体外受精-胚胎移植取消周期47例临床分析

目的 :探讨在体外受精 -胚胎移植周期中因卵巢反应不良而取消周期的病因及处理方法。方法 :对2 0 0 0年 1 1月至 2 0 0 1年 1 2月接受超促排卵周期因故而取消周期 47例进行分析 ,选择与取消周期者同日或最接近日进入周期接受超促排卵并完成移植周期的 75例作为对照组。结果 :在超促排卵周期中因卵巢反应不良而取消周期 34例 ,占 6 .9% ,反应不良组平均年龄及不孕年限均较对照组长 (P <0 .0 5) ,基础FSH >8IU/L和 /或E2 >50pg/ml反应不良组明显高于对照组 (P <0 .0 1 ) ,反应不良组Gn起始用量及每日用量均明显高于对照组 ,(P <0 .0 0 1 )。结论 :反应不良的原因为卵巢储备功能低下 ,体内存在Gn抗体 ,原因不明 ;加大Gn剂量、降低GnRH -a用量、合用生长激素为常用处理方法。     

Endocrinology: Two cases of ovarian tumours in women who had undergone multiple ovarian stimulation attempts

Concerns have been raised recently about the possible associationbetween superovulation and ovarian cancer. In order to contributeto the limited literature on this important issue, two casesof ovarian tumours in women who had undergone multiple ovulationinductions are presented. In the first case, the patient hadsecondary anovulatory infertility. She was treated with humanmenopausal gonadotrophin (HMG) alone and in combination withclomiphene citrate or buserelin for six cycles. She then underwentovarian stimulation with buserelin/HMG in the long protocolfor in-vitro fertilization (IVF) and embryo transfer. In preparationfor a new IVF/embryo transfer attempt, 8 months later, the screeningultrasound revealed a cystic formation of the left ovary andan enlargement of the right. During laparotomy, both ovarieswere found to bear large tumours (approximately 6x5x4 cm) whichwere removed. Histological examination showed that they wereepithelial tumours (serous-papillary cystadenomas) of borderlinemalignancy. The patient conceived spontaneously 1.5 years afterthe operation. In the second case, the patient presented withsecondary anovulatory infertility. She underwent ovulation inductionwith clomiphene/HMG and with buserelin/HMG in the long protocol,and intra-uterine insemination with husband's spermatozoa andconceived (singleton pregnancy). She was delivered by Caesareansection, during which a cystic tumour of the left ovary wasremoved. Histological examination revealed a benign mucous cystadenomaof the ovary. In conclusion, the clinical information from thesetwo cases does not support a causal association between ovarianstimulation and ovarian tumours but does potntially supporta facilitating one.     

影响助生殖技术的因素分析

目的　了解影响助生殖因素。②方法　用助生殖技术对 10 6例不孕妇女进行助孕 ,观察助生殖过程中激素水平对卵泡发育及排卵影响 ,不同获能方法对精子受精率影响 ,同时分析控制性超排卵 (COH)异常反应 卵巢过度刺激综合征 (OHSS)发生、发展相关因素。③结果　COH中 ,高雌二醇、低孕激素水平可促进卵泡发育 (t=1.99～ 6 2 5 .75 ,P <0 .0 0 1,0 .0 5 ) ;体外分离法获能精子活率明显高于上游法 (t=11.40～ 32 .41,P <0 .0 0 1) ;中、重度OHSS组胚胎移植日血清及卵泡液血管内皮生长因子 (VEGF)水平显著高于正常组 (t=4.2 6 ,11.5 1,P <0 .0 1)。④结论　激素水平、精子获能方法及VEGF水平对助生殖可能有影响作用。     

Aberrant DNA methylation of imprinted loci in superovulated oocytes

BACKGROUND: There is an increased incidence of rare imprinting disorders associated with assisted reproduction technologies (ARTs). The sex-specific epigenetic modifications that are imposed during gametogenesis act as a primary imprint to distinguish maternal and paternal alleles. The most likely candidate for the gametic mark is DNA methylation. However, the timing of DNA methylation acquisition in adult oocytogenesis and the effects of superovulation are unknown. METHODS: We examined the maternal methylation of PEG1(MEST), LIT1(KCNQ1OT1) and ZAC(PLAGL1) and the paternal methylation of H19 in adult growing oocytes of humans and mice and compared them with the methylation status of mouse neonatal growing oocytes by using bisulphite sequencing. Furthermore, we examined the effects of superovulation in the human and mouse. RESULTS: Maternal methylation of these genes has already been initiated to some extent in adult human and mouse non-growing oocytes but not in mouse neonates. In addition, the methylation dynamics during adult human and mouse oocyte development changed more gradually than those during neonatal oocyte development. Furthermore, we found the demethylation of PEG1 in growing oocytes from some ART-treated infertile women and a gain in the methylation of H19. We also detected methylation changes in superovulated mice. CONCLUSION: Our studies in the human and mouse suggest that superovulation can lead to the production of oocytes without their correct primary imprint and highlight the need for more research into ARTs.     

