输卵管切除术对超排卵的影响

目的:探讨单侧输卵管切除,切除侧卵巢对超排卵的反应性。方法:以因输卵管妊娠行单侧输卵管切除后不孕接受IVF-ET治疗的患者45例共52个周期为研究组,并以同期因输卵管阻塞(无输卵管积水)不孕行IVF-ET治疗的患者875例共913个周期为对照,分析输卵管切除侧卵巢与对侧卵巢对超排卵的反应性。结果:①两组的促性腺激素(Gn)用量、用药天数、hCG日E_2水平、卵裂率、平均移植胚胎数、种植率、临床妊娠率、流产率、异位妊娠率差异无统计学意义(P>0.05)。但单侧输卵管切除组的获卵数减少,差异有统计学意义(P<0.05)。②研究组卵泡晚期(注射hCG日)两侧卵巢大小(分别为35.1±6.5mm、38.2±5.9 mm)有差异,P<0.05。取卵日两组卵泡数(个)分别为6.7±4.5、8.6±3.3(P<0.05),回收卵子数(个)分别为4.9±3.7、6.4±3.6,P<0.05。结论:单侧输卵管切除者切除侧卵巢在行超排卵时,其卵泡晚期(注射hCG日)卵巢较小,取卵日的卵泡数和回收卵子数明显减少,手术可能影响卵巢的血液供应和超排卵效果。     

不同输卵管手术方式对体外受精-胚胎移植治疗结局的影响

目的:探讨体外受精-胚胎移植(IVF-ET)中不同的输卵管手术方式对治疗结局的影响。方法:回顾性分析长方案超促排卵IVF周期378例输卵管因素不孕患者:双侧输卵管切除58例(A组);双侧输卵管造口45例(B组);双侧输卵管近端结扎+远端造口37例(C组);单侧输卵管整形42例(D组);单侧输卵管切除45例(E组);随机选取单纯双侧输卵管梗阻无积水患者151例作为对照组(F组);比较患者的一般情况、卵巢对促排卵的反应性和临床治疗结局。结果:①基础窦卵泡(bAFC)数、Gn使用总量、Gn用药时间、hCG注射日卵泡数目、获卵数及冷冻胚胎数,A组较其他手术组及对照组差异均有统计学意义(P<0.05);其他手术组与对照组比较,差异无统计学意义(P>0.05)。各组间受精率、优质胚胎率和移植胚胎数均无统计学差异(P>0.05)。B组妊娠率和种植率显著低于其他各组,而异位妊娠率和流产率显著高于其他各组(P<0.05)。②E组患侧(手术侧)hCG注射日卵巢体积(OVVOL)、卵泡数(直径≥15 mm)和获卵数明显少于健侧卵巢(P<0.05),而D组患侧与健侧上述指标差异无统计学意义(P>0.05)。结论:双侧输卵管切除术增大了促排卵Gn用量和使用天数,减少了获卵数;但不影响受精率、优质胚胎率及着床率,因而不影响IVF-ET单次临床妊娠率。单侧手术由于健侧输卵管的代偿作用对IVF治疗无明显影响。造口术再次发生输卵管积水风险升高,种植率、妊娠率下降,异位妊娠率和流产率升高。     

输卵管手术对控制性超排卵时卵巢反应性的影响

目的:探讨IVF-ET中不同的输卵管手术方式对控制性超排卵(COH)过程中患者卵巢反应性的影响。方法:回顾性分析长方案超排卵IVF周期临床资料,选择397例因输卵管因素不孕患者,其中手术组176例,非手术组221例;手术组患者均因输卵管妊娠或输卵管阻塞、粘连或积水行单侧或双侧输卵管切除或输卵管修复整形手术,其中单侧输卵管切除组70例(A组),双侧输卵管切除组46例(B组),单侧输卵管整形组27例(C组),双侧输卵管整形组33例(D组);非手术组均未为双侧输卵管阻塞无积水患者,作为对照组(E组)。比较各组的临床资料、卵巢对促排卵的反应性和妊娠结局。结果:B组基础FSH值显著高于E组(P<0.05),卵泡数(直径≥15mm)、获卵数显著低于E组(P<0.05)。A组术侧卵巢卵泡数(直径≥15mm)和获卵数明显少于健侧卵巢(P<0.05)。但输卵管手术不影响IVF-ET,各组的的妊娠率和种植率无统计学差异。结论:输卵管切除降低了卵巢超排卵时的反应性,手术可能影响卵巢的血供进而影响卵巢对COH的反应。     

