不同促排卵方案排卵结局和不同受精方式妊娠结局的相关因素探讨

目的:探讨不同促排卵方案的排卵结局和不同受精方式妊娠结局的相关因素。方法:100例需诱发排卵或行宫腔内人工受精(IUI)治疗的不孕症患者,随机分为两组,分别采用hp-hMG或hMG促排。用化学发光法测量基础及治疗各期血清中的性激素水平。结果:两组患者应用促性腺激素的时间和剂量、卵泡数、排卵率、妊娠率无统计学意义。但hCG注射日大卵泡数(1.8±1.3vs2.5±1.9)、E2水平在hp-hMG组显著低于hMG组(577.77vs925.23pmol/ml),而P/E2水平无明显差别。合并两组后LH<4IU/L组的排卵率(100%)、妊娠率(27.5%)明显较LH>4IU/L组(90%和10.0%)增高,当hCG日子宫内膜厚度在8-12mm时妊娠率最高(21.3%);IUI患者hCG注射日E2水平、卵泡数(>14mm)和卵泡破裂数在妊娠组显著高于非妊娠组(E2:1324.00±971.52vs733.97±724.87pmol/L;卵泡数:3.28±2.39vs2.19±1.55;卵泡破裂数:2.2±1.1vs1.2±0.5),而P/E2在妊娠组显著低于非妊娠组(1.25±1.20vs2.62±2.05)。结论:hMG和hp-hMG在促排卵治疗中无论是排卵率、妊娠率均无明显差异,但hp-hMG更为有效;基础LH水平在促排卵治疗中对排卵率和妊娠率有重要作用;hCG注射日的E2和P/E2水平与妊娠率明显相关。     

培养液中添加不同促性腺激素对卵母细胞体外成熟的影响

目的:比较卵母细胞体外成熟培养液中添加不同促性腺激素对未成熟卵母细胞体外成熟结局的影响。方法:将行卵母细胞体外成熟(IVM)的35例患者共42个新鲜取卵周期,随机分成A组:22个取卵周期将重组人促卵泡激素(果纳芬,rFSH)和重组人绒毛膜促性腺激素(艾泽,hCG)按1∶1的比例混合添加,终浓度为75 mIU/ml;B组:20个取卵周期添加终浓度为75 mIU/ml的尿源性促性腺激素(hMG),进行未成熟卵母细胞体外成熟培养。35例患者中新鲜取卵周期未移植或移植后未孕者行解冻胚胎移植。比较组间患者的卵母细胞成熟率、受精率、卵裂率、优质胚胎率、累计临床妊娠率及胚胎着床率。结果:取卵均于月经周期第12日或最大卵泡发育至10￣12 mm时进行,故所获卵均为未成熟卵。A组获卵181枚,经培养后成熟84枚,行卵胞浆内单精子注射(ICSI)84枚,受精60枚,卵裂55枚,优质胚胎20枚;新鲜胚胎移植9例,获1例临床妊娠,解冻胚胎移植5例,获1例临床妊娠,累计临床妊娠率为14.29%,胚胎着床率为7.14%。B组获卵176枚,经培养后成熟120枚,行ICSI 120枚,受精97枚,卵裂90枚,优质胚胎41枚,新鲜胚胎移植6例,获4例临床妊娠,解冻胚胎移植9例,获3例临床妊娠,累计临床妊娠率为46.67%,胚胎着床率为33.33%。结论:卵母细胞体外成熟培养液中添加尿源性促性腺激素可获得较添加重组人促卵泡激素和重组人绒毛膜促性腺激素高的卵母细胞成熟率、临床妊娠率及胚胎着床率。     

