控制性超排卵中血清促黄体生成素浓度过低对体外受精-胚胎移植的影响

目的 :探讨控制性超排卵中血清促黄体生成素 (L H)浓度过低对体外受精 -胚胎移植的影响。方法 :为 2 0 0 0年 6月至 2 0 0 1年 8月在本所接受体外受精 (IVF)或卵母细胞单精子显微注射 (ICSI)助孕的不孕症患者 ,对其中具有正常促性腺激素功能的妇女 16 0例采用促性腺激素释放激素激动剂 (Gn RH- a)长方案并单纯用人基因重组促卵泡生长素 (r- FSH)进行控制性超排卵 (COH) ,以注射绒毛膜促性腺激素 (HCG)日血清 L H浓度分为两组 ,低 L H组为血清 L H≤ 0 .5 m IU/ml,对照组为血清 L H>0 .5 m IU/ml,其中低 L H组 72个周期 ,占 4 5 % ,对照组 88个周期 ,总共 16 0个周期。按本所常规方法过行 IVF/ICSI。我们对这 16 0例临床资料进行回顾性分析。结果 :低 L H组平均 r- FSH用药量和用药时间明显多于对照组 (30 .2 1± 8.12支与 2 7.17± 7.99支 ,10 .93± 1.2 5 d与 10 .0 2± 1.18d,P<0 .0 1) ;r- FSH刺激第 8天的血清 L H浓度和雌二醇 (E2 )浓度 (2 .0 5± 1.4 9m IU/ml与 2 .6 2± 1.5 8m IU/ml,182 7.3± 897.6 pg/ml与 2 0 93.3±92 3.7pg/ml,P<0 .0 5 )、注射 HCG日血清 L H浓度和 E2 浓度 (0 .15± 0 .16 m IU/ml与 1.6 0± 0 .92 m IU/ml,1916 .8±989.5 pg/ml与 3495 .2± 938.2 pg/ml,P<0 .0 0 1)     

重组人黄体生成素在体外受精-胚胎移植高龄患者促排卵中的应用

目的:评价重组人黄体生成素(r-hLH)在高龄患者促排卵中的应用价值以及对临床结局的影响。方法:选择协和医院生殖中心进行试管婴儿治疗,长方案降调节,年龄≥35岁,卵泡刺激素促排卵第7天,血清LH水平低于2U/L的患者146例。根据是否使用r-hLH进行分组:A组78例给予r-hLH治疗,B组68例未给予r-hLH治疗。比较两组患者的血清LH水平变化、平均促性腺激素(Gn)使用量、获卵数、双原核胚胎数、优质胚胎率、着床率及临床妊娠率。结果:两组患者血清LH变化情况、平均Gn用量、获卵数、优质胚胎率差异无统计学意义(P>0.05);A组的平均双原核胚胎数、着床率及临床妊娠率均显著高于B组(P<0.05)。结论:对于卵泡刺激素促排卵第7天血清LH<2U/L的高龄患者,补充r-hLH可以获得较高的双原核胚胎数、着床率及临床妊娠率。     

不同黄体支持方法对体外受精-胚胎移植结果的影响

目的:探讨三种黄体支持方法对体外受精-胚胎移植(IVF-ET)结果的影响。方法:回顾性分析195个IVF-ET周期的结果,根据注射hCG当天的血E2水平、B超示直径≥14 mm卵泡数目及所用的黄体支持方法分组。A组:112例,E2<2 000 pg/mL,直径≥14 mm的卵泡数<10个,hCG进行黄体支持;对E2≥2 000 pg/mL,卵泡数目≥10个者,随机分为两组,B组,46例,单用黄体酮进行黄体支持;C组,37例,黄体酮加雌激素进行黄体支持。结果: 三组间妊娠率、种植率、流产率、OHSS发生率差异均无显著性,P>0.05。结论:hCG用于IVF黄体支持并不优于黄体酮,但在一定程度上可避免某些患者由于注射黄体酮产生的痛苦。黄体酮+雌激素进行黄体支持应该是黄体支持较合理的方案,还需进一步研究。     