输卵管手术对体外受精-胚胎移植患者卵巢血流及反应性的影响

目的:探讨在体外受精-胚胎移植(IVF-ET)中输卵管手术对控制性超排卵(COH)患者卵巢的血流及卵巢储备功能的影响。方法:选择因异位妊娠或输卵管阻塞粘连行一侧输卵管切除或修复整形(单侧手术组)、双侧输卵管切除或双侧输卵管修复整形(双侧手术组)以及双侧输卵管均未行手术(对照组)的输卵管性不孕患者共70例,观察其在IVF-ET控制性超排卵中卵巢的血流变化及卵巢对COH的反应。结果:①3组患者的年龄、不育年限、用药天数及用药量均无统计学差异(P>0.05),单侧手术组术侧卵巢月经d3卵巢基质血流的搏动指数(PI)、收缩期峰流速(PSV)及hCG注射日(dhCG)PI与健侧卵巢差异无统计学意义(P>0.05)。但术侧卵巢d3血流阻力指数(RI)、RI(dhCG)明显大于健侧卵巢,PSV(dhCG)则明显小于健侧卵巢(P<0.05)。术侧卵巢的基础窦卵泡数(AFC)、dhCG≥14mm卵泡数以及获卵数明显少于健侧卵巢(P<0.05);②3组患者在d3的PI、RI、PSV,PI(dhCG)、RI(dhCG)差异无统计学意义(P>0.05)。但双侧手术组PSV(dhCG)明显低于对照组(P<0.05),其基础AFC、hCG注射日≥14mm卵泡数及获卵数也明显少于对照组(P<0.05)。结论:输卵管手术会影响卵巢的血运,降低卵巢的储备功能。     

适当延后促排卵启动时间有利于IVF-ET结局

目的:探讨不同促排卵(COH)启动时间对IVF-ET结局的影响。方法:回顾性分析845个IVF-ET周期结局。分别比较过度抑制组(A组)及非过度抑制组(B组)中d3-5启动(亚组1)和d6-8启动(亚组2)的临床结局。同时比较GnRH-a降调后常规d3COH启动病例(C组)中,出现垂体过度抑制与未出现过度抑制组的临床结局。结果:C组中垂体过度抑制者与非过度抑制者相比,Gn用量、Gn刺激天数增加,获卵数、优质胚胎数、胚胎种植率、持续妊娠率低(P<0.05)。hCG注射日E2、LH下降(P<0.01)。而A组与B组的比较中均得出同样的结论:d6-8启动比d3-5启动获得更多的直径>14mm的卵泡数及获卵数,Gn用量及Gn使用天数减少,hCG注射日有更高的E2和LH水平(P均<0.05),但是2种启动时间相比获得的优质胚胎数、胚胎种植率及持续妊娠率均无统计学差异(P均>0.05)。结论:延迟COH启动时间可减少卵巢刺激时间、Gn用量,可增加>14mm卵泡数及获卵数,且不影响优质胚胎数、胚胎种植率及持续妊娠率。     

