降低hCG的剂量不影响控制性超促排卵中卵泡的最终成熟及随后冷冻胚胎移植的妊娠结局

目的:在卵巢中等反应和高反应患者中,比较2 000 IU、3 000 IU低剂量hCG与5 000 IU hCG在控制性超促排卵(COH)过程中诱导卵泡成熟及随后冷冻胚胎移植(FET)的妊娠结局。方法:回顾性分析2 166例接受IVF/ICSI治疗的患者的临床资料,根据hCG的剂量分为3组:2 000 IU(A组,n=722),3 000 IU(B组,n=722)和5 000 IU(C组,n=722),观察比较成熟卵母细胞的比例、受精率、临床妊娠率、累计妊娠率及卵巢过度刺激综合征(OHSS)的发生率等。结果:3组患者获得成熟卵母细胞比例(89.92%,91.40%,90.20%)和受精率(79.80%,80.07%,80.51%)均无统计学差异(P0.05)。A组hCG注射日E2水平、获成熟卵数及优质胚胎数均显著高于B组和C组。3组患者每次移植的临床妊娠率(45.95%,43.97%,44.25%)、继续妊娠率(43.17%,40.91%,42.53%)、种植率(30.74%,27.78%,29.86%)及每位患者的累计妊娠率(CPR)(58.31%,53.60%,54.85%)均无统计学差异。3组的OHSS发生率很低(0.00%,0.14%,0.28%)。结论:对于卵巢中等与高反应患者,2 000 IU hCG与5 000 IU hCG在诱导卵泡的成熟中发挥同样的效果,2 000 IU hCG不仅不影响妊娠结局,而且阻止了OHSS的发生。     

卵巢肿瘤经保守性手术后进行IVF/ICSI治疗的安全性及有效性探讨——附23例病例分析与总结

目的:探讨不孕症合并卵巢肿瘤手术史患者的IVF/ICSI-ET治疗的妊娠结局及安全性。方法:回顾性分析23例卵巢肿瘤保守性手术后行IVF/ICSI-ET治疗患者的临床结局及随访资料。结果:23例患者共35个新鲜移植周期,8个冷冻胚胎移植周期;平均基础FSH和E2分别为6.26±1.87 IU/L,41.9±24.7 pg/ml;平均Gn启动剂量165±59 IU,平均Gn使用总量1 516±866 IU,平均Gn使用天数8±3 d;hCG注射日E2峰值平均水平1 202±976 pg/ml;平均获卵数6.0±5.3个,平均成熟卵子数5.2±4.8个,受精率83.5%,平均可移植胚胎数3.1±2.7个,平均优质胚胎数2.8±2.8个,平均胚胎移植数1.8±0.7个;新鲜周期着床率29.0%,临床妊娠率28.6%;冻融胚胎周期着床率25.0%,临床妊娠率25.0%;平均随访时间(即首次IVF启动时间至末次随访日)为23个月,经IVF治疗后仅有1例复发,没有与卵巢肿瘤相关的死亡。结论:卵巢良性及交界性肿瘤经保守性手术治疗后合并不孕的患者,IVF-ET治疗有效且安全。     

200 IU hCG替代hMG在晚卵泡期应用于控制性卵巢刺激的疗效观察

目的:探讨200 IU hCG在控制性卵巢刺激(COS)过程的晚卵泡期替代hMG对COS的疗效。方法:回顾性分析行体外受精/单精子卵胞质内注射-冻融胚胎移植(IVF/ICSI-FET)患者资料共154例,进行154个COS周期,根据晚卵泡期是否应用200 IU hCG分为:A组,COS完全应用hMG(65个周期);B组,COS的早卵泡期应用hMG,晚卵泡期则应用hCG(200 IU/d)替代hMG(89个周期)。后续166个周期进行FET,其中,A组70个周期,B组96个周期。统计分析COS周期的用药情况、IVF/ICSI-FET结局。结果:B组的hMG用药剂量和用药时间分别显著少于A组(1 361.0±494.6 IU vs 1 782.7±475.2 IU,P0.05;7.3±2.3 d vs 9.5±2.0 d,P0.05);B组的成熟卵母细胞数显著多于A组(15.2±6.6 vs 11.6±5.7,P0.05);冻融胚胎移植中A、B组的临床妊娠率(64.29%vs 64.58%,P0.05)及活产率(80.00%vs 79.03%,P0.05)比较无统计学差异。结论:200 IU hCG能够在COS的晚卵泡期替代hMG,能安全、有效地维持卵泡生长发育,并且减少Gn的用量,避免卵巢过度刺激综合征(OHSS)发生。     

