囊胚培养及囊胚移植

背景：利用囊胚培养技术,待胚胎形成囊胚后再植入子宫腔,缩短了胚胎移植入子宫腔发育与着床之间的间隔,且子宫收缩逐渐减少,并减少胚胎排出体外的机会,因此,囊胚移植更符合自然的生理现象。 目的：追踪随访囊胚移植的临床妊娠情况。 方法：采用促性腺激素释放激素激动剂及促性腺激素超促排卵。将卵泡液中捡出的卵冠丘复合物洗涤后,置于含人血清白蛋白的受精液中。授精后16~18 h转移入卵裂培养液中,观察受精情况,记录原核情况并对其进行评分。第3天时观察胚胎的发育情况,记录胚胎的卵裂球数及分级。 结果与结论：271例患者中,33例未培养出囊胚的患者,只有1例妊娠,余238例患者,囊胚移植后临床妊娠率49.16%,各年龄组的临床妊娠率无差异。移植囊胚其中一个为优质囊胚的患者122例,临床妊娠率56.56%;移植囊胚均未达优质的患者116例,临床妊娠率41.38%。实验结果表明：女方年龄对囊胚移植的临床妊娠率无影响;未形成囊胚的患者可取消移植,形成囊胚的患者不论是否优质囊胚,均应移植。 关键词：囊胚培养;囊胚移植;临床妊娠;内细胞团;滋养层细胞     

影响玻璃化冻融胚胎移植结局的相关因素分析

【摘要】目的 探讨辅助生殖技术中影响玻璃化冻融胚胎移植结局的相关因素。方法 对142例共154个周期的相关资料进行回顾性统计学分析,根据患者年龄、胚胎发育时期、受精方式、子宫内膜准备方案、移植日子宫内膜厚度、移植过程是否顺利和胚胎解冻复苏后成活细胞比例进行分组，比较各类分组的胚胎种植率和临床妊娠率。结果 不同年龄、受精方式、子宫内膜准备方案、子宫内膜厚度和移植过程是否顺利组间胚胎种植率及临床妊娠率无显著性差异(P>O.05)；受精第二天的胚胎冻融（D2）组和受精第三天的胚胎冻融（D3）组的临床妊娠率没有显著性差异，但胚胎种植率D3组明显高于D2组。胚胎复苏后成活细胞比例对胚胎种植率和临床妊娠率有显著影响(P<0.05)。结论 在冻融胚胎移植周期, 解冻后胚胎质量对妊娠的成功率起主要作用,准备适宜的子宫内膜厚度能提高临床妊娠率。     

人绒毛膜促性腺激素注射日血清雌孕激素及其比值对体外受精结局的影响

背景：在体外受精-胚胎移植过程中，由于超促排卵，使多个卵泡发育，血清中的孕酮、雌二醇水平明显高于自然月经周期水平，其是否会导致卵子质量、子宫内膜接受性等发生变化，从而降低种植率和妊娠率，在国内外仍存在争议。 目的：探讨注射人绒毛膜促性腺激素日血清雌孕激素及其比值对体外受精-胚胎移植妊娠结局的影响。 方法：收集接受体外受精-胚胎移植治疗的218名不孕患者的资料，根据注射人绒毛膜促性腺激素日的血清雌二醇水平分为3组：雌二醇< 3 000 ng/L组、3 000 ng/L≤雌二醇< 5 000 ng/L组和雌二醇≥ 5 000 ng/L组；根据孕酮水平分为3组：孕酮≤ 0.9 ng/L组、0.9 ng/L <孕酮≤ 3 ng/L组和孕酮> 3 ng/L组；根据孕酮/雌二醇比值分为2组：孕酮/雌二醇≤ 1组和孕酮/雌二醇> 1组，回顾性分析其种植率和临床妊娠率。 结果与结论：随着雌二醇水平和孕酮 /雌二醇比值的升高，种植率和临床妊娠率下降，但差异无显著性(P > 0.05)，孕酮水平升高到3 ng/L，种植率和临床妊娠率显著下降(P < 0.01)。结果表明，人绒毛膜促性腺激素日血清高孕酮水平对体外受精-胚胎移植的种植率和临床妊娠率有不利影响。 关键词：体外受精-胚胎移植；雌二醇；孕酮；妊娠率；不孕     

