体外受精-胚胎移植治疗不孕症85例报道

目的：评价应用体外受精－胚胎移植（ＩＶＦ－ＥＴ）治疗８５例不孕患者的临床结果。方法：用药方案有：①ＧｎＲＨａ／ＦＳＨ／ｈＭＧ；②ＧｎＲＨａ／ＦＳＨ；③ＧｎＲＨａ／ｈＭＧ。培养液包括Ｅａｒｌｅ’ｓ平衡盐液及人类输卵管液（ＨＴＦ）。结果：８５例进行了１０９个ＩＶＦ周期治疗，１２个周期（１１０％）因反应不良而取消。每周期获取卵母细胞（１０２±５４）个，卵子受精率６８９％，卵裂率６０８％，每个转移胚胎植入率７７％（３１／４０２）。９４个移植周期中，每周期移植（４９±２４）个胚胎，获２０次临床妊娠（２１３％）。采用ＨＴＦ妊娠率为２２４％，高于应用Ｅａｒｌｅ’ｓ液的妊娠率（１８５％），但差异无统计学意义。２０次妊娠患者中，１次输卵管妊娠，４次自然流产（２０％），５例足月分娩，１０例继续妊娠。多胎妊娠率４０％，重度ＯＨＳＳ发生率４１％。结论：ＩＶＦ－ＥＴ是治疗输卵管因素、子宫内膜异位症等不孕症的重要而有效的手段。体外培养时用ＨＴＦ可能优于Ｅａｒｌｅ’ｓ液，而有利于提高妊娠率。     

体外受精与胚胎移植中hCG注射前血孕酮水平与妊娠的关系

用ＧｎＲＨａ－ＦＳＨ－ｈＭＧ－ｈＣＧ方案控制性超排卵进行体外受精与胚胎移植（ＩＶＦ－ＥＴ）治疗７８例不孕患者，在ｈＣＧ注射前抽血用放射免疫法（ＲＩＡ）测孕酮（Ｐ）水平。初步了解ｈＣＧ注射时血孕酮水平与ＩＶＦ－ＥＴ结果的关系。结果，当Ｐ〈０．３５μｇ／Ｌ时９例中无１例妊娠，而０．３５≤Ｐ≤０．９μｇ／Ｌ组（５４例）与Ｐ〉０．９μｇ／Ｌ组（１５例）的妊娠率分别为２２．６％及２６．７％，但三组间无显著差     

胰岛素样生长因子-Ⅰ辅助促排卵的实验研究

目的探讨胰岛素样生长因子Ⅰ（ＩＧＦⅠ）辅助促排卵的作用。方法建立小白鼠排卵障碍动物模型,将排卵障碍性小白鼠分为３组,分别于每只小白鼠腹腔内一次性注射ＩＧＦⅠ１μｇ加人绝经期促性腺激素（ｈＭＧ）５ＩＵ（ＩＧＦⅠ加ｈＭＧ组）、ＩＧＦⅠ２μｇ（ＩＧＦⅠ组）和ｈＭＧ１０ＩＵ（ｈＭＧ组）,观察阴道脱落细胞涂片的周期性变化和输卵管内卵母细胞数。结果ＩＧＦⅠ加ｈＭＧ组、ＩＧＦⅠ组和ｈＭＧ组阴道脱落细胞涂片呈周期性变化者分别为８０％、２０％和６０％,ＩＧＦⅠ加ｈＭＧ组高于ＩＧＦⅠ组和ｈＭＧ组（Ｐ＜０．０１和Ｐ＜０．０５）,ＩＧＦⅠ组与ｈＭＧ组比较,差异无显著性（Ｐ＞０．０５）。输卵管内卵母细胞数,ＩＧＦⅠ加ｈＭＧ组平均为１２．３个,ｈＭＧ组平均为９．２个,两组比较,差异有显著性（Ｐ＜０．０５）。ＩＧＦⅠ组阴道脱落细胞呈周期性变化的小白鼠,输卵管内未见卵母细胞。结论ＩＧＦⅠ可作为辅助促排卵剂。     

