促性腺激素释放激素激动剂超短方案在超促排卵中的应用

目的：探讨促性腺激素释放激素激动剂（ＧｎＲＨ－ａ）超短方案在促排卵中的作用。方法：以采用克罗米芬联合人绒毛膜促性腺激素（ＣＣ／ｈＣＧ组，５０个周期、３１例），及克罗米芬联合人绝经期促性腺激素、绒毛膜促性腺激素（ＣＣ／ｈＭＧ／ｈＣＧ组，１６个周期、１６例）方案者为对照，对比ＧｎＲＨ－ａ超短方案联合人绝经期促性腺激素、绒毛膜促性腺激素方案者（ＧｎＲＨ－ａ超短方案／ｈＭＧ／ｈＣＧ组，１５个周期、１５例）ｈＣＧ注射日激素水平、优势卵泡个数、子宫内膜厚度、宫颈评分及妊娠率。ＧｎＲＨ－ａ超短方案／ｈＭＧ／ｈＣＧ组全部来自采用ＣＣ助孕失败或采用ＣＣ／ｈＭＧ／ｈＣＧ方案显示卵巢反应性差的患者。结果：ＣＣ／ｈＭＧ／ｈＣＧ组有３例（１８．８％）发生过早黄素化。ＧｎＲＨ－ａ超短方案／ｈＭＧ／ｈＣＧ组ｈＣＧ注射日血清黄体生成素（ＬＨ）水平明显低于对照组，其优势卵泡个数、子宫内膜厚度及宫颈评分都明显高于对照组，差异均具有显著性（Ｐ＜０．０５）。３组周期妊娠率相近。结论：ＧｎＲＨ－ａ超短方案／ｈＭＧ／ｈＣＧ方案为一种较好的促超排卵方案，对ＣＣ助孕失败及ＣＣ／ｈＭＧ／ｈＣＧ方案卵巢反应性差的患者仍有较好的效果。     

促性腺激素释放激素激动剂在多囊卵巢综合征促排卵高危周期中的应用

目的探讨促性腺激素释放激素激动剂（ＧｎＲＨａ）代替ｈＣＧ在多囊卵巢综合征（ＰＣＯＳ）中诱发排卵治疗的效果及并发症。方法对采用绝经期促性腺激素或卵泡刺激素促排卵治疗的１４例ＰＣＯＳ患者（１８个周期）,于卵泡≥１８ｍｍ时给予ＧｎＲＨａ,观测血清雌二醇（Ｅ２）水平、排卵率、妊娠率、卵巢过度刺激综合征（ＯＨＳＳ）和多胎妊娠发生情况。结果１４例１８个治疗周期给予ＧｎＲＨａ日血清Ｅ２为（８３７９±２９５８）ｐｍｏｌ／Ｌ,周期排卵率和妊娠率分别为８３３％和２２２％。中度ＯＨＳＳ和多胎妊娠各１例。结论在ＰＣＯＳ不孕患者中以ＧｎＲＨａ代替ｈＣＧ具有相似的排卵率和妊娠率,但能明显降低ＯＨＳＳ发生率,减少多胎妊娠。     

经阴道配子输卵管内移植42例临床分析

目的开展经阴道配子输卵管内移植（ｔｒａｎｓｖａｇｉｎａｌｇａｍｅｔｅｉｎｔｒａｆａｌｏｐｉａｎｔｒａｎｓｆｅｒ,ＴＶＧＩＦＴ）技术并探讨其实用价值。方法１９９６年５月至１９９７年１０月,对证实至少有一条以上输卵管正常的不孕患者４２例（４３个周期）,采用卵泡刺激素、绝经期促性腺激素、人绒毛膜促性腺激素（ＦＳＨｈＭＧ／ｈＣＧ）及ｈＭＧ／ｈＣＧ超排卵方案,经阴道穿刺取卵,改良上游法处理精液,以ＪａｎｓｅｎＡｎｄｅｒｓｅｎ输卵管导管系统行ＴＶＧＩＦＴ,平均移植卵子（４．０±０．９）个／周期。结果输卵管插管成功率６７．４％（２９／４３）,临床妊娠１３例,双胎５例,周期妊娠率３０．２％（１３／４３）;９例分娩（出生婴儿１３个）,４例流产。结论ＴＶＧＩＦＴ适用于至少一侧输卵管通畅的不孕患者,技术简便,易于掌握,无需开腹及腔镜操作,有较高的妊娠成功率,值得开展推广     

GnRH-a超短周期联合hMG方案与CC/hMG及单独hMG方案的比较

目前,促排卵药广泛地应用于排卵障碍性不孕症以及其他原因不孕的各种助孕技术。其中,各种促性腺激素释放激素激动剂（ＧｎＲＨ－ａ）联合人绝经期促性腺激素（ｈＭＧ）方案现已广泛应用于临床,为各大生殖医学中心所采纳。ＧｎＲＨ－ａ超短周期由于其疗程短,监测次数少...     

