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。     

应用复方醋酸环丙孕酮治疗多囊卵巢综合征及合并耐氯Di酚不育的 …

目的 评估复方醋酸环丙孕酮（复方ＣＰＡ）治疗多囊卵巢综合征（ＰＣＯＳ）的疗效及安全性,探索葶药后改善促排卵效果的可行性。方法 ２９例ＰＣＯＳ患者「１６例为耐氯Ｄｉ酚（ＣＣ）或绝经期促性腺激素（ｈＭＧ）促排卵失败的无排卵性不育」,于自然月经或撤退性出血第５天服复方ＣＰＡ,共４～６个周期。服药前后观察临床表现、盆腔超声相、血清生殖激素、血脂水平的变化及副反应。停药后,耐ＣＣ的１２例再行ＣＣ促排卵２２个     

人绒毛膜促性腺激素和胰岛素对多囊卵巢综合征卵泡内膜细胞雄激素分泌的影响

目的检验多囊卵巢综合征（ＰＣＯＳ）患者卵巢卵泡内膜细胞（简称内膜细胞）雄激素合成是否异常。方法对来自８例ＰＣＯＳ的卵巢卵泡与１８例正常妇女卵巢卵泡内膜细胞进行单层培养，采用放射免疫法测定两者在基础状态、人绒毛膜促性腺激素（ｈＣＧ）和胰岛素（ＩＮＳ）刺激作用下培养液中１７α羟孕酮（ＯＨＰ）、雄烯二酮（Ａ）、孕酮（Ｐ）。结果在基础状态、ｈＣＧ与ＩＮＳ刺激作用下，ＰＣＯＳ患者的卵巢内膜细胞分泌Ａ、ＯＨＰ和Ｐ的量与正常妇女相比，除在基础状态下Ｐ无明显增加外（Ｐ＞０．０５），其余均显著增加，分别为几倍到十几倍（Ｐ＜００５～０００１）。此外，ｈＣＧ和ＩＮＳ还有协同刺激作用。ＰＣＯＳ患者３种激素分泌的持续时间比正常妇女长。结论ＰＣＯＳ患者的卵巢内膜细胞存在雄激素的合成异常，ＩＮＳ可能起关键作用。     

多囊卵巢综合征促排卵失败的相关因素探讨

探讨多囊卵巢综合征（ＰＣＯＳ）妇女促排卵失败的危险因素。方法：将 １０３名ＰＣＯＳ病人,随机分为 ３组,分别以 ＣＣ／ ｈＣＧ、ＣＣ／ｈＭＧ／ｈＣＧ及 ＧｎＲＨ－ａ／ｈＭＧ／ｈＣＧ三种促排卵方案治疗,并以 ３１名正常妇女作对照,应用放免法测定４组对象血清性激素水平。应用糖耐量试验及胰岛素释放试验测定糖负荷后 ０ ｍｉｎ、 ６０ ｍｉｎ、 １２０ ｍｉｎ血糖及胰岛素水平。结果：促排卵治疗失败者卵巢过度刺激综合征（ＯＧＴＴ）后 １２０ ｍｉｎ胰岛素水平明显增高,与排卵者相比,Ｐ＜０．０５,ＯＲ＝１．０１３;而 ＣＣ／ｈＭＧ／ｈＣＧ治疗方案失败率较低,ＯＲ＝０． ３１１０。结论：ＯＧＴＴ后 １２０ ｍｉｎ胰岛素是促排卵失败的危险因素, ＣＣ／ｈＭＧ／ｈＣＧ方案是较为成功的促排卵治疗方案。     

经阴道输卵管插管行配子输卵管移植的临床初步研究

目的 了解经阴道配子输卵管移植治疗非输卵管性不孕症（子宫内膜异位症、男性少弱精症、不明原因不孕等）的效果。方法 对２１例（２３个周期）不孕症患者分别采用（１）绝经期促性腺激素（ｈＭＧ）／ｈＣＧ（７个周期）;（２）卵泡刺激素（ＦＳＨ）／ｈＣＧ（２个周期）;（３）短方案促性腺激素释放激素激动剂（ＧｎＲＨ－ａ）／ｈＭＧ／ｈＣＧ（２个周期）;（４）长方案ＧｎＲＨ－ａ／ＦＳＨ／ｈＭＧ／ｈＣＧ（１２个周期）进     

