移植8cell胚胎个数与妊娠率的关系

目的:探讨体外受精-胚胎移植(IVF-ET)周期中第三天移植8cell胚胎数量与临床结局的关系。方法:以2009年1月至2010年12月在本中心接受IVF-ET治疗625个周期为研究对象。将所有移植周期按移植8cell胚胎个数分为三组,分析三组的临床妊娠率、胚胎种植率、多胎率有无差异。结果:移植两个8细胞胚胎组(C组)的临床妊娠率(59.5%)显著高于无8细胞胚胎移植组(A组)和含一个8细胞组(B组)(P<0.05),A、B两组临床妊娠率无显著性差异;C组种植率(39.8%)显著高于其他两组,A组和移植胚胎中含一个8细胞组(B组)种植率比较有显著性差异,;多胎率分析,C组明显高于其他两组。结论:在IVF-ET周期中第3天移植8cell胚胎个数对妊娠率及种植率、多胎率有影响,在挑选胚胎时移植一个8cell胚胎搭配一个其他细胞数的胚胎也能得到较好的妊娠率并有效降低多胎率。     

未见原核胚胎的移植价值

目的:比较未见原核来源胚胎与双原核(2PN)胚胎临床结局,探讨未见原核胚胎的临床应用价值。方法:回顾性分析重庆市妇幼保健院2016年1月至2018年4月常规体外受精—胚胎移植周期(IVF-ET),比较移植2PN来源第2天4细胞,第3天8细胞(4-8细胞)胚胎和非4-8细胞胚胎以及未见原核来源4-8细胞胚胎临床结局。结果:2PN来源4-8细胞与未见原核来源4-8细胞胚胎的种植率比较,差异无统计学意义(47.29%vs 44.44%,P>0.05),2PN来源非4-8细胞胚胎种植率明显低于未见原核来源4-8细胞胚胎,差异有统计学意义(33.86%vs 44.44%,P<0.05)。结论:在IVF-ET周期中无2PN来源4-8细胞移植胚胎选择时,未见原核4-8细胞模式卵裂胚胎可考虑移植。     

移植优质胚胎及减少移植胚胎数量对体外受精-胚胎移植结局的影响

在进行体外受精-胚胎移植(IVF—ET)的过程中,1个治疗周期往往植入较多的胚胎以增加妊娠的机会。但由此导致多胎妊娠的发生率为自然妊娠(3％)的10倍,甚至10倍以上。而多胎妊娠,又会给母儿带来一系列的并发症,剖宫产率、新生儿患病率和死亡率也随即增加。本研究的目的,是探讨首次接受IVF-ET的35岁以下妇女,移植2个或3个胚胎,对胚胎植入率、临床妊娠率的影响和发生多胎妊娠的情况。     

移植胚胎数和着床胚胎数与妊娠早期血清β-hCG值的关系

目的:探讨移植胚胎数和着床胚胎数与妊娠早期血清β-hCG值的关系。方法:回顾性分析IVF/ICSI新鲜胚胎移植后820个宫内妊娠周期,根据移植胚胎数及移植后35 d B超显示的妊娠囊数分组,比较移植14 d、18 d血清β-hCG水平及其上升幅度。结果:不同移植胚胎数相同妊娠囊数组间比较血清β-hCG差异无统计学意义(P>0.05);妊娠早期血清β-hCG水平:三妊娠囊组>双妊娠囊组>单妊娠囊组,差异有统计学意义(P<0.05);血清β-hCG上升幅度各组比较无统计学意义(P>0.05)。结论:移植胚胎数对妊娠早期血清β-hCG无直接影响;着床胚胎数影响妊娠早期血清β-hCG水平。妊娠囊越多,其hCG水平就越高。     

