黄素化未破裂卵泡综合征的病因,诊断与治疗

目的：研究黄素化未破裂卵泡综合征（ＬＵＦＳ）的发生机制，并探讨其诊断与治疗方法。方法：用经阴道Ｂ超与血清，卵泡液Ｅ２，Ｐ值监测４９３例不孕妇女７５９个周期，诊断ＬＵＦＳ患者１１２例，发生ＬＵＦ周期１３６个。采用经阴道穿刺抽吸与连续Ｂ超监测至ＬＵＦ消失两种方法处理。其中６７例于处理后行助孕治疗，２６例获临床妊娠。对各种不孕因素与不同周期ＬＵＦＳ的发生率及两种ＬＵＦ处理方法，几种助孕方案的妊娠作了比较     

基础激素水平在判断卵巢储备功能中的作用

目的探讨不孕症患者基础激素水平在判断卵巢储备功能中的作用。方法采用放射免疫方法测定６０例１１２个促排卵周期周期第２天血卵泡刺激素（ＦＳＨ）、黄体生成素（ＬＨ）及雌二醇（Ｅ２）水平,Ｂ超观察卵泡发育情况,监测有无妊娠发生,分析基础激素水平与卵巢反应性、优势卵泡数目及周期妊娠率的关系。结果周期第２天血ＦＳＨ≥１５ＩＵ／Ｌ者,卵巢反应性差发生率高,优势卵泡数目少,周期妊娠率低。周期第２天血Ｅ２≥４５ｎｇ／Ｌ者,周期妊娠率低于血Ｅ２＜４５ｎｇ／Ｌ者。周期第２天血ＬＨ值与周期妊娠率无关。结论周期第２天血ＦＳＨ可作为判断卵巢储备功能的指标,而周期第２天血Ｅ２值对血ＦＳＨ值判断卵巢储备功能有辅助作用。     

促排卵药物处理后刺破卵泡及宫腔内授精治疗不孕症

目的:为提高宫腔内人工授精（ＩＵＩ）妊娠率,降低流产率。方法：本文对４０例患有排卵障碍、轻度输卵管因素不孕、免疫性不孕、原因不明性不孕等妇女,在促排卵药物处理后行卵泡刺破同时行ＩＵＩ共 ４７个周期。结果：生化妊娠 １８例,占 ４５％;临床妊娠 １６例,占４０％,周期妊娠率为３４％;２例于妊娠６周自然流产,流产率占５％;２ 例已分娩获得活婴,继续妊娠１２例（其中三胞胎一例）。结论：本组行卵泡刺破加ＩＵＩ的患者均为ｈＣＧ注射３６ｈ后经阴道Ｂ超观察至４０ ｈ卵子未排出者,在阴道Ｂ超引导下,适时刺破卵泡排出多个卵子,避免卵子因延迟排出而老化,从而提高排出卵子的质量和数量,提高妊娠率。     

卵泡发育类型和黄体功能关系的探讨

应用阴道Ｂ超连续监测不孕症患者７６例，其中正常单卵泡排卵者４８例（单卵泡组），正常双卵光排卵者５例（双卵泡组），小卵泡排卵者１４例（小卵泡组），多囊卵巢（ＰＣＯ）排卵者３例（ＰＣＯ组），卵泡不破裂黄素化综合征（ＬＵＦＳ）排卵者６例（ＬＵＦＳ组）。结果：单卵泡组子宫内膜发育迟缓２例，黄体期过短５例，黄体功能不全（ＬＰＤ）的发生率为１４．５８％；双卵泡组黄体功能均正常；小卵泡组子宫内膜发育迟缓３例，黄     

穿刺辅助释放卵子用于黄体化卵泡未破治疗的探讨

黄体化卵泡未破 (ＬＵＦ)是一种常见的排卵异常现象。临床观察发现 ,子宫内膜异位症患者频繁发生ＬＵＦ[1 3 ] 。此外 ,在应用氯米芬诱导排卵时 ,ＬＵＦ发生率也增加[4 ,5] 。ＬＵＦ与不孕有密切关系 ,并存在不明原因ＬＵＦ现象。本研究探讨穿刺辅助释放卵子治疗ＬＵＦ的可行性。一、资料与方法1.研究对象 :2 0 0 0年 6月至 2 0 0 1年 1月间 ,因各种原因不孕在门诊接受排卵监测的患者中 ,有 47例次 6 0个周期发生ＬＵＦ(连续监测 3个周期 ) ,对其中 8例患者行辅助排卵。 8例中 4例 (3例为丈夫无精子 ,1例为严重少精症 )为接受供精人工授精 3…     

