子宫内膜厚度变化对冻胚移植周期妊娠结局的影响

目的:探讨子宫内膜厚度在加用孕酮前后变化对激素替代周期单枚卵裂期优质胚胎冻胚移植(FET)妊娠结局的影响。方法:回顾性分析天津市中心妇产医院生殖中心2014年7月至2019年1月行激素替代周期(HRT)符合纳入标准共102例患者的临床资料,加入孕激素后的最后1天子宫内膜厚度(移植日内膜厚度)较加用孕激素当日子宫内膜厚度(孕激素日内膜厚度)减小为内膜变薄组(52例),子宫内膜厚度不变或增厚为内膜增厚或不变组(50例),比较两组的一般情况及妊娠结局,同时采用Logistic回归模型对活产的相关因素进行分析。结果:两组间年龄、不孕年限、不孕原因、体质量指数(BMI)及临床妊娠率、活产率、生化妊娠率、早期自然流产率、晚期自然流产率间差异均无统计学意义(P>0.05)。Logistic回归显示:校正女方年龄、不孕年限、BMI、孕激素日内膜厚度、移植日内膜厚度等因素后,内膜厚度变化并不是活产的独立影响因素(P>0.05)。结论:单枚卵裂期胚胎FET周期中加用孕激素前后子宫内膜厚度变薄、增厚或不变具有相似的妊娠结局。     

腹腔镜手术对子宫内膜异位症合并不孕症患者的妊娠结局影响北大核心CSCD

目的分析腹腔镜手术对子宫内膜异位症(EMT)合并不孕症患者治疗后的妊娠结局及相关影响因素。方法 2013年1月至2015年12月选择在海南妇产科医院进行腹腔镜手术治疗EMT合并不孕症患者126例,分析术后24个月的妊娠情况、妊娠结局及相关因素的影响。结果术后24个月,累积妊娠率51.59%,良好妊娠结局率为34.13%,不同年龄、术后时间、不孕年限、不孕类型患者的妊娠率及良好妊娠结局率不同(P <0.05),而临床病理分型,r-AFS分期Ⅰ、Ⅱ期之间,Ⅲ、Ⅳ之间与术后妊娠率及良好妊娠结局率差异无统计学意义(P>0.05)。结论年龄、术后时间、不孕年限、不孕类型与EMT合并不孕症患者是否妊娠及妊娠结局有关,而目前的证据无法提示临床病理分型,r-AFS分期Ⅰ、Ⅱ期之间,Ⅲ、Ⅳ之间与术后妊娠率及良好妊娠结局率有关。     

腹腔镜手术对子宫内膜异位症合并不孕症患者的妊娠结局影响

目的分析腹腔镜手术对子宫内膜异位症(EMT)合并不孕症患者治疗后的妊娠结局及相关影响因素。方法 2013年1月至2015年12月选择在海南妇产科医院进行腹腔镜手术治疗EMT合并不孕症患者126例,分析术后24个月的妊娠情况、妊娠结局及相关因素的影响。结果术后24个月,累积妊娠率51.59%,良好妊娠结局率为34.13%,不同年龄、术后时间、不孕年限、不孕类型患者的妊娠率及良好妊娠结局率不同(P 0.05),而临床病理分型,r-AFS分期Ⅰ、Ⅱ期之间,Ⅲ、Ⅳ之间与术后妊娠率及良好妊娠结局率差异无统计学意义(P0.05)。结论年龄、术后时间、不孕年限、不孕类型与EMT合并不孕症患者是否妊娠及妊娠结局有关,而目前的证据无法提示临床病理分型,r-AFS分期Ⅰ、Ⅱ期之间,Ⅲ、Ⅳ之间与术后妊娠率及良好妊娠结局率有关。     

