剖宫产后瘢痕子宫对IVF/ICSI-ET临床结局的影响

目的：比较剖宫产后瘢痕子宫患者与非瘢痕子宫患者在体外受精/胞浆内单精子注射-胚胎移植（IVF/ICSI-ET）治疗中的临床结局。方法：回顾性分析2016年1月—2018年12月在我中心行首次IVF-ET的患者共3 331个周期,其中A组249个周期（剖宫产后瘢痕子宫组）,B组3 082个周期（非瘢痕子宫组）,比较2组患者的总体临床特征,并分别比较在行囊胚或卵裂期胚胎移植时2组患者的妊娠结局。结果：在囊胚移植及单卵裂期胚胎移植者中,2组患者的优胚移植率、胚胎着床率、临床妊娠率、异位妊娠率、流产率、活产率和多胎率差异无统计学意义（P>0.05）,A组早产率高于B组,差异有统计学意义（P<0.05）。在双卵裂期胚胎移植者中,A组患者的优胚移植率、胚胎着床率、临床妊娠率、活产率和多胎率均低于B组,差异有统计学意义（P<0.05）,2组患者异位妊娠率、流产率和早产率差异无统计学意义（P>0.05）。结论：在胚胎条件类似的情况下,行单胚胎移植的剖宫产后瘢痕子宫的患者除早产率升高外,可获得与非瘢痕子宫患者类似的临床妊娠结局。双胚胎移植的临床结局仍需进一步研究。     

IVF-ET中观察胚胎早期卵裂预测胚胎发育潜力的研究

目的:探讨通过观察胚胎早期卵裂预测胚胎发育潜力,以期得到较好的临床妊娠结局。方法:对117个IVF、IC-SI周期,1 169个胚胎在受精24~28h的早期卵裂及后期发育情况进行观察,并根据早期卵裂情况将胚胎分为早期卵裂组、未早期卵裂组和原核(PN)未消失组,最终结合早期卵裂,第2天(D2)、第3天(D3)胚胎评分等情况选择适合移植的胚胎进行移植,共移植102个周期。同时对优胚率、妊娠率、种植率等指标进行比较。结果:①早期卵裂组D3优胚率高于其它两组(P<0.05);②全部移植早期卵裂胚胎组和全部移植未早期卵裂胚胎组的生化妊娠率高于全部移植PN未消失胚胎组(P<0.05),但临床妊娠率差异无统计学意义(P>0.05);③移植2~3个优胚与移植1个优胚和1~2个非优胚的周期妊娠率和种植率差异无统计学意义(P>0.05),但都高于未移植优胚周期(P<0.01)。结论:观察胚胎早期卵裂可有效预测胚胎发育潜力,有利于挑选适合移植的胚胎,从而获得较高的妊娠率,但对临床妊娠率的影响不明显,临床妊娠率主要取决于优胚率。     

卵巢低反应中胚胎移植时间与临床妊娠率的关系

目的:探讨在卵巢低反应周期中,不同胚胎移植时间对临床妊娠率的影响。方法 :回顾性分析卵巢低反应患者行IVF-ET治疗74个周期的资料,比较受精方式、优质胚胎数、可利用胚胎数、卵裂球的细胞数,48 h组与72 h组的获卵数、受精率、卵裂率、优胚率、可利用胚胎率、临床妊娠率。结果:48 h(IVF20个周期与ICSI13个周期)组与72 h(26/IVF与15/ICSI)组间的年龄、不育年限、用药方案等差异均无统计学意义(P>0.05);两组受精率、卵裂率比较差异无统计学意义(P>0.05);优胚率48 h组较72 h组有所提高,但组间比较差异无统计学意义(P>0.05);可利用胚胎率、ET胚胎数、临床妊娠率两组比较差异均有统计学意义(P<0.05)。结论 :卵巢低反应周期,48h胚胎移植不仅能提高优质胚胎率、可利用胚胎率,还能增加移植胚胎数及临床妊娠率,减少周期取消率。     

精子DNA损伤对体外受精胚胎移植的影响

目的 探讨不育男性患者其精子DNA损伤对体外受精-胚胎移植(IVF-ET)的胚胎质量及临床结局的影响.方法 回顾性分析了在乌鲁木齐市妇幼保健院生殖中心行常规体外受精(IVF)和卵胞浆内单精子显微注射(ICSI)治疗的不孕夫妇,共计125例.按照精子DNA碎片指数(DFI)＜15％、15％～30％、＞30％为正常组、低损...     