应用腹腔镜及阴道B超检测不孕因素的探讨

目的：分析女性不孕的因素。方法：对８５例不孕妇女进行阴道Ｂ超检测卵泡发育、排卵，并于排卵后２～６天行腹腔镜检查。结果：阴道Ｂ超检测卵泡发育类型有６种，分别为正常卵泡排卵４８例（５６．４７％）；双卵泡排卵５例（５．８８％），卵泡大（与正常卵泡比较）；小卵泡排卵１４例（１６．４７％），卵泡小，排卵迟，发育速度慢；卵泡不破裂黄素化综合征（ＬＵＦＳ）６例（７．０６％），卵泡大；多囊卵巢排卵３例（３．５３％），卵泡小，排卵晚；无排卵月经９例（１０．９０％）。腹腔镜检查发现，子宫内膜异位症（ＥＭＳ）３６例（４２．３５％），盆腔结核１７例（２０．００％），盆腔粘连３０例（３５．２９％），输卵管不通和不畅２８例（３２．９４％），ＥＭＳ患者输卵管大都通畅，排卵者因粘连包裹未见血体及排卵斑的假ＬＵＦＳ６例。结论：卵泡发育与不孕有关，盆腔结核仍为不孕的主要原因，Ｂ超与腹腔镜检查在不孕诊断中有一定价值     

三种助孕技术治疗多囊卵巢综合征不孕的疗效比较

目的：观察３种助孕技术：ＩＶＦ ＥＴ、ＧＩＦＴ和控制性超促排卵（ＣＯＨ）后自行同房对多囊卵巢综合征（ＰＣＯＳ）不孕患者的疗效。方法：应用３种方法治疗,观察各组的临床妊娠率和发生卵巢过度刺激综合征（ＯＨＳＳ）的情况。结果：ＩＶＦ ＥＴ和ＧＩＦＴ与ＣＯＨ相比能得到更高的临床妊娠率,而前二者发生ＯＨＳＳ的危险性明显低于后者。结论：为避免ＣＯＨ后发生ＯＨＳＳ,建议对因ＰＣＯＳ不孕的患者采取体外助孕技术治疗。应用何种技术要根据患者的具体情况而定。如果有至少１ 条输卵管完全正常,可先试行ＧＩＦＴ。此外,须将多余的卵子进行体外授精试验,观察其受精及卵裂情况,从而对今后的治疗提出指导性建议,并要将得到的胚胎进行冷冻保存,以备今后使用。     

多囊卵巢综合征不孕患者未成熟卵泡抽吸术的疗效分析

目的:探讨对克罗米芬抵抗的多囊卵巢综合征(PCOS)不孕患者在超声引导下行小卵泡抽吸术(IMFA)的治疗效果。方法:将42例PCOS合并克罗米芬(CC)抵抗的不孕患者,随机分为A组:19例,穿刺前用CC或来曲唑(LE)联合少量hMG促排卵;B组:23例,穿刺前用少量hMG促排卵。在阴道B超引导下进行未成熟卵泡抽吸术(IMFA),观察穿刺前及穿刺后第2周期患者的卵巢基础窦卵泡数(AFC)、抗苗勒氏管激素(AMH)、血中游离睾酮指数(FAI)、黄体生成素与卵泡刺激素的比值(LH/FSH),以及术后并发症、3个月促排卵情况和妊娠率。结果:42例患者治疗时均没有发生卵巢过度刺激综合征(OHSS)。与治疗前比较,穿刺术后A、B组AFC显著减少,AMH、FAI和LH/FSH显著降低(P<0.01)。A、B组间比较,FAI、LH/FSH、排卵率和妊娠率无统计学差异(P>0.05)。A、B组共21例妊娠,妊娠率为50%。42例患者均没有发生出血、感染、OHSS。结论:IMFA治疗克罗米芬抵抗的PCOS不孕患者有较好的疗效,本方法安全、有效。     

