卵巢低反应患者高孕激素状态下促排卵的有效性研究

目的:探讨高孕激素状态下促排卵对卵巢低反应患者LH水平的影响及促排卵效果。方法:将100例存在卵巢低反应的患者随机分为观察组、对照组,每组各50例。观察组采用醋酸甲羟孕酮联合注射用尿促性素促排卵,对照组采用超短方案。分析观察组促排卵过程中LH水平的变化,比较两组患者的获卵数、成熟卵数、优质胚胎数及行冻融胚胎移植(FET)后的妊娠率等。结果:观察组在促排卵过程中未监测到LH峰;两组的获卵数、成熟卵数、受精数等比较,差异均无统计学意义(P0.05),两组行FET后的妊娠率、胚胎种植率比较,差异无统计学意义(P0.05)。结论:高孕激素状态下促排卵能有效抑制LH峰,对于卵巢低反应者能达到较好的促排卵效果,可作为一种备选方法。     

克罗米芬联合高孕激素促排卵抑制早发LH峰的临床结局研究

目的:探讨在控制性超促排卵中克罗米芬(CC)联合高孕激素促排卵方案抑制早发LH峰的临床效果。方法:回顾性分析126名行体外受精/卵胞质内单精子显微注射(IVF/ICSI)取卵周期的患者,分为CC联合高孕激素促排卵组(试验组,n=63)和短方案治疗组(对照组,n=63)。观察过早LH峰发生率、促排卵中Gn用量和用药天数、获卵数、成熟卵数、内分泌及胚胎试验室结果。结果:试验组获卵数、成熟卵数、有效胚胎数、生化妊娠率、临床妊娠率、胚胎种植率与对照组比较均无统计学差异(P0.05)。所有对象在促排卵过程中未监测到早发LH峰,试验组月经第9~10日和诱发排卵日LH水平与基础值间无统计学差异(P0.05)。试验组Gn用量和用药天数均高于对照组(P0.05)。结论:CC联合高孕激素促排卵方案可以有效抑制早发LH峰,促排卵过程中LH水平平稳,且可以获得有发育潜能的胚胎。     

多囊卵巢综合征患者在高孕激素超促排卵中LH与IVF/ICSI临床结局的相关性分析

目的:探讨在高孕激素超促排卵方案中基础血黄体生成素(LH)水平对多囊卵巢综合征(PCOS)患者行体外受精/卵胞质内单精子显微注射(IVF/ICSI)治疗的临床结局的影响。方法:回顾性分析183例PCOS患者采用从早卵泡期开始使用安宫黄体酮(MPA)联合促性腺激素(Gn)的高孕激素超促排卵方案行IVF/ICSI治疗;根据基础LH水平分为3组,A组:0~5 IU/L,B组:5~10 IU/L,C组:10 IU/L,分析3组患者在高孕激素超促排卵过程中不同血LH水平与控制性超促排卵特征及IVF临床结局的相关性。结果:3组在促排卵过程中LH水平均呈下降趋势,且在基础LH水平、中期LH水平、诱发排卵当日的LH水平及诱发排卵次日的LH水平3组间比较均有统计学差异(P0.05),在扳机日LH水平波动于0.08~12.33 IU/L之间,无一例发生自发性LH峰;在获卵数、成熟卵数及获卵率A组与C组间有统计学差异(P0.05),而成熟卵率、正常受精卵数、优质胚胎数及有效胚胎数3组间比较无统计学差异(P0.05);后续的冻融胚胎移植(frozen-thawed embryo transfer,FET)周期结果表明,临床妊娠率、早期流产率及继续妊娠率组间比较均无统计学差异(P0.05)。结论:高孕激素促排卵方案可有效预防PCOS患者行IVF/ICSI治疗的自发性LH峰发生,并且基础高LH水平未损害PCOS患者的卵子及胚胎质量,对其临床结局也无明显影响,因此高孕激素超促排卵方案是一种新的简单安全、高效的垂体非降调节超促排卵方案,但还需大样本多中心的随机对照试验进一步证实。     