卵巢储备的预测

卵巢储备与生殖潜能的关系愈来愈受到重视。对卵巢储备的预测技术主要有基础ＦＳＨ、氯Ｄｉ酚胺（ＣＣ）兴奋试验和促性腺激素释放激素增效剂（ＧｎＲＨ－ａ）刺激试验。前二种研究的开展相对较早而深入，当结果异常时，预测卵巢储备低下的价值较高，尤以ＣＣ兴奋试验的敏感性更高。但结果正常时的预测价值下降，需要同时考虑年龄因素对生殖潜能的影响。ＧｎＲＨ－ａ刺激试验的研究仅限于对ＧｎＲＨ－ａ加ＦＳＨ和ＨＭＧ超促排卵方案     

体外受精周期中应用长效促性腺激素释放激素激动剂治疗多囊卵巢综合征

目的：观察长效促性腺激素释放激素激动剂（ＧｎＲＨ－ａ）治疗多囊卵巢综合征（ＰＣＯＳ）的疗效。方法：在体外受精－胚胎移植（ＩＶＦ－ＥＴ）周期中，应用长效ＧｎＲＨ－ａ（ｄｅｃａｐｅｐｔｙｌ，Ｆｅｒｉｎｇ）及促性腺激素（Ｇｎ）治疗２６例顽固性ＰＣＯＳ患者（Ｄｅｃａｐｅｐｔｙｌ组），并与其中前次常规ＩＶＦ－ＥＴ方案治疗的１９例（非Ｄｅｃａｐｅｐｔｙｌ组）进行比较。结果：（１）Ｄｅｃａｐｅｐｔｙｌ组受精率和妊娠率分别为７６．２％和３８．５％，明显高于非Ｄｅｃａｐｅｐｔｙｌ组（Ｐ＜０．０５）。（２）Ｄｅｃａｐｅｐｔｙｌ组用药２周后，子宫内膜厚度及卵巢面积明显缩小，用药第４周时，达最小值。（３）Ｄｅｃａｐｅｐｔｙｌ组黄体生成素（ＬＨ）、促卵泡激素、睾酮、雌二醇在用药１周后开始下降，至用药第４周达早卵泡期水平。结论：对在应用常规ＩＶＦ－ＥＴ周期或外源性促性腺激素治疗过程中，发生卵巢过度刺激综合征或过早ＬＨ峰，以及使用外源性Ｇｎ６个周期无受孕的ＰＣＯＳ患者，长效ＧｎＲＨ－ａ联合Ｇｎ超排卵，是较好的方案。     

GnRH—a超短周期联合HMG方案在促排卵中的应用

促性腺激素释放激素激动剂（ＧｎＲＨ－ａ）超短周期联合人绝经期促性腺激素（ＨＭＧ）方案可抑制内源性黄体生成素（ＬＨ）峰值，降低周期取消率，提高卵细胞采集率，受精率及妊娠率。     

促卵泡激素低剂量缓增方案治疗耐氯米芬多囊卵巢综合征？…

目的 评估促卵泡激素（ＦＳＨ）低剂量缓增方案治疗多囊卵巢综合征（ＰＣＯＳ）耐氯米芬（ＣＣ）无排卵不孕症的有效性和安全性。方法 对９例耐ＣＣ的ＰＣＯＳ不孕症患者,进行１０个周期低剂量ＦＳＨ缓增方案促排卵治疗,采用尿ＦＳＨ（Ｍｅｔｒｏｄｉｎ）或基因重组人ＦＳＨ（Ｇｏｎａｌ－Ｆ）治疗各５个周期。以阴道Ｂ超和血雌二醇（Ｅ２）水平作为监测卵泡发育的指标。结果 除１例因多卵泡发育、卵泡持续不长而中止外,余周期     

