黄体中期子宫内膜轻创对冷冻胚胎移植妊娠结局的影响

目的:探讨黄体中期子宫内膜轻创对下一个周期冷冻胚胎移植妊娠结局的影响。方法:回顾性分析进行冷冻胚胎移植的143例患者的临床资料,其中29个周期黄体中期行子宫内膜轻创(轻创组),114个FET周期未行此项干预(对照组),比较两组的妊娠结局。结果:轻创组临床妊娠率为62.07%,对照组临床妊娠率为44.35%,前者有明显的增高趋势,但无统计学差异。对照组中自然周期准备内膜(n=70)和人工周期准备内膜(n=44)的临床妊娠率分别是48.57%和38.64%,两者相比无统计学差异。结论:对于反复种植失败的患者于FET的前一个周期的黄体中期轻创子宫内膜可以在一定程度上提高临床妊娠率。FET时自然周期和人工周期准备内膜其临床妊娠率无明显差异。     

雌孕激素替代法准备子宫内膜在冻融胚胎移植中的临床研究

目的:探讨雌孕激素替代法作为子宫内膜准备方法对冻融胚胎移植(FET)妊娠结局的影响.方法:对我中心应用雌孕激素替代法作为子宫内膜准备方法拟进行FET的129例患者(140个周期)进行回顾性分析,观察冷冻复苏移植的效果.结果:140个雌孕激素替代周期中进行FET 132个周期,周期取消率5.7%(8/140).移植周期妊娠率38.6%(51/132),胚胎种植率19.6%(70/357).妊娠组与非妊娠组在雌二醇水平、子宫内膜厚度、胚胎复苏存活率及完整存活率上比较,差异均无统计学意义(P>0.05);但年龄及优质胚胎率比较,差异有统计学意义(P<0.05).结论:对排卵障碍患者采用雌孕激素替代法准备子宫内膜,进行FET是一种有效、依从性好的方法.影响FET妊娠率的主要因素可能是患者的年龄及可移植的优质胚胎.     

子宫内膜蠕动波频率对冻融胚胎移植妊娠结局的影响

目的:研究胚胎移植日子宫内膜蠕动波频率(UPF)对冻融胚胎移植妊娠结局的影响。方法:对166个行自然周期及替代周期冻融胚胎移植(FET)者于胚胎移植(ET)日阴道B超下监测子宫内膜蠕动波5 min,同时测定患者ET日的子宫内膜厚度、血清雌二醇(E2)及孕酮(P)水平。结果:所有FET周期中未妊娠组患者ET日UPF高于妊娠组;ET日UPF在1~2次/min时临床妊娠率最高;替代周期组ET日UPF高于自然周期组,但无统计学差异(P0.05)。FET妊娠结局相关因素的Logistic回归证实ET日UPF是影响妊娠结局的危险因素。结论:FET周期ET日适度低频UPF预示良好的妊娠结局。     

他莫昔芬用于薄型子宫内膜患者冻融胚胎移植时子宫内膜准备的研究

目的探讨他莫昔芬(tamoxifen)方案应用于以往自然周期和激素替代治疗反复出现子宫内膜薄的患者行冻融胚胎移植(FET)时子宫内膜准备的临床效果。方法 2011年11月至2014年4月南方医科大学南方医院妇产科生殖医学中心,回顾性分析61例既往因自然周期和激素替代治疗准备冷冻周期子宫内膜,显示子宫内膜薄而取消移植或者移植后未妊娠患者使用他莫昔芬治疗,观察子宫内膜厚度、性激素水平以及FET后的妊娠结局。结果他莫昔芬周期和既往激素替代治疗周期相比,前者的子宫内膜厚度[(8.8±1.8)mm、(6.5±0.3)mm]和血清雌二醇(E2)水平[(2091.2±1020.5)pmol/L、(969.6±474.2)pmol/L]明显较高,且差异具有统计学意义(P0.05);子宫内膜准备天数明显减少[(13.2±2.9)d、(23.1±4.9)d],差异有统计学意义(P0.05)。他莫昔芬周期的临床妊娠率、早期流产率、胚胎种植率、畸形率分别为44.3%(27/61)、7.4%(2/27)、24.2%(32/132)、0(0/17)。结论对于子宫内膜薄的患者,在冻融胚胎移植周期使用他莫昔芬准备子宫内膜方法简单可行,而且子宫内膜准备时间较短、子宫内膜厚度显著提高,并可获得较满意的妊娠结局。     

