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。     

微刺激促排卵在IVF/ICSI卵巢低反应患者中的应用

目的:探讨微刺激促排卵在IVF/ICSI卵巢低反应患者中的应用。方法:回顾性分析进行IVF/ICSI助孕的卵巢低反应患者共114个周期,根据用药情况分为3组:A组(来曲唑组,34个周期),B组(克罗米芬组,41个周期),C组(短方案组,39个周期)。比较3组患者的一般情况、Gn使用天数及总量、IVF相关指标及助孕结局。结果:①年龄、体质量指数(BMI)、不孕年限、基础内分泌水平组间比较均无统计学差异(P>0.05)。②A组Gn使用天数及总量、hCG注射日E2水平、优质胚胎率低于C组(P<0.05);hCG注射日LH水平、提前排卵率高于C组(P<0.05);平均获卵数、受精率、卵裂率、着床率、临床妊娠率A组与C组间比较均无统计学差异(P>0.05)。③B组Gn使用天数及总量、hCG注射日E2水平、平均获卵数、卵裂率均低于C组(P<0.05);hCG注射日LH水平高于C组(P<0.05);提前排卵率、受精率、优质胚胎率、着床率、临床妊娠率B组与C组间均无统计学差异(P>0.05)。④B组Gn使用天数及总量高于A组(P<0.05);其余相关指标组间比较均无统计学差异(P>0.05)。结论:微刺激方案可以获得与GnRH-a短方案相近的临床效果,同时降低Gn使用总量,减轻患者单周期治疗费用,是卵巢储备功能低下患者较理想的促排卵方案。     

卵巢储备正常人群拮抗剂方案促排卵添加来曲唑的应用

目的:探讨卵巢储备正常人群拮抗剂方案联合来曲唑促排卵的效果.方法:回顾性分析2015年1月至2019年10月于中山大学附属第六医院生殖医学研究中心行第1次或第2次促排卵周期,月经周期25～35天,年龄在22～38岁,抗苗勒管激素(AMH)1.1～3.6 ng/ml,促卵泡生成素(FSH)＜10 U/L,窦卵泡数量(AF...     

GnRH-a长方案和GnRH-ant方案在高龄患者IVF-ET中应用效果的比较

目的比较高龄患者应用促性腺激素释放激素激动剂（GnRH-a）长方案和促性腺激素释放激素拮抗剂（GnRH-ant）方案行体外受精-胚胎移植（in vitro fertilization-embryo transfer,IVF-ET）的疗效,探讨适合高龄患者控制性卵巢刺激的方案。方法回顾性分析2007年1月至2010年6月156例高生育年龄（35～40岁）不孕症女性在南方医科大学南方医院生殖医学中心行IVF-ET的临床资料,评估GnRH-a长方案和GnRH-ant方案的助孕效果。结果 GnRH-a长方案组和GnRH-ant方案组患者的促性腺激素（Gn）应用总量及hCG日孕激素（P）水平比较,差异无统计学意义（P〉0.05）;但两组在Gn应用时间、hCG日雌二醇（E2）水平、hCG日子宫内膜厚度、获卵数、成熟卵子数、受精数和2PN数比较,差异有统计学意义（P〈0.01）;同时,两组的hCG日黄体生成素（LH）水平比较,差异有统计学意义（P〈0.05）;GnRH-a长方案组的临床妊娠率和着床率显著高于GnRH-ant方案组（P〈0.001）。结论高生育年龄患者IVF-ET中应用GnRH-a长方案的助孕结局优于GnRH-ant方案。     

在GnRH拮抗剂方案中添加来曲唑对卵巢储备功能低下者体外受精-胚胎移植结局的影响

目的:探讨在促性腺激素释放激素(GnRH)拮抗剂方案中添加来曲唑(LZ),对卵巢储备功能低下者体外受精-胚胎移植(IVF-ET)结局的影响.方法:回顾性分析63个应用LZ结合小剂量促性腺激素(Gn)的IVF周期(Gn+ LZ组)和177个单纯应用大剂量Gn的IVF周期(Gn组)的临床结局.Gn+ LZ组在月经周期第2～6天给予LZ 5 mg/d,于月经周期第5天开始加用Gn 150～ 225 U/d.Gn组在月经周期第2天开始应用Gn 300 ～ 450 U/d.两组均在月经周期的第7天开始给予醋酸西曲瑞克(思则凯)0.25 mg/d,直至HCG日.结果:Gn+ LZ组的周期取消率显著高于Gn组(P=0.005),获卵数显著低于Gn组(P=0.000),但着床率显著高于Gn组(P =0.006).两组的妊娠率、临床妊娠率和继续妊娠率差异无统计学意义(P＞0.05).Gn+LZ组的Gn用量显著低于Gn组(P =0.000).结论:卵巢储备功能低下者在拮抗剂方案中添加LZ可以改善着床率,妊娠结局与应用单纯大剂量Gn相似,同时减少了患者Gn的用量.     