小剂量生长激素在体外受精超排卵周期中的作用

在体外受精－胚胎移植（ＩＶＦ－ＥＴ）超排卵周期中，对反应差的不育妇女２７例采用促性腺激紊释放激素激动剂（ＧｎＲＨ－ａ）／小剂量重组人生长激奈（ＧＨ）结合人绝经期促性腺激奈（ｈＭＧ）／人绒毛膜促性腺激素（ｈＣＧ）进行超排卵１２例（ＧＨ组），与采用ＧｎＲＨ－ａ／ｈＭＧ／ｈＣＧ的１５例（对照组）进行比较。结果表明，ＧＨ能促进卵母细胞成熟，提高受精率，增加移植胚胎数，明显提高妊娠率。但未能影响卵泡的招募及诱发排卵所需ｈＭＧ的剂量和用药时间。血清胰岛素样生长因子Ｉ（ＩＧＦ－Ｉ）的水平在使用ＧＨ期间从１５０±４４ｎｇ／ｍｌ升达２２２±６ｎｇ／ｍｌ（Ｐ＜０．０１），而对照组无类似变化。证实小剂量ＧＨ在体外受精超排卵周期中的使用是有效的。     

连续3次体外受精周期中的卵巢反应

为评估连续体外受精 (ＩＶＦ)周期中的卵巢反应 ,作者对 1 995年 1月至 1 998年 1 2月间连续接受 3次ＩＶＦ周期的不孕症患者进行回顾性研究。所有研究对象使用长方案 ,于黄体期开始促性腺激素释放激素兴奋剂 (ＧｎＲＨ ａ)进行垂体脱敏。达到脱敏状态后 ,应用尿促卵泡素 (ＦＳＨ)或绝经期促性腺激素 (ＨＭＧ)。结合患者年龄 ,早卵泡期血清ＦＳＨ水平以及先前对卵巢刺激的反应等 ,ＦＳＨ的起始量为 75～ 60 0ＩＵ。同时连续Ｂ超和血清雌二醇 (Ｅ2 )测定监测卵泡生长 ,根据卵泡反应调整ＦＳＨ剂量。当Ｂ超提示 2或3个优势卵泡直径达 1 6ｍｍ…     

Tubal catheterization for intrafallopian insemination and transvaginal gamete (GIFT) or zygote intrafallopian transfer (ZIFT): Our experience in a total of 1128 treatment cycles

Purpose Our purpose was to increase the number of fertile spermatozoa at the natural site of fertilization by retrograde tubal insemination (TV-IFI; transvaginal intrafallopian insemination) and also to perform transvaginal GIFT or ZIFT (TV-GIFT or TV-ZIFT) avoiding the laparoscopic procedure, especially in selected high-risk cases.Results The method was used in a total of 1128 treatment cycles (948 for TV-IFI and 180 for TV-GIFT or TV-ZIFT). TV-IFI was possible in 882 of the 948 cycles, resulting in 108 clinical pregnancies (12.24%). The remaining 66, due to bilateral tubal catheterization failure (6.9%), underwent intrauterine insemination (IUI) instead. Bilateral TV-IFI gave better results than unilateral, while combination with IUI did not seem to improve the outcome. Of the 180 cycles prepared for TV-GIFT or ZIFT the procedure was completed in 166, resulting in 24 clinical pregnancies (19% per patient and 14.45% per cycle). Due to bilateral tubal catheterization failure (8.2%) in the remaining 14 cycles (9 patients), IVF-ET was employed as an alternative.Conclusion Simple and cost-effective TV-IFI may achieve a reasonable pregnancy rate, justifying its application in cases with previously failed IUI and before entering the IVF program. On the other hand, TV-GIFT or ZIFT, although less effective than the classical laparoscopic approach and IVF-ET, is worth pursuing, considering its safety and the minimal surgical intervention without anesthesia, and especially in selected highsurgical risk and obese patients.     

Vaginal gamete intrafallopian transfer. Experience with 14 cases

A procedure utilizing transvaginal aspiration of stimulated gametes followed by transcervical, ultrasound-guided catheterization of the tubal ostia was performed as a modification of the standardized gamete intrafallopian transfer (GIFT) technique. Among 14 patients with 16 cycles there were four normal, intrauterine pregnancies and one ectopic pregnancy. In two patients the beta-human gonadotropin level rose significantly and then started to fall; the patients aborted spontaneously. The procedure can be performed with a higher degree of patient acceptance than can traditional GIFT, and the success rate in this small series was promising.     

