口服避孕药预处理在体外受精-胚胎移植中的临床观察

目的为探讨促排卵周期前口服避孕药（OCP）预处理在体外受精-胚胎移植（IVF-ET）的意义。方法对2010年8月至2012年8月在本所行IVF或ICSI助孕92例患者予促性腺激素释放激动剂（GnRH-a）长方案降调节前是否使用OCP药物分为OCP治疗组50例和对照组42例进行分析,比较口服避孕药对患者促排卵的效果以及对助孕结果的影响。结果 OCP预处理明显减少卵巢功能性囊肿形成和减少周期取消率（P〈0.05）,而两组Gn时间、用量、获卵数、受精率、妊娠率比较无显著性。结论在IVF-ET中使用OCP预处理能减少功能性囊肿的形成,减少周期取消率,OCP联合GnRH-a能获得较好的促排卵效果。     

口服避孕药对体外受精-胚胎移植术中卵巢反应不良患者的意义

目的 研究促排卵周期前应用口服避孕药(OCP)对体外受精 胚胎移植术（IVF ET）中卵巢反应不良者的意义。方法 将143例行IVF-ET的卵巢反应不良患者按排卵周期前是否使用过OCP药分为OCP治疗组69例和对照组74例，对入选患者的病历资料进行统计分析，评估口服避孕药对患者促排卵的效果以及对IVF ET手术结果的影响。结果 预先使用OCP的患者促性腺激素用量［平均（44.06±9.30）支］较对照组［平均(51.37±13.68)支］少,周期取消率(11.6%)较对照组（25.7%）低（均P＜0.05），但两组获卵数、受精率、临床妊娠率等均差异无显著性。结论 对卵巢反应不良的患者，在行IVF ET前口服避孕药可改善促排卵治疗效果，降低周期取消率。     

口服避孕药在子宫内膜异位症体外受精-胚胎移植治疗中的作用研究

摘要：目的:探索在子宫内膜异位症患者的体外受精-胚胎移植（IVF）治疗中使用短效口服避孕药（OCP）预处理对促排卵效果、胚胎质量和妊娠结局的影响。方法:采用回顾性队列研究方法,共纳入子宫内膜异位症患者512例,其中OCP组患者216例,在IVF治疗前使用OCP进行预处理;对照组296例,在IVF治疗前未使用OCP预处理。主要评价指标为活产率和临床妊娠率,次要评价指标为促排卵结局和胚胎参数。结果:OCP组患者的促排卵时间[（10.60±2.17）d vs.（11.07±2.36）d,P<0.05]和促排卵药物剂量[（2 441.30±938.74）IUvs.（3 042.40±1 136.73）IU,P<0.01]均显著低于对照组,而血清峰值雌激素水平[（4 893.15±2 899.82） pg·ml-1vs.（3 678.17±2 612.71）pg·ml-1,P<0.01]和获卵数[（12.48±6.49）vs.（9.72±6.73）,P<0.01]均显著高于对照组。两组患者的受精方式、受精率和卵裂率无明显差异,但OCP组患者的优质胚胎率（74.69%vs.70.99%,P<0.05）和优质胚胎数[（5.64±2.09）vs.（4.20±2.19）,P<0.01]均显著高于对照组。两组患者的临床妊娠率和活产率差异无统计学意义（P>0.05）。OCP组药品不良反应发生率较低,无严重不良反应发生。结论:OCP可能提高子宫内膜异位症患者的促排卵效率,降低治疗花费,改善胚胎质量,且对IVF妊娠结局无明显负面影响,故可作为一种治疗子宫内膜异位症相关性不孕的有效治疗手段。     

Effect of two different controlled ovarian hyperstimulation methods on isolated polycystic ovaries

目的 探讨两种超促排卵方案对单纯多囊卵巢患者接受体外受精-胚胎移植(IVF-ET)或卵胞浆内单精子显微注射(ICSI)治疗过程及结局的影响.方法 72例接受IVF-ET或ICSI的单纯多囊卵巢患者中,口服避孕药(OC)预处理组28例,应用常规长方案组44例.比较两组病例在超促排卵过程中各项指标及妊娠结果.结果 两组在促性腺激素用量、获卵数、受精率、种植率、临床妊娠率、自然流产率、异位妊娠率、卵巢过度刺激发生率等方面比较,差异均无统计学意义(P＞0.05).结论 单纯多囊卵巢患者IVF超促排卵时可以选择常规长方案,不必要OC预处理.     