影响人类冻融胚胎移植妊娠率的相关因素

回顾分析南昌大学第一附属医院辅助生殖科进行冻融胚胎移植的144例患者共162个周期的临床资料，探讨影响人类冻融胚胎移植妊娠率的相关因素。采用探索性的病例对照研究方法，以现场获取病例资料的方式，分别调查妊娠组与非妊娠组的可能相关因素如年龄、不孕年限、不孕原因、体外授精方式、胚胎情况、移植周期方案、移植时机判断方法及子宫内膜容受性超微结构标志物(胞饮突)的检测等。先采用单因素分析，然后根据单因素分析的结果采用非条件Logistic回归模型分析各研究因素与FET结局的定量关系，减少了各种混杂因素之间的交叉作用。统计结果显示，移植胚胎的质量、子宫内膜厚度和移植时机的判断方法对临床妊娠成功有显著影响。     

不孕症患者的精神治疗

目的：探讨精神治疗在不孕症治疗中的作用。方法：对325例不孕症患者实施不孕症治疗，同时给予精神治疗，观察其治疗周期的长短、妊娠、流产情况。结果：通过治疗，180例能配合医生治疗，110例不配合医生治疗，33例转院治疗，2例失访。配合医生组治疗周期平均为3周期，不配合医生组治疗周期平均为8周期，在5个治疗周期内，配合医生组妊娠86例，妊娠率为47．8％，流产8例，流产率9．3％；不配合医生组妊娠％例，妊娠率30．9％，流产8例，流产率23．5％。结论：精神治疗在不孕症治疗中有重要作用，应该加以重视。     

受精第3天胚胎的融合程度与植入潜能

背景：虽然辅助生殖技术发展迅速,但是胚胎植入率仍不理想,关于胚胎融合程度与植入潜能的关系尚无定论。 目的：探讨受精第3天胚胎早期融合与植入率的相关性。 方法：回顾性分析420例(共移植胚胎1 016个)患者在超促排卵、体外受精及胚胎移植后,植入成功胚胎早期融合情况与未植入成功胚胎早期融合情况的差别。 结果及结论：受精第3天移植早期融合胚胎共200个,其中植入成功48个;受精第3天移植未早期融合胚胎共816个,其中植入成功133个,两组比较差异显著(P < 0.05)。植入胚胎中有3个早期融合胚胎妊娠率达71.43%,有2个为31.91%,有1个为51.06%,0个为39.81%。可见,在目前的胚胎选择标准下,胚胎早期融合可以显著提高胚胎的植入率,但是其具体机制,还有待进一步研究。     

