不同受精方式对胚胎冻融结局影响的比较

目的比较常规体外受精(IVF)和卵胞浆内单精子注射(ICSI)对胚胎冻融结局的影响。方法选取2008年1月至2008年12月在我中心进行胚胎冻融移植的142周期(IVF104周期,ICSI38周期),比较两组患者的临床结局。结果142周期共复苏胚胎375枚,IVF组275枚,ICSI组100枚,两组的复苏胚胎存活率相比无差异(89.09%和87.00%);IVF组妊娠率、种植率分别为38.46%、21.22%,ICSI组分别为34.21%、24.14%,两组相比也无统计学差异(P0.05)。结论本研究结果提示ICSI对冻融胚胎的存活率和发育潜能没有显著影响。     

科学家从人卵细胞培育出胚胎干细胞

据2011年10月6日Noggle S[Nature,2011,478(7367):70-75]报道,美国研究人员用人类卵细胞培育出了胚胎干细胞,虽然这项成果还存在一些缺陷,但已是黄禹锡造假事件后最接近培育出正常人类胚胎干细胞的成果。将体细胞中的遗传物质植入卵细胞中,将其培育成为胚胎干细胞甚至最终培养出新的个体,就是常说的克隆技术,著名的克隆羊多利就是用这种技术得到的。2004年,韩国研究人员黄禹锡曾宣称用这种方法培育出了人类胚胎干细胞,引起一时轰动,但后来证明这是一起造假事件。     

异丙酚静脉全身麻醉对血糖的影响

1　资料与方法1.1　临床资料6 0例ASAI～II级中上腹部手术的病人 ,男 2 8例 ,女 32例 ,年龄 31～ 70岁 ,体重 45～ 74kg ,I组 (n =30 )为非糖尿病病人 ,II组 (n =30 )为糖尿病病人 (注 :术前血糖已控制在正常或接近正常范围 ) ,其中合并高血压的 15例 ,I组 7例 ,II组 8例 ,两组患者其它情况无统计学差异 ,详见表 1。表 1　两组病人一般情况比较 ( x±s)年龄 (岁 )体重 (kg)手术时间 (min)异丙酚用量 (mg)I组 (n =30 ) 52± 2 .51 53± 4 .5 30 0± 1 3 2 51 0± 35II组 (n =30 ) 53± 2 .35 54± 3 .0 2 78± 1 2 2 538± 40 　…     

ASAb对体外受精卵子成熟度、受精率、卵裂率、胚胎质量的影响

目的探讨抗精子抗体（ASAb）对IVF—ET技术卵子成熟度、受精率、卵裂率及胚胎质量的影响。方法分析36例血清ASA阳性妇女，19例精子表面ASA阳性男性患者IVF—ET周期受精率、卵裂率及胚胎质量与对照组的区别。结果女性血清中ASAbrgM为多，男性精子表面IgA联合IgG为主，两种情况均可降低卵子的受精率和卵裂率，但对卵子成熟度和胚胎质量无影响；行IVF—ET的ASAb阳性妇女受精率和卵裂率明显低于对照组，行ICSI的ASAb阳性妇女各参数与对照组无明显差异。结论女性血清中IgM和男性精子表面IgA及kG能降低体外受精的受精率及卵裂率；对选择体外受精助孕的夫妇当女性血清中IgM阳性，男性精子表面IgA和kG同时阳性时ICSI是优先选择的助孕方式。     

用荧光原位杂交技术研究人类未受精卵细胞的染色体非整倍体

目的　探讨人类未受精卵细胞非整倍体的产生机制。方法　取未受精卵细胞固定后行多色荧光原位杂交 ,分析卵细胞中 13、16、18、2 1和 2 2号染色体的核型情况。结果　 4 7%的卵细胞核型正常 ,5 3%的卵细胞为异常核型 ,其中 18%为同源染色体不分离 ,12 %为姐妹染色单体非平衡性过早分离 ,36 %为姐妹染色单体平衡性过早分离 ;在体外培养 >2 4小时的卵细胞中 ,姐妹染色单体平衡性过早分离的发生率明显高于体外培养≤ 2 4小时的卵细胞 ( P<0 .0 1)。结论　同源染色体不分离和姐妹染色单体平衡性及非平衡性过早分离这三种机制均参与了卵细胞非整倍体的产生。姐妹染色单体平衡性过早分离与体外培养时间具有相关性     