两种不同超促排卵方案在高龄患者中应用的比较

随着辅助生殖技术如体外受精-胚胎移植(IVF-ET)、卵母细胞浆内单精子显微注射(ICSI)等在治疗不孕不育中的应用,越来越多的不育夫妇得以生育.但是,高龄患者如何获得高质量、多数量的卵子和优质胚胎,进一步提高临床妊娠率,仍是生殖医学工作者关注的焦点.本研究通过对用两种超促排卵方案的136例高龄患者进行分析,比较了两者的Gn用药天数、剂量、获卵数、优质胚胎率及临床妊娠率,以探讨高龄患者的最佳超促排卵方案.     

来曲唑预防取卵术后卵巢过度刺激综合征的临床效果研究

目的:探讨卵巢过度刺激综合征(OHSS)高危人群在取卵术后,口服来曲唑预防OHSS发生的临床效果。方法:回顾性分析厦门市妇幼保健院2011年11月至2016年5月行体外受精-胚胎移植(IVF-ET)助孕,使用(GnRH-a)长方案或超长方案超促排卵,因预防OHSS取消移植,行全胚冷冻患者621例,按照是否于取卵术后口服来曲唑分为两组。一组于取卵术后未口服来曲唑(对照组),共298例;另一组于取卵术后口服来曲唑(研究组),共323例。对比两种方案患者助孕情况和OHSS的发生率、中重度OHSS的发生率。结果:研究组323例患者中OHSS的发生率为15.17%,显著低于对照组(P0.05)。研究组中重度OHSS的发生率为4.64%,也显著低于对照组(P0.05)。研究组促性腺激素(Gn)总量、Gn总天数、HCG日的雌二醇(E2)、黄体生成激素(LH)、孕酮(P)和获卵数与对照组比较差异无统计学意义(P0.05)。结论:来曲唑可以更好地降低高危人群在取卵术后OHSS的发生率及中重度OHSS的发生率。临床上可以考虑将来曲唑作为预防OHSS的药物使用。     

短方案和微刺激方案在卵巢低反应助孕患者中的应用研究

目的探讨卵巢低反应助孕患者在进行体外受精-胚胎移植（IVF-ET）治疗中微刺激方案和短方案的应用价值。方法将2009年1月至2010年12月首次在江西省妇幼保健院生殖中心接受IVF/ICSI-ET治疗并预测卵巢低反应的121例患者分为微刺激方案（57例,微刺激组）和短方案（64例,短方案）组。比较两组的周期取消率、hCG注射日子宫内膜厚度、血LH、E2、P水平,以及平均获卵数、MⅡ卵率、着床率和临床妊娠率。结果微刺激组的周期取消率高于短方案组,差异有统计学意义（P〈0.05）。微刺激组Gn天数低于短方案组,微刺激组hCG日LH值高于短方案组,差异均有统计学意义（P〈0.01）。微刺激组hCG日P值高于短方案组,但差异无统计学意义（P〉0.05）。微刺激组hCG日E2值、子宫内膜厚度和获卵数均低于短方案组,差异有统计学意义（P〈0.05）。微刺激组MⅡ卵率和临床妊娠率低于短方案组,着床率高于短方案组,但差异均无统计学意义（P〉0.05）。结论微刺激方案是卵巢低反应患者较理想的促排卵方案。     

高剂量来曲唑在卵巢低反应患者微刺激方案中的临床观察#br#

Objective?To explore the clinical application value of high-dose letrozole in poor ovarian response(POR) patients during mild ovarian stimulation protocols receiving IVF/ICSI. Methods?A retrospective analysis was performed on 102 patients with POR treated with letrozole mild ovarian stimulation in IVF/ICSI at our reproductive Center from January 2016 to December 2018. The high-dose letrozole group (7.5 mg/d×5 d) was the high-dose group (n=50), and the conventional letrozole group (5 mg/d×5 d) was the conventional dose group (n=52). Results?The age and basal FSH of the high-dose group were higher than those of the conventional dose group (P<0.05), and the number of sinus follicles (AFC) in the high-dose group was significantly lower than that in the conventional dose group (P<0.05). The time of use of gonadotropin (Gn) in high dose group was shorter than that in conventional dose group (P<0.05), the daily serum E2 level of human chorionic gonadotropin (hCG) was significantly decreased (P<0.05), the egg number was lower than that in conventional dose group, but the egg MⅡrate was significantly higher than that in conventional dose group (P<0.05). The clinical pregnancy rate and live birth rate per fresh transplant cycle increased in the high-dose group [55.56% vs 50%; 55.56% vs 37.5%], but the difference was not statistically significant compared with the conventional dose group (P>0.05). Conclusion?For POR patients receiving ART, high-dose letrozole with mild ovarian stimulation protocol can improve the clinical pregnancy outcome of POR patients to some extent without obvious adverse reactions, especially for POR patients with poor ovarian reserve, which may benefit from improving oocyte quality and high MII rate suggesting improved follicle quality.     

