanghaidomesticagentsofHMGhavebeenproducedbyBiochemicalPharma-ceuticalLaboratories(SBPL)sincel98O's.Thisstudyistoevaluateitsefficacyinthetreatmentof11Ocasesofanovulatoryinfertilepatientsin4ShanghaimunicipalandteachinghospitalsbetweenNov.199OandMar.l992.SubjectsandMethodsSubjectselection:LowbloodFSHandLHvalues(atleastoneofthemislowerthan5IU/L)andbloodpr…     

Monitoring of artificial insemination

Artificial insemination (ADI) has been carried out with donor semen since 1984. Following artificial insemination 14 women out of 27 became pregnant in 1984, 30 women out of 57 in 1985 and 33 women out of 56 until October 1, 1986. The cycles were monitored. Serum LH and oestradiol levels were determined every day from the 10th day of the cycle. Follicle size was monitored daily and cervical mucus was also examined every day. LH reaches the highest level at the time of ovulation. 17-Beta-oestradiol level increases parallel with the growth of follicle. Follicular growth can be best monitored by ultrasound folliculometry, providing 50–60% effectiveness.     

Parameters of ovulation in clomiphene citrate treated cycles. The effect of pre-ovulatory administration of oestrogen and human chorionic gonadotropin

This study was undertaken to evaluate the parameters used for monitoring ovulation in patients on clomiphene citrate treatment for the induction of ovulation. The mean serum oestradiol level for every follicle larger than 17 mm on the day before ovulation was 1 885 pmol/l. This value is significantly higher than the value found in spontaneous cycles. The maximum average pre-ovulatory follicle size was 22 mm, also significantly larger than in spontaneous cycles. The maximum pre-ovulatory cervical mucus score is significantly lower than that found in spontaneous cycles. The average midluteal serum progesterone and oestradiol values were significantly higher than in spontaneous cycles. These differences should be taken into consideration in interpreting the results of patients treated with clomiphene citrate for ovulation abnormalities and before in vitro fertilization. Seven patients with a healthy cervix had poor cervical mucus scores in spite of high pre-ovulatory serum oestradiol levels; scores did not improve with administration of exogenous oestrogen, but became optimal with subsequent human menopausal gonadotrophin treatment. Poor cervical mucus despite ovulation and adequate pre-ovulatory serum oestradiol levels in patients on clomiphene treatment should therefore be considered as an indication for gonadotrophin treatment. Pre-ovulatory administration of human chorionic gonadotrophin had no effect in increasing midluteal serum progesterone and oestradiol levels.     

Changes in serum prolactin, sex hormones and thyroid function with alternate nightly nocturnal home haemodialysis

Aim: Uraemia is associated with hyperprolactinaemia, low total (TT) and free (FT) serum testosterone, high luteinizing hormone (LH) and follicle‐stimulating hormone (FSH) and, in women, anovulatory cycles and premature menopause. We hypothesize that extended hours haemodialysis may improve these derangements. Methods: This is an observational cohort study of 30 men (age 54 ± 13 years, body mass index (BMI) 28.1 ± 5.8 kg/m²) and seven women (age 41 ± 11 years, BMI 32.2 ± 11.2 kg/m²) established on chronic home haemodialysis (3–5 h, 3.5–5 sessions weekly) who were converted to nocturnal home haemodialysis (6–9 h, 3.5–5 sessions weekly). Serum was collected at baseline and 6 months for measurement of TT, sex hormone binding globulin (SHBG), LH, FSH, prolactin, thyroid‐stimulating hormone and thyroxine. Results: In the male patients (n = 25), serum prolactin significantly fell (281 (209.5–520) vs 243 (187–359) mU/L, P = 0.001) and TT (12.6 ± 5.8 vs 15.2 ± 8.1 nmol/L, P = 0.06) and FT (281 ± 118 vs 359 ± 221 pmol/L, P = 0.01) increased. SHBG, LH and FSH were unchanged. At 6 months, two of the three women under 40 years of age had return of regular menses after being amenorrhoeic or having prolonged and irregular menses at baseline. There were insufficient women in this study to further analyse changes in sex hormone levels. Thyroid function tests remained stable. Conclusion: Alternate nightly nocturnal haemodialysis significantly improves hyperprolactinaemia and hypotestosteronaemia in men. Menstrual cycling may be re‐established in young women. The effect of these changes on fertility has not been established. Patients should be counselled about the possibility of increased fertility before conversion to extended hours haemodialysis regimens.     

