胚胎移植后11天血β-hCG水平与妊娠结局关系的研究

目的:探讨体外受精-胚胎移植后11天单次血β-hCG水平的临床预测价值,分析其与不同妊娠结局的关系。方法:选取胚胎移植后11天测定血清β-hCG确定妊娠并继续妊娠至12周以上的患者192例,分为无效妊娠组(包括生化妊娠、异位妊娠和妊娠早期流产)和继续妊娠组(包括单胎妊娠、双胎妊娠和三胎妊娠),比较各组间的血清β-hCG水平,分析其与各妊娠结局的关系。结果:胚胎移植后11天,无效妊娠组的血β-hCG水平为81·43±73·15U/L明显低于继续妊娠组的323·75±315·29U/L,具有显著性差异(P<0·001);单胎妊娠组血β-hCG水平均明显低于双胎妊娠组和三胎妊娠组,差异亦具有显著性(P<0·001)。当血中β-hCG介于10~50U/L时,生化妊娠和异位妊娠的阳性预测价值为81·8%,阴性预测价值达94·4%;当血β-hCG≤100U/L时,早期流产的阳性预测价值为80·8%,阴性预测价值为77·8%;当血β-hCG>250U/L时,双胎、三胎妊娠的阳性预测价值为83·3%,阴性预测价值为74·4%。结论:胚胎移植后11天单次血清β-hCG水平能有效地预测体外受精-胚胎移植周期不同的妊娠结局,具有临床指导意义。     

IVF-ET周期多囊卵巢综合征患者卵泡液及血清抵抗素水平的研究

目的:探讨体外受精-胚胎移植(IVF-ET)周期中多囊卵巢综合征(PCOS)患者的卵泡液及血清的抵抗素水平、抵抗素与PCOS表现型的相关关系,以及抵抗素对P-COS妇女的卵子发育与成熟及临床妊娠的影响。方法:选择IVF-ET治疗的不孕妇女82例分为3组:第1组为PCOS肥胖组(BMI>24kg/m2)32例,第2组为PCOS非肥胖组(BMI≤24kg/m2)30例,第3组为非PCOS不孕患者作为对照组20例。在超促排卵周期的取卵日留取外周血和卵泡液,离心(2000r/min,5min)后取上清密封保存于-20℃待测。采用ELISA方法检测血清及卵泡液内抵抗素的水平,分析抵抗素水平与PCOS及其表现型的相关关系,同时比较各组间的获卵数、卵裂数、受精率、植入率、临床妊娠率及流产率。结果:PCOS肥胖组血清抵抗素水平明显高于其它两组(P<0·001),3组的卵泡液内抵抗素水平无差异(P>0·05),3组中卵泡液内的抵抗素水平明显低于血清内的抵抗素水平(P<0·001);PCOS患者的临床妊娠结果与抵抗素无关;1、2组的获卵数、卵裂数明显高于对照组(P<0·05);PCOS组的受精率比非PCOS组低(P<0·05),但是1组与2组间无差异(P>0·05)。3组患者年龄、不孕年限、使用促性腺激素支数以及植入率、临床妊娠率、流产率等无明显差异(P>0·05)。结论:PCOS患者血清抵抗素水平高低与BMI呈正相关,而卵泡液中的抵抗素水平与BMI无明显相关性。抵抗素在PCOS患者的IVF-ET治疗周期及治疗结局中可能不起作用。     

