尿促黄体生成激素峰与体外受精—胚胎移植结局的探讨

从１９９１年６月１日至１９９２年７月３０日，因输卵管因素造成不孕而进行体外受精－胚胎移植（ＩＶＦ－ＥＴ）共１５０个周期。经用克罗米酚及促性腺激系促超排卵，其中４１个周期（２７．３３％）于注射人绒毛膜促性腺激素（ｈＣＧ）前，尿中出现促黄体生成激素（ＬＨ）峰（ＬＨ＞４０ＩＵ／Ｌ），１６个周期（１０．６７％）表现为ＬＨ升高（ＬＨ＝４０ＩＵ／Ｌ），９３个周期（６２．００％）无ＬＨ峰（ＬＨ＜４０ＩＵ／Ｌ）。     

尿促性腺激素片段在滋养细胞疾病监测中的意义

对４６例滋养细胞疾病患者尿标本２７５份进行尿促性腺激素片段（ＵＧＦ）测定，并自身对照收集同期血标本２７５份，测定绒毛膜促性腺激素（ｈＣＧ），并进行比较。另选１２例健康非妊娠妇女为对照组。结果，滋养细胞疾病患者尿ＵＧＦ阳性串（＞０．２μｇ／Ｌ）为６４．０％，血清ｈＣＧ阳性率（＞２０μｇ／Ｌ）为６６．５％，两者差异无显著性（Ｐ＞０．１）。血清ｈＣＧ阴性患者中，尿ＵＧＦ阳性者５７．６％。提示在滋养细胞疾病患者血ｈＣＧ呈高值时，尿ＵＧＦ阳性率亦高，测定意义不大。而血ｈＣＧ呈低值、ｈＣＧ阴性时，尿ＵＧＦ仍有一定的检出率。对照组１２例无假阳性。     

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。     

促排卵药物处理后刺破卵泡及宫腔内授精治疗不孕症

目的:为提高宫腔内人工授精（ＩＵＩ）妊娠率,降低流产率。方法：本文对４０例患有排卵障碍、轻度输卵管因素不孕、免疫性不孕、原因不明性不孕等妇女,在促排卵药物处理后行卵泡刺破同时行ＩＵＩ共 ４７个周期。结果：生化妊娠 １８例,占 ４５％;临床妊娠 １６例,占４０％,周期妊娠率为３４％;２例于妊娠６周自然流产,流产率占５％;２ 例已分娩获得活婴,继续妊娠１２例（其中三胞胎一例）。结论：本组行卵泡刺破加ＩＵＩ的患者均为ｈＣＧ注射３６ｈ后经阴道Ｂ超观察至４０ ｈ卵子未排出者,在阴道Ｂ超引导下,适时刺破卵泡排出多个卵子,避免卵子因延迟排出而老化,从而提高排出卵子的质量和数量,提高妊娠率。     

用人绝经期尿促性腺激素治疗无排卵性不孕症110例分析

１９９０年１１月至１９９２年３月上海四家医院用国产人绝经期尿促性腺激素（ｈＭＧ）治疗无排卵性不孕症１１０例。患者平均３１．２岁，平均闭经时间５．９年，原发不孕症者占７９％。用ｈＭＧ－ｈＣＧ序贯法治疗１９８个周期，平均每个周期用药３３针。结果：１００例排卵率１００％，周期排卵率９４％，妊娠率５０％，周期妊娠率２７％。卵巢过度刺激综合征发生率３４．３％（轻度１０．９％，中度１９％，重度４．５％），双胎发生率１４．５％。表明国产ｈＭＧ对低促性腺激素性团经和无排卵性稀发月经的治疗效果令人满意。     

卵巢上皮性癌组织黄体生成激素—绒毛膜促性腺激素…

目的：探讨卵巢上皮性癌组织黄体生成激素（ＬＨ）与人绒毛膜促性腺激素（ｈＣＧ）受体（ＬＨ－ＣＧ）表达与临床预后的关系，方法：应用Ｗｅｓｔｅｒｎ免疫印迹方法，对４０例卵巢上皮性细胞组织ＬＨ－ＣＧ受体蛋白进行半定量分析，应用免疫组化方法检测受体蛋白表达的部位。结果：４０例中ＬＨ－ＣＧ受体蛋白阳性表达率为７２．５％（２９／４０），其中Ｉ，ＩＩ期患者高于Ⅲ，Ⅳ期患者，但差异无显著性（Ｐ〉０．０５）。高分化癌     

