Laparoscopic treatment of recurrent ectopic pregnancy in the ipsilateral salpinx after ovulation induction and intrauterine insemination

ObjectiveTo report a case of recurrent ectopic pregnancy in the ipsilateral salpinx after and intrauterine insemination treated by laparoscopy.Case reportA 33-year-old woman with unexplained infertility sought evaluation at our hospital due to pelvic pain after ovulation induction and intrauterine insemination. She had a history of a right salpingectomy. Transvaginal ultrasonography did not reveal an intrauterine pregnancy, but showed a suspected extrauterine gestational sac on the operated adnexal area with free fluid in the pouch of Douglas. The patient was diagnosed with a recurrent ruptured ectopic pregnancy and an emergency laparoscopy was performed.ConclusionRecurrent ectopic pregnancy in the ipsilateral fallopian tube is rare, but it is important to be suspicious of the diagnosis to prevent serious morbidity. This case also demonstrates transtubal or transperitoneal migration of the gametes because ovulation and ectopic pregnancy occurred on opposite sides.     

Ovulation disturbances and mood across the menstrual cycles of healthy women

We examined the cyclicity of negative mood relative to ovulation and ovulation disturbances in Menstrual Cycle Diary© data collected daily during a 1-year study of ovulation, exercise, and bone change. A validated quantitative basal temperature-based methodology was used to determine the onset of the luteal phase. ‘Feeling depressed’, ‘feeling anxious’, and ‘feeling angry/frustrated’ were scored on a scale of 0 (absent) to 4 (very intense). Mood scores were examined over two 15-day intervals centered on either ovulation/midpoint, or on the onset of flow. Data were available from 765 cycles of 62 healthy and initially ovulatory women with a mean age of 33.9?±?5.4 years. Of 739 cycles that could be classified, 532 (72%) were normally ovulatory, 185 (25%) were ovulatory with a short (<10 day) luteal phase, and 22 (3%) were anovulatory. Minor cyclic mood changes were present in both ovulatory and anovulatory menstrual cycles. In anovulatory cycles, mood tended to be more variable but less negative, with a time course that differed from that in ovulatory cycles. Mood scores did not differ based on luteal phase length or with hormone levels. Patterns and mechanisms of mood change in very symptomatic women appear to be essentially amplifications of normal experiences.     

3种促排卵药物在IVF-ET/ICSI中的临床疗效与经济学分析——1项基于真实世界的回顾性分析

目的 基于最小成本分析和决策树模型，比较3个促排卵药物在体外受精-胚胎移植/卵胞浆内单精子注射（in vitro fertilization-embryo transfer/intracytoplasmic sperm injection，IVF-ET/ICSI）中的临床疗效与经济学分析。方法 回顾性分析2017年3月—2018年12月在上海交通大学医学院附属国际和平妇幼保健院辅助生殖中心采用拮抗剂方案控制性超促排卵进行IVF-ET/ICSI的患者，共282个周期，按照患者使用促性腺激素（gonadotropin，Gn）药物的不同分为A组：重组人促卵泡激素a注射液108个周期；B组：注射用尿源性促卵泡素87个周期；C组：重组人促卵泡激素β注射液87个周期。比较3组的一般情况、成本及治疗结局，采用最小成本分析法对3组促排卵药物的治疗方案进行药物经济学评价。结果 3组的一般情况及治疗结局差异无统计学意义，3组的直接医疗总成本差异有统计学意义（P<0.05），A、B、C组的直接医疗成本分别为15 737.58元、14 782.68元、13 421.20元。3组均无明显不良反应发生。C组成本最小，B组次之，A组最大。故C组治疗方案最具经济性。结论 在IVF-ET/ICSI的3组促排卵药物治疗方案中，重组促卵泡素β注射液更具经济学优势，注射用尿促卵泡素次之，重组人促卵泡激素注射液不具优势。     

条件基因敲除技术在卵泡发育调控机制研究中的应用进展

卵泡发育是受内分泌、旁分泌及基因调节的复杂生理过程。条件基因敲除能选择去除调控特定发育阶段特定细胞或器官的基因,是在体基因功能研究的主要手段。近年来该技术被广泛应用于卵泡发育调控机制的研究。本文综述了条件基因敲除技术在始基卵泡激活、卵母细胞成熟、排卵、黄体形成及早期胚胎发育等机制研究中的应用进展。     

Ⅱ型排卵障碍女性使用克罗米芬或来曲唑诱导排卵的AID临床结局及妊娠结局比较

目的比较Ⅱ型排卵障碍女性使用克罗米芬(CC)方案或来曲唑(LE)方案诱导排卵后供精人工授精(AID)周期的临床结局和妊娠结局。方法回顾性分析2012年1月至2019年8月578名Ⅱ型排卵障碍妇女在我中心完成的1253个AID周期的超声监测数据及临床资料。比较单用CC或LE或联合促性腺激素(Gn)诱导排卵的AID周期的参数和临床结局。采用单因素和多因素Logistic回归分析,探讨诱导排卵方案与宫内妊娠和活产的关系。比较CC及LE方案的妊娠结局和新生儿出生状况。结果总体上4种方案的宫内妊娠率和活产率无显著差异(P>0.05);校正混杂因素后,与单用CC相比,CC联合Gn及LE联合Gn均显著促进宫内妊娠(分别为OR=1.641,P=0.024;OR=1.543,P=0.019)和活产(分别为OR=1.589,P=0.047;OR=1.508,P=0.034),而单用LE与单用CC相比均无显著差异(P>0.05);各种妊娠结局的发生率及新生儿出生状况在CC及LE方案之间均无显著差异(P>0.05)。结论在宫内妊娠和活产方面,无论单用还是与Gn联用,LE与CC疗效相当,且联用Gn优于单用;LE和CC方案的妊娠结局及新生儿出生状况基本可比。     