盆腔输卵管因素不孕且前次助孕失败患者再次冻融胚胎移植中应用GnRH-a的临床妊娠结局分析

目的:探讨盆腔输卵管因素不孕患者助孕失败后，在冻融胚胎移植(FET)中使用促性腺激素释放激素激动剂(GnRH-a)对妊娠结局的影响。方法:回顾性分析2015年1月至2018年1月在四川省人民医院因盆腔输卵管因素不孕行FET且前次助孕失败的患者319例，根据FET周期中是否使用GnRH-a分为对照组(n=135)和GnRH-a组(n=184),比较两组患者一般临床资料和妊娠结局，并采用Logistic回归模型分析临床妊娠和自然流产的相关影响因素。同时按照子宫内膜厚度是否>8 mm和是否高龄(≥35岁)对患者进行再次分层，比较分层后患者一般临床资料和妊娠结局。结果:(1)单因素分析提示GnRH-a组子宫内膜更厚，临床妊娠率和自然流产率更高(P<0.05),但活产率差异无统计学意义(P>0.05)。Logistic回归分析提示：FET内膜准备方案中使用GnRH-a不是临床妊娠的独立影响因素(OR 1.428,P=0.142),是自然流产的独立影响因素(OR 2.499,P=0.024)。(2)分层分析发现，与对照组比较，子宫内膜厚度>8 mm且年龄<35岁患者中，GnRH-a组临床妊娠率(64.28%vs.50.00%,P<0.05)和自然流产率(30.86%vs.14.29%,P<0.05)更高。结论:对于盆腔输卵管因素不孕且有助孕失败史的患者，GnRH-a未提高患者的活产率，且自然流产率增加。     

影响冻融胚胎移植妊娠结局的相关因素分析

目的:探讨影响冻融胚胎移植(FET)妊娠结局的相关因素。方法:回顾性分析324个周期行FET患者的临床资料,分析患者年龄、体质量指数(BMI)、移植日子宫内膜厚度、内膜准备方案、移植胚胎数等相关因素对FET妊娠结局的影响。结果:324个周期共解冻胚胎727个,复苏成活720个(99.0%),临床妊娠144例(44.4%),胚胎植入196例(27.2%)。其中自然内膜准备周期组和激素替代内膜准备周期组患者年龄、不孕年限、基础卵泡刺激素(bFSH)、基础黄体生成素(bLH)、基础雌二醇(bE2)、复苏胚胎数、移植胚胎数、移植日子宫内膜厚度、胚胎种植率及临床妊娠率组间均无统计学差异(P0.05)。年龄≤35岁组的临床妊娠率高于年龄35岁组,差异有统计学意义(P0.05);BMI≥24.0 kg/m2的肥胖组临床妊娠率与正常体质量(BMI=18.5~23.9 kg/m2)组无统计学差异(P0.05);移植日子宫内膜厚度≥7 mm组的临床妊娠率高于移植日子宫内膜厚度7 mm组,但差异无统计学意义(P0.05);各移植胚胎数组间临床妊娠率无统计学差异(P0.05)。结论:年龄是影响FET临床结局的重要因素,内膜准备方案、BMI、移植日内膜厚度、移植胚胎数对冻融胚胎移植临床结局无影响。     

宫腔镜子宫内膜微刺激术后再次冻融胚胎移植的临床结局

目的探讨宫腔镜子宫内膜微刺激术对再次移植冻融胚胎患者临床结局的影响。方法选取2015年1月—2016年8月在本院行体外受精(IVF)助孕首次移植治疗失败的患者共281例,随机分为研究组(A组)和对照组(B组)。A组129例,月经干净后第3~7日进行宫腔镜子宫内膜微刺激术;B组152例,第2次移植前未行手术。统计分析冻融胚胎移植(FET)的妊娠结局。结果 (1)A、B两组间患者年龄、不孕年限、基础性激素、体质量指数、黄体酮转化日内膜厚度、移植胚胎数、优质胚胎率、异位妊娠率、多胎率、早期流产率相比较,差异无统计学意义(P0.05)。(2)A组的临床妊娠率和着床率分别是58.1%、34.0%,显著高于B组(47.4%、27.6%)(P0.05)。进一步运用多因素Logistic回归分析显示,宫腔镜子宫内膜微刺激术能够显著增加临床妊娠的几率(OR=1.50,95%CI=1.12~2.43),而对异位妊娠、多胎妊娠及早期流产的发生无明显影响。结论宫腔镜子宫内膜微刺激术属微创手术、并发症少,手术方便快捷,能更直观评价患者的宫腔内情况,并且通过对子宫内膜局部轻微刺激,改善内膜容受性,提高着床率、妊娠率,故宫腔镜子宫内膜微刺激术值得推广。     