子宫内膜异位症合并不孕患者经体外受精/卵胞质内单精子注射-胚胎移植治疗后妊娠结局及相关因素的分析

目的探讨子宫内膜异位症(EMS)对不孕患者经体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)治疗后妊娠结局的影响及其与妊娠结局相关的因素。方法选择行IVF/ICSI-ET治疗的46例EMS合并不孕患者的55个取卵周期作为EMS组;选择同期行IVF/ICSI-ET治疗的126例非EMS患者的156个周期作为对照组。回顾性分析患者的临床资料,并进一步分析与妊娠结局相关的因素。结果 EMS组CA-125水平、周期取消率显著高于对照组(P0.05);基础窦卵泡数(AFC)、hCG注射日成熟卵泡数、获卵数、MII卵数、双原核(2PN)数、卵裂数、优质胚胎数、优质胚胎率显著低于对照组(P0.05);hCG注射日成熟卵泡数与EMS患者未妊娠的相关回归系数0。结论 EMS合并不孕患者卵巢储备功能下降,卵子和胚胎质量下降,更易取消周期。但其卵子成熟率、正常受精率及临床结局与非EMS对照组不孕患者相比无统计学差异;hCG注射日成熟卵泡数是EMS患者妊娠的保护因素。     

hCG注射日雌二醇(E_2)增幅及每成熟卵泡E_2水平对控制性促排卵hCG扳机的影响

目的:探讨控制性促排卵(COS)hCG注射日雌二醇(E2)在hCG扳机时的作用。方法:接受长方案垂体降调节IVF/ICSI-ET助孕的不孕症患者1 811例,测量COS周期中E2水平,计算E2增幅[E2增幅=(hCG注射日E2值-hCG注射前日E2值)/hCG注射前日E2值]。按照E2的增幅分为5组:A1组E2增幅≤-10%,A2组E2增幅为-9%~10%,A3组E2增幅为11%~50%,A4组E2增幅为51%~100%,A5组E2增幅100%;另按hCG注射日每卵泡E2水平分为5组:B1组E2≤200 pg/ml,B2组E2为201~300 pg/ml,B3组E2为301~400 pg/ml,B4组E2为401~500 pg/ml,B5组E2500 pg/ml。比较各组间一般临床特征及IVF-ET的临床结局。结果:①A1组hCG注射日直径≥14 mm卵泡数、获卵数及2PN数较其他4组高,hCG注射日直径≥18 mm卵泡比例,较其他4组低,差异均有统计学意义(P0.05),临床妊娠率偏低,但与其余4组间无统计学差异(P0.05);②A5组hCG注射日P水平、hCG注射日直径≥14 mm卵泡数、获卵数、2PN数、临床妊娠率和胚胎着床率均较其他4组低,差异有统计学意义(P0.05);③B2组临床妊娠率和胚胎着床率较其他4组高,差异有统计学意义(P0.05)。结论:hCG注射日E2增幅介于-9%~100%、每成熟卵泡E2值介于201~300 pg/ml之间是hCG扳机的最佳时机。     

