低剂量诺坤复和赠卵治疗卵巢功能衰竭不孕症

1999年1月至12月,用诺坤复(微粒化17β雌二醇),黄体酮和赠卵治疗卵巢衰竭不孕症20例共21个周期,由17例同时行IVF-ET或GIFT的不孕患者和l例正常妇女提供卵母细胞,供卵和接受赠卵者共移植38个周期,妊娠16例,妊娠率为42．1％。其中接受赠卵21个周期中,临床妊娠10例,供卵者移植17例中,临床妊娠6例,妊娠率分别为47．6％和35．3％,两组无显著差别。妊娠与未妊娠患者之间平均年龄,不孕原因和移植的胚胎数均无显著差别。     

Reversing the natural decline in human fertility. An extended clinical trial of oocyte donation to women of advanced reproductive age.

OBJECTIVE--To evaluate the effect of age on pregnancy success rates in functionally agonadal women undergoing oocyte donation. DESIGN--A prospective study of 100 consecutive patients using oocyte donation for the treatment of infertility. PATIENTS--Women aged 40 years and above requesting oocyte donation (N = 104) were required to undergo medical, reproductive, and psychological screening. Suitable candidates (n = 65) were matched with an oocyte donor whose cycle was synchronized with that of the potential recipient, prior to the donor's undertaking ovarian hyperstimulation and transvaginal ultrasound-directed follicle aspiration. Outcomes were compared with those of two groups undergoing therapy at the same time: (1) women below 40 years of age undergoing oocyte donation for premature ovarian failure (n = 35) and (2) women 40 years of age and above undergoing standard in vitro fertilization and embryo transfer using their own oocytes (n = 57). MAIN OUTCOME MEASURES--Embryo implantation and pregnancy rates. SETTING--The in vitro fertilization program of the University of Southern California and the California Medical Center, Los Angeles. RESULTS--Improved outcomes were observed with regard to fertilization rates in vitro, number of embryos transferred, embryo implantation rate, clinical pregnancy rates, and ongoing or successfully completed pregnancy rates when women undergoing oocyte donation regardless of age were compared with women 40 years of age and above using their own oocytes. No age-related decline in fertility was demonstrable when oocyte donation was used, with a mean age of 44.3 +/- 3.1 years for those successfully conceiving (range, 40 to 52 years). Perinatal outcomes (n = 27) were generally uncomplicated, with a mean gestational age at delivery of 38.4 +/- 2.1 weeks (range, 34 to 42 weeks), although multiple births occurred in 24.1% of cases. CONCLUSIONS--The age-related decline in female fertility may be reversed in couples electing to use donated oocytes from a younger woman, and women of advanced reproductive age may conceive, carry, and give birth to infants with success rates similar to those of their younger counterparts using assisted reproductive methods.     

Clinical implications of developments in in vitro fertilisation

During February 1979 to December 1983, 831 infertile couples were treated by in vitro fertilisation and embryo transfer. The problems they faced included deciding on the number of oocytes to be collected at laparoscopy, the numbers to be donated or fertilised, the numbers of embryos to be transferred and frozen, and whether abnormal embryos should be used for research or discarded. The 831 patients received a total of 1530 treatment cycles. Of the 763 patients for whom complete data were available, 136 (17.8%) became pregnant. The rate of pregnancy, however, increased dramatically from 7.4% when only one embryo was transferred to 21.1% and 28.1% when two and three embryos were transferred, respectively. The chance of multiple pregnancy also increased with the number of embryos transferred, but the risk (2% for twins) was far outweighed by the relatively poor result after transferring a single embryo. Out of 40 embryos freeze-thawed, 23 survived thawing and were transferred; of these, 4 (17%) resulted in pregnancy. Thirty four transfers of donor oocyte embryos also resulted in four pregnancies (12%), but two of these ended in abortion. Neither microscopy nor any other available test can determine the potential of an oocyte to result in pregnancy, so that discarding oocytes that may look abnormal simply reduces the chances of conception--both for the patient and for any prospective recipient of donor oocyte embryos. In any case, abnormal embryos tend to die when growth is allowed to continue in vitro. Probably all oocytes harvested from a patient should be inseminated and the utilisation of the embryos decided once the number developed is known.     

