不同剂量电离辐射所致Leydig细胞对hCG反应性的变化

本文报告了不同剂量X线所致Leydig细胞对hCG反应性的变化。幼年雄性大鼠睾丸的Leydig细胞经预培养24小时后,分别接受25,50,75,100,250mGy小剂量的X线照射(剂量率为12.5mGy/分)以及0.5,1.0,2.0,4.0,8.0Gy大剂量X线照射(剂量率0.51Gy/分)。然后加入浓度为0.025或0.05i.u./ml的hCG,继续培养48小时,观察Leydig细胞对hCG反应性的变化。结果表明,小剂量辐射在25,50mGy组引起Leydig细胞对0.05i.u./ml hCG的反应性增高,而在各小剂量组对0.025i.u./ml hCG的反应性无明显变化。大剂量辐射Leydig细胞在各剂量组对0.025和0.05i.u/ml hCG的反应性均降低,此种降低有照射剂量依赖性。对上述变化的可能机制进行了讨论。     

孕妇血清PAPPA、AFP、β-hCG与严重胎儿缺陷的关系

目的 探讨孕妇血清妊娠相关蛋白A(PAPPA)、甲胎球蛋白(AFP)和β绒毛膜促性腺激素(β-hCG)与胎儿唐氏综合征、神经管缺陷等严重胎儿缺陷的关系。方法 用ELISA方法对832例早、中期妊娠妇女进行检测，均追踪至出生。结果检出异常胎儿14例。(1)唐氏综合征孕妇血清β—hCG明显升高，其他指标均降低。(2)无脑儿、脊柱裂脑脊膜膨出、腹裂、唇腭裂、自然流产、死胎孕妇血清AFP明显升高。(3)葡萄胎患者AFP明显降低，其他则显著升高。结论 以上3种生化指标联合检测为产前诊断严重胎儿缺陷的有效方法。     

The efficacy of converting high response – Ovulation induction cycles to in vitro fertilization in patients with PCOS

ObjectiveTo evaluate the outcomes of high response clomiphene citrate (CC)-gonadotropin ovulation induction cycles for natural unassisted conception in patients with PCOS (Polycystic Ovary Syndrome) being converted to IVF–ICSI–ET and compare them with other PCOS patients who underwent planned IVF–ICSI–ET using the GnRH-antagonist protocol.Study designProspective study with a retrospective controlled section. The study was conducted at Taiba Hospital in Kuwait during the period from January 2010 to August 2012. It included 128 infertile patients with the diagnosis of PCOS, divided into two groups. Group I comprised 64 PCOS patients who received ovulation induction, using CC-gonadotropin, in view of natural conception and were converted to IVF–ICSI–ET due to high response. Group II comprised 64 age-matched PCOS patients who underwent planned IVF using the GnRH-antagonist protocol. Primary outcomes were number of mature oocytes, number of grade 1 embryos transferred, and implantation and clinical pregnancy rates.ResultsThe implantation and clinical pregnancy rates were comparable in the two groups (in group I were 23.43% and 43.75%, respectively and in group II were 25% and 45.31%, respectively). There was no statistically significant difference between group I and group II as regards number of retrieved oocytes (7.7 ± 1.3 vs. 8.1 ± 1.4, respectively), number of mature oocytes (5.7 ± 1.1 vs. 6.1 ± 1.3, respectively), total number of embryos (4.9 ± 0.8 vs. 5.1 ± 0.5, respectively), number of cells/embryo (8.1 ± 0.8 vs. 7.9 ± 0.7, respectively).ConclusionConversion of high response CC-gonadotropin ovulation induction cycles in patients with PCOS to IVF–ICSI–ET is a safe, economic and effective strategy.     

重组人黄体生成激素与人绝经期促性腺激素对IVF-ET结局影响的对比研究

目的:比较黄体中期长方案垂体降调节中应用重组人黄体生成激素(r-hLH,Luveris)与人绝经期促性腺激素(HMG)对体外受精-胚胎移植(IVF-ET)结局的影响.方法:选取2011年2月-11月行IVF/卵胞浆内单精子注射(ICSI)-ET治疗的正常促性腺激素(Gn)水平患者281例,对其临床资料进行回顾性分析.根据加用外源性LH的不同分为HMG组和r-hLH组.其中HMG组共100个周期,r-hLH组共181个周期.比较2组在获卵数、受精率、优胚率、人绒毛膜促性腺激素(hCG)日内膜厚度、中重度卵巢过度刺激综合征(OHSS)发生率和临床妊娠率等方面的差异.结果:HMG组总Gn刺激时间少于r-hLH组(P=0.049),前者hCG日雌二醇(E2)水平高于r-hLH组(P=0.033); HMG组OHSS发生率高于r-hLH组(P=0.016); HMG组受精率高于r-hLH组(P=0.000).2组在Gn总量、hCG日内膜厚度、获卵数、正常受精率、种植率、优良胚胎形成率以及临床妊娠率方面差异均无统计学意义(P＞0.05).结论:与HMG相比,r-hLH可能具有更为安全的妊娠结局.     