体外受精—胚胎移植中影响临床妊娠的因素

目的 探讨体外受精－胚胎移植（ＩＶＦ－ＥＴ）中影响临床妊娠率的因素。方法 对１９９２年至１９９５年１１月因双侧输卵管梗阻而行ＩＶＦ－ＥＴ的５５９个周期的资料进行回顾性分析,应用计算机ＳＰＳＳ－ＰＣ－Ｖ３．０系统,进行单因素变异方差分析。 ５５９个周期总临床妊娠率为２１．６％。结核性输卵管梗阻占２８．４％,继发不孕中３４．９％有人工流产史。环境改变、阻塞原因不同及过去子宫内妊娠,不影响ＩＶＦ－ＥＴ成     

经阴道配子输卵管移植术──广西首例报道

经阴道配子输卵管转移术（ｔｒａｎｓｖａｇｉｎａｌ　ｇａｍｅｔｅｉｎｔｒａｆｏｌｌｏｐｉａｎｔｕｂｅ ｔｒａｎｓｆｅｒ，ＴＶ－ＧＩＦＴ）是配子输卵管内移植（ｇａｍｅｔｅ ｉｎｔｒａｆｏｌｌｏｐｉａｎｔｕｂｅ ｔｒａｎｓｆｅｒ，ＧＩＦＴ）中的方法之一。近几年来国内外学者采用此法治疗不孕症获得妊娠成功。该方法操作简便，但盲目插管成功率不高，且妊娠率尚有争议。我们选用此项技术治疗不孕症患者７例（８周期），２例临床妊娠，其１例已足月妊娠分娩，现报道如下。 资料与方法 一、研究对象 １９９８年３月至１９９８年１１…     

体外受精-胚胎移植中影响临床妊娠的因素——附559个周期分析

目的探讨体外受精胚胎移植（ＩＶＦＥＴ）中影响临床妊娠率的因素。方法对１９９２年至１９９５年１１月因双侧输卵管梗阻而行ＩＶＦＥＴ的５５９个周期的资料进行回顾性分析，应用计算机ＳＰＳＰＣＶ３０系统，进行单因素变异方差分析。结果５９个周期总临床妊娠率为２１６％。结核性输卵管梗阻占２８４％，继发不孕中３４９％有人工流产史。环境改变、阻塞原因不同及过去子宫内妊娠，不影响ＩＶＦＥＴ成功率。当移植胚胎数增加到５个时，临床妊娠率最高，为３２５％。累积胚胎评分或胚胎质量与临床妊娠率明显有关。结论移植胚胎数及其质量，是影响临床妊娠成功的重要因素，同时应注意预防高序多胎妊娠发生，并对胚胎存活潜力及子宫接受力作进一步研究。     

体外受精-胚胎移植周期中黄体期血清性激素水平与妊娠率的关系

目的探讨体外受精－胚胎移植（ＩＶＦ－ＥＴ）周期中黄体期血清性激素水平的变化及与妊娠率的关系。方法随机选取６２个采用卵泡刺激素／绝经期促性腺激素／绒毛膜促性腺激素（ＦＳＨ／ｈＭＧ／ｈＣＧ）促超排卵的ＩＶＦ－ＥＴ周期（６２例患者）,采用放射免疫测定技术,测定其自然周期与促超排卵周期中黄体期血清雌二醇（Ｅ２）、孕酮（Ｐ）、催乳素（ＰＲＬ）水平,观察其妊娠情况。结果促超排卵周期中黄体期血清性激素水平明显高于自然周期（Ｐ＜０．０５）。补充黄体酮者的Ｐ、Ｐ／Ｅ２值,明显高于未补充黄体酮者（Ｐ＜０．０５）。临床妊娠者的Ｅ２水平明显低于未妊娠者,而Ｐ／Ｅ２、ＰＲＬ值明显高于未妊娠者（Ｐ＜０．０５）,并且当Ｐ／Ｅ２值为３００～４００、ＰＲＬ值为６０～１００μｇ／Ｌ时妊娠率最高。结论ＩＶＦ－ＥＴ周期中黄体期血清性激素水平对妊娠有影响,其中Ｅ２、Ｐ协同发挥作用,ＰＲＬ在一定范围内有利于胚胎着床。在ＩＶＦ－ＥＴ中应适当补充黄体酮,调节性激素至最适水平,可提高临床妊娠率     