子宫内膜异位症影响体外受精一胚胎移植的具体环节探讨

目的探讨子宫内膜异位症(内异症)对体外受精-胚胎移植(IVF-ET)的影响.方法回顾性分析85例输卵管因素不孕的患者(A组,123个周期)、18例卵巢子宫内膜异位囊肿的患者(B组,25个周期)和16例无卵巢子宫内膜异位囊肿的内异症患者(C组,20个周期)的获卵数、受精率、卵裂率、胚胎种植率和临床妊娠率等情况.结果B组的获卵数为(7.1±5.9)个,非常显著地少于A组的(11.6±8.4)个和C组的(12.1±7.8)个,P＜0.01;B组和C组的受精率分别为69.5%和70.3%,均显著地低于A组的77.5%,P＜0.05;A、B、C三组的卵裂率、子宫内膜的厚度与类型、胚胎种植率和临床妊娠率均无显著差别.结论子宫内膜异位囊肿影响卵巢对超排卵的反应,内异症影响卵子的受精,但不影响受精卵的分裂、子宫内膜容受力、胚胎种植率和临床妊娠率.     

子宫内膜异位症影响体外受精—胚胎移植的具体环节探讨

目的　探讨子宫内膜异位症 (内异症 )对体外受精 -胚胎移植 (IVF ET)的影响。方法　回顾性分析85例输卵管因素不孕的患者 (A组 ,12 3个周期 )、18例卵巢子宫内膜异位囊肿的患者 (B组 ,2 5个周期 )和 16例无卵巢子宫内膜异位囊肿的内异症患者 (C组 ,2 0个周期 )的获卵数、受精率、卵裂率、胚胎种植率和临床妊娠率等情况。结果　B组的获卵数为 (7 1± 5 9)个 ,非常显著地少于A组的 (11 6± 8 4)个和C组的 (12 1± 7 8)个 ,P <0 0 1;B组和C组的受精率分别为 6 9 5 %和 70 3% ,均显著地低于A组的 77 5 % ,P <0 0 5 ;A、B、C三组的卵裂率、子宫内膜的厚度与类型、胚胎种植率和临床妊娠率均无显著差别。结论　子宫内膜异位囊肿影响卵巢对超排卵的反应 ,内异症影响卵子的受精 ,但不影响受精卵的分裂、子宫内膜容受力、胚胎种植率和临床妊娠率。     

低氧对体外受精-胚胎移植胚胎发育潜能的影响

目的:探讨低氧环境(体积分数5%O2)对体外受精-胚胎移植(in vitro fertilization-em-bryo transfer,IVF-ET)中胚胎发育潜能及临床结局的影响。方法:将接受IVF-ET长方案治疗的265名不孕症患者随机分为研究组(n=156):患者取卵后受精及整个胚胎培养过程全部在三气培养箱(体积分数5%O2)中进行,对照组(n=109):患者取卵后受精及整个胚胎培养过程全部在常规培养箱(体积分数20%O2)内进行,所有患者均移植授精第2日或第3日胚胎。比较组间受精率、正常受精率、卵裂率、正常卵裂率、优质胚胎率、可用胚胎率、生化妊娠率、临床妊娠率和异位妊娠率。结果:组间患者年龄、不孕年限、体质量指数、基础性激素、获卵数、成熟卵数、授精至移植时间和移植胚胎数均无统计学差异(P>0.05)。研究组受精率(84.4%)、正常受精率(72.0%)、卵裂率(97.6%)、优质胚胎率(43.3%)和可用胚胎率(72.5%)均显著高于对照组(分别为80.8%、68.7%、96.1%、35.1%、59.5%)(P<0.01或P<0.05),研究组与对照组正常卵裂率(97.7%vs 98.0%)、生化妊娠率(50.0%vs 39.4%)、临床妊娠率(44.9%vs 35.8%)、异位妊娠率(8.6%vs 12.8%)均无统计学差异(P>0.05)。结论:低氧环境(5%O2)似乎能够提高胚胎的发育潜能,获得更多优质胚胎和可用胚胎。     

