抗精子抗体与免疫不育

<正> 近年来由免疫学因素造成的不育已引起了人们的极大关注。最近的研究表明在原因不明性不育夫妇中有10～30%可能由于抗精子抗体(AsAb)所引致。早期的工作表明同种睾丸提取物免疫雄性豚鼠可导致睾丸炎及精子形成障碍。随后又从不育夫妇血清中查出抗精子抗体(AsAb)。此后,人们对精子的抗原性,AsAb的产生与检测、AsAb对受精过程及受精后的影响、及对由AsAb引起的免疫不育的诊断与治疗进行了大量的研究报道,本文综述了近年来上述各方面的研究进展。     

452例不孕与不育的宫腔镜诊断与治疗

女性不孕与不育症是妇科常见疾病。随着腹腔镜技术的开展,引起不孕症的盆腔病因已比较明确,主要是慢性盆腔炎性疾病和子宫内膜异位症[1]。引起不孕与不育的其它病因有很多,本文根据作者3年间(1995年～1997年)对452例不孕与不育患者进行的宫腔镜检查术与宫腔镜输卵管通液术的资料,重点阐明不孕和不育与宫腔和输卵管疾病间的关系,以及宫腔镜的诊断与治疗。资料与方法　　一、研究对象　　1.对象的选择　根据国内外文献对不孕症的定义[2,3],以不孕与不育≥1a作为标准,自1995～1997年共选择患者452例。其中原发组284例(62.8%),继发组168例(37.2%…     

输卵管性不育及输卵管病变的腹腔镜诊断

目的探讨应用腹腔镜对输卵管性不育的诊断价值。于腹腔镜下对１１２０例输卵管性不育患者的盆腔进行观察，并通过输卵管通液，观察输卵管病变。结果输卵管性不育患者点不育患者的３２．８％。     

128例不孕症妇女血清生殖激素的测定

近年来,我所内分泌研究室测定了１２８例经妇科检查无异常发现,经子宫输卵管碘油造影显示子宫形态正常,双侧输卵管通畅,其配偶的精液常规检查各项数据均在正常范围内,经夫妻双方的抗精子抗体检查,其结果均为阴性的不孕症妇女的六项生殖激素：促卵泡成熟激素（ＦＳＨ...     

1607例妇女精神伤害状况分析

目的：了解深圳市妇女精神伤害的一般情况,探讨妇女精神伤害的影响因素及防控措施。方法：采取整群抽样的方法,调查深圳市16岁以上妇女1607人,分析妇女精神伤害的发生情况。结果：深圳市妇女精神伤害发生率为15．25％,各种类型的精神伤害发生率的差异具有统计学意义（P〈0．05）,非语言伤害的发生率最高为10.39％,强势压迫的发生率最低为2．61％。婚姻状况、月均收入、个人认知态度不同的妇女精神伤害发生率的差异有统计学意义（P〈0．05）,以已婚者、月均收入3000元者、认为精神伤害不违法、性质说不清的妇女精神伤害发生率较高,分别为10．21％、7．22％、14．87％、10．52％。结论 精神伤害严重影响着深圳市妇女的身心健康,应及早开展相应的干预措施,减少妇女精神伤害的发生。     

抗精子抗体与不育

抗精子抗体与不育王苏梅，邱毅综述王志新审校（山东省计划生育科学技术研究所，济南，２５０００２）精子作为一种独特抗原，与机体免疫系统接触后可引起自身或同种免疫反应，产生抗精子抗体（ＡｓＡｂ）。研究资料证实，体内存在ＡｓＡｂ可导致不育，这类情况占不育患者...     

不孕妇女输卵管通畅性检查三种方法的比较

不孕妇女输卵管通畅性检查三种方法的比较解放军３０９医院妇产科（１０００９１）吕秋兰肖金娥梁东雷承慧近年来，Ｂ超和腹腔镜在临床广泛应用，丰富了子宫输卵管检查手段。本文对实时Ｂ超监测下子宫输卵管通液（ＵＳ）、腹腔镜下美蓝通液（ＬＳＰ）及子宫输卵管碘油造影...     