安宫黄体酮和来曲唑联合Gn超促排卵在卵巢储备减退患者IVF/ICSI-FET中应用效果的比较

目的:比较安宫黄体酮(MPA)联合促性腺激素(Gn)超促排卵与来曲唑微刺激促排卵在卵巢储备功能减退(DOR)患者体外受精及冻融胚胎移植(FET)中的应用效果。方法:回顾分析730周期拟行体外受精助孕的DOR的不孕症患者的临床资料,380周期行MPA联合Gn促排卵(MPA组),350周期行来曲唑联合Gn促排卵(来曲唑组)。观察两组的周期取消率、Gn天数、Gn剂量、性激素水平、获卵数、可利用胚胎数、优胚率和FET妊娠率、种植率、流产率和活产率。结果:MPA组患者的Gn使用时间、Gn使用总量、优胚率均显著高于来曲唑组(P0.05),而HCG日LH水平、HCG日P水平、可用胚胎数显著低于来曲唑组(P0.05)。两组的获卵数、成熟卵数、受精卵数、卵裂数比较,差异均无统计学意义(P0.05)。MPA组患者的FET种植率和临床妊娠率均显著高于来曲唑组(P0.05)。两组患者的流产率、异位妊娠率和活产率比较,差异均无统计学意义(P0.05)。结论:与来曲唑联合Gn促排卵比较,MPA联合Gn促排卵对于DOR患者可有效抑制早发LH峰,减少提前排卵发生,能获得可观的临床妊娠率,值得临床应用推广。     

孕激素抑制LH峰在控制性卵巢刺激过程中的疗效观察

目的:探讨在控制性卵巢刺激(COS)过程中应用孕激素抑制黄体生成素(LH)峰的临床效果。方法:回顾性分析83例行体外受精/卵胞质内单精子注射-冻融胚胎移植(IVF/ICSI-FET)患者的资料,所有患者均采用孕激素联合促性腺激素方案,83个取卵周期共完成了92个FET周期,统计分析促排卵过程中的激素变化、胚胎实验室情况及妊娠结局。结果:在促排卵过程中,LH持续低水平,基础、中期(月经第9~11日)、诱发排卵当日LH水平分别为3.85±2.03 IU/L、3.64±2.01 IU/L、2.62±1.77 IU/L,未监测到LH峰。h MG的用药剂量为1 964.76±468.73 IU,孕激素(商品名:安琪坦)的用药剂量为2.05±0.34 g。平均获卵数为10.9±6.1,每个取卵周期平均冷冻5.0±2.5个胚胎。FET后临床妊娠率为52.17%(48/92),胚胎种植率为39.34%(72/183),流产率为10.42%(5/48)。结论:孕激素能够有效抑制LH峰,孕激素联合Gn促排卵方案为基于FET的促排卵技术提供了新的备选方案。     

高效孕激素下超促排卵和微刺激方案在卵巢功能减退患者中应用效果分析

目的探讨高效孕激素下超促排卵(PPOS)和微刺激两种方案在卵巢功能减退患者(DOR)中的促排卵效果和全胚冷冻后行冻融胚胎移植(FET)的临床妊娠结局的差异。方法对2015年12月至2016年7月在郑州大学第二附属医院行体外受精-胚胎移植(IVF-ET)辅助生殖技术的431例卵巢储备功能下降患者的资料进行回顾性分析,其中PPOS方案组209例,微刺激组222例,比较两组的促排卵实验室结局和全胚冷冻后FET的妊娠结局。采用多因素Logistic回归校正混杂因素后比较两种促排卵方案的临床妊娠率。结果 PPOS组扳机日促黄体生成素(LH)水平低于微刺激组[3.63(2.40,5.46)U/L vs.7.07(4.04,11.92)U/L,P0.05],PPOS组取消取卵率低于微刺激组(1.44%vs.7.21%,P0.05),PPOS组获卵数、可利用胚胎数和优质胚胎数均高于微刺激组(P0.05)。全胚冷冻后行复苏移植,PPOS组临床妊娠率(29.17%)和胚胎着床率(14.63%)略高于微刺激组(19.70%和12.59%,P0.05)。多因素Logistic回归分析结果显示:PPOS方案可以获得更高的临床妊娠率(OR=6.79,95%CI 1.15~40.06,P=0.035)。结论对于DOR患者,PPOS方案较微刺激方案可减少取消取卵率,并可获得更多的获卵数、可利用胚胎数和优质胚胎数,累积胚胎提供更多移植机会。PPOS方案可作为DOR患者行IVF-ET辅助生殖技术时促排卵方案的一种选择。     