冷冻保存对人卵母细胞纺锤体及发育潜能的影响

背景：卵子冷冻技术的发展为人类辅助生殖技术带来重大的突破,但卵子冷冻的效果并不理想。 目的：研究冷冻保存对不同成熟时期人卵母细胞纺锤体及发育潜能的影响。 设计、时间及地点：随机对照细胞学体外实验,于2005-04/2006-05在重庆市妇幼保健院完成。 材料：体外受精-胚胎移植和卵胞浆内单精子显微注射治疗周期中剩余的未成熟卵子(GV期和MI期)。 方法：将未成熟卵子随机分为对照组、MI/GV卵冷冻组和体外成熟后MII卵冷冻组,用慢冻速融的方法对MI/GV卵和体外成熟的MII卵进行冷冻和解冻,应用Polscope对卵子的纺锤体进行观察,并观察卵子的发育潜能。 主要观察指标：不同组卵子的纺锤体可见率,体外成熟情况,冷冻不同时期卵子的复苏情况,及后期的受精、卵裂、可用胚胎情况。 结果：对照组纺锤体可见率77.3%,明显高于MII卵冻融组、MI/GV卵冻融组(56.3%,53.8%,P < 0.05),冷冻造成了纺锤体的损伤;冷冻后未成熟卵的体外成熟率下降,但无统计学差异;MII期卵、MI期卵和GV期卵复苏率相似;对照组的受精率(81.8%)明显高于MII卵冻融组、MI/GV卵冻融组(62.5%,59.0%,P < 0.05),冷冻后的卵子受精能力受到损害;对照组的卵裂率与MII卵冻融组差异无显著性意义(84.4%,72.7%,P > 0.05),MII卵冷冻组的卵裂没有受到明显影响;对照组的卵裂率与MI/GV卵冻融组差异有显著性意义(84.4%,52.9%,P < 0.05),MI/GV卵冻融后卵裂率明显下降;冷冻组的胚胎质量下降,可用胚胎率明显降低。 结论：控制性超排卵周期中剩余的未成熟卵子无论是直接冷冻还是先体外培养成熟后再冷冻,卵子的纺锤体都受到了一定的损伤,对卵子的发育潜能造成了影响。     

辅助受孕婴儿的新生情况及12月龄时的精神运动发育水平

目的 探讨辅助受孕婴儿与自然受孕婴儿的新生情况以及12月龄时的精神运动发育水平有无差异。方法 采用配对对照研究方法，将实验组与对照组母亲在年龄、产次、种族、地域、社会阶层、受教育程度等几个方面严格配对后，自母亲孕28周起入组登记并定期随访收集相关资料如婴儿胎龄、出生身长、出生体重、是否需要入住新生儿重症监护室（NICU）、有无出生缺陷等信息．出生后定期随访两组婴儿至12月龄时采用CDCC婴幼儿发育量表行精神运动发育评估。结果 辅助受孕组婴儿出生时的身长、体重明显低于自然受孕组（P〈0．01），且辅助受孕组婴儿中早产、低出生体重、新生儿期入住NICU等发生率也明显高于对照组（P〈0．05），但在剔除两组人群中的双胎妊娠儿，只考虑单胎妊娠儿时，这些差异消失。另外，两组婴儿在12月龄时的智力发育指数（MDI）及运动发育指数（PDI）差异无显著性意义（P〉0.05）。结论 辅助生殖技术本身对婴儿的生长发育无明显影响，高发的双胎及多胎妊娠是引起辅助受孕儿有更差的新生情况的主要原因。故限制胚胎移植数量，降低双胎、多胎妊娠的发生率将成为保证辅助受孕子代生存质量的当务之急。     

亚临床甲状腺功能减退对妊娠期孕妇焦虑、抑郁情绪及新生儿的影响

目的研究亚临床型甲状腺功能减退症(SHT)对妊娠期孕妇焦虑、抑郁情绪的影响,以及左甲状腺素钠片对新生儿的影响。方法选择2014年1月~2017年1月我院收治的150例患有SHT的孕妇作为研究组,并将其随机分成A组和B组(每组各75例),其中A组采用左甲状腺素钠片进行治疗,B组经患者及家属同意,未给予药物治疗,只是定期监测甲状腺功能情况,观察A、B两组孕妇妊娠期并发症、妊娠结局及新生儿情况。同时选择年龄、性别与研究组匹配的同期健康孕妇80例作为对照组,比较研究组和对照组汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评分情况。结果研究组HAMA评分(15.13±3.22)和HAMD评分(22.06±2.71)分均明显高于对照组(7.68±1.04和8.93±1.65)。A组妊娠期并发症发生率和宫产率(20.0%,39.2%)明显低于B组妊(34.7%,47.8%)(P0.05)。A组早产率及流产率均低于B组(P﹤0.05);A组新生儿出生体重(3.18±0.94 Kg)明显高于B组(2.67±0.71 Kg)。结论 SHT可能造成妊娠期孕妇出现焦虑、抑郁情绪,给SHT孕妇左甲状腺素钠片,可以有效降低不良妊娠结局的发生,减少妊娠期并发症的发生,提高新生儿出生体重。     

