体外受精 - 胚胎移植后异位妊娠的危险因素、诊断及治疗

目的　探讨体外受精 -胚胎移植 (IVF-ET)后异位妊娠 (EP)的危险因素、诊断及治疗方法。方法　对我院 1992年 10月～ 2 0 0 2年 6月接受体外受精-胚胎移植治疗 (包括单精子胞浆内注射 ,ICSI)后 82 1例临床妊娠中 38例异位妊娠进行回顾性分析。结果　IVF -ET后异位妊娠的发生率 4 6 % ,多胚胎不同部位妊娠(HP)的发生率 0 6 %。异位妊娠组取卵数明显多于对照组。单因素分析发现异位妊娠史、盆腔炎性疾病 (PID)史是IVF-ET后异位妊娠的危险因素。结论　盆腔炎性疾病史、异位妊娠史是IVF -ET后异位妊娠的高危因素。胚胎移植后妇女激素水平可能与异位妊娠的发生相关 ,但需进一步的研究证实。早期诊断和微创性治疗 ,减少异位妊娠的并发症和死亡率     

The impact of embryo quality on pregnancy outcome in elderly women undergoing in vitro fertilization-embryo transfer (IVF-ET)

Most IVF-ET units limit the procedure to women below age 38. Nevertheless, demands for infertility treatment, including IVF therapy, are more frequent nowadays. We compared 46 cycles for ovulation induction for IVF in 46 women aged 40 or more (Group I) to 51 induced cycles for this procedure in younger women of mean age 30.2 years (Group II). Cancellation rates due to early luteinization or ovulation were significantly higher in group I than in group II (28.2 and 17.6%, respectively) (P<0.001). Also, significantly higher abortion rates were observed in older women (62.5%), in comparison to the younger control group, (25%), (P<0.001). It is suggested that the high abortion rate considered to be due to genetic factors in older women, may possibly also be due to the aging uterine environment. Furthermore, while embryos with fragmentations may often produce clinical pregnancies in the young, the aging uterus in the elderly woman does not encourage the development of clinical pregnancies in such embryos. Consequently the higher abortion rate in the elderly woman.     

Multiple attempts at embryo transfer: Effect on pregnancy outcome in an in vitro fertilization and embryo transfer program

Purpose This study derives from the observation that a correlation exists between failed first attempts (FFA) at embryo transfer caused by one or more embryos remaining in the catheter and reduced pregnancy rates (20.3 vs 3.0%). The aim of this study was to examine the relationship between failed first attempts at transfer and contamination of the transfer set; the related aspects of cervix dilatation and late embryo transfer were also investigated.Results The following observations were made. Retention of embryos in the transfer sets significantly reduced the pregnancy rate (P =0.015); catheters contaminated with blood and cervical mucus indirectly contributed to this effect by increasing the incidence of failed first transfer attempts. Even though cervical dilatations, if indicated by uterus sounding, were done 2 days before embryo transfer, no pregnancies were effected in these 18 cases (P =0.0001). Late transfers of embryos, due to delayed fertilization or slow cleavage rates, yielded a pregnancy rate of 10.5%. Conclusion The approach of immediately retransferring retained embryos does not solve the problem of reduced pregnancy rates in FFA cases. It is suggested that ET should be repeated 1 day later in FFA cases in an attempt to improve pregnancy rates.     

体外受精-胚胎移植技术中74例异位妊娠的临床分析

目的:分析体外受精-胚胎移植(in vitro fertilization and embryo tranfer,IVF-ET)助孕技术中发生异位妊娠的影响因素、诊断、治疗方法及预防措施。方法:回顾性分析IVF-ET助孕技术中发生异位妊娠74例患者的临床资料。结果:所有接受IVF-ET的1 585患者中,共发生异位妊娠74例,异位妊娠发生率为4.67%;异位妊娠类型中输卵管妊娠71例,占总异位妊娠的95.95%。新鲜胚胎移植周期组异位妊娠发生率(5.41%)显著性高于冷冻胚胎复苏移植(frozing embryo transfer,FET)周期组(2.35%)(P<0.05)。移植深度距离宫底>1.2 cm时异位妊娠发生率显著性低于移植深度0.8~1.2 cm组。结论:IVF-ET助孕技术中异位妊娠发生率较自然妊娠过程中高;输卵管因素、促排卵药物的应用以及胚胎移植的深度是异位妊娠发生的主要影响因素。     

Clinical study on embryo transfer after human in vitro fertilization

One hundred forty-six embryo transfers were carried out in the In Vitro Fertilization (IVF) Clinic at St. Pierre Hospital, Brussels, between November 1983 and February 1985. In each of these cases a series of characteristics of the replacement procedure was systematically rates indicated that (i) no significant differences appeared among three different operators, (ii) the absence or occurrence of cervical bleeding and subjective evaluation of the procedure were related to the chances of establishing a pregnancy, and (iii) the duration of replacement had no influence on the outcome of trials. A prospeative randomized study of 100 replacements showed that (i) no better pregnancy rate was obtained by placing patients in the knee-to-chest rather than the dorsal position and (ii) the addition of a rigid external sleeve to the catheter did not provide any advantage. A simplified method of replacement is thus advocated.     