女人最妙不过感性又个性

女人缺少感性不真实：女人缺少性感寡淡无味。感性如一杯纯牛奶；性感是一种化学元素个性丰富的女人才是性感中的性感，女人中的女人。     

子宫内膜异位症合并不育患者腹腔液内皮素含量的测定

内皮素（ＥＴ）是１９８８年Ｙａｎａｇｉｓａｗａ等［１］从猪主动脉内皮细胞分离出来的一种由２１个氨基酸组成的强收缩血管肽。机体内存在３种异构体,即ＥＴ１、ＥＴ２和ＥＴ３,其中生物活性以ＥＴ１最强。近年来已证明,ＥＴ１存在于卵泡液及颗粒细胞培养...     

不育夫妇的心理状态分析

对６５２例不盲妇女和其中４２５例妇女的丈夫进行心理咨询调查。结果显示：８０．０％以上的夫妇承受着不育所致的各种心理压力，最普遍的心情是不甘认可。女方的压力略显严重，但与其丈夫间差异无显著性。然而男方对这种精神压力的自我调节能力明显优于女方。对不育治疗的信心及预后的态度，男女比较差异尤显著性。农民和文化水平较低的不育夫妇心理压力更大。不育使１２．０％～１５．０％的夫妇性生活受到影响，７．０％～８．０％婚姻关系恶化甚至濒临破裂，８．６％因不育而家庭关系紧张。约３０．０％的妇女表示不育检查和治疗过程本身亦带来一定的精神紧张和心理负担。提示：对要求治疗的不育夫妇，除药物治疗外．精神上的同情理解及心理支持，是不可忽视的。     

生育镜在不孕症诊治中的应用

目的探讨生育镜用于不孕症诊治的价值。方法用生育镜[包括经阴道注水腹腔镜（THL）与宫腔镜]对115例不孕症患者进行盆腔检查,观察内容包括输卵管通畅性、盆腔粘连情况等,以及盆腔完全评价率（即盆腔器官是否能被生育镜全部观察到）及术中、术后并发症。同时行THL下输卵管通液术和宫腔镜下输卵管口插管通液术。穿刺套管针成功从后穹窿穿刺入子宫直肠陷凹110例,其中原发性不孕（原发组）49例,继发性不孕（继发组）61例。既往输卵管检查为双侧阻塞者,原发组21例,继发组22例。结果术后输卵管双侧或一侧通畅者原发组34例（69．4％,34／49）,继发组42例（68．9％,42／61）,两组比较,差异也无统计学意义（P〉0．05）;既往输卵管检查为双侧阻塞者,术后双侧或一侧输卵管通畅者原发组10例（47．6％,10／21）,继发组11例（50．0％,11／22）,两组比较,差异无统计学意义（P〉0．05）。盆腔粘连者原发组21例（42．9％,21／49）,继发组37例（60．7％,37／61）,两组比较,差异无统计学意义（P〉0．05）。两组总的盆腔完全评价率为69．1％（76／110）,其中原发组为77．6％（38／49）,继发组为62．3％（38／61）．两组比较,差异无统计学意义（P〉0．05）。术后需行常规腹腔镜手术者20例（18．2％,20／110）,原发组与继发组分别为4例（8．2％,4／49）和16例（26．2％,16／61）,两组比较,差异有统计学意义（P〈0．05）;其中17例接受了微型腹腔镜手术。术中无盆腔脏器损伤、出血、直肠损伤或穿孔,术后无穿刺部位出血及盆腔感染等并发症发生。结论生育镜用于不孕症的诊治,操作简单、微创、安全、患者依从性好;对于临床或超声检查均无明显盆腔疾病证据的不孕症患者,生育镜可以取代经腹腹腔镜,成为一步到位的盆腔检查方法。     

Body composition characteristics and fat distribution patterns in young infertile women