联合应用克罗米酚和hMG促超排卵与宫腔内人工授精助孕成功因素分析

近年,应用药物促超排卵或药物促超排卵联合宫腔内人工授精（ｉｎｔｒａｕｔｅｒｉｎｅ　ｉｎｓｅｍｉｎａｔｉｏｎ,ＩＵＩ）［１－３］、体外受精－胚胎移植（ｉｎ　ｖｉｔｒｏ　ｆｅｒｔｉｌｉｚａｔｉｏｎ－ｅｍｂｒｙｏ　ｔｒａｎｓｆｅｒ　, ＩＶＦ－ ＥＴ）和配子输卵管内移植（gamate intrafallopian transfer, GIFT）治疗不孕症,提高了临床妊娠率（clinial pregnancy rate, CPR）。鉴于后两者手术复杂,费用昂贵,对输卵管通畅的不孕症患者,我们采用ＣＣ／ｈＭＧ／ＩＵＩ和ｈＭＧ／ＩＵＩ两种方案助孕,并对两种不同精液处理…     

尿促黄体生成激素峰与体外受精—胚胎移植结局的探讨

从１９９１年６月１日至１９９２年７月３０日，因输卵管因素造成不孕而进行体外受精－胚胎移植（ＩＶＦ－ＥＴ）共１５０个周期。经用克罗米酚及促性腺激系促超排卵，其中４１个周期（２７．３３％）于注射人绒毛膜促性腺激素（ｈＣＧ）前，尿中出现促黄体生成激素（ＬＨ）峰（ＬＨ＞４０ＩＵ／Ｌ），１６个周期（１０．６７％）表现为ＬＨ升高（ＬＨ＝４０ＩＵ／Ｌ），９３个周期（６２．００％）无ＬＨ峰（ＬＨ＜４０ＩＵ／Ｌ）。     

尿促黄体生成激素峰与体外受精－胚胎移植结局的探讨

从１９９１年６月１日至１９９２年７月３０日，因输卵管因素造成不孕而进行体外受精－胚胎移植（ＩＶＦ－ＥＴ）共１５０个周期。经用克罗米酚及促性腺激素促超排卵，其中４１个周期（２７．３３％）于注射人绒毛膜促性腺激素（ｈＣＧ）前，尿中出现促黄体生成激素（ＬＨＭ）峰（ＬＨ＞４０ＩＵ／Ｌ），１６个周期（１０．６７％）表现为ＬＨ升高（ＬＨ＝４０ＩＵ／Ｌ），９３个周期（６２．００％）无ＬＨ峰（ＬＨ＜４０ＩＵ／Ｌ）。三组所获得的平均卵子数无明显差异。在有ＬＨ峰的周期中，卵裂率明显低于无峰周期，其临床妊娠率低于无ＬＨ峰者，两者比较差异无显著性。说明在注射ｈＣＧ前，尿中出现ＬＨ峰影响卵子质量，从而将影响受精卵的分裂，可导致临床妊娠率下降。     

促排卵周期PCOS妇女子宫内膜纤维粘连蛋白及层粘连蛋白的表达

目的:了解促排卵药物氯米酚(CC)、hMG及GnRH-a对黄体中期子宫内膜内膜纤维粘连 蛋白(FN)及层粘连蛋白(LN)表达的影响。方法:应用单克隆抗体,采用免疫组织化学技术检测50 例正常妇女自然周期以及50例正常妇女,45例多囊卵巢综合征妇女应用CC／hCG,CC／hMG／hCG 及GnRH-a／hMG／hCG方案促排卵治疗后黄体中期子宫内膜FN和LN的表达。结果:子宫内膜FN 和LN表达在正常妇女自然周期着床窗口时呈现强阳性;而CC、hMG抑制FN和LN的表达,使 其阳性强度减弱,有显著性统计学差异P<0．01;GnRH-a对FN和LN抑制不明显。同时妊娠者较 未妊娠者FN和LN表达强度高。结论:CC／hCG及CC／hMG／hCG方案促排卵后黄体中期子宫内膜 中FN和LN表达下降或缺失,内膜容受性下降,妊娠率降低。     

Initial experience with a modification of the follicle aspiration, sperm injection, and assisted rupture technique