严重自发空泡化对胚胎发育潜能的影响

目的:探讨授精后第5天(D5)严重自发空泡化的形成对胚胎发育潜能的影响。方法:回顾性分析2016年1月-2017年12月于本中心行体外受精-胚胎移植(IVF-ET)或卵细胞胞质内单精子注射术(ICSI)治疗患者的临床资料,选取授精后D5出现严重自发空泡化的873个胚胎作为空泡组,同期形态无异常的5709个胚胎作为对照组。比较两组第6天(D6)胚胎的可利用囊胚率、优质囊胚率及临床结局。结果:空泡组D6可利用囊胚率(8.3%)及优质囊胚率(22.2%)均低于对照组(27.9%、65.2%)(P<0.05)。临床结局方面,无论是单胚复苏移植还是与正常胚胎的联合复苏移植,空泡组与对照组的妊娠率、活产率和流产率均无差异(P>0.05)。结论:授精后D5严重自发空泡化的形成虽然影响D6可利用囊胚率及优质囊胚率,但可利用囊胚与对照组有相似的临床结局。     

透明带辅助孵化获68例临床妊娠

目的采用蛋白酶消化透明带和激光打孔的方法增加胚胎着床的机会,获得临床妊娠。方法对具有透明带增厚(≥15μm);年龄≥35岁;前次胚胎种植失败;胚胎发育延迟及基础FSH≥12mIU/ml共141周期及105个冻融移植(FET)周期的胚胎,予10IU/mlPronase溶液消化或透明带激光打孔后移植。结果68例获临床妊娠,其中22例妊娠来自FET后。2例3胎妊娠,16例双胎妊娠,50例单胎妊娠。结论两种透明带辅助孵化的方法均获得临床妊娠,是方便且实用的辅助生殖技术。     

辅助生殖技术结局的临床相关因素分析

目的:回顾分析辅助生殖技术(IVF/ICSl)中妊娠结局,并对临床相关因素及其对妊娠结局的影响进行分析。方法:收集我院生殖中心2004年1月1日~6月31日176例患者189个辅助生殖周期治疗的临床资料,进行整理统计和分析。结果:种植率、生化妊娠率及临床妊娠率分别为22.97%、33.53%、30.64%;冻融胚胎移植临床妊娠率23.08%,单周期累计临床妊娠率32.37%;妊娠者较未妊娠者年龄轻(P<0.05);年龄≤35岁组较年龄>35岁组妊娠率高(分别为48.98%和11.11%,P<0.05);妊娠史对治疗结局有一定影响。结论:分析IVF/ICSI中影响妊娠结局的临床相关因素将提高种植率和妊娠率。     

不同胚胎移植策略对体外受精临床结局的影响

目的：比较人类胚胎体外培养第3天4种胚胎移植策略的临床结局。方法：回顾性分析了本中心2010年1月—2012年12月收治的≤35岁患者的第3天胚胎移植周期,均为第一次促排卵周期,采用控制性促排卵长方案和短方案,排除供精周期和遗传性疾病患者,获卵数≥2个。根据移植胚胎数及评分（评为Ⅰ、Ⅱ、Ⅲ、Ⅳ级,Ⅰ、Ⅱ级为高评分胚胎,Ⅲ、Ⅳ级为低评分胚胎）分为4组：A组移植1枚高评分胚胎,B组移植2枚高评分胚胎,C组移植1枚高评分胚胎和1枚低评分胚胎,D组移植2枚低评分胚胎。比较4组的临床妊娠率、胚胎着床率、双胎率、流产率和活产率。结果：4组的流产率分别为8.67%、10.34%、13.54%、20.00%,差异无统计学意义（χ2=4.146,P=0.246）;B组的每周期临床妊娠率和活产率分别为55.94%、49.38%,均高于A组（32.05%、28.63%）和C组（42.86%、37.72%）,差异有统计学意义（P＜0.000 1）,C组的每周期临床妊娠率和活产率高于A组,差异有统计学意义（P＜0.01）;然而,B组的双胎率（36.31%）高于A组（0.67%）和C组（27.60%）,差异有统计学意义（P＜0.01）。结论：选择1枚高评分胚胎与1枚低评分胚胎协同移植,可获得可接受的每周期临床妊娠率和活产率,亦未提高双胎率。     