胚胎密度对卵裂期优质胚胎率的影响

目的 通过调整协变量来探索培养的胚胎密度与第3天卵裂期胚胎发育结果之间的相关性.方法 回顾性分析206对夫妇1196个胚胎体外受精-胚胎移植(IVF-ET)治疗的资料.培养条件为低氧,培养液每微滴体积为30 μl.以第3天卵裂期胚胎的优质胚胎率为终点指标对胚胎质量进行评价.选择女方年龄,男方年龄,窦卵泡数,抗苗勒管激素...     

不同玻璃化冷冻载体对胚胎复苏的影响

目的比较分析封闭式玻璃化冷冻载体-JYstraws和及开放式载体-medicult管用于人卵裂期胚胎玻璃化冷冻的效果。方法以本中心2010年10月至2013年7月的患者卵裂期胚胎（1678个）为研究对象,选择合适的胚胎进行玻璃化冷冻。实验分为封闭式载体-JY straws管冷冻组和开放式载体．medicult管冷冻组,比较其复苏胚胎成功率及复苏胚胎完整率。进一步,我们将冻存的胚胎按照胚胎质量分为优质胚胎和非优质胚胎,分别比较两种冷冻载体对不同质量胚胎的复苏效果。结果开放式载体-medicult管的胚胎复苏成功率（98．69％）和复苏完整率（90．23％）明显高于封闭式载体-JYstraws的胚胎复苏率（87．41％）和复苏完整率（65．41％）。无论优质胚胎还是非优质胚胎,开放式载体的复苏成功率及复苏胚胎完整率均好于封闭式载体。结论开放式载体-medicult管胚胎解冻效果更好。     

早期卵裂作为胚胎质量预测指标对体外授精结局的影响

目的探讨早期卵裂是否可作为评估胚胎质量、胚胎种植率、临床妊娠率的预测指标。方法对2006年1月～2006年12月的471对夫妇，480个周期随机分A组和B组（对照组）。A组：262个周期，即从授精25～27h后观察2PN受精卵是否出现早期卵裂，同时第二天、第三天观察胚胎质量并进行分级；B组：218个周期，第二天、第三天观察胚胎质量并进行分级，但授精25—27h后不观察2PN受精卵是否出现卵裂。同时根据移植胚胎中含有出现早期卵裂的个数分为四组A，（三个移植胚胎均出现早期卵裂），A2（移植胚胎含两个出现早期卵裂），A1（移植胚胎一个出现早期卵裂），A0（移植胚胎无出现早期卵裂）。比较四组胚胎种植率。结果A组种植率和临床妊娠率均高于未观察早期卵裂B组，但统计学分析无显著意义；A3、A2、A1、A0组间胚胎种植率分别为30．9％、26．1％、21．2％、11．2％，有显著性差异（P〈0．001）。结论（1）第2，3天胚胎形态学分级依然可作为评定胚胎质量的参数。（2）早期卵裂是可作为预测高种植率胚胎的指标之一。     

毫米波辐射对植入前小鼠胚胎及早期胚胎的影响

本文报道小鼠受精卵体外及在体受毫米波辐照后一些改变。毫米波源为36.11GHz固态微波连续发生器,波长8mm,功率密度为10mW/cm~2、8mW/cm~2、4mW/cm~2及2mW/cm~2。结果发现2-4mW/cm~2毫米波辐照即可使体外培养之受精卵细胞表面微绒毛减少、脱落,细胞表面形成许多囊泡。透射电镜下可见细胞间隙扩大、胞浆中线粒体膨胀、空化,用FITC-ConA试验可见细胞表面结合荧光减少。酶试验证明辐照后卵胚细胞表面AKP,ATPase,5′-Nase均有降低。在体受精卵细胞经辐射后证明,辐射可使胎儿体重增长减慢,囊胚形成数量下降,植入率降低,而表面酶下降不明显。     

流感病毒对早期妊娠胚胎影响的分析

目的探讨流行性感冒病毒对孕妇的早孕胚胎的影响.方法选择在2003年4月,5月两个月中来我院优生遗传咨询门诊就诊的244位患者中,末次月经为2003年1月至3月份的,经实验室检查证实患有流感的妊娠妇女50例进行胚胎发育的追踪,随访.结果在50例受到流感病毒感染的孕妇中感染时间在妊娠期1～3月中发生胚胎停育9例,先兆流产6例,胎儿畸型1例.结论孕妇是受流感感染的高危人群,特别是妊娠早期受感染者容易出现不良的妊娠结局.     