尿促黄体生成激素峰与体外受精－胚胎移植结局的探讨

从１９９１年６月１日至１９９２年７月３０日，因输卵管因素造成不孕而进行体外受精－胚胎移植（ＩＶＦ－ＥＴ）共１５０个周期。经用克罗米酚及促性腺激素促超排卵，其中４１个周期（２７．３３％）于注射人绒毛膜促性腺激素（ｈＣＧ）前，尿中出现促黄体生成激素（ＬＨＭ）峰（ＬＨ＞４０ＩＵ／Ｌ），１６个周期（１０．６７％）表现为ＬＨ升高（ＬＨ＝４０ＩＵ／Ｌ），９３个周期（６２．００％）无ＬＨ峰（ＬＨ＜４０ＩＵ／Ｌ）。三组所获得的平均卵子数无明显差异。在有ＬＨ峰的周期中，卵裂率明显低于无峰周期，其临床妊娠率低于无ＬＨ峰者，两者比较差异无显著性。说明在注射ｈＣＧ前，尿中出现ＬＨ峰影响卵子质量，从而将影响受精卵的分裂，可导致临床妊娠率下降。     

口服黄体酮在体外受精-胚胎移植中的应用

目的 验证口服黄体酮胶囊-益玛欣的孕激素活性；探讨其应用于体外受精-胚胎移植（IVF—ET）的临床意义。方法 2006-06—2006-09对福建省妇幼保健院8例非子宫性闭经患者行人工周期治疗，口服益玛欣前后取血查孕酮，个别患者口服益玛欣后取子宫内膜活检。另将IVF—ET患者52例，随机分为2组。研究组26例，给予益玛欣＋黄体酮；对照组26例，单纯给予黄体酮。所有患者于注HCG日及取卵后8d取血查孕酮。结果 （1）8例人工周期治疗患者，益玛欣用药后与用药前比较。血孕酮明显升高（P〈0．01），其中1例用药后子宫内膜活检提示中分泌期子宫内膜。（2）IVF—ET两组患者血孕酮水平及妊娠率差并无显著性（P〉0．05）。结论 口服黄体酮胶囊-益玛欣具有明显的孕激素活性；用于IVF—ET的临床疗效与黄体酮针剂效果相似，是IVF—ET周期补充黄体功能的另一可供选择的药物。     

三种促超排卵方案体外受精-胚胎移植临床妊娠率的分析

目的 :分析 3种促超排卵方案 (tropichyperovulationprogramme ,THOP)体外受精 -胚胎移植 (IVF -ET)的临床妊娠率。方法 :不孕症 136例分为 3组 :1组 5 1例 ,应用高纯促卵泡成熟激素 (HP -FSH ,商品名Metrodine -HP) ,递减给药促超排卵 ,应用促性腺激素释放激素兴奋剂 (GnRH -a ,商品名Buserelin)长方案降调节 ,从月经第 3天开始递减HP-FSH。 2组 5 0例 ,HP -FSH和人绝经期促性腺激素 (hMG)联合递减给药的促超排卵长方案降调节。 3组 35例 ,hMG递增给药促超排卵。分析 3种THOP的平均取卵数、受精后卵裂数、移植数、临床妊娠数及IVF -ET移植周期的临床妊娠率。结果 :(1) 1组 ,平均取卵数 10 .13± 4 .4 9,卵受精数 7.83± 4 .13,受精率 77.2 9% ,卵裂数 7.6 2± 4 .19,移植数3.88± 1.17及临床妊娠数 18,临床妊娠率 35 .2 9% ;(2 ) 2组 ,平均取卵数 9.16± 5 .4 9,卵受精数 6 .84± 4 .2 3,受精率 74 .6 7% ,卵裂数 6 .5± 4 .2 2 ,移植数 3.6 8± 0 .99及临床妊娠数15 ,临床妊娠率 30 .0 % ;(3) 3组 ,平均取卵数 11.31± 7.6 4 ,卵受精数 7.89± 5 .36 ,受精率 6 9.82 % ,卵裂数 7.75± 5 .94 ,移植数 3.6 8± 1.0 8及临床妊娠数 15 ,临床妊娠率4 2 .86 %。 1组与 2组用药安瓿比较 ,差异有高度显著性 (P     