输卵管切除术对超排卵的影响

目的:探讨单侧输卵管切除,切除侧卵巢对超排卵的反应性。方法:以因输卵管妊娠行单侧输卵管切除后不孕接受IVF-ET治疗的患者45例共52个周期为研究组,并以同期因输卵管阻塞(无输卵管积水)不孕行IVF-ET治疗的患者875例共913个周期为对照,分析输卵管切除侧卵巢与对侧卵巢对超排卵的反应性。结果:①两组的促性腺激素(Gn)用量、用药天数、hCG日E_2水平、卵裂率、平均移植胚胎数、种植率、临床妊娠率、流产率、异位妊娠率差异无统计学意义(P>0.05)。但单侧输卵管切除组的获卵数减少,差异有统计学意义(P<0.05)。②研究组卵泡晚期(注射hCG日)两侧卵巢大小(分别为35.1±6.5mm、38.2±5.9 mm)有差异,P<0.05。取卵日两组卵泡数(个)分别为6.7±4.5、8.6±3.3(P<0.05),回收卵子数(个)分别为4.9±3.7、6.4±3.6,P<0.05。结论:单侧输卵管切除者切除侧卵巢在行超排卵时,其卵泡晚期(注射hCG日)卵巢较小,取卵日的卵泡数和回收卵子数明显减少,手术可能影响卵巢的血液供应和超排卵效果。     

IVF-ET周期中GnRH-a、FSH、hMG配伍方案的比较研究

目的:探讨IVF周期中采用不同促排卵方案时,卵泡液及血清中FSH、LH、E2水平的变化及对胚胎发育、受精、妊娠的影响;单用国产hMG促排卵的效果。方法:120例分成4组。测定卵泡液及取卵日血清中FSH、LH、E2水平,比较四种方案的取卵数、受精率、Ⅰ级、Ⅱ级胚胎形成率和每移植周期妊娠率。结果:四种促排卵方案的卵泡液和血清FSH、E2水平没有差别（P>0.05）,不同垂体降调节者,卵泡液和血清LH水平明显升高（P<0.0001）,四种促排卵方案的取卵数、受精率、优质胚胎形成率、移植周期妊娠率经统计学处理均无显著性差异。结论:卵泡液和血清中LH水平升高可能与应用垂体降调节有关,而与选择纯FSH还是hMG促排卵无关。轻度LH升高并不影响卵泡发育、卵子质量和以后的胚胎发育。IVF周期首选垂体降调节加FSH或FSH/hMG促排卵方案,单用hMG促排卵也可以作为选择。     

低回收卵患者囊胚培养和移植结局的初步探讨

目的探讨体外受精-胚胎移植(IVF-ET)中,在低回收卵数患者中进行囊胚培养和移植是否能改善IVF结局.方法回顾分析2000年1月至2月在我室行IVF治疗的59例患者的临床资料.其中21例行囊胚培养(囊胚组),在受精后第5天移植;另38例行常规的第2天胚胎移植(对照组).比较分析两组患者的临床结局.结果囊胚组平均取卵数(6.6±2.8)个,临床妊娠率为43%,分娩率38%;对照组平均取卵数(6.9±3.7)个,临床妊娠率为37%,分娩率29%,两组比较,差异无显著性(P＞0.05).囊胚组无一例出现高序多胎,对照组出现1例3胎,1例5胎.结论在IVF-ET中,对低回收卵数患者进行囊胚培养和移植与常规第2天移植相比,并不会显著提高妊娠率,但却可以在不降低妊娠率的情况下,减少多胎的出现.     

卵胞质内单精子显微注射后异常受精的影响因素分析

目的:探讨卵胞质内单精子显微注射(ICSI)后异常受精发生的影响因素。方法:回顾性分析299个ICSI周期,按照是否有异常受精分为异常受精组(n=118)和正常对照组(n=181),异常受精组至少发生1个非2原核(2PN)的受精卵。比较分析异常受精组和对照组临床和实验室资料。结果:异常受精组hCG注射日E2水平(14 097±3 066 pmol/L)高于对照组(1 2461±6 836 pmol/L),差异有统计学意义(P<0.05);异常受精组获卵数及成熟卵数分别为17.8±7.2个、15.3±6.1个,多于对照组的13.6±7.0个、10.2±5.3个,差异均有统计学意义(P<0.01);卵子成熟率(81.7%vs76.4%)、2PN受精率(78.4%vs 86.9%),组间比较差异均有统计学意义(P<0.01);而患者年龄、基础激素水平、促性腺激素(Gn)使用总量、精子来源及质量、着床率、临床妊娠率组间比较,差异均无统计学意义(P>0.05)。结论:卵巢对Gn刺激的高反应性可能与ICSI后异常受精的发生有关。异常受精卵的发生虽对临床结局无明显影响,但减少异常受精发生率,增加卵子利用率,可能会提高累积妊娠率。     