3种不同超促排卵方案在高龄患者体外受精-胚胎移植中的临床效果分析

目的:探讨高龄(36~45岁)患者采用不同超促排卵方案对体外受精-胚胎移植周期妊娠结局的影响。方法:回顾分析484个周期的高龄患者的资料,根据促排卵方案不同将患者分组:GnRH-a长方案组(148个周期)、拮抗剂方案组(165个周期)、GnRHa超短方案组(171个周期),比较3组患者的基本资料及临床结局。结果:GnRH-a长方案组的h CG日LH水平低于拮抗剂方案组和GnRH-a超短方案组,GnRH-a长方案组的Gn时间最长,获卵数、2PN受精数、2PN卵裂数、优质胚胎数及冷冻数最多(P0.05);GnRH-a超短方案组的Gn用量最多,2PN受精数、2PN卵裂数最少(P0.05)。3组的h CG日子宫内膜厚度、新鲜周期胚胎移植数、周期取消率、早期流产率、活产率比较,差异均无统计学意义(P0.05);胚胎种植率及临床妊娠率:GnRH-a长方案组最高,GnRH-a超短方案组最低,两组比较差异有统计学意义(P0.05)。结论:对于卵巢储备功能相对较好的高龄患者,GnRH-a长方案具有较好的临床结局;对于卵巢储备较差者,拮抗剂方案Gn用量相对少,临床结局尚可,是一种可选择的比较经济的方案。     

安宫黄体酮降调节在40岁以上高龄妇女体外受精中的应用价值

目的:探讨安宫黄体酮(MPA)降调在40岁以上高龄妇女体外受精中的应用价值。方法:回顾分析2014年6月~2015年12月在解放军第105医院生殖中心实施体外受精/卵胞质内单精子显微授精(IVF/ICSI)治疗的40岁以上女性患者的临床资料,其中69例采用MPA垂体降调节(A组),126例采用GnRH-a短方案者(B组),并对A组中36例(A1组)前一周期采用其他促排方案因无可移植胚胎或胚胎移植后未孕者(A2组)进行自身对照观察,比较两组及A组自身对照的促排卵及IVF结局。结果:A组与B组的Gn用量和天数、HCG日≥14mm卵泡数、HCG日E_2及LH水平、获卵数、成熟卵率、受精率、卵裂率、优质胚胎率、可利用胚胎数、取卵周期取消率、无可利用胚胎周期取消率均无统计学差异(P0.05);A组出现早发LH峰比例为4.35%,显著低于B组(15.87%)(P0.05)。A1组的成熟卵率及优质胚胎率(84.17%vs 68.82%)均显著高于A2组(71.03 vs 44.78%)(P0.05),早发LH峰率则显著低于A2组(0 vs 33.33%)(P0.05)。结论:MPA降调节能有效降低40岁以上女性超促排卵过程中早发LH峰发生率,获得更多的成熟卵数及优质胚胎,为高龄患者提供了一个简便、经济、高效,患者依从性好的垂体降调方案。     

诱发日内源性孕酮升高对PCOS患者的IVF/ICSI临床结局的影响

目的:在高孕激素超促排卵(progestin-primed ovarian stimulation,PPOS)及全胚胎冷冻移植的背景下,探讨诱发排卵日内源性孕酮(P)水平与多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者体外受精/卵胞质内单精子显微注射(IVF/ICSI)临床结局的关系。方法:回顾性纳入180例PCOS患者行IVF/ICSI-冻融胚胎移植(FET)的资料,所有患者均采用促性腺激素(gonadtropin,Gn)联合孕激素的超促排卵方案,取卵后全部胚胎冷冻,择期行FET,根据诱发排卵日P水平分为A组(P1.0μg/L,n=125)和B组(P≥1.0μg/L,n=55),比较两组患者的促排卵结局和妊娠结局。结果:A组与B组的Gn总用量(1950.8±384.5 IU vs 1931.2±308.9 IU)及周期治疗时间(11.2±1.4 d vs 11.1±1.1 d)均无统计学差异(P0.05)。A组诱发日直径14 mm卵泡数(14.1±7.7 vs21.0±10.3)、获卵数(14.0±7.8 vs 24.1±10.3)、成熟卵数(12.1±7.1 vs 21.1±9.0)、正常受精卵数(9.8±6.1 vs 16.8±8.2)及冷冻胚胎数(5.3±3.6 vs 7.2±3.4)均较B组低,且差异均具有统计学意义。成熟卵率、正常受精卵率、周期取消率、临床妊娠率及种植率组间均无统计学差异(P0.05)。结论:在FET的前提下,高孕激素超促排卵过程中诱发日内源性P水平的升高提示卵巢反应良好,对PCOS患者的IVF/ICSI临床结局无明显影响。     