OBJECTIVE: To establish cycle fecundity with a modification of the follicle aspiration, sperm injection, and assisted rupture (FASIAR) technique. DESIGN: Prospective, observational study. SETTING: University and health maintenance organization-based infertility centers. PATIENT(s): Infertile couples were enrolled from our professional practices. All patients were 16-18 mm in diameter by transvaginal ultrasonography. A modified FASIAR procedure was performed 22 to 28 hours after hCG injection. MAIN OUTCOME MEASURE(s): Clinical pregnancy rate. RESULT(s): No clinical pregnancies were observed with the modified FASIAR technique. CONCLUSION(s): The FASIAR technique is still an attractive and economical technique. Our modification of the FASIAR technique, however, resulted in a suboptimal cycle fecundity.     

Dose of human menopausal gonadotropin influences the outcome of an in vitro fertilization program

This study compares outcomes of in vitro fertilization (IVF) in two groups of 57 patients when either 2 (group 1) or 3 (group 2) ampules of human menopausal gonadotropin (hMG) were administered daily. Treatment began on day 3 of the cycle and was discontinued when at least 2 follicles attained diameters greater than or equal to 1.5 cm. Human chorionic gonadotropin (hCG) was given either 24 or 48 hours after the last dose of hMG. Although serum estradiol levels were lower in group 1, the average number of oocytes retrieved (3.2 versus 2.9), fertilized (1.9 versus 2.0), and cleaved (1.7 versus 1.8) per completed cycle did not differ between groups 1 and 2. Likewise, the number of oocytes that fertilized abnormally was similar in both groups (0.5 versus 0.3/cycle). However, the number of atretic oocytes (0.03 versus 0.5/cycle) and the percent of oocytes recovered from the cul-de-sac (0 versus 7.2%) were significantly (P less than 0.05) lower in group 1. In group 1, administration of hCG 48 hours after the last dose of hMG was associated with a higher number of cleaving embryos (2.1 versus 1.5/cycle) and a higher pregnancy rate (34.8 versus 14.7%; P less than 0.05) when compared with injection at 24 hours. In group 2, the interval between hMG and hCG did not influence these results. Together, the associations between fewer oocytes that were atretic or recovered from the cul-de-sac, and a trend toward a higher pregnancy rate, suggest that follicular recruitment with 2 ampules of hMG is more appropriate than 3 ampules in an IVF program.     

超声下未成熟卵泡抽吸术治疗多囊卵巢综合征不孕的临床研究

目的　探讨超声下未成熟卵泡抽吸术(IMFA)对多囊卵巢综合征(PCOS)不孕患者卵巢窦卵泡计数及其内分泌功能的影响;观察IMFA后,应用人绝经期促性腺激素(hMG)促排卵治疗的效果、妊娠及并发症情况。方法　将71例PCOS不孕患者随机分为两组。组Ⅰ: 37例,穿刺前用少量hMG促排卵; 组Ⅱ: 34例,不用任何促排卵药物。在阴道超声引导下进行IMFA,检查穿刺后第2个周期患者的内分泌功能和卵巢基础窦卵泡计数,可连续2~3个周期进行穿刺。随后2组均用hMG常规促排卵治疗,随访其排卵及妊娠情况。结果　组Ⅰ进行了88个周期的穿刺治疗,经过2~3次穿刺后,睾酮水平、黄体生成素(LH )与卵泡刺激素(FSH)的比值均明显降低,与治疗前比较,差异有统计学意义(P<0. 01), 33例(89%, 33 /38)患者基础窦卵泡计数降至10个/卵巢以下。组Ⅱ进行了87个周期治疗,所有患者睾酮水平均显著降低,与治疗前比较,差异有统计学意义(P<0 01 ); 30例LH/FSH<2, 28例(82%, 28 /34)患者基础窦卵泡计数降到10个/卵巢以下。在IMFA之后, 诱发排卵时hMG用量组Ⅰ为(21±6)支,组Ⅱ(23±10)支,两组比较,差异无统计学意义(P>0 .05),在注射人绒毛膜促性腺激素(hCG)后均出现排卵, 组Ⅱ有2例发生轻度卵巢过度刺激综合征(OHSS)。连续促排卵治疗1 ~3个月后, 共36例(51% )     

In vitro fertilization and embryo replacement at the department of obstetrics and gynecology,University of Kiel,F.R.G.