The effect of propofol anaesthesia on oocyte fertilization and early embryo quality

Propofol, frequently used for i.v. induction of anaesthesia in assisted reproduction procedures, has been suspected of damaging oocytes. Concentrations of propofol have recently been shown to increase in follicular fluid during oocyte retrieval. Our study was designed to assess whether exposure to increasing concentrations of propofol has a measurable effect on in-vitro fertilization, cleavage and embryo development. A cohort of 130 women underwent i.v. anaesthesia using propofol and fentanyl. Time of anaesthesia from i. v. injection of propofol was measured, as were the doses of the two drugs. In 32 women expected to have more than 15 oocytes retrieved, first, middle and last oocytes were cultured separately. The mean time from i.v. injection to first follicle aspiration was 200 s. The mean time for the aspiration of each additional oocyte was 17.6 s. In 10 out of 11 cases where follicular fluid concentrations of propofol were measured, there was an increase from the first to the last follicle, but no difference was found in the ratio of mature to immature oocytes. Nor were any differences found in fertilization, cleavage and embryo cell number. In so far as in-vitro development reflects embryo quality, we conclude that the time elapsed between retrieval of the first and last oocyte does not affect oocyte quality.     

Fertilization and early embryology: The applicability of the cumulative embryo score system for embryo selection and quality control in an in-vitro fertilization/embryo transfer programme

The cumulative embryo score system involves three aspects ofrelevance in pregnancy achievement during in-vitro fertilization(IVF) and embryo transfer: cleavage rates, morphological qualitiesand the number of embryos transferred. The scores of 602 IVF/embryotransfer trials were calculated and analysed to determine thesystem's relationship to pregnancy rate, pregnancy outcome andthe incidence of twin and triplet pregnancies. The system wasalso applied to cycles where endotoxins were either presentin or absent from culture medium, in order to evaluate its validityin quality control analyses. Pregnancy rates were found to increasefrom 4%, with scores between 1 and 10, to 35% in the 41–50group. The score of 20 was the criterion for separating patientsinto poor and good pregnancy prognosis groups (P = 0.00001).Biochemical abortions occurred more frequently with scores <20(P = 0.00978), but a similar relationship was not found in clinicalabortion rates (P = 0.62206). Birth rates below and above ascore of 20 (2.8 and 19.2%, respectively) differed significantly(P = 0.0005). The scores of twins overlapped extensively withthose of singleton births, but those of all triplets were >40. The system did not reflect a correlation between embryoquality and the presence of endotoxins in culture medium.     

骨桥蛋白对小鼠体外受精及早期胚胎发育的影响

目的 探讨骨桥蛋白（OPN）对小鼠体外受精及早期胚胎发育的影响。方法 120只昆明雌鼠和30只雄鼠,采用体外受精、胚胎培养方法,将小鼠精子、卵子、原核期胚胎和2-细胞期胚胎分别用不同浓度的OPN抗体预处理,观察小鼠受精、卵裂以及早期胚胎发育情况。结果 不同浓度的OPN抗体分别预处理精子和卵子后,与对照组比较,受精率显著降低(P＜0.01)。OPN抗体预处理原核期胚胎后,0.01mg/L OPN抗体组的卵裂率较对照组低,但差异无显著性 (P =0.052),1.00mg/L OPN抗体组的卵裂率低于0.01mg/L 组（P ＜0.01）及0.10mg/L组（P ＜0.05）。不同浓度的OPN抗体预处理2-细胞胚胎后可抑制胚胎发育。1.00mg/L OPN抗体组的4-细胞率和8-细胞率与0.10mg/L OPN抗体组相比差异无显著性(P ＞0.05),但前者的囊胚形成率显著低于后者（P ＜0.01）。1.00mg/L OPN抗体组的4-细胞率、8-细胞率以及囊胚形成率均显著低于0.01mg/L OPN抗体组（P ＜0.01）。结论 OPN可促进小鼠的受精和早期胚胎发育。     