大卵泡穿刺抽吸用于GnRH-a长方案卵泡发育不同步时对IVF-ET结局的影响

目的:探讨GnRH-a长方案周期中出现卵泡发育不同步患者采用大卵泡穿刺抽吸治疗后对体外受精-胚胎移植(IVF-ET)妊娠结局的影响.方法:对64例GnRH-a长方案周期中出现卵泡发育不同步患者的临床资料进行回顾性分析,根据促性腺激素(Gn)启动10日内是否进行大卵泡穿刺抽吸治疗分为穿刺抽吸组(31例)和未穿刺抽吸组(33例),比较两组患者启动Gn4～6天和启动Gn 7—10天卵泡发育不同步情况、促排卵用药情况及妊娠结局,以及未穿刺抽吸组患者取卵时卵泡中有卵子和无卵子(即囊肿)情况及其临床妊娠率的比较.结果:①两组启动Gn 4～6天和启动Gn 7～ 10天时,出现卵泡发育不同步情况比较,差异无统计学意义(P＞0.05).②两组患者GnRH-a剂量、GnRH-a天数、Gn天数、Gn总量、HCG日内膜厚度、HCG日E2/P值、获卵数、获卵率、成熟卵数、成熟卵率、优质胚胎数、临床妊娠率和流产率比较,差异均无统计学意义(P＞0.05).③未穿刺抽吸组患者仅依靠Gn使用的调整,取卵日大卵泡中有卵子与证实为囊肿的患者的临床妊娠率比较,差异无统计学意义(P=1.000).结论:卵泡的不同步发育可以发生在GnRH-a长方案控制性超促排卵的不同时间,出现卵泡发育不同步现象不需要中途进行穿刺抽吸治疗,其与通过调整Gn的使用来调节卵泡的发育而获得的妊娠结局相同.     

促卵泡激素低剂量缓增方案治疗耐氯米芬多囊卵巢综合征？…

目的 评估促卵泡激素（ＦＳＨ）低剂量缓增方案治疗多囊卵巢综合征（ＰＣＯＳ）耐氯米芬（ＣＣ）无排卵不孕症的有效性和安全性。方法 对９例耐ＣＣ的ＰＣＯＳ不孕症患者,进行１０个周期低剂量ＦＳＨ缓增方案促排卵治疗,采用尿ＦＳＨ（Ｍｅｔｒｏｄｉｎ）或基因重组人ＦＳＨ（Ｇｏｎａｌ－Ｆ）治疗各５个周期。以阴道Ｂ超和血雌二醇（Ｅ２）水平作为监测卵泡发育的指标。结果 除１例因多卵泡发育、卵泡持续不长而中止外,余周期     

Luteinized unruptured follicle syndrome

In a group of 109 infertile women, 180 cycles were monitored with B type ultrasound, BBT and cervical scoring. The incidence of LUF in stimulated cycles was 31.8%, significantly higher than that in spontaneous cycles (10.1%). During the follicular phase, no difference was found between the LUFS and normal ovulatory cycles as to follicular growth curve, maximal diameter of dominant follicle and the cervical scores. Therefore prediction of the LUFS is difficult. 63.6% of the LUF patients had recurrences, and high incidence of abnormality (70.6%) in their non-LUF cycles. 7 of the 14 patients with LUFS were originally diagnosed as unexplained infertility. It suggests that LUFS is of particular importance in the group of women with unexplained infertility.     