卵巢低反应预处理后对IVF-ET结局的影响

目的 探讨在超排卵前补佳乐人工周期处理3个周期后对卵巢反应不良患者IVF-ET结局的影响.方法 选择2005年1月～2006年12月在我中心接受IVF-ET或ICSI治疗中预测将出现卵巢低反应的患者,21例设为研究组,在超排卵前给予补佳乐行人工周期3个周期;22例作为对照组,分析两组超排卵前不孕原因、不孕时间、基础内分泌以及超排卵时所用Gn天数、Gn支数、获卵数、受精数、优质胚胎数、妊娠率、早期流产率.结果 两组在不孕原因、不孕时间、基础内分泌无统计学差异性(P＞0.05);两组Gn天数、Gn支数、获卵数、受精数和优胚数亦无统计学差异性(P＞0.05),研究组妊娠率高于对照组,早期流产率低于对照组(P＜0.05).结论 补佳乐预处理后,可以提高卵巢反应不良患者的妊娠率,降低流产率.     

基因重组人卵泡刺激素用于非低反应人群卵泡期长效促排卵方案的疗效分析

目的 比较2种基因重组人卵泡刺激素（rFSH）制剂用于卵泡期长效促排卵方案的非低反应人群的疗效及 安全性。方法 回顾性纳入首次行卵泡期长效促排卵方案体外受精/胞质内单精子显微注射技术（IVF/ICSI）助孕治 疗的非卵巢低反应不孕患者,均行控制性卵巢刺激（COS）卵泡期长效促排卵方案治疗,根据使用rFSH不同分为国产 rFSH组（267个周期）和进口rFSH组（240个周期）。比较2组患者在超促排卵过程中的卵巢反应、用药情况、卵子受 精及胚胎情况、新鲜胚胎移植及胚胎解冻移植后的妊娠率及活产率。结果 超促排卵过程中,国产rFSH组HCG注 射日雌二醇（E2）水平低于进口rFSH组（P＜0.05）,2组Gn总量、Gn使用天数、减数分裂中Ⅱ期（MⅡ）卵数、D3优质胚 胎数、获得优质囊胚数等差异均无统计学意义（P＞0.05）。主要疗效指标中,国产rFSH组及进口rFSH组的平均获卵 数、新鲜胚胎移植周期临床妊娠率、冻融移植周期临床妊娠率等差异均无统计学意义（P＞0.05）,且2组患者的一次 COS累积活产率比较差异均无统计学意义（P＞0.05）。结论 非低反应患者在卵泡期长效促排卵方案中使用国产 rFSH或进口rFSH可获得同等安全的促排卵疗效和妊娠结局。     

卵泡冲洗在卵巢功能减退患者实施辅助生殖助孕中的应用

目的:研究卵泡冲洗在卵巢功能减退患者行体外授精-胚胎移植(IVF-ET)助孕中的作用。方法:选择行IVF-ET助孕的卵巢储备功能差的患者共100个取卵周期,分为常规取卵组(对照组)50例和卵泡冲洗取卵组(冲洗组)50例。比较两组的获卵及胚胎情况、临床结局。结果:卵泡冲洗组的获卵率高于常规取卵组(P<0.05),其临床妊娠率有增高趋势,但差异无统计学意义(P>0.05)。结论:卵泡冲洗可以提高卵巢储备功能差的患者的获卵数,因此卵泡数少的患者取卵时,卵泡冲洗是必要的。     

黄体期促排卵与拮抗剂方案在高龄妇女体外受精助孕的对比研究

目的：对黄体期促排卵与拮抗剂方案在高龄妇女体外受精（IVF）助孕中的临床应用效果进行分析。方法于本院生殖中心接受IVF助孕且年龄不低于40岁的妇女共228个周期,对照组79个周期采用拮抗剂方案,观察组149个周期采用黄体期促排卵方案,对比两组受精率、妊娠率、优胚率、周期取消率及早期流产率。结果两组获卵数、受精率、妊娠率、优胚率、周期取消率、早期流产率间差异无统计学意义（P〉0.05）。结论在高龄妇女体外受精助孕中黄体期促排卵与拮抗剂方案均有显著效果,可提升胚胎质量,临床结局良好,值得在临床中推广。     