干预治疗对子宫内膜形态不良者体外受精-胚胎移植结局的影响

目的:探讨干预治疗对超声检查显示子宫内膜形态不良的不孕患者体外受精-胚胎移植(IVF-ET)结局的影响。方法:采用回顾性对照研究,选择近排卵期子宫内膜超声检查形态不良者并行子宫内膜搔刮的干预性治疗后至内膜回声正常的患者30例(34周期)为干预组,子宫内膜回声不良而未行干预性治疗的患者37例(40周期)为未干预组;另选择同期子宫内膜形态正常的不孕患者51例(53周期)为对照组。比较3组患者的临床特征、内膜厚度、卵巢反应和妊娠结局。结果:干预组30例患者中,19例干预治疗1次,2例干预治疗4次,其余9例干预治疗2~3次后至内膜形态基本恢复正常。3组患者的基本临床特征、内膜厚度、卵巢反应、受精数以及移植胚胎数等比较,差异均无统计学意义(P0.05)。干预组的胚胎种植率、周期临床妊娠率(27.1%,50.0%)均高于未干预组(13.4%,25.0%),差异有统计学意义(P0.05),但与对照组(19.4%,35.8%)相比,差异无统计学意义(P0.05)。未干预组的胚胎种植率、周期临床妊娠率低于对照组,但差异无统计学意义(P0.05)。结论:超声检查提示子宫内膜形态不良的患者行干预治疗至内膜回声正常后有利于提高子宫内膜容受性,改善IVF-ET治疗结局。     

hCG日子宫内膜厚度与体外受精-胚胎移植妊娠结局多中心回顾性研究

目的探讨h CG日子宫内膜厚度对体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法纳入2015-01-01—2015-12-31 8家生殖中心共3601个IVF-ET周期。在h CG注射日测量子宫内膜厚度,绘制子宫内膜厚度与助孕结局的分布表,根据子宫内膜厚度分为2组,A组(289个周期):h CG日子宫内膜厚度8mm,B组(3312个周期):h CG日子宫内膜厚度≥8mm。比较两组临床妊娠率、活产率、妊娠丢失率、单胎妊娠持续时间、单胎出生体重。结果 A、、47.0%(P=0.000),妊娠丢失率分别为23.3%、15.8%(P=0.024)。两组单胎分娩胎儿妊娠持续时间和单胎分娩胎儿体重比较差异无统计学意义。采用多因素logistic回归校正女方年龄、BMI、移植胚胎数后,B组与A组比较,临床妊娠率(a OR=1.492,P=0.001)与活产率(a OR=1.621,P=0.000)均增加。结论 h CG日子宫内膜厚度影响IVF-ET妊娠结局,子宫内膜厚度8mm时,IVF-ET的临床妊娠率与活产率较低,在患者进行移植策略决策时,应充分告知;但h CG日子宫内膜厚度不影响单胎妊娠的妊娠持续时间和胎儿出生体重。     

自然周期准备内膜在子宫内膜异位症患者冻融胚胎移植中的结局分析

目的:研究以自然周期作为子宫内膜准备方式对子宫内膜异位症(EMS)患者冻融胚胎移植(FET)妊娠结局的影响。方法:回顾性分析EMS患者353个FET周期,按EMS严重程度分组,A组:I~II期,120个周期;B组:III~IV期,233个周期;另将B组中囊肿复发的47个周期设为D组;而将输卵管因素不孕患者的300个FET周期纳入为对照组(C组),比较A、B、C组患者自然周期准备内膜的妊娠结局。结果:A、B、C组患者的种植率、活产率、继续妊娠率、流产率、妊娠期并发症率无统计学差异(P0.05),且妊娠结局与EMS的分期无关。A、B、C组均没有出生缺陷儿。当高质量的胚胎移植时,卵巢内膜异位囊肿并不影响妊娠结局。B组较C组低出生体质量儿和早产儿的发生率高。结论:EMS患者自然周期准备内膜与输卵管性因素不孕患者有相似的妊娠结局,且与EMS严重程度无关,妊娠结局不受内膜异位囊肿的影响,是经济、高效的内膜准备方法。     