激光辅助孵化对冻融卵裂期胚胎和囊胚移植妊娠结局的影响

目的：探讨激光辅助孵化（LAH）对玻璃化冻融卵裂期胚胎和囊胚移植妊娠结局的影响。方法：回顾性分析565个玻璃化冻融移植周期,根据是否行LAH,将426个卵裂期胚胎移植周期分为AH组和非AH组,139个囊胚移植周期分为AH1组和非AH1组。比较患者一般情况和妊娠结局。结果：卵裂期胚胎AH组和非AH组患者的临床妊娠率、胚胎种植率、多胎率、流产率、异位妊娠率比较差异均无统计学意义（P＞0.05）。囊胚AH1组的胚胎种植率和多胎率高于非AH1组（P＜0.05）,2组的临床妊娠率、流产率和异位妊娠率差异无统计学意义（P＞0.05）。结论：LAH可提高玻璃化冻融囊胚移植的胚胎种植率和多胎率,但并不能提高玻璃化冻融卵裂期胚胎移植的临床妊娠率和胚胎种植率。     

PREGNANCY/IMPLANTATION RATES AS RELATED TO AGE FOLLOWING TRANSFER OF FROZEN EMBRYOS PRODUCED BY ICSI

A study has suggested that one drawback of ICSI is that if these embryos are cryopreserved they have lower implantation rates after thawing and transfer as compared to other frozen embryos derived from conventional oocyte insemination. Other studies have not shown such adverse effects on pregnancy rates following frozen embryo transfer (ET) of embryos formed by ICSI. The study presented here evaluated the largest number of frozen ET cycles of embryos following ICSI, which were compared to couples having frozen ET with embryos formed by conventional insemination. In women age 39 and younger, the clinical, viable, pregnancy rates and implantation rates were very similar. Similar rates were reached for the older group. These data convincingly demonstrate that fertilization by ICSI does not adversely effect the implanting capacity of frozen-thawed embryos.     

D2形态特征对胚胎体外发育能力和体内着床潜能的影响

目的:探讨D2胚胎的各种形态特征对D3胚胎质量、D6囊胚发育和胚胎着床潜能的影响,以评估D2形态在体外受精-胚胎移植(IVF-ET)中的临床应用价值。方法:于常规IVF或ICSI授精后42～44 h观察D2胚胎形态特征,按D2细胞数、碎片比例、卵裂球大小均匀程度和卵裂球内的核特征进行分组,比较各组间的D3优质胚胎率、D6囊胚形成率和着床率。按卵裂球内的核特征分组,将胚胎分为A级(胚胎的每个卵裂球内均可见单核)、B级(胚胎至少有1个卵裂球内未见核)、C级(胚胎每个卵裂球均未见核)和D级〔胚胎至少有1个卵裂球内见多核(≥2个核)〕。结果:①4细胞胚胎的体外发育能力和体内着床潜能优于另外两组,>4细胞胚胎的D3优质胚胎率和着床率高于<4细胞胚胎。②碎片≤10%的D2胚胎的体外发育能力和体内着床潜能优于碎片>10%的胚胎。③与其他各组相比,A组具有最高的体外发育能力和着床潜能,在形态优质的D2胚胎中,也得到同样的结果。而D组胚胎中,D3优质胚胎率明显低于其他各组,而且在移植的27个D组胚胎中,没有胚胎着床。结论:碎片≤10%的4细胞胚胎具有较高的体外发育能力和体内着床潜能;同时,D2核评估可独立预测胚胎体内外发育能力,选择时应优先考虑每个卵裂球上均可见单核的胚胎;胚胎中多核的存在是发育潜能受损的表现。     