卵巢高反应对体外受精-胚胎移植的影响

目的探讨体外受精-胚胎移植周期控制性超排卵（COH）中卵巢高反应对妊娠结局的影响。方法回顾性分析中山大学附属第二医院生殖中心1082个IVF／ICSI周期的临床资料，根据HCG注射日血E2〉11010pmol／L或获卵数〉15个定义为高反应组，HCG注射日血E2〉1835pmol／L，且获卵数5～15个为正常反应组，比较两组的妊娠结局。结果与正常反应组相比，高反应组获得的优质胚胎数显著增多（P〈0．001），但两者的受精率、卵裂率、胚胎种植率、临床妊娠率、流产率比较，差异无显著性（P〉0．05）。结论COH中卵巢高反应对妊娠结局无明显影响，但需注意预防卵巢过度刺激综合征的发生.     

胚胎移植技术对体外受精-胚胎移植妊娠结局的影响

目的:评价胚胎移植的难易程度、出血、移植管胚胎遗留对体外受精.胚胎移植(IVF-ET)妊娠结局的影响.方法:回顾性分析我院生殖中心自2001年3月至2005年12月620个IVF-ET周期的胚胎移植技术与其临床结局的关系.结果:困难移植组的临床妊娠率(20.00%)和胚胎种植率(10.29%)低于容易移植组32.79%和15.96%(P＜0.05).移植管出血组的临床妊娠率(19.23%)低于无出血组32.57%(P＜0.05);但胚胎种植率两组分别为11.33%和15.77%,差异无统计学意义.移植管胚胎遗留对临床妊娠率(28.00%与31.60%)和胚胎种植率(14.67%与15.42%)均无明显的影响.结论:胚胎移植过程中出现的困难胚胎移植和出血,将会影响IVF-ET的临床妊娠结局,因此移植过程中应尽量避免.     

不同类型多囊卵巢综合征患者行体外受精-胚胎移植的妊娠结局分析

目的:对不同类型多囊卵巢综合征(PCOS)患者行体外受精-胚胎移植(IVF-ET)的妊娠结局进行分析,以了解其相互关系,并对PCOS不孕患者进行IVF-ET前的治疗提供参考和依据.方法:对2000年1月至2009年2月在中山大学附属第一医院生殖医学中心进行首个IVF-ET周期的无排卵或稀发排卵PCOS患者共576例进行回顾性分析.按患者进入周期前的临床特征分为4个组别.高雄激素组(高T组):高T的临床和(或)生化表现+双侧卵巢PCO样+稀发或无排卵,共85例;高黄体生成激素组(高LH组):LH/FSH>2+双侧卵巢PCO样+稀发或无排卵,共105例;高T+高LH组:高T的临床和(或)生化表现+LH/FSH>2+双侧卵巢PCO样+稀发或无排卵,共70例;对照组:仅符合双侧卵巢PCO样+稀发或无排卵,共316例.对4组患者的基本资料、IVF-ET周期的卵子和胚胎情况及妊娠结局进行回顾性比较.结果:4组患者的年龄、体重指数、不孕年限比较,差异无统计学意义(P>0.05);IVF周期中的获卵数、受精率、卵裂胚胎数和种植率比较,差异也无统计学意义(P>0.05);临床妊娠率对照组高于其他3组(P<0.05);早期流产率在4组中比较,差异无统计学意义(P>0.05);继续妊娠率对照组高于高T组和高T+高LH组(P<0.05),而高LH组与其他各组比较,差异无统计学意义(P>0.05).结论:在接受IVF-ET的不同类型无排卵或稀发排卵的PCOS患者中,不合并高T和(或)高LH的患者妊娠结局最佳,高LH血症和高T均对妊娠结局产生不利影响.对PCOS不孕患者行IVF-ET前内分泌紊乱的正确评估及积极纠正可能有利于改善其妊娠结局.     