不孕症患者种植窗期子宫内膜中L-选择素配体合成酶的表达及意义

目的检测不孕症患者体外受精-胚胎移植(IVF-ET)前种植窗期子宫内膜N-乙酰氨基葡萄糖-6-磺基转移酶(N-acetylglucosamine-6-O-sulfo trans ferase)的表达,比较受孕者和未受孕者的表达差异,探讨选择素与其配体相结合与胚泡的附植过程的关系及其发挥的作用。方法2004-07-2005-03南京医科大学第一附属医院生殖中心在进行IVF-ET治疗前,于黄体中期行宫腔镜检查的不孕症患者作为研究对象,受孕者14例作为研究组,未受孕者28例作为对照组,用反转录-聚合酶链反应(RT-PCR)方法检测两组患者种植窗期的表达水平。结果不孕症患者受孕组种植窗期子宫内膜N-乙酰氨基葡萄糖-6-磺基转移酶的mRNA的表达水平(灰度值)平均为(0.65±0.33),未受孕组种植窗期子宫内膜N-乙酰氨基葡萄糖-6-磺基转移酶的mRNA的表达水平(灰度值)平均为(0.41±0.36),其N-乙酰氨基葡萄糖-6-磺基转移酶的mRNA的表达水平显著低于受孕组,P<0.05。结论选择素与其配体相结合的机制可能参与了胚泡的附植过程,并可能是子宫内膜对胚胎接受能力的重要参数之一。     

2,3,7,8-四氯苯二噁哄对小鼠胚胎毒作用的研究

目的　探讨动物妊娠早期接触2 ,3 ,7,8 四氯苯二(TCDD)后造成胚胎丢失的原因以及对小鼠成活率的影响。方法　90只妊娠NHI小鼠分9组,在妊娠的第1天,第2天和第3天分别观察胚胎转移率、检测血清雌二醇和孕酮含量;2 40只妊娠NIH小鼠分2 4组,于妊娠第9天和第18天测定子宫重量,观察胚胎成活情况。结果　与正常对照组胚胎数比较,TCDD未影响胚胎转移率,但造成着床前胚胎丢失(14±4 2 0 ,4 63±6 0 9,P <0 0 1) ;不同时期染毒均可降低胚胎和胎儿成活率(P <0 0 0 1) ;血清雌二醇含量升高(P <0 0 0 1)、孕酮水平下降(P <0 0 1)。结论　TCDD对胚胎和母体均具有毒性,血清类固醇激素的改变可影响子宫功能,造成第9天胚胎成活率下降;同时TCDD具有持续毒性的特点,使出生前第18天胚胎成活数低于第9天胚胎成活数。     

超排卵后黄体期血雌孕激素水平对胚胎着床的影响

目的测定控制下超排卵周期黄体期血雌二醇(E2)和孕酮(P)水平,探讨黄体期甾体激素对体外受精-胚胎移植(IVF-ET)结局的影响.方法选择在本院辅助生育技术病房进行IVF-ET助孕治疗的因输卵管因素不孕的64例患者,用GnRHa(达必佳)/FSH/hMG/hCG超排卵治疗,在注hCG日及取卵后7天采集静脉血5ml,用双抗放射免疫法(RIA)测定血清雌二醇(E2)和孕酮(P).结果未妊娠组高反应组与正常反应组获卵数存在显著差异(P＜0.05),年龄、获卵数、移植胚胎数两组无显著差异(P＞0.05).继续妊娠组与流产组E2峰、黄体中期E2、P水平及P/E2比均无显著差异(P＞0.05),继续妊娠组E2从峰值下降至黄体中期水平与流产组相比,存在显著差异(P＜0.05),继续妊娠组E2下降幅度大;未孕高反应组E2峰、黄体中期E2、P水平与继续妊娠组相比均显著增高(P＜0.05),但P/E2比无显著差异,未孕正常反应组各激素水平及比与继续妊娠组相比无显著差异(P＞0.05).结论超排卵治疗后黄体期雌孕激素对妊娠的影响与卵巢反应有关,高反应组黄体中期过高的雌孕激素不利于妊娠,正常反应组黄体中期雌孕激素水平与妊娠无关.E2从峰值至黄体中期水平下降幅度与妊娠有关,E2缺乏下降也许对妊娠不利.     

