阴道B超结合尿黄体生成素试纸监测排卵指导不孕夫妇性生活

目的 探讨阴道B超结合尿黄体生成素（LH）试纸监测排卵,指导不孕夫妇性生活,在不孕症患者的临床诊治的应用. 方法 对96例不孕患者208个自然月经周期通过阴道B超进行监测排卵,根据卵泡大小、子宫内膜厚度及分类,同时结合LH试纸测试LH峰,预算排卵日,以指导不孕症夫妇性生活.观察卵泡发育、排卵情况及受孕情况. 结果 第1个自然周期正常卵泡排卵比例为78.1％,75例正常卵泡排卵患者共监测167个自然周期,指导性生活,临床妊娠率为24.0％,第2、3正常卵泡排卵自然周期指导性生活92个周期中,临床妊娠率为10.9％（10/92）;第1个自然周期小卵泡排卵、黄素化未破裂卵泡综合征和无排卵周期发生率分别为12.5％、4.2％和5.2％;12例小卵泡排卵患者监测26个周期,1例妊娠,4例黄素化未破裂卵泡综合征患者监测10个自然周期,1例妊娠;临床总妊娠率为31.3％. 结论 阴道B超结合尿LH试纸监测排卵,指导不孕夫妇性生活,既可以诊断不孕患者排卵情况,同时提高受孕率,起到良好的临床诊治效果.     

卵巢子宫内膜异位囊肿伴不孕患者56例治疗体会

目的:探讨对不孕年限较短的卵巢子宫内膜异位囊肿患者的治疗方法。方法:囊肿小者先予自然周期监测排卵并指导性生活3~6个周期;囊肿大者以及自然周期监测排卵未孕者全部行子宫输卵管造影;再选择输卵管通畅者进行阴道超声引导下卵巢囊肿穿刺术,术后注射达菲林至复查阴道B超无囊肿再次生长或囊肿很小。待月经复潮后于月经周期第1天开始服用散结镇痛胶囊,同时从月经周期第3~5天开始诱导排卵并指导性生活3~6个疗程。结果:12例自然周期监测排卵患者中3例获临床妊娠;49例穿刺术后诱导排卵患者中31例获临床妊娠。结论:对于卵巢子宫内膜异位囊肿伴不孕患者应依据年龄、不孕年限、病变程度以及是否合并其他不孕因素等实际情况进行综合分析,为其制定周密的连续的个体化治疗方案。     

小卵泡排卵不孕及习惯性流产患者的临床诊治研究

小卵泡排卵可引起不孕及反复自然流产,经阴道B超监测卵泡发育及尿LH测定是诊断小卵泡排卵的主要方法[1].小卵泡排卵的周期妊娠率低,自然流产率高,因此监测过程中如发现为小卵泡排卵应以避免妊娠为宜.     

阴道B超监测不明原因反复自然流产患者排卵的临床意义

目的:探讨阴道B超监测不明原因反复自然流产患者排卵的临床意义。方法:采用阴道B超观察96例不明原因反复自然流产患者的卵泡生长模式(观察组),同时进行性激素测定及子宫内膜病理组织学检查。对56例92个周期给予促排卵及黄体支持治疗,观察妊娠结局。选择90例因男性因素不孕的患者作为对照组。结果:观察组卵泡发育不良综合征(FMS)发生率为79.2%(107/135),对照组FMS发生率为29.5%(37/90),二者差异有统计学意义(P<0.05);观察组中有排卵者的黄体中期雌二醇(E2)及孕激素(P)水平均明显低于对照组(P<0.05),子宫内膜分泌不良的发生率亦明显高于对照组(P<0.001);56例92个周期的促排卵及黄体支持治疗后共有48例妊娠,周期妊娠率52.1%(48/92),活产率为33.3%(42/56)。结论:卵泡发育不良是导致反复自然流产的病因之一;B超监测卵泡发育是诊断卵泡发育不良准确而有效的方法;在促排卵或黄体支持治疗中进行卵泡监测可预防再次发生自然流产。     