不同剂量HCG对体外受精-胚胎移植的影响

目的 :比较使用不同剂量人绒毛膜促性腺激素 (HCG)对体外受精 /胞浆内单精子注射 (IVF/ICSI)的结局及对卵巢过度刺激综合征 (OHSS)发病率的影响。方法 :对在本所接受IVF/ICSI辅助生育的 2 6 2例采用GnRH a长方案促排卵的患者进行回顾性分析 ,按HCG用量分为A组 (HCG 5 0 0 0～ 6 0 0 0U)、B组 (HCG 80 0 0～ 10 0 0 0U)。结果 :两组临床妊娠率分别为 35 .94 %和 38.0 5 % (P >0 .0 5 ) ,OHSS发生率分别为 2 .34%和 4 .4 8% (P >0 .0 5 )。结论 :减少HCG用量后对IVF/ICSI的临床妊娠率无明显影响 ,且可以减少OHSS的发生。     

Reducing the dose of human chorionic gonadotropin in high responders does not affect the outcomes of in vitro fertilization

OBJECTIVE: The lowest effective hCG dose in high responders during IVF-embryo transfer (ET) has not been established. This study was performed to confirm that a dose of 3,300 IU is sufficient to provide adequate oocyte maturation and fertilization. DESIGN: Retrospective review of IVF clinical data. SETTING: Infertility center at a tertiary care university. PATIENT(S): Ninety-four IVF cycles were analyzed from high responders based on peak E(2) levels. Demographics were compared including age, diagnosis, and stimulation protocol. INTERVENTION(S): On the day of hCG administration, if E(2) levels were >/=2,500 but <4,000 pg/mL, patients received 5,000 IU (group A). For levels between 4,000 pg/mL and 5,500 IU pg/mL, they received 3,300 IU (group B). MAIN OUTCOME MEASURE(S): Number of oocytes retrieved, proportion of mature oocytes, fertilization rates, chemical and clinical pregnancy rates (PR). The incidence and severity of ovarian hyperstimulation syndrome (OHSS) was also analyzed. RESULT(S): Mean ages were 35.4 +/- 0.7 and 33.2 +/- 0.7 for groups A and B, respectively. Peak E(2) levels differed significantly (2,907 +/- 76 vs. 4,260 +/- 129 pg/mL), as well as the mean number of eggs retrieved (15.9 +/- 0.9 vs. 20.3 +/- 1.2). Proportion of mature eggs (81.6% vs. 81.9%), fertilization rate (70.5% vs. 68.7%), chemical PR (58.7% vs. 58.7%), and clinical PR (50.0% vs. 43.5%) were similar. There was no difference in the incidence of mild, moderate, or severe OHSS. CONCLUSION(S): A reduced hCG dose of 3,300 IU results in a similar proportion of mature eggs, similar fertilization rates, and similar PRs compared to 5,000 IU. Reducing the dose of hCG does not eliminate the risk of OHSS in a high-risk group.     

Serum leptin concentration during<Emphasis Type="Italic">in vitro</Emphasis> fertilization treatment with controlled ovarian hyperstimulation: Serum leptin concentration decreases in the early luteal phase in pregnancy

Purpose  To investigate the change pattern of leptin duringin vitro fertilization and embryo transfer (IVF-ET) treatment with controlled ovarian hyperstimulation (COH) and at the stages of very early pregnancy. Methods  The serum leptin concentration was investigated in 65 patients treated with assisted reproductive technology (ART) in five different periods (ART-1: on the first day of ovarian stimulation with follicle-stimulating hormone; ART-2: at human chorionic gonadotropin administration before oocyte retrieval; ART-3: 7 days after oocyte retrieval; ART-4: 14 days after oocyte retrieval and ART-5: 21 days after oocyte retrieval). Results  The leptin concentration showed significant lower values in the pregnancy group than the non-pregnancy group at ART-3 and ART-4 (P < 0.05). In the pregnancy group, leptin concentration increased from ART-1 (13.5 ±8.2 ng/mL) to ART-2 (23.0 ±15.1 ng/mL) (P < 0.001). The values significantly decrease at 7 days after oocyte retrieval, from ART-2 to ART-3 (18.1 ± 12.0 ng/mL) (P < 0.01), and then showed no remarkable change until 21 days after oocyte retrieval. In the non-pregnancy groups, leptin concentration increased from ART-1 (17.3 ± 11.5 ng/mL) to ART-2 (25.7 ± 12.1 ng/mL) (P < 0.0001). There was no remarkable change in leptin concentration until 14 days after oocyte retrieval, followed by a significant decrease in leptin concentration at ART-4 (21.9 ± 11.9 ng/mL) to ART-5 (18.1 ± 11.8 ng/mL) (P < 0.05). Conclusion  The serum leptin concentration increases during COH in the pregnancy and non-pregnacy groups. In the pregnancy group, leptin concentration showed a fall of leptin values at early luteal phase. These findings might be useful to elucidate the role of leptin in the IVF-ET patients.     