微刺激方案在常规IVF-ET治疗失败后卵巢低反应患者中的应用

目的:探讨微刺激方案在IVF-ET过程中对卵巢低反应患者的应用价值。方法:对56例卵巢低反应患者应用常规促排卵方案进行112个IVF周期治疗失败后改用微刺激方案的201个周期进行回顾性分析,比较使用这2种方案的治疗效果及临床结局,同时比较微刺激方案中使用与未使用GnRH-拮抗剂的临床数据与治疗结局。结果:112个常规促排卵周期中6个周期取消。106个周期取卵,95个周期获得卵母细胞,平均获卵数3.7±1.5个。共91个周期进行胚胎移植,均未获得妊娠。201个微刺激周期中17个周期取消,184个取卵周期中163个周期获得卵母细胞,平均获卵数3.4±1.4个。共160个周期进行胚胎移植,临床妊娠18例,双胎妊娠2例,流产3例,胚胎种植率为5.9%(20/336),起始周期临床妊娠率为9.8%(18/184),移植周期临床妊娠率为11.3%(18/160),累计继续妊娠率为26.8%(15/56)。比较前、后2种方案,常规促排卵方案中刺激时间为12.0±1.4 d,Gn使用总量为3 780±1 350 IU,远多于微刺激方案中的8.0±1.2 d和650±120 IU(P<0.05),而hCG注射日E2值(860±36 pg/ml vs 756±28 pg/ml)、平均获卵数(3.7±1.5 vs 3.4±1.4)、受精率(68.5%vs 64.5%)、优质胚胎率(56.7%vs 47.7%)2种方案均无显著性差异(P>0.05)。微刺激周期中使用拮抗剂组较未使用拮抗剂组周期取消率降低(4.5%vs 22.0%),hCG注射日LH值降低(2.3±1.1 U vs 7.8±2.4 U)(P<0.05),优质胚胎率(53.7%vs 25.7%)、胚胎着床率(6.5%vs3.9%)及临床妊娠率(12.3%vs 6.7%)均有增高的趋势,但差异均无统计学意义(P>0.05)。结论:微刺激方案对卵巢反应不良患者具有简便、疗程短、患者心理负担轻、医疗风险小等特点,值得推广应用,并建议联合拮抗剂使用。     

不同促排卵方案在卵巢低反应患者中的应用

目的:探讨不同促排卵方案在接受体外受精-胚胎移植(IVF-ET)的卵巢低反应患者中的应用价值。方法:对87例卵巢低反应患者采用不同方案进行IVF/ICSI-ET共200个周期的临床资料进行回顾性分析,其中短方案者50个周期(A组),拮抗剂方案者39个周期(B组),微刺激方案者93个周期(C组),自然周期方案者18个周期(D组)。比较分析各组的促排卵结局。结果:4组间周期取消率无统计学差异,hCG注射日LH水平A组低于其他3组,E2水平高于其他3组,与C、D组比有统计学差异(P<0.05),优势卵泡数及平均获卵数D组低于其他3组,而正常受精率高于其他3组,与A、B组比有统计学差异(P<0.05),hCG注射日内膜厚度、P值、MⅡ卵率、可利用胚胎率、临床妊娠率C组临床妊娠率略高,但各组间差异均无统计学意义(P>0.05)。结论:对卵巢低反应患者微刺激方案在IVF-ET促排卵中相对其他方案有更好的临床效果。     

年龄与颗粒细胞卵泡刺激素受体表达的关系

目的:探讨卵巢正常反应型妇女中,年龄与颗粒细胞卵泡刺激素受体(follicle-stimulating hormone receptor,FSHR)表达的关系。方法:根据年龄将90例卵巢正常反应型妇女分为A组:>37岁(30例),B组:35～37岁(30例),C组:<35岁(30例)。采用蛋白印迹法测定颗粒细胞FSHR蛋白的水平。电化学发光法测定卵泡液(follicularfluid,FF)中的FSH浓度。比较各组成熟卵泡数、重组FSH(rFSH)使用剂量的差异。结果:3组之间rFSH使用剂量(A组:3494.0±1086.9IU,B组:3000.8±902.9IU,C组:2510.0±726.8IU)、卵泡液FSH浓度(A组:8.6±0.6pmol/L,B组:8.2±0.7pmol/L,C组:7.2±0.6pmol/L)和成熟卵泡数(A组:6.9±1.9,B组:7.9±1.9,C组:9.1±1.6)有显著差异(P均<0.01)。随着年龄增长,FSHR蛋白相对表达量显著降低(A组:20.28±0.08,B组:0.32±0.08,C组:0.36±0.06),P<0.01。结论:年龄与颗粒细胞FSHR蛋白表达有关。临床上对大龄妇女采取增加rFSH剂量的方法并不能增加成熟卵泡数的原因可能与FSHR表达下降有关。     

