人工皱缩囊胚腔对囊胚玻璃化冷冻后妊娠结局的影响

目的 探讨人工皱缩囊胚腔对囊胚玻璃化冷冻的效果、妊娠结局及新生儿的影响.方法 2006年1月至2009年12月,选择在广西壮族自治区妇幼保健院生殖医学中心接受体外受精-胚胎移植(IVF-ET)或卵母细胞胞质内单精子注射(ICSI)治疗的患者,新鲜胚胎移植妊娠失败后要求行冻融囊胚移植的342个周期,其中,314个周期的囊胚在玻璃化冷冻前,用显微注射针刺入囊胚腔内抽出囊胚液使之皱缩,然后以玻璃微细管为载体行玻璃化冷冻(皱缩组),28个周期未行囊胚腔人工皱缩(未皱缩组).比较两组经冷冻、复苏及移植后的胚胎存活率、种植率、临床妊娠率和取消移植率等.在已妊娠者中,比较两组的流产率、活胎分娩率、分娩孕周、新生儿出生缺陷发生率、新生儿平均出生体质量等,并与同期新鲜移植周期(新鲜周期组,520个周期)进行比较.结果 皱缩组胚胎存活率、种植率及临床妊娠率分别为95.3%(403/423)、38.0%(153/403)、44.6%(140/314),未皱缩组分别为64.3%(27/42)、7.4%(2/27)、7.1%(2/28),分别比较,差异均有统计学意义(P＜0.05);皱缩组取消移植率为0,未皱缩组为25.0%(7/28),两组比较,差异也有统计学意义(P＜0.05).皱缩组的流产率[18.2%(10/55)]、活胎分娩率[80.0%(44/55)]、分娩孕周[(38.2±1.3)周]、新生儿出生缺陷发生率[2.1%(1/47)]、新生儿平均出生体质量[(2989±640)g]与新鲜周期组[17.5%(91/520)、74.0%(385/520)、(37.9±2.3)周、1.7%(8/479)、(2856±640)g]比较,差异均无统计学意义(P＞0.05).结论 人工皱缩囊胚腔能明显提高囊胚玻璃化冷冻效果,并且新生儿先天异常发生率无明显升高.     

女方染色体多态对体外受精-胚胎移植妊娠结局的影响

目的探讨女方染色体多态性对体外受精-胚胎移植(IVF-ET)结局的影响。方法回顾性比较IVF-ET助孕治疗的女方染色体多态(65对,女方多胎组)和正常对照夫妇(160对,正常对照组)的妊娠结局。结果女方多态组与正常对照组患者双原核(2PN)受精率、妊娠率、生化妊娠率均无统计学差异(P0.05);然而多态组1PN受精率(8.48%)及多PN受精率(12.50%)均显著高于正常对照组(3.90%,7.96%)(P0.01),卵裂率(89.21%)显著低于正常对照组(98.36%)(P0.01)。虽然妊娠率比较未见明显差异,但多态组种植率(23.89%)低于正常对照组(35.40%)(P0.05)。将不同的多态类型详细分组与正常对照组对比结果显示:1号、9号、16号染色体异染色质增加组1PN受精率(11.36%)及多PN受精率(17.02%)均显著高于正常对照组(3.90%,7.96%)(P0.01),卵裂率(87.90%)显著低于正常对照组(98.36%,P0.01);D/G组随体柄增长组卵裂率(80.00%)及种植率(17.65%)均低于对照组(98.36%,35.40%)(P0.01,P0.05);而9号染色体臂间倒位[inv(9)]患者各项指标与正常对照组相比无统计学差异。结论女方染色体多态,尤其是1号、9号、16号染色体异染色质增加会导致IVF助孕患者异常受精比例增加以及种植率降低;Inv(9)对IVF临床预后无明显影响,临床可根据患者不同的多态类型个体化给与遗传咨询指导。     