丙氨瑞林在诱导排卵中的应用

目的:探讨丙氨瑞林在对无排卵者诱导排卵中的应用。方法:回顾性分析WHO II型无排卵患者1155个周期,A组572个周期,月经周期d2开始使用hMG促排,至hCG日。B组583个周期,在A组方案基础上,d2开始肌注醋酸丙氨瑞林0.15mg/d至hCG日。二组均待有优势卵泡时注射hCG,指导同房或行IUI术,其后行黄体支持治疗。结果:A、B组患者的卵泡(直径≥16mm)数(2.7±2.3枚vs2.0±2.0枚)、排卵数(2.2±2.1vs1.8±1.8)、排卵日(12.2±2.5d vs12.5±2.1d)、hMG用量(10.8±2.3支,12.3±5.3支)、hCG日子宫内膜厚度(8.9±1.7mm vs9.3±1.7mm)、双胎妊娠率(16.6%vs13.7%)、三胎妊娠率(5.5%vs6.5%)和多胎妊娠率(22.1%vs20.2%)比较均无统计学差异,P>0.05;卵泡平均直径达到14mm日LH水平(7.5±3.9U/L vs4.1±3.9U/L)、周期取消率(17.8%vs2.6%)、流产率(26.8%vs4.6%)、轻度、中重度OHSS发生率(5.5%vs1.0%,0.5%vs0)、临床妊娠率(9.6%vs22.4%)间有显著性差异(P<0.05)。结论:hMG+丙氨瑞林诱导排卵方案与单用hMG比较,既能达到较好的临床妊娠率,又能降低周期取消率、流产率和OHSS的发生率。     

Comparison between Highly Purified-FSH and hMG for Superovulation in Women undergoing in vitro Fertilization

Objective: to assess the efficacy of highly purified follicle stimulating hormone (HP-FSH) compared to human menopausal gonadotrophin (hMG) in in vitro fertilization (IVF).Design: open, prospective, randomized parallel group, comparative, multicentre study.Setting: one private and one public institution.Patient: infertile population undergoing in vitro fertilization.Outcome of interest: ovarian response to drugs: birth rate.Results: increased number of follicles, oocytes and embryos in HP-FSH group and comparable birth rates.Conclusions: use of HP-FSH in IVF offers similar success rates to hMG. Subcutaneous administration makes HP-FSH simpler for both patients and medical staff.     

Ovarian stimulation for in vitro fertilization and embryo transfer, human menopausal gonadotropin versus pure human follicle stimulating hormone: a randomized prospective study

A randomized, prospective study was conducted to compare ovarian stimulation with human menopausal gonadotropin (hMG) and human follicle-stimulating hormone (hFSH) in an in vitro fertilization and embryo transfer (IVF-ET) program. Minimal inclusion criteria included age less than or equal to 37, tubal infertility, regular menstrual cycles before IVF, and a normal semen analysis. Equivalent doses (225 IU/day) of either hMG (N = 20) or hFSH (N = 20) were administered, and the patients followed by serum estradiol (E2) levels and pelvic ultrasound. Parameters related to the ovarian response to therapy, the number and quality of ova recovered, and the cycle outcome were compared in the two groups using the Student's t-test and chi-square analysis. No difference was detected between the groups in peak E2 levels (828 +/- 78 versus 819 +/- 79 in the hMG and hFSH groups, respectively), day of human chorionic gonadotropin (hCG) administration (9.3 +/- 0.3 versus 9.7 +/- 1.01), occurrence of spontaneous luteinizing hormone (LH) surge (44% versus 27%, P greater than 0.05, chi square analysis), average number of ova recovered (5.0 +/- 0.7 versus 5.6 +/- 1), ova maturation (7.5% versus 12.7% rate of immature ova), rate of normal and abnormal fertilization (9.2% versus 8.1% polyspermic fertilization), cleavage stage at transfer (3.6 +/- 0.4 versus 3.4 +/- 0.7 cells per embryos), the number of embryos transferred (2.5 +/- 0.3 versus 2.6 +/- 0.3), or the occurrence of pregnancy (1 in the hMG group and 2 in the hFSH group).(ABSTRACT TRUNCATED AT 250 WORDS)     