体外受精与胚胎移植中hCG注射前血孕酮水平与妊娠的关系

用ＧｎＲＨａ－ＦＳＨ－ｈＭＧ－ｈＣＧ方案控制性超排卵进行体外受精与胚胎移植（ＩＶＦ－ＥＴ）治疗７８例不孕患者，在ｈＣＧ注射前抽血用放射免疫法（ＲＩＡ）测孕酮（Ｐ）水平。初步了解ｈＣＧ注射时血孕酮水平与ＩＶＦ－ＥＴ结果的关系。结果，当Ｐ〈０．３５μｇ／Ｌ时９例中无１例妊娠，而０．３５≤Ｐ≤０．９μｇ／Ｌ组（５４例）与Ｐ〉０．９μｇ／Ｌ组（１５例）的妊娠率分别为２２．６％及２６．７％，但三组间无显著差     

62例不同类型不孕症人绝经期促性腺激素治疗效果分析

本院于１９９１年至１９９４年期间用人绝经期促性腺激素（ｈＭＧ）治疗不同类型不孕症６２例。３８例＜３５岁者周期排卵率为８３．３％，妊娠率为５２．６３％。２４例≥３５岁者周期排卵率为７５．９２％，妊娠率为２５．００％。低促性腺激素的排卵障碍者周期排卵率为８２．８５％，妊娠率为５８．８２％。高促性腺激素者周期排卵率１４．２８％，妊娠率０。可见年龄及疾病类型能影响ｈＭＧ的治疗效果。     

经阴道配子输卵管内移植42例临床分析

目的开展经阴道配子输卵管内移植（ｔｒａｎｓｖａｇｉｎａｌｇａｍｅｔｅｉｎｔｒａｆａｌｏｐｉａｎｔｒａｎｓｆｅｒ,ＴＶＧＩＦＴ）技术并探讨其实用价值。方法１９９６年５月至１９９７年１０月,对证实至少有一条以上输卵管正常的不孕患者４２例（４３个周期）,采用卵泡刺激素、绝经期促性腺激素、人绒毛膜促性腺激素（ＦＳＨｈＭＧ／ｈＣＧ）及ｈＭＧ／ｈＣＧ超排卵方案,经阴道穿刺取卵,改良上游法处理精液,以ＪａｎｓｅｎＡｎｄｅｒｓｅｎ输卵管导管系统行ＴＶＧＩＦＴ,平均移植卵子（４．０±０．９）个／周期。结果输卵管插管成功率６７．４％（２９／４３）,临床妊娠１３例,双胎５例,周期妊娠率３０．２％（１３／４３）;９例分娩（出生婴儿１３个）,４例流产。结论ＴＶＧＩＦＴ适用于至少一侧输卵管通畅的不孕患者,技术简便,易于掌握,无需开腹及腔镜操作,有较高的妊娠成功率,值得开展推广     

催乳素延缓hCG诱导大鼠排卵和下调纤维溶酶原激活系统在卵巢中的表达

给幼龄大鼠注射１０ＩＵ ＰＭＳＧ，４８ｈ后注射７ＩＵ ｈＣＧ，或ｈＣＧ加不同剂量的催乳素（ＰＲＬ）。在不同时间取出卵巢，检查输卵管中卵子数和卵巢不同细胞中组织型纤维溶酶原激活因子（ｔＰＡ）和抑制因子（ＰＡＩ－１）ｍＲＮＡ含量和活性。结果表明：ＰＲＬ减少ｈＣＧ诱发的排卵数并有明显剂量和时间抑制曲线．当ｈＣＧ注射２４ｈ后，在两组动物输卵管的卵子数无明显差异。ＰＲＬ同时抑制ｈＣＧ所诱发的颗粒细胞ｔＰＡ     

Efficacy of induced luteinizing hormone surge after "trigger" with gonadotropin-releasing hormone agonist

The magnitude of the LH surge after GnRH agonist "trigger" was correlated with oocyte yield and maturity and was suboptimal in approximately half of the cycles. A modest reduction in oocyte yield and maturity was observed when the serum level of LH 12 hours after GnRH agonist trigger was less than the median value (52 IU/L), and a dramatic reduction in yield and maturity was observed when that level was less than 12 IU/L.     