精液的两种不同处理方式对体外受精-胚胎移植的影响

目的：探讨精液的两种不同处理方式对体外受精-胚胎移植的影响。方法：对73例继发不育的IVF—ET患者的结局进行回顾性分析。根据进入周期精液处理方式的不同将患者分为2组：梯度离心法处理组（A组）42例;梯度离心上游法联合应用组（B组）31例。结果：两组的促性腺激素用量、促排天数、获卵数、受精率、卵裂率、优质胚胎率间差异无统计学意义（P〉0．05）,胚胎种植率和临床妊娠率A组低于B组,A组分别为18．2％（16／88）,26．2％（11／42）;B组2．3（20／62）,51．6％（16／31）,两组的种植率和临床妊娠率相比较有统计学意义（P〈0．05）。结论：梯度离心法和上游法联合应用处理精液比单纯应用梯度离心法处理精液有助于提高IVF—ET患者的种植率和临床妊娠率,可改善妊娠结局。     

首例经自体颗粒细胞线粒体移植的双胞胎儿出生

1名37岁妇女，婚后有2次自然流产史，并发不孕症。来我院2次行体外受精和胚胎移植，由于胚胎质量差，均未妊娠。第3周期对患者的5个成熟卵子进行自体颗粒细胞线粒体移植。4个卵子做胞浆内单精子注射。经线粒体移植后的胚胎质量优于胞浆内单精子注射组。移植3个经线粒体移植后的胚胎，获3胎临床妊娠。妊娠5周时l例胚胎停育，其余2胎发育正常。患者在妊娠前后进行了5次丈夫淋巴细胞免疫治疗。妊娠30周患者因重度妊高征住院治疗，疗效不明显。遂于2003年8月6日妊娠32周时行剖宫产，娩出发育正常的男女2个新生儿。在新生儿病房治疗后健康出院。此为我国大陆地区首例经线粒体移植妊娠出生的胎儿。     

首例经自体颗粒细胞线粒体移植的双胞胎儿出生

1名37岁妇女,婚后有2次自然流产史,并发不孕症。来我院2次行体外受精和胚胎移植,由于胚胎质量差,均未妊娠。第3周期对患者的5个成熟卵子进行自体颗粒细胞线粒体移植,4个卵子做胞浆内单精子注射。经线粒体移植后的胚胎质量优于胞浆内单精子注射组。移植3个经线粒体移植后的胚胎,获3胎临床妊娠。妊娠5周时1例胚胎停育,其余2胎发育正常。患者在妊娠前后进行了5次丈夫淋巴细胞免疫治疗。妊娠30周患者因重度妊高征住院治疗,疗效不明显,遂于2003年8月6日妊娠32周时行剖宫产,娩出发育正常的男女2个新生儿。在新生儿病房治疗后健康出院。此为我国大陆地区首例经线粒体移植妊娠出生的胎儿。     

Successful pregnancy with laparoscopic oocyte retrieval and in-vitro fertilisation in mullerian agenesis

A 28-year-old woman with mullerian agenesis presented with primary infertility and was considered for laparoscopic oocyte retrieval and in-vitro fertilisation. Her 27-year-old younger sister served as a gestational carrier. The patient underwent ovarian stimulation and 11 mature oocytes were retrieved by laparoscopy. After successful in-vitro fertilisation, two embryos were transferred to the gestational carrier. Two weeks after embryo transfer, the pregnancy was confirmed by serum human chorionic gonadotropin levels. Another two weeks later, an ongoing singleton pregnancy with foetal heartbeat was confirmed by transvaginal ultrasonography.     