Gonadotropin-Releasing Hormone Test for Hypogonadic Men

Gonadotropin patterns before and after stimulation with gonadotropin-releasing hormone (GnRH) have been studied in 69 hypogonadic men of various types: patients with expansive hypothalamus-pituitary disorders before and after surgery, patients with hypogonadotropic hypogonadism, and patients with oligozoospermia or azoospermia who have primary partial or total testicular deficiency. Three characteristic gonadotropin patterns were found: (a) low basal values of LH and FSH with either absent or decreased and delayed responses; (b) normal basal values and pituitary responses above the normal range; or (c) high basal values and pituitary responses above the normal range. These gonadotropin patterns were correlated with disorders of the hypothalamus-pituitary-testis axis. The advantages and disadvantages of the GnRH test for the clinical evaluation of male hypogonadism are discussed.     

Metformin administration in patients with polycystic ovary syndrome who receive gonadotropins for in vitro fertilization cycles: 10-year experience in a large infertile population

The study aim was to evaluate our personal experience regarding the use and the reproductive effect of metformin administration in a large population of infertile patients with polycystic ovary syndrome (PCOS) undergoing gonadotropins ovarian stimulation for in vitro fertilization (IVF). Infertile patients with PCOS undergoing gonadotropins ovarian stimulation with (metformin group, n?=?191) or without (control group, n?=?187) metformin and IVF were evaluated. Treatment characteristics, patients’ data and reproductive outcomes were evaluated. In all cases, metformin with an immediate-release formulation was administered, and in most of cases it was given as pre- and co-treatment (74.9%) and at a dosage of 1700?mg/day (59.7%). Stimulation length and gonadotropins doses were significantly (p?<?0.05) higher in metformin group than in control group. The number of dominant follicles on day of ovarian maturation triggering and peak oestradiol levels were significantly (p?<?0.05) lower in metformin group than in control group. Cycle cancellation rate under metformin resulted significantly influenced by interaction with body mass index (BMI), age and basal follicle-stimulating hormone (FSH) levels. Notwithstanding, metformin use in infertile PCOS patients who receive gonadotropins for IVF is not standardized, it seems to modulate the ovarian response to stimulation. This effect may benefit or harm on the basis of ovarian reserve and patients’ characteristics.     

国产人绝经期促性腺激素-人绒毛膜促性腺激素诱发排卵的临床应用

应用国产人绝经期促性腺激素(HMG)治疗52例长期无排卵者,其中缺乏内源性雌激素活动者28例,有内源性雌激素活动的各种月经紊乱者24例:共100个周期。采用宫颈评分及 B 超监测卵泡发育,98％的周期卵泡成熟。以改变 HMG 剂量的方法促使卵泡生长,结果使卵泡生长到成熟的期限接近自然排卵周期。当优势卵泡>18mm、宫颈评分>8分2天以上时,根据卵巢大小应用不同剂量的人绒毛膜促性腺激素(hCG)或促黄体生成素释放激素(LHRH)诱发排卵。结果 hCG 的排卵率为98.8％,各剂量排卵率无差别;LHRH 排卵率为25％(P<0.01)。妊娠26例,其中流产5例,卵巢过度刺激征(OHSS)发生率41％(41/100),其中重度Ⅰ级6.0％,Ⅱ级1.0％。本文分析了适应证及用药方法与疗效的关系、发生 OHSS 的高危因素及 OHSS 与妊娠及流产的关系,提出了结合国内监测条件,提高疗效,避免 OHSS 的合理用药方法。     

冻融后移植的小鼠卵巢组织对促性腺激素的反应

目的 探讨冻融后移植的小鼠卵巢组织对促性腺激素的反应.方法 将36只性成熟雌性小白鼠随机分为新鲜移植组、冻融移植组和对照组,每组12只.新鲜移植组小鼠切除双侧卵巢,将卵巢切成小组织块,立即移植人双侧肾被膜下;冻融移植组小鼠切除双侧卵巢,将卵巢切成小组织块,采用玻璃化冷冻方法冷冻保存,2周后将冷冻卵巢组织复苏,移植入小鼠双侧肾被膜下.卵巢组织移植2周后,新鲜移植组和冻融移植组每组随机取6只小鼠应用7.5 IU人绝经期促性腺激素及10 IU绒毛膜促性腺激素,观察移植后的卵巢组织对促性腺激素的反应.同时应用免疫组化染色方法观察各组卵泡中卵泡刺激素受体的表达情况.结果 新鲜移植组、冻融移植组和对照组未应用促性腺激素小鼠卵巢组织内近成熟卵泡百分率分别为2.3%、2.3%和2.6%,应用促性腺激素小鼠卵巢组织内近成熟卵泡百分率分别为4.2%、4.0%和5.8%,各组内分别比较,差异均有统计学意义(P＜0.05);新鲜移植组和冻融移植组与对照组比较,差异均元统计学意义(P＞0.05).新鲜移植组、冻融移植组和对照组卵泡刺激素受体表达积分吸光度值在窦状卵泡中分别为9408±2777、9175±3093和8838±2064,在窦前卵泡中分别为4531±1903、4808±1386和5516±1136,各组间分别比较,差异均无统计学意义(P＞0.05).结论 卵巢组织冷冻保存、复苏及移植过程未影响卵巢卵泡刺激素受体的表达,冻融后移植的小鼠卵巢组织对外源性促性腺激素的反应未受冷冻、复苏及移植等过程影响.     