Gamete intrafallopian transfer by hysteroscopy as an alternative treatment for infertility

OBJECTIVE: To evaluate efficacy and safety of the hysteroscopic cannulation by flexible catheter of the fallopian tubes for gamete intrafallopian transfer (GIFT). DESIGN: We studied the pregnancy rate (PR) and the safety of this new technique. SETTING: All patients were enlisted for GIFT at our Reproductive Medicine Unit. PATIENTS: We treated 26 patients whose infertility causes were terminal tubal damage, male factors, unexplained factors, and endometriosis. Patients with uterine tubal ostia unsuitable for gamete transfer or cervical incontinence were not included in the group. INTERVENTIONS: The patients underwent ovulation induction and oocyte retrieval by transvaginal ultrasonically guided puncture. The gamete transfers were carried out by hysteroscopic procedure using a flexible catheter put through the operating channel. MAIN OUTCOME MEASURE: The efficacy was evaluated by the PR (25.9%). RESULTS: Seven clinical pregnancies were obtained, but two patients aborted during the first weeks of pregnancy. No ectopic pregnancies were observed. CONCLUSIONS: Our results indicate that hysteroscopic GIFT is an alternative, safe, effective, and not invasive technique for fertility problems.     

X线下模拟逆行经阴道输卵管插管过程对TV-GIFT插管可靠性的评估

目的 :对在X线下模拟逆行经阴道输卵管插管过程对TV -GIFT插管的可靠性进行评估。方法 :采用KJITS - 50 0 0导管对不孕症 2 1例 (模拟组 ) ,在X线透视下模拟TV -GIFT输卵管插管过程 ,根据荧屏显示金属导丝及注入造影剂判断插管是否成功 ,并与 30例TV -GIFT(TV -GIFT组 )中的判断指标及插管成功率进行比较。结果 :X线下证实经阴道输卵管插管成功率为 4 2 .86% ( 19/ 2 1) ,与采用同类导管行TV -GIFT的插管成功率 ( 70 % ,2 1/ 30 )相比差异无显著性 (P >0 .0 5) ;TV -GIFT过程中置植入管有无阻力 ,导管标记位置是否正确 ,患者感觉及植入管有无扭曲 4项指标与X线下的结果显著相关 ,其中置植入管有无阻力与X线下结果的符合率最高。结论 :TV -GIFT过程中经阴道输卵管插管切实可行 ,但插管成功率有待提高 ;判断插管成功与否的几项指标基本可靠。     

Zygote intrafallopian transfer as a treatment for nontubal infertility: a 2-year study

Zygote intrafallopian transfer (ZIFT) was used as a treatment for long-standing nontubal infertility for a 2-year period. The overall clinical pregnancy rate for 114 tubal transfers was 40.4% with a delivery/ongoing rate of 34.2%. Concurrent use of in vitro fertilization and embryo transfer (IVF-ET) for tubal factor infertility gave significantly lower clinical pregnancy and delivery/ongoing rates (21.1% and 15.8%, respectively). The use of gamete intrafallopian transfer (GIFT) for nontubal infertility yielded a 32% clinical pregnancy rate and a 26% delivery rate for 53 transfers. Zygote intrafallopian transfer resulted in an implantation rate per zygote of 17% overall compared with 8.1% per embryo for IVF-ET and 11.2% per oocyte for GIFT. The transfer of three zygotes per patient gave the same clinical pregnancy rate as the transfer of four while reducing the incidence of multiple gestation from 19% to 7.8% per transfer. No significant decline in the clinical pregnancy or delivery rate was seen with ZIFT in women aged 25 through 39.     

Zygote intrafallopian transfer in patients with tubal factor infertility after repeated failure of implantation with in vitro fertilization-embryo transfer

OBJECTIVE: To evaluate the efficacy of zygote intrafallopian transfer (ZIFT) in terms of implantation and pregnancy rates in patients with tubal factor infertility and repeated implantation failure in IVF-ET cycles. DESIGN: Retrospective analysis of ZIFT cycles. SETTING: An IVF unit in a university hospital. PATIENT(S): Criteria for patient selection for ZIFT included at least four failures of implantation in IVF-ET cycles in which at least 3 embryos were replaced per transfer and a cause of infertility diagnosed as male, unexplained, or tubal factor with proof of one patient tube. INTERVENTION(S): Four to six zygotes were transferred by laparoscopy into the fallopian tube 24-26 hours after oocyte retrieval. MAIN OUTCOME MEASURE(S): Implantation and pregnancy rates were determined in 112 ZIFT cycles performed in 81 patients with repeated failure of implantation. Results were further stratified for patients with tubal factor (n = 15) and patients without tubal factor (n = 66). RESULT(S): The pregnancy and implantation rates for all ZIFT cycles were 35.1% and 11.1%, respectively. Pregnancy and implantation rates per cycle in patients with tubal factor versus patients without tubal factor were 26.6% versus 37.1% and 9.4% versus 11.4%, respectively. CONCLUSION(S): ZIFT can be considered as a mode of treatment for patients with repeated failure of implantation in IVF-ET and with tubal factor with proved patency of one tube.     