体外受精-胚胎移植短方案周期中移植胚胎数与临床妊娠结局的关系

目的:探讨体外受精-胚胎移植(IVF-ET)短方案周期中移植不同胚胎数对于临床妊娠率和多胎发生率的影响。方法:回顾性分析2002.01-2004.10期间进行第一次IVF-ET短方案周期治疗、年龄<35岁的患者1463例,将2002.01-2003.09间移植2个胚胎者为A组(n=84)、移植3个胚胎者为B组(n=716);2003.10-2004.10期间移植2个胚胎者为C组(n=663)。分析和比较3组的可移植胚胎数、胚胎种植率、临床妊娠率和多胎发生率等。结果:B组的可移植胚胎数(7.8±3.7)显著高于移植2个胚胎的A组(4.6±4.7)和C组(6.9±3.9),P均<0.05,胚胎种植率各组间无显著性差异(A:20.62%,B:14.88%,C:21.66%),P均>0.05。B组的临床妊娠率(42.96%)显著高于A组(25.93%)和C组(39.06%),P均<0.05;各组间的单胎妊娠率无显著性差异(A:27.19%,B:20.99%,C:29.42%,P均>0.05);A组(4.94%)和C组(10.06%)的多胎妊娠率均比B组(15.77%)显著降低,P<0.05。结论:IVF-ET短方案周期中,减少移植胚胎数可能会降低临床妊娠率,但移植2枚胚胎能够有效降低多胎妊娠的发生。     

人类卵裂期胚胎sHLA-G表达与种植率和妊娠率的关系

目的:定量测定卵裂期胚胎可溶性人白细胞抗原G(sHLA-G)的表达,探讨sHLA-G分泌与胚胎种植率、妊娠率的关系。方法:收集40例体外受精-胚胎移植(IVF-ET)助孕的80份胚胎培养液样本,用ELISA法定量检测样本中sHLA-G的表达。结果:80份胚胎培养液样本中有35份sHLA-G表达阳性(≥2U/mL),阳性率43.8%,表达阳性组的平均含量为4.68±1.29U/mL;40例患者中27例至少1个移植胚胎培养液中sHLA-G表达阳性,19例妊娠,妊娠率70.4%(19/27),所有患者均移植2枚胚胎,种植率46.2%(25/54);sHLA-G表达阴性(<2U/mL)的13例患者中3例妊娠,妊娠率23.1%(3/13),种植率15.4%(4/26),两组差异有统计学意义(P<0.01)。结论:胚胎培养液中sHLA-G含量与胚胎种植率、妊娠率有关,可用于预测胚胎的发育潜能,将sHLA-G表达水平结合形态学评分可作为选择胚胎的一种临床工具。     

取卵后第3天胚胎形态学指标与移植后着床的关系

目的:探讨取卵后第3天(Day3)多个胚胎形态学指标与胚胎着床的关系。方法:选取年龄≤35岁,进行Day3胚胎移植患者,按胚胎移植后全部植入或未植入分为,植入组:30个移植周期,56个胚胎;未植入组:32个移植周期,64个胚胎。分析Day3胚胎卵裂球数目、大小差异、卵裂球核、卵裂球颜色及颗粒、碎片比例和类型、胞质内空泡等与胚胎种植之间的相关性。结果:Day3胚胎发育速度、卵裂球核数量和碎片类型在两组间差异有显著性(P<0.05)。植入组中7~8细胞组最多见(71.4%),尤其是8细胞高达60.7%。卵裂球核指标中,植入组至少一单核组最多见(57.1%)。碎片类型中植入组T1出现率最高,为41.1%。其他形态学指标在两组间无统计学差异(P>0.05)。判别分析表明卵裂球数和碎片类型较卵裂球核、卵裂球大小差异、碎片多少对胚胎植入判别符合率为70.0%。结论:在选择移植胚胎时,胚胎生长速度及碎片类型是考虑的首要因素,其次是胚胎碎片含量。     