改良超长方案在卵巢储备功能低下高龄患者中的应用

目的:探讨改良超长方案行体外受精-胚胎移植(IVF-ET)助孕的高龄(年龄≥40岁)且卵巢储备功能低下(窦卵泡3~7个)患者的治疗结局。方法:采用随机对照前瞻研究的方法,将行IVF-ET的120例高龄且卵巢储备功能低下患者随机分成:改良超长方案组(A组,n=55)和拮抗剂方案组(B组,n=65),比较A、B组间IVF-ET结局。结果:A组的Gn使用总量(3 955.2±1194.3 IU)、Gn使用天数(11.7±1.9 d)、hCG注射日E2水平(2 452.7±1 285.6 pg/ml),hCG注射日子宫内膜厚度(12.1±2.3 mm)均明显高于B组(分别为2 022.5±610.1 IU、9.1±1.7 d、1 257.7±696.0 pg/ml、11.3±2.0 mm),P<0.05;周期取消率、优质胚胎率、妊娠率、着床率、流产率、宫外孕发生率组间均无统计学差异(P>0.05)。A组hCG注射日LH水平(1.0±0.5 mIU/ml)及P/E2值(0.3±0.2)明显低于B组(3.4±2.4 mIU/ml及0.5±0.2),P<0.05。结论:改良超长方案经过GnRHa的预处理,使患者充分降调节,hCG注射日可以获得良好的LH水平、P/E2值及内膜厚度;而hMG的使用,既可降低患者费用,又可以适当补充LH,提高子宫内膜容受性。因此,对于高龄且卵巢储备功能低下的患者,改良超长方案是一个经济有效的治疗选择。     

反复多周期促排卵对小鼠母体卵巢组织及胚胎发育潜能的影响

目的:比较多周期连续促排卵对小鼠卵巢组织和胚胎发育潜能的影响。方法:建立反复多周期促排卵小鼠模型(A组),观察其卵巢组织内各级卵泡数形态并计数。统计获取的卵母细胞及受精卵数、卵裂率、优质胚胎率和囊胚形成率,并与单次促排卵周期小鼠(B组)、自然周期排卵小鼠(C组)比较。结果:B组获取的卵母细胞数及受精卵数显著增多(41.6±11.0)。而A组获取的卵母细胞及受精卵数显著降低(5.5±2.9),但初级卵泡形态异常率(33.34%)和次级卵泡形态异常率(27.14%)显著高于C组(8.33%、5.62%)与B组(10.34%、8.97%)(P<0.01);卵裂率(44.83%)、优质胚胎率(0)和囊胚形成率(0)均显著低于C组(88.07%、75.09%、74.74%)和B组(81.05%、69.02%、66.94%)(P<0.01)。结论:单次促排卵能增加卵母细胞和胚胎的数量。但多次连续促排卵会增加卵巢内异常的初级卵泡和次级卵泡数,降低卵母细胞质量。同时,会降低优质胚胎率和囊胚形成率,影响卵裂后胚胎进一步发育的潜能。     

Gonadotropin-releasing hormone agonist versus human chorionic gonadotropin for triggering follicular maturation in in vitro fertilization.

OBJECTIVE: To compare the use of gonadotropin-releasing hormone agonist (GnRH-a) with human chorionic gonadotropin (hCG) for triggering the final stage of follicular maturation for in vitro fertilization (IVF). DESIGN: In vitro fertilization outcome was determined in a randomized, prospective study. SETTING: The University of Toronto IVF program at The Toronto Hospital, Toronto General Division. PATIENTS AND INTERVENTIONS: One hundred seventy-nine women in the IVF program were given a subcutaneous injection of leuprolide acetate (500 micrograms) or an intramuscular injection of hCG (5,000 IU) 34 to 36 hours before oocyte retrieval. Vaginal progesterone (P) suppositories (50 mg) were used two times a day for luteal phase support. A subgroup of 41 women had serum estradiol (E2) and P levels determined 2 and 7 days after embryo transfer (ET). MAIN OUTCOME MEASURES: Pregnancy rates and luteal phase E2 and P were compared. RESULTS: In the GnRH-a group, there were 18 pregnancies from 84 ETs (20%). In the hCG group, there were 19 pregnancies from 95 ETs (19%). Luteal phase E2 and P levels were significantly lower in the GnRH-a group compared with the hCG group, and 18% of the former group had an apparent short luteal phase. CONCLUSIONS: Gonadotropin-releasing hormone agonist appears to be an effective alternative to hCG for inducing follicular maturation in IVF. The lower luteal phase E2 concentrations may potentially be beneficial in preventing ovarian hyperstimulation and for enhancing implantation. Better luteal phase support or a different dose of GnRH-a is needed to prevent luteal phase deficiency.     