不同促排卵方案在卵巢低反应患者中的应用

目的:探讨不同促排卵方案在接受体外受精-胚胎移植(IVF-ET)的卵巢低反应患者中的应用价值。方法:对87例卵巢低反应患者采用不同方案进行IVF/ICSI-ET共200个周期的临床资料进行回顾性分析,其中短方案者50个周期(A组),拮抗剂方案者39个周期(B组),微刺激方案者93个周期(C组),自然周期方案者18个周期(D组)。比较分析各组的促排卵结局。结果:4组间周期取消率无统计学差异,hCG注射日LH水平A组低于其他3组,E2水平高于其他3组,与C、D组比有统计学差异(P<0.05),优势卵泡数及平均获卵数D组低于其他3组,而正常受精率高于其他3组,与A、B组比有统计学差异(P<0.05),hCG注射日内膜厚度、P值、MⅡ卵率、可利用胚胎率、临床妊娠率C组临床妊娠率略高,但各组间差异均无统计学意义(P>0.05)。结论:对卵巢低反应患者微刺激方案在IVF-ET促排卵中相对其他方案有更好的临床效果。     

Human chorionic gonadotropin serum levels following ovulation triggering and IVF cycle outcome

Purpose

The clinical significance of serum hCG levels after ovulation triggering was studied previously with conflicting results. Our aim was to study the correlation of hCG levels on the day after ovulation triggering using recombinant hCG (r-hCG) with treatment outcome.

Methods

A prospective observational study of all fresh IVF/ICSI cycles in a single medical center, between January 2015 and June 2016, was performed. hCG serum levels were obtained 10–12 h following ovulation triggering with 250 mcg r-hCG. Clinical and laboratory outcome parameters were compared between cycles with serum hCG above and below median level. A multivariate regression analysis was performed in order to study the association between hCG levels and live birth rate, after controlling for confounders.

Results

Overall, 326 cycles were included. Median serum hCG level was 91.35 IU/L. hCG levels were lower as age and BMI were higher (p?=?0.004, p?<?0.001, respectively). The study groups did not differ with regard to clinical pregnancy rate (p?=?0.14), live birth rate (p?=?0.09), fertilization rate (p?=?0.45), or metaphase II oocyte rate (p?=?0.68). On multivariate regression analysis, hCG level was not associated with live birth (aOR 0.99, 95% CI 0.98–1.005), after controlling for patient’s age and BMI.

Conclusions

hCG levels on the day after ovulation triggering with 250 mcg r-hCG are inversely correlated with patient age and BMI. However, they are not correlated with any clinical or laboratory outcome parameter. Therefore, testing for hCG levels after ovulation induction seems futile and cannot be recommended.

     

Comparison of mild stimulation and conventional stimulation in ART outcome

Purpose  

To provide a treatment for particular condition that is the most effective treatment with the least risk and cost for the patient we compared the efficacy of using clomiphene 100 mg + delayed low dose gonadotropin + flexible GnRH antagonist administration for ovarian stimulation protocol and GnRH agonist + gonadotropin for stimulation protocol in IVF outcome.     

The decrease of serum luteinizing hormone level by a gonadotropin-releasing hormone antagonist following the mild IVF stimulation protocol for IVF and its clinical outcome