小卵泡排卵致不孕症69例临床观察

目的探讨小卵泡排卵的诊断及治疗方法。方法 回顾性分析69例小卵泡排卵患者B超监测卵泡发育情况,并对其进行周期性促排卵治疗。结果69例患者均进行了2个周期以上的监测,重复出现小卵泡排卵的56例,重复出现率81.16%（56/69）。经促排卵药物治疗后临床妊娠率46.03%（29/63）,周期妊娠率为23.02%（29/126）。结论小卵泡排卵是造成不孕的主要原因之一。B超监测卵泡发育情况是诊断小卵泡排卵的主要方法,促排卵是治疗小卵泡排卵所致不孕症的有效方法。     

经阴道超声监测不孕症患者卵泡发育及子宫内膜厚度的意义

目的:应用经阴道超声监测不孕症妇女的卵泡发育及子宫内膜生长情况,根据超声的图像特征判断卵泡的成熟度和是否排卵,并观察子宫内膜与卵泡生长之间的关系。方法:198例不孕妇女,从月经周期第9天开始监测卵泡发育情况,同时记录子宫内膜厚度及形态。结果:根据卵泡发育情况超声图像表现可分为排卵正常型、小卵泡型、卵泡黄体化不破裂型、卵泡生长过度形成囊肿型及无卵泡发育型。各种类型内膜生长均有其特征性表现。结论:经阴道超声监测排卵及子宫内膜厚度对诊断和指导不孕症有重要的意义。     

不孕症198例经阴道超声监测卵泡发育结果分析

目的探讨经阴道超声监测不孕患者的卵泡发育、卵巢血流灌注及子宫内膜生长的情况。方法回顾性分析我院198例不孕妇女,并选取40例正常妇女作为对照。从患者月经周期第8 d起开始监测卵泡发育情况及卵巢血流灌注,同时记录子宫内膜厚度及形态结果。并根据超声的图像特征判断卵泡的成熟度和是否排卵,并观察子宫内膜与卵巢血流灌注和卵泡生长之间的关系。结果对照组各个时期的卵泡发育情况均明显好于不孕组（P〈0.05）,对照组各个时期的RI值及S/D值均明显低于不孕组（P〈0.05）。卵泡大小与卵巢血流灌注成正相关。对照组的子宫内膜厚度要低于原发性不孕组,而高于继发性不孕组;对照组卵泡发育情况要好于不孕组。结论经阴道超声监测卵泡发育情况、卵巢血流灌注及子宫内膜生长的情况,为临床诊治提供了科学依据,提高不孕症患者受孕机率。     

不同剂量来曲唑对多囊卵巢综合征不孕症患者诱导排卵的临床观察

目的比较不同剂量来曲唑诱导排卵的临床效果。方法将121例多囊卵巢综合征(polycystic ovary syndrome,PCOS)不孕妇女分为A组57例,B组64例,分别口服来曲唑2.5 mg、5 mg,共5天。阴道B超监测卵泡和子宫内膜生长,内膜薄时口服戊酸雌二醇。最大卵泡平均直径≥18 mm时肌肉注射绒毛膜促性腺激素(human chorionic gonadotrophin,HCG)10 000 U,观察各种临床指标。结果两组子宫内膜厚度、A型内膜比例、戊酸雌二醇用量比较,差异无统计学意义(P>0.05)。注射HCG日优势卵泡数、排卵数B组多于A组,卵泡生长时间B组短于A组(P<0.05),成熟卵泡数、最大卵泡平均直径、排卵率、卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)发生率、自然流产率两组比较,差异无统计学意义(P>0.05)。妊娠率B组显著高于A组(P<0.05)。结论 5 mg来曲唑更适合多囊卵巢综合征不孕症患者诱导排卵。     