适当延后促排卯启动时间有利于IVF-ET结局

目的:探讨不同促排卵(COH)启动时间对IVF-ET结局的影响.方法:回顾性分析845个IVF-ET周期结局.分别比较过度抑制组(A组)及非过度抑制组(B组)中d 3-5启动(亚组1)和d 6-8启动(亚组2)的临床结局.同时比较GnRH-a降调后常规d3 COH启动病例(C组)中,出现垂体过度抑制与未出现过度抑制组的临床结局.结果:C组中垂体过度抑制者与非过度抑制者相比,Gn用量、Gn刺激天数增加,获卵数、优质胚胎数、胚胎种植率、持续妊娠率低(P＜0.05).hCG注射日E2、LH下降(P＜0.01).而A组与B组的比较中均得出同样的结论:d 6-8启动比d 3-5启动获得更多的直径＞14mm的卵泡数及获卵教,Gn用量及Gn使用天数减少,hCG注射日有更高的E2和LH水平(P均＜0.05),但是2种启动时间相比获得的优质胚胎数、胚胎种植率及持续妊娠率均无统计学差异(P均＞0.05).结论:延迟COH启动时间可减少卵巢刺激时间、Gn用量,可增加＞14 mm卵泡数及获卵数,且不影响优质胚胎数、胚胎种植率及持续妊娠率.     

超促排卵时输卵管切除对卵巢功能的影响

目的:探讨输卵管切除术对体外受精-胚胎移植(IVF-ET)治疗患者卵巢功能的影响。方法:选择在本中心行输卵管切除,且手术前、后均IVF-ET治疗的46例患者,共92个治疗周期。其中单侧输卵管切除22例,双侧输卵管切除24例。记录卵巢超促排卵过程中的各项指标,比较输卵管切除前、后卵巢对超促排卵治疗的反应。结果:单侧输卵管切除患者:切除前、后的促性腺激素(Gn)用药天数、Gn用量、E2值(hCG日血清E2值)、获卵数、有效胚胎数、优质胚胎数均无显著性差异(P>0.05)。与切除前比,双侧输卵切除患者切除后Gn用药天数较长(P<0.05),Gn用量较大(P<0.05);切除前、后的E2值、获卵数、有效胚数、优质胚胎数均无显著性差异(P>0.05)。结论:单侧输卵管切除术不影响卵巢对超促排卵治疗的反应性。双侧输卵管切除术将降低卵巢对Gn的敏感性,使Gn的用药天数和用药量增加,切除双侧输卵管需谨慎。     

卵巢及输卵管手术对卵巢反应性的影响

目的:探讨卵巢肿瘤剔除术,输卵管手术对卵巢功能的影响。方法:以曾做卵巢肿瘤剔除术、输卵管妊娠行输卵管手术者为实验组,输卵管阻塞性不孕患者为对照组,回顾性分析两组因不孕行体外受精-胚胎移植患者的卵巢对控制性超排卵的反应。结果:实验组窦卵泡数,hCG日直径≥14mm、<14 mm的卵泡数,取卵数均明显少于对照组,促性腺激素(FSH)用量明显多于对照组;卵巢肿瘤剔除术组hCG日直径≥14 mm的卵泡数、取卵数明显少于输卵管切除术组和输卵管修补组;输卵管切除术组hCG日直径≥14 mm,<14 mm的卵泡数,取卵数均明显少于输卵管修补术组。三实验组术侧卵巢对比,卵巢肿瘤剔除术组除各项参数均明显低于输卵管切除术组及输卵管修补术组。结论:卵巢及输卵管手术均影响卵巢功能,减低卵巢储备能力,手术范围越大,损伤越大。     