Psychological studies of in vitro fertilization/embryo transfer participants

During the last decade, reproductive endocrinology has provided new technologies for treatment of infertilityone of which is in vitro fertilization/embryo transfer (IVF/ET). The use of this technology has been accompanied by considerable interest in understanding the psychology of those seeking IVF/ET and in understanding psychological reactions during and after IVF/ET. This paper reviews the psychological research within the IVF/ET literature as divided into three major areas: first, psychological profiles of women and their partners requesting IVF/ET; second, clinical reports which describe the psychological experience of IVF/ET and provide recommendations for counseling both before and during IVF/ET; and third, follow-up studies of IVF/ET participants. This paper is designed to highlight initial findings in these three areas of research and thus provide a context for future research directions. Specific suggestions for future study include redirecting research effort from investigations of psychopathology to detecting stress which may affect IVF/ET outcome.     

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.     

体外受精-胚胎移植后妊娠早期胚胎停止发育相关因素分析

目的探讨体外受精-胚胎移植(IVF-ET)术后早期妊娠胚胎停止发育的相关因素。方法回顾性分析2004年1月至2009年2月IVF-ET周期助孕临床妊娠后发生早期胚胎停止发育34例患者的临床资料,选择同期IVF-ET后妊娠并正常分娩患者266例为对照。结果胚胎停止发育组短方案促排卵所占比例高于分娩组,但无统计学意义(P=0.055),胚胎停止发育组年龄、促性腺激素(Gn)用量高于分娩组(P0.05);多因素Logistic回归分析显示,年龄是胚胎停止发育的危险因素(P0.05)。结论高龄是体外受精-胚胎移植术后早期妊娠胚胎停止发育的危险因素。     

Heterotopic pregnancy from in vitro fertilization

A case of heterotopic or combined intrauterine and tubal ectopic pregnancy is described following in vitro fertilization and the transfer of five four-cell embryos. The phenomenon is known to be related to ovarian stimulation by gonadotropin therapy, and there is an increased risk with underlying tubal disease. This patient had both variables. Techniques applied at the time of embryo transfer are also implicated, namely, the use of culture medium with 50% maternal serum to convey the embryos to the uterus, the catheterization method, and the position of the patient during transfer.     

Accelerated decline in pregnancy rate afterin vitro fertilization and embryo transfer in 35–41-year-old women: 15 years’ experience in the Okinawa Islands, Japan

Aim:  To describe 15 years of in vitro fertilization and embryo transfer (IVF–ET) treatment at University Hospital, with special reference to a potential association between pregnancy rate and patient age.
Methods:  A retrospective analysis of 2355 IVF–ET cycles carried out in 789 patients was undertaken. The main outcome measures were ovarian response, fertilization rate and pregnancy rate.
Results:  Pregnancy rates in ET cycles carried out in women aged between 23 and 46 years fell significantly with patient age, with a more rapid decline after 35 years and particularly between 35 and 41 years. Almost all laboratory findings were significantly worse with increased patient age, although fertilization rate did not drop with age. The spontaneous abortion rate increased drastically with age and the vast majority of abortions resulted from chromosomal abnormality.
Conclusion:  It is essential to provide infertile women with practical and reliable information on the age-associated pregnancy rate for appropriate counseling and to encourage them to seek IVF–ET treatment at an earlier age. (Reprod Med Biol 2006; 5 : 51–57)     

体外受精—胚胎移植120个妊娠周期中移植胚胎形态学分析

目的为体外受精和胚胎移植临床中选择移植胚胎提供参考指标。方法回顾性分析在本中心行IVF-ET治疗并在取卵后第2天移植胚胎的120个妊娠周期共453个移植胚胎的资料。结果120个治疗周期中单胎75例,双胎33例,3胎10例,4胎以及5胎各1例。4细胞期胚胎所占的比例从单胎的47.3％增至双胎的53.2％和3胎的72.5％,妊娠胎数随移植胚胎中≥4细胞期胚胎的增多而明显增加(χ2=10.813,P＜0.05)。结论形态学可以作为选择移植胚胎的参考指标之一,但如何在保证妊娠率的同时减少移植胚胎的数目而降低多胎妊娠率还需进一步的前瞻性研究。     

