浅谈肝俞龙虎交战针法为主治疗排卵障碍性不孕

结合中医理论及外界影响因素分析认为,排卵障碍性不孕以"肝气郁结、疏泄失调"为病机,治则立"疏肝解郁、调畅气机"为大法,探讨治疗该病选用肝俞施用龙虎交战针法的理论依据。为针灸治疗排卵障碍性不孕提供新的思路及方法,同时也体现了古典针法创新性的运用。     

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。     

补肾活血汤对小卵泡排卵不孕症患者卵泡发育、卵巢动脉血流的影响

目的:观察补肾活血汤对小卵泡排卵(SFO)不孕症患者卵泡发育、卵巢动脉血流的影响。方法:将80例SFO不孕症患者随机分为两组,对照组40例接受枸橼酸氯米芬口服治疗,观察组40例,在对照组基础上加用补肾活血汤治疗,两组均治疗3个月经周期。统计两组临床疗效,并比较两组最大卵泡平均直径、子宫内膜厚度、成熟卵泡排卵率、未破裂卵泡黄素化综合征(LUFS)、妊娠率、早期自然流产率、性激素与卵巢动脉血流。结果:观察组治疗的临床总有效率为82.50%,明显高于对照组的62.50%(P<0.05)。与治疗前比较,两组治疗后最大卵泡平均直径、子宫内膜厚度均明显增加(P<0.05),且治疗后观察组以上指标均高于对照组(P<0.05)。观察组成熟卵泡排卵率和妊娠率高于对照组(P<0.05),LUFS发生率、早期自然流产率低于对照组(P<0.05)。与治疗前比较,治疗后两组血清LH、E₂水平、卵巢动脉PSV、EDV均明显增加(P<0.05),血清FSH、RI均明显降低(P<0.05),且治疗后观察组上述指标均优于对照组(P<0.05)。结论:补肾活血汤可明显促进SFO不孕症患者卵泡发育,增加成熟卵泡排卵率与妊娠率,并改善性激素与卵巢动脉血流循环。     

吡格列酮联合他莫昔芬治疗多囊卵巢综合征的疗效观察

目的探讨盐酸吡格列酮片联合枸橼酸他莫昔芬片治疗多囊卵巢综合征的临床疗效。方法选取2014年9月—2017年10月江油市人民医院妇科收治的多囊卵巢综合征患者100例为研究对象,将所有患者随机分为对照组和治疗组,每组各50例。对照组患者于月经周期开始的第5天口服枸橼酸他莫昔芬片,20 mg/次,1次/d。治疗组患者在对照组治疗的基础上早餐后口服盐酸吡格列酮片,30 mg/次,1次/d。以21 d为1个疗程,两组患者均连续治疗3个疗程。比较两组治疗前后排卵情况、临床症状、卵巢情况、性激素水平、胰岛素抵抗指标和不良反应发生情况。结果治疗后,对照组患者成熟卵泡数为(1.6±0.5)个,排卵率为64.0%;治疗组患者成熟卵泡数为(2.2±0.5)个,排卵率为88.0%,两组排卵情况比较差异有统计学意义(P0.05)。治疗后,两组月经稀发、痤疮、多毛例数均显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗后治疗组临床症状例数均显著少于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组卵巢体积显著降低,子宫内膜厚度显著增加,同组治疗前后比较差异有统计学意义(P0.05);且治疗后治疗组卵巢情况显著优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组黄体生成素(LH)、睾酮(T)水平明显降低,促卵泡激素(FSH)、雌二醇(E2)水平明显升高,同组治疗前后比较差异有统计学意义(P0.05);且治疗后治疗组性激素水平改善显著优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)均显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗后治疗组胰岛素抵抗指标显著低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组不良反应发生率为6.0%,明显低于对照组的16.0%,两组比较差异具有统计学意义(P0.05)结论盐酸吡格列酮片联合枸橼酸他莫昔芬片治疗多囊卵巢综合征疗效显著,可显著改善患者的临床症状,促进性激素紊乱和胰岛素抵抗情况的恢复,具有一定的临床推广应用价值。     