Ultrasonographical study on luteinized unruptured follicle

The clinical features and the intrafollicular environment of luteinized unruptured follicle (LUF) were investigated in 60 infertile women by means of ultrasonography. LUF was diagnosed in daily ultrasound scans in 52 (13.5%) of 384 apparently ovulatory cycles. High incidences of LUF cycle were observed in the patients with polycystic ovary (37.5%), endometriosis (24.7%) and a history of pelvic surgery (26.2%), whereas LUF cycles were rare in the patients who conceived (2.7%). Mean follicular diameter measured by transvaginal ultrasonography showed no difference between LUF and ovulatory cycles during the follicular phase, whereas during the luteal phase, a continual growth pattern without follicular collapse was observed in LUF cycles. The ultrasonic aspiration of the follicle was carried out in 21 LUF cycles on the luteal phase. In 19 cases, hormonal profiles for the aspirated follicular fluid coincided with the preoperative diagnosis, and in 6 of 19 cases (31.6%), the presence of entrapped oocytes, direct evidence of LUF, was demonstrated. The morphological observation revealed that the oocytes recovered from the LUF follicle were in the stage of postmaturity, and the fertilization test in which they were used resulted in abnormal fertilization. These results indicate that LUF is an important cause of infertility and that periovarian abnormality might contribute to the failure of follicular rupture and postmaturity.     

Ultrasound-guided transvaginal needle aspiration of follicles for in vitro fertilization

In search of a simpler and less traumatic method of oocyte retrieval for in vitro fertilization (IVF), 37 infertile patients underwent ultrasound-guided transvaginal needle aspiration of the follicles instead of the conventional laparoscopic aspiration. Although only intravenous analgesics and sedatives were used, patients experienced little discomfort. There were no infections or bleeding complications after the procedure. Eleven patients (30%) achieved ongoing pregnancies; this rate of success is comparable to that with our laparoscopic method. Considering this reasonable pregnancy rate, lack of substantial morbidity, and good patient acceptance, laparoscopic oocyte retrieval for IVF can be largely replaced by the ultrasound-guided transvaginal needle aspiration technique.     

Mild endometriosis and ovulatory dysfunction: effect of danazol treatment on success of ovulation induction

The effectiveness of ovulation induction with clomiphene citrate or human menopausal gonadotropins was evaluated in 52 infertile women with stage I or stage II endometriosis and ovulatory dysfunction: anovulation or luteinized unruptured follicle (LUF) syndrome before (group I) and after (group II) danazol treatment. The incidence of anovulation and LUF in the endometriosis population was 9% and 34%, respectively. In group I, 10 of 36 patients (27.8%) conceived, with an average of 17.6 induction cycles per pregnancy. In group II, 21 of 30 patients (70%) conceived, with an average of 4.5 cycles per pregnancy (difference significant at P less than 0.001). There was no difference in the average number of ovulation induction cycles per patient between groups I and II (4.9 and 3.1, respectively). Of 14 patients who did not conceive in group I and crossed over to group II, 9 (64.3%) conceived (not different from group II). Spontaneous abortion rates were 20% in group I and 14% in group II. These results indicate that mild endometriosis may interfere with conception through mechanisms other than ovulatory dysfunction and that treatment with danazol appears to more than double the fertility rate.     

Effect of luteinized unruptured follicle cycles on clinical outcomes of frozen thawed embryo transfer in Chinese women

OBJECTIVE: To determine the effect of luteinized unruptured follicle (LUF) cycles on frozen thawed embryo transfer (FET). DESIGN: A retrospective analysis comparing the clinical outcomes after FET among 144 cases of luteinized unruptured follicle (LUF) cycles and 866 cases of ovulation cycles. SETTING: Reproductive medical center, Beijing China. PATIENTS: Chinese infertile women who underwent FET. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Clinical pregnancy rate (PR), implantation rate. RESULTS: The implantation rate, clinical pregnancy rate, on-going pregnancy rate and live birth rate in LUF group were 12.76% (49/384), 27.78% (40/144), 24.31% (35/144) and 19.44% (28/144), respectively, and in ovulation group, 14.74% (332/2251), 31.29% (271/866), 28.29% (245/866) and 22.23% (193/866), respectively (p > 0.05). CONCLUSIONS: LUF does not affect the clinical outcomes of FET. Patients of LUF should be included in FET treatment.     