阴道B超介入下卵巢子宫内膜异位囊肿穿刺治疗

目的探讨阴道B超介入下对卵巢子宫内膜异位囊肿进行穿刺治疗的效果。方法对86例不孕合并卵巢子宫内膜异位囊肿的病人在阴道B超介入下行穿刺治疗，术后辅以药物治疗3个月，并与43例手术治疗（术后用同样药物治疗方案）的病人相对照，观察疗效。结果穿刺组与手术组的妊娠率相近，差异无统计学意义（P〉0.05），穿刺组的复发率明显高于手术组，差异有统计学意义（P〈0．05），穿刺组的再手术率明显高于手术组，但差异无统计学意义（尸〉0.05）。结论阴道B超介入下卵巢子宫内膜异位囊肿穿刺术辅以药物治疗是治疗卵巢子宫内膜异位囊肿合并不孕的一种安全、有效的方法。     

尿LH联合超声在黄素化不破裂卵泡综合征诊治中的应用

目的:观察尿LH联合经阴道超声监测排卵在未破裂卵泡黄素化综合征(LUFS)诊断和治疗中的作用,探讨LUFS的诊治方法。方法:对79例临床诊断LUFS患者的307个月经周期进行回顾性分析,根据基础体温及经阴道超声等相关检查结果,将此307个周期分为3组:排卵周期组,LUF周期组及成功妊娠周期组。应用尿LH联合经阴道超声(transvaginal sonography,TVS)监测排卵,对不同周期组优势卵泡出现距排卵日(或预计排卵日)时间(T1),尿LH高峰出现距排卵日(或预计排卵日)时间(T2),尿LH高峰值及尿LH高峰出现时子宫内膜厚度和类型进行比较,应用Logestics回归对LUF周期的出现及成功妊娠与上述观察项目进行相关性分析。307个周期中有245个周期接受促排卵治疗,根据不同治疗方式将此245个周期分为适时HCG治疗组(112个周期)和其他治疗组(133个周期)。其中适时HCG治疗的方法为:当患者尿LH开始升高后持续2天无明显升高趋势,TVS监测有一个卵泡直径达18mm以上或两个卵泡直径大于等于16mm以上,TVS监测无排卵征象时,给予HCG5000U~10000U一次肌肉注射。对两治疗组的成功妊娠率进行比较。结果:LUF患者307个被观察周期中排卵周期177个(57.7%),LUF周期110个(35.8%),成功妊娠周期20个(6.5%)。重复出现的LUFS周期32个,占LUFS患者被观察周期的10.4%。排卵周期、LUF周期及成功妊娠周期中,排卵周期和成功妊娠周期与LUF周期相比,T1、尿LH高峰出现时子宫内膜厚度和类型均无显著性差异,P>0.05。排卵周期,LUF周期及成功妊娠周期组的T2分别为:-1.18±0.53天,2.01±1.61天,1.50±0.52天,LUFS周期组明显晚于其他周期组,P<0.01;尿LH最大值分别为:45.65±28.30mIU/ml,21.46±4.22mlU/ml,63.33±12.20mlU/ml,LUFS周期明显小于其他周期,P<0.01。上述观察项目中只有T2可作为LUFS周期出现的预测因素,P=0.03,比值比(oddsratio,OR)=4.30,其他项目均不是LUFS周期出现的预测因素,P>0.05。上述观察项目均不是成功妊娠的预测因素,P>0.05。接受促排卵治疗的周期245个(79.8%),其中接受适时HCG治疗的112个周期(45.7%)成功妊娠14个周期(12.5%),接受其他治疗的133个周期(54.3%)成功妊娠6个周期(4.5%),两者成功妊娠率有显著性差异,P=0.037。结论:LUFS在不孕症患者中有一定的发生率和重复发生率,提示LUFS是不孕症的重要原因之一。LUFS周期的尿LH峰明显延迟,峰值明显降低,预计排卵日后2天内没有尿LH峰出现可提示LUFS周期的出现,尿LH联合经阴道超声监测可用于LUFS的临床诊断。尿LH联合经阴道超声监测可用以指导LUFS的适时HCG治疗。     

