白细胞介素对小鼠体外受精及早期胚胎发育的影响

本文就人白细胞介素（ＩＬ－１β、５、６）对小鼠的体外受精率、体外受精卵的发育率，以及从交配雌鼠体内回收的２细胞期胚（体内受精卵）的发育率带来的影响进行了探讨。ＩＬ－１β５０ｎｇ／ｍｌ、ＩＬ－５５ｎｇ－ｍｌ以上、ＩＬ－６０．５ｎｇ／ｍｌ以上时对小鼠的体外受精率有明显抑制（Ｐ＜０．０５）。体外受精卵序的发育仅ＩＬ－６实验组见到抑制，０．５ｎｇ／ｍｌ以上对４细胞期胚发育有抑制，５０ｎｇ／ｍｌ时对８细胞期胚到囊胚期的发育有抑制。对体内受精卵的发育ＩＬ－１β和ＩＬ－６实验组与对照组间均未见到差异，但ＩＬ－５对囊胚期的发育有促进。以上结果提示，子宫内膜异位症时，人腹腔液中存在的ＩＬ－１β、５、６由于其抑制受精率而造成不孕。     

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。     

阴道超声下最大卵泡经线及主导卵泡群比例对体外受精-胚胎移植结局的影响

目的:分析人绒毛膜促性腺激素(HCG)注射日最大卵泡直径及主导卵泡群比例对体外受精-胚胎移植(IVF-ET)结局的影响,以探讨HCG扳机的超声标准。方法:回顾分析2010年6月至2012年6月在河南省人民医院生殖所接受IVF-ET治疗的患者共2566周期,根据HCG日最大卵泡径线(D)分为:A组(D≤18mm)、B组(18mmD≤21mm)、C组(21mmD≤24mm)、D组(24mmD≤27mm)和E组(D27mm),比较5组的年龄、基础FSH、HCG日E2、HCG日≥14mm卵泡数、HCG日主导卵泡比例、2PN数、可移植胚胎数、胚胎着床率、临床妊娠率等。结果:A、B组HCG日≥14mm卵泡数、HCG日≥20mm比例及HCG日≥18mm比例显著低于其余3组,A组显著低于B组,差异均有统计学意义(P0.001):A、B组的HCG日≥16mm比例、胚胎着床率、临床妊娠率均低于C、D、E组,差异有统计学差异(P0.001)。5组患者的年龄、基础FSH、卵子数、2PN数、可移植胚胎数、早期流产率等比较,差异均无统计学意义(P0.05)。结论:HCG日扳机的超声标准应以主导卵泡群比例为主要参考指标并兼顾最大卵泡直径,各主导卵泡群的比例:HCG日≥20mm卵泡比例35%、≥18mm卵泡比例55%~60%、≥16mm卵泡比例80%;最大卵泡直径21mm。     

卵冠丘复合体中的血凝块对体外受精-胚胎移植的影响

目的:探讨卵冠丘复合体中的血凝块对IVF-ET的影响。方法:采用IVF-ET常规长方案超促排卵、获得的卵冠丘复合体上有血凝块的患者为研究对象,将其随机分为A组,切除血凝块,50例;B组,不切除,53例;另以获得的卵丘复合体上无血凝块者为对照组(C组,91例);比较分析各组的临床结局。结果:3组患者的年龄、不孕年限、Gn用量、Gn使用总天数及获卵数组间两两比较,均无统计学差异,A组的受精率及2PN率最高,为85.4%和71.1%,C组次之,为77.5%和64.9%,B组最低,为75.8%和62.2%,A组显著高于B、C组(P<0.01),B、C组间统计学差异;移植后A组的种植率、妊娠率略高于B、C组,但无统计学差异(P>0.05)。结论:切除卵冠丘复合体上的血块不会增加操作成本及操作的复杂性,但却可以近一步改善患者的助孕结局,值得推广使用。     