The analysis of the coexistence of endometrial carcinoma and uterine myoma

OBJECTIVE: An epidemiologic study of coexistence uterus myoma with endometrial cancer patients is presented. Coexistence of endometrial carcinoma with uterus myoma was evaluated and controlled for age, residence, civil status, education, parity, menarche age, last menstruation age, length of reproductive period, blood group, hypertension, diabetes, body mass index, sterility, histological subtype, grading, staging. DESIGN: From 1984-1998 136 endometrial carcinomas have been evaluated in the Department of Gynecology & Obstetrics in Hospital of S?upsk retrospectively. MATERIAL AND METHODS: Uterus myoma was coexistence with endometrial cancer in 22 cases (16.2%). Of 136 endometrial carcinomas 16 (11.6%) were multiple malignant neoplasms. Of these neoplasms 9 (6.6%) occur together with breast cancer, 3 (2.2%) with ovarian carcinoma, 1 (0.7%) with stomach carcinoma, 1 (0.7%) with rectum carcinoma, 1 (0.7%) with carcinoma in focus of endometriosis and 1 (0.7%) coexists with double neoplasms (bowel and endometriosis carcinoma) During the 14-year period of study 15 patients (11.0%) out of 136 patients diagnosed as having endometrial cancer had double and 1 (0.6%) had triple primary malignant neoplasms. There was not significant difference in age rate (p = 0.16), residence rate (p = 0.72), civil status rate (p = 0.37), education rate (p = 0.53), parity rate (p = 0.49), menarche age rate (p = 0.33), last menstruation age rate (p = 0.12), length of reproductive period rate (p = 0.66), blood group rate (p = 0.19), hypertension rate (p = 0.38), diabetes rate (p = 0.96), overweight status rate (p = 0.76), sterility rate (p = 0.35), histological subtype rate (p = 0.25), grading rate (p = 0.29), staging rate (p = 0.54), second primary malignant neoplasma (p = 0.77) between both patients group (with and without uterus myoma). CONCLUSION: Patients with endometrial cancer should be carefully and regularly followed up by monitoring et every anatomic site, especially the breast, stomach, and colon, in order that the development of a second primary carcinoma can be detected as early as possible, and not be overlooked in examinations. There is not additional risk factors for endometrial carcinoma between patients with and without coexistence uterus myoma. In the observation of patients with myoma in postmenopause, cytological investigation of endometrial aspirates, ultrasound and mammographic screening should be carried out.     

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。     

黄体期使用生长激素在高龄卵巢储备功能减退患者中的临床应用

目的探讨黄体期使用生长激素(GH)对高龄卵巢储备功能减退(DOR)患者超促排卵治疗的影响。方法选择接受体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)且高龄(年龄≥35岁)DOR不孕患者156例为研究对象,均采用拮抗剂方案,分为研究组(加用GH)和对照组(不加用GH)。分析GH对促性腺激素(G n)使用总量、G n使用时间、获卵数、移植前内膜厚度、双原核(2 P N)率、优质胚胎率、着床率的影响。结果 Gn使用时间、Gn使用总量、移植前内膜厚度组间有统计学差异(P0.05)。h CG注射日E 2水平、获卵数、2 P N受精率、优质胚胎率、着床率、临床妊娠率及累积妊娠率组间无统计学差异(P0.05)。研究组临床妊娠率为28.0%、对照组为19.4%,研究组累积妊娠率为33.3%、对照组为20.0%,组间均无统计学差异(P0.05),但研究组临床妊娠率及累积妊娠率有上升趋势。结论 GH对年龄≥35岁DOR患者可明显降低Gn的使用总量及使用时间,增加子宫内膜的厚度,临床妊娠率及累积妊娠率有提高的趋势。     

腹腔镜激光打孔术治疗多囊卵巢68例临床分析

本文对行腹腔镜激光打孔术治疗的68例多囊卵巢(PCO)进行了分析。结果;①总排卵率91.2％,妊娠率48.5％;②单纯激光与激光加CC(克罗米芬)的排卵率及妊娠率均无明显差异(P>0.05),但排卵周期率有明显差异(P<0.01);③稀发月经型与闭经型及多囊型与硬化型的排卵率及妊娠率相比,均为前者高于后者(P<0.01);④术后第一周期内72.9％恢复排卵,47.1％术后半年内妊娠,本文还对腹腔镜激光打孔术的术式及适应证进行了介绍。     

子宫颈高级别上皮内病变患者的治疗对策及转归

目的 通过分析宫颈高级别上皮内病变(HSIL)患者手术前后病理和预后,探讨合适的手术方案.方法 对528例阴道镜下活检诊断为宫颈HSIL的患者分别行冷刀锥切术(CKC)(n=353)和环形电切术(LEEP)(n=175),病理回报宫颈HSIL及浸润癌者给予二次手术.比较手术前后病理等级分布,分析二次手术情况、首次手术切...     