子宫内膜轻微吸刮术改善反复着床失败妇女妊娠结局的应用

目的:探讨子宫内膜微吸刮术对反复着床失败妇女再次体外受精-胚胎移植(IVF-ET)临床妊娠结局的影响。方法:选择2011年8月至2012年5月北京大学第三医院生殖医学中心的164例反复着床失败妇女进行前瞻性对照研究,研究组82例于再次IVF-ET术前行子宫内膜轻微吸刮术,对照组82例IVF-ET术前未行子宫内膜轻微吸刮术。观察两组患者妊娠结局。结果:两组患者年龄、不孕年限、不孕原因、基础FSH值比较,差异均无统计学意义(P>0.05)。两组间促性腺激素使用天数、HCG注射日子宫内膜厚度、获卵数、移植胚胎数比较,差异均无统计学意义(P>0.05)。研究组和对照组胚胎着床率(22.12% vs 10.55%)、临床妊娠率(41.46% vs 20.73%)及继续妊娠率(36.58% vs 15.85%)比较,差异有统计学意义(P<0.01)。结论:子宫内膜轻微吸刮术能提高反复着床失败妇女再次IVF-ET术后的临床妊娠率,改善临床妊娠结局。     

影响不孕妇女IUI治疗成功率的因素分析

目的:探讨影响IUI治疗成功的各种临床因素。方法:回顾性分析260例接受IUI治疗妇女的促排卵方案、子宫内膜厚度、优势卵泡的数目和直径、IUI的时机、输卵管壶腹部的直径、输卵管伞端距宫角的距离、洗涤后精子的密度和精子的动力、IUI的周期数、AsAb与妊娠结局的关系。结果:IUI治疗结局与子宫内膜的厚度、IUI治疗的时机、输卵管壶腹部的直径、输卵管伞端距宫角的距离、洗涤后精子的密度和动力有关(P<0.01,P<0.05)。与促排卵方案、优势卵泡的数目和直径、抗精子抗体无关(P>0.05)。1-3个周期IUI治疗的妊娠率明显高于3个以上治疗周期的妊娠率(P<0.05)。结论:影响IUI结局的主要因素是:子宫内膜的厚度、IUI治疗的时机、输卵管壶腹部的直径、输卵管伞端距宫角的距离、洗涤后精子的密度和动力。延长IUI治疗的周期数,并不能提高病人的成功率。     

Maternal life events and adverse pregnancy outcomes: lessons from the Auvergne ectopic pregnancy registry

OBJECTIVE: To investigate stressful maternal life events as candidate risk factors for ectopic pregnancy. DESIGN: Population-based registry study. SETTING: Auvergne ectopic pregnancy registry (France). PATIENT(S): Women (n = 641) registered between 1997 and 2000. INTERVENTION(S): Standard treatment of ectopic pregnancy. MAIN OUTCOME MEASURE(S): Based on the Psychiatric Epidemiology Life Events Scale, we analyzed the nonresponse bias, the confounding effects of sociobehavioral factors associated with both life events and ectopic pregnancy, and the potential buffering effects of socio-cultural variables. A multivariate model was constructed to test the association between life events and ectopic pregnancy, adjusting for identified confounders and testing interactions. RESULT(S): The primary hypothesis that life events might be independent risk factors for ectopic pregnancy was not confirmed in this study, which nevertheless illustrated the numerous biases and measurement problems confronting association studies of life events with adverse pregnancy outcomes. CONCLUSION(S): Recommendations are made for future studies on life events and adverse pregnancy outcomes to avoid most selection, information, and confounding biases. Methodological improvements are needed for measurement of life events to develop measures that more closely consider the consequences of stress and the mechanisms of buffering.     