Laparoscopic and transvaginal ova recovery: the effect on ova quality

Transvaginal follicle aspiration guided by transvaginal ultrasound for ova recovery is rapidly gaining popularity in many centers practicing in vitro fertilization and embryo transfer (IVF-ET). Cycle outcome following this new method has not been directly compared to the traditional, laparoscopic recovery technique. To this end, the authors evaluated multiple parameters in 66 laparoscopic (group A), and 44 transvaginal ova recovery procedures (group B) in patients undergoing IVF-ET. No statistically significant differences could be demonstrated between the groups in all but the rate of ova fertilization. The rate of fertilization was higher in the ova recovered by transvaginal follicle aspiration (59.6 versus 69.2%; P less than 0.01). No difference could be demonstrated between the groups in the other parameters examined, which included the number of ova recovered (5.7 +/- 0.4 versus 6.0 +/- 0.7), ova maturity (87 versus 84% intermediate ova), rate of polyspermic fertilization (3.9 versus 5%), rate of cleavage (88 versus 91%), cleavage stage at transfer (3.7 +/- 0.8 versus 3.5 +/- 0.4 cells per embryo), number of embryos transferred per patient (2.7 +/- 0.1 versus 3.3 +/- 0.2), and pregnancy rates. The potential detrimental effects of general anesthesia and CO2 pneumoperitoneum present during laparoscopy but not ultrasound guided recovery on ova quality may underlie the observed difference in fertilization between the groups.     

A prospective randomized comparison of luteal phase versus concurrent follicular phase initiation of gonadotropin-releasing hormone agonist for in vitro fertilization.

OBJECTIVE: To compare the effects of gonadotropin-releasing hormone agonist (GnRH-a) initiation either preceding or concurrent with controlled ovarian hyperstimulation (COH) in patients undergoing in vitro fertilization-embryo transfer (IVF-ET). DESIGN: Fifty-five patients were prospectively randomized to receive either GnRH-a on cycle day 21 before COH until ovarian suppression was achieved (group I) or GnRH-a concurrently with COH commencing on cycle day 3 (group II). MAIN OUTCOME MEASURES: Serum gonadotropin and ovarian steroid hormone levels, as well as fertilization, spontaneous abortion, and live birth rates. RESULTS: Twenty-six patients in group I and 29 patients in group II underwent COH for IVF-ET. Patients in group II had significantly higher serum luteinizing hormone, progesterone, and testosterone levels during stimulation with human menopausal gonadotropins (hMG) before oocyte retrieval (P < 0.05). Despite similar fertilization, biochemical, and clinical pregnancy rates, the spontaneous abortion rate was higher in group II (5/6) compared with group I (1/7) (P < 0.05). Thus, the live birth rate/retrieval for group I was 6 of 24 (25%) as compared with that of group II, which was 1 of 26 (3.8%) (P < 0.05). CONCLUSIONS: The initiation of GnRH-a in the follicular phase concurrently with hMG is associated with evidence of premature luteinization, hyperandrogenemia, and poorer pregnancy outcome compared with luteal phase administration of GnRH-a before hMG for IVF-ET.     