反复多周期促排卵对小鼠母体卵巢组织及胚胎发育潜能的影响

目的:比较多周期连续促排卵对小鼠卵巢组织和胚胎发育潜能的影响。方法:建立反复多周期促排卵小鼠模型(A组),观察其卵巢组织内各级卵泡数形态并计数。统计获取的卵母细胞及受精卵数、卵裂率、优质胚胎率和囊胚形成率,并与单次促排卵周期小鼠(B组)、自然周期排卵小鼠(C组)比较。结果:B组获取的卵母细胞数及受精卵数显著增多(41.6±11.0)。而A组获取的卵母细胞及受精卵数显著降低(5.5±2.9),但初级卵泡形态异常率(33.34%)和次级卵泡形态异常率(27.14%)显著高于C组(8.33%、5.62%)与B组(10.34%、8.97%)(P<0.01);卵裂率(44.83%)、优质胚胎率(0)和囊胚形成率(0)均显著低于C组(88.07%、75.09%、74.74%)和B组(81.05%、69.02%、66.94%)(P<0.01)。结论:单次促排卵能增加卵母细胞和胚胎的数量。但多次连续促排卵会增加卵巢内异常的初级卵泡和次级卵泡数,降低卵母细胞质量。同时,会降低优质胚胎率和囊胚形成率,影响卵裂后胚胎进一步发育的潜能。     

体外受精周期不同获卵数的移植策略

目的:探讨体外受精周期不同获卵数胚胎移植策略.方法:采用回顾性分析方法,2018年10月至2019年9月在成都市锦江区妇幼保健院生殖中心行体外受精-胚胎移植2756个周期,按获卵数分为5组(A组获卵数≤5枚,B组获卵数6～9枚,C组获卵数10～14枚,D组获卵数15～19枚,E组获卵数≥20枚),比较5组之间全胚冷冻率...     

观察胚胎早期卵裂预测体外受精-胚胎移植妊娠结局的价值

目的:观察胚胎早期卵裂用于预测体外受精-胚胎移植妊娠结局的价值。方法:2009年8月至2011年5月在我院生殖中心首次因输卵管因素行常规体外受精-胚胎移植治疗的136个周期,授精25～27h后观察2PN受精卵是否出现早期卵裂,第3天行胚胎移植时分为移植胚胎中有早期卵裂胚胎组(A组)和无早期卵裂胚胎组(B组)。A组含有1个早期卵裂胚胎的为A1组,有2个早期卵裂胚胎的为A2组,有3个早期卵裂胚胎的为A3组。比较各组之间优胚率、种植率及妊娠率。结果:有早期卵裂的胚胎优胚形成率(63.3%)高于无早期卵裂的胚胎优胚率(49.0%),差异有统计学意义(P<0.01);移植胚胎中有早期卵裂胚胎组(A组)种植率、妊娠率高于无早期卵裂胚胎组(B组)(35.9%vs 22.2%;53.2%vs 33.7%),A1组种植率高于A2组(23.3%vs 45.7%),差异均有统计学意义(P<0.05)。结论:观察胚胎早期卵裂可预测胚胎发育潜能,有利于提高体外受精-胚胎移植种植率。     

短时受精与长时受精对体外受精及临床妊娠结局的影响

目的:探讨短时受精与长时受精对体外受精及临床妊娠结局的影响。方法:2008年1月至2010年12月因女性输卵管因素或盆腔炎症在本中心接受短时IVF与长时IVF。短时IVF共1095周期,长时IVF共1008周期,比较短时受精与长时受精两组患者的基本情况、受精、胚胎及临床妊娠情况。结果:两组患者正常受精(2PN)率的差异无统计学意义(P>0.05)。长时受精的0PN率(18.1%vs 13.5%)、1PN率(3.8%vs1.6%)明显高于短时受精组,3PN率比较,结果相反(4.5%vs 7.8%)。短时受精的卵子利用率(58.4%vs 53.7%)、优质胚胎率(70.6%vs 65.5%)、胚胎利用率(85.2%vs80.1%)明显高于长时受精组,两组临床妊娠率无统计学差异(44.6%vs 41.5%,P>0.05)。结论:短时IVF的多PN率比长时IVF高,但是0PN、1PN率显著降低,卵子利用率提高。短时IVF的优质胚胎率、胚胎利用率明显高于长时IVF。短时受精在一定程度上能提高卵子利用率,改善胚胎质量从而提高胚胎利用率。     