体重指数和年龄对非多囊卵巢综合征不孕患者体外受精的影响

目的 探讨体重指数(BMI)和年龄对非多囊卵巢综合征(PCOS)不孕症患者体外受精-胚胎移植(IVF-ET)及卵细胞浆单精子注射(ICSI)结局的影响.方法 回顾性分析IVF-ET治疗的非PCOS不孕症患者1426例.比较BMI(低体重:BMI＜18.5 kg/m2,标准体重:BMI 18.5～23.99 kg/m2,超重肥胖:BMI≥24 kg/m2)与年龄(低龄:20～34岁,高龄:35～45岁)对卵巢控制性超排卵[包括促性腺激素(Gn)用量及使用天数、人绒毛膜促性腺激素(HCG)注射日血清E2水平、获卵数及成熟卵数]、受精数、双原核(2PN)数、卵裂数、正常胚胎数、冷冻胚胎数及治疗结局的影响.结果 (1)高龄者的Gn总量与年龄呈正相关(P＜0.001),Gn总量总变异的12.70%与高龄有关(标准化偏回归系数为0.343);(2)超重肥胖及高龄者HCG日E2值分别与BMI及年龄呈负相关(P值分别为0.037和0.018),HCG日E2值总变异的0.80%与高龄及超重肥胖有关,而高龄因素影响稍大(标准化偏回归系数分别为0.066和0.058);(3)高龄者的Gn使用天数、获卵数、成熟卵数、受精数、卵裂数、2PN数、正常胚胎数及冷冻胚胎数均与年龄呈负相关(P＜0.05);(4)高龄低体重及高龄正常体重者妊娠的优势分别是低龄正常体重者的0.482倍和0.529倍.结论 年龄是影响非PCOS不孕患者IVF/ICSI治疗及结局的因素之一;未发现BMI对非PCOS不孕患者IVF/ICSI结局有影响,但超重或肥胖者在接受治疗前适当减轻体重可减少控制性超排卵过程中的Gn用量.     

子宫纵隔切除患者的IVF/ICSI-ET临床结局分析

目的：探讨子宫纵隔切除术（transcervical resection of septum,TCRS）后不孕患者的体外受精/胞浆内单精子注射-胚胎移植（IVF/ICSI-ET）临床结局。方法：回顾性分析2010年1月—2014年12月在首都医科大学附属北京妇产医院生殖医学中心行IVF/ICSI助孕并有TCRS史的35例患者的临床资料（观察组）,随机抽取同期子宫形态正常的不孕患者70例作为对照组,比较2组的基本情况及妊娠结局。结果：观察组既往流产次数高于对照组,差异有统计学意义（Z=6.224,P＜0.001）。2组患者年龄、不孕时间、获卵数、受精率、优质胚胎率、临床妊娠率、异位妊娠率、活产率和早产率差异均无统计学意义（均P＞0.05）。结论：TCRS能够纠正宫腔形态异常,使患者获得良好的IVF助孕结局。     

Birth and clinical pregnancy from fresh and frozen oocytes fertilized with cryopreserved testicular spermatozoa

This is the first report showing a second clinical pregnancy of a couple who already have a baby from a previous frozen embryo transfer cycle when the embryos were generated from fresh oocytes that were fertilized by intracytoplasmic sperm injection (ICSI) using frozen testicular spermatozoa (the couple have unsuccessful fresh and frozen embryo transfer cycles). Fifty-two months after the first IVF/ICSI cycle the couple had their second IVF/ICSI cycle, but the collected oocytes (n=8) were frozen because no spermatozoa was obtained from the frozen testicular tissue samples which were cryopreserved prior to the first IVF/ICSI cycle. New testicular tissue samples were obtained and frozen. Finally, 58 months after the first IVF/ICSI cycle all of the 8 frozen oocytes of the couple were thawed and fertilized by ICSI using frozen testicular spermatozoa obtained from the newly cryopreserved testicular tissue. Three embryos were transferred and the couple has an ongoing pregnancy, which is in the 20(th) week of pregnancy. Our case report shows that: 1) developmentally competent embryos can be generated by ICSI of frozen-thawed testicular spermatozoa into both fresh and frozen human oocytes, and 2) clinical pregnancy and a healthy baby can be conceived from both frozen and fresh oocytes fertilized with cryopreserved testicular spermatozoa.     