The Effect of Body Condition on Ovarian Activity of Free Ranging Tropical Jennies (Equus asinus)

Serial ultrasonography was performed on seven jennies to study the effect of seasonally fluctuating body condition on ovarian activity during the dry, short rainy and long rainy seasons. Kendall Tau correlations and differences of least square mean values were compared. A distinct seasonal pattern was observed both in body condition and ovarian activity. The mean (±SD) Body Condition Score (BCS) was lowest during the dry season 2.6 ± 0.45 when compared with 3.5 ± 0.52 and 3.9 ± 0.58 during the short and long rainy seasons, respectively. The mean (±SD) number of total follicles was also proportionally low 7.3 ± 1.6 during the dry season compared with 9.6 ± 2.4 and 11.3 ± 3.3 found during the short and the long rainy seasons, respectively. The BCS was positively correlated to the total number of follicles and the diameter of the largest follicle during all seasons. Periods of increasing BCS and transition between seasons with both increasing and decreasing body conditions were strongly correlated to the number and size of ovarian follicles. Seasonal fluctuation in the body condition was found to be the result of variation in feed resource and ovarian activity was also closely following this seasonal pattern. The improvement in body condition has generally, a positive impact on emergence of small growing follicles there by having influence on the total count of ovarian follicles.     

慢性肾炎患者血浆海蟾蜍毒素水平及其肾脏受体表达变化

目的 了解慢性肾小球肾炎（CGN）患者血浆海蟾蜍毒素（MBG）水平及其受体Na+-K+-ATP酶（NKA）在肾组织中的表达情况。 方法 竞争抑制ELISA法测定28例CGN患者和14例健康人血浆MBG浓度。应用免疫荧光共聚焦、免疫组化和图像分析技术检测CGN患者肾组织内NKA的表达部位及表达量。 结果 CGN患者血浆MBG浓度低于健康对照组[（0.579±0.214） nmol/L比（0.715±0.154） nmol/L,P < 0.05],其中高血压者与血压正常者血浆MBG浓度差异无统计学意义[（0.595±0.231） nmol/L比（0.557±0.197） nmol/L,P > 0.05]。血浆MBG浓度与24 h尿钠排泄量无相关（r = -0.022,P > 0.05）。与正常肾组织比较,CGN患者近端肾小管NKA表达下降,肾小管NKA表达阳性面积百分比明显减少[2.1%（0.5%~6.2%）比 5.6%（3.5%~10.8%）,P < 0.01],且与24 h尿钠排泄量呈正相关（r = 0.551,P < 0.01）。 结论 CGN患者血浆MBG水平及其受体NKA在近端肾小管表达的下降可能参与CGN患者钠代谢调节。     

中西医结合治疗卵巢功能低下性不育症48例临床观察

目的观察中西医结合治疗卵巢功能低下性不育的疗效。方法对2004年5月至2006年12月诊治的48例卵巢功能低下不育患者,分为体外受精-胚胎移殖失败组16例、卵巢早衰组9例和卵巢功能低下组23例。从生命网络调控的观点出发,进行中药俞氏促卵泡方为主,辅以适量雌激素、中药外敷和身心健康指导半年以上的治疗。观察治疗后全身症状、基础体温(BBT)、排卵率、妊娠率以及"月经"第3天血清性激素变化。结果48例患者治疗后,全身症状明显改善,妊娠率40%,排卵率由治疗前的17%(8/48)增至治疗后的56%(27/48)(P<0.01)。治疗后各组患者血清雌二醇(E2)水平无明显变化(P>0.05),血清卵泡刺激素(FSH)水平及FSH/黄体生成素(LH)比值明显下降(P<0.05)。结论以俞氏卵泡方为主的中西医结合治疗,有效缓解卵巢功能低下患者的临床症状,提高排卵率和妊娠率。     

Male reproductive hormone profile in Rwandan students

To illustrate the male reproductive hormone profile, a study was conducted among healthy male university students living at Butare, Rwanda (altitude: 1 768 m, barometric pressure: 629 mm Hg). Venous blood was collected in the morning, after overnight fasting. Hormonal assays were performed by classical sandwich ELISA technique. Mean values (±standard deviation SD) were follicle‐stimulating hormone FSH: 3.7 ± 1.6 IU l^?1; luteinising hormone LH: 3.6 ± 2.2 IU l^?1; and total testosterone: 21.0 ± 7.5 nm . The results compare well with findings of other studies.