体外受精-胚胎移植前行宫腔镜检查的应用价值

目的探讨在体外受精-胚胎移植(IVF-ET)前行宫腔镜检查的应用价值。方法对准备行体外受精-胚胎移植的160例患者进行随机分组,其中80例作为研究组,在体外受精-胚胎移植前进行了宫腔镜检查并做相应治疗,随后进入IVF-ET周期;另外80例患者未行宫腔镜检查而直接行IVF-ET,作为对照组。对研究组的宫腔镜检查结果及两组的妊娠结局进行分析。结果研究组经宫腔镜检查,异常宫腔占61.25%;研究组与对照组的新鲜周期移植种植率分别为27.96%、15.06%,临床妊娠率分别为42.55%、22.86%;研究组与对照组的冻融胚胎移植种植率分别为27.69%、13.79%,临床妊娠率分别为42.42%、20.00%,研究组新鲜周期移植及冻融胚胎移植胚胎着床率与临床妊娠率均明显高于B组。结论体外受精-胚胎移植前行宫腔镜检查有重要的临床诊疗价值,对于女方输卵管因素性不孕、原发性不孕同时不孕年限>5年以上,或继发性不孕同时不孕年限>3年以上准备行体外受精-胚胎移植的患者,术前常规做宫腔镜检查可以提高临床妊娠率。     

Acupuncture Enhances Chances of Pregnancy in Unexplained Infertile Patients Who Undergo A Blastocyst Transfer in A Fresh-Cycle

Objective: To analyze the effects of acupuncture on in vitro fertilization patients with unexplained infertility. Methods: We retrospectively analyzed the charts of a total of 302 cycles performed in 273 patients attending Assisted Reproductive Technology (ART) Centre from August 2013 to August 2016. During the study period, embryo transfer with acupuncture (Acupuncture group, 46 cases) and without acupuncture (Control group, 42 cases) were applied. Prior to embryo transfer, the following points were used in the acupuncture group: Neiguan (CX 6), Diji (SP 8), Taichong (Liv 3), Baihui (Gv 20), and Guilai (S 29). These sessions were carried out two times before and after embryo transfer in a single day. In addition, auricular acupuncture was also performed at ear points, including ear point 55 (Shenmen), ear point 58 (Zhigong), ear point 22 (Neifenmi) and ear point 34 (Naodian). The biochemical pregnancy rate and clinical pregnancy rate after transplantation were compared between two groups. Results: The clinical pregnancy rate in the acupuncture group was higher than that in the control group [60.9% (28/46) vs. 33.3% (14/42), respectively, P<0.05]. Likewise, the live birth rate in the acupuncture group was also higher than that in the control group [71.7% (33/46) vs. 31.0% (12/42), P<0.01). Conclusion: Administration of acupuncture on the day of embryo transfer dramatically improved fertility results in women who underwent in vitro fertilization/intra-cytoplasm sperm injection for reproduction.     

Embryo donation at an Australian university in-vitro fertilisation clinic: issues and outcomes

OBJECTIVES: To review the choices of couples relinquishing frozen embryos and the outcomes of embryo donation at a major in-vitro fertilisation (IVF) clinic. DESIGN AND SETTING: Retrospective audit of 11.5 years of data (1991-2002) from the Monash University IVF clinic, Melbourne. PARTICIPANTS: Couples who make decisions regarding the fate of their frozen embryos, and recipient couples taking part in embryo adoption. MAIN OUTCOME MEASURES: Couples' choices with regard to the fate of their frozen embryos, and the outcome of donated embryo treatment cycles. RESULTS: Of 1246 couples relinquishing frozen embryos, 1116 (89.5%) opted to discard rather than donate their embryos. Sixty-six per cent of donated embryos survived thawing. From donated-embryo transfer to 50 women in 92 cycles, a 17.4% pregnancy rate per transfer cycle was achieved, and 10 women delivered 11 healthy babies at term. At the time of our audit there were 98 couples on the waiting list to adopt embryos. CONCLUSIONS: It is worth considering how couples can be encouraged to donate rather than discard their surplus frozen embryos. An educational program on relevant legal, social and clinical issues may facilitate this.