精子质量和数量对体外受精率,卵裂率和卵裂胚胎的影响

目的观察精子质量和数量对体外受精－胚胎移植（ＩＶＦ－ＥＴ）的卵细胞受精、卵裂和卵裂胚胎的影响。方法观察常规ＩＶＦ－ＥＴ９２个周期的精液和授精精子的密度和活动力与孕卵细胞分裂的关系。结果对４８１个成熟卵及２７３个未成熟卵的观察表明,快速直线运动（ａ级）精子和快速非直线或慢速直线运动（ｂ级）精子的密度下降,使成熟卵和未成熟卵的细胞受精率和受精卵的卵裂率明显下降;ａ级和ｂ级精子的密度增高,可明显降低形态不良卵裂胚胎的比率。结论精子的密度和活动力对体外受精过程非常重要。     

丹那唑与激素治疗子宫内膜异位症对卵子发育的影响

文收集了接受体外受精－胚胎移植（ＩＶＦ－ＥＴ）的子宫内膜异位症患者３２例，包括曾经丹那唑治疗２１例（丹那唑组）和孕激素或ＧｎＲＨ类似物治疗１１例（激素组），并以因单纯输卵管疾病接受ＩＶＦ－ＥＴ者２１例作对照组，分析ＩＶＦ－ＥＴ的各项参数。结果：丹那唑组的ｈＣＧ注射前血清Ｅ２，卵泡直径＞１５ｍｍ卵泡数和卵子受精率显著低于对照组（Ｐ＜０．０５，Ｐ．＜０．０１和Ｐ＜０．０５），而激素组与对照组相比，差异均无显著性。提示丹那唑可能妨碍卵泡发育，降低卵子质量而影响卵子受精。对于拟接受助孕技术的子宫内膜异位症患者宜选用孕激素或ＧｎＲＨ类似物制剂治疗。     

人窦前卵泡的体外发育及其卵母细胞成熟过程的观察

目的探讨在体外培养条件下,人窦前卵泡发育及其卵母细胞成熟的可能性。方法建立适宜的体外培养环境,应用正交设计将不同剂量的人绝经期促性腺激素（ｈＭＧ）、卵泡液、表皮生长因子（ＥＧＦ）组合,作用于来自体外受精－胚胎移植（ＩＶＦ－ＥＴ）抽吸的卵泡液及冲洗液中获得的窦前卵泡。结果窦前卵泡于培养第６～１２天形成窦卵泡,培养２１～２８天时直径≥３００μｍ的卵泡数显著增多（Ｐ＜０．００５）,当以ｈＭＧ１５０ＩＵ／Ｌ、卵泡液４０％、ＥＧＦ６μｇ／Ｌ作用于卵泡时,卵母细胞排出率与再经培养后成熟率均达最高,分别为８３％和３８％（Ｐ＜０．００５）。结论在适宜的培养条件下,来自ＩＶＦ－ＥＴ病人的抽吸卵泡液的窦前卵泡在体外能够发育,且其卵母细胞可达到成熟,是一新的人卵来源。窦前卵泡的体外发育和体内不同     

人基因重组促卵泡生长激素与高纯度人尿促卵泡生长激素在控制性超排卵中的疗效比较

应用体外受精与胚胎移植助孕技术治疗不孕症 ,在全世界已广泛开展。为提高助孕技术的成功率 ,首先要选择一种最佳诱导排卵方案。目前 ,比较一致的看法是促卵泡生长激素 (ＦＳＨ)在促卵泡发育中起主导作用。本研究就人基因重组ＦＳＨ(ｒ ＦＳＨ)与高纯度人尿ＦＳＨ(ｕ ＦＳＨ ＨＰ)在控制性超排卵中的效果进行分析研究。一、资料与方法1.研究对象 :1998年 6月至 1999年 5月 ,在本研究所进行体外受精 胚胎移植 /单精子卵细胞浆内显微注射授精(ＩＶＦ/ＩＣＳＩ)助孕的不孕症患者 115例 :(1)年龄 2 3～ 37岁 ;(2 )具有正常的排卵和月经周期 ;(3…     

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     

影响体外受精-胚胎移植妊娠的相关因素分析

近年来 ,虽然行体外受精 (ＩＶＦ)或卵母细胞浆内单精子注射 (ＩＣＳＩ)受精与胚胎移植 (ＥＴ) (ＩＶＦ/ＩＣＳＩ ＥＴ)后的临床妊娠率已有较大幅度的提高 ,但由于患者自身情况和操作技术等因素的影响 ,仍有较大比例的ＩＶＦ/ＩＣＳＩ ＥＴ未能妊娠成功。本研究对有关临床和实验资料进行综合分析 ,寻找影响ＩＶＦ/ＩＣＳＩ ＥＴ妊娠的临床相关因素。一、资料和方法1 研究对象 :研究对象为 2 0 0 0年 2月～ 2 0 0 1年 1月在本中心完成ＩＶＦ/ＩＣＳＩ ＥＴ治疗的患者 887例 ,共进行 947个周期的治疗。2 临床资料收集 :对 887例患者按本中心…     