玻璃化冷冻与程序化冷冻对胚胎发育潜能及临床结局的影响

目的:比较玻璃化冷冻与程序化冷冻对胚胎发育潜能及临床结局的影响。方法:回顾性分析590个复苏周期,比较2种冷冻方法的胚胎复苏率、临床妊娠率、胚胎种植率和流产率等各项指标。结果:玻璃化冷冻组的平均移植胚胎数(2.2±0.5枚)显著少于程序化组(2.5±0.6枚)(P<0.05),复苏率(94.4%)、完整胚胎率(73.7%)、临床妊娠率(50.8%)和种植率(30.2%)显著高于程序化组(77.2%、44.3%、36.2%、21.1%)(P<0.05),而流产率和周期取消率组间均无统计学差异(16.6%vs 27.7%,1.3%vs 2.3%)(P>0.05)。程序化冷冻胚胎的种植率在完整胚胎(13.5%)和非完整胚胎(16.0%)组间无统计学差异(P>0.05);玻璃化冷冻完整胚胎组的种植率(30.4%)显著高于非完整胚胎组(20.1%)(P<0.05);而2种冷冻方法的流产率完整胚胎组(35.7%,15.1%)均显著高于非完整胚胎组(8.7%,2.9%)(P<0.05)。在玻璃化冷冻中,卵裂期胚胎组的各项指标与囊胚期组相比均无统计学差异(P>0.05)。结论:玻璃化冷冻法适用于人类胚胎的保存,对卵裂期和囊胚期胚胎有同样理想的保存效果和临床结局,玻璃化冷冻中,胚胎完整性对胚胎种植率起着重要的作用。     

The coexistence of endometrial cancer with second primary malignant neoplasms

OBJECTIVE: An epidemiologic study of multiple primary malignant neoplasms with endometrial cancer patients is presented. Coexistence of endometrial carcinoma with second primary malignant neoplasms was evaluated and controlled for age, residence, civil status, education, parity, menarche age, last menstruation age, length of reproductive period, blood group, hypertension, diabetes, body mass index, sterility, histological subtype, grading, staging. DESIGN: From 1984-1998 136 endometrial carcinomas have been evaluated in the Department of Gynecology & Obstetrics in Hospital of S?upsk retrospectively. All double and triple neoplasms have been histologically recorded, doubtful cases have been excluded. MATERIAL & METHODS: Of 136 endometrial carcinomas 16 (11.6%) were multiple malignant neoplasms. Of these neoplasms 9 (6.6%) occur together with breast cancer, 3 (2.2%) with ovarian carcinoma, 1 (0.7%) with stomach carcinoma, 1 (0.7%) with rectum carcinoma, 1 (0.7%) with carcinoma in focus of endometriosis and 1 (0.7%) coexists with double neoplasms (bowel and endometriosis carcinoma) During the 14-year period of study, 15 patients (11.0%) out of 136 patients diagnosed as having endometrial cancer had double and 1 (0.6%) had triple primary malignant neoplasms. There was not significant difference in age rate (p = 0.72), residence rate (p = 0.93), civil status rate (p = 0.76), education rate (p = 0.70), parity rate (p = 0.76), menarche age rate (p = 0.46), blood group rate (p = 0.45), hypertension rate (p = 0.94), diabetes rate (p = 1.0), not overweight status rate (BMI < 29) (p = 0.55), sterility rate (p = 0.45), histological subtype rate (p = 0.39), grading rate (p = 0.67), staging rate (p = 0.26) between both patients group (with and without second primary malignant neoplasma). We observed statistically significant difference in body mass index (BMI > 32) rate (p = 0.03), last menstruation age rate (p = 0.04), length of reproductive period rate (p = 0.04) between both patients group (with and without second primary malignant neoplasma). CONCLUSION: Patients with endometrial cancer should be carefully and regularly followed up by monitoring et every anatomic site, especially the breast, stomach, and colon, in order that the development of a second primary carcinoma can be detected as early as possible, and not be overlooked in examinations. Additional risk factors for endometrial carcinoma with multiple malignant neoplasma include: menopause occurring after age fifty-one; obese women with body mass index (BMI) higher than 32; reproductive period longer than 37 years.     