针药结合促排卵的临床观察

目的中药结合梅花针循经叩刺在促进卵泡发育、排卵中的临床意义。方法选择我院120例无排卵的患者,治疗组以中药结合梅花针循经任督带脉叩刺,对照组以中药对症治疗,临床观察6个月经周期。结果两组均能提高临床排卵率,治疗组明显高于对照组。结论梅花针循经任督带脉叩刺可在促进排卵的过程中发挥作用,可用于临床以提高排卵率。     

Ovulation induction in young girls with menometrorragia: a safe and effective treatment

The prevalence of menometrorrhagia in fertile women is 11.4–13.2% and increases with aging. The presence of metrorrhagia is a relatively common cause of concern among adolescents and their parents, as well as a frequent cause of visits to emergency departments, gynaecologists, and pediatricians. Clomiphene is a selective estrogen receptor modulator (SERM) that increases the production of gonadotropins by inhibiting negative feedback on the hypothalamus.

Clomiphene is primarily used in the treatment of female infertility for ovulation induction to reverse oligoovulation or anovulation, as occurs in polycystic ovary syndrome.

Objective: The aim of our study was to evaluate the use of clomiphene citrate in ovulation induction, and therefore, in the cessation of bleeding in adolescents with menometrorrhagia in the absence of uterine, ovarian, or systemic pathologies.

Design: Cohort study.

Materials and methods: The study group was comprised of 50 subjects (age range, 13–16 years) with menometrorrhagia (bleeding >7 days in length with an average blood loss >80?ml). The treatment with clomiphene citrate at a dose of 50?mg/day for 5 days during the attack cycle, and from days 3 to 7 of three subsequent cycles, was offered to the patients.

Results: After three cycles of therapy, all patients had resolution of the menometrorrhagia and resumption of ovulatory cycles. No patient reported unwanted side effects.

Conclusion: We propose that low-dose clomiphene should be the first step in the treatment of adolescent dysfunctional bleeding (DUB).     

ICR小鼠卵母细胞通过旁分泌机制促进排卵关键过程

目的:利用国内医学研究常用ICR品系小鼠,在构建用于研究卵母细胞-卵丘细胞交互作用培养模型的基础上,研究卵母细胞及其产生的旁分泌因子生长分化因子9(GDF9)和骨形态发生蛋白15(BMP15)对排卵过程中的关键事件——卵丘扩展的调控作用?方法:通过显微手术制备摘除卵母细胞后的卵丘细胞复合体(OOX),并通过与卵母细胞共培养或GDF9和BMP15 处理研究卵母细胞及其特异释放的旁分泌因子对表皮生长因子(EGF)诱导卵丘扩展过程的调控?结果:成功构建了ICR小鼠OOX培养模型,发现卵母细胞及其释放的旁分泌因子GDF9和BMP15为EGF诱导卵丘扩展所必需?结论:ICR小鼠卵母细胞通过旁分泌机制促进排卵关键过程?     

Effect of chronic thyroid hormone treatment on cycling, ovulation, serum reproductive hormones and ovarian LH and prolactin receptors in rats

We studied the effect on cycling, ovulation and hormone secretion of a chronic thyroxine treatment (HT, 1 mg/kg,S.C., daily, initiated at oestrus) on female rats. HT rats showed normal 4-day vaginal cycles on the first three cycles after initiation of the treatment, but on the fourth cycle had a prolonged oestrus and subsequently entered in constant di-oestrus. In spite of the normal vaginal cycles only 66%, 50%, 33% and 10% of the HT rats ovulated on cycles 1 to 4 respectively. In contrast, during cycles 2 and 3, ovulating HT rats shed a significantly greater number of ova than controls. Hormones were measured at 12.00 and 18.00 h (pre-ovulatory) on prooestrus and at 11.00 h on oestrus. HT ovulating rats had normal LH levels on the first two cycles, but low levels on the third one, while non-ovulating HT rats had low preovulatory LH levels. Serum FSH concentrations were elevated in all the HT rats on cycles 1 and 2 and on pro-oestrus morning in cycle 3 and may have been responsible for the increase in ovulation rate. On oestrus, ovulating HT rats had higher FSH values than nonovulating ones. Serum prolactin levels were similar to controls in all the HT rats on cycle 1, but on the subsequent cycles pre-ovulatory levels were lower than controls in all the HT rats, while values were increased in the non-ovulating HT rats on the third and fourth oestrus mornings. Pro-oestrous serum oestradiol concentrations in all the HT rats were not different from controls on cycles 1 and 2 and diminished on 3 and 4. Oestrous levels were significantly lower on the cycle 1 and only on the nonovulating HT rats on cycle 2. Serum progesterone levels had values similar to those of FSH, with increased values in the first two cycles. Serum corticosterone levels were increased in the mornings of cycles 2 and 3, but values were normal on the fourth one. Ovarian prolactin and LH receptor mRNAs, measured on HT rats on the third prooestrus by Northern blotting, showed significant increases in all the majoritary molecular forms (2.5 and 7 kb for LH receptor and 0.9, 2.9–3, 5 and 10 kb for the prolactin receptor) with respect to control pro-oestrous rats. These results show a progressive disruption of cycling, ovulation and hormonal secretion after the initiation of a chronic thyroid hormone treatment in rats, which eventually lead to an anovulatory state. These results may be of importance for the interpretation of the reproductive disfunctions provoked by hyperthyroidism in women.