输卵管手术对IVF-ET卵巢反应性及妊娠结局影响的研究

目的:探讨输卵管手术对体外受精-胚胎移植(IVF-ET)过程中卵巢反应性和妊娠结局的影响。方法:接受IVF-ET治疗、符合纳入标准的650例不孕症患者共650个周期。曾因输卵管妊娠或输卵管阻塞、粘连或积水行输卵管切除术或修复整形手术的共304例,其中行输卵管切除术155例(A组),单侧输卵管切除126例(单侧输卵管切除组),双侧输卵管切除29例(双侧输卵管切除组);输卵管修复整形术149例(B组)。同期因输卵管因素不孕或单纯男方因素行IVF-ET者为对照组,346例。检测各组的性激素水平及AFC,比较卵巢反应性及妊娠结局。结果:1A组与对照组相比,低反应发生率增加(P0.05),而B组与对照组相比差异无统计学意义(P0.05)。2A组与对照组相比,基础促卵泡生成素(b FSH)、b FSH/黄体生成素(b LH)、雌二醇(b E2)水平均明显增高(P0.01,P0.05),B组b E2显著高于对照组(P0.01)。3A组、B组与对照组相比,促性腺激素(Gn)天数延长(P0.01,P0.05)、Gn用量均增加(P0.01),A组Gn天数长于B组(P0.05)。3组间优质胚胎率、正常受精率、临床妊娠率、种植率和流产率差异均无统计学意义(P0.05)。4单侧输卵管切除患者术侧卵巢与对侧卵巢比较,术侧卵巢的窦卵泡数与获卵数均明显减少(P0.01)。5双侧输卵管切除组与单侧输卵管切除组相比,Gn天数延长,Gn用量增加(P0.01)。结论:输卵管手术会影响卵巢储备功能和卵巢反应性,影响程度与手术范围和手术损伤程度有关,但不会明显影响IVF-ET的结局。     

体外受精——胚胎移植中血清及卵泡液催乳激素变化相关分析

目的:探讨体外受精-胚胎移植(IVF-ET)过程中血清及卵泡液催乳激素(PRL)的变化规律及其意义。方法:检测38例接受IVF-ET患者治疗前(基础日)、治疗中(Gn 6日、HCG日、取卵日)血清PRL水平及取卵日卵泡液(左、右卵巢)PRL水平,分析变化规律及其与获卵、受精、胚胎质量及妊娠情况的相关性。结果:1PRL在取卵日左、右卵巢卵泡液的浓度明显高于基础日、Gn 6日、HCG日血清水平(P0.05)。2PRL的血清浓度从卵泡期开始上升,在HCG日达峰,约为基础日浓度的2.43倍,取卵日稍下降,Gn 6日、HCG日和取卵日的血清PRL浓度均显著高于基础日血清PRL浓度(P0.05)。3HCG日血清PRL浓度与回收卵数、成熟卵数呈正相关(P0.05);取卵日血清PRL浓度与回收卵数、成熟卵数、受精数、优胚数均呈正相关(P0.05);其余指标之间无显著相关性。4妊娠组与未妊娠组在IVF-ET过程中基础日、Gn 6日、HCG日、取卵日血清和左、右卵巢卵泡液中的PRL值比较,差异均无统计学意义(P0.05)。结论:垂体降调节及控制性超促排卵过程对垂体的PRL分泌无显著影响,HCG日、取卵日的血清PRL的浓度与获卵、受精及胚胎质量有一定的相关性。IVF-ET与正常月经周期存在相似的一过性PRL升高过程,但未影响妊娠结局。     

卵巢储备功能测定在体外受精(IVF)技术中的临床价值探讨

目的:探讨在体外受精-胚胎移植技术中对超促排卵最具临床价值的卵巢储备功能测定指标。方法:将2003.10-2004.10间,105例接受IVF-ET治疗的不孕患者的年龄、基础FSH值、基础窦卵泡数、卵巢体积和卵巢基质血流测定指标与IVF超排中卵巢的实际反应进行对比并作相关性分析。结果:年龄、FSH与获卵数呈非常显著负相关,与促性腺激素(Gn)注射支数呈显著正相关;窦卵泡数、卵巢体积与获卵数呈非常显著正相关,与Gn注射支数呈非常显著负相关;其中以基础窦卵泡数与卵巢反应关系最为密切。卵巢基质血流与卵巢反应无显著相关。结论:年龄、基础FSH值、阴道超声测量基础窦卵泡数和卵巢体积均能预测超排时卵巢对促性腺激素刺激的反应性,并有简便、经济之优点,其中以窦卵泡计数的预测价值最高,窦卵泡计数不仅可用于卵巢低反应的预测,还可预测卵巢反应过激,而年龄与基础FSH仅在预测卵巢低反应中较为敏感,卵巢基质血流对预测卵巢反应的意义有待进一步探讨。     

The impact of unilateral salpingectomy on antral follicle count and ovarian response in ICSI cycles: comparison of contralateral side

Objective: To determine the impact of salpingectomy on the ovarian reserve. Comparisons are made with the contralateral side in patients with unilateral salpingectomy undergoing intracytoplasmic sperm injection (ICSI) cycles.