卵丘颗粒细胞SIRT1表达对卵胞浆内单精子显微注射助孕结局的影响

目的 探讨卵丘颗粒细胞SIRT1表达对ICSI助孕结局的影响.方法 收集120例因男方因素在我院辅助生殖技术研究室行ICSI助孕的女性患者卵丘颗粒细胞,采用免疫组化法检测SIRT1蛋白.比较分析ICSI妊娠与非妊娠组SIRT1表达率,并分析其与ICSI实验室各项指标如穿卵泡数、获卵数、获卵率,受精数、受精率,卵裂数、卵裂率,优质胚胎数、囊胚形成数及囊胚冷冻数之间关系.结果 妊娠与未妊娠组SIRT1表达率差异有统计学意义(P＜0.05).SIRT1表达率与穿卵泡数、Ⅲ级OCCs数、ICSI卵子数、受精数、卵裂数、平均优质胚胎数、平均囊胚数、优质囊胚数、平均冷冻胚胎数间均有显著相关性(P＜0.01).结论 SIRT1在卵丘颗粒细胞表达可能影响卵母细胞成熟及卵子发育能力,进而与ICSI助孕结局有关.     

不同扳机方式对多囊卵巢综合征患者新鲜周期移植妊娠结局的影响比较

目的比较不同扳机方式对多囊卵巢综合征患者在新鲜周期移植妊娠结局的影响。方法回顾性分析中国人民解放军陆军第七十三集团军医院生殖医学中心2017年1月至2020年6月收治的多囊卵巢综合征并行体外受精-胚胎移植(IVF-ET)助孕的患者255例, 在助孕过程中根据不同扳机方式分为:人绒毛膜促性腺激素(HCG)扳机组(HCG扳机组, 81例)和促性腺激素释放激素激动剂(GnRH-a)联合低剂量HCG扳机组(联合扳机组, 174例)。比较两组的一般资料、获卵数、可利用胚胎数、MⅡ卵率、临床妊娠率、持续妊娠率、早期流产率及卵巢过度刺激综合征(OHSS)发生率。采用t检验、χ2检验进行统计分析。结果两组间获卵数、可利用胚胎数、MⅡ卵率、临床妊娠率、持续妊娠率、早期流产率比较, 差异均无统计学意义(均P>0.05)。HCG扳机组的OHSS总发生率(6.17%, 5/81)低于联合扳机组(0), 差异有统计学意义(χ2=10.956, P=0.001)。结论在多囊卵巢综合征患者行新鲜周期IVF-ET助孕过程中, GnRH-a联合低剂量HCG扳机更优, 能减少OHSS的发生。     

Chronic GnRH agonist administration down-regulates platelet serotonin transporter in women undergoing assisted reproductive treatment

The effect of pretreatment with the gonadotropin releasing hormone (GnRH) agonistd-Trp6-LHRH (Decapeptyl) on platelet serotonin transporter in women undergoing assisted reproductive treatment (ART) was investigated and compared with women treated with human menopausal gonadotropin (Pergonal). The study group (n=10) was exposed for 12 days to 3.2 mg Decapeptyl C.R. while a comparison group (n=9) was exposed to 11 days of human meno-pausal gonadotropin (Pergonal). All patients were assessed with the Hamilton depression and anxiety scales before and after treatment, and platelet and plasma samples were collected at the same time points. Plasma levels of estradiol, progesterone, FSH and LH were determined by radioimmunoassay (RIA). Platelet serotonin transporter was labeled using high affinity [³H]imipramine binding. The GnRH analogue induced ovarian suppression as reflected by low plasma estradiol levels, while Pergonal administration induced ovarian stimulation. An elevation in the Hamilton depression and anxiety scale scores was observed in the Decapeptyl treated group; this mood alteration was associated with a significant decrease (19%,P<0.05) in the density (B_max) of platelet [³H]imipramine binding sites. No significant change was observed in the B_max of the Pergonal treated group. These results indicate that ovarian suppression (menopausal-like state) in young women is associated with depressed and anxious mood and decreased serotonin transporter density.     

Effects of age, sex and the oral contraceptive on the platelet membrane fibrinogen binding site (glycoprotein IIb/IIIa).

1. We have studied the effects of age, sex and the oral contraceptive pill on platelet fibrinogen 'receptor' density (Bmax) and affinity (Kd). 2. [125I]-fibrinogen binding to gel-filtered platelets was assessed after stimulation with adenosine 5-diphosphate (ADP) and thrombin in 60 normal subjects; 37 females and 23 males. 3. For both agonists there was no significant difference in Bmax or Kd between the sexes. A trend towards increasing affinity (reduced Kd) with age was noted in the female group following ADP stimulation. This was not considered to be physiologically relevant. In the group as a whole no significant relationship of Bmax and Kd with age was demonstrated. 4. A further group of eight women taking low dose oestrogen combined oral contraceptive pill were studied on days 7, 14, 21 and 28 of the treatment cycle and compared with eight women with regular ovulatory cycles. No significant variations in Bmax or Kd were detected within or between cycles in these two groups.     

