IVF-ET助孕后的妊娠及分娩结局分析

目的研究影响IVF-ET助孕后妊娠和分娩结局的因素。方法回顾性分析IVF-ET后获妊娠的233个周期,根据年龄分为A、B、C三组。A组;21～30岁,B组31～35岁,C组26～42岁。比较不同年龄的妊娠率及妊娠丢失率,分娩率。结果 36～42岁组,妊娠率为25.96%,显著低于31～35岁组(39.69%)和21～30岁组(50.99%);该组的妊娠丢失率为44.44%,显著高于31～35岁组(37.66%)和21～30岁组(16.28%);38例双胎妊娠分娩中,3例均有其中的1婴儿畸形;133例单胎妊娠分娩均获得正常活婴。结论年龄和多胎妊娠是影响IVF-ET助孕后妊娠及分娩结局的重要因素。     

黄体期添加不同剂量雌激素对IVF-ET妊娠结局的影响

目的:探讨长方案控制性超促排卵体外受精-胚胎移植(IVF-ET)周期黄体期减少外源性雌激素剂量对妊娠结局的影响。方法:回顾性分析2011年7月至2012年4月1614个长方案控制性促排卵周期的资料。根据黄体期补充补佳乐剂量不同分为2组:A组(785例)补佳乐2mg/d;B组(829例)补佳乐4mg/d。两组黄体支持期所用孕激素剂型、剂量相同。结果:两组间的临床特征、超排卵情况(COH)、胚胎形成情况均无统计学差异(P>0.05);添加补佳乐2mg/d组与4mg/d组的临床妊娠率(49.81%vs 49.88%)、胚胎种植率(34.25%vs 34.93%)及流产率(9.21%vs 10.92%)均无统计学差异(P>0.05)。结论:长方案IVF-ET周期黄体支持常规添加不同剂量雌激素助孕结果无显著差异,减少雌激素用量不影响妊娠结局。     

宫腔细菌感染与IVF-ET结局

目的:探讨IVF-ET者子宫内膜细菌感染对妊娠结局的影响。方法:677例第1次新鲜胚胎移植周期进行宫腔培养,比较感染组和未感染组的临床妊娠率和种植率。结果:宫腔细菌感染率为16.4%,感染组临床妊娠率为25.2%,种植率为14.8%;未感染组为40.61%和23.8%,组间比较有统计学差异,P<0.05。结论:宫腔内细菌感染会明显降低IVF-ET的种植率和临床妊娠率。     

输卵管手术对IVF-ET卵巢反应性及妊娠结局影响的研究

目的:探讨输卵管手术对体外受精-胚胎移植(IVF-ET)过程中卵巢反应性和妊娠结局的影响。方法:接受IVF-ET治疗、符合纳入标准的650例不孕症患者共650个周期。曾因输卵管妊娠或输卵管阻塞、粘连或积水行输卵管切除术或修复整形手术的共304例,其中行输卵管切除术155例(A组),单侧输卵管切除126例(单侧输卵管切除组),双侧输卵管切除29例(双侧输卵管切除组);输卵管修复整形术149例(B组)。同期因输卵管因素不孕或单纯男方因素行IVF-ET者为对照组,346例。检测各组的性激素水平及AFC,比较卵巢反应性及妊娠结局。结果:1A组与对照组相比,低反应发生率增加(P0.05),而B组与对照组相比差异无统计学意义(P0.05)。2A组与对照组相比,基础促卵泡生成素(b FSH)、b FSH/黄体生成素(b LH)、雌二醇(b E2)水平均明显增高(P0.01,P0.05),B组b E2显著高于对照组(P0.01)。3A组、B组与对照组相比,促性腺激素(Gn)天数延长(P0.01,P0.05)、Gn用量均增加(P0.01),A组Gn天数长于B组(P0.05)。3组间优质胚胎率、正常受精率、临床妊娠率、种植率和流产率差异均无统计学意义(P0.05)。4单侧输卵管切除患者术侧卵巢与对侧卵巢比较,术侧卵巢的窦卵泡数与获卵数均明显减少(P0.01)。5双侧输卵管切除组与单侧输卵管切除组相比,Gn天数延长,Gn用量增加(P0.01)。结论:输卵管手术会影响卵巢储备功能和卵巢反应性,影响程度与手术范围和手术损伤程度有关,但不会明显影响IVF-ET的结局。     