Fertility after ectopic pregnancy. III. The prognostic role of antecedents

Fertility after conservative laparoscopic treatment for ectopic pregnancy (EP) was studies in 223 patients based on the existence of either past EP, salpingitis, having a single tube, or sterility. These factors impact significantly on fertility rate. The global fertility rate is statistically much higher for patients who do not fit into any of these categories (group a-101 patients) compared to patients with 1 or more criteria (group B-122 patients). For each group, the compared intrauterine pregnancy rate is 90% (91 cases) for group A and 42.6% (52 cases) for group B (p001). The compared ectopic recurrence rate is 5% (5 cases) in group A and 18% (22 cases) in group B (0.001p0.01). The rate of sterility was only 5% (5 cases) in group A as compared to 39.4% (48 cases) in group b (p0.001). Moreover, the fertility rate for patients with 1 or more of the above mentioned criteria is significantly much lower that that of patients without any of the factors examined. This is a significant difference when intrauterine rate, ectopic recurrence rate, and sterility rate are each examined separately. A positive past history for these criteria also affects cumulative intrauterine pregnancy (IUP) rate. For all patients, cumulative IUP rate is 54.60% at 2 years. For patients in group A, this rate increased up to 75.70%. For patients with 1 of these factors, the cumulative IUP rate is only between 12.90% and 25.50%. Finally, these factors delay the onset of subsequent intrauterine pregnancy. Globally, 70% of all IUP occurred with 2 years after the conservative laparoscopic treatment for EP. This rate is 83.20% for patients without any of these factors and 50% for those with at least 1 factor. (author's modified)     

Success in intrauterine insemination: the role of etiology

BACKGROUND: We aimed to identify the prognostic factors for the highest pregnancy rate and lowest multiple pregnancy rate in different infertility etiology groups among women undergoing insemination treatment. METHODS: A total of 1,171 cycles among 532 infertile couples were retrospectively studied and the impact of different prognostic factors on pregnancy rate in five different etiology subgroups was analyzed. RESULTS: The pregnancy rate/cycle was highest (19.2%) among women with anovulatory infertility and lowest (11.9%) in endometriosis based infertility. Multiple pregnancy rate varied between 3.6% (male infertility) and 13.2% (anovulatory infertility). In unexplained infertility ovarian stimulation resulting in three follicles (pregnancy rate 24.2%) and inseminated motile sperm count >30x10(6) (pregnancy rate 19.8%) were significant prognostic factors. In anovulatory infertility stimulation with sequential clomiphene citrate and human menopausal gonadotrophin was a positive predictive factor, with a pregnancy rate of 36%. In male infertility stimulation with sequential clomiphene citrate/human menopausal gonadotrophin resulted in the best pregnancy rate (25.0%). In endometriosis-based infertility the pregnancy rate was best with clomiphene citrate stimulation (21.1%) and inseminated motile sperm count >30x10(6) (24.3%). In combined infertility the highest pregnancy rate was with sequential clomiphene citrate/human menopausal gonadotrophin stimulation and with three follicles (30%), and even 18.2% with inseminated motile sperm count <5.0x10(6). CONCLUSIONS: The etiology of the infertility is important when optimal insemination treatment is planned. The impact of the woman's age, sperm count, stimulation protocol, and the follicle number on the pregnancy rate and multiple pregnancy rate is associated with the etiology of the infertility.     

卵泡发育迟缓者在体外受精中延长使用促性腺激素的临床疗效观察

目的探讨体外受精（IVF）周期中,卵泡发育迟缓者延长使用促性腺激素（Gn）的临床效果。方法将552个IVF周期按Gn用药时间、剂量和获卵数分组,观察组（69个取卵周期,66个移植周期）：Gn起始用量为75IU／d-300IU／d,用药时间≥16d,用至卵泡达到取卵标准为止,获卵数≥4个;对照组（483个取卵周期,464个移植周期）：Gn起始用量为150IU／d～300IU／d,用药时间≤15d,且总Gn用量≤3300IU,获卵数≥4个。比较两组患者的Gn用量及用药时间、获卵数、临床妊娠率、胚胎着床率及治疗结局。结果观察组和对照组的临床妊娠率分别为45．5％（30／66）和51．7％（240／464）;胚胎着床率分别为28．0％（46／164）和30．5％（385／1262）;分娩率分别为37．9％（25／66）和39．4％（183／464）;两组患者的临床妊娠率、胚胎着床率、分娩率等比较,差异均无统计学意义（P〉0．05）。观察组和对照组的多囊卵巢（PCO）和（或）多囊卵巢综合征（PCOS）患者的比例分别为55．1％（38／69）和20．1％（97／483）;基础窦卵泡数分别为（20±11）个和（15±6）个;Gn用药时间分别为（20．8±4．2）d和（10．3±1．8）d;Gn用药总量分别为（3090±1140）IU和（2302±862）IU;血清雌二醇峰值分别为（4595±5181）pmol／L和（7272±6320）pmol／L;获卵数分别为（10±6）个和（14±7）个;移植胚胎数分别为（2．5±0．6）个和（2．7±0．5）个;两组上述各指标比较,差异均有统计学意义（P〈0．01）。结论对IVF周期中卵泡发育迟缓的患者,延长使用Gn有效、方便,能获得满意的临床结局。     