A transvaginal sonographic needle-guided method of ovum pickup in a fertilization in vitro/embryo transfer program

Methods of ovum pickup in the IVF/ET program in our hospital from January 1st 1988 to January 31st 1989, were reported. In the initial stage of the program in 1987, laparotomy follicle aspiration was used, which resulted in two cases of clinical pregnancy and full term delivery. Ovum pickup using an ultrasonic endovaginal transducer with a needle guide was introduced in the latter part of 1987. In 1988, the transvaginal method was employed more frequently than the laparotomy and has since become the routine in our program. The rate of embryo transfer and the average number of embryos transferred were quite similar in the two groups. Either method was adopted at that time according to the facilities available and the characteristic pathological conditions of our patients, of whom most had previous history of operation resulting in severe pelvic adhesions. The transvaginal ultrasonic needle guided method for egg retrieval is non-invasive, readily accepted by the patients and therefore may be done repeatedly on one patient in order to increase the cumulative pregnancy rate. However, the laparotomy (transabdominal) route for ovum pickup together with other pelvic surgeries is still indicated in some cases. The clinical pregnancy rate per transfer showed no statistical difference between the two groups.     

Low Multiple Pregnancy Rates and Reduced Frequency of Cancellation After Ovulation Induction with Gonadotropins, If Eventual Supernumerary Follicles Are Aspirated to Prevent Polyovulation

Purpose: Our purpose was to demonstrate the feasibility of the routine aspiration of supernumerary follicles in infertile patients with imminent polyovulation after ovulation induction with gonadotropins and to examine its effect on the frequency of cycle cancellation and on the (multiple) pregnancy rate. Methods: The data on 796 treatment cycles, performed between 1989 and 1996 on 410 infertile couples, were analyzed retrospectively. From October 1992, whenever necessary, supernumerary ovarian follicles were selectively aspirated transvaginally under ultrasound guidance to prevent the ovulation of more than three follicles. Thereafter, intrauterine insemination was performed. Results: After the adoption of transvaginal ultrasound-guided aspiration of supernumerary follicles into the treatment protocol in October 1992, the number of canceled cycles (P < 0.0001) and the multiple pregnancy rate (P < 0.01) were significantly reduced compared to those previously. The overall pregnancy rate remained stable. No ovarian hyperstimulation syndrome requiring hospitalization was noted, and no complications resulting from the follicle aspiration were registered. Conclusions: Transvaginal ultrasound-guided aspiration of supernumerary ovarian follicles increases both the efficacy and the safety of ovulation induction with gonadotropins. Because of the limited equipment required, this method represents an alternative for conversion of overstimulated cycles to more costly alternatives such as in vitro fertilization.     

The role of superovulation with menotropins in ovulatory infertility: a review

The risks of menotropin therapy (ovarian hyperstimulation syndrome, multiple gestation, adnexal torsion) are well known and have been previously described. Superovulation should not be considered for the indications described herein until more traditional therapies for infertility have been tried and found unsuccessful and sufficient time has elapsed for conception to occur. The cost of superovulation is high: the medications are expensive, frequent E2 monitoring and US studies are costly, and pregnancy complications relating to the higher rate of pregnancy loss and multiple gestation may add substantially to the overall cost. Yet, compared with IVF and GIFT, superovulation cycles combined with IUI cost between one third to one sixth that of an IVF cycle. Protocols involving combined CC/hMG/hCG, which reduce the total number of ampules of Pergonal needed per cycle and still provide multiple follicular development, may further reduce costs. There is a growing consensus that superovulation-IUI protocols should be attempted before GIFT and IVF in couples with normal pelvic viscera. There is little doubt that IVF and GIFT cycles are more costly, stressful, and complex. No comparative data have clearly shown IVF and GIFT to be superior to superovulation protocols in ovulatory women with normal pelvic anatomy. In the only study examining this issue published to date, Kaplan et al. retrospectively analyzed all GIFT and superovulation/IUI cycles at a single university center and found GIFT to be three times more efficient. However, the inherent limitations of a nonrandomized, nonprospective study of this kind are obvious as these authors have suggested. Therefore, it may be wise to consider the use of superovulation before assisted reproductive technologies until this issue is settled. It would be interesting to determine if the high PRs reported for couples with unexplained infertility or mild endometriosis in IVF and GIFT cycles in some centers not incorporating superovulation/IUI protocols would hold up if such an approach was routinely followed. Despite the increasing acceptance of superovulation protocols, we must be aware that many of the studies suggesting a role of hMG in treating ovulatory infertile women with normal pelvic anatomy suffer from deficiencies in experimental design. In a payor-driven system, such as in the United States, the difficulties in designing and carrying out scientifically sound clinical studies examining infertility therapies are obvious. The lack of federal or outside funding for the study of infertility issues contributes to the problem. It is our hope that better designed studies examining the role of superovulation in the treatment of ovulatory infertile women with normal pelvic anatomy will be forthcoming.     