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。     

薄型子宫内膜冻融胚胎移植周期中应用雌二醇/雌二醇地屈孕酮的疗效观察

目的:探讨雌二醇/雌二醇地屈孕酮(芬吗通)对薄型子宫内膜患者冻融胚胎移植(FET)周期中的子宫内膜厚度及妊娠结局的影响。方法:回顾性分析2013年1月至2014年6月56例患者62个FET周期的临床资料,根据内膜准备方案分为戊酸雌二醇(补佳乐)组29例(34个周期)和芬吗通组27例(28个周期),比较两组患者的一般情况、基础激素水平、超排卵情况、用药量及用药前后子宫内膜增幅和妊娠情况的差异。结果:两组一般情况、基础激素水平、超排卵情况及用药后妊娠情况比较,差异均无统计学意义(P0.05)。两组用药前、用药后子宫内膜厚度比较,差异无统计学意义(P0.05);但用药后子宫内膜厚度均增加(均8 mm),分别与用药前比较,差异均有统计学意义(P0.05);芬吗通组用药后子宫内膜厚度增幅(2.58±1.69 mm)大于补佳乐组(2.00±0.99 mm),差异有统计学意义(P0.05)。芬吗通组用药剂量(65.36±40.22 mg)少于补佳乐组(80.50±63.14mg),差异有统计学意义(P0.05)。结论:补佳乐及芬吗通均可改善薄型子宫内膜患者的内膜厚度,但芬吗通用药量较少且效果更明显,并可获得与补佳乐患者相似的妊娠结局。     

无GnRH-a降调激素替代和hMG促排作子宫内膜准备对冻融胚胎移植影响的研究

目的:研究以无GnRH-a降调激素替代作为子宫内膜准备方式对冻融胚胎移植(FET)临床妊娠率和胚胎植入率的影响。方法:对我中心进行的88个以无GnRH-a降调激素替代(A组)和hMG促排(B组)两种方法进行子宫内膜准备的FET周期进行回顾性分析,比较组间移植日子宫内膜厚度以及临床妊娠率、胚胎植入率的差异。结果:A组32个周期,共移植91枚胚胎,胚胎植入率13.19%,临床妊娠率31.25%(10/32);B组56周期,共移植156枚胚胎,胚胎植入率15.48%,临床妊娠率32.14%(18/56)。两组移植日子宫内膜厚度、临床妊娠率和胚胎植入率等方面均无统计学差异(P>0.05)。结论:无GnRH-a降调激素替代、hMG促排作为FET子宫内膜的准备方式,得到的FET临床妊娠率和胚胎植入率无差异。     

自然周期冻融胚胎移植中不同孕酮转化内膜时间临床结局分析

目的:探讨自然周期冻融胚胎移植(FET)中不同孕酮转化内膜时间对临床结局的影响。方法:回顾分析2014年1月至2018年7月于河南省人民医院生殖中心行自然周期冻融胚胎移植共891个周期的临床结局。根据孕酮转化内膜时间不同将其分为2-3组(孕酮转化子宫内膜2天后移植D3胚胎,n=506)、3-3组(孕酮转化子宫内膜3天后移植D3胚胎,n=172)、4-5组(孕酮转化子宫内膜4天后移植囊胚,n=115)和5-5组(孕酮转化子宫内膜5天后移植囊胚,n=98),比较各组基础指标和临床结局相关指标。结果:2-3组和3-3组,4-5组和5-5组患者的一般情况比较,差异均无统计学意义(P0.05)。2-3组、3-3组、4-5组和5-5组的种植率分别为40.54%(390/962)、43.77%(144/329)、74.19%(115/155)和62.20%(79/127),临床妊娠率分别为57.71%(292/506)、58.72%(101/172)、80.87%(93/115)和70.41%(69/98),异位妊娠率分别为4.45%(13/292)、0(0/101)、0(0/93)和2.90%(2/69),早期流产率分别为9.25%(27/292)、5.94%(6/101)、12.90%(12/93)和4.35%(3/69),持续妊娠率分别为52.37%(265/506)、55.23%(95/172)、70.43%(81/115)和67.35%(66/98)。2-3组和3-3组、4-5组和5-5组的种植率、临床妊娠率、异位妊娠率、早期流产率、持续妊娠率比较,差异均无统计学意义(P0.05)。结论:自然周期FET中孕酮转化子宫内膜2～3天移植第3天卵裂期胚胎,孕酮转化子宫内膜4～5天移植囊胚均可获得满意的临床结局,临床工作中可以根据医院工作安排及患者的情况进行灵活调整。     