A comparison of three different target-controlled remifentanil infusion rates during target-controlled propofol infusion for oocyte retrieval

OBJECTIVE:

To evaluate the effects of three different target-controlled remifentanil infusion rates during target-controlled propofol infusion on hemodynamic parameters, pain, sedation, and recovery score during oocyte retrieval.

METHODS:

Sixty-nine women were scheduled for oocyte retrieval. Target-controlled propofol infusion at an effect-site concentration of 1.5 µg/mL was instituted. The patients were randomly allocated to receive remifentanil at an effect-site concentration of either 1.5 (group I, n = 23), 2 (group II, n = 23) or 2.5 ng/mL (group III, n = 23). Hemodynamic variables, sedation, pain, the Aldrete recovery score, and side effects were recorded.

RESULTS:

Hemodynamic variables, sedation and pain scores and the number of patients with the maximum Aldrete recovery score 10 min after the procedure were comparable among the groups. The number of patients in group III with the maximum Aldrete recovery score 5 min after the procedure was significantly lower than that in groups I and II. One patient in group II and one patient in group III suffered from nausea.

CONCLUSION:

Similar pain-free conscious sedation conditions without significant changes in hemodynamic parameters were provided by all three protocols. However, target controlled infusion of remifentanil at 1.5 or 2 ng/mL proved superior at providing early recovery compared to 2.5 ng/mL.     

人抗卵透明带抗体阳笥血清对小鼠体外受精和早期胚发育的影响

本研究在小鼠体外受精和早期胚胎发育中添加抗卵透明带抗体阳性不孕妇女血清(n＝11）,结果显示：与对照组相比较,6例完全阻断受精和发育（P＜0.01）;2例仅阻断受精,不明显抑制发育;3例则与对照组无显著性差异（P＞0.05）。提示人抗卵透明带抗体的主要效应是阻断受精,并可以进一步抑制胚胎早期发育,但效应的程度表现出个体差异。     

精液优化后置时间与受精时间对胚胎质量的作用评价

目的探讨精液优化后置时间与体外受精时间对胚胎质量评价。方法 61个IVF周期,共获卵610枚:实验组:200枚卵子,精液优化后2h制作精子微滴加入培养后卵子,待2h后将拆除部分颗粒细胞的受精卵转移至新鲜的受精微滴皿中,培养14h-16h;对照组:410枚卵子,常规精液优化后2h,制作精子微滴加入培养后卵子,培养受精16h-18h。两组均在次日拆蛋,观察原核及受精情况,受精66h-72h观察其卵裂,并进行胚胎评分,比较两组的受精率、卵裂率、可利用胚胎率、优质胚胎率。结果实验组的受精率、卵裂率、可利用胚胎率分别为:77%、96.1%、59.5%;对照组为:74.6%、94.1%、53.4%;两组受精率、卵裂率、可利用胚胎率比较结果无统计学差异,P0.05。但实验组中可利用胚胎率较高于对照组;实验组的优质胚胎率为:53.4%较对照组43.4%高,统计学比较有显著性差异P0.05。结论降低精液优化后置时间和缩短受精时间不仅不影响胚胎的受精率、卵裂率;且会提高胚胎的可利用胚胎率、优质率,延伸临床的种植潜能,增加患者周期妊娠率。     

Dielectrophoretic oocyte selection chip for in vitro fertilization

This paper reports a new dielectrophoretic separation method of porcine oocytes for in vitro fertilization. Conventional manual selection of oocyte highly depends on the expert’s experience and lacks universal standards for identifying the quality of oocyte. In this study, an electrode array chip with castellated shape was developed to evaluate dielectrophoretic velocities of oocytes, under applied bias conditions with an AC 3 V waveform at 1 MHz for 15 s. Based on different dielectrophoresis (DEP) response, the selected group of oocytes that moved showed a better developmental potential than the group of oocytes that stayed, representing a higher rate of blastocyst formation and a lower rate of polyspermic fertilization. In addition, the overall developmental potential of oocytes selected by the DEP device was comparable to that of oocytes selected by conventional manual method. These results demonstrate that the difference in dielectrophoretic velocity can be used to establish an objective criterion for the selection of oocytes. Consequently, this method will open the possibility to develop an automatic tool for oocyte selection, which would be helpful for assisted reproductive technologies such as transgenic and clonal animal production. Choi and Kim contributed equally to this work.     