卵泡微环境中外泌体对IVF-ET妊娠结局的影响

目的 分析卵泡微环境中外泌体对体外受精-胚胎移植（IVF-ET）妊娠结局的影响。方法 选取96例卵巢功能正常的不孕患者,均给予IVF-ET助孕治疗,根据患者是否妊娠分为妊娠组（45例）与未妊娠组（51例）。观察卵泡微环境中外泌体对IVF-ET妊娠结局。结果 妊娠组外泌体浓度、BCA蛋白浓度高于未妊娠组（P<0.05）;血清抗苗勒管激素（AMH）、血清卵泡刺激素（FSH）/促黄体生成素（LH）、基础窦卵泡数（AFC）与卵子质量无关（P>0.05）;血清FSH、卵泡液中外泌体浓度与卵子质量有关（P<0.05）,为影响卵子质量的独立危险因素;基础AFC、卵泡液中外泌体浓度为影响妊娠结局的独立危险因素（P<0.05）。结论 卵泡微环境中外泌体可影响IVF-ET妊娠结局。     

605例体外受精-胚胎移植后妊娠并发症和结局

自从1978年世界第1例体外受精一胚胎移植(in vitro fertilization—embryo transfer，IVF-ET)婴儿诞生以来，辅助生殖技术(assisted reproductive technology，ART)已成为治疗不孕症的有效方法。随着ART技术的逐渐普及，将会有越来越多的ART婴儿出生，因此，对ART后出生婴儿的密切随访和评估将是围产医学重要的内容之一，为此，我们随     

Glycodelin-A与IVF-ET的子宫内膜容受性及妊娠结局的关系

目的 探讨Glycodelin-A表达与体外受精-胚胎移植(IVF-ET)的子宫内膜容受性及妊娠结局的关系.方法 回顾性选择2016年8月至2018年1月武汉市第一医院生殖医学中心接诊的拟行IVF-ET治疗患者71例,分析人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)日抽血检测性...     

不同黄体支持方案对新鲜周期移植双胎妊娠围生期结局的比较

目的:比较阴道用黄体酮缓释凝胶和注射用黄体酮针两种黄体支持方案对卵裂期新鲜胚胎移植周期双胎妊娠围生期结局的影响。方法:回顾性分析2011年1月至2016年3月在郑州大学第三附属医院生殖医学中心行体外受精/卵细胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)孕早期临床确诊双胎妊娠患者900例(共900个周期),采用电话随访和电子病历查询方法,其中双胎分娩患者共705个周期,依据移植时黄体支持方案分为注射用黄体酮针组(551个周期)和阴道用黄体酮缓释凝胶组(154个周期)。比较两组间围生期妊娠期并发症发生率及妊娠结局、新生儿结局的差异。结果:两组间流产(早期流产、晚期流产)、死胎、死产、自然减胎、行减胎术、活产率(活单胎、活双胎率)比较,差异均无统计学意义(P0.05)。阴道用黄体酮缓释凝胶组的妊娠期糖尿病发生率(8.4%)较注射用黄体酮针组(3.8%)高,差异有统计学意义(P0.05),余妊娠期并发症两组间差异无统计学意义(P0.05)。两组间新生儿畸形、出生后死亡、平均出生体质量差异无统计学意义(P0.05)。结论:阴道用黄体酮缓释凝胶黄体支持方案使用方便,患者依从性好,且可获得与注射用黄体酮针相似的双胎妊娠围生期结局。     

体外受精—胚胎移植术后妊娠妇女的产科结局

探讨行体外受精－胚胎移植术后妊娠妇女的产科结局；方法，对我院分娩的２０例ＩＶＦ－ＥＴ术后妊娠妇女的产科情况进行回顾性分析并与８２１０例同期住院分娩的非ＩＶＦ－ＥＴ术后妊娠妇女比较。     