卵泡发育迟缓者在体外受精中延长使用促性腺激素的临床疗效观察

目的探讨体外受精（IVF）周期中,卵泡发育迟缓者延长使用促性腺激素（Gn）的临床效果。方法将552个IVF周期按Gn用药时间、剂量和获卵数分组,观察组（69个取卵周期,66个移植周期）：Gn起始用量为75IU／d-300IU／d,用药时间≥16d,用至卵泡达到取卵标准为止,获卵数≥4个;对照组（483个取卵周期,464个移植周期）：Gn起始用量为150IU／d～300IU／d,用药时间≤15d,且总Gn用量≤3300IU,获卵数≥4个。比较两组患者的Gn用量及用药时间、获卵数、临床妊娠率、胚胎着床率及治疗结局。结果观察组和对照组的临床妊娠率分别为45．5％（30／66）和51．7％（240／464）;胚胎着床率分别为28．0％（46／164）和30．5％（385／1262）;分娩率分别为37．9％（25／66）和39．4％（183／464）;两组患者的临床妊娠率、胚胎着床率、分娩率等比较,差异均无统计学意义（P〉0．05）。观察组和对照组的多囊卵巢（PCO）和（或）多囊卵巢综合征（PCOS）患者的比例分别为55．1％（38／69）和20．1％（97／483）;基础窦卵泡数分别为（20±11）个和（15±6）个;Gn用药时间分别为（20．8±4．2）d和（10．3±1．8）d;Gn用药总量分别为（3090±1140）IU和（2302±862）IU;血清雌二醇峰值分别为（4595±5181）pmol／L和（7272±6320）pmol／L;获卵数分别为（10±6）个和（14±7）个;移植胚胎数分别为（2．5±0．6）个和（2．7±0．5）个;两组上述各指标比较,差异均有统计学意义（P〈0．01）。结论对IVF周期中卵泡发育迟缓的患者,延长使用Gn有效、方便,能获得满意的临床结局。     

South Asian women with polycystic ovary syndrome exhibit greater sensitivity to gonadotropin stimulation with reduced fertilization and ongoing pregnancy rates than their Caucasian counterparts

Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome. In vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) is required for PCOS cases that are refractory to standard ovulation induction or have co-existing infertility factors in women with PCOS and Tubal factor subfertility. OBJECTIVES: Assess ethnic variations in response to IVF/ICSI treatment. STUDY DESIGN: Observational Comparative study in a University hospital fertility clinic in women with PCOS and Tubal factor subfertility. Women with PCOS (Asians: AP=104; Caucasians: CP=220) and those with tubal factor infertility seeking fertility treatment were assessed (Asians: AC=84; Caucasians: CC=200). Six hundred and eight fresh IVF or ICSI cycles using long protocol of GnRHa suppression and resulting in a fresh embryo transfer were compared. The primary endpoint was to assess the dose of gonadotropins used in the cycles. The secondary outcomes were: total number of oocytes retrieved, fertilization and ongoing clinical pregnancy rates. RESULTS: We found that the South Asian women presented at a younger age for the management of sub-fertility. An extended stimulation phase and Caucasian ethnicity showed an inverse correlation with the number of oocytes retrieved in the PCOS subgroup. Caucasian ethnicity was associated with a higher fertilization rate however increase in body mass index (BMI) and the laboratory technique of IVF appeared to have a negative impact on fertilization rates in the PCOS subgroup. Commencing down regulation on day 1 of the cycles was negatively associated with fertilization rates in the tubal group. In terms of clinical pregnancy rates, the Caucasian PCOS had a 2.5 times (95% CI: 1.25-5) higher chance of an ongoing clinical pregnancy as compared with their Asian counterpart. Also, a unit increase in the basal FSH concentration reduced the odds of pregnancy by 18.6% (95% CI: 1.8-32.6%) in the PCOS group. CONCLUSIONS: The Asian PCOS have a greater sensitivity to gonadotropin stimulation with lower fertilization and ongoing clinical pregnancy rates as compared with their Caucasian counterparts.