控制性超排卵治疗对多囊卵巢综合征患者卵母细胞质量的影响

目的探讨辅助生育技术中控制性超排卵治疗对多囊卵巢综合征不孕患者卵母细胞质量的影响。方法对接受GnRH—a长方案降调控制性超排卵的多囊卵巢综合征患者50例（共52个周期）,和同期因输卵管因素不孕接受GnRH—a长方案降调的对照组患者57例（共60个周期）,观察取卵后卵-冠-丘复合物,对其卵母细胞质量进行评级,比较两组卵母细胞质量、成熟率、受精率、卵裂率、优质胚胎率和妊娠结局。结果PCOS组3级卵母细胞数、优质胚胎数高于对照组,有显著性差异（P〈0．05）,而3级卵母细胞率、优质胚胎率与对照组相比无明显统计学差异（P〉0．05）,PCOS组1级、2级和4级卵母细胞数及比例与对照组相比无明显统计学差异（P〉0．05）。PCOS组与对照组卵母细胞成熟率（88．0％vs88．3％）、受精率（79．3％VS82．1％）、卵裂率（76．9％VS80．3％）、临床妊娠率（38．5％VS40．0％）等,差异无明显统计学意义（P〉0．05）。结论PCOS患者经促排卵治疗后,其优质卵母细胞数、优质胚胎数目明显高于正常对照组,能获得与正常对照患者相同的优质卵母细胞率、卵母细胞成熟率、受精率、卵裂率、优质胚胎率及临床妊娠率。     

体外受精-胚胎移植中三种镇痛方法在取卵术的研究

目的探讨异丙酚,笑气与度冷丁三种镇痛方法用于经阴道B超引导下穿刺取卵术中的应用,并比较其疗效。方法将体外受精一胚胎移植患者随机分为异丙酚组,笑气组与度冷丁组,比较三组麻醉效果。结果异丙酚组麻醉效果及手术时间与另外两组相比有显著性差异。笑气组麻醉效果及手术时间与度冷丁组相比有显著性差异。异丙酚组麻醉前后血压、心率、血氧相比有显著性差异,另两组无显著性差异。三组之间获卵数,卵子受精率、卵裂率、优质胚胎形成率、妊娠率无显著性差异。结论异丙酚麻醉效果优于笑气及度冷丁。笑气的麻醉效果优于度冷丁,安全有效,使用方便。而且三组麻醉方式均不影响体外受精—胚胎移植最终结局。     

Effect of in-utero diethylstilboestrol exposure on human oocyte quality and fertilization in a programme of in-vitro fertilization.

Genital tract abnormalities and adverse pregnancy outcome are well known in women exposed in utero to diethylstilboestrol (DES). Data about adverse reproductive performance in women exposed to DES have been published, including controversial reports of menstrual dysfunction, poor responses after ovarian stimulation, oocyte maturation and fertilization abnormalities. We compared oocyte quality, in-vitro fertilization results and embryo quality for women exposed in utero to DES with a control group. Between 1989 and 1996, 56 DES-exposed women who had 125 in-vitro fertilization (IVF) attempts were retrospectively compared to a control group of 45 women with tubal disease, who underwent 73 IVF attempts. Couples suffering from male infertility were excluded. The parameters compared were oocyte quality (maturation abnormalities, immature oocyte, mature oocyte), fertilization and cleavage rate (per treated and metaphase II oocytes), and embryo quality (number and grade). We found no significant difference in oocyte maturational status, fertilization rates, cleavage rates, embryo quality and development between DES-exposed subjects and control subjects. These results suggest that in-utero exposure to DES has no significant influence on oocyte quality and fertilization ability as judged during IVF attempts.