Follicle curetting at the time of oocyte retrieval increases the oocyte yield

Purpose  To determine whether follicle curetting at the time of oocyte retrieval increases oocyte yield. Methods  Retrospective review of all patients who underwent oocyte retrieval from July 1, 2003 to June 30, 2005. Main outcome measure  Number of oocytes retrieved. Secondary outcome measures: retrieval time, number of cryopreserved embryos, pregnancy rates, and incidence of ovarian hyperstimulation syndrome. Results  There were no differences in patient demographics, antral follicle count, cycle stimulation characteristics, fertilization rates, embryo quantity or quality, embryo cryopreservation rates, clinical pregnancy rates, live birth rates, or ovarian hyperstimulation syndrome between the groups. Retrievals that utilized curetting took three minutes longer. Follicle curetting significantly increased the number of oocytes retrieved, 13.9 ± 0.6 compared to 11.4 ± 0.6 oocytes without curetting (P = 0.003). The quantity of mature oocytes was also increased with curetting (10.3 ± 0.5 versus 8.4 ± 0.5, P = 0.006). Conclusions  This study demonstrated that follicle curetting significantly increased oocyte yield. While it did not increase live birth rates, this increase in oocyte yield should lead to increased numbers of embryos for selection at transfer and increased embryos for cryopreservation. Capsule   Patients undergoing follicle curetting at the time of oocyte retrieval had a 22% increase in oocyte yield which was significant.     

Heterotopic pregnancy after in vitro fertilization-embryo transfer.

OBJECTIVE: A ruptured cornual pregnancy is a rare and challenging problem. We present two cases of cornual pregnancies after in vitro fertilization and embryo transfer (IVF-ET) treated by cornual resection, with an excellent perinatal outcome for the intrauterine pregnancy in both cases. A literature review of cornual pregnancy after IVF-ET is also included. CASE REPORTS: Two women had undergone IVF-ET because of tubal problems. Emergent laparotomy was performed because of internal bleeding at 12 weeks of gestation in one case and 17 weeks in the other, and in both cases, ruptured cornual pregnancies were found. Cornual resection and primary repair were performed. The women were discharged on the 6th and 7th postoperative day, respectively, and they underwent an elective cesarean delivery at 37 weeks of pregnancy. They were delivered of healthy babies, one weighing 2700 g and the other 2310 g. CONCLUSION: These cases illustrate that good perinatal outcomes can be achieved by surgical intervention in heterotopic pregnancies, even in the event of a ruptured cornu.     

In vitro fertilization programmed for weekday-only oocyte harvest: Analysis of outcome based on actual retrieval day

Objective: Our aim was to assess the effect of the day of ovum retrieval on outcome in an IVF program scheduled for weekday-only ovum retrievals. Design: This was a retrospective study of patients who underwent transvaginal ultrasound-guided ovum retrieval (TVUS-OR) in an IVF program from August 10, 1992, to April 30, 1993. Setting: A university-based tertiary referral hospital center was the setting. Participants and Methods: All patients (n=501) who underwent TVUS-OR were divided into three groups: (1) patients who underwent TVUS-OR on Monday; (2) patients who underwent retrieval on Tuesday, Wednesday, or Thursday; and (3) patients who underwent retrieval on Friday. All patients were induced by the same controlled ovarian hyperstimulation protocol, which consisted of a GnRH analogue “flare-up” followed by parenteral menotropins, after a scheduled oral contraceptive-induced menses. Patients and cycle characteristics in the three groups were compared and clinical outcome was evaluated. Results: The similarity of patients and cycle characteristics confirmed the uniformity of the three groups. No difference was found in any of the clinical outcomes. However, in the first half of the program, we revealed a trend in which patients at high risk for ovarian hyperstimulation syndrome, requiring freezing all embryos and not allowing transfer during the treatment cycle, occurred more commonly in women whose retrieval occurred on Monday. This trend disappeared in the second half of the analysis. Conclusions: In an in vitro fertilization program in which ovum retrievals occurred only on weekdays, no significant difference in outcome was found in patients undergoing ovum retrieval on Monday or Friday versus midweek. In addition to significant savings by eliminating weekend retrievals, IVF outcome is not compromised.     