Optimal parameters for determining the LH surge in natural cycle frozen-thawed embryo transfers

Background

There is no consensus on the exact parameters that define the LH surge for natural cycle frozen-thawed embryo transfers (NC-FET). Accurately determining the LH surge would affect the timing, and subsequently the success rates, of embryo transfer. Therefore, the aim of this study was to delineate the optimal levels and relationship for luteinizing hormone (LH) and estradiol in an effort to optimally identify the LH surge in NC-FET.

Methods

It is a retrospective study that was performed in an academic medical center. Patients who underwent blastocyst NC-FET who either had preimplantation genetic screening (PGS) or were <35 years old but did not undergo PGS (non-PGS) were included in separate analyses. They were divided into two groups: Group A included patients whose LH surge was defined as the first attainment of LH ≥ 17 IU/L during the follicular phase with a ≥30% drop in estradiol levels the following day; group B encompassed patients whose LH level continued to rise and the surge was defined as the highest serum LH level occurring a day after LH ≥ 17 IU/L despite a ≥ 30% drop in estradiol levels. The main outcomes measures were implantation and live birth rates.

Results

Four hundred-seven non-PGS and 284 PGS NC-FET were included. Among non-PGS cycles, group A was associated with significantly higher implantation rates (48.7% vs. 38.1%) and live birth rates (52.9% vs. 40.1%) compared to group B. In contrast, group A and B had comparable live birth rates among PGS cycles.

Conclusions

Among non-PGS cycles, measuring LH and estradiol levels the day after an LH ≥ 17 IU/L and defining the surge as the first day of LH ≥ 17 IU/L in the context of a ≥ 30% drop in estradiol the following day was associated with better NC-FET outcomes than defining the surge as the day representing the highest serum LH level despite a ≥30% drop in estradiol levels.

     

In vitro fertilization: diurnal and seasonal variation in luteinizing hormone surge onset and pregnancy rates

The authors studied 740 consecutive in vitro fertilization (IVF) cycles over a 3-year period to compare the results of cycles in which an endogenous luteinizing hormone (LH) surge occurred with cycles in which human chorionic gonadotropin (hCG) was administered for induction of follicular maturation. Clomiphene citrate (100 to 150 mg daily on cycle days 5 to 9) and human menopausal gonadotropin (hMG; 75 to 150 IU daily from cycle day 6) were used for stimulation. Embryo transfer (ET) occurred in 164 (81.2%) of the LH surge cycles and 452 (84%; P = not significant [NS] of the hCG cycles. The first urinary rise in LH was detected in the 6 or 9 A.M. collections in 78 (47.3%) of the LH surge cycles, a greater number (P less than 0.01) than expected if LH surge onset was random. A total of 107 pregnancies was achieved, for an overall pregnancy rate of 17.4% per ET. The pregnancy rate in the hCG-stimulated cycles was 13.9% per ET (63/452) and, in spontaneous LH surge cycles, was 28.8% (44/166; P less than 0.001). The spontaneous abortion rate was 9.1% in LH surge cycles, compared with 25.4% in hCG-triggered cycles (P less than 0.001). The result was a 2.4 times increase in live births for LH surge cycles compared with cycles in which hCG was administered. In this program, occurrence of an LH surge is a favorable event, associated with higher pregnancy and live birth rates than hCG-stimulated cycles, and usually occurring in the early morning, allowing oocyte retrieval during normal working hours.     

多囊卵巢综合征患者IVF-ET前达英-35预处理不同时间临床效果分析

目的:探讨不同的达英-35预处理时间对多囊卵巢综合征患者IVF-ET助孕结局的影响。方法:回顾性分析在我院接受IVF助孕的119个PCOS助孕周期。所有患者均接受达英-35预处理,根据达英-35预处理周期数分为A组(达英-35预处理时间≤3个月),B组(达英-35预处理时间>3个月),检测比较治疗前、后血清LH水平、睾酮水平、游离雄激素指数(FAI)、获卵数、空卵泡率、临床妊娠率、着床率、OHSS发生率等。结果:A、B组达英-35预处理前血清LH值分别为:5.96±3.03 IU/L、6.91±4.40 IU/L;FAI分别为:1.42±1.10、1.76±1.67,治疗后均明显下降,与治疗前比有显著统计学差异(LH:3.50±2.19 IU/L,3.78±0.21 IU/L,FAI:0.54±0.38,0.54±0.48,P<0.05);B组空卵泡率、OHSS发生率分别为17.4%、6.8%,均低于A组(30.2%,20.0%),受精率为83.5%,较A组(74.8%)高,差异均有统计学意义(P<0.05)。结论:IVF前达英-35预处理可以显著降低PCOS患者高LH、高雄激素水平;随着达英-35预处理时间延长,空卵泡率和OHSS发生率进一步下降,受精率得到改善。     

Luteinising hormone profiles in conception and non-conception natural cycles

Objective: The aim of this study was to assess whether luteinising hormone (LH) surge characteristics influenced the likelihood of conceiving naturally.