行体外受精-胚胎移植的40岁以上妇女妊娠结局分析

目的 探讨行体外受精-胚胎移植(IVF-ET)40岁以上妇女的结局及其影响因素.方法 采用回顾性分析方法,收集2001年3月至2006年3月于广东省妇幼保健院行IVF-ET治疗不孕症的40岁以上妇女82例,共93个周期,从中找出不同年龄妇女进行IVF-ET的临床结局及其影响因素.结果 82例患者共行93个超促排卵周期,其中取消周期11个,取消率11.83%;行新鲜胚胎移植74个周期,临床妊娠率25.68%,着床率10.87%,流产率36.4%;40岁、41岁、42岁、43岁及以上组临床妊娠率分别为32.14%、36.36%、25.00%和0;前3组的流产率分别为44.44%、25.00%和50.00%;与短方案组比较,长方案组促性腺激素(Gn)刺激时间、用量明显增多,获胚胎数和移植胚胎数更多(P＜0.05),但两组临床妊娠率、着床率和流产率差异并无显著意义;42岁及以下妇女当获卵数超过4个,妊娠率明显增加.结论 40岁以上妇女行IVF-ET妊娠率和着床率均明显降低,并且流产率升高.对于40岁以上妇女,一定数量的卵子可能提高IVF成功率.     

不同降调节方案对子宫内膜异位症患者IVF-ET妊娠结局的影响

目的:探讨超长方案对子宫内膜异位症患者IVF-ET妊娠结局的影响。方法:回顾性分析79例(82个周期)子宫内膜异位症患者采用超长方案(42个周期)和常规长方案(40个周期)对IVF-ET妊娠结局的影响。结果:与常规长方案组相比超长方案组的获卵数(8.2vs10.7)、受精率(69.32%vs72.11%)、卵裂率(87.49%vs89.78%)无明显差异(P>0.05),但Gn总量(44.55支vs33.79支)、优质胚胎数(4.3vs5.8)、临床妊娠率(20.00%vs40.48%)、胚胎植入率(9.90%vs19.64%)等几项指标,超长方案组均显著增高(P<0.05)。结论:在IVF-ET超促排卵前,采用超长方案进行降调节能显著提高子宫内膜异位症患者IVF-ET的成功率。     

超声引导下宫腹腔镜联合治疗子宫斜隔妊娠一例并文献复习

子宫斜隔又名Robert子宫,为阻塞型苗勒管发育畸形,隔板的下端与一侧子宫壁融合,使该侧宫腔封闭,其在子宫畸形中较为罕见。Robert子宫通常是宫腔被纵隔分为两腔,纵隔偏向宫腔一侧,多在青春期和月经来潮后由于宫腔积血不断增多产生进行性加重痛经而发现,部分病例痛经不是特别明显。临床上着床于斜隔内的妊娠更为罕见,且多存在漏诊、误诊等情况。本例患者停经41 d,查血人绒毛膜促性腺激素（hCG）3 077.83 mIU/mL,妇科彩色超声示：右侧肌壁不均回声团——输卵管间质部妊娠待除外（大小约1.6 cm×0.9 cm×1.2 cm,内可见一大小为0.5 cm×0.4 cm×0.4 cm暗区,与宫腔不相通）;盆腔积液,行宫腔镜下诊断性刮宫,术后3 d复查hCG为10 220.12 mIU/mL,行超声引导下宫腹腔镜联合手术,最终诊断为子宫斜隔妊娠。本例患者诊治经验对临床异常妊娠处理及诊断流程有一定参考价值,为减少罕见异常妊娠漏诊、误诊提供了临床经验。     