Endometrial pattern,thickness and growth in predicting pregnancy outcome following 3319 IVF cycle

A retrospective study of 3319 women was conducted to assess predictive ability of endometrial characteristics for outcomes of IVF and embryo transfer. Endometrial thickness, growth and pattern were assessed at two time points (day 3 of gonadotrophin stimulation and day of HCG administration). Endometrial patterns were classified as pattern A: triple-line pattern comprising a central hyperechoic line surrounded by two hypoechoic layers; pattern B: an intermediate isoechogenic pattern with the same reflectivity as the surrounding myometrium and poorly defined central echogenic line; and pattern C: homogenous, hyperechogenic endometrium. The endometrium of pregnant women was thinner on day 3 of stimulation, thicker on the day of HCG administration, and showed greater growth in thickness compared with non-pregnant women. Clinical pregnancy rates differed according to endometrial pattern on the day of HCG administration (55.2%, 50.9% and 37.4% for patterns A, B and C, respectively). A positive linear relationship was found between endometrial thickness on the day of HCG administration and clinical pregnancy rate. Endometrial thickness, change and pattern were independent factors affecting outcome. Receiver operator characteristic curves showed that endometrial pattern, thickness and changes were not good predictors of clinical pregnancy. Discriminant analysis indicated that 58.7% of original grouped cases were correctly classified. Although endometrium with triple-line or increased thickness may favour pregnancy, combined endometrial characteristics do not predict outcomes.     

Predictors of intracytoplasmic sperm injection (ICSI) outcome in couples with and without male factor infertility

AIM: To find out the predictors of ICSI outcome. METHODS: Forty-three pregnancies in 100 consecutive ICSI cycles. RESULTS: Every 1,000 pg/ml increase in hCG-day E2 (OR = 0.46, CI: 0.25-0.83, p = 0.01) and 1% decrease in the rate of normal sperm morphology (OR = 0.81, CI: 0.67-0.98, p = 0.03) caused a significant decrease in clinical pregnancy rate and live birth rate (respectively, OR = 0.5, CI: 0.32-0.96, p = 0.03, OR = 0.66, CI: 0.5-0.86, p = 0.002) while every increase in the number of good quality embryos transferred caused a two-time increase in the clinical pregnancy rate (OR = 2.1, CI: 1.2-4, p = 0.01). On the other hand, every increase in the number of four-cell cleavage embryos (OR = 1.02, CI: 1.002-1.04, p = 0.03) and hCG-day endometrial thickness (OR = 1.6, CI: 1.15-2.24, p = 0.005) were found to increase the live birth rate. Implantation rate (m = 8.3 +/- 14.6) was significantly lower in cases with leucocytospermia (n = 33) compared to cases without leucocytospermia (n = 67, m = 17.4 +/- 24.6, p = 0.02). CONCLUSION: Leucocytospermia, hCG-day E2 level and endometrial thickness, normal sperm morphology, and number of good quality embryos are predictors of implantation, clinical pregnancy and live birth rate following ICSI.     

黄体期使用生长激素在高龄卵巢储备功能减退患者中的临床应用

目的探讨黄体期使用生长激素(GH)对高龄卵巢储备功能减退(DOR)患者超促排卵治疗的影响。方法选择接受体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)且高龄(年龄≥35岁)DOR不孕患者156例为研究对象,均采用拮抗剂方案,分为研究组(加用GH)和对照组(不加用GH)。分析GH对促性腺激素(G n)使用总量、G n使用时间、获卵数、移植前内膜厚度、双原核(2 P N)率、优质胚胎率、着床率的影响。结果 Gn使用时间、Gn使用总量、移植前内膜厚度组间有统计学差异(P0.05)。h CG注射日E 2水平、获卵数、2 P N受精率、优质胚胎率、着床率、临床妊娠率及累积妊娠率组间无统计学差异(P0.05)。研究组临床妊娠率为28.0%、对照组为19.4%,研究组累积妊娠率为33.3%、对照组为20.0%,组间均无统计学差异(P0.05),但研究组临床妊娠率及累积妊娠率有上升趋势。结论 GH对年龄≥35岁DOR患者可明显降低Gn的使用总量及使用时间,增加子宫内膜的厚度,临床妊娠率及累积妊娠率有提高的趋势。     