全部胚胎冷冻对不同促排卵方案患者临床应用的探讨

目的分析不同超促排卵方案新鲜胚胎移植和冻融胚胎移植的临床妊娠结局,探讨全部胚胎冷冻技术在临床应用中的价值。方法回顾性分析行胚胎移植的525个周期患者的临床资料,其中253个周期为新鲜胚胎移植周期,272个周期为同期的复苏胚胎移植周期。纳入的促排卵方案包括促性腺激素释放激素激动剂(GnRH-a)长方案组(A组)和GnRH-a短方案组(B组)。分别比较两组中新鲜胚胎移植和冻融胚胎移植(FET)的妊娠结局,以及新鲜胚胎移植周期和复苏胚胎移植周期中2种方案妊娠结局。结果 A组中,新鲜胚胎移植周期(A1组)和FET周期(A2组)的临床妊娠率分别为45.95%和47.71%(P0.05);B组中,新鲜胚胎移植周期(B1组)和FET(B2组)的临床妊娠率分别为27.94%和46.30%(P0.05);A1组和B1组的受精率和可用胚胎率组间无统计学差异(P0.05),A组的平均获卵数、临床妊娠率和胚胎种植率显著高于B组(P0.05);A2组和B2组的临床妊娠率和胚胎种植率均无统计学差异(P0.05)。结论 FET并不能显著改善长方案患者的临床妊娠结局,但可显著提高短方案组的临床妊娠率,提示短方案患者可考虑采用全部胚胎冷冻。     

Co-existent ovarian mucinous cystadenocarcinoma and ovarian choriocarcinoma

We present the case of a 63-year-old woman with an ovarian neoplasm in which mucinous cystadenocarcinoma and choriocarcinoma coexisted. Blood levels of β-hCG were elevated and bilateral ovarian stromal luteinization was seen. The rarity of this association and its clinical and pathologic implications are discussed. Received: 15 February 2001 / Accepted: 29 May 2001     

Influence of ovarian cysts during controlled ovarian hyperstimulation

BACKGROUND: The use of gonadotrophin-releasing hormone agonist and purified follicular stimulating hormone increases the incidence of ovarian cysts during in vitro fertilization-embryo transfer cycles. The aetiopathogenesis and the effects of ovarian cysts on controlled ovarian hyperstimulation is unclear; most authors observed no-detrimental influence of ovarian cysts in controlled ovarian hyperstimulation cycles for IVF. The aim of this study was the evaluation of the real incidence and effects of ovarian cysts during in vitro fertilization-embryo transfer cycles. METHODS: Design: retrospective study. Setting: reproductive medicine units. Patients: 130 women. Interventions: r-FSH--225 U.I. was administered to 130 women i.m. after a long protocol of down regulation with GnRH-a (Triptoreline 3.75). The drug administration was personalized on the basis of: pre-existent patients pathologies; E2 blood levels; ultrasound evaluation of the follicular development. Main outcome measures: E2 levels, number and quality of oocytes retrieved, fertilization rate, number of embryos developed, pregnancy rate. RESULTS: At the end of stimulation ovarian cyst was observed in eighteen cases. There was no difference, between the cycles with or without cysts, in the follicular development, number and quality of eggs retrieved, fertilization rate, number and quality of the transferred embryos, pregnancy and miscarriage rate. CONCLUSIONS: The conclusion is drawn that the incidence of ovarian cysts during COH can be reduced observing some simple rules like: to exclude from the stimulation protocols patients with follicles of more than 12 mm diameters as observed at the preliminary ultrasound control; to personalize the therapeutic regime with the pre-existent patients pathologies; ultrasound evaluation of the follicular development; determination of the E2 serum levels, every two days.     