Controlled ovarian stimulation with exclusive FSH followed by stimulation with hCG alone, FSH alone or hMG

OBJECTIVE: To assess if low-dose hCG is similar to hMG and to rFSH in the late follicular phase. STUDY DESIGN: In a prospective randomized controlled trial, 51 patients undergoing controlled ovarian stimulation received ovarian priming with rFSH and then received hCG (200 IU/day) (hCG group, n=17), hMG (225 IU/day) (hMG group, n=17) or rFSH (200 IU/day) (FSH group, n=17) in the late stage of follicular development. Parameters of follicular response and serum estradiol, progesterone and testosterone levels were assessed. RESULTS: Pre-ovulatory ovarian follicle occurrence and length of treatment were similar among the three treatment groups. Serum progesterone level on the day of pre-ovulatory hCG was significantly higher in the hCG group than in the hMG or rFSH group. Clinical pregnancy rates were similar for all groups. The total cost of treatment was significantly lower for the hCG group than for the groups supplemented with hMG or rFSH. CONCLUSIONS: LH in the form of low-dose hCG during the late follicular phase induced the same follicular pattern as hMG and rFSH after ovulation induction. The procedure using hCG produced pregnancy rates similar to those obtained using hMG and rFSH, even though the patients showed higher serum progesterone levels on the hCG day.     

Hemodynamic changes induced by urinary human chorionic gonadotropin and recombinant luteinizing hormone used for inducing final follicular maturation and luteinization

OBJECTIVE: To compare the safety of recombinant human luteinizing hormone (LH) with that of urinary hCG in terms of the hemodynamic changes when they are used to induce final follicular maturation in patients undergoing in vitro fertilization (IVF). A secondary end point was efficacy in terms of IVF outcome. DESIGN: Prospective, randomized clinical trial. SETTING: University teaching hospital. PATIENT(S): Thirty IVF patients. INTERVENTION(S): Ovarian stimulation was induced with FSH under pituitary suppression. Patients were randomized to receive either hCG or recombinant human LH as a trigger of oocyte maturation (5,000 IU) and for luteal phase support (5,000 IU, 2,500 IU, and 2,500 IU on the day of follicular aspiration, 2 days later, and 5 days later, respectively). MAIN OUTCOME MEASURE(S): Mean arterial pressure, cardiac output, peripheral vascular resistance, and serum levels of progesterone, plasma concentrations of aldosterone, norepinephrine, and plasma renin activity were measured in all patients on postovulatory day 7 of the spontaneous menstrual cycle preceding IVF (baseline) and 7 days after the hCG/recombinant human LH ovulatory injection during the IVF cycle. RESULT(S): Ovarian response and IVF outcome (pregnancy rate, 60%) were similar in both treatment groups. On the seventh day after hCG/recombinant human LH administration, the peripheral vascular resistance was significantly lower and serum progesterone concentrations significantly higher in the hCG group as compared with the recombinant human LH group. The percentage change from baseline values during IVF cycles in all hemodynamic and neurohormonal variables investigated was higher (albeit not statistically different) in the group treated with hCG vs. the group treated with recombinant human LH. CONCLUSION(S): Recombinant human LH is associated with less intense circulatory changes than hCG when it is given to induce final follicular maturation and luteal phase support in IVF procedures.     