未促排卵的未成熟卵母细胞体外培养成熟治疗不孕症40例分析

目的比较未促排卵的未成熟卵母细胞体外培养成熟(IVM)治疗多囊卵巢综合征(PCOS)和正常月经周期伴不孕患者的临床疗效。方法回顾性分析2004年8月至2005年1月温州医学院第一医院收治的40例不孕患者,接受54个周期的IVM治疗,其中难治性PCOS不孕患者26例35个周期(A组),月经周期正常且经其它辅助生育技术失败的不孕患者14例19个周期(B组),均未采用任何药物刺激。结果共有7个周期取消,其中A组1个,取消率为2.8%;B组6个,取消率为31.6%,差异有极显著性意义(P<0.01)。有胚胎移植的47个周期中,两组的平均获卵数、体外成熟率、正常受精率和卵裂率、平均移植胚胎数差异无显著性意义(P>0.05)。A组1例生化妊娠,15例临床妊娠,B组4例临床妊娠。两组每穿刺周期的临床妊娠率(42.9%、21.1%)差异有极显著性意义(P<0.01),每移植周期的临床妊娠率、种植率和多胎率差异无显著性意义(P>0.05)。结论未促排卵的IVM技术治疗不孕症,尤其对于难治性PCOS不孕更是一种有效的方法。     

人类未成熟卵母细胞玻璃化冷冻研究

目的:探讨玻璃化冷冻未成熟卵母细胞的有效性。方法:根据有无颗粒细胞将实施玻璃化冷冻的GV期卵母细胞分为含颗粒细胞(非裸卵)组和不含颗粒细胞(裸卵)组;将部分GV期卵母细胞体外培养至MⅡ期卵母细胞实施玻璃化冷冻,比较非冷冻IVM组与MⅡ卵玻璃化冷冻组间、裸卵组与非裸卵组间的存活率、成熟率、受精率、卵裂率及囊胚形成率。结果:非裸卵组的成熟率大于裸卵组(P<0.05),而存活率、受精率、2-细胞形成率、>2-细胞形成率之间均无统计学差异(P>0.05)。另外,非冷冻IVM组与GV玻化组间成熟率、受精率、卵裂率均存在显著性差异(P<0.05);非冷冻IVM组与MⅡ期卵玻化组间成熟率、受精率、卵裂率间均存在统计学差异(P<0.05);GV玻化组与MⅡ玻化组间存活率、成熟率、受精率、卵裂率间均无统计学差异(P>0.05)。结论:玻璃化冷冻未成熟卵母细胞需要保留颗粒细胞,同时初步构建了人GV期卵的玻璃化冷冻联合IVM技术的雏形。     

Influence of polyvinylpyrrolidone on the outcome of intracytoplasmic sperm injection

OBJECTIVE: To assess the effectiveness of a procedure for intracytoplasmic sperm injection (ICSI) modified so as not to use polyvinylpyrrolidone (PVP) and to examine clinical outcome. STUDY DESIGN: Seventy-seven cycles of ICSI were performed over a one-year period. PVP was used for sperm immobilization in 39 of these cycles and was eliminated from the other 38 cycles. Difference in fertilization rate, cleavage rate, parthenogenetic activity, clinical pregnancy rate, ongoing pregnancy rate and grading of preembryos between the two groups was compared. RESULTS: The non-PVP group had a higher fertilization rate (57.63% vs. 84.43%, P < .001) and better preembryo quality (chi 2 = 6.80, P = .009) than the PVP group. There was no significant difference in cleavage rate, parthenogenetic activity, clinical pregnancy rate and ongoing pregnancy rate between the two groups. CONCLUSION: Performing ICSI without PVP may improve the fertilization rate and preembryo grading. However, further study with a larger cohort is necessary to determine whether the modified procedure can increase the pregnancy rate.     