配子赠送在体外受精—胚胎移植中的应用

本文报道２例配子赠送体外受精－胚胎移植（ＩＶＦ－ＥＴ）妊娠成功，并分娩正常婴儿。１例染色体异常，１例丈夫染色体异常。２例均有反复流产史。本文对这２例染色体平衡易位者形成配子的情况进行讨论，说明这２例为获得健康后代都有应用赠送配子的必要性。同时，赠送卵子必须应用ＩＶＦ－ＥＴ技术，其中１例赠送精子应用ＩＶＦ－ＥＴ技术，是因其他助孕技术屡次失败。     

经皮穿刺附睾吸取精子卵浆内注射受精治疗不育

本文应用经皮穿刺附睾吸精子（ｐｅｒｃｕｔａｎｅｏｕｓｅｐｉｄｉｄｙｍａｌｓｐｅｒｍａｓｐｉｒａｔｉｏｎ，ＰＥＳＡ）经卵细胞浆内显微注射技术（ｉｎｔｒａｃｙｔｏｐｌａｓｍｉｃｓｐｅｒｍｉｎｊｅｃｔｉｏｎ，ＩＣＳＩ），对因精道不通致不育的８对夫妇进行治疗。按ＩＶＦ常规促超排卵方案及阴道Ｂ超取卵，共８个周期。ＰＥＳＡ有３例为输精管绝育术后吻合失败者，５例为先天双侧输精管缺如（ＣＢＡＶＤ），吸出精子活率１～８０％，精子密度２～８２×１０６／ｍｌ，共获６９个成熟卵母细胞，ＩＣＳＩ后７个卵子损伤，６２个存活，其中可见２原核正常受精的５０个，正常受精率为８０．６４％，至１９９８年８月已有５例妊娠，临床妊娠率为６２．５％，出生１例健康男婴，发育正常。结果显示，ＰＥＳＡ结合ＩＣＳＩ技术治疗精道不通不育，是一种有效的治疗方法。     

促超排卵周期胰岛素样生长因子—1对人卵泡发育的调控

目的：探讨促超排卵周期胰岛素样生长因子－１（ＩＧＦ－１）对人卵泡发育的调控。方法：采用放射免疫法检测体外受精－胚胎移植（ＩＶＦ－ＥＴ）患者体液（１３例用药前血清、３８例卵泡液及同期血清）中ＩＧＦ－１及性激素的含量；采用原位杂交技术检测５例在ＩＶＦ周期得到的颗粒细胞上ＩＧＦ－１及其受体（ＩＧＦ－１Ｒ）的表达。结果：（１）促超排卵过程中血清ＩＧＦ－１含量显著增高（Ｐ＜０．００１），其在卵泡液内的平均含量低于同期血清中水平（Ｐ＜０．０５），且与卵泡发育数之间呈负相关关系（Ｐ＜０．０１）；在卵泡发育数少于３个的卵巢低反应型患者中，卵泡液水平接近同期血清水平。（２）卵泡液内ＩＧＦ－１与卵泡刺激素（ＦＳＨ）、同期末梢血清中ＩＧＦ－１与雌二醇（Ｅ２）呈显著的负相关（Ｐ＜０．０１）。（３）颗粒细胞上存在ＩＧＦ－１Ｒ，但不能产生ＩＧＦ－１。结论：促超排卵药物作用后血清ＩＧＦ－１水平升高，并进入卵泡液内协同促性腺激素参与对卵泡发育的调控。     

体外培养24小时受精失败卵母细胞单精子显微注射再授精的观察

目的 探讨采用单精子显微注射（ＩＣＳＩ）技术处理体外培养２４ｈ后常规体外受精（ＩＶＦ）失败卵母细胞的效果。方法 对１９９７年６月至１９９８年１０月在我院生殖医学研究中心接受常规ＩＶＦ治疗的１７例非男性因素不育患者,采用常规超排卵方案治疗,经阴道Ｂ超介导取卵,共获卵１７９个,体外培养２４ｈ,所有卵母细胞在常规ＩＶＦ失败后,采用ＩＣＳＩ再授精。结果 共有１３０个卵母细胞常规ＩＶＦ失败后进行ＩＣＳＩ再授     