Factors useful in predicting the success of oocyte donation: a 3-year retrospective analysis.

OBJECTIVE: To establish prognostic relevance of parameters assessed in oocyte donation cycles. DESIGN: Retrospective analysis. SETTING: Large university-based donor oocyte program. PATIENT(S): All oocyte recipient cycles achieving embryo transfer from September 1995 to October 1998. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Pregnancy. RESULT(S): Recipient age and reproductive status, day 9 and 12 serum estradiol (E(2)) levels and a progesterone (P) level obtained 2 days after initiation of hormonal therapy did not correlate with pregnancy. Endometrial thickness, but not endometrial pattern, was useful in predicting pregnancy outcome. The clinical pregnancy and live-birth rate in cycles where the endometrial thickness was less than 8 mm was significantly lower when compared to cycles with an endometrial thickness > or =9 mm. Cycles where optimal quality embryos were transferred had the highest implantation (36%), clinical pregnancy (63%) and live birth (54%) rates and these rates were significantly higher than those of cycles where only poor quality embryos were available for transfer (10% implantation, 17% clinical pregnancy, and 8% live birth rates, respectively; P<.05). CONCLUSION(S): The most reliable predictive factors for pregnancy in oocyte donation cycles are the quality of the embryos transferred and the recipient's mid-cycle endometrial thickness. Recipient monitoring should minimally include ultrasound assessment of endometrial thickness.     

Associations of life events during pregnancy with longitudinal change in symptoms of antenatal anxiety and depression

Objective

to investigate the association of life events during pregnancy with change in antenatal anxiety and depression symptoms. We distinguished pregnancy related and non-pregnancy related events and assessed specificity of these associations for depressive or anxious symptoms. In addition, we investigated whether the associations were affected by personality or childhood adversities.

Design

observational prospective cohort study

Setting

primary and secondary obstetric care centres in the Netherlands

Participants

1603 women during their first trimester of pregnancy between May 2010 and May 2012

Measurements and findings

we performed linear regression analyses to test the associations of pregnancy related, non-pregnancy related life events, childhood adversities and the personality traits neuroticism and extraversion with the change in symptoms of anxiety (State Trait Anxiety Inventory) and depression (Edinburgh Postnatal Depression Scale) from week 12 to week 36.Life events during pregnancy were associated with increasing antenatal symptoms of anxiety and depression. Effect sizes associated with the highest numbers of events observed ranged from 0.59 to 1.31. Pregnancy related events were specifically associated with increasing symptoms of anxiety (p=0.009), whereas non-pregnancy related events were merely associated with an increase in symptoms of depression (p<0.001). Neither personality traits nor childhood trauma influenced the associations under study.

Key conclusions

the most important finding is that pregnancy related life events during pregnancy increase levels of antenatal anxiety, whereas depression levels increase when women experience life events that are unrelated to pregnancy. Furthermore, non-pregnancy related events show stronger associations with increases in symptoms of anxiety or depression compared to pregnancy related events.

Implications for practice

our findings may help midwives to tailor psychosocial care to the specific risks of the pregnant woman which may eventually have a positive impact on the health of mother and child.     