体外受精-胚胎移植中注射人绒毛膜促性腺激素后不同时间受精对早期胚胎发育及临床结局的影响

目的探讨人绒毛膜促性腺激素(h CG)注射后不同时间受精对体外受精-胚胎移植(IVF-ET)治疗患者实验室指标及临床指标的影响。方法选取行IVF-ET治疗并符合纳入标准的患者200例,根据h CG注射后受精时间不同随机分为4组:h CG注射后38.0~39.0 h受精为A组;注射h CG后39.1~40.0 h受精为B组、h CG注射后40.1~41.0 h受精为C组、h CG注射后41.1~42.0 h受精为D组,每组50例,观察并比较四组间实验室指标及临床指标。结果可用胚胎率B组(65.7%)、C组(63.3%)、D组(66.8%)均高于A组(55.5%)(P0.05);优质胚胎率A组(50.6%)显著低于C组(60.2%)与D组(63.6%)(P0.05),B组(54.3%)明显低于D组(P0.05);C组获得了较好的临床结局,临床妊娠率(50.0%)和着床率(34.2%)较高,流产率(9.1%)较低。正常受精率、正常卵裂率、临床妊娠率、着床率以及流产率组间比较,差异均无统计学意义(P0.05)。结论在一定时间范围内(38.0~42.0 h),随着h CG注射后受精时间的延长,优质胚胎率呈增高趋势;本中心IVF-ET治疗患者的最佳受精时间为h CG注射后40.1~41.0 h,此时受精患者有较高的临床妊娠率,较低的早期流产率及较好的临床妊娠结局。     

人未成熟卵母细胞体外培养成熟、受精及胚胎移植

目的 应用卵母细胞体外成熟(IVM)技术帮助卵泡成熟障碍的不孕症患者获得妊娠及分娩。方法 接受未成熟卵IVM技术治疗者30例35个周期,其中多囊卵巢综合征14例,有卵巢过度刺激综合征病史6例,体外受精和胚胎移植(IVF-ET)周期中卵巢反应不良患者10例。设计卵巢刺激方案,采用含人成熟卵泡液的IVM培养液,建立未成熟卵母细胞的体外培养方法。结果 35个周期共取得未成熟卵母细胞203个,平均每个周期5．8个。培养后有156个卵母细胞排出第一极体,IVM率76．8％(156／203);在卵胞浆单精子显微注射(ICSI)12～18h后观察原核,正常受精率为76．9％(120／156);共有移植周期33个,获8例临床妊娠,妊娠率24％(8／33);有5例共7个婴儿出生。结论 IVM对一些卵泡发育和成熟障碍,特别是顽固性多囊卵巢综合征患者,是一种有效的辅助生育措施。人成熟卵泡液含有理想的自然促卵母细胞成熟的成分。     

体外受精-胚胎移植周期中注射绒毛膜促性腺激素日性激素水平与妊娠率的关系

目的：探讨在体外受精－胚胎移植（IVF－ET）周期中注射绒毛膜促性腺激素（HCG）日性激素水平与妊娠率的关系。方法：对71个常规IVE－ET和卵母细胞单精子显微注射（ICSI）周期中注射HCG日的性激素水平进行测定。结果：促黄体生成素（LH）普遍受抑制，与临床妊娠无关；孕酮（P）＜2．86nmol/L时妊娠率较高，雌二醇（E2）（每卵子）513．8－770．7pmol/L时妊娠率高于其它两组。结论：在IVF－ET和ICSI周期中，注射HCG日的P值和E2（每卵子）水平是预测妊娠成功率的一个比较好的指标，当两者联合应用时，可提高预测的准确率。     

Influence of oocytes and spermatozoa on early embryonic development

OBJECTIVE: To evaluate the effect of oocytes and spermatozoa on early embryonic development. DESIGN: Retrospective study. SETTING: Infertility Clinic, the Family Federation of Finland. PATIENT(S): Fifty-nine oocyte donation cycles with oocytes shared among 118 recipient couples. INTERVENTION(S): Culture of all fertilized oocytes. MAIN OUTCOME MEASURE(S): Standard sperm (concentration, progressive motility, and morphology according to Tygerberg strict criteria) and embryo (morphology and cleavage stage) characteristics. RESULT(S): A marked effect of the oocyte on both embryo morphology and blastomere cleavage rate was demonstrated. In addition, a significant sperm effect on blastomere cleavage rate was found. Sperm morphology as determined according to strict criteria rather than sperm count or progressive motility was positively associated with the blastomere cleavage rate. None of the measured sperm characteristics influenced embryo morphology. CONCLUSION(S): Embryo morphology, i.e., fragmentation and blastomere uniformity, are predominantly determined by oocyte quality, whereas both the oocyte and spermatozoa influence the blastomere cleavage rate.     