Ultrasound guidance of embryo transfer: A role for midwife

ObjectiveEvaluate the role of midwife with no experience in assisting ultrasound guided embryo transfer.MethodsA prospective randomized study comparing results of IVF after ultrasound guided embryo transfer (ET) assisted either by a midwife with no formal training in US, or by a doctor trained to guide. ET procedure was performed on 553 patients undergoing ultrasound guided ET. The number of embryos transferred, the pregnancy rate (PR), the incidence of extrauterine pregnancy, ongoing pregnancy rate, the implantation rate (IR), difficulty of embryo transfer and quality of US assistance were compared among the groups.ResultsNo significant differences were observed between the two groups regarding the number of embryos transferred (2.5 + 0.7 Group A vs 2.4 + 0.8 Group B) implantation rate (15.6% Group A vs 15.2% Group B), pregnancy rate (34.3% Group A vs 36.2% Group B), ongoing pregnancy rate (23.4% Group A vs 23.9% Group B), and rate of extrauterine pregnancies (1.4% Group A vs 1% Group B). Difficult transfers (2.9% Group A vs 3.6% Group B) and unsatisfactory visualization of uterus and catheter (6.2% Group A vs 7.3% Group B) were also similar in both groups of patients.DiscussionHaving an inexperienced nurse or midwife to perform ultrasound guidance during ET does not markedly affect the clinical results compared to using experienced clinicians for this purpose.     

Infertile Couples Entering an In Vitro Fertilisation Programme: A Preliminary Survey

This paper presents the findings of a pilot survey of 30 infertile couples who presented for in vitro fertilisation treatment at the Monash—Epworth—Queen Victoria Medical Centre. Wives of the couples underwent an extensive pre-treatment interview for demographic information and psychiatric evaluation. In addition, psychometric testing was carried out to provide psychological profiles. Husbands were interviewed separately and completed self-report questionnaires on marital adjustment. Two sub-groups were identified where the diagnosis of infertility was regarded as of organic or ‘idiopathic’ aetiology. Differences between the two sub-groups were found on neuroticism, anxiety, locus of control and dyadic adjustment. At 2 months after treatment great difficulty was experienced in obtaining follow-up responses. Reasons for this are suggested and recommendations for further investigations and supportive therapy are presented.     

Proliferating Cell Nuclear Antigen (PCNA) Expression in Tooth Primordia in the Field Vole ( Microtus agrestis,Rodentia)

Cell proliferation in developing tooth germs has been studied particularly using bromodeoxyuridine (BrdU) incorporation into growing tooth primordia and by counting and three-dimensional (3D) reconstruction of mitoses in serial sections of developing teeth. PCNA has been proposed as an alternative marker of proliferation activity. The aim of our study was to detect immunohistochemically locations of PCNA-positive cells in developing tooth germs of Microtus agrestis (Rodentia). PCNA expression could be distinguished in oral epithelium and mesenchyme before first signs of dental lamina elevation. During bud, cap, and bell stages, positive immunostaining could be observed at defined sites in enamel organ, tooth papilla, and dental follicle. Rudimental tooth germs of the upper diastema, enamel knots, and inner enamel epithelium at day of ontogeny 18 and 19 showed negative reaction. PCNA marks cycling and early G0 cells and can be used successfully as a proliferation marker even in collection material.     

Nodal蛋白在肾细胞癌组织中的表达及意义

目的研究胚胎成形素Nodal蛋白在肾细胞癌组织中的表达情况，并探讨其临床意义．方法采用免疫组织化学、Westernblot及Realtime PCR方法分别检测25例肾细胞癌组织及16例正常肾组织中NodalmRNA、蛋白的表迭，并检测微血管密度（MVD）指教，分析比较不同临床分期、组织学分级肾细胞癌组织中Nodal的表达情况及其与MVD之间的相关关系。结果肾细胞癌高表迭Nodal mRNA基因及蛋白，且随着临床分期的升高及组织学分级的恶化，NodalmRNA基因及蛋白表达水平不断上升；不同的临床分期及组织学分级中，Nodal蛋白的表达与MVD的变化趋势之间均存在明显的正相关关系。结论肾细胞癌高表达Nodal基因及蛋白，Nodal可能通过促进新生肿瘤血管生成促进肾癌的发展。