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。     

促排卵治疗对多囊卵巢综合征患者子宫内膜整合素αv,β3表？…

目的 了解促排卵药物对多囊卵巢综合征（ＰＣＯＳ）患者黄体中期子宫内膜整合素αｖ、β３表达的影响。方法 应用单克隆抗体,采用免疫组织化学技术对２２例正常妇女、４０例无排卵ＰＣＯＳ患者促排卵治疗后黄体中期的子宫内膜整合素αｖ、β３进行测定。结果正常妇女子宫内膜整合素αｖ、β３表达在“着床窗口期”呈现强阳性;而氯米芬（ＣＣ）及绝经期促性腺激素（ｈＭＧ）抑制αｖ、βｂ的表达,使其表达呈弱阳性;而促性腺素释     

高胰岛素血症在多囊卵巢综合征发病中的作用及抗胰岛素的治疗

目的探讨高胰岛素（ＩＮＳ）血症在多囊卵巢综合征（ＰＣＯＳ）发病中的作用及二甲双胍对ＰＣＯＳ的治疗效果。方法将２３例ＰＣＯＳ病人分为肥胖组（１２例）和非肥胖组（１１例）,于服二甲双胍前及服二甲双胍８～１２周后,应用放射免疫法测定基础状态下雄激素、黄体生成素（ＬＨ）、性激素结合球蛋白及促性腺激素释放激素激动剂（ＧｎＲＨａ）刺激后,血１７α羟孕酮（１７ＯＨＰ）和ＬＨ的水平、口服糖耐量试验（ＯＧＴＴ）中血ＩＮＳ水平。结果用药后肥胖组空腹血ＩＮＳ水平和非肥胖组ＯＧＴＴ时血ＩＮＳ反应曲线下面积均明显下降;两组基础状态下的血１７ＯＨＰ、雄烯二酮（Ａ）、睾酮（Ｔ）水平均显著下降、性激素结合蛋白水平显著增加;ＬＨ基值及ＧｎＲＨａ刺激后的ＯＨＰ和ＬＨ值均无明显变化。结论高ＩＮＳ血症在ＰＣＯＳ的高雄激素血症起重要作用,二甲双胍可用于ＰＣＯＳ的治疗     

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     

单纯疱疹病毒胸腺嘧啶核苷激酶基因/羟甲基无环鸟苷系统对人卵巢癌裸鼠网膜移植瘤的作用

目的观察单纯疱疹病毒胸腺嘧啶核苷激酶基因（ＨＳＶ１ｔｋ）／羟甲基无环鸟苷（ＧＣＶ）系统对人卵巢癌的体内治疗作用。方法先将人卵巢癌细胞ＡＯ及携有ＨＳＶ１ｔｋ基因的ＡＯ细胞（ＡＯ／ＨＳＶ１ｔｋｃ）注射于裸鼠皮下,形成肿瘤后再移植于裸鼠网膜,并以病毒生产细胞（ＶＰＣ／ＨＳＶ１ｔｋｃ）的培养液对ＡＯ网膜移植瘤进行体内转染,然后以ＧＣＶ对体外ＡＯ／ＨＳＶ１ｔｋｃ转移的肿瘤及经体内转染的ＡＯ肿瘤进行治疗。结果ＨＳＶ１ｔｋ／ＧＣＶ基因治疗系统对ＡＯ裸鼠网膜移植瘤的抑制率为４６．８％,而ＡＯ／ＨＳＶ１ｔｋｃ裸鼠网膜移植瘤经ＧＣＶ治疗后,多数仅残留显微镜下可见的癌灶。结论ＧＣＶ在腹腔内对携有ＨＳＶ１ｔｋ基因的肿瘤具有更为显著的杀伤效应;ＨＳＶ１ｔｋ／ＧＣＶ基因治疗系统在卵巢癌的治疗上可能具有良好的应用前景。     

自然及促排卵周期子宫内膜整合素α4β1的表达

目的 了解氯米芬（CC）、绝经期促性腺激素（hMG）对黄体中期子宫内膜整合素α4β1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48例正常妇女自然周期以及48例正常妇女、30例多囊卵巢综合征患者应用CC／绒毛膜促性腺激素（hCG）及CC／hMG/hCG方案促卵治疗后黄体中期子宫内膜整合素α4β1的表达。结果 子宫内膜整合素α4β1在正常妇女自然周期着床窗口期呈现强阳性表达,而CC、hMG抑制整合率α4β1的表达,两者比较,差异有极显著性（P＜0．01）;妊娠者较妊娠者整合素α4β1表达强度高。结论 促排卵周期黄体中期整合素α4β1表达下降或缺失,子宫内膜容受性下降,妊娠率降低。     