From July 1982 until September 1983, 194 pelviscopies were performed in Kiel (phase I). The patients were stimulated either with Clomidlhuman menopausal gonadotropin (hMG)/human chorionic ganadotropin (hCG) or with Clomid/hCG or hMG/hCG alone. Follicular maturation was monitored by ultrasonography and the daily measured E₂ and luteinizing hormone (LH) response. Surgic therapeutical pelviscopy with follicular puncture followed 36 hr after hCG application. Oocytes were incubated in either Ham's F-10 or Menezo B₂ medium in an automatically gas-controlled exsiccator. Forty-eight hours after insemination normal-looking four- to eight-cell embryos were replaced into the uterine cavity. Oocytes were successfully collected in 87.4% of the patients, with an average of 2.2 oocytes per patient. Eighteen pregnancies resulted of 101 embryo replacements. The overall pregnancy rate was 16.2% per replacement and 9.3% per pelviscopy. Undivided oocytes and polyploid embryos were analyzed cytogenetically. From October 1983 to October 1984 the overall pregnancy rate after 144 pelviscopies and 88 embryo replacements (phase II) improved to 23.9% per replacement and 14.6% per pelviscopy.     

An increased initial follicle-stimulating hormone/luteinizing hormone ratio does not affect ovarian responses and the outcomes of in vitro fertilization

The tenet that a combination of human follicle-stimulating hormone (hFSH)/human menopausal gonadotropin (hMG) improves follicular recruitment was assessed by randomly treating ovulatory women either with hFSH/hMG on days 3 and 4 of the cycle followed by two ampules of hMG daily or with a constant daily dose of 2 ampules of hMG. Estradiol (E2) levels on the day of human chorionic gonadotropin (hCG) and the mean number of mature, immature and atretic oocytes per cycle did not differ between the two groups. Likewise, fertilization, cleavage, and pregnancy rates were similar for the two treatments. When daily hormone levels were compared in 11 patients during two successive treatment cycles with both stimulation protocols, the temporal pattern of FSH accumulation was repeated in both cycles, but FSH levels were significantly higher when patients received hFSH/hMG. Nevertheless, during both cycles, E2 reached similar peak levels and the mean number of follicles per cycle on the day of hCG administration was not different. We conclude that routine use of hFSH/hMG does not improve the success of an in vitro fertilization (IVF) program and that higher FSH levels do not change the individuality of ovarian response in the same woman.     

Ovarian stimulation with gonadotropin-releasing hormone (GnRH) analogue improves the in vitro fertilization (IVF) pregnancy rate with both transvaginal and laparoscopic oocyte recovery

The relative impact of ovarian stimulation protocal and oocyte retrieval technique on success rates of in vitro fertilization program was studied in 200 patients. Sixty-three patients received gonadotropin-releasing hormone analogue (GnRHa) with human menopausal gonadotropin (hMG), and 137 received hMG only. The GnRHa+ hMG protocol resulted in higher pregnancy rates than the hMG-only protocol (19.0 vs 9.5%, respectively; P<0.01) despite a lower cleavage rate. Oocyte retrieval was performed via laparoscopy in 100 patients and transvaginally in 100 patients. The number of oocytes recovered per cycle was 6.1±3.9 with laparoscopy and 7.0±3.1 transvaginally. Pregnancy rates were similar for both retrieval techniques (13 and 12%, respectively). A breakdown of these results showed that the advantage for the GnRHa+hMG protocol was not affected by the oocyte retrieval technique. A comparison of simultaneous blood and follicular fluid pH measured every 10 min during laparoscopy and transvaginal oocyte recovery revealed a constant decline in follicular fluid pH during laparoscopy, while no changes were observed during the vaginal procedure. We conclude that the improvement in in vitro fertilization results during the period of our study is due primarily to the introduction of GnRHa+hMG protocol rather than the method of oocyte retrieval.     

Sequential clomiphene citrate/hMG versus hMG for ovulation induction in clomiphene citrate-resistant women

Objective

This study was designed to compare sequential clomiphene citrate/hMG regimen to hMG regimen for ovulation induction in clomiphene citrate-resistant women.

Study design

A comparative prospective study.