OBJECTIVE: To document body composition and fat patterning characteristics in normal and underweight infertile women. DESIGN: Status quo method. SETTING: University clinics. PATIENT(S): Fifteen amenorrheic women with anorexia nervosa, 16 women with polycystic ovary syndrome (PCO2), 10 women with primary amenorrhea and 19 healthy controls. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Determination of body mass index, body composition parameters such as fat mass, lean body mass, bone mass using dual-energy x-ray absorptiometry (DEXA), fat distribution patterns, 17beta-estradiol, FSH, LH, prolactin, progesterone, testosterone, DHEA-S, and androstenedione levels. RESULT(S): A statistically significant difference was found comparing all proband groups with healthy controls for the majority of body fat and bone mineral content parameters but not for lean body mass. Infertile women of normal weight, with PCOS, and with primary amenorrhea exhibited an extraordinarily high amount of fat tissue and a tendency toward android fat patterning. In contrast, patients with anorexia nervosa and the healthy controls showed predominantly gynoid fat patterning. According to logistic regression analyses, anorexia nervosa was characterized by reduced fat tissue and PCOS was characterized by android fat patterning and an increased fat percentage. Patients with primary amenorrhea were characterized by reduced bone mass. CONCLUSION(S): Infertile young women showed characteristic differences in body composition and fat distribution patterns when compared with healthy, fertile, age-matched counterparts.     

Hypothyroidism among infertile women in Finland

The main aim of this retrospective study was to evaluate the occurrence of hypothyroidism among Finnish women with infertility. For this purpose, the records of 335 women presenting for the first time with infertility at the outpatient clinic of reproductive endocrinology at Turku University Central Hospital during a 3-year period (January 1992 to December 1994) were reviewed. Due to missing data, 36 women were excluded from the analysis. Thyroid function was screened by measuring serum thyroid stimulating hormone (TSH) levels in conjunction with serum prolactin using immunoradiometric assays. Prior to enrolment in the infertility examinations, ten out of 299 women had used thyroxine substitution for primary hypothyroidism. In the TSH screening test, 12 women (4%) exhibited elevated serum TSH levels ranging from 5.1 to 32 mU/l. Three of these cases were previously diagnosed with hypothyroidism and were using an inadequate dose of thyroxine. The prevalence of abnormal TSH levels was highest in the ovulatory dysfunction (6.3%) and unknown infertility (4.8%) groups and lowest in the tubal infertility (2.6%) and male infertility (1.5%) groups, although no statistically significant differences between the groups were observed. Oligo/amenorrhea was present in 101 (34%) women in the whole study population and in eight (67%, p < 0.5) women with elevated serum TSH at screening. The relatively high occurrence of abnormal TSH levels in infertile women with ovulatory dysfunctions or unknown infertility, as well as with oligo/amenorrhea, emphasizes the importance of TSH screening in these patient groups.     

卵泡发育不良的临床分析

目的探讨卵泡发育不良（ＦＭ）的表现及其结局。方法对２９６例不孕患者中的ＦＭ患者８０例（ＦＭ组）及２０例正常排卵者（对照组）进行连续宫颈评分、Ｂ超监测卵泡发育、放射免疫法测定血雌二醇（Ｅ２）值等检查,并行腹腔镜和子宫内膜活体组织检查。结果（１）在不孕妇女中ＦＭ发生率为２７０％;（２）ＦＭ组宫颈评分最高分为７３±１８分（ｘ±ｓ,下同）,对照组为１３２±１８分;月经中期血Ｅ２水平,ＦＭ组为３００±１００ｐｍｏｌ／Ｌ,对照组为９００±４００ｐｍｏｌ／Ｌ,两组比较,差异有显著性（Ｐ＜０．０１）;（３）Ｂ超检查显示,ＦＭ组卵泡模糊,常为多个小卵泡;（４）腹腔镜检查ＦＭ组约２／３以上病例卵巢上可见黄体,但无排卵裂孔,约１／３病例无黄体;（５）ＦＭ组子宫内膜呈分泌改变者占５６７％,呈增生期改变者占３３３％左右。结论（１）ＦＭ是不孕的一个重要原因;（２）ＦＭ结局有二,一为卵泡闭锁,另一为未成熟卵泡黄素化。     