Tubal embryo transfer for the treatment of infertility.

The outcome of treatment for male factor infertility with either gamete intrafallopian transfer (GIFT) or in vitro fertilization and embryo transfer (IVF/ET) has been unsatisfactory. A better approach may be tubal embryo transfer (TET). In our medical center, from November 1989 to December 1990, 80 couples (male factor, n = 35, non-male factor, n = 45) entered our program for TET. Superovulation was conducted with either human menopausal gonadotropins (hMG) or gonadotropin-releasing hormone agonist (GnRH-a, buserelin)/hMG. Ovum retrieval (OR) was possible in 73 patients and successful fertilization after insemination occurred in 64 of them. TET was performed only when there was at least one grade III-V embryo. The mean number of embryos transferred was 3.92 +/- 0.13 (range 1-5). There were 35 pregnancies out of 55 TET (64% per TET, 48% per OR). In the group with male factor infertility, OR occurred in 32, and 24 achieved fertilization. Ten pregnancies were achieved after 19 TET (53% per TET, 31% per OR). In comparison, the group with non-male factor infertility had a higher pregnancy rate (69% per TET and 61% per OR). There have been 15 live births, 14 ongoing pregnancies (eight sets of twins and 21 singletons), five abortions and one ectopic pregnancy. Our results indicate that: 1) TET is a valuable treatment for non-tubal factor infertility; and 2) in the group with male factor infertility, it has the advantages of demonstrating fertilization in vitro and preventing unrewarding laparoscopies.     

Assisted procreation in the presence of a positive direct mixed antiglobulin reaction test

Twenty-five infertile couples in which the male had antisperm antibodies were treated by in vitro fertilization (IVF), zygote intrafallopian transfer, or gamete intrafallopian transfer in 38 cycles. In 10 females a tubal pathology was present, and in the normal female patients repeated intrauterine insemination with husband sperm had failed. The presence of an andrological factor in 17 male patients did not influence the fertilization and the cleavage of the retrieved oocytes. Although the fertilization rate of 45.8% was significantly lower than in patients with tubal pathology, the pregnancy rate was 34.2% per started cycle and 44.8% per replacement. Furthermore, the embryos were of lesser quality than in couples with tubal and idiopathic infertility. This study suggests that IVF could be considered as a useful therapeutic approach for couples with a positive direct mixed antiglobulin reaction test before advising them the use of heterologous sperm.     

Relationship between the timing of hysterosalpingography before gamete intrafallopian transfer and the subsequent fertility outcome

AIM: To investigate the prognostic significance of hysterosalpingography carried out before one-sided gamete intrafallopian transfer for unexplained infertility. METHODS: Fifty-nine first gamete intrafallopian transfer cycles in 59 couples with unexplained infertility were evaluated in two groups: 30 women with a hysterosalpingogram carried out 1-6 months prior to gamete intrafallopian transfer procedure combined with diagnostic laparoscopy, and 29 women with a hysterosalpingogram carried out during any other interval up to 2 years. The outcome measures were biochemical pregnancy, clinical pregnancy, miscarriage, preterm delivery, and term delivery. Groups were compared using Student's t-test and chi-squared tests. Logistic regression was used to predict the effects of hysterosalpingography on subsequent fertility outcomes. RESULTS: Univariate analysis yielded no significant differences across groups regarding the baseline characteristics and outcome measures. When confounding factors were controlled, carrying out hysterosalpingography at some time before 6 months of gamete intrafallopian transfer was associated with 5.2- and 3.4-fold increased clinical pregnancy and term delivery rates, respectively. CONCLUSIONS: An additional hysterosalpingography at most 6 months prior to gamete intrafallopian transfer procedure might improve fertility prospects. This effect could be attributed to proper selection of the fallopian tube for cannulation during transfer or some therapeutic effect of hysterosalpingography.