自然周期和促排卵周期宫腔内人工授精临床结局的比较

目的:分析3777个夫精宫腔内人工授精周期,探讨促排卵周期的安全性.方法:总结我院2006年1月至2008年12月706个自然周期和3071个促排卵周期,比较两组妊娠结局.结果:①自然周期与促排卵周期妊娠率比较,差异无统计学意义(P>0.05);但促排卵周期流产率较高(P<0.05);②促排卵周期中仅氯米芬+雌二醇+HMG方案妊娠率高于自然周期(P<0.05),仅氯米芬+雌二醇方案流产率高于自然周期(P<0.05);③不明原因不孕患者促排卵周期流产率高于自然周期(P<0.05);④非排卵障碍患者,促排卵周期与自然周期妊娠率、流产率和异位妊娠率间比较,差异无统计学意义(P>0.05);⑤促排卵周期中排卵障碍患者妊娠率和双胎率均高于其他病因患者(P<0.05).结论:促排卵周期与自然周期相比流产率增高;促排卵周期可以提高排卵障碍患者的妊娠率但不能改善非排卵障碍患者的妊娠结局;自然周期宫腔内人工授精安全性较高.     

人工授精周期诱导排卵药物及方案的研究进展

诱导排卵联合宫腔内人工授精是广泛应用的一项辅助生育技术。诱导排卵目的是形成单一卵泡的发育成熟,尽可能地减少发生多胎妊娠和卵巢过度刺激综合征的风险。抗雌激素类和芳香化酶抑制剂因口服方便而广泛应用,单独使用妊娠率较低。促性腺激素类药物可以获得较高的临床妊娠率,采用小剂量递增的温和方案不但能够保证较高的单卵泡发育还能够明显的减少并发症的发生。关于促性腺激素促排卵治疗中卵巢反应预测因子还有待于进一步研究。     

单次及双次宫腔内人工授精的临床结局分析

官腔内人工授精(intrauterine insemination，IUI)是治疗不孕症的有效手段，适用于一侧或双侧输卵管通畅、有自发或促排卵后排卵的不孕妇女。IUI的受精过程较接近自然受孕过程，操作简单，如何提高IUI的妊娠率是人们共同关心的问题。本研究旨在分析行单次IUI和行双次IUI的妊娠率及授精时机的选择。     

超排卵对宫腔内人工授精周期妊娠率的影响

目的分析超排卵对人工授精结局的影响，探讨超排卵对不同人群治疗的有效性。方法回顾性分析我院生殖科2000年3月-2007年12月期间女方有自发排卵的739个人工授精周期，比较不孕原因、女方年龄、有无子宫内膜异位症等因素下超排卵与自然周期妊娠率。结果739个人工授精周期中，超排卵周期233个，自然周期506个，妊娠率分别为21．6％和13．5％（P〈0.05），不孕因素中，宫颈因素为378个，男性因素为100个，盆腔输卵管因素44个，子宫内膜异位症85个，不明原因132个，其中宫颈因素和不明原因不孕周期超排卵周期妊娠率明显高于自然周期（22．40％，14．62％；27．03％，12．63％ P〈0.05）；男性因素、输卵管因素、子宫内膜异位症、女方年龄大于37岁周期，超排卵与自然周期妊娠率差异无显著性（P〉0.05）。超排卵周期中，氯米芬与促性腺素周期临床妊娠率无显著差异（P〉0.05）。结论因宫颈因素、不明原因不孕行人工授精夫妇超排卵周期妊娠率高，而男性因素、子宫内膜异位症、盆腔输卵管因素或年龄大于37岁妇女进行人工授精时慎重选择排卵诱导。     

控制超促排卵宫腔内人工授精治疗原因不明性不孕症应限制于3个周期之内

目前体外受精(IVF)及卵细胞内单精子注射(ICSI)的结果已有显著提高,用控制超促排卵(COH)结合宫腔内人工授精(IUI)广泛应用于治疗原因不明性不孕症已被人们认为,但治疗几个周期为最佳方案尚未取得一致意见,为探讨在IVF/ICSI治疗前做几个周期的COH/IUI为最佳,对不孕限≥4年的594例原因不明性不孕症患者进行研究。原因不明性不孕症诊断标准为:月经周期规律,黄体中期孕激素水平     