卵巢反应性对IVF-ET妊娠结局的影响

目的:探讨IVF-ET促排卵周期中卵巢反应性对妊娠结局的预测能力。方法:回顾性分析402个长方案促排卵周期中所需外源性重组卵泡刺激素总量(rFSH)/成熟卵母细胞数(n)的比值(rFSH/n)与妊娠结局的关系。结果:随着rFSH/n比值升高,基础窦卵泡数(AFC)减少、rFSH总用量增大、获卵数减少、平均胚胎评分下降(P<0.05)。当rFSH/n>450时,临床妊娠率明显下降(P<0.05)。结论:卵巢反应性是影响IVF结局的重要因素,妊娠率随着rFSH/n的增加而下降的截点为rFSH/n>450。     

35例先天子宫畸形患者行IVF-ET治疗临床结局分析

目的:总结子宫畸形患者行IVF-ET治疗的妊娠结局。方法:回顾性分析行IVF-ET治疗的35例先天子宫畸形患者(子宫畸形组)的临床结局,随机抽取同期子宫正常、单纯输卵管因素不孕症患者110例作为对照组。结果:患者年龄、不孕年限、BMI、bFSH、bLH、促排卵天数、FSH使用总剂量、hCG注射日E2、受精率、卵裂率、临床妊娠率、着床率、多胎率和流产率组间均无统计学差异,但子宫畸形组的分娩孕周、活婴体质量、早产率均差于对照组,差异有统计学意义(P<0.05),所有新生儿均未观察到畸形。结论:要重视子宫畸形患者的早期诊断和临床处理,建议患者在获得多胎妊娠后减为单胎,同时加强孕期及分娩过程中的检查与监护,以期获得更好的妊娠结局。     

Pregnancy Outcome in Patients with Solitary Kidney

Background

Solitary kidney may be congenital or as a result of nephrectomy. There is a lot of literature available on quality of life in these patients, but there is limited data on pregnancy outcome.

Objectives

To study pregnancy outcome in patients with solitary kidney either congenital or due to nephrectomy.

Materials and Methods

Study Design This is a retrospective observational study conducted at tertiary health center in Ahmedabad, from 2011 to 2014. Sample Size There were 164 patients of solitary kidney, out of which two patients had congenital solitary kidney and the remaining had solitary kidney due to nephrectomy. Among 164 patients, 96 (58.53 %) patients had completed family, 37 (22.56 %) patients did not try for pregnancy, 15 (9.14 %) patients have conceived, 12 (7.3 %) were lost to follow up and 4 (2.43 %) patients were infertile. Method Patients in reproductive age group (20–40 years), with solitary kidney either congenital or due to nephrectomy, were included. Maternal and fetal outcome was studied, and patients were followed up till 2 years postpartum. Exclusion Criteria Patients with solitary kidney due to post-renal transplant were excluded.

Results

There were 15 (9.14 %) patients who had conceived, out of which 11 (73.33) patients delivered and 4 (26.67 %) patients had spontaneous abortion. Two patients developed gestational hypertension and one had preeclampsia. On follow-up, all babies were normal and none of them had delayed developmental milestones.

Conclusion

Preconceptional counseling should be done in these patients regarding risk of developing preeclampsia during pregnancy and preterm delivery. These patients can have good pregnancy outcome with close monitoring during antenatal period.

     

移动抑制因子与体外受精-胚胎移植妊娠结局的相关性研究

目的:探讨人卵泡液中是否存在移动抑制因子(MIF)及其卵泡液和血液中的浓度对IVF-ET 妊娠结局的影响。方法:选择2004．08-2005．08行IVF-ET助孕的不孕妇女共37例,按妊娠结局分 为妊娠和非妊娠两组。收集取卵时的血液及卵泡液,定量酶联免疫法(ELISA)分别测定血及卵泡液 中MIF的浓度。并检测取卵前血中LH、P、E2值。结果:两组在获卵数、受精率、卵裂率、移植 胚胎数和激素水平无显著差异。妊娠组血清及卵泡液中MIF浓度分别为1．79±0．98 ng／ml和 22．97±10．62 ng／ml;非妊娠组分别为1．91±1．71 ng／ml和13．44±8．5ng/ml。两组卵泡液中 MIF浓度比较有显著差异(P<0．05);血清中浓度差异不明显(P>0．05)。卵泡液MIF浓度与优质胚 胎率呈正相关(r=0．3277,P<0．05),优质胚胎率在两组间差异显著(P<0．02)。结论:卵泡液中MIF可 能与卵泡发育及卵细胞质量有关,进而影响IVF-ET的结局。     