重组人生长激素在薄型子宫内膜患者冻融胚胎移植中的应用

目的:研究重组人生长激素(rhGH)治疗薄型子宫内膜患者冻融胚胎移植(FET)的应用价值.方法:收集2018年1月至2020年12月在广西医科大学第三附属医院生殖医疗中心的薄型子宫内膜患者129例,采用激素替代周期进行FET,根据开始进行激素替代治疗(HRT)的时间分为3组:宫腔灌注组(HRT+宫腔灌注rhGH,44例...     

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。     

Clinical outcomes of two different endometrial preparation methods for cryopreserved-thawed embryo transfer in patients with a normal menstrual cycle

Aim:  To compare the clinical outcomes of cryopreserved-thawed embryo transfer among patients with a normal menstrual cycle who had natural or hormone-replacement cycles.
Methods:  From January 2004 to June 2006, cryopreserved embryos following conventional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) were thawed and transferred in a total of 720 natural cycles and 136 hormone-replacement cycles.
Results:  Cryopreserved-thawed embryo transfer in patients who had a natural or hormone-replacement cycle resulted in clinical pregnancy in 43.1% and 40.4%, respectively; a rate of miscarriage of 14.5% and 23.6%, respectively; and a rate of ongoing pregnancy and delivery of 36.5% and 30.9%, respectively. None of these differences were statistically significant.
Conclusions:   Patients with a normal menstrual cycle who have natural or hormone-replacement cycles can be expected to have comparable clinical outcomes with cryopreserved-thawed embryo transfer. (Reprod Med Biol 2007; 6 : 53–57)     

Dispositional resilience as a moderator of the relationship between chronic stress and irregular menstrual cycle

Abstract

Purpose: Menstrual-cycle irregularity may have an important influence on the subsequent development of chronic diseases. Several risk factors for irregular menstrual cycles have been detected, including stress. Our aim was to extend research on the link between chronic stress and menstrual-cycle irregularity and to assess potential protective factors, such as dispositional resilience, which we hypothesize to be associated with the maintenance or promotion of a healthy menstrual cycle.

Methods: For this cross-sectional study, data on 696 healthy women aged 20–40 years were obtained. The women completed measures of chronic stress, dispositional resilience and menstrual-cycle irregularity. Furthermore, potential confounds were assessed.

Results: Of the participants, 383 (55%) reported no current use of hormonal contraceptives; 313 (45%) reported current use hormonal contraception and were included as a control group. The results suggest that in women not using hormonal contraception, chronic stress (OR?=?1.05, 95%CI?=?1.02–1.08, p?=?0.001) and dispositional resilience (OR?=?0.43, 95%CI?=?0.31–0.59, p?<?0.001) have a main effect on menstrual cycle regularity. In addition, women with greater dispositional resilience have reduced risk for irregular menstrual cycles in the face of low to moderate chronic stress; however, this association is changed at the highest level of chronic stress.

Conclusions: These findings suggest that dispositional resilience may be a protective psychological trait that modulates reproductive functioning.     