人类胚胎冻融技术及其影响因素

为探讨冻融胚胎的方法,提高试管婴儿妊娠成功率,我们对人体外受精(IVF)及卵浆内单精子显微注射(ICSI)后的348个早期胚胎加保护剂(丙二醇、蔗糖),采用Testart慢速冷冻方法保存。将其中79个胚胎用快速融解法解冻,有57个胚胎存活,存活率72.16％。57个胚胎分别给13例患者移植,结果5例生化妊娠,其中4例发展为临床妊娠,1例已出生健康婴儿。结论:采用冻融胚胎技术可以提高一次取卵的总妊娠率。     

In vitro fertilization at our department. A decade's work in figures and facts (1994-2003)

We report here on the first decade of in vitro fertilization (IVF) treatments performed at a newly established clinical infertility and assisted reproductive unit. OBJECTIVE: We present the number of treatment cycles, the distribution of treatment modalities ("classical" IVF and intracytoplasmic sperm injection, ICSI) and success rates, and relate them to national and international data. METHODS: During the last decade, ICSI was introduced gradually and is now used routinely at our department. In certain cases of azoospermia, testicular sperm extraction (TESE) is used to retrieve male gametes for ICSI. Embryo cryopreservation, which is also part of the routine, provides the chance to establish pregnancy in subsequent cycles without the need to repeat hormonal stimulation. Preimplantation genetic diagnosis helps us to avoid transferring embryos carrying certain hereditary diseases. RESULTS: 1517 IVF cycles were started in the past ten years. Oocyte pickup and IVF were performed in 1423 cases. In the end of the described period, ICSI was used in more than two thirds of treatment cycles. Pregnancy rates were 39.0% per embryo transfer (ET), 36.3% per oocyte pickup, and 34.0% per started cycle. Clinical pregnancy was achieved in 34.2% per ET, and the delivery rate was 27.9% per ET. These success rates have exceeded the national average every year since 1996. Pregnancy rates in frozen-thawed ET cycles and in cryo-TESE-ICSI cycles are in the range of international data. CONCLUSIONS: We attribute the gradual and continuous improvement in our success rates to rigorous and well-coordinated clinical and laboratory work and to judicious adoption of the latest assisted reproductive techniques.     

胚胎透明带厚度及厚度变量与IVF-ET治疗结局关系探讨

目的:观察体外受精-胚胎移植(IVF-ET)中移植胚胎透明带厚度(ZPT)及透明带厚度变量(ZPTV)与IVF-ET治疗结局的关系。方法:利用图像采集系统测量51对夫妇51个IVF-ET周期119个新鲜胚胎ZPT并计算ZPTV。分别根据受精方式、治疗结局、ZPTV值、患者年龄、基础FSH值、种植率进行分组,分析胚胎ZPT和ZPTV对IVF-ET结局的影响。结果:①不同受精方式(IVF/ICSI)胚胎间ZPT、ZPTV值差异无统计学意义;②妊娠组与非妊娠组ZPT差异无统计学意义;妊娠组ZPTV(19.13±7.16%)大于非妊娠组(14.08±6.45%,P<0.001);移植胚胎ZPTV≥20%组的妊娠率(60%)高于ZPTV<20%组(38.89%,P<0.005);③患者年龄<30岁组、30～35岁组、≥35岁组ZPT值和ZPTV值差异均无统计学意义(P>0.05);④基础FSH≥8U/L组ZPTV为14.51±4.90%,低于FSH<8U/L组(17.16±7.69%,P<0.05),ZPT在两组间差异无统计学意义;⑤种植率分别为0、33.33%～66.67%、100%,3组间ZPT值差异无统计学意义;种植率为0组与其他两组比较ZPTV差异有统计学意义(P<0.001)。结论:ZPTV是评价胚胎质量和预测妊娠结局的有效指标。     