Duchenne型肌营养不良症胚胎植入前遗传学诊断及随访研究

目的对DMD基因携带者行胚胎植入前遗传学诊断,以阻断患儿的出生。方法对1例DMD基因第10~30号外显子缺失突变的女性携带者行卵泡质内单精子显微注射授精,采用多重置换扩增技术行全基因组扩增,并行DMD基因检测和单倍体型分析。选择健康优质胚胎移植入子宫,分别于孕中期和分娩时进行遗传学检测,并进行为期3年的随访。结果携带者第2个胚胎植入前遗传学诊断周期获得成功,共获得7个胚胎共14个单卵裂球,多重置换扩增成功率为13/14,等位基因脱扣率为18.75%(18/96)。移植3个健康优质胚胎并获双胎妊娠,孕16周时采集羊水行基因检测未见DMD基因突变,孕35周时行剖宫产生产1名正常男婴和1名正常女婴,外周血基因检测结果与胚胎植入前遗传学诊断和孕中期产前诊断结果一致。随访3年,幼儿生长发育、运动功能和动态血清肌酸激酶水平均正常。结论经胚胎植入前遗传学诊断出生的正常婴儿生长发育良好。     

Neonatal neurologic characteristics of preterm twin infants <1,250 gm birth weight

The study objectives were to determine the incidence, time of onset, and clinical characteristics of neonatal neurologic injury in preterm twin infants <1,250 gm birth weight. Forty-one twin infants of birth weight 929 gm ± 160 and 27.3 ± 1.96 weeks gestation were evaluated and compared to 225 singleton infants <1,250 gm. Seventeen infants were monozygotic and 24 dizygotic. Six of the 9 monozygotic pregnancies were complicated by the polyhydramnios/oligohydramnios syndrome; a weight discordancy of>20% was observed in 8 of the monozygotic twin sets and polycythemia (hematocrit>65%) in 3 infants. Nine (22%) of the 41 infants died. Periventricular-intraventricular hemorrhage (PV-IVH) developed in 11 (27%) of 41 infants and was severe in 9 (22%) infants. IVH was noted on day 1 (n = 2), day 2 (n = 3), and day 3 (n = 6). IVH developed in 69 (30%) of the 225 singletons and was severe in 28 (12%) infants. Twin infants were more likely to have been delivered via cesarean section, to have required intubation in the delivery room, and to have been administered surfactant as compared with singletons (P < .01). It was concluded that pretern twin infants <1,250 gm are at high risk for developing severe IVH, and that the onset of IVH was within the first 3 postnatal days in all cases.     

新生儿颅脑损伤的产科因素分析

目的探讨影响新生儿颅脑损伤的产科因素。方法选取2015-03—2016-08于我院进行分娩,后转入儿科并接受颅脑超声检查后确诊为颅脑损伤的患者40例(观察组),选取同期非颅脑损伤患者40例为对照组,对2组临床资料进行回顾性分析。结果孕周小、新生儿体质量轻会增加新生儿脑损伤的风险,复杂性单绒毛膜双胎也是引发新生儿颅脑损伤的重要危险因素。结论分娩孕周越早,新生儿发生颅脑损伤的风险越高,特别是30周且新生儿体质量1.5kg时,风险系数明显增高,复杂性单绒毛膜双胎也是导致新生儿发生颅脑损伤的重要危险因素。     

Antenatal and delivery risk factors and prevalence of cerebral palsy in Duzce (Turkey)