体外受精—胚胎移植120个妊娠周期中移植胚胎形态学分析

目的为体外受精和胚胎移植临床中选择移植胚胎提供参考指标。方法回顾性分析在本中心行IVF-ET治疗并在取卵后第2天移植胚胎的120个妊娠周期共453个移植胚胎的资料。结果120个治疗周期中单胎75例,双胎33例,3胎10例,4胎以及5胎各1例。4细胞期胚胎所占的比例从单胎的47.3％增至双胎的53.2％和3胎的72.5％,妊娠胎数随移植胚胎中≥4细胞期胚胎的增多而明显增加(χ2=10.813,P＜0.05)。结论形态学可以作为选择移植胚胎的参考指标之一,但如何在保证妊娠率的同时减少移植胚胎的数目而降低多胎妊娠率还需进一步的前瞻性研究。     

应用颗粒细胞部分剥除法提高行体外受精-胚胎移植后胚胎质量及临床妊娠率的研究

行体外受精-胚胎移植（IVF—ET）后，约50％以上的胚胎发育至4～8细胞阶段，即发生阻断现象，胚胎不再继续发育。动物研究证明，应用颗粒细胞部分剥除法（即将保留的部分自体卵母细胞周围颗粒细胞与胚胎共培养），是克服体外胚胎发育阻断的有效方法，用于共培养的细胞可来自自体，也可来自异体。目前，有关研究报道较多的是选用输卵管上皮细胞，也有选用颗粒细胞的。本研究旨在探讨应用颡粘细胞部分剥除法在行常规IVF—ET中的应用价值。     

The relationship between follicle diameter, fertilization rate, and microscopic embryo quality

The diameter of preovulatory ovarian follicles was measured at the time of transvaginal US-guided oocyte retrieval, and the oocytes were subsequently examined to assess fertilization rates and the quality of developing embryos. With follicles divided into three groups of increasing diameter, there were no significant differences in the fertilization rates of oocytes recovered from follicles of different size. Embryo quality improved with increasing follicle size, although the differences were not highly significant. Our results demonstrate that an acceptable laboratory outcome can be achieved with oocytes retrieved from smaller sized follicles.     

High pregnancy rate after early human embryo freezing

Human embryos produced by in vitro fertilization (IVF) were frozen with 1,2-propanediol as a cryoprotectant. Embryo survival after thawing was related to the presence of a nucleus in frozen cells and decreased with the increasing number of cells in the frozen embryo. None of five embryos frozen 3 or 4 days after IVF survived when thawed. Of 48 early embryos (35 patients) frozen 1 or 2 days after IVF, 42 (87.5%) were transferred in 32 patients. Ten pregnancies were initiated after frozen embryo transfer (ET). If we exclude the three infertile patients who had sexual intercourse in the fertile period, the pregnancy rate for each patient who had 1- or 2-day frozen embryo(s) was 22% (7 of 32). One of the pregnancies was obtained after ET of a 1-cell pronucleated frozen and thawed embryo. The rate of ongoing pregnancies after triple fresh ET was 23%. In patients having four embryos obtained in a single IVF cycle, the expected overall liveborn rate in an IVF-ET program including embryo cryopreservation could theoretically equal that of natural human fertility.     

The association between homocysteine in the follicular fluid with embryo quality and pregnancy rate in assisted reproductive techniques

Purpose  

To investigate the association between follicular fluid homocysteine levels and embryo quality and pregnancy rates in patients undergoing assisted reproduction.     