Methods: This was a single-cycle, home-based, observational, case-controlled study. Volunteers collected daily urine samples for one menstrual cycle. LH was measured and the basal levels, surge day, peak day, peak concentration and magnitude of LH surges were examined. Predictive models using sociodemographic data, LH surge characteristics, and sociodemographic data combined with LH profile properties, were evaluated.

Results: The surge profile did not differ between cycles with early or late ovulation and was not affected by age or body mass index (BMI). The mean LH surge day was day 16 for both groups. Mean LH surge and concentrations did not differ between groups (surge concentration 54.8?IU/l vs. 58.2?IU/l and peak concentration 82.0?IU/l vs. 81.6?IU/l for pregnant vs. non-pregnant volunteers, respectively). Non-pregnant volunteers were more likely, however, to have a raised or a reduced basal LH on day 6 or have an atypical LH profile. Sociodemographic characteristics were significant predictors of pregnancy, and sociodemographic variable-based models had the greatest predictive ability for conception, providing up to 65% predictive accuracy.

Conclusions: Sociodemographic variables can be used to predict the likelihood of a woman conceiving naturally. Provided an LH surge is present, its profile does not relate to the likelihood of spontaneous pregnancy. The conception rate was significantly lower, however, in women with elevated or reduced basal levels of LH, suggesting that follicular maturation needs an optimal basal level of LH in natural conception cycles.     

The outcome of continued treatment of luteinizing hormone-surged cycles in in vitro fertilization with the use of human menopausal gonadotropin

Over a 2-year period 75 patients were treated for 109 cycles with human menopausal gonadotropin for in vitro fertilization. The occurrence of endogenous luteinizing hormone (LH) surges was monitored by daily blood sampling. Forty-six cycles (42%) showed an endogenous LH surge. Instead of canceling the treatment cycle as other programs do, we proceeded to oocyte collection when the surge was detected. Human chorionic gonadotropin was administered routinely to the "surge" patients as soon as the LH surge was determined. The oocyte collection was carried out around 24 hours after the "surge" blood had been drawn, although the beginning of the endogenous LH surge was unable to be pinpointed. Significantly more immature oocytes, lower fertilization rate, and lower cleavage rate were seen in the "surge" patients than in the "nonsurge" patients. In five "surge" cycles laparoscopy for oocyte collection was canceled, but none was canceled because of premature ovulation detected by the immediately preoperative ultrasonography. In four "surge" cycles no potentially fertilizable egg was recovered. This was not significantly different from that of the "nonsurge" group. The pregnancy rate of the "surge" group (4/41 or 9.8% per laparoscopy and 4/34 of 11.8% per embryo transfer) was not statistically different from that of the "nonsurge" group (7/61 or 11.5% per laparoscopy and 7/56 or 12.5% per embryo transfer). This study presents the possibility of proceeding to oocyte collection, fertilization, embryo transfer, and pregnancy in patients with endogenous LH surge in in vitro fertilization procedures with the use of human menopausal gonadotropin treatment.     

Is there a critical LH level for hCG trigger after the detection of LH surge in modified natural frozen-thawed single blastocyst transfer cycles?

PurposeThere is no consensus yet in the literature on an optimal luteinizing hormone (LH) level for human chorionic gonadotrophin (hCG) trigger timing in patients undergoing frozen-thawed embryo transfer (FET) with modified natural cycles (mNC). The objective of our study was to compare the clinical results of hCG trigger at different LH levels in mNC-FET cases.MethodsThis retrospective study was conducted in Istanbul Memorial Hospital ART and Genetics Center. A total of 1076 cases with 1163 mNC-FET cycles were evaluated. LH levels between the start of LH rise (15 IU/L) and LH peak level (> 40 IU/L) were evaluated. Cycles were analyzed in four groups: group A (n = 287) LH level on the day prior to the day of hCG; groups B, C and D, LH levels on the day of hCG: group B (n = 245) LH 15–24.9; group C (n = 253), LH 25–39.9; group D (n = 383) LH ≥ 40. Cycle outcomes in the four groups were compared.ResultsSubgroup analyses of mNC-FET groups showed that implantation, clinical and ongoing pregnancy rates, and pregnancy losses were not significantly different in patients with different LH levels on the day of hCG trigger.ConclusionOur study suggests that hCG can be administered at any time between the start of LH rise (≥ 15 IU/L) and LH peak level (≥ 40 IU/L) without a detrimental effect on clinical outcome.     