宫腔镜在不孕症女性子宫腔内病变中的诊治价值

目的 探讨宫腔镜在不孕症女性子宫腔内病变中的临床诊断和治疗价值.方法 筛选自2009年1月至2012年12月期间在我院就诊的本市192例不孕症患者,对192例不孕症患者采用宫腔镜检查和输卵管插管通液,统计常见的子宫腔内病变类型.结果 经过详细的宫腔镜检查后,发现有139例患者存在子宫腔内病变,病变率为72.39％,139例病变中有52例是宫腔粘连,比例为37.41％,明显高于其它病变类型,差异具有显著性（P＜0.05）;在对不孕症患者实行了输卵管插管通液后,输卵管阻塞情况明显改善.结论 宫腔镜检查安全可靠,对患者影响小,在不孕症的诊断和治疗中有着很好的前景.     

Influence of medical conditions and lifestyle factors on the menstrual cycle

BACKGROUND: Few studies have described medical and lifestyle factors associated with various menstrual cycle characteristics. METHODS: We analyzed cross-sectional data collected from 3941 premenopausal women from Iowa or North Carolina participating in the Agricultural Health Study between 1994 and 1996. Eligible women were age 21-40, not taking oral contraceptives, and not currently pregnant or breast feeding. We examined four menstrual cycle patterns: short cycles (24 days or less), long cycles (36 days or more), irregular cycles, and intermenstrual bleeding. RESULTS: Long and irregular cycles were less common with advancing age and more common with menarche after age 14, with depression, and with increasing body mass index. The adjusted odds of long cycles increased with increasing body mass index, reaching 5.4 (95% confidence interval [CI] = 2.1-13.7) among women with body mass indexes of 35 or higher compared with the reference category (body mass index of 22-23). Smoking was associated with short cycles. Long cycles, irregular cycles, and intermenstrual bleeding were associated with a history of infertility. Having long cycles was associated with a doubling in the adjusted odds of having a fetal loss among women who had been pregnant within the last 5 years (odds ratio = 2.3; 95% CI = 0.9-5.7). CONCLUSIONS: Menstrual patterns are influenced by a number of host and environmental characteristics. Factors that perturb menstruation may increase a woman's risk of other reproductive disorders.     

男性精液因素对体外受精妊娠结局的影响

目的：探讨男性精液指标与体外受精（IVF）妊娠结局的关系,以指导控制性促排卵周期受精方法的选择。方法：收集郑州大学第一附属医院生殖中心2012年1月—2013年6月第一周期长方案控制性促排卵的2 591个IVF周期,匹配妊娠女方与未妊娠女方的年龄、体质量、不孕原因、基础卵泡刺激素（FSH）和黄体生成激素（LH）、注射人绒毛膜促性腺激素（hCG）日子宫内膜厚度及获卵数等因素,共获得457对,分析不同妊娠结局夫妇中男性因素的差异。结果：妊娠组男性精子正常形态率高于未妊娠组（P＜0.05）,但2组精子密度、活力、活率和合格率差异均无统计学意义（P＞0.05）。结论：不同妊娠结局IVF周期精子形态有差异,精液常规分析中的正常形态率较其他指标对IVF妊娠结局具有更高的参考价值。     

Infertility in Australia circa 1980: an historical population perspective on the uptake of fertility treatment by Australian women born in 1946‐51