The use of gonadotropin releasing hormone agonist (GnRHa) in good responders undergoing repeat in vitro fertilization/embryo transfer (IVF/ET)

The use of gonadotropin releasing hormone agonists (Gn-RHa) has been shown to improve the response in patients classified as poor responders undergoing ovarian stimulation for in vitro fertilization/embryo transfer (IVF/ET). This study sought to determine whether GnRHa therapy would benefit patients undergoing IVF/ET who had been classified as good responders in prior attempts. Twenty-three patients who had completed a prior IVF/ET attempt but who failed to conceive underwent ovarian stimulation using a combination of GnRHa and human menopausal gonadotropin (hMG). Each patient's prior stimulation served as her control and consisted of clomiphene citrate (CC)/hMG in 18 patients and follicle stimulating hormone (FSH) and/or hMG in 5 patients. The numbers of oocytes retrieved, oocytes fertilized, embryos cleaved, and embryos transferred were all significantly greater in cycles treated with GnRHa/hMG compared to control cycles. The clinical pregnancy rate was 39% and the ongoing pregnancy rate was 26% during the cycle when GnRHa pretreatment was utilized. These data suggest that GnRHa therapy is of benefit even to those patients previously classified as good responders undergoing ovarian stimulation for IVF/ET.Presented at the 45th Annual Meeting of the American Fertility Society, November 1989, San Francisco, California.     

成熟卵泡获卵率对体外受精结局的影响

目的比较在体外受精-胚胎移植/卵细胞浆内单精子注射（IVF-ET/ICSI）过程中,控制性超促排卵（COH）后成熟卵泡获卵率对IVF-ET/ICSI的实验室和临床结局的影响。方法回顾性分析2010年5月至2010年12月四川大学华西第二医院行IVF-ET/ICSI治疗的693例患者,共746个周期,根据获卵率将患者分为A组：获卵率≥80%;B组：获卵率50%～79%;C组：获卵率30%～49%;D组：获卵率〈30%。比较4组患者的临床和实验室结局。结果 A、B组卵子成熟率、受精率、卵裂率和可移植胚胎形成率等各项临床和实验室结局比较,差异均无统计学意义（P〉0.05）。随着获卵数的减少,获卵数最低的D组的卵子成熟率、受精率、卵裂率和可移植胚胎形成率与A组和B组比较,差异有统计学意义（P〈0.05）;同时,D组的临床妊娠率、胚胎种植率和累积妊娠率明显低于其他各组（P〈0.05）。C组受精率、卵裂率、可移植胚胎形成率和临床妊娠率也显著低于A组（P〈0.05）,C组卵裂率、临床妊娠率低于B组（P〈0.05）,但C组的累积妊娠率与A组和B组相似（P〉0.05）。结论获卵率减少可导致卵子成熟率、受精率、卵裂率和可移植胚胎形成率下降,直接导致临床妊娠率下降。     