Study design: Patients under 40 with unilateral salpingectomy and without history of ovarian surgery were selected for the multicentre retrospective study. Women with bilateral salpingectomy and history of endometriosis were excluded from the study. Antral follicle count, controlled ovarian hyperstimulation (COH) parameters and number of collected oocytes were the main outcome measures of the study.

Results: A total of 56 patients were eligible for this study. The mean age of the patients was 31.6?±?4.7 years. The reasons for the salpingectomy were hydrosalpinx (39.3%, n?=?22) and ruptured ectopic pregnancy (60.7%, n?=?34). The ongoing pregnancy rate per embryo transfer was 30.6%. There was no statistically significant difference between the operated and non-operated sides in antral follicle count (AFC), follicles ≥?17?mm and 10–17?mm on day of human chorionic gonadotrophin (hCG), or number of aspirated oocytes. In the subgroup analysis, AFC, number of growing follicles on day of hCG and number of collected oocytes were comparable between the ectopic pregnancy group and hydrosalpinx group.

Conclusion: The study suggests that salpingectomy is not associated with detrimental effects on AFC and ovarian response.     

Effect of salpingectomy on ovarian response to superovulation in an in vitro fertilization–embryo transfer program

Objective: To investigate the effect of salpingectomy on the response of each ovary in patients undergoing an IVF-ET treatment cycle and to compare the results with those of patients who had not had surgery and were undergoing IVF-ET during the same period.

Design: A prospective study.

Setting: Tertiary referral academic IVF unit.

Patient(s): Twenty-nine ET cycles were evaluated in 29 patients who previously had undergone unilateral salpingectomy because of ectopic pregnancy (study group). Seventy-three patients with unexplained or male factor infertility served as controls.

Intervention(s): Ovulation induction and IVF-ET.

Main Outcome Measure(s): In the study group, mean ovarian volume, number of follicles, and number of oocytes recovered from each ovary were assessed and compared. The overall results, cycle characteristics, and pregnancy rates of the two groups were compared.

Result(s): Among the patients who had undergone salpingectomy, significantly fewer follicles developed and consequently fewer oocytes were retrieved from the ovary on the operated side (4.4 versus 8.2 follicles and 3.8 versus 6.0 oocytes). There were no differences in the total numbers of follicles and oocytes recovered from both ovaries, the cycle characteristics, or the pregnancy rates between study and control groups.

Conclusion(s): Salpingectomy has no detrimental effect on the total ovarian performance during IVF-ET treatment or on the outcome of IVF-ET. However, the ipsilateral ovary could be adversely affected. This could be detrimental in selected patients undergoing IVF-ET, in whom the second ovary already is compromised or missing.     

Prediction of ovarian response and IVF/ICSI outcome by three-dimensional ultrasonography and power Doppler angiography