微刺激促排卵方案在体外受精-胚胎移植中的应用

目的研究微刺激促排卵方案在体外受精-胚胎移植（IVF-ET）中的应用。方法将351例不孕患者分为卵巢正常反应组（n=225）及卵巢反应不良组（n=126）。以上2组再各分为微刺激促排卵方案试验组及常规促排卵方案对照组。比较各组的促排卵治疗结果和临床结局。结果卵巢正常反应组中常规促排卵组的Gn天数、Gn支数、获卵数显著多于微刺激组（P〈0.05）,卵巢反应不良组中常规组的Gn天数、获卵数、HCG日内膜厚度与微刺激组无显著性差异（P〉0.05）,常规组的Gn支数显著多于微刺激组（P〈0.05）。卵巢正常反应组中常规组的临床妊娠率、种植率、双胎率、中重度OHSS发生率均显著高于微刺激组（P〈0.05）,宫外孕率、流产率、受精率、卵裂率、优胚率无显著性差异（P〉0.05）。卵巢反应不良组中常规组的临床妊娠率、种植率、宫外孕率、流产率、双胎率、受精率、卵裂率、优胚率与微刺激组均无显著性差异（P〉0.05）,中重度OHSS发生率均为0。结论微刺激促排卵方案在不影响临床妊娠率的前提下能明显减少Gn量,节省了大量的费用,对于卵巢反应不良患者使用微刺激方案更佳。     

Pregnancies in reliable pill takers

This study is an extension of a previous study on oral contraceptive pill method failure in reliable pill takers. It documents 137 cases which presented during the 3 year period from December 1985 to December 1988. The most important new finding is that smoking is a significant risk factor in failure on the combined pill (67% were smokers, n = 118), but not on the progestagen-only pill, although the numbers in the latter group were small (n = 19). Diarrhoea and/or vomiting (46%) and drug interactions (33%) are confirmed as important predisposing factors. Systemic illness and/or severe psychological stress may also affect pill utilisation and such factors were found in 47%. Menstrual disturbances were found in 32% of women on the combined pill and 68% of these were smokers. Multiple factors were present in most cases (79%). Repeat failures occurred in 25%.     

标准长方案治疗的不孕患者改行改良超长方案后对妊娠结局的影响

目的 探讨不孕症患者因长方案垂体降调不全改行改良超长方案联合人绝经期促性腺激素（HMG）促排卵后进行体外受精/卵胞浆内单精子注射-胚胎移植（IVF/ICSI-ET）对妊娠结局的影响。方法 回顾性分析2015年6月至2016年6月在安徽省立医院生殖中心接受标准长方案IVF或ICSI治疗的不孕患者218例临床资料。根据垂体是否达到降调标准及是否需再次降调,将218例患者分为A组（行标准长方案降调完全的患者）98例,B组（行标准长方案降调不全改行改良超长方案降调的患者）104例,C组（行标准长方案降调不全直接促排卵的患者）16例,统计分析这3组患者行IVF/ICSI-ET的促排卵参数（促排天数、促性腺激素用量、获卵数,受精率、卵裂率、优质胚胎率）及妊娠结局（临床妊娠率、胚胎着床率、流产率、双胎率）。结果 3组患者促排天数、Gn用量、获卵数比较,差异无统计学意义（P>0.05）;A组受精率（77.86%）高于B组（66.98%）,差异有统计学意义（P<0.01）;A组优质胚胎率（68.52%）高于B组（68.52%）,差异有统计学意义（P<0.01）。胚胎着床率、临床妊娠率及周期取消率3组比较,差异无统计学意义（P>0.05）。结论 不孕症患者因垂体降调不全而改行改良超长方案不影响胚胎着床率及临床妊娠率,具有可行性。     

Effect of repeated gonadotropin stimulation on ovarian reserves and proliferation of ovarian surface epithelium in mice