体外受精-胚胎移植术后妊娠结局回顾性分析

目的:探讨体外受精-胚胎移植术后的妊娠结局。方法:回顾性分析在本生殖医学中心行体外受精-胚胎移植术、单精子卵胞浆内注射术、冻融胚胎移植术后306个妊娠周期的结局及围产儿情况,并与自然受孕妇女进行比较。结果:在306个妊娠周期中,生化妊娠11个周期,临床妊娠295个周期,流产53个周期,宫外孕10个周期,宫内外同时妊娠5个周期。共有168例分娩,与同期在我院自然妊娠分娩的6 203例相比,多胎率(34.52％vs 0.77％)、早产率(33.33％vs 4.56％)有显著性差异(P<0.05)。助孕出生的231例新生儿与自然分娩的6 186比,低体重儿率(37.23％vs 3.30％)、新生儿死亡率(0.87％vs 0.21％)、新生儿畸形率(2.16％vs 4.24％)、死胎率(1.70％vs 0.27％)均有有显著性差异(P<0.05)。另两组在前置胎盘和产后出血方面,差异也有显著性。结论:辅助生育其并发症显著高于自然妊娠。     

Comparison of Virtual Ultrasonographic Hysteroscopy with Conventional Hysteroscopy in the Workup of Patients Who Are Infertile

Study ObjectiveTo compare the tolerability and diagnostic accuracy of virtual ultrasonographic hysteroscopy (VUH) with that of conventional diagnostic outpatient hysteroscopy in the workup of patients who are infertile.DesignA single-center, retrospective cohort study.SettingDepartment of Obstetrics and Gynecology, Gynecologic Oncology, and Minimally Invasive Pelvic Surgery Unit of Sacred Heart Hospital Don Calabria in Negrar, Italy.PatientsA total of 120 consecutive women who underwent hysterosalpingosonography and subsequent VUH and conventional hysteroscopy for infertility evaluation were included. The inclusion criterion was infertility for at least 1 year, with evaluation in the early or intermediate follicular phase of the menstrual cycle.InterventionsAfter the placement of an intracervical catheter, a Ringer Lactate solution was injected into the uterine cavity and fallopian tubes, and a 3D volume was obtained. The ultrasound volume acquired was successively elaborated offline, and a VUH was performed. Subsequently, a variable amount of air was introduced into the uterine cavity, and the patency of the salpinges was evaluated.Measurements and Main ResultsThe VUH findings were compared with those of conventional hysteroscopy performed in the subsequent month. For the detection of endometrial pathology in the overall pool, the sensitivity and specificity of VUH in comparison with conventional hysteroscopy were 100% (95% confidence interval [CI], 84.6%–100%) and 100% (95% CI, 96.3%–100%), respectively. For the detection of uterine cavity pathology and uterine malformations in the overall pool, the sensitivities of VUH were 80% (95% CI, 28.4%–99.5%) and 100% (95% CI, 75.3%–100%), respectively, with specificities of 100% (95% CI, 96.8%–100%) and 100% (95% CI, 96.6%–100%), respectively, when compared with conventional hysteroscopy. The positive predictive values for endometrial pathology, uterine cavity alterations, and uterine malformations were 100% (95% CI, 84.6%–100%), 100% (95% CI, 39.8%–100%), and 100% (95% CI, 75.3%–100%), respectively, with a receiver operating characteristic area of 100%, 90% (95% CI, 70%–100%), and 100%, respectively. There were no cases of severe vasovagal reactions or other complications. Most patients (67%, 81 of 120 women) described the examination as “less painful than expected,” 25% (30 of 120 women) “just as expected,” and only 7% (9 of 120 women) as “more painful than expected.”ConclusionVUH was well tolerated and showed a high accuracy (100%) in the study of the uterine cavity when compared with conventional hysteroscopy.