瘦素及胰岛素样生长因子-Ⅰ与卵泡发育的关系

目的：探讨卵泡液和血清中瘦素（Leptin）与胰岛素样生长因子-I（IGF-I）水平与卵泡发育的关系。方法：应用放射免疫法（RIA）检测67例患者取卵日血清及卵泡液中的Leptin与IGF-I水平。结果：（1）取卵日血清中的Leptin水平为（13．20±5．43）mg／L，显著高于卵泡液中kptin水平（10．86±5．73）mg／L，P〈0．05；卵泡液中的Leptin水平与血清中的Leptin水平呈正相关（r=0．84，P〈0．001）。血清中的IGF-I水平为（7．18±4．58）mg／L，显著高于卵泡液中IGF-I水平（4．36±3．03）mg／L（P〈0．05），卵泡液中的IGF-I水平与血清中的IGF-I水平呈正相关（r=0．79，P〈0．001）；（2）卵巢低反应型者的血清及卵泡液中Leptin水平显著高于卵巢中高反应型者，差异有显著性（P〈0．05）；（3）三种卵巢反应类型的血清及卵泡液中IGF—I水平比较，差异无显著性（P〉0．05）；（4）卵泡液及血清中的Leptin水平与IGF—I水平无明显的相关性（r=-0．079，P〉0．05）及（r=-0．127，P〉0．05）。结论：（1）卵泡液中的Leptin及IGF-I均来自血清；（2）高浓度的Leptin可能抑制卵泡发育，而低浓度的Leptin可能对卵泡发育没有影响；（3）体内IGF-I可能与其受体结合后发挥对卵泡发育的调节作用；（4）Leptin与IGF-I之间无明显相关关系。     

Gamete intrafallopian transfer vs superovulation with intrauterine insemination for the treatment of infertility

Superovulation with intrauterine insemination (SO-IUI) has been suggested as an alternative to gamete intrafallopian transfer (GIFT), despite the absence of controlled or comparative trials. We retrospectively analyzed all GIFT and SO-IUI cycles performed concurrently from January 1985 to August of 1987 at a single university center. Pregnancy rates were significantly better for GIFT than SO-IUI (P<0.001), with an odds ratio of 3.25 (P=0.001). Stepwise multiple logistic regression identifield factors that correlate with pregnancy: absence of endometriosis (P=0.05), infertility<3 years' duration (P=0.002), TMS 30×10⁶ (P=0.005), and treatment with GIFT rather than SO-IUI (P=0.001). These data give a first approximation of the increased efficacy of GIFT versus SO-IUI and provide valuable insight into significant confounding variables to be considered when planning a randomized, prospective trial to evaluate these techniques.     

输卵管切除术对卵巢反应性的影响

目的探讨输卵管切除术对卵巢功能的影响。方法以曾因输卵管妊娠行单侧输卵管切除术后不孕患者为研究组,以同期因双侧输卵管阻塞(无输卵管积水)不孕患者为对照组,分析两组因输卵管因素不孕行体外受精——胚胎移植患者的卵巢对控制性超排卵的反应。结果两组的促性腺激素(Gn)用量、用药天数、受精率、卵裂率比较,差异无统计学意义(P>0.05),但研究组的卵泡数、获卵子数少于对照组,差异有统计学意义(P<0.05)。促排卵后输卵管切除侧的卵巢体积、卵泡数、获卵子数小于或少于对侧卵巢(P<0.05);但在卵泡早期两侧卵巢体积无明显差异(P>0.05);卵子的受精率、卵裂率也无显著差异(P>0.05)。结论输卵管切除术在短期内虽然不影响卵巢体积,但却降低了同侧卵巢的储备功能,手术可能影响了卵巢的血液供应和超排卵效果。因此,临床上对有生育要求的输卵管妊娠患者,应尽可能地保留患侧输卵管。     

输卵管切除术对体外受精-胚胎移植中控制性超促排卵的影响

目的：探讨输卵管切除术对体外受精-胚胎移植（IVF-ET）周期超促排卵中卵巢反应性的影响.方法：选择因异位妊娠行一侧输卵管切除、双侧输卵管切除的患者以及双侧输卵管未切除的管性不孕患者,观察在IVF-ET中卵巢对控制性超排卵的反应.结果：3组患者年龄、促性腺激素用量、获卵数、受精数以及妊娠率差异无统计学意义.单侧输卵管切除的患者中输卵管切除侧卵巢获卵数少于对侧,但差异无统计学意义.结论：输卵管切除术对IVF-ET周期中卵巢反应性以及妊娠率无明显影响.输卵管积水患者拟行IVF-ET前预防性切除输卵管是可行的.     

Factors responsible for multiple pregnancies after ovarian stimulation and intrauterine insemination with gonadotropins

Purpose: The present study was undertaken in order to analyze possible factors that could be responsible for multiple pregnancies in normoovulatory women undergoing superovulation with gonadotropins and intrauterine artificial insemination. Methods: We retrospectively analyzed several clinical parameters in patients that achieved gestation with this treatment. Patients were divided into two groups depending on sperm origin (husband and donor sperm). Furthermore, they were subclassified as follows: (a) cycles resulting in single pregnancies (n=366), (b) cycles ending in multiple pregnancies (n=126), and (c) a control group composed of unsuccessful cycles (n=366). Results: In cycles employing husband's sperm, the age, number of cycles necessary to reach pregnancy, serum estradiol (E₂) levels, and number of follicles were significantly (P<0.05) different in multiple pregnancies compared to single or nonpregnant cycles. In donor insemination, women with multiple pregnancies were significantly younger than nonpregnant patients. There was a significant increase in the number of follicles developed (P<0.00001) and serum E₂ levels on the day of hCG (P<0.05) in multiple compared to single pregnancies and unsuccessful cycles. The number of motile sperm in the insemination specimen was not different among the established groups. When both types of treatments were grouped, pregnant patients were significantly (P<0.00001) younger than women with failed cycles. In addition, multifetal pregnancies were significantly (P<0.05) more frequent in women <30 years old. E₂ production was significantly (P<0.00008) higher in twin and multifetal pregnancies than in single or nonpregnant cycles. Follicular development was also significantly (P<0.00001) higher in twin and multifetal pregnancies compared to failed cycles. Conclusions: The results suggest that young women (<30 years) who develop more than six follicles with E₂ >1000 pg/ml when stimulated with gonadotropins are at higher risk of multiple gestation. These data may be helpful in preventing this undesired complication of assisted reproduction techniques.