体外受精-胚胎移植中注射人绒毛膜促性腺激素后不同时间受精对早期胚胎发育及临床结局的影响

目的探讨人绒毛膜促性腺激素(h CG)注射后不同时间受精对体外受精-胚胎移植(IVF-ET)治疗患者实验室指标及临床指标的影响。方法选取行IVF-ET治疗并符合纳入标准的患者200例,根据h CG注射后受精时间不同随机分为4组:h CG注射后38.0~39.0 h受精为A组;注射h CG后39.1~40.0 h受精为B组、h CG注射后40.1~41.0 h受精为C组、h CG注射后41.1~42.0 h受精为D组,每组50例,观察并比较四组间实验室指标及临床指标。结果可用胚胎率B组(65.7%)、C组(63.3%)、D组(66.8%)均高于A组(55.5%)(P0.05);优质胚胎率A组(50.6%)显著低于C组(60.2%)与D组(63.6%)(P0.05),B组(54.3%)明显低于D组(P0.05);C组获得了较好的临床结局,临床妊娠率(50.0%)和着床率(34.2%)较高,流产率(9.1%)较低。正常受精率、正常卵裂率、临床妊娠率、着床率以及流产率组间比较,差异均无统计学意义(P0.05)。结论在一定时间范围内(38.0~42.0 h),随着h CG注射后受精时间的延长,优质胚胎率呈增高趋势;本中心IVF-ET治疗患者的最佳受精时间为h CG注射后40.1~41.0 h,此时受精患者有较高的临床妊娠率,较低的早期流产率及较好的临床妊娠结局。     

Ultrashort gonadotropin-releasing hormone agonist (GnRH-a) protocol in comparison with the long-acting GnRH-a protocol and menotropin alone.

OBJECTIVE: To compare the in vitro fertilization and embryo transfer (IVF-ET) outcome of a 3-day gonadotropin-releasing hormone agonist (GnRH-a) administration: ultrashort protocol with the outcome of long-acting GnRH-a cycles or human menopausal gonadotropin (hMG) alone. DESIGN: Ninety-two cycles of the ultrashort protocol were matched with 92 cycles with long GnRH-a and with 92 hMG cycles. SETTING: The IVF-ET program. MAIN OUTCOME MEASURES: Amount and duration of hMG treatment, hormonal profile on the day of human chorionic gonadotropin administration, cancellation rate, number of oocytes retrieved, and fertilization and pregnancy rates (PRs) were examined and compared among the three groups. RESULTS: The ultrashort group needed a higher number of hMG ampules than the hMG group but significantly less than in the long GnRH-a regimen. The number of oocytes in the ultrashort protocol was the same as in the long GnRH-a, but the number of embryos per retrieval was significantly lower than with the long GnRH-a protocol and similar to that found in the hMG group. The ultrashort protocol yielded 10% PR per cycle and 17% per replacement, significantly lower than with the long GnRH-a protocol, 26% and 36%, respectively, but also lower than in the hMG one, namely 13% and 28%. CONCLUSION: The ultrashort protocol, although being convenient and having some advantages found in the long GnRH-a protocol, is inferior in its outcome compared with the two other protocols.     

治疗GnRH-a引发的卵巢囊肿对体外受精结局的影响

目的:了解体外受精-胚胎移植过程中,促性腺激素释放激素激动剂(GnRH-a)引发的卵巢囊肿黄体晚期穿刺治疗对体外受精结局的影响。方法:选择2002年2月至2004年7月在我院行体外受精,黄体中期应用GnRH-a长方案的患者,其中35周期应用GnRH-a后引发卵巢囊肿,全部行囊肿穿刺治疗,设为研究组(A);对照组设为B、C两组,B组(46周期):选择与A组同期应用GnRH-a,未发现卵巢囊肿者;C组(35周期)选择与A组同期取卵进行体外受精-胚胎移植(IVF)或卵细胞浆单精子注射(ICSI)者。3组分别比较临床过程(降调满意时间、Gn的用量、获卵数)、实验室结果(受精率、卵裂率、可移植胚胎率、种植率)及结局(妊娠率、流产率)。结果:3组间临床、实验室结果及妊娠结局,统计学均无显著差异(P>0.05)。结论:黄体晚期穿刺治疗GnRH-a引发的卵巢囊肿,不影响体外受精的结局。     

The outcome of in vitro fertilization and embryo transfer in women with polycystic ovary syndrome failing to conceive after ovulation induction with exogenous gonadotropins.