高龄女性促排卵长方案与拮抗剂方案临床分析

目的 分析高龄女性体外受精-胚胎移植（IVF-ET）助孕治疗中两种促排卵方案（长方案与拮抗剂方案）的临床结局。方法回顾性分析郑州大学第三附属医院2016年3月至2018年3月收治的年龄≥35周岁、采用两种不同促排卵方案行体IVF-ET/体外单精子胞内注射-胚胎移植（ICSI-ET）助孕的2 515个周期患者,分为长方案组（1 545周期）与拮抗剂方案组（970周期）。结合两组患者的年龄、不孕年限、月经周期天数、体质指数（BMI）、基础内分泌水平、抗苗勒管激素（AMH）、基础窦卵泡数（AFC）等相关指标,比较两组患者促性腺激素（Gn）天数、Gn用量、获卵数、受精率、可移植胚胎数、子宫内膜厚度、周期取消率、妊娠率、卵巢过度刺激综合征（OHSS）发生率和流产率等结局相关指标。结果（1）在不同促排卵方案中不孕年限、月经周期天数、BMI、基础内分泌水平、AMH、AFC均差异无统计学意义(P>0.05);（2）拮抗剂方案组患者治疗中Gn使用量及使用时间,统计均低于长方案患者,差异有统计学意义（P<0.001）;（3）两组在获卵数、受精率、流产率、有效胚胎数、子宫内膜厚度差异无统计学意义(P>0.05);统计拮抗剂方案组患者OHSS发生率明显低于长方案组患者,而有效胚胎数、妊娠率高于长方案组,差异有统计学意义（P<0.05）。结论拮抗剂方案促排卵在高龄女性IVF助孕治疗中,可明显降低Gn用量和Gn使用时间的前提下获得更多可移植有效胚胎,提高妊娠率降低OHSS发生率,在条件相当的前提下,为高龄患者推荐选择的促排卵方案。     

中医周期疗法在PCOS不孕症患者促排卵周期中的疗效观察

目的:观察中医周期疗法结合西药促排卵治疗对多囊卵巢综合征(PCOS)不孕症患者排卵率、妊娠率及肌注人绒毛膜促性腺激素日(HCG日)子宫内膜厚度、类型,未破裂卵泡黄素化综合征(LUFS),克罗米芬(CC)反应不良及卵巢过度刺激综合征(OHSS)发生率的影响。方法:选取PCOS不孕症患者58例,随机分为对照组(克罗米芬+补佳乐),治疗组(克罗米芬+补佳乐+中医周期疗法),各29例,治疗3个月经周期,比较两组排卵率、妊娠率及HCG日子宫内膜厚度、类型,LUFS,CC反应不良及OHSS发生率。结果:对照组、治疗组总周期排卵率分别为64.38%,80.28%,两组比较差异具有统计学意义(P0.05)。治疗组HCG日A型子宫内膜所占比例高于对照组,两组比较差异具有统计学意义(P0.05)。治疗组妊娠率高于对照组,但两组比较差异无统计学意义。两组LUFS,CC反应不良及OHSS发生率均低于对照组,两组比较差异无统计学意义。结论:中医周期疗法结合西药促排卵治疗,可提高PCOS患者的排卵率,改善子宫内膜容受性,增加妊娠率,并减少LUFS,CC不反应的发生率。     

Factors influencing ovulation and the risk of ovarian cancer in BRCA1 and BRCA2 mutation carriers

The role of the lifetime number of ovulatory cycles has not been evaluated in the context of BRCA‐associated ovarian cancer. Thus, we conducted a matched case–control study to evaluate the relationship between the cumulative number of ovulatory cycles (and contributing components) and risk of developing ovarian cancer in BRCA mutation carriers (1,329 cases and 5,267 controls). Information regarding reproductive and hormonal factors was collected from a routinely administered questionnaire. Conditional logistic regression was used to evaluate all associations. We observed a 45% reduction in the risk of developing ovarian cancer among women in the lowest vs. highest quartile of ovulatory cycles (OR = 0.55; 95% CI 0.41–0.75, p = 0.0001). Breastfeeding for more than 12 months was associated with a 38% (95% CI 0.48–0.79) and 50% (95% CI 0.29–0.84) reduction in risk among BRCA1 and BRCA2 mutation carriers, respectively. For oral contraceptive use, maximum benefit was seen with five or more years of use among BRCA1 mutation carriers (OR = 0.50; 95% CI 0.40–0.63) and three or more years for BRCA2 mutation carriers (OR = 0.42; 95% CI 0.22–0.83). Increasing parity was associated with a significant inverse trend among BRCA1 (OR = 0.87; 95% CI 0.79–0.96; p‐trend = 0.005) but not BRCA2 mutation carriers (OR 0.98; 95% CI 0.81–1.19; p‐trend = 0.85). A later age at menopause was associated with an increased risk in women with a BRCA1 mutation (OR trend = 1.18; 95% CI 1.03–1.35; p = 0.02). These findings support an important role of breastfeeding and oral contraceptive use for the primary prevention of ovarian cancer among women carrying BRCA mutations.     

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.     

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.