OBJECTIVE: The objective was to evaluate whether three-dimensional ultrasonography (3D-US) and power Doppler angiography (PDA) measurements can predict ovarian response and/or are associated with IVF/ICSI outcome. STUDY DESIGN: A prospective clinical study in 65 women undergoing IVF cycles. Ovarian volume (OV), number of antral follicles > or =2mm (NAF) and PDA indices: vascularisation index (VI), flow index (FI), and vascularisation flow index (VFI) were evaluated by 3D-US and PDA on the day of pituitary suppression control. These measurements, age and BMI were correlated with the number of follicles>10mm on the hCG day and the number of oocytes retrieved. RESULTS: Ovarian volume, NAF, VI, FI and FVI correlate significantly (P<0.01) with the number of follicles and oocytes recovered. Ovarian volume and the number of antral follicles predicted significantly the number of follicles (R=0.67; adjusted R(2)=0.43) and oocytes retrieved (R=0.63; adjusted R(2)=0.37). The oestradiol peak and the number of follicles, oocytes and Grade 1 embryos transferred were higher in the pregnant group. CONCLUSIONS: Three-dimensional ultrasound and PDA make it easier to evaluate all the sonographic parameters implied in ovarian response. Ovarian volume and the number of antral follicles are the only independent predictors of the number of follicles developed and oocytes retrieved.     

Ovarian Response to Gonadotropins in Patients With Tubal Factor Infertility: Salpingectomy Versus Nonsalpingectomy

Study ObjectiveTo evaluate the effects of salpingectomy on the ovarian response to gonadotropins and in vitro fertilization–embryo transfer (IVF-ET) cycle outcomes in women with tubal factor infertility.DesignA retrospective study (Canadian Task Force Classification II-3)SettingAn in vitro fertilization laboratory in a university hospital in Taiwan.PatientsWe analyzed the outcomes of 288 consecutive fresh IVF-ET cycles in 251 consecutive women with tubal factor infertility from January 2001 to December 2011. Two hundred eighty-eight cycles were divided into 2 groups comprising 103 cycles with laparoscopic salpingectomy and 185 cycles with prior bilateral tubal sterilization, laparoscopic tuboplasty, or proximal tubal occlusion as the control group.InterventionsControlled ovarian hyperstimulation and IVF-ET.Measurements and Main ResultsThe main outcome was measured by comparing the duration of stimulation, number of gonadotropin ampoules per cycle, number of follicles, number of oocytes retrieved, fertilization rate, implantation rate, clinical pregnancy rate, and live birth rate. We observed no significant difference in any ovarian response parameter between the salpingectomy and nonsalpingectomy groups. Implantation rates, clinical pregnancy rates, and live birth rates were similar. The mean numbers of follicles and oocytes retrieved ipsilateral to the operated side in the salpingectomy group were similar to the numbers of follicles and oocytes retrieved from the nonoperated ovary.ConclusionsLaparoscopic salpingectomy did not have a negative effect on the ovarian response in women with tubal factor infertility.     

TVF-ET治疗周期中卵泡提前黄素化的相关因素分析

目的：初步探讨控制性超促排卵（COH）过程中如何避免卵泡提前黄素qE（premature luteinization,PL）,提高IVF—ET妊娠率。方法：回顾性分析行GnRH-a黄体中期长方案的IvF．ET治疗患者的临床资料,共2355个周期,根据hCG注射El孕酮（P）／雌二醇（Ez）水平的比值是否〉1分为PL组：即卵泡提前黄素化组,P／Ez≥1,共63个周期;非PL组：即卵泡未提前黄素化组,P／E2〈1,共2292个周期。比较患者的一般资料及COH的参数资料,分析可能与PL相关的因素。结果：PL在GnRH．a长方案IVF-ET患者中的发生率为2．68％。女方年龄、男方年龄、女方体质量指数（BMI）、基础Ez（1）E2）、bLH、bFSH、不孕年限、治疗周期数、Gn启用剂量、hMG使用总量、hMG使用总天数、hCG注射日LH值组间差异无统计学意义（P〉0．05）。PL组的Gn使用总量及Gn使用天数比非PL组的高,差异有统计学意义（P〈0．05）。PL组的hCG注射日直径〉15mln卵泡数及MII卵数比非PL组的少,差异有统计学意义（P〈0．05）。结论：PL在行GnRH-a长方案的IVF．ET治疗患者中的发生率为2．68％。Gn的使用天数,On总量过多,卵巢低反应可能是发生PL的相关因素,为避免发生PL可适当减少Gn的使用天数及Gn使用总量。