Patients and methods

Ninety infertile women were randomized to receive either sequential CC/hMG regimen (45 women) or low-dose step-up protocol of hMG (45 women). All participants had received at least six consecutive cycles of clomiphene citrate for ovulation induction within the last year before inclusion in this study, but they did not conceive. The CC/hMG regimen group received clomiphene citrate 100 mg/day for 5 days, followed by hMG 75 IU for 4 days. The hMG group received low-dose step-up protocol for 10–14 days. To detect the number and size of the follicles, TVS was done on cycle day 8 and repeated daily or every other day according to follicular development. When one to three follicles reached a diameter ≥18 mm, hCG injection was scheduled. Before hCG injection, the E2 level and endometrial thickness were evaluated. β-hCG levels were measured on cycle day 22.

Results

There was no significant difference between the two studied groups regarding the demographic data, sperm parameters, and day 3 FSH, LH and estradiol. Also, there was no significant difference between the two studied groups regarding endometrial thickness, number of mature follicles, peak of E2 before hCG injection and number of cases that developed ovarian cyst or OHSS. The dose of gonadotropins used was significantly low in the CC/hMG group compared to the hMG group (295.2 ± 75.5 vs. 625.3 ± 65.0, respectively), and the pregnancy rate was significantly high in the CC/hMG group compared to the hMG group [12 (26.7 %) vs. 3 (6.7 %), respectively, p < 0.05].

Conclusion

The sequential CC/hMG regimen is as effective as hMG regimen for ovulation induction, produces satisfactory pregnancy results and reduces the treatment cost.     

Ovulation induction with human menopausal gonadotropins--a changing scene

The aim of human menopausal gonadotropin treatment (hMG), to simulate normal follicular development by injecting FSH and LH and induce follicular rupture with hCG, is rarely met. Multiple follicular development occurs because hypothalamic-pituitary feedback is bypassed. This, exacerbated by the long half-life of hCG, causes the principal complications of hMG therapy--multiple pregnancy and hyperstimulation. The initial use of hMG in pituitary deficiency has been widened to include failure to respond to clomiphene, polycystic ovaries, 'unexplained infertility' and in vitro fertilization. Reported pregnancy rates, incidence of hyperstimulation and of multiple pregnancy vary widely. We reviewed the results of hMG therapy from 1977 to 1989 in 260 consecutive women with clomiphene-resistant infertility. Conception and live birth rates after six treatment cycles were 45.7% and 43.3%, respectively and were influenced by the cause of infertility, age, weight and sperm parameters. The miscarriage rate was 18.6% and multiple pregnancy rate 19.3%. The conception rate fell during the 12-year period in all groups except those with regular anovulatory cycles. Over this period, age, weight and male subfertility increased in patients referred to us. hMG is an effective and safe treatment for women with clomiphene-resistant infertility and patent tubes.     

Fallopian tube sperm perfusion versus intrauterine insemination in unexplained infertility: a randomized, prospective, cross-over trial

OBJECTIVE: To compare the results of fallopian tube sperm perfusion (FSP) versus standard intrauterine insemination (IUI) in patients with unexplained infertility undergoing controlled ovarian hyperstimulation (COH). DESIGN: Randomized, prospective, cross-over study. SETTING: Reproductive medicine unit of a university hospital. PATIENT(S): Fifty-six couples with unexplained infertility. INTERVENTION(S): COH was induced by recombinant FSH and monitored by serial transvaginal ultrasound. On the day of hCG administration during the first treatment cycle, patients were randomized to either IUI or FSP. Thereafter, in case no pregnancy was achieved, patients went on being treated with FSP and IUI in alternate cycles. A maximum of four treatment cycles per couple was performed. FSP was performed using a pediatric Foley's catheter inseminating 4 mL of sperm-enriched suspension; a Kremer-Delafontaine catheter delivering 0.5 mL of sperm suspension was used for IUI. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate per cycle. RESULT(S): One hundred twenty-seven cycles (58 FSP, 69 IUI) were performed. The clinical pregnancy rate per cycle was 21.7% for IUI and 8.6% for FSP, respectively. No major adverse effects were recorded for either technique. CONCLUSION(S): After COH, FSP is less effective than IUI in couples with unexplained infertility.