改良超长方案中促排卵时不同时期添加高纯度尿促性素对助孕结局的影响

目的 探讨促性腺激素释放激素激动剂(GnRH-a)改良超长方案促排卵中高纯度尿促性素(HPhMG)不同添加时机和剂量对助孕结局的影响。方法 回顾性分析本中心首次行体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)中采用改良超长方案并添加使用了HP-hMG的454例患者的临床资料,根据添加HP-hMG的时机分为全程添加组(A组)和后半期添加组(B组)。A组:Gn启动日血清黄体生成素(LH)1.2 IU/L的患者在重组卵泡刺激素(r-FSH)促排卵的第1日同时添加HP-hMG至hCG注射日;B组:Gn启动日血清LH≥1.2 IU/L的患者r-FSH促排卵的第6日开始添加HP-hMG至hCG注射日。对不同年龄阶段患者(≤35岁和36~40岁)进行分析,观察Gn使用总量和使用时间、hCG注射日激素水平、获卵情况、胚胎质量、着床率、临床妊娠率、活产率、流产率和中重度卵巢过度刺激综合征(OHSS)风险等临床结果。结果 ≤35岁的患者中A组相比B组,虽然Gn使用总量有所增加,但hCG注射日孕酮(P)水平降低,IVF受精率明显增高,差异均有统计学意义(P0.05);着床率分别为58.2%和42.4%,临床妊娠率分别为80.1%和61.7%,活产率分别为68.9%和49.5%,差异均有统计学意义(P0.05)。36~40岁的患者中,A组与B组的临床妊娠率分别为61.9%和26.3%,活产率分别为47.6%和15.8%,差异均有统计学意义(P0.05)。A、B两组在不同年龄段的流产率和中重度OHSS发生率相似。结论 改良超长方案中患者全程添加HP-hMG较后半期添加能降低hCG注射日P水平,显著提高着床率、临床妊娠率和活产率。     

卵巢正常反应不孕症患者体外受精不同长方案促排卵效果的研究

目的探讨卵巢正常反应不孕症患者体外受精/卵胞质内单精子显微注射(IVF/ICSI)促排卵时应用口服避孕药(OC)长方案和黄体中期长方案的促排卵效果及临床结局。方法选择接受长方案IVF/ICSI助孕的卵巢正常反应患者共4 677个周期;根据年龄分为≤35岁组和35岁组,不方便超声监测排卵或自然周期超声监测卵泡不破裂的患者共2 762个周期,应用OC长方案(OC组);自然周期超声监测正常排卵的患者共1 915个周期,应用黄体中期长方案(黄体中期组);常规行IVF/ICSI,比较上述不同年龄人群2种促排卵方案的临床和实验室相关指标。结果 (1)OC组促性腺激素(Gn)启动日雌二醇(E2)[≤35岁组:(24.63±10.62)ng/L,35岁组:(24.24±10.40)ng/L]和促黄体生成素(LH)水平[≤35岁组:(0.92±0.59)IU/L,35岁组:(0.82±0.66)IU/L]均明显低于黄体中期组[≤35岁组:(25.89±12.80)ng/L,35岁组:(25.71±10.93)ng/L;≤35岁组:(1.37±0.59)IU/L,35岁组:(1.01±0.70)IU/L](P0.05);(2)OC组人绒毛膜促性腺激素(h CG)注射日E2水平[≤35岁组:(4 143.8±2 769.9)ng/L,35岁组:(3 597.5±2 160.4)ng/L]和因卵巢过度刺激综合征(OHSS)行全胚冷冻率(≤35岁组:9.1%,35岁组:10.2%)均明显高于黄体中期组[≤35岁组:(3 850.8±2 092.4)ng/L,35岁组:(3 213.4±1 804.5)ng/L;≤35岁组:4.9%,35岁组:5.9%](P0.05),但h CG注射日的内膜厚度[≤35岁组:(10.75±2.25)mm,35岁组:(10.47±2.38)mm]却明显小于后者[≤35岁组:(11.62±2.43)mm,35岁组:(11.09±2.68)mm](P0.05);(3)在年龄35岁的OC组Gn总用量[(3 775.4±1 200.0)IU]和使用时间[(13.5±2.2)d]明显高于黄体中期组[(3 516.9±1 156.1)IU,(12.4±2.2)d](P0.05);(4)2种降调节方案患者的获卵数、ICSI成熟卵数、双原核(2PN)受精率、平均移植胚胎数、优质胚胎率和早期流产率均无明显差异(P0.05),但OC组的着床率(≤35岁组:41.4%,35岁组:25.5%)和临床妊娠率(≤35岁组:55.7%,35岁组:37.5%)明显小于黄体中期组(≤35岁组:46.7%,35岁组:31.4%;≤35岁组:65.6%,35岁组:46.9%)(P0.05)。结论 (1)OC长方案可加深垂体抑制,尤其是35岁的高龄患者需增加Gn用量才能达到与黄体中期长方案相似的促排卵效果;(2)OC长方案可能通过影响子宫内膜厚度及容受性而降低着床率和临床妊娠率;(3)OC长方案使h CG注射日E2水平更高,易诱发OHSS的发生。故对卵巢功能正常的不孕患者,IVF/ICSI助孕时尽量选择黄体中期长方案。     