人巨细胞病毒感染对人胚肺成纤维细胞Cdt1与Geminin因子表达的影响

目的 研究人巨细胞病毒(human cytomegalovirus,HCMV)感染对人胚肺成纤维(human embryonic lung fibroblasts,HEL)细胞Cdtl与Geminin因子表达的影响.方法 用血清饥饿法同步化HEL细胞于G0/G1期,流式细胞术测细胞周期;用HCMV感染同步化的HEL细胞作为感染组,同时设模拟感染组为对照组.于感染后12、24、48、72和96 h收获细胞,提取总的RNA,采用半定量逆转录-聚合酶链反应检测Cdtl-mRNA和Geminin-mRNA的表达水平.结果 (1)血清饥饿后的HEL细胞82.8%处于G0/G1期.(2)12、24、48和72 h两组HEL细胞Cdtl mRNA表达水平比较均有统计学意义(t值分别为32.231,6.349,-5.846,-1.573;P均为0.000),12和24 h时感染组较模拟感染组明显降低,48和72 h时感染组较模拟感染组明显升高.(3)12、24、48和72 h两组HEL细胞Geminin mRNA表达水平比较均有统计学意义(t值分别为-8.891,-6.483,13.010,10.572;P均为0.000),12和24 h时感染组较模拟感染组明显增加,48和72 h时模拟感染组较感染组明显升高.结论 (1)血清饥饿法将绝大部分细胞同步于G0/G1期,血清饥饿法同步化HEL细胞效果较佳.(2)HCMV能诱导Cdtl及Geminin因子表达异常,使Geminin/Cdtl平衡失调,这可能是HCMV感染导致细胞周期阻滞于G1期的机制.     

Frozen blastocyst embryo transfer using a supplemented natural cycle protocol has a similar live birth rate compared to a programmed cycle protocol

PurposeThe purpose of this study is to compare outcomes for a supplemented natural cycle with a programmed cycle protocol for frozen blastocyst transfer.MethodsA retrospective analysis was performed of frozen autologous blastocyst transfers, at a single academic fertility center (519 supplemented natural cycles and 106 programmed cycles). Implantation, clinical pregnancy, miscarriage, and live birth and birth weight were compared using Pearson’s Chi-squared test, T-test, or Fisher’s exact test.ResultsThere was no significant difference between natural and programmed frozen embryo transfers with respect to implantation (21.9 vs. 18.1 %), clinical pregnancy (35.5 vs. 29.2 %), and live birth rates (27.7 vs. 23.6 %). Mean birth weights were also similar between natural and programmed cycles for singletons (3354 vs. 3340 g) and twins (2422 vs. 2294 g)ConclusionFrozen blastocyst embryo transfers using supplemented natural or programmed protocols experience similar success rates. Patient preference should be considered in choosing a protocol.     

Temporary obstructive effect of human cervical mucus on spermatozoa throughout reproductive life: a scanning electron microscopic study

An investigation correlating scanning electron microscopic observations with sperm penetration tests carried out on cervical mucus samples taken throughout the menstrual cycle and pregnancy, during and after the onset of menopause, is presented. The results demonstrate that the temporary occlusion of the cervical canal by its mucous secretion can be accounted for, at the macromolecular level, by a variation in size of the glycoproteic meshes which constitute its infrastructure.Different types of experiments, some of which involve the stretching of the mucus prior to sperm penetration, have been carried out to reconstitute in vitro the various conditions of sperm orientation within the cervical canal. Conclusions are given concerning the behavior of sperm in the different kinds of cervical mucus. They strengthen the conclusion of Odeblad's theory.     

Levels of immunoreactive inhibin-like material in urine during the menstrual cycle

Using a specific and sensitive radioimmunoassay, the authors determined levels of inhibin-like material in the urine of eight healthy women with normal menstrual cycle length of 28 ± 4 days. The results revealed a cyclic variation in urinary immunoreactive inhibin levels during the menstrual cycles, with a sharp rise in levels three to four days prior to luteinizing hormone (LH) and follicle-stimulating hormone (FSH) peaks. These levels of immunoreactive inhibin may thus serve as a parameter to detect impending LH surge.