微波子宫内膜去除术治疗月经过多的远期疗效分析

目的 探讨微波子宫内膜去除术(MEA)治疗月经过多的远期疗效及影响因素.方法 选择因月经过多药物治疗无效而行MEA治疗且资料完整的患者共334例为观察对象,患者年龄29～59岁,其中合并子宫腺肌病59例.术后随访患者的月经、贫血症状的改善情况;53例患者术后进行宫腔镜检查及子宫内膜活检,观察子宫内膜组织的病理改变.术后平均随访时间64.7个月(3～96个月).结果 MEA治疗月经过多总有效率为91.3%(305/334),其中闭经率为49.7%(166/334),月经量减少或正常为41.6%(139/334);术后痛经改善的有效率为71.1%(140/197);患者对手术的满意率为91.9%(307/334);其中年龄＞40岁者,手术有效率为92.9%(196/211)、满意率为93.8%(198/211)、闭经率为64.9%(137/211),年龄≤40岁者手术有效率为88.6%(109/123)、满意率为88.6%(109/123)、闭经率为23.6%(29/123),不同年龄的患者MEA有效率、满意率、闭经率比较,差异均有统计学意义(P＜0.05).术后因症状复发(由于子宫内膜的破坏不完全导致宫角部子宫内膜岛状残留)等行再次治疗42例(12.6%,42/334),其中行二次MEA 9例,因月经过多症状复发、子宫腺肌病或子宫肌瘤最终行子宫切除术33例,子宫切除率9.9%(33/334).术后即时宫腔镜检查见宫腔内子宫内膜全部破坏,光镜下病理学改变表现为由表及里的凝固性坏死和部分平滑肌坏死层构成的热损伤带.结论 MEA治疗月经过多安全、有效;子宫内膜的不完全破坏导致宫角子宫内膜岛状残留是术后复发的重要原因.年龄、合并子宫腺肌病是影响MEA手术远期疗效的主要因素.     

乙肝病毒携带对不同卵巢储备功能女性体外受精-胚胎移植结局的影响

目的探讨乙肝病毒携带对不同卵巢储备功能女性进行体外受精-胚胎移植(IVF-ET)助孕胚胎发育及妊娠结局的影响。方法回顾性分析接受IVF-ET助孕的1 310例不孕症患者资料,按照血清抗苗勒管激素(AMH)水平,分为三组:卵巢储备低下组(A组)AMH2μg/L,正常卵巢储备组(B组)AMH 2~7μg/L,卵巢高储备组(C组)AMH7μg/L,每组按HBs Ag检测结果分为女方乙肝病毒携带组和正常对照组,比较两组的正常受精率、卵裂率、优质胚胎率、着床率、临床妊娠率及流产率有无差异。结果 A组及C组中,乙肝病毒携带组与正常对照组的正常受精率、卵裂率、优质胚胎率、着床率及临床妊娠率差异无统计学意义(P0.05),但A组中乙肝病毒携带组的无可移植胚胎率(14.6%)高于正常对照组(5.9%)(P0.05);B组中乙肝病毒携带组的正常受精率(69.8%)、卵裂率(96.97%)、优质胚胎率(21.8%)、着床率(31.3%)及临床妊娠率(44.1%)均低于正常对照组(73.6%,98.6%,26.2%,41.3%,59.8%)(P0.05),差异有统计学意义。3组中乙肝病毒携带组的流产率均高于正常对照组(P0.05),差异有统计学意义。结论乙肝病毒携带可能干扰了卵巢储备低下及正常卵巢储备女性的卵子质量及胚胎的发育,最终影响妊娠结局。     