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。     

Luteal dysfunction in ovulation induction: the role of repetitive human chorionic gonadotropin supplementation during the luteal phase

Several studies have indicated that ovulation induction with human menopausal gonadotropin (hMG)/human chorionic gonadotropin (hCG) or clomiphene citrate (CC) is associated with luteal phase defect. To assess the efficiency of luteal support by hCG to an infertile population undergoing ovulation induction, with CC/hCG or hMG/hCG, we have randomly administered 2500 IU hCG intramuscularly on days 3, 6, and 9 after ovulation induction by 10,000 IU of hCG to 74 patients on 265 treatment cycles. As controls served 357 ovulation induction cycles in the same 74 patients. The treatment cycles were randomly alternated with control cycles so that each patient served as her own control. However, the mean +/- standard deviation (SD) midluteal P was 38.1 +/- 10.8 ng/ml in the study group versus 15.7 +/- 10.5 ng/ml in the control group (P less than 0.001). Luteal phase length was 15.4 +/- 1.5 days in the treatment group versus 12.1 +/- 1.7 in the control group (P less than 0.01). In the treatment group, 64.8% of the patients achieved pregnancy (27% pregnancies/treatment cycle) versus 47.3% in the control group (11.5% pregnancies/control cycle) (P less than 0.01). The pregnancy wastage rates (including abortions and "chemical" pregnancies) were 30.6% in the treatment group versus 56% in the control group (P less than 0.01). We conclude that repetitive hCG administration may be an efficient luteal support in infertile patients undergoing ovulation induction.     

N-acetylcysteine as an adjuvant to clomiphene citrate for successful induction of ovulation in infertile patients with polycystic ovary syndrome

Aim: The aim of this study was to evaluate the effect of oral N-acetylcysteine (NAC) administration as an adjuvant to clomiphene citrate (CC) on induction of ovulation outcomes in patients with polycystic ovary syndrome (PCOS). Material and Methods: In this placebo-controlled double-blind randomized clinical trial, 180 PCOS infertile patients were randomly divided into two groups for induction of ovulation. Patients in group 1 received CC 100?mg/d plus NAC 1.2?g/d and patients in group 2 received CC plus placebo for 5?days starting at day 3 of the cycle. On the 12th day of the menstrual cycle in the presence of at least one follicle with an 18-20-mm diameter in ultrasound evaluation, 10?000?U hCG was injected intramuscularly and timed intercourse was advised 36?h after hCG injection. Serum β-hCG level was measured on the 16th day after hCG injection. Results: The number of follicles >18?mm and the mean endometrial thickness on the day of hCG administration were significantly higher among the CC+NAC group (P-value?=?0.001). The ovulation and pregnancy rates were also significantly higher in the CC+NAC group (P-value?=?0.02 and 0.04, respectively). No adverse side-effects and no cases of ovarian hyperstimulation syndrome were observed in the group receiving NAC. Conclusion: NAC as a safe and well-tolerated adjuvant to CC for induction of ovulation can improve the ovulation and pregnancy rates in PCOS patients. It may also have some beneficial impacts on endometrial thickness.     

生长激素在多囊卵巢综合征促排卵中的作用

目的　探讨生长激素(GH)在多囊卵巢综合征(PCOS)患者促排卵中的作用。方法　测定130例PCOS患者(PCOS组)及107例正常妇女(对照组)的血中生殖激素及GH和胰岛素样生长因子Ⅱ(IGF-Ⅱ)的基础水平，并应用GH辅助促排卵方案治疗7例对人绝经期促性腺激素(hMG)反应不良的PCOS患者，观察疗效。结果　PCOS患者血中GH水平明显降低，肥胖者更为明显，非肥胖与肥胖者分别为(2.50±1.33)μg/L及(1.04±0.47)μg/L,而对照组肥胖与非肥胖者分别为(2.95±1.49)μg/L、（5.30±2.26）μg/L（P均<0.05）;PCOS组肥胖者IGF-Ⅱ水平为（136±27）nmol/L，高于非肥胖者的（123±20）nmol/L，两者比较，差异有显著性（P<0.05）。应用GH辅助促排卵治疗，可以明显减少hMG用量1～12支，缩短hMG刺激时间3～12d，增加优势卵泡的数量。结论　PCOS患者存在GH分泌障碍，应用GH辅助促排卵可以提高排卵率。     