黄体期长方案控制性卵巢刺激周期体外受精-胚胎移植临床分析

目的探讨黄体期GnRH-a 1.25 mg长方案控制性卵巢刺激周期体外受精-胚胎移植的临床效果。方法回顾性分析在广西妇幼保健院生殖中心实施的137个黄体期GnRH-a 1.25 mg长方案控制性卵巢刺激周期体外受精-胚胎移植（IVF-ET）资料,对比妊娠组与未妊娠组的体外受精情况,并将获卵数≤8设为1组,获卵数9～17个为2组,获卵数≥18个为3组,比较分析三组的卵巢刺激过程的内分泌变化及临床结局。结果妊娠组与未妊娠组对比获卵数差异无统计学意义（P〉0.05）,正常受精率差异有统计学意义（P〈0.05）;按三组不同获卵数分析的结果,三组年龄最小,卵巢反应性高,胚胎冷冻率较1组、2组显著升高（P〈0.05）,但三组单次移植周期妊娠率差异无统计学意义（P〉0.05）,随着获卵数增多,发生卵巢过度刺激综合征的风险明显增高（P〈0.05）。结论黄体期长方案控制性卵巢刺激周期在维持一定的正常受精率的基础上可以获得满意的临床效果。     

自然周期与促排卵周期供精人工授精妊娠结局的比较

目的:探讨供精人工授精(AID)应用自然周期的妊娠结局。方法:回顾性分析1 100个AID周期的临床资料,其中自然周期736个,促排卵周期364个,比较两者的妊娠率和早期流产率及多胎率。结果:①自然周期妊娠率为24.45%(180/736),与促排卵周期妊娠率为23.9%(87/364),两者比较差异无统计学意义(P>0.05);②自然周期早期流产率为9.4%(17/180),而促排卵周期早期流产率为19.54%(17/87),显著高于自然周期,差异有统计学意义(P<0.05);③促排卵周期多胎率为13.8%(12/87)。结论:促排卵周期与自然周期供精人工授精的妊娠率相当,但其早期流产率和多胎率较自然周期明显升高。     

实时盆腔超声监测排卵用于人工授精

我们对18例因丈夫患无精症而要求作人工授精的妇女用B超监测排卵而适时作人工授精,共40个周期,计192次B超检查,74次供者人工授精。妊娠率为55.6%。此法较观察基础体温的转变及宫颈评分监测排卵更为准确。妊娠周期中,排卵前优势卵泡的平均直径为20～26mm。迫近排卵的超声显象有:(1)优势卵泡内壁见到一金字塔形的回声区(4/10);(2)优势卵泡周围有一低回声晕(6/10);(3)优势卵泡内壁边缘呈锯齿状(5/10);(4)宫腔线周围有一低回声区(4/5),和/或宫腔内有咖啡豆样显象(2/5)。排卵后的超声显象有:(1)卵泡消失(5/10);(2)卵泡塌陷(4/10);(3)血体形成(1/10);(4)宫腔内有环形显象(3/5)。     

IVF周期中非多囊卵巢患者基础睾酮值对卵巢功能的预测

目的：研究体外受精胚胎移植（IVF-ET）周期中患者基础睾酮（T）值的水平,探讨其与卵巢反应性之间的关系。方法：回顾分析2011年5月至2012年7月于我中心行第一周期IVF长方案控制性促排卵（COH）助孕的1413例患者。根据基础T值分为A组（T≤20ng/dl,473例）和B组（T〉20ng/dl,940例）。比较两组患者的基础T值与卵巢反应性之间的关系。结果：两组患者的体重指数（BMI）、基础FSH水平、基础LH水平、窦卵泡数、Gn天数、Gn总量、〉14mm卵泡数、获卵数、HCG日内膜厚度（cm）、优质胚胎数、冷冻胚胎数均差异显著（P〈0.05）。基础T水平与卵巢反应性、HCG日〉14mm卵泡数及Gn总用量呈正相关性。结论：基础T值能预测患者的卵巢功能及COH中Gn用量。     