Objective: To estimate the prevalence of lifetime infertility in Australian women born in 1946‐51 and examine their uptake of treatment. Methods: Participants in the Australian Longitudinal Study on Women's Health born in 1946‐51 (n=13,715) completed up to four mailed surveys from 1996 to 2004. The odds of infertility were estimated using logistic regression with adjustment for socio‐demographic and reproductive factors. Results: Among participants, 92.1% had been pregnant. For women who had been pregnant (n=12738): 56.5% had at least one birth but no pregnancy loss (miscarriage and/or termination); 39.9% experienced both birth and loss; and 3.6% had a loss only. The lifetime prevalence of infertility was 11.0%. Among women who reported infertility (n=1511), 41.7% used treatment. Women had higher odds of infertility when they had reproductive histories of losses only (OR range 9.0‐43.5) or had never been pregnant (OR=15.7, 95%CI 11.8‐20.8); and higher odds for treatment: losses only (OR range 2.5‐9.8); or never pregnant (1.96, 1.28‐3.00). Women who delayed their first birth until aged 30+ years had higher odds of treatment (OR range 3.2‐4.3). Conclusions: About one in ten women experienced infertility and almost half used some form of treatment, especially those attempting pregnancy after 1980. Older first time mothers had an increased uptake of treatment as assisted reproductive technologies (ART) developed. Implications: This study provided evidence of the early uptake of treatment prior to 1979 when the national register of invasive ART was developed and later uptake prior to 1998 when data on non‐invasive ART were first collected.     

Infertility, medical advice and treatment with fertility hormones and/or in vitro fertilisation: a population perspective from the Australian Longitudinal Study on Women's Health

Objective: To identify the factors associated with infertility, seeking advice and treatment with fertility hormones and/or in vitro fertilisation (IVF) among a general population of women.
Methods: Participants in the Australian Longitudinal Study on Women's Health aged 28-33 years in 2006 had completed up to four mailed surveys over 10 years (n=9,145). Parsimonious multivariate logistic regression was used to identify the socio-demographic, biological (including reproductive histories), and behavioural factors associated with infertility, advice and hormonal/IVF treatment.
Results: For women who had tried to conceive or had been pregnant (n=5,936), 17% reported infertility. Among women with infertility (n=1031), 72% (n=728) sought advice but only 50% (n=356) used hormonal/IVF treatment. Women had higher odds of infertility when: they had never been pregnant (OR=7.2, 95% CI 5.6-9.1) or had a history of miscarriage (OR range=1.5-4.0) than those who had given birth (and never had a miscarriage or termination).
Conclusion: Only one-third of women with infertility used hormonal and/or IVF treatment. Women with PCOS or endometriosis were the most proactive in having sought advice and used hormonal/IVF treatment.
Implications: Raised awareness of age-related declining fertility is important for partnered women aged ∼30 years to encourage pregnancy during their prime reproductive years and reduce the risk of infertility.     

130例妊娠期肝内胆汁淤积症的临床分析

目的:总结妊娠期肝内胆汁瘀积症(ICP)患者的诊疗体会。方法:选择2007年8月～2010年8月期间不同孕周的诊断单纯患有妊娠期肝内胆汁瘀积症(无其他基础疾病及妊娠期并发症)的130例孕妇进行入院宣教、心理指导、孕期监护、分娩及分娩后的监护,总结ICP的治疗护理时间及严重度的不同对妊娠结局的影响。结果:该130例ICP孕妇,共分娩胎儿127例,其中早产11例,围生儿死亡1例,胎儿分娩率为97.7%,胎儿存活率为96.9%,产妇术后大出血3例。结论:对妊娠期肝内胆汁瘀积症患者的早期诊断、评估及治疗、严密监测及全面护理是孕妇成功分娩、提高围生儿存活率及降低孕妇产后并发症发生率的关键。     

影响宫腔内人工授精治疗结果的因素探讨

目的:探讨影响宫腔内人工授精(IUI)治疗结果的因素,以提高IUI治疗的临床效果。方法:对415个IUI治疗周期的240例患者的年龄、不孕年限、不孕原因、精液处理方法和处理后精子情况、IUI治疗周期数、一个周期内2次IUI以及促排卵方案与治疗结果的关系进行分析。结果:患者的年龄、处理后精子情况、IUI周期数和促排卵药物的使用与治疗结果有关;精液处理方法、一个周期内2次IUI和不同的促排卵方案对治疗结果没有影响。结论:患者的年龄、处理后精子情况、IUI周期数和促排卵药物的使用是影响IUI治疗结果的重要因素;一个周期内2次IUI和增加IUI的治疗周期数无法提高IUI治疗的临床妊娠率。     