Hysteroscopic findings in infertile women: A retrospective study

BackgroundLower pregnancy rates are observed in patients with uterine cavity anomalies. The correction of these anomalies has been associated with improved pregnancy rates. Diagnostic hysteroscopy can be performed in an office with minimal discomfort and superior sensitivity and specificity in evaluation of the uterine cavity. Our study was done to evaluate the importance of office hysteroscopy (OH) in diagnosis of pathology among infertile women.ObjectiveTo study incidence of abnormal hysteroscopic findings among infertile women.Materials and MethodsWe retrospectively studied 432 office hysteroscopies in patients referred to our unit because of their infertility problem. Two hundred and seventy-four patients (63.43%) were with primary infertility and 158 (36.57%) were with secondary infertility.ResultsNormal hysteroscopic findings were reported in 344 women (79.63%). The other 88 (20.37%) were with abnormal hysteroscopy. The most common reported hysteroscopic abnormality was intrauterine adhesions (IUA) 31.81% (28/88) followed by endometrial polyp 26.13% (23/88). Pre-hysteroscopic uterine investigations (ultrasound or hysterography) were available, only, in 207 women. In 143 patients with normal pre-hysteroscopic uterine investigations, office hysteroscopy revealed uterine cavity abnormalities in 21 women (14.68%). Of those with abnormal pre-hysteroscopic findings, 64 patients, hysteroscopy examinations were normal in 16 patients (25%).ConclusionsOffice hysteroscopy should be a part of routine work up in infertile patients as routine uterine investigatory methods (ultrasonography and hysterography) have only sensitivity and specificity value of 67.19% and 85.31% respectively.     

Hysterosalpingographic findings in infertile women with genital tuberculosis

OBJECTIVES: To evaluate the hysterosalpingographic findings from infertile women who were subsequently diagnosed with genital tuberculosis. METHODS: A retrospective study of 70 infertile women who underwent hysterosalpingography to investigate infertility and were subsequently diagnosed with genital tuberculosis. RESULTS: The mean age of the women was 27.3 years and the mean duration of infertility was 6.1 years. A total of 57 (81.4%) women had primary infertility while 13 had secondary infertility. Diagnosis of genital tuberculosis was made by polymerase chain reaction (54.3%), tuberculous granuloma on biopsy (22.8%), acid-fast bacilli culture (2.8%), and at laparoscopy or hysteroscopy (20%). Hysterosalpingographic findings were a normal uterine cavity observed in 57.1% of women, an irregular cavity in 18.5%, a shrunken cavity in 2.8%, and an irregular filling defect in 18.5%. Synechiae were observed in 17.1% of women. CONCLUSION: Genital tuberculosis is a common cause of infertility in India, causing significant uterine and tubal pathologies.     

不孕症患者子宫内膜容受性的评估及改善研究

在辅助生殖技术(assisted reproductive technology,ART)中,优质的胚胎、良好的子宫内膜容受性(endometrial receptivity,ER)以及胚胎和子宫内膜的同步发育是影响胚胎成功植入的三个关键因素,多项研究表明移植失败的主要原因是ER的欠缺,而胚胎因素仅占三分之一,因此如何提高胚胎着床率已成为辅助生殖领域讨论的焦点。本文对目前国内外在ER评估和改善这两方面的进展进行综述,以期对临床决策有所帮助。     

电视腹腔镜手术治疗子宫内膜异位症合并不孕128例临床效果分析

目的　探讨电视腹腔镜手术对子宫内膜异位症合并不孕患者的治疗效果 ,了解术后获得妊娠的时间分布特点。方法　收集自 1997年 1月至 1998年 12月在我院因不孕而接受电视腹腔镜手术治疗的子宫内膜异位症患者共 12 8例 ,按腹膜型子宫内膜异位症组和卵巢子宫内膜异位囊肿组来进行统计 ,分析其手术后妊娠率及术后获得妊娠时间分布特点。结果　 12 8例患者术后随诊 10 6例 ,随访率为 82 81%。子宫内膜异位症合并不孕腹腔镜手术治疗后的总妊娠率为 5 0 0 0 % (5 3/ 10 6 ) ,其中腹膜型子宫内膜异位症行电灼术后妊娠率为 6 0 0 0 % (42 /70 ) ,子宫内膜异位囊肿术后妊娠率为 30 5 6 % (11/ 36 ) ,二者比较 ,差异有显著性意义 ,P <0 0 5。术后 18个月内获得妊娠者占 88 6 8% (47/ 5 3)。结论　电视腹腔镜手术集诊断和治疗于一体 ,可及时诊断引起不孕的病因 ,对子宫内膜异位症合并不孕患者的治疗有一定效果。如果患者术后一年半以上仍不怀孕 ,应采取其它辅助生育措施。