多囊卵巢综合征患者中未成熟卵母细胞体外培养成熟后体外受精的初步研究

目的:探讨未成熟卵母细胞体外培养成熟后体外受精、胚胎培养技术在多囊卵巢综合征患者中的初步应用及其影响因素。方法:用小剂量促性腺激素促使卵泡生长后,根据优势卵泡直径分为2组,直径6～8mm者为组1,10—12mm者为组2。采集未成熟卵母细胞,经体外培养成熟后,再进行体外授精和胚胎培养。结果:组1的GV期卵的成熟率和受精率低于组2者,但两组的MI期卵的成熟率、受精率没有明显差别。两组卵裂率没有明显差别,但形成胚胎的质量组2优于组1。总计成熟率69.3％,成熟卵中正常受精率61.5％。结论:可以用小荆量Gn促使卵泡生长后,采集未成熟卵,用体外成熟-体外授精(IVM/IVF)的方法使多囊卵巢患者在避免OHSS的情况下获得质量良好的胚胎。     

Relationships between polypronuclear fertilization and follicular fluid hormones in gonadotropin-treated women

Similar incidences of congenital abnormalities in in vitro fertilization and embryo transfer (IVF-ET) pregnancies and births in the general population have not supported earlier concerns that IVF may increase chromosomal aberrations. Nevertheless, polypronuclear fertilization is a common, undesirable, and poorly understood outcome of IVF. We evaluated hormone levels in 20 follicular fluids that were associated with mature oocytes that have fertilized abnormally (greater than or equal to pronuclei) and compared them to follicles with mature oocytes that cleaved normally, fertilized but failed to cleave, or did not fertilize. Progesterone (P), androstenedione, estradiol, percent free estradiol, sex hormone-binding globulin, insulin, and prolactin were measured. P levels were significantly higher in follicular fluids associated with oocytes that fertilized abnormally than in the other groups. Levels of the other hormones were similar in all the study groups. We conclude that IVF of oocytes from highly luteinized follicles as judged by P levels may result in polypronuclear fertilization.     

Correlation between human follicular diameter and oocyte outcomes in an ICSI program

Purpose: To determine the correlation between the follicular sizes and oocyte recovery, metaphase II oocyte recovery, fertilization rate and good embryo quality from mature and immature oocytes in an intracytoplasmic sperm injection (ICSI) program. Methods: 991 follicles obtained from 72 ICSI cycles were classified into three groups according to their diameters as measured by transvaginal ultrasound including group A (<10 mm), group B (10–14 mm), and group C (>14 mm). All obtained oocytes were classified according to their nuclear maturation: germinal vesicle (GV), metaphase I (MI) and metaphase II (MII). Mature oocytes underwent ICSI while immature oocytes were further cultured until maturity before ICSI was performed. The rates of fertilization and good quality embryos at day 3 were evaluated. Results: A progressive and significant increase in the rates of oocyte recovery and MII oocyte recovery were observed from group A follicles compared to the other groups (p < 0.001). The fertilization rate of mature and in vitro matured oocytes, as well as the rate of good quality embryos showed a tendency to increase from group A to group C follicles, but not significantly. The corresponding fertilization rates were 78 and 55.3% (p < 0.001) for mature and in vitro matured oocytes, respectively. Conclusion: Collection of oocytes from small follicles, especially with a mean diameter less than 10 mm, and in vitro maturation of immature oocytes before fertilization may allow the total number of good quality and transferable embryos to be increased.     

Increased fertilization and pregnancy rate in polypronuclear fertilization cycles in in vitro fertilization-embryo transfer.

OBJECTIVE: To compare fertilization and pregnancy rates between cycles with polypronuclear fertilizations and cycles with normal fertilizations. DESIGN: In vitro fertilization-embryo transfer (IVF-ET) cycles in which oocytes were retrieved were divided into two groups according to the nature of fertilization. PATIENTS: All patients were participants of our IVF-ET program. RESULTS: A significantly higher fertilization rate was found in the polypronuclear fertilization cycles (61% versus 36.6%) and also an improved pregnancy rate (47.5% versus 19.6%) and per embryo transfers (53% versus 28.8%). The vast majority of polypronuclear fertilizations occurred in mature oocytes. CONCLUSION: We believe that the increased receptability of the oocytes improves fertilization and conception rates. The polypronuclear fertilization is an extreme expression of such improved receptibility and should be considered as an encouraging sign for conception.     

人卵,受精卵及前期胚胎染色体初步分析

应用３６例妇女进行体外授精－胚胎移植研究淘汰的未受精卵，未分裂的受精卵及形态不好的前期胚胎，制成染色体标本４４个，进行染色体分析。结果：正常未受精卵标本１３个，染色体数目正常，卵母细胞处于第二次减数分裂中期，体外授精失败，结合病史分析，与精子质量和卵成熟度有关；异常未受精卵标本４个；正常卵受精标本７个，染色体数目正常的卵母细胞虽受精，但有的未抛出第二极体，精卵发育不同步；异常卵受精标本８个，染色体     