1340例妊娠期肝内胆汁淤积症的回顾性分析

目的 回顾分析1340例妊娠期肝内胆汁淤积症(intrahepatic eholestasis of pregnancy,ICP)患者的临床资料,探讨ICP分型对诊断和处理的临床意义. 方法 对我院2000年1月至2007年12月的8年中收治的1340例ICP患者病例资料进行回顾性分析.比较不同ICP分型患者的临床表现、生化结果、分娩方式、围产儿结局等指标. 结果 ICP患者占同期产科住院孕妇总数的8.58 oA(1340/15 625),院内分娩孕妇的早产发生率为11.72 %(124/1058).新生儿窒息率为2.07%(23/1110),围产儿死亡率为1.08%(12/1110).75.97%(1018/1340)的ICP孕妇以皮肤瘙痒为主要症状,轻、重型ICP患者皮肤瘙痒症状出现的比例差异无统计学意义[74.89%(522/697)和77.14%(496/643),X~2=0.94,P>±.05].ICP患者有、无皮肤瘙痒时的围产儿死亡率(1.02%和1.46%)、新生儿窒息率(2.30%和1.82%)和早产发生率(11.61%和12.04%)差异均无统计学意义(P均>0.05).甘胆酸(glycocholic,acid,CG)≥64.43/μmol/L与CG＜64.43μmol/L、AST和(或)ALT≥250U/L与AST和ALT均<250U/L、TBA>40/μmol/L与TBA<40μmol/L的患者比较,前者的围产儿死亡率、新生儿窒息率和早产的发生率均低于后者(P均d0.05).轻型ICP患者平均分娩孕周晚于重型ICP患者[(38.3±1.9)周和(36.1±1.7)周,P<0.05],而剖宫产率(73.73%和97.33%)、早产率(6.13%和18.28%)、新生儿窒息率(1.05%和3.49%)和围产儿死亡率(0.18%和2.26%)均低于重型ICP患者(P均<0.05). 结论 ICP分型对终止妊娠时问、分娩方式选择有指导意义,重型ICP宜剖宫产,轻型ICP可在密切监护下阴道试产.     

供精人工授精1102例妊娠结局及影响因素分析

目的探讨供精人工授精(AID)助孕后的妊娠结局及其安全性。方法对2007年3月至2010年4月在广东省计划生育专科医院AID助孕成功妊娠的1102例1134个周期的临床资料进行总结。结果自然流产发生率为14.11%(160/1134),其中生化妊娠流产占20.00%(32/160),临床妊娠流产占80.00%(128/160)。随着年龄的增加,自然流产的发生率呈逐渐上升趋势(P=0.001)。异位妊娠发生率为1.32%(15/1134),妊娠中晚期引产发生率为0.88%(10/1134)。多胎发生率为2.73%(31/1134),其中三胎占12.90%(4/31),双胎占87.10%(27/31)。726例分娩,其中单胎占97.66%(709/726),双胎占2.34%(17/726),分娩方式中顺产自然分娩占42.15%(306/726),剖宫产占57.85%(420/726)。出生新生儿743个,男婴占50.87%(378/743),女婴占49.13%(365/743),男女性别比为104∶100。新生儿出生体重(3180±480)g,出生孕周(39.15±1.43)周。低出生体重儿占6.73%(50/743),巨大胎儿2.69%(20/743),早产儿4.17%(31/743)。出生缺陷发生率为1.74%(13/748)。结论女性年龄是AID妊娠重要影响因素。AID助孕在自然流产、异位妊娠、妊娠分娩、子代出生缺陷和健康状况等方面和自然受孕相似,是一项安全可靠的辅助生殖技术。     

无GnRH-a降调激素替代和hMG促排作子宫内膜准备对冻融胚胎移植影响的研究

目的:研究以无GnRH-a降调激素替代作为子宫内膜准备方式对冻融胚胎移植(FET)临床妊娠率和胚胎植入率的影响。方法:对我中心进行的88个以无GnRH-a降调激素替代(A组)和hMG促排(B组)两种方法进行子宫内膜准备的FET周期进行回顾性分析,比较组间移植日子宫内膜厚度以及临床妊娠率、胚胎植入率的差异。结果:A组32个周期,共移植91枚胚胎,胚胎植入率13.19%,临床妊娠率31.25%(10/32);B组56周期,共移植156枚胚胎,胚胎植入率15.48%,临床妊娠率32.14%(18/56)。两组移植日子宫内膜厚度、临床妊娠率和胚胎植入率等方面均无统计学差异(P>0.05)。结论:无GnRH-a降调激素替代、hMG促排作为FET子宫内膜的准备方式,得到的FET临床妊娠率和胚胎植入率无差异。