GnRH-a长方案和GnRH-ant方案在高龄患者IVF-ET中应用效果的比较

目的比较高龄患者应用促性腺激素释放激素激动剂（GnRH-a）长方案和促性腺激素释放激素拮抗剂（GnRH-ant）方案行体外受精-胚胎移植（in vitro fertilization-embryo transfer,IVF-ET）的疗效,探讨适合高龄患者控制性卵巢刺激的方案。方法回顾性分析2007年1月至2010年6月156例高生育年龄（35～40岁）不孕症女性在南方医科大学南方医院生殖医学中心行IVF-ET的临床资料,评估GnRH-a长方案和GnRH-ant方案的助孕效果。结果 GnRH-a长方案组和GnRH-ant方案组患者的促性腺激素（Gn）应用总量及hCG日孕激素（P）水平比较,差异无统计学意义（P〉0.05）;但两组在Gn应用时间、hCG日雌二醇（E2）水平、hCG日子宫内膜厚度、获卵数、成熟卵子数、受精数和2PN数比较,差异有统计学意义（P〈0.01）;同时,两组的hCG日黄体生成素（LH）水平比较,差异有统计学意义（P〈0.05）;GnRH-a长方案组的临床妊娠率和着床率显著高于GnRH-ant方案组（P〈0.001）。结论高生育年龄患者IVF-ET中应用GnRH-a长方案的助孕结局优于GnRH-ant方案。     

基础FSH/LH比值及晚卵泡期LH水平对体外受精-胚胎移植结局的影响

目的:探讨患者基础FSH/LH比值及控制性超促排卵(COH)时降调后hCG注射日血清LH水平对IVF-ET结局的影响及与COH各参数的关系。方法:回顾性分析首次进行IVF/ICSI-ET助孕、应用GnRH-a长方案降调节的不孕妇女,共427个周期。结果:ROC曲线显示FSH/LH比值与IVF-ET临床妊娠率无明显相关性;FSH/LH≥2与FSH/LH<2组间虽然临床妊娠率无差异,但FSH/LH≥2组Gn用量增加,获卵数少,优质胚胎数少,存在统计学差异(P<0.05)。hCG注射日血清LH≥0.65IU/L者妊娠率(55.8%)明显高于LH<0.65IU/L者(24.6%)。结论:基础FSH/LH比值增高能较早反映卵巢储备功能并指导超排方案及Gn用量;降调节后卵泡晚期(hCG注射日)的LH水平过低(<0.65IU/L),将会导致临床妊娠率下降。     

IVF-ET中促性腺激素释放激素激动剂的超促排卵应用与剂量研究

促性腺激素释放激素激动剂(GnRH-a)是体外受精-胚胎移植(IVF-ET)技术中重要用药。GnRH-a与GnRH受体结合后,早期"突发"作用可刺激垂体促性腺激素急剧释放,持续应用后使垂体受抑制,内源性促性腺激素(Gn)水平下降,即所谓的降调节作用。利用这种生物学特性,GnRH-a联合Gn超促排卵可预防早发黄体生成素(LH)峰,避免卵泡过早黄素化。另外,GnRH-a代替人绒毛膜促性腺激素诱发排卵可降低卵巢过度刺激综合征(OHSS)发生率。探索既能有效抑制LH峰,又不使垂体过度抑制的GnRH-a有效低剂量对于超促排卵有重要意义。     

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。     

The dynamic changes of anti-Mullerian hormone and inhibin B during controlled ovarian hyperstimulation in decreased ovarian reserve women and the effect on clinical outcome

Abstract

Objective: To investigate the dynamics of anti-Mullerian hormone (AMH) and inhibin B (INHB) levels during controlled ovarian hyperstimulation (COH) in women with decreased ovarian reserve (DOR), and assess the effect of these dynamic changes on the prediction of clinical outcome in in-vitro fertilization (IVF).

Methods: A total of 124 women undergoing IVF cycles were divided into normal ovarian reserve (NOR) and DOR groups. AMH and INHB levels were measured in serum on menstrual cycle day 2 or 3 (D2/3), day 5 of stimulation (D5), hCG day (D-hCG) and follicular fluid (FF) on oocyte retrieval day.

Results: Serum AMH levels were gradually decreased while INHB levels were gradually increased from D2/3 to D-hCG during the COH in both groups. Serum AMH, INHB levels on D2/3 and FF AMH, INHB levels were highly positively correlated with AFC and oocytes retrieval. Multivariate logistic regression analysis revealed that clinical pregnancy did not directly correlate with serum and FF AMH and INHB levels.

Conclusion: Serum AMH and INHB levels were not directly related to clinical pregnancy, dynamic serum AMH and IHNB levels were positively correlated with COH outcomes.