Purpose While performing the mild ovarian stimulation protocol with a GnRH antagonist, the pregnancy rate was compared between the groups, which were divided by the degree that the luteinizing hormone (LH) level decreased. Materials and methods Patients aged 27 to 42years (36.1 ± 3.79) underwent 308 IVF cycles who opted for IVF via the mild ovarian stimulation protocol began clomiphene citrate on day 3 and recombinant FSH on day 5. A GnRH antagonist was administered when the dominant follicle reached 14mm. Serum LH was measured at the time of GnRH antagonist administration and at the time of hCG injection. The pregnancy rate and implantation rate were compared between 50 cycles in which the LH level dropped less than one-third and the control (LH level within 1/3). Result(s) The pregnancy rate for the group in which the LH level fell less than one third was 18%. Conversely, the pregnancy rate for the control group was 39%. The implantation rate was 18% for the less than one-third group and 26% for the control group. Both the pregnancy rate and the implantation rate for the group in which the LH level fell less than one-third were significantly lower than that of control (p < 0.02). Conslusion(s) When performing the mild ovarian stimulation protocol, serum LH should be followed. If the serum LH level is less than one-third at the time of hCG injection, both the pregnancy rate and implantation rate are significantly lower. Capsule If the serum LH level is less than one-third at the time of hCG injection, both the pregnancy rate and implantation rate are significantly lower following the Mild IVF stimulation protocol.     

两种短效曲普瑞林降调节方案诱发排卵效果比较

目的:比较两种剂量短效曲普瑞林降调节方案促排卵的效果。方法:将接受超促排卵降调节长方案的178例患者分为两组,A组86例,从前一月经周期的第21天始,每天皮下注射短效曲普瑞林0.1mg 10~21天降调节后,减量至0.05mg/d直至注射HCG日;B组92例,从前一月经周期第21天始隔日1次皮下注射短效曲普瑞林0.1mg 10~21天降调节后减量至0.05mg/d直至注射HCG日,比较两组的获卵率、优质胚胎、胚胎冷冻率、着床率、妊娠率、继续妊娠率、激素水平等。结果:A组获卵率、优质胚胎数、优质胚胎率、冻胚率较B组高(P<0.01);着床率、临床妊娠率、继续妊娠率A组较B组有增高趋势。结论:月经周期第21天始,皮下注射短效曲普瑞林0.1mg/d降调节效果最好。     

Clinical experience with an ovarian stimulation protocol for intrauterine insemination adopting a gonadotropin releasing hormone antagonist at low dose

Studies testing the effectiveness of GnRH antagonists in controlled ovarian stimulation (COS) for intrauterine insemination (IUI) have provided controversial results. The present study was undertaken to evaluate, whether the use of a half of the conventional dose of the GnRH antagonist cetrorelix can be effective in increasing the successful rate of IUI cycles. Patients started COS with human menopausal gonadotropin (hMG) on day three of the menstrual cycle. Cetrorelix was started when at least one follicle of ≥14?mm, was detected at the ultrasound scan, according to the flexible multiple daily dose protocol, and continued until the trigger day with recombinant hCG. Patients adopting GnRH antagonist at low dose had a pregnancy rate (21.7%) that was significantly higher (p?相似文献   

Comparison of mild and microdose GnRH agonist flare protocols on IVF outcome in poor responders

Purpose  

To compare the IVF outcome of clomiphene citrate/gonadotropin/antagonist (mild protocol) and microdose GnRH agonist flare protocols for poor responders undergoing in vitro fertilization.     

卵巢刺激周期促性腺激素用量对卵母细胞形态及临床结局的影响

目的:探讨卵巢刺激周期促性腺激素用量对卵母细胞形态及临床结局的影响。方法:将96个卵巢内单精子注射(ICSI)周期按促性腺激素用量分为高剂量组(>3375 IU)、中剂量组(2325~3375 IU)、低剂量组(<2325 IU),对1006个MⅡ期卵母细胞进行形态学(第一极体、卵周隙和卵浆形态)评估,比较各组卵母细胞形态、受精率、卵裂率、优质胚胎率和妊娠结局。结果:Gn高、中、低剂量组卵母细胞的Ⅲ~Ⅳ级极体形态发生率和卵周隙异常发生率间差异无统计学意义(P>0.05),高剂量组胞浆形态异常发生率明显高于低中剂量组(50.5%vs 35.8%、36.2%,P<0.05),高剂量组卵母细胞出现胞浆色深、粗颗粒的比例明显高于低中剂量组(27.1%vs 17.0%、18.1%,P<0.05)。高剂量组卵母细胞卵周隙内出现颗粒比例也明显高于低中剂量组(40.2%vs 17.5%、23.2%,P<0.01)。3组卵母细胞出现浆内空泡、浆内聚集体比例和相应受精率、卵裂率、优质胚胎率、临床妊娠率均较接近,差异无统计学意义(P>0.05),但高剂量组的流产率(50.0%)与低中剂量组(16.6%、12.0%)相比,有增加趋势。结论:卵巢刺激周期高促性腺激素用量(>3375 IU)可使卵母细胞出现较多的形态异常,主要是卵胞质颜色加深,有粗颗粒和卵周隙内颗粒,并有可能增加流产率。