Luteinizing hormone concentrations after gonadotropin-releasing hormone antagonist administration do not influence pregnancy rates in in vitro fertilization-embryo transfer

OBJECTIVE: To determine the impact of circulating LH concentrations during controlled ovarian hyperstimulation on the outcome of IVF. DESIGN: Retrospective study. SETTING: University hospital. PATIENT(S): Two-hundred seventy women who had a short stimulation protocol with GnRH antagonist and ovarian stimulation with recombinant FSH (rFSH). INTERVENTION(S): GnRH antagonist and rFSH were administered SC; blood samples were collected on the day of GnRH antagonist administration, 1 day after, and on the day of hCG administration. MAIN OUTCOME MEASURE(S): A threshold of 0.5 IU/L on the day of hCG was chosen to discriminate between women with LH concentrations 0.5 IU/L (group B, n = 151). RESULT(S): The two groups were comparable with regard to the clinical parameters. In group A, significantly lower LH concentrations were observed on day 9 of the cycle and on the day of hCG administration. The numbers of oocytes retrieved, embryos obtained, and embryos cryopreserved were significantly higher in group A compared with group B. The proportion of clinical pregnancies was similar in the two groups (21.1% vs. 22.7 % per ET). CONCLUSION(S): In GnRH antagonist and rFSH protocols, suppressed serum LH concentrations do not have any influence on the final stages of follicular maturation, pregnancy rates, or outcomes.     

来曲唑/FSH促排卵中GnRHa与hCG诱发卵泡成熟效果的比较

目的:比较曲普瑞林和hCG在来曲唑(LE)/FSH促排卵行IVF-ET治疗中诱发卵泡成熟的效果。方法:391个IVF-ET治疗周期随机分成促性腺激素激动剂(GnRHa)组(n=267)和hCG组(n=124),所有患者均采用LE/FSH促排卵方案,当主导卵泡平均直径达18～20mm时,GnRHa组患者采用达菲林0.1mg诱导卵泡成熟,hCG组采用hCG10000IU诱导卵泡成熟,比较组间的获卵数、MII卵率、受精率、卵裂率、优胚率、临床妊娠率和中-重度卵巢过度刺激综合症(OHSS)发生率。同时比较两组患者诱导日(d0)、取卵日(d2)、胚胎移植前日(d4)和胚胎移植后第4日(d9)的血清E2、P、LH水平。结果:hCG组Gn使用总量、MII卵率、卵裂率、中-重度OHSS发生率显著高于GnRHa组(P<0.05)。Gn使用天数、获卵数、受精率、种植率、临床妊娠率、流产率组间无统计学差异(P>0.05)。GnRHa组d0LH、d2LH、d9LH水平显著高于hCG组(P<0.05),而d2P、d4E2、d4P、d4LH、d9E2、d9P水平显著低于hCG组(P<0.05)。结论:在LE/FSH促排卵方案中可以用GnRHa替代hCG诱导卵泡成熟,而不影响IVF结局,并显著降低OHSS发生率。GnRHa诱导卵泡成熟的IVF周期其黄体期存在黄体功能不全,需适当补充外源性hCG加强黄体支持。     

中药二至天癸颗粒对控制性超排卵周期卵泡液IL-1β、IL-6以及对胚胎质量的影响

目的:探讨补肾中药二至天癸颗粒对提高控制性超排卵所获卵和胚胎质量的作用机理。方法:将66例因输卵管因素行IVF-ET的患者随机分为中药+控制性超排组(实验组,n=33)和控制性超排组(对照组,n=33)。应用双抗体酶联免疫吸附法(ELISA)检测取卵日成熟卵泡卵泡液IL-1β、IL-6水平,移植日采用形态学标准对胚胎进行评分。结果:实验组卵泡液IL-1β水平显著高于对照组(P<0.05);实验组的胚胎评分显著高于对照组(P<0.01);卵泡液IL-1β与移植日胚胎评分呈正相关(P<0.01)。结论:二至天癸颗粒能够改善控制性超排卵周期的胚胎质量,可能与调控卵泡液IL-1β水平有关。