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 role of uterine straightening by passive bladder distension before embryo transfer in IVF cycles

Purpose: The present study investigated the effect of bladder distension on in vitro fertilization and embryo transfer (IVF-ET) results. Methods: The study comprised 796 patients after successful transvaginal oocyte pickup and IVF, who, on the basis of bladder filling for ET, were divided into two groups. In group E, 385 patients underwent ET with an empty bladder, and in group F, 411 patients underwent ET with a full bladder. Results: Sixty-four pregnancies were achieved in group E (16.6%), compared to 110 pregnancies in group F (26.8%, P=0.006). A similar pregnancy loss rate was observed in both groups, 13 in group E (20.3%) and 29 in group F (26.4%; P=NS). Conclusions: A significantly higher pregnancy rate was achieved with routine bladder distension before ET, probably attributable to the smooth and easy insertion of the ET catheter.     

Efficacy of dehydroepiandrosterone (DHEA) supplementation for in vitro fertilization and embryo transfer cycles: a systematic review and meta-analysis

Dehydroepiandrosterone (DHEA) supplementation might hold some promise in vitro fertilization and embryo transfer cycles. However, the results remain controversial. We conducted a systematic review and meta-analysis to evaluate the efficacy of DHEA in patients for in vitro fertilization. PubMed, EMbase, Web of science, EBSCO and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of DHEA versus placebo on in vitro fertilization were included. Two investigators independently searched articles, extracted data and assessed the quality of included studies. The primary outcomes were clinical pregnancy and live birth rate. Meta-analysis was performed using random-effect model. Six RCTs involving 745 patients were included in the meta-analysis. Overall, compared with placebo, DHEA supplementation was associated with the significant increase in clinical pregnancy (OR?=?1.45; 95% CI?=?1.04–2.03; p?=?.03), live birth rate (OR?=?2.70; 95% CI?=?1.24–5.85; p?=?.01) and endometrial thickness (Std. mean difference?=?0.67; 95% CI?=?0.02–1.32; p?=?.04) but showed no influence on E₂ on hCG day (Std. mean difference?=?0.69; 95% CI?= ?0.46 to 1.85; p?=?.24), embryos transferred (Std. mean difference?=?0.42; 95% CI?= ?0.04 to 0.88; p?=?.07) and miscarriage rate (OR?=?0.43; 95% CI?=?0.03–6.66; p?=?.55). DHEA supplementation could significantly improve clinical pregnancy, live birth rate, endometrial thickness and retrieved oocytes but failed to alter E₂ on hCG day, embryos transferred and miscarriage rate.     

子宫内膜异位症影响体外受精—胚胎移植的具体环节探讨

目的　探讨子宫内膜异位症 (内异症 )对体外受精 -胚胎移植 (IVF ET)的影响。方法　回顾性分析85例输卵管因素不孕的患者 (A组 ,12 3个周期 )、18例卵巢子宫内膜异位囊肿的患者 (B组 ,2 5个周期 )和 16例无卵巢子宫内膜异位囊肿的内异症患者 (C组 ,2 0个周期 )的获卵数、受精率、卵裂率、胚胎种植率和临床妊娠率等情况。结果　B组的获卵数为 (7 1± 5 9)个 ,非常显著地少于A组的 (11 6± 8 4)个和C组的 (12 1± 7 8)个 ,P <0 0 1;B组和C组的受精率分别为 6 9 5 %和 70 3% ,均显著地低于A组的 77 5 % ,P <0 0 5 ;A、B、C三组的卵裂率、子宫内膜的厚度与类型、胚胎种植率和临床妊娠率均无显著差别。结论　子宫内膜异位囊肿影响卵巢对超排卵的反应 ,内异症影响卵子的受精 ,但不影响受精卵的分裂、子宫内膜容受力、胚胎种植率和临床妊娠率。     

Delayed embryo implantation following in vitro fertilization and embryo transfer (IVFET)

Purpose: Our goal was to compare serum human chorionic gonadotropin (hCG) levels in singleton pregnancies achieved following IVFET with those achieved following spontaneous conception. Results: The mean serum hCG level of patients who became pregnant following IVFET lagged 1.5 days behind that of patients who became pregnant spontaneously. Conclusions: The use of gonadotropin releasing hormone analogue as part of the stimulation protocol leading to egg retrieval and IVFET results in a delay in embryo implantation.