OBJECTIVE: To assess the outcome of in vitro fertilization and embryo transfer (IVF-ET) in women with refractory polycystic ovarian syndrome (PCOS). DESIGN: Retrospective case series with an age-matched control group. SETTING: Ovulation induction and IVF programs in a tertiary referral center. PATIENTS AND INTERVENTIONS: Nine patients with PCOS who failed standard ovulation induction treatment (clomiphene citrate plus greater than or equal to 6 ovulatory human menopausal gonadotropin [hMG] cycles) underwent 19 cycles of IVF-ET. Forty age-matched tubal factor patients who completed 40 cycles of IVF-ET served as a control group. OUTCOME MEASURES: Demographic features and IVF-ET cycle characteristics were compared using Student's t-test and Fisher's exact test. RESULTS: Cycles of IVF-ET in patients with PCOS were associated with higher estradiol levels (5,222 versus 4,009 pmol/L), lower hMG requirements (15.8 versus 19.6 vials), greater numbers of oocytes (7.6 versus 5.6), and lower fertilization rates (56% versus 75%) compared with tubal factor cycles (P less than 0.05). However, the number of embryos transferred (3.9 versus 4.0) and the clinical pregnancy rate per embryo transfer (24% versus 25%) did not differ significantly between the two groups. CONCLUSION: These results suggest that conception failure after six or more ovulatory hMG cycles in patients with PCOS does not adversely affect subsequent IVF performance.     

骨形态蛋白(BMP)-15对子宫内膜异位症患者IVF结局影响的临床研究

目的:探索卵丘颗粒细胞早期凋亡和骨形态蛋白-15(bone morphogenetic protein-15,BMP-15)对子宫内膜异位症(EMs)患者IVF结局的影响。方法:行体外受精-胚胎移植(IVF-ET)的不孕患者,根据不孕指征分为EMs组及对照组。分别记录患者一般情况、获卵数、正常受精卵数、卵裂数、优质胚胎数、胚胎种植数和临床妊娠率。流式细胞仪测定所有对象卵丘颗粒细胞的早期凋亡率,Western blotting检测卵泡液中BMP-15蛋白的表达量。结果:获卵率、受精率、卵裂率、优质胚胎率差异无统计学意义(P>0.05);EMs组与对照组相比,获卵数分别为8.2±5.7个和12.0±5.8个,着床率分别为29.73%和47.31%,临床妊娠率分别43.37%和69.32%,差异均有统计学意义(P<0.05)。EMs组卵丘颗粒细胞的早期凋亡率为37.82±15.81%,对照组为8.85±5.58%,差异具有统计学意义(P<0.01)。卵泡液中BMP-15蛋白相对表达量EMs组为0.67±0.18,对照组0.94±0.33,差异有统计学意义(P<0.05)。结论:EMs患者IVF着床率及临床妊娠率降低,可能与卵母细胞分泌较少的BMP-15、颗粒细胞早期凋亡率增加,影响卵母细胞质量和胚胎的正常发育有关。     

同期体外受精-胚胎移植(IVF-ET)赠卵的临床应用

目的:探讨当前形势下中国赠卵的可行性、赠卵数、影响因素及存在的问题。方法:行IVF-ET并自愿捐卵的21例患者及同期接受赠卵并完成IVF-ET周期的23例患者,分析供、受双方的受精率、妊娠率和种植率。结果:23例患者共接受赠卵135枚,平均每周期接受卵子5.6±1.5枚,29个移植周期,12例妊娠,周期妊娠率为41.4%。供卵的21例患者,9个新鲜胚胎移植周期,2例妊娠;32个解冻胚胎移植周期,12例妊娠,冷冻移植周期的妊娠率为37.5%。供、受双方受精率、冷冻胚胎移植周期的妊娠率、累积妊娠率均无统计学差异(P>0.05)。结论:供卵者提供6个左右的卵子既不影响供卵者的妊娠,也能为受卵者提供一个良好的妊娠机会。