Correlation between follicular diameters and flushing versus no flushing on oocyte maturity,fertilization rate and embryo quality

Objective

To determine (a) the correlation between follicular sizes, oocyte maturity, normal fertilization rate, cleavage and embryo quality; and (b) to establish whether oocytes recovered with or without follicular flushing have different developmental competence.

Design

Prospective observational study.

Setting

Academic medical center.

Patients

Forty nine cycles (37 ICSI and 12 IVF).

Interventions

Measurement of 360 follicular diameters on the day of egg retrieval and classification into three groups Group A (mean diameter 12–14.5 mm.), group B (mean diameter 15–18 mm.) and group C (diameter >18.5 mm.).

Main outcome measure

Correlation between follicular size at the time of retrieval and oocyte maturity, fertilization and cleavage rate in 226 oocytes (163 ICSI and 63 IVF). Developmental competence of oocytes retrieved with flushing versus non flushing.

Results

Almost all (99 %) of the oocytes recovered from follicles of group C were in metaphase II as opposed to 80 % in group A and 81 % in group B (p < 0.01). Overall there was a progressive and significant increase in fertilization rates from group A follicles to group C (47 % vs. 67 %, p 0.05). Overall 53 % of oocytes retrieved from group A follicles showed either no fertilization or abnormal fertilization versus 27 % in group C (p 0.05). The oocyte recovery rate with follicular flushing improved from group A to group B and to group C follicles (65 % vs. 49 % vs.37 % respectively p < 0.01). There were no differences in rates of immature oocyte, fertilization, abnormal or not fertilization and cleavage.

Conclusions

The results of this study shows that: a) Follicles larger than 18 mm at retrieval have consistently mature oocytes with a higher rate of fertilization; b) Small size follicles are still capable of containing mature oocytes, but their rate of abnormal or no fertilization is high; c) Oocytes recovered with flushing are still able to produce embryos with full developmental competence.     

A modest increase in serum progesterone levels on the day of human chorionic gonadotropin (hCG administration may influence pregnancy rate and pregnancy loss in in vitro fertilization-embryo transfer (IVF-ET) patients

Purpose Our purpose was to study the effect of a modest increase in preovulatory serum progesterone (P₄) levels in hyperstimulated patients and its association with pregnancy rate and pregnancy loss following in vitro fertilization (IVF) and embryo transfer (ET).Patients Only patients with mechanical factor and three transferred embryos were included in the present study. They were divided into two groups according to two critical breakpoints for P₄ serum levels on the day of hCG administration: serum P₄ below 0.6 ng/ml in 28 cycles (group I) and >0.6 ng/ml in 80 cycles (group II).Setting The setting was the IVF program at Carmel Medical Center, Haifa, Israel.Results The pregnancy rate per embryo transfer was 53% (15/28) in group I and 10% (8/80) in group II (P < 0.025). Of 15 pregnancies achieved in group I, 14 were ongoing pregnancies, compared to 4 of 8 ongoing pregnancies in group II (P <0.03). Conclusions Our findings suggest that a very modest increase in serum P₄ levels on the day of hCG administration is associated with lower pregnancy and ongoing pregnancy rates in IVF-ET.     

精子顶体精氨酸酰胺酶测定在体外受精-胚胎移植妊娠结局中的价值研究

目的研究精子顶体精氨酸酰胺酶在体外受精-胚胎移植(IVF-ET)中的应用价值。方法选择349个IVF治疗周期,其中精氨酸酰胺酶高值组162个周期,精氨酸酰胺酶低值组187个周期。比较两组间的受精率、正常受精率、卵裂率、优质胚胎率以及新鲜移植周期的生化妊娠率、临床妊娠率、流产率及活产率等指标。结果精子精氨酸酰胺酶高值组的受精率(78.74%)高于低值组(76.07%,P0.05),而卵裂率高值组(98.24%)低于低值组(99.58%,P0.05)。两组间正常受精率和优质胚胎率比较无统计学差异。高值组新鲜移植周期的临床妊娠率(58.75%)及活产率(52.50%)均明显高于低值组(44.00%,P0.05;33.00%,P0.01)。两组间生化妊娠率和流产率比较无统计学差异(P0.05)。结论精子精氨酸酰胺酶活性与IVF-ET精卵结合有一定关系,并对妊娠结局有一定的指导作用。