腹腔镜卵巢穿刺内凝治疗多囊卵巢不孕症的临床研究

目的探讨腹腔镜卵巢穿刺内凝对多囊卵巢不孕症的治疗价值。方法１５１例腹腔镜卵巢穿刺内凝术（实验组）和１５１例开腹卵巢楔切术（对照组）治疗多囊卵巢不孕症配对对比研究。结果实验组的手术时间３３．１±７．２ｍｉｎ，术中失血１５．６±４．７ｍｌ，总排卵率９２．０５％，总妊娠率４９．６７％，均优于对照组（Ｐ＜０．０１）；术后雄激素、ＬＨ／ＦＳＨ下降幅度小于对照组（Ｐ＜０．０１）。随时间推移，两组术后排卵巢、妊娠率均有下降倾向，而术后雄激素、ＬＨ／ＦＳＨ则有逐渐回升的倾向。结论腹腔镜卵巢穿刺内凝术对多囊卵巢不孕症有较好的治疗效果     

Endocrinology: High incidence of embryo transfer cancellations in patients with polycystic ovarian syndrome

This study was aimed at assessing the outcome of in-vitro fertilization(IVF) and embryo transfer in patients with polycystic ovariansyndrome (PCOS). The results of IVF and embryo transfer in PCOSpatients (PCOS group, 78 cycles of 26 patients) were comparedwith those of a control group (423 cycles in 202 patients withoutmale factor; age and ovarian stimulation protocol were matched).Although the pregnancy rate per transfer was not different inthe two groups of patients (25 versus 34%, PCOS versus controlgroup), the PCOS group had a significantly lower pregnancy rateper follicle aspiration (19 versus 31%, P < 0.05). A notableresult was a significantly higher incidence of embryo transfercancellations in the PCOS group (22 versus 8%, P < 0.01),which resulted from unpredictable failure of either oocyte recoveryor fertilization. The incidence of unexplained complete failureof fertilization was significantly higher in the PCOS group(18 versus 5%, P < 0.01). These results may reflect a reducedquality of the oocytes in the PCOS group, and there was a subgroupof PCOS patients who repeatedly produced poor results of treatment.Although the ovarian stimulation regimen best suited to PCOSpatients remains to be determined, special care should be takenduring ovarian stimulation, especially when the PCOS patientshad experienced unexplained failure of oocyte recovery or fertilizationin the previous treatment cycle(s).     

克罗米酚对血清雌激素和孕激素水平的影响

目的探讨克罗米酚(CC)在诱发排卵过程中对雌、孕激素水平的影响。方法采用放射免疫法,测定16例不明原因不孕妇女在自然周期和用药周期的排卵前1天和排卵后10天血清雌二醇(E2)和孕酮(P)浓度。结果排卵前1天和排卵后10天,用药周期的E2、P浓度均高于自然周期(P<0.05)。结论克罗米酚在诱发排卵过程中可导致内源激素平衡紊乱。     

Ovulation induction: a mini review

Ovulation induction is the method for treating anovulatory infertility. For patients with hypogonadotrophic hypogonadism, the treatment involves administration of both FSH and LH, while HCG is injected for follicle rupture. Pulsatile GnRH has the same effectiveness as gonadotrophins and the advantage of the low multiple pregnancy rate. In polycystic ovary syndrome (PCOS), the first treatment choice is clomiphene citrate. With this drug, in properly selected patients, the cumulative pregnancy rate approaches that of normal women. Low-dose protocols of FSH are the second line of treatment, effective in inducing monofollicular development. Laparoscopic ovarian drilling can be an alternative but not as a first choice treatment in clomiphene-resistant patients. Other treatments, such as pulsatile GnRH and GnRH agonists, are hardly used today in PCOS. However, in obese women with PCOS, weight loss and exercise should be recommended as the first line of therapy. Newer agents including aromatase inhibitors and insulin sensitizers, although promising, need further evaluation.     

Periovulatory increase in temperature difference within the rabbit oviduct

BACKGROUND: Earlier studies demonstrated a small temperature difference between the sperm storage and fertilization sites within the oviducts of rabbits and pigs. Our aim was to reveal the time dependence of this temperature difference relative to ovulation, and to determine how this difference is generated-by temperature elevation at one of these sites or by temperature decrease at the other site. METHODS: The temperature at the sperm storage site (at the isthmus near the uterotubal junction) and at the fertilization site (the isthmic-ampullary junction) of rabbit oviducts were measured before, during, and after ovulation by two probes, connected to digital thermometers. Rectal temperature was constantly measured and served as a control for body temperature. RESULTS: The temperature difference between the fertilization site and the storage site was 0.8+/-0.2 degrees C before ovulation. This difference increased at ovulation, reaching 1.6+/-0.1 degrees C after ovulation (P<0.03). This increased difference was mainly due to temperature decrease in the sperm storage site. CONCLUSION: The temperature-difference increase within the rabbit oviduct is generated at ovulation by a reduced temperature at the sperm storage site. This temperature gradient may play a role in mammalian reproduction via sperm thermotaxis.     

Growth hormone co-treatment for ovulation induction may enhance conception in the co-treatment and succeeding cycles, in clonidine negative but not clonidine positive patients

To investigate the effect of co-treatment with growth hormone(GH) for ovulation induction with human menopausal gonadotrophins(HMG) on conception, we compared the pregnancy rate and responseto co-treatment with GH versus HMG/human chorionic gonadotrophin(HCG) alone in a prospective, randomized, cross-over protocolof volation induction for either in-vivo or in-vitro fertilization(IVF). The main outcome measures were the amount of gonadotrophinused and conception. Co-treatment with GH was associated witha reduction of 30% in gonadotrophin requirement. In 24 clonidinenegative patients 14 pregnancies were achieved (58.3%) eitherin the GH/HMG/HCG cycle or in the succeeding one. GH co-treatmentdid not generate any pregnancy in eight clonidine positive patients.We conclude that growth hormone may increase the pregnancy ratewhen combined with HMG/HCG for ovulation induction, not onlyin the co-treatment cycle but also in the succeeding one. Thebeneficial, synergistic effect of GH co-treatment was detectedin clonidine negative but not in clonidine positive infertilepatients.     

Evidence for the involvement of blood flow-related mechanisms in the ovulatory process of the rat

To elucidate whether any relationship exists between ovarian blood flow and ovulation rate, the effects on these parameters were examined in equine chorionic gonadotrophin/human chorionic gonadotrophin (eCG/HCG) (15I U/15I U) primed rats after bilateral ligation and severance of either the ovarian branch of the uterine artery and vein (UL), the ovarian artery and vein (OL) or both sites (UL+OL) in comparison to sham operations. Laser Doppler flowmetry demonstrated the presence of microcirculatory vasomotion and a reduction of blood flow after UL, OL and UL+OL performed during the intervals 0-3 h (78, 66 and 19% of pretreatment values respectively) and 6-9 h (68, 57 and 20%) after HCG. Experiments utilizing radioactive microspheres also indicated decreased ovarian blood flow by UL and OL. Ovulation rate was assessed 20 h after HCG in animals where ligations had been performed at 0, 3, 6 and 9 h after HCG. No ovulations were seen after UL+OL and significantly decreased ovulation rates ( approximately 50% of sham operated animals) were seen after UL at 0 and 3 h and after OL at 0, 6 and 9 h. Progesterone concentrations in blood 20 h after HCG were reduced by OL but not UL and ovarian weights were unaffected by ligation. It is concluded that acute blood flow reduction during the ovulatory interval reduces ovulation rate in the rat.