Efficacy of the urinary hemagglutination test (Higonavis) and enzyme immunoassay (Ovustick) in detection of the spontaneous luteinizing hormone surge in an in vitro fertilization/gamete intrafallopian transfer (IVF/GIFT) program

Fifty-eight treatment cycles in an in vitro fertilization/gamete intrafallopian transfer (IVF/GIFT) program were studied to compare the efficacy of two urinary methods, hemagglutination test (Higonavis) and enzyme immunoassay (Ovustick), in detection of spontaneous luteinizing hormone (LH) surge. If an isolated rise in urinary LH level was taken as indicative of LH surge, the false-positive rate was 36.7% for Higonavis and 10.2% for Ovustick. The difference was statistically significant (P<0.001). If only a sustained rise in urinary LH was taken to indicate LH surge, the false-positive rate was 6.1% for Higonavis and 0% for Ovustick. In the seven cycles with a spontaneous plasma LH surge, there was a positive correlation between the plasma LH levels and the two urinary assay methods in six cycles (85.7%). Compared to plasma LH, there was a mean delay of 17.4 hr by the Higonavis test and 15.6 hr by the Ovustick test. If a sustained rise in urinary LH levels was taken as indicative of LH surge, both methods are quite accurate but the Ovustick appeared to be more specific.     

基础FSH/LH比值及晚卵泡期LH水平对体外受精-胚胎移植结局的影响

目的:探讨患者基础FSH/LH比值及控制性超促排卵(COH)时降调后hCG注射日血清LH水平对IVF-ET结局的影响及与COH各参数的关系。方法:回顾性分析首次进行IVF/ICSI-ET助孕、应用GnRH-a长方案降调节的不孕妇女,共427个周期。结果:ROC曲线显示FSH/LH比值与IVF-ET临床妊娠率无明显相关性;FSH/LH≥2与FSH/LH<2组间虽然临床妊娠率无差异,但FSH/LH≥2组Gn用量增加,获卵数少,优质胚胎数少,存在统计学差异(P<0.05)。hCG注射日血清LH≥0.65IU/L者妊娠率(55.8%)明显高于LH<0.65IU/L者(24.6%)。结论:基础FSH/LH比值增高能较早反映卵巢储备功能并指导超排方案及Gn用量;降调节后卵泡晚期(hCG注射日)的LH水平过低(<0.65IU/L),将会导致临床妊娠率下降。     

Twin pregnancies and perinatal outcomes: a comparison between fresh and frozen embryo transfer: a two-centre study

Research questionWhat is the optimal timing for transfer in natural cycle vitrified–warmed embryo transfers (NC-VET)?DesignThis retrospective cohort study uses data from a large university-affiliated IVF clinic. The study included 341 NC-VET cycles with autologous oocytes and non-preimplantation genetic testing, vitrified embryos from January 2013 to September 2017. Each cycle was classified by timing of embryo transfer in relation to LH surge ≥20 IU/l. Group 1: LH ≥20 IU/l one day and blastocyst was transferred 6 days later; Group 2: LH ≥20 IU/l two consecutive days and blastocyst was transferred 6 days after the initial surge; Group 3: LH ≥20 IU/l two consecutive days and blastocyst was transferred 7 days after the initial surge. The primary outcome was ongoing pregnancy rate (OPR). The secondary objective was to compare OPR in relation to serum oestradiol dynamics and progesterone concentration (according to threshold 1.0 ng/ml) 6 days prior to embryo transfer.ResultsOPR were similar for all three groups (66.8%, 65.0%, 62.9% for Groups 1, 2 and 3, respectively). When stratified according to oestradiol and progesterone, no significant differences were noted in OPR.ConclusionsThe results suggest that the timing of blastocyst transfer in a natural cycle after LH surge is flexible within 24 h. Outcomes are equally good with day of embryo transfer 6 or 7 days after LH surge date. Oestradiol dynamics and progesterone concentration 6 days prior to NC-VET did not have a significant impact on OPR.