State of the art in in-vitro oocyte maturation

PURPOSE OF REVIEW: The recovery of immature oocytes followed by in-vitro maturation (IVM) and in-vitro fertilization is an attractive alternative to conventional in-vitro fertilization treatment in which controlled ovarian stimulation with gonadotropins is used to increase the number of available oocytes and embryos. Significant progress has been made to improve pregnancy and implantation rates from in-vitro matured oocytes. This review summarizes current knowledge and achievements in human oocyte in-vitro maturation for clinical application, and will highlight recent advances reported in in-vitro maturation treatment. RECENT FINDINGS: It has been demonstrated that priming of ovarian immature oocytes with follicle-stimulating hormone or human chorionic gonadotropin prior to immature oocyte retrieval improves oocyte maturation rates and embryo quality as well as pregnancy rates in infertile women with polycystic ovaries or polycystic ovary syndrome. The size of follicles may be important for the subsequent embryonic development, but the developmental competence of oocytes derived from the small antral follicles is not adversely affected by the presence of a dominant follicle. However oocyte maturation in vitro is profoundly affected by culture conditions. Currently more than 300 healthy infants have been born following immature oocyte retrieval and in-vitro maturation. In general, the clinical pregnancy and implantation rates have reached 30-35% and 10-15% respectively in infertile women with polycystic ovaries or polycystic ovary syndrome. SUMMARY: In-vitro maturation treatment can now be offered as a successful option to infertile women with polycystic ovaries or polycystic ovary syndrome. It is possible to combine natural cycle in-vitro fertilization with immature oocyte retrieval followed by in-vitro maturation, and thus offer women with various causes of infertility reasonable pregnancy and implantation rates without recourse to ovarian stimulation. Further research remains to be done to address the mechanism of oocyte maturation in order to refine culture conditions and improve the implantation rate of oocytes matured in vitro.     

Maturation of immature oocytes by coculture with granulosa cells

To increase the number of embryos available for transfer, immature human oocytes were cocultured with granulosa cells from preovulatory follicles. Greater numbers of immature oocytes incubated with granulosa cells had dispersion of the cumulus and corona cells compared with immature oocytes cultured in media alone. Fifty-four percent of immature oocytes were fertilized after coculture with granulosa cells compared with 20% fertilization of immature oocytes cultured without granulosa cells. There were no cases in which only embryos developed from immature oocytes were transferred, and thus we could not determine if the immature oocytes could contribute to a pregnancy.     

超排卵周期未成熟卵体外培养的研究

目的:研究来源于超排卵周期中的未成熟卵在拆除卵丘细胞后进行体外成熟培养(IVM)的成熟、受精及胚胎发育能力,探讨IVM技术的临床应用。方法:选取46名体外受精/卵胞浆内单精子显微注射-胚胎移植(IVF/ICSI-ET)患者为研究对象,比较MI和GV期不成熟卵的体外成熟情况,并比较体内成熟卵和体外成熟卵进行ICSI后的正常受精、异常受精、卵裂和优质胚胎形成情况。结果:体外培养中69.8%的MI期卵和77.2%的GV期卵均在24小时内达到成熟,其24小时和48小时的成熟率、总成熟率均无明显差异(P>0.05)。体外成熟卵与体内成熟卵相比较,正常受精率、异常受精率和卵裂率均无明显差异(P>0.05),优质胚胎形成率较低,差异有显著性(P<0.05)。结论:常规超排卵周期中的未成熟卵在拆除卵丘细胞后能够继续体外发育成熟,具有与体内成熟卵相似的ICSI受精、卵裂能力。虽然优质胚胎的形成率低于体内成熟卵,但增加了可移植胚胎和冷冻胚胎数量,提高了助孕成功率。     

单侧输卵管切除术对体外受精-胚胎移植周期卵巢反应性和结局的影响

目的:研究单侧输卵管切除术对体外受精-胚胎移植(IVF-ET)周期卵巢反应性和妊娠结局的影响。方法:以行IVF-ET单侧输卵管切除的106例不孕患者为研究组,同期双侧输卵管梗阻的患者360例为对照组,比较研究组输卵管切除后术侧和健侧超促排卵启动日卵巢的大小和窦卵泡数、hCG注射日卵巢的大小、≥12mm卵泡数和获卵数,同时比较研究组和对照组≥12mm卵泡数、获卵数、受精数、优质胚胎数以及Gn用量、用药天数、妊娠率。结果:研究组中术侧和健侧启动日卵巢的大小无显著性差异,然而超促排卵启动日窦卵泡数、hCG注射日双侧卵巢大小、≥12mm卵泡数和获卵数均有统计学差异。研究组无论是hCG注射日≥12mm卵泡数、获卵数、Gn用量、用药天数,还是受精数、优胚数和妊娠率与对照组比较,均无显著性差异。结论:单侧输卵管切除术降低同侧卵巢的反应性,但总体上不影响卵巢对Gn的反应和IVF-ET妊娠结局。