玻璃化冻融人卵裂期胚胎移植结局的影响因素分析

目的:探讨玻璃化冻融人第3天卵裂期胚胎移植结局的影响因素。方法:回顾分析977例1301个冻融胚胎移植周期,根据患者年龄、新鲜周期结局、移植胚胎质量等因素分组,比较各分组的胚胎植入率、临床妊娠率。结果:复苏3598个胚胎,存活3462个。周期临床妊娠率24.1%,出生婴儿291个。新鲜周期结局、移植胚胎质量组间胚胎着床率、临床妊娠率的差异有统计学意义(P<0.01)。子宫内膜准备方案、胚胎的复苏程度组间差异无统计学意义(P>0.05)。不同年龄组相同不孕年限亚组间的胚胎着床率、临床妊娠率的差异有统计学意义(P<0.05)。移植日子宫内膜厚度>12.0mm组与其他两组相比,胚胎着床率、临床妊娠率较高(P<0.05);不同FET次数组间,1次组的胚胎着床率、临床妊娠率明显高于其他两组(P<0.01)。非条件逐步logistic回归分析表明年龄(P<0.01,OR=0.43)、FET次数(2次组P<0.01,OR=0.30;3次组P<0.01,OR=0.19)、新鲜周期结局(P<0.01,OR=9.01)、移植胚胎质量(P<0.01,OR=3.52)与移植结局相关。结论:年龄、新鲜周期结局、移植胚胎质量等是影响冻融胚胎移植结局的重要因素。     

A continuous-step density percoll gradient for use in AIH and life table analysis of pregnancy rates

For use in artificial insemination with husband's semen (AIH), a continuous-step Percoll density gradient technique was used to wash and concentrate sperm from ejaculate. To evaluate usefulness, the pregnancy rates were analyzed by the life table method. 1. After washing by the continuous-step Percoll density gradient method, sperm density increased from 28.8 X 10(6)/ml (original semen) to 40.9 X 10(6)/ml and sperm motility improved from 52.4% (original semen) to 77.0% respectively. 2. A group of 119 infertile patients whose diagnosis involved oligoasthenozoospermia, cervical factor and unexplained infertility were selected for AIH. After 640 insemination cycles, 37 women conceived with a pregnancy rate of 31.1%. By using life table analysis, the cumulative conception probability rate reached 0.652 after 13 insemination cycles. 3. Cumulative pregnancy rates by diagnostic category were 0.494 in male factor and 0.745 in cervical factor after 12 cycles, respectively. 4. The poorest results were obtained in unexplained infertility with a cumulative pregnancy rate of only 0.355 after 12 cycles. 5. In the follow up study, 24 viable babies were born and seven (18.9%) resulted in spontaneous abortion in the first trimester. These results indicate that the continuous-step Percoll density gradient technique is useful for improving the pregnancy rate in AIH.     

降调节联合人工周期方案在冻融胚胎移植周期中的应用

目的:探讨降调节联合人工周期方案对冻融胚胎移植助孕周期临床妊娠结局的影响。方法:收集到行冻融胚胎移植助孕治疗的297个周期,按不同内膜准备方案分组,133例降调节联合人工周期为降调节组,164例行单纯人工周期为人工周期组进行比较分析,同时对部分2种方案均实施过的同一患者进行自身对照分析,并对影响降调节联合人工周期的妊娠结局进行多因素回归分析。结果:患者的年龄、不孕年限、基础FSH、体质量指数(BMI)、内膜厚度、移植胚胎数、优质胚胎数、优质胚胎率、多胎率、异位妊娠率、早期流产率组间均无统计学差异(P>0.05)。降调节组的临床妊娠率、胚胎着床率分别为42.11%(56/133)、24.32%(81/333),显著高于人工周期组的29.88%(49/164)、13.83%(52/376),差异有统计学意义(P<0.05)。自身对照分析显示患者的内膜厚度、优质胚胎率均无统计学差异(P>0.05),但降调节联合人工周期的临床妊娠率[52.17%(24/46)]显著高于单纯人工周期的[13.04%(6/46)],差异有统计学意义(P<0.05)。另外,Logistic回归分析显示,优质胚胎数、手术史可影响妊娠结局。结论:在临床上,对于既往有盆腔手术史、多次冻融周期助孕失败史的患者,可试行降调节联合人工周期方案进行助孕。