This cross-sectional study aimed at investigating the prevalence and the etiological factors of cerebral palsy (CP) and comparing them with normal population within the rural and urban areas of Duzce province. Of the 102 children with cerebral palsy, 98 were associated with antenatal and delivery risk factors. The mean crude prevalence of cerebral palsy was 1.1 per 1000 live births. The children with CP were compared with 530 control subjects. The mothers of the children with cerebral palsy were significantly younger than the mothers of children in control group, and they had less parity and abortion. Preeclampsia, premature rupture of membranes, home births, prolonged labor, and twin pregnancies were significantly more common in the mothers of children with cerebral palsy, where no significant differences were found between the groups in terms of breech delivery, rate of cesarean births, gestational diabetes, and hemorrhage in late pregnancy. Birth asphyxia, liqueur with meconium stained, prolonged jaundice and neonatal seizure were also significantly more common in the group with cerebral palsy. Of the children with cerebral palsy, 78% were born at term, 20% were born with gestational ages of 32-36 weeks, 2% were born with gestational ages of 30-31 weeks. Nine percent of those children had a birth weight of >or= 3000 g, 12.2% had a birth weight of 2500-2999 g, 33.7% had a birth weight of 1500-2499 g, and 5.1% had a birth weight of 相似文献   

Genetic factors in epileptic seizures: evidence from a large twin population

The Finnish Twin Cohort study (27776 individuals; all twins of the same sex born before 1958 and alive in 1967) detected 316 cases of epileptic seizures occurring in 310 twin pairs: 89 monozygotic pairs and 221 dizygotic pairs, including three concordant monozygotic pairs and three concordant dizygotic pairs. The ratio of the observed to expected number of concordant pairs for epileptic seizures was 5.48 (90% CL 1.5–14.2) in monozygotic and 2.12 (90% CL 0.6–5.5) in dizygotic pairs. The results suggest that 8% to 27% of the incidence of epileptic seizures is related to genetic variability. The study of environmental differences in discordant monozygotic pairs should provide insights into the etiology of this group of disorders.     

兔骨髓基质细胞核移植的初步研究

目的 通过建立骨髓基质细胞核移植的方法，为进一步从克隆囊胚的内细胞团细胞分离培养出全能性的胚胎干细胞并用于治疗性克隆等研究奠定基础。方法 超排获得的兔成熟卵母细胞去核后，将同种的单个骨髓基质细胞核注入其内；电融合后，经离子霉素（ionomycin）和6-甲氨基嘌呤（6-DMAP）激活，用10％胎牛血清（FBS）的TCM-199进行体外培养直至囊胚阶段。结果 实验对147个卵母细胞去核，去核成功率为70．75％（104／147）；注核后有82．69％（86／104）的卵细胞保持形态完整；重构后的体细胞-卵母细胞质复合体经电融合后的融合率为56．79％（46／81）；激活后的重构胚于体外培养后分裂率为65．22％（30／46），囊胚率为17．39％（8／46），获得的囊胚有62．5％（5／8）进入孵化阶段；孵化出来的细胞贴壁生长并向周围扩展，显示了具有向下一阶段发育的潜能，为从囊胚内细胞团细胞中分离并培养出胚胎干细胞提供了可能。结论 实验结果表明，以兔成体体细胞的骨髓基质细胞为核供体，经克隆技术生产出囊胚并从中分离内细胞团细胞具有可行性。     

Hypnosis in pregnancy with intrauterine growth restriction and oligohydramnios: an innovative approach

The clinical application of hypnosis has been effective in obstetrics. Intrauterine growth restriction and oligohydramnios are dreaded complications of pregnancy that may result in preterm deliveries causing increased perinatal morbidity and mortality. In this longitudinal prospective study, clinical hypnosis was used in addition to the conventional medical management in such pregnancies. The perinatal outcome was compared with the control group wherein hypnosis was not used. The hypnosis group had a significantly shorter preterm delivery rate (p = .004) and fewer incidence of low birth weight babies (p = .009). Significantly reduced operative intervention in terms of lower rate of cesarean section (p = .008) was also observed in the experimental group. Hence, the use of clinical hypnosis as a viable adjunct to medical management is suggested to help to prevent neonatal morbidity and fetal loss. A multicenter randomized, controlled clinical trial is encouraged in this area.     