Value of hysteroscopy in management of unexplained infertility

ObjectiveTo assess the value of hysteroscopy in unexplained infertility.Methods200 infertile women in whom standard infertility investigations revealed no abnormalities were included in the study between January 2009 and December 2013. All women underwent hysteroscopy for diagnosis and treatment of any uterine lesion which was previously undetected by hysterosalpingography (HSG). Treated women were followed up for one year during which pregnancy rate was determined. As all other causes that contribute to infertility (other than the subtle uterine lesions) were excluded. No other infertility treatment was performed during this period.ResultsOf the 200 women studied, hysteroscopy revealed abnormalities in 65 (33%) women. Most uterine abnormalities were mild adhesions, small submucous myomas and polyps and their incidence was greater in women aged ≥ 30 years and women with secondary infertility. The overall pregnancy rate in the treated women within one year of follow up was 46%.ConclusionAs a cause of unexplained infertility, subtle uterine abnormalities are diagnosed only during hysteroscopy and they are relatively common in infertility women. Although the presence of these abnormalities is not detected by the basic investigations for infertility, their correction seems to be necessary when infertility is desired and other infertility causes are excluded.     

不孕症人群心理测评分析

目的：应用心理测评量表对不孕症人群进行心理状况调查分析,探讨不孕症人群心理健康状况,为不孕症的诊治提供依据。方法：对163例不孕症夫妇分别采用症状自评量表（SCL-90）结合综合医院焦虑／抑郁情绪测定表（HADS）进行心理状况测评,并进行统计分析。结果：不孕症夫妇SCL-90自评量表总分、总均分、阳性项目数、抑郁、焦虑、人际关系敏感、敌对、躯体化等因子分均高于全国常模（P〈0.05）;不孕症夫妇在总分、总均分、抑郁因子、焦虑因子为高度相关（r〉0.7,P〈0.001）,并且女方总分、总均分、阳性项目数均高于男方（P〈0.01）。HADS测查中焦虑和抑郁情绪得分阳性率与SCL-90相接近,两个量表的焦虑和抑郁情绪得分呈高度相关性（r〉0.700,P〈0.001）。结论：不孕症人群心理状况的整体水平较正常人低,不良情绪以抑郁、焦虑等为主。在不孕症诊治中,要重视不孕不育夫妇之间不良情绪的相互影响作用,并进行有效的心理干预。     

附睾精子抽吸术结合卵细胞浆内单精子注射治疗阻塞性无精子症所致男性不育的研究

目的:探讨附睾精子抽吸术(ESA)结合卵细胞内单精子注射(ICSI)技术治疗阻塞性无精子症所致男性不育的治疗效果。方法:选择2002年1月~2003年12月到我院治疗不育症确诊为阻塞性无精子症男性不育患者,采用ESA方法吸取男性附睾液,分离精子用于ICSI;同时按常规体外受精-胚胎移植方法(IVF-ET),采用GnRH-α+FSH/hMG+hCG促排卵方案对女性进行促排成熟卵细胞(M II)用于显微注射授精,受精卵体外培养3 d后移植回子宫内。结果:采用MESA结合ICSI技术治疗32周期阻塞性无精子症所致不育的夫妇,所获成熟卵(M II)162个,受精率66.28%,卵裂率62.21%,临床妊娠率31.20%。结论:采用ESA结合ICSI技术治疗阻塞性无精子症所致男性不育获得良好的效果,该方法为阻塞性无精子症男性不育患者提供了一种快速、方便、无痛、有效的治疗方法。