Treatment with piroxicam before embryo transfer increases the pregnancy rate after in vitro fertilization and embryo transfer

OBJECTIVE: To examine the effect of beta-cyclodextrin piroxicam treatment for priming of the uterus on the pregnancy outcome of IVF-embryo transfer (ET) programs. DESIGN: Prospective, randomized, double-blinded placebo-controlled clinical study. SETTING: Large urban medical center. PATIENT(S): One hundred eighty-eight consecutive cycles of fresh IVF-ET and 78 cycles of frozen-thawed ET. The patients underwent IVF because of tubal, male infertility, unexplained, or endometriosis factors. They were randomly divided into treatment and control groups. INTERVENTION(S): In the treatment group, 94 cycles in fresh ET and 39 cycles in frozen-thawed ET the patients received an oral dose of 10 mg of piroxicam. In the control group, the same number cycles corresponding to the treatment group were treated with placebo. Both groups started piroxicam or placebo treatment 1-2 hours before ET. Patients and staff were blinded to the treatment. MAIN OUTCOME MEASURE(S): Implantation rate (IR) and pregnancy rate (PR). RESULT(S): Piroxicam increased significantly IR (18.7%) and PR (46.8%) compared to the control group (8.6% and 27.6%, respectively) in fresh cycles. With the exception of an unexplained factor, patients with the tubal, male infertility, or endometriosis factor had significantly higher PR in the treatment group compared to the control group. The beneficial effect of piroxicam was found in patients less than 40 years old, but was not found in patients more than 40 years. In frozen-thawed cycles, there were statistically significant differences between the treatment group and the control group in IR (9.4% vs. 2.3%) and PR (25.6% vs. 7.7%), respectively. CONCLUSION(S): Our study showed that piroxicam increases IR and PR after IVF-ET in both fresh and frozen-thawed ET cycles. The beneficial effect seems to be more remarkable in patients less than 40 years old with tubal, male infertility, or endometriosis factors. These results suggest that piroxicam treatment before ET is very effective in the priming of a uterus suitable for embryo implantation. This is the first study to investigate the possible consequence of piroxicam for improving the PR after IVF-ET.     

Correlation between embryological factors and pregnancy rate: development of an embryo score in a cryopreservation programme

Purpose  

To establish which embryo parameters, in frozen thawed embryo transfers, have the highest prognosis value in the establishment of pregnancy. The relative importance of different embryo parameters is used to develop an embryo score.     

The association between level of physical activity and pregnancy rate after embryo transfer: a prospective study

Research questionIs physical activity after embryo transfer, as assessed by a smart band activity tracker, associated with decreased pregnancy rates?DesignProspective observational cohort study comprising infertile women aged < 38 years, who had undergone fewer than three previous embryo transfers, achieved a good ovarian response and were undergoing frozen–thawed embryo transfer in a tertiary-referral centre. A validated smart band activity tracker was used to assess physical activity level immediately after the embryo transfer and until the pregnancy test. No specific recommendations were given to participants on level or intensity of physical activity. Physicians and patients were blinded to the data stored in the pedometer. Primary outcome was ongoing pregnancy rate.ResultsFifty women met the inclusion criteria. Ongoing pregnancy rate was 30%. In a pooled analysis, participants walked significantly fewer steps per day on the day of embryo transfer compared with the first 2 days after embryo transfer (4075, interquatile range [IQR] 2932–5592 versus 5204, IQR4203–8584, P = 0.01). No significant difference was observed between pregnant women and non-pregnant women in the median steps per day after embryo transfer until serum beta-HCG was measured (7569, IQR 6008–10884 versus 6572.5, IQR 5299–8786, P = 0.43). No significant difference was observed in the median number of steps on the day of embryo transfer or the first 2 days after embryo transfer between pregnant and non-pregnant women.ConclusionsA quantitative objective assessment of the association between physical activity and pregnancy rates after frozen–thawed embryo transfer was conducted. Ambulation after embryo transfer has no adverse effect on pregnancy rates and, therefore, women should resume regular activity immediately after embryo transfer.     

宫内节育器带器妊娠及异位妊娠的研究

宫内节育器(IUD)是我国育龄妇女采取的主要长效避孕方式,其与带器妊娠和异位妊娠的关系各家报道不一,存在一定争议。本文综述了近年来宫内节育器带器妊娠和异位妊娠的发病率及影响因素、病因学、节育器移位诊断、预后等方面的研究进展。