Fertility in the population of women with epilepsy

Retrospective inquiry investigations of 263 women with epilepsy at the age above 15 years demonstrated that the reproductive functions in these women were twice lower than in the general population of this region. The number of unmarried was 7% above that in the population, 25% of married epileptic women had no children, and most married women controlled the birth rate resorting frequently to artificial abortions. The index of perinatal mortality of the newborns, dead fetuses and early deaths) was over three times higher than in the population: 88.2 and 25.6 respctively. The risk of spontaneous abortion was 11.3%, the risk of stillbirth 3.9%, the risk of early neonatal death 4.6%. The risk of spontaneous abortion and early neonatal death was higher in the group of women taking anticonvulsants during pregnancy.     

Antidepressants in pregnancy: a systematic review

Part of three systematic reviews on the effects of psychotropic medication exposure in pregnancy, this paper critically reviews the literature on adverse effects of antidepressant use during pregnancy, and derives recommendations for clinical practice. Electronic databases were searched for original research studies examining the effects of gestational exposure to antidepressants on pregnancy, neonatal and longer-term developmental outcomes. Most results were derived from cohort (prospective and retrospective) and casecontrol studies. There were no randomized controlled trials. Congenital malformations: 35 studies identified, 12 demonstrated a significant association between antidepressant use in early pregnancy and congenital malformations. Pregnancy outcomes: 35 articles identified, outcomes measured rates of spontaneous abortion (4 out of 7 studies reporting elevated risk), preterm birth (15 out of 19 reporting elevated risk) and abnormal birth weight (8 out of 23 reporting elevated risk). Neonatal outcomes: 17 controlled studies including one meta-analysis were identified concerning neonatal adaptation. 15 studies showed an association between gestational exposure to antidepressants and neonatal adaptation difficulties. Three studies examined an association between selective serotonin reuptake inhibitor (SSRI) exposure and persistent pulmonary hypertension in the neonate with conflicting results. Longer-term developmental outcomes: 6 of 7 studies comparing developmental outcomes of children exposed to antidepressants in utero with non- exposed children reported no significant differences. Most of these medications remain relatively safe in pregnancy, but some significant areas of concern exist, particularly some evidence of higher risk of preterm birth, neonatal adaptation difficulties and congenital cardiac malformations (with paroxetine). The impact of these findings on the risk-benefit analysis when treating pregnant women with antidepressants is discussed.     

Myasthenia gravis in pregnancy: Experience of a portuguese center

Introduction: We evaluated the clinical course during pregnancy and neonatal outcomes of a cohort of Portuguese women with myasthenia gravis (MG). Methods: Retrospective study. Results: Twenty‐five patients with 30 pregnancies were included. Mean maternal age was 32.4 ± 4.1 years. Miscarriage rate was 6.7%, with delivery of 28 newborns. Deterioration in MG during pregnancy occurred in 43.3%, and 46.4% occurred at postpartum. Eighty percent were medicated with pyridostigmine, 43.3% with corticosteroids, and 40% with intravenous immunoglobulin. There were no maternal or neonatal deaths. Mean gestational time at delivery was 38.2 weeks. No cases of fetal growth restriction, preeclampsia, preterm delivery, or fetal demise were observed. Global cesarean rate was 64.3%. Two newborns developed transient neonatal myasthenia. Conclusions: A high rate of clinical worsening of MG in the mother was observed in this retrospective study, which highlights the importance of a multidisciplinary approach for avoiding maternal adverse outcomes. Muscle Nerve 54 : 715–720, 2016