不同促排卵方案来源胚胎冻融胚胎移植妊娠结局分析北大核心CSCD

目的探讨不同促排卵方案来源胚胎冻融胚胎移植(FET)的妊娠结局。方法回顾性分析2016年1月至2021年5月在南通大学附属医院生殖医学中心接受体外受精或卵泡浆内单精子注射-胚胎移植(IVF/ICSI-ET)治疗,因鲜胚移植失败或全胚冷冻而要求FET的252个周期,根据刺激周期方案的不同将其分为5组:高孕激素促排卵(PPOS)组(n=26)、枸橼酸氯米芬+人绝经期促性腺激素(CC+hMG)组(n=50)、超短方案组(n=57)、拮抗剂组(n=78)及长方案组(n=41),分析各组的临床结局。结果 252个FET周期中,各组体重指数(BMI)、不孕年限、不孕类型、刺激周期时扳机日E2水平/扳机日直径≥14mm卵泡数、移植周期时转化日内膜厚度、转化日E2水平、移植D3胚胎或囊胚比例,差别均无统计学意义(P>0.05)。各组间患者年龄、基础FSH、获卵数、刺激周期Gn总量及平均移植胚胎数,差异有统计学意义(P<0.05)。各组间hCG阳性率、临床妊娠率、流产率及继续妊娠率差异无统计学意义(P>0.05)。但CC+hMG组hCG阳性率、临床妊娠率及继续妊娠率数值上最低,长方案组hCG阳性率、临床妊娠率及继续妊娠率数值上均最高。多因素logistic回归分析发现CC+hMG组FET临床妊娠率低于长方案组,差别有统计学意义(P<0.05),但与其他各组比较差异无统计学意义。其他4组间比较妊娠结局无明显差异(P>0.05)。结论 PPOS、超短方案、长方案、拮抗剂促排卵方案来源胚胎FET妊娠结局在数值上优于CC+hMG促排卵方案,其中长方案显著优于CC+hMG促排卵方案。     

Ovulation induction increases serum levels of insulin-like growth factor binding protein 1.

The effect of ovulation induction on serum insulin-like growth factor binding protein 1 (IGFBP-1) level in relation to sex hormone binding globulin (SHBG) levels was evaluated. Serum samples were collected 8 to 12 days after ovulation from 26 women undergoing ovulation induction with clomiphene citrate (CC), and from 58 women treated with CC in combination with human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG). In addition, serum samples were obtained from 63 spontaneously ovulating women and from 12 women during an anovulatory cycle. Luteal phase serum IGFBP-1 levels were 4.22 +/- 2.95 micrograms/L (P less than .05) in the CC group and 7.31 +/- 6.13 micrograms/L (P less than .001) in the CC/hMG/hCG group as compared to unstimulated ovulatory cycles (2.64 +/- 2.52 micrograms/L). No significant difference in IGFBP-1 levels was seen between spontaneously ovulatory and anovulatory cycles. The serum IGFBP-1 levels correlated positively to SHBG levels (r = .52, P less than .001). The data show that ovulation induction increases serum IGFBP-1 levels in parallel to SHBG levels, indicating that ovarian stimulation, which results in increased steroid hormone production, also induces changes in other factors known to modulate steroid hormone actions.     

Prognostic factors for ovulatory response with clomiphene citrate in polycystic ovary syndrome

OBJECTIVE: To evaluate prospectively the prognostic factors for ovulatory responses following clomiphene citrate (CC) administration in polycystic ovary syndrome (PCOS). STUDY DESIGN: Fifty-nine infertile patients with a diagnosis of PCOS were recruited. Ovulation was induced using 100 mg/day CC administered daily from days 5 to 9 of the cycle. Endocrine and metabolic parameters between responder and non-responder groups were analyzed. RESULTS: For a 75-g fasting glucose load (75-g OGTT), blood glucose levels at 60 and 120 min, the area under the curve (AUC) and blood insulin levels at 120 min in the non-responder group (n=25) were significantly higher than those in the responder group (n=34), although the measurements of fasting blood glucose and insulin were not significantly different between the two groups. In the receiver operating characteristic curves, the most appropriate cutoff point was 120 mg/dl for the blood glucose level at 120 min and 9000 for the blood glucose x insulin level at 120 min. There were no significant differences in the clinical characteristics or in the endocrine and metabolic parameters between conceived (n=9) and non-conceived groups (n=21). CONCLUSION: The levels of blood glucose and blood glucose x insulin at 120 min after 75-g OGTT could be good biochemical markers of CC resistance in PCOS. No predictors of conception following CC therapy were identified by this study.