Hydatidiform mole following successful gonadotropin ovulation induction and donor artificial insemination

A case of successful gonadotropins ovulation induction and donor artificial insemination (AID) followed by a complication of hydatidiform mole is presented. A review of the published papers related to this topic are commented. The organization of a world registry of AID depending on the World Health Organization is encouraged.     

促排卵并发症及其防治

临床上促排卵治疗常常致多个卵泡发育,在提高妊娠率的同时也带来诸多并发症,如多胎妊娠、卵巢过度刺激综合征（OHSS）、异位妊娠和卵巢扭转等。虽然这些并发症并不多见,但有时会非常严重,甚至威胁生命。因此,促排卵过程中应加强监测,防范重于治疗。     

Laparoscopic treatment of recurrent ectopic pregnancy in the ipsilateral salpinx after ovulation induction and intrauterine insemination

ObjectiveTo report a case of recurrent ectopic pregnancy in the ipsilateral salpinx after and intrauterine insemination treated by laparoscopy.Case reportA 33-year-old woman with unexplained infertility sought evaluation at our hospital due to pelvic pain after ovulation induction and intrauterine insemination. She had a history of a right salpingectomy. Transvaginal ultrasonography did not reveal an intrauterine pregnancy, but showed a suspected extrauterine gestational sac on the operated adnexal area with free fluid in the pouch of Douglas. The patient was diagnosed with a recurrent ruptured ectopic pregnancy and an emergency laparoscopy was performed.ConclusionRecurrent ectopic pregnancy in the ipsilateral fallopian tube is rare, but it is important to be suspicious of the diagnosis to prevent serious morbidity. This case also demonstrates transtubal or transperitoneal migration of the gametes because ovulation and ectopic pregnancy occurred on opposite sides.     

Effects of ovulation induction on ovarian morphology: an animal study

OBJECTIVE: The aim of this study was to investigate whether the ovulation induction has relation with postneoplastic lesions. MATERIALS AND METHODS: Seventy-eight female, 90-day-old rats were enrolled for the trial. They were divided into three groups. In the first group, 13 rats received one cycle of ovulation induction with Follitropin Beta and human chorionic gonadotropin. The second group of 13 rats received three cycles of ovulation induction, and the third study group consisted of 13 rats which received six cycles of ovulation induction. Each group had a control group consisting of same number of rats that had not received ovulation induction. At the 12th month after the ovulation induction protocols ended, rat ovaries were extirpated for histopathological examination. In histopathological examination, malignant lesions, ovarian cyst and cyst diameter, epithelial stratification, epithelial tufting, mitotic index, polymorphism of epithelial cells and nucleus, epithelial cell nuclear diameter, chromatin density nuclear atypia, and mitotic activity in ovarian cyst epithelium were evaluated. RESULTS: No malignant ovarian lesion was found in the three groups. Ovarian cyst development was most frequent in the rats that underwent six cycles of ovulation induction. Epithelial stratification and tufting were most frequent in the rats which underwent ovulation induction six times. Significant difference was found between induction and control groups in second and third groups for cellular and nuclear polymorphism, presence of nucleolus, and nuclear chromatin density. CONCLUSIONS: Although development of malignant lesion were not found in any of the rat ovaries after ovulation induction, increase in the prevalence of epithelial dysplasia especially with increase in the number of induction cycles shows that some ovarian pathologies can occur subsequent to ovulation induction.     