Superovulation with human menopausal gonadotropins in the treatment of infertility associated with minimal or mild endometriosis: a controlled randomized study.

OBJECTIVE: To determine the efficacy of superovulation with buserelin acetate, human menopausal gonadotropins (hMG), and human chorionic gonadotropin (hCG) in the treatment of infertility associated with minimal or mild endometriosis. DESIGN: Prospective, randomized, controlled study. SUBJECTS: Forty-nine infertile women with a laparoscopic diagnosis of endometriosis stage I (n = 29) or II (n = 20) according to the revised American Fertility Society classification, randomly assigned to three superovulation cycles (n = 24) or 6 months' expectant management (n = 25). MAIN OUTCOME MEASURES: Cycle fecundity rates and cumulative pregnancy rates (CPR) in the two groups. RESULTS: Nine pregnancies were obtained in the superovulation-treated patients and six in the nontreated ones. The cycle fecundity rates and CPR were 0.15% and 37.4% after three superovulation cycles and 0.045% and 24% after 6 months of expectant management (P less than 0.05 and P = not significant, respectively). The women who did not achieve a pregnancy after three cycles of superovulation were followed for a total of 50 months during which no therapy was given. One pregnancy started in this period (cycle fecundity rate = 0.020). One spontaneous abortion occurred in each group. Three treated patients had multiple pregnancies, and four had ovarian hyperstimulation syndrome. CONCLUSION: Superovulation seems to be associated with a better cycle fecundity rate but not a better CPR than expectant management in infertile women with endometriosis stages I and II. The efficacy and side effects of this therapeutic approach should be evaluated in larger series.     

Laparoscopic resection or sonography-guided vaginal aspiration of endometriomas prior to ICSI-ET does not worsen treatment outcomes

OBJECTIVE: To evaluate the effect of the management modality of ovarian endometriomas on ovarian response to COH (controlled ovarian hyperstimulation) and ART (assisted reproductive technology) treatment outcome. DESIGN: Retrospective case control study. SETTING: Ege University Infertility-Family Planning Research and Treatment Center. PATIENTS: 115 cycles of 84 patients who underwent ICSI-ET (intracytoplasmic sperm injection-embryo transfer) with ejaculated sperm were enrolled in the study. The endometrioma resection group (Group I) was comprised of 36 cycles in 29 patients who were treated with laparoscopic endometrioma cyst resection prior to treatment; endometrioma aspiration (Group II) was comprised of 26 cycles in 15 patients whose endometriomas were aspirated prior to treatment; and the control group (Group III) was comprised of 53 cycles in 40 patients for whom the only infertility cause was the tubal factor. INTERVENTIONS: ICSI-ET treatment, laparascopic ovarian endometrioma cyst resection, transvaginal ultrasonography-guided endometrioma cyst aspiration. Main OUTCOMES MEASURES: COH results and ICSI-ET treatment outcomes. RESULTS: The groups were similar in all characteristics except for the mean age of the patients in group II being older than those in group I. Gonadotropin consumption was higher, peak estradiol level lower, and the number of oocytes less in the laparascopic resection group (Group I) with respect to the control group. The number of follicles was lower in the cyst aspiration group (Group II) with respect to the control group. The number of follicles larger than 15 mm, number of metaphase II oocytes, the fertilization, pregnancy and implantation rates were similar in all three groups. CONCLUSION: Interventions (laparascopic endometrioma resection, transvaginal ultrasound-guided endometrioma cyst aspiration) performed on endometriomas prior to ART treatment do not worsen the treatment outcome.