SCHEDULE TO INJECT IN VITRO MATURED OOCYTES MAY INCREASE PREGNANCY AFTER INTRACYTOPLASMIC SPERM INJECTION

To ascertain the value of using immature oocytes in an intracytoplasmic sperm injection (ICSI) program, the authors designed a schedule, at 5 p.m. on day 1 (the day of oocyte retrieval) and at 8 a.m. and 2 p.m. on day 2, to recognize and inject the in vitro matured (IVM) oocytes. For the 1166 oocytes retrieved in 107 ICSI cycles, 128 (11.0%) were at the stage of metaphase I (MI) and 113 (9.7%) at germinal vesicle. Routine ICSI for metaphase II oocytes was performed at 2 p.m. on day 1 (initial ICSI). In culture medium of human tubal fluid with 15% maternal serum, 85.1% (205/241) immature oocytes progressed to maturation in which 16.4% (21/128) of MI oocytes matured at 5 p.m. of day 1. The rate of normal fertilization for IVM oocytes (58.5%) was not significantly different from that of initial ICSI (64.0%). One patient received a transfer of two fertilized IVM oocytes alone that were injected at 5 p.m. of day 1, maturing from the MI stage, and achieved a normal pregnancy. The fertilized IVM oocytes were replaced along with the embryos from initial ICSI for 40 cycles that led to 14 (35%) clinical pregnancies. In 43 fertilized IVM oocytes donated for research, we observed that cleavage (95.3%) to the 2- to 4-cell stage was not distinct from that of initial ICSI (94.6%); however, the percentage of embryos of grade I and II morphology was significantly smaller (24.4% vs. 62.5%). Only five (11.6%) developed to blastocysts in vitro. Twenty-one fertilized IVM oocytes were frozen for future transfer. A schedule to inject IVM oocytes in ICSI cycles may generate more accessible embryos for fresh transfer or cryopreservation to increase the chance of pregnancy, although the embryo quality was relatively poor.     

人类冻融胚胎应用的探讨

目的：探讨冷冻胚胎的临床应用，提高试管婴儿成功率。方法：取IVF与ICSI剩余胚胎，采用慢速冷冻法冻存，快速解冻后用于临床，探讨其效果。结果：从1998年起实施31例胚胎冷冻，复苏后胚胎存活率达71．0％，妊娠率达22．2％。结论：采用冻融胚胎技术可以提高一次取卵的总妊娠率。     

原因不明性不孕患者同胞卵母细胞行IVF和ICSI结果比较

目的:探讨原因不明性不孕患者行常规IVF、ICSI对受精、受精后胚胎的影响。方法:回顾性分析2005年6月~2007年12月间非男性因素不孕的夫妇采用同胞卵和同一份精液行常规IVF和ICSI的受精情况、受精后胚胎的发育潜能。结果:50例原因不明性不孕患者中11例常规IVF受精完全失败,IVF完全受精失败率为22%,ICSI组无完全受精失败。IVF、ICSI均受精组ICSI受精率(82%)高于常规IVF(79%),差异无显著性意义(P>0.05)。均受精组和仅ICSI受精组患者的年龄、不孕年限、基础FSH、BMI以及精液标本分析均无显著性差异。比较移植不同受精方式的胚胎着床率、妊娠率差异均无显著性意义。结论:对于原因不明性不孕的夫妇选择施行IVF-ICSI split既可避免受精失败所致的周期取消,保证一定的成功率,又可为下一次施行IVF时决定受精方式提供依据,值得推广。尚需要大样本研究原因不明性不孕患者年龄、不孕年限和受精完全失败的关系,为选择ICSI提供依据。