This study aimed to evaluate the effect of repeated ovarian stimulation (OS) on the ovarian follicular population and morphology in female mice and its influence on the embryo’s developmental ability, and the profile of the ovarian surface epithelium (OSE). A total of 75 mice were enrolled in this experiment and randomly assigned into three groups: repeated ovarian stimulated group [n = 25; receiving 5 IU pregnant mare serum gonadotrophin (PMSG) and human chorionic gonadotropin (hCG) at 6 day intervals for 5 cycles]; single ovarian stimulated group (n = 25; receiving 5 IU PMSG and hCG for 1 cycle), and control group (n = 25; without additional treatment). The follicle number at various stages and the morphologies were recorded respectively in the three groups. The harvested oocytes or embryos, cleavage rate, good quality embryo rate, and blastocyst production rate were counted and calculated, and the proliferations of ovarian surface epithelium were evaluated respectively. In the three groups, the single ovarian stimulation treatment significantly increased the mean number of ovarian oocytes or embryos (39.25±10.77 one-cell embryos/female); on the other hand, repeated gonadotropin stimulation obtained the lowest mean number (5.15± 2.81 eggs/female, P<0.01). Repeated ovarian stimulation also tended to decrease normal follicles of primary follicles (66.67%) and secondary follicles (72.86%), and got the lowest cleavage rate (67.47%), lowest good quality embryo rate (2.41%), and lowest blastocyst production rate (0). The OSE cells adjacent to the antral follicles and corpus luteum (CL) in the repeated ovarian stimulated group (81.8%) had a significantly higher proliferation rate than the other groups. The proliferation rate of the OSE in the single ovarian stimulated group (56.4%) was significantly higher than that in the control group (37.5%) (P<0.01). In conclusion, single ovarian stimulation may produce more oocytes/embryos. However, repeated gonadotropin stimulation may have a negative effect on the ovarian follicular quality, the number of mature retrieved oocytes, and the embryo quality, even increasing the chance of ovarian cancer. All authors contributed equally to this work.     

逍遥丸对调节雄激素致排卵障碍模型大鼠卵巢氧化损伤和颗粒细胞凋亡的研究

目的 观察逍遥丸对雄激素致排卵障碍模型大鼠卵巢氧化损伤和颗粒细胞凋亡的影响.方法 60只9日龄SD雌性大鼠随机选取20只为正常组,余40只皮下注射丙酸睾丸酮建立雄激素致排卵障碍模型大鼠模型,造模成功后,随机分为模型组和逍遥丸治疗组,每组20只,给药5周,于动情前期断头取血,比色法测定3组大鼠血清和卵巢T-AOC水平,硫代巴比妥法测定3组大鼠血清和卵巢MDA水平;免疫组化SP法检测3组大鼠卵巢组织中Caspase-3蛋白的表达.结果 与正常组比较,模型组大鼠血清和卵巢中T-AOC水平显著降低,MDA水平显著升高(P<0.05),模型组卵巢颗粒细胞Caspase-3蛋白表达明显高于正常组(P<0.01).与模型组比较,逍遥丸治疗组大鼠血清和卵巢中T-AOC水平升高,MDA水平降低(P<0.05),逍遥丸治疗组大鼠卵巢颗粒细胞Caspase-3蛋白表达值显著低于模型组(P<0.05).结论 逍遥丸能够改善排卵障碍疾病.     

Oral contraceptive pills induced hemichorea in an adolescent female with polycystic ovarian disease

Chorea is a neurological adverse effect of oral contraceptive pills (OCPs). The onset of chorea following OCPs usage varies widely from few weeks to several years. We report a rare case of chorea which developed within a week of starting OCPs in an adolescent girl with polycystic ovarian disease.KEY WORDS: Chorea, oral contraceptive pills, polycystic ovarian disease     

LH活性药物联合FSH促排在Poseidon 1组、2组患者的疗效分析

目的 探讨使用FSH联合LH活性药物促排在Poseidon 1组、2组低预后患者中的有效性。方法 回顾分析2014年1月～2019年12月在广州医科大学附属第三医院进行IVF/ICSI助孕Poseidon 1组、2组低预后患者的临床资料。将患者分为两组：FSH组（单纯使用FSH促排,共1 679例1 740周期）、FSH+LH组（FSH联合LH活性药物促排,共471例478周期）,比较两组间的基础指标及临床结局指标,其中卵泡-卵母细胞转化指数（Follicle-To-Oocyte Index,FOI）为主要的结局指标。结果 FSH+LH组与FSH组的卵巢储备基线差异无统计学意义（P> 0.05）。FSH组的FOI较高,卵泡输出率（Follicular Output Rate,FORT）、获卵数、MII卵率、受精率、临床妊娠率、胚胎种植率等结局指标与FSH+LH组无统计学差异（P> 0.05）。结论 黄体期长方案常规联合LH活性药物促排,并不能改善非预期卵巢反应不良患者的结局,且增加患者经济成本,不推荐常规使用。