Benign or malignant ovarian neoplasms and ovarian endometriomas

STUDY OBJECTIVE: To investigate clinical features and biologic behavior of ovarian cancer that might be closely related to endometrioma and/or endometriosis. DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: All 324 women who were operated for endometriomas and/or ovarian tumors 5 cm or greater in diameter between January 1988 and December 1997. INTERVENTION: One hundred twelve women underwent laparoscopic surgery and 212 had laparotomy. MEASUREMENTS AND MAIN RESULTS: All tissues were evaluated histologically. Clinical examinations including ultrasound and serum tumor makers were performed in all patients preoperatively. No malignancies were found at laparoscopic surgery (76 endometriomas, 36 ovarian tumors). The frequency of endometriosis in benign, borderline malignant, and malignant tumors was 9.7%, 12.5%, and 11.4%, respectively. Endometriosis was present most frequently (40%) in women with endometrioid adenocarcinoma. It was present in 81 patients with endometriomas and 25 with ovarian neoplasms. Of these, nine women (8.5%) had malignant tumors, including borderline malignancy. Among patients with malignant tumors, those without endometriosis were significantly older (mean +/- SD age 54.9 +/- 16.2 yrs) than those with endometriosis elsewhere in the pelvis (45.9 +/- 8.9 yrs). CONCLUSION: Endometriosis may be closely related to ovarian tumors such as endometrioid adenocarcinoma. Surgeons should be aware of this possibility, and candidates for laparoscopic surgery should be carefully selected based on preoperative evaluations.     

原发性卵巢功能不全与卵巢早衰的病因学研究进展

目前,卵巢早衰(premature ovarian failure,POF)是被广泛接受和应用的专业术语,通常是指女性40岁之前闭经,伴有高卵泡刺激素(FSH)和低雌激素水平.由于临床治疗很棘手,如何预防和预测POF的发生风险,成为临床医生关注的焦点.尽管在POF发病机制的探讨中,染色体结构或数目异常、自身免疫功能、医源性及环境等相关因素与POF发病的相关性研究已取得很大进展,但仍有部分POF患者的病因不清,称为"特发性POF".     

Genetic alterations in ovarian borderline tumours and ovarian carcinomas

OBJECTIVE: To evaluate the benefits associated with routine uterine curettage following complete second trimester termination of pregnancy by extraovular prostaglandin E2. STUDY DESIGN: Fifty-five patients between 15 and 24 weeks' gestation who had undergone complete termination of pregnancy by continuous extraovular instillation of prostaglandin E2 (PGE2), were randomly assigned into either no further intervention (n=25), or uterine curettage under general anesthesia (n=30). The need for late uterine curettage, clinical and ultrasonographic parameters at 1 and 42 days follow-up, as well as the incidence of the minor and major complications, were compared between groups. RESULTS: Baseline and post-abortion clinical and ultrasonographic characteristics were similar in both groups. Mean (+/- Standard error of the mean) number of post-abortion bleeding days in the curettage group was 8.9+/-1.8 versus 10.1+/-2.6 days in the non-curettage group (P=NS). No patient in the former group, compared to three patients in the latter group, needed late uterine curettage, (P=NS). Major and minor complications rates in the curettage and in the no-curettage groups were not significantly different. Considerably more patients in the curettage group needed analgesic agents following the abortion compared to the no-curettage group (60% vs. 3.3%, respectively; P<0.001). CONCLUSIONS: Routine uterine curettage in patients undergoing complete second trimester termination of pregnancy by extraovular instillation of PGE2, exerts no benefit.     

A case of primary ovarian adenomyoma mimicking ovarian malignancy

Adenomyoma is a benign tumor composed of smooth muscle and benign endometrium. These tumors typically originate within the uterus. An extrauterine adenomyoma is an extremely rare entity. After an extensive literature search, only four cases of primary ovarian adenomyoma appear to have thus far been reported. Here, we report a case of ovarian adenomyoma in a 39-year-old woman mimicking malignant neoplasma of the ovary, along with a brief literature review.     

卵巢储备功能与卵巢反应性评估

辅助生殖技术（ART）的成功率依赖于正确的卵巢刺激方案,而卵巢刺激方案的决定依靠准确的卵巢储备功能和卵巢反应性的评估,主要包括年龄、基础性激素水平、基础窦卵泡数（AFC）、抗苗勒管激素（AMH）等,但是目前尚无能够独立评价卵巢储备功能和卵巢反应性的特异性标志物,仍需联合应用评估。