促排卵对不同病因宫腔内人工授精的结局分析

目的:探讨促排卵对不同病因不孕患者人工授精的影响。方法:回顾性分析因男性因素、输卵管盆腔因素、子宫内膜异位症(EMS)和不明原因进行人工授精患者的资料,根据患者进行自然周期或促排卵周期分组,比较不同周期组的临床妊娠率和活产率。采用多元回归分析模型校正患者年龄、不孕年限、不同因素构成比、基础FSH、LH、E_2、子宫内膜厚度、类型、宫腔内人工授精(IUI)日卵泡直径及男性前向运动精子总数。评估在男性因素、输卵管盆腔因素、EMS和不明原因中促排卵周期与临床妊娠率的关系。结果:①促排卵组患者平均年龄、不孕年限以及不孕因素构成比(男性因素、输卵管盆腔因素、EMS和不明原因)与自然周期比较,无统计学差异(P0.05),而临床妊娠率和活产率均高于自然周期,但无统计学差异(P=0.08);②通过多元因素回归分析校正了年龄、基础内分泌水平、不孕因素、内膜厚度和类型及前向运动精子总数等混杂因素后,促排卵周期相对于自然周期依然有显著优势(OR=1.607;95%CI=1.115~2.316);③在不同因素不孕患者中,促排卵周期可提高输卵管盆腔因素患者的活产率(OR=4.56;95%CI=1.53~13.53)。结论:促排卵周期可提高输卵管盆腔因素患者宫腔内人工授精的临床妊娠和活产率。     

Stage IV ovarian carcinoma following ovulation induction: a report of three cases

Recent attention, in both the medical and lay communities, has been focused on a possible causal relationship between ovulation induction and ovarian carcinoma. The three cases reported here display marked heterogeneity in their risk factor profiles for ovarian cancer, illustrating several of the inconsistencies that have hampered epidemiological studies examining the proposed mutagenic effect of fertility drugs on ovarian epithelium. Three cases of stage IV invasive ovarian carcinoma, developing in infertility patients following from one to seven cycles of ovulation induction, are presented. The biological plausibility of a causal effect of fertility drugs on ovarian carcinogenesis has not been corroborated by consistent dose-dependent or lag-time effects. Fertility drug use may be an incidental finding associated with the known ovarian cancer risk factor of infertility. Nevertheless, until the precise effects of fertility drugs on ovarian epithelium are elucidated, a high index of suspicion for malignant ovarian neoplasms in women using these medications is indicated.     

Retrograde ejaculation: a more convenient method for artificial insemination

A case of retrograde ejaculation not responding to medical treatment is described in which the problem of sterility was overcome by artificial insemination. The semen was collected from urine after coitus by previous alkalinization with 1.63 g NaHCO₃ once daily. Pregnancy occurred at the 4th insemination during the 1st treatment cycle. This technique seems to be the most suitable for artificial insemination in cases of retrograde ejaculation.     

放弃治疗的153个促排卵周期的临床后果分析

目的 了解促排卵过程中因过激反应或促排卵失败而放弃治疗周期的临床后果。方法 对放弃治疗的促排卵周期继续进行观察和回访，并进行分类分析。结果 153个放弃治疗的促排卵周期，因有过激反应的86个周期（56．2％），因促卵失败的67个周期（44．8％）。因宵过激反应而放弃治疗的86个周期，出现9例妊娠（10．5％），2例多胎妊娠（2．3％），5例卵巢过度刺激综合征（5．8％）。因促排卵失败而放弃治疗的67个周期，出现妊娠2例（3．0％），无多胎妊娠和卵巢过度刺激综合征出现。结论 临床因卵巢过激反应而放弃治疗的周期，还存在一定的妊娠率，但同时也存在一定的多胎妊娠和卵巢过度刺激综合征的风险。因促卵失败而放弃治疗的周期，也有一定的妊娠率，但无多胎妊娠和卵巢过度刺激综合征的风险。     

重视促排卵的质量与安全性

促排卵治疗是决定辅助生殖成功率的关键步骤,随着促排卵药物的大量应用,促排卵治疗方式的选择及并发症带来的风险也日益受到关注。这一领域需要更多的大样本、多中心临床研究和动物试验研究,以此指导促排卵的临床合理应用。