体外受精--胚胎移植后宫内宫外同时妊娠4例分析

目的 :探讨体外受精、胚胎移植后宫内宫外同时妊娠的危险因素、诊断及治疗。方法 :回顾性分析 1999年 3月至 2 0 0 1年 3月体外受精—胚胎移植后临床妊娠的 179人中发生宫内宫外同时妊娠的 4例患者。结果 :4例患者在明确诊断后行患侧输卵管切除术 ,术后 3例宫内继续妊娠 ,1例难免流产。结论 :体外受精—胚胎移植后 ,宫内宫外同时妊娠的发生率增加 ,尤其是既往有异位妊娠史及输卵管积水患者。加强 B超监测有助于早诊断、早治疗     

Contamination of Embryo Transfer Catheter and Treatment Outcome in In Vitro Fertilization

Purpose: The effect of embryo transfer (ET) catheter contamination with mucus and/or blood on treatment outcome in an in vitro fertilization (IVF) program was evaluated. Methods: One thousand four ET procedures in 877 patients having conventional IVF in the long (1189 cycle) and short (15 cycles) protocol were analyzed to determine the impact of catheter contamination on the Incidence of retained embryos and the clinical pregnancy rate. Results: Catheter contamination with mucus and/or blood is a feature of difficult ET. Embryos were significantly more likely to be retained when the transfer catheter was contaminated with mucus (17.8 versus 3.3%) or blood (12 versus 3.3%). When the catheter was contaminated and an embryo(s) was retained and immediately retransferred, the pregnancy rate was not compromised. The pregnancy rate was significantly reduced when the ET catheter was contaminated with blood (15.5 versus 27.1%;P = 0.002), but no embryo was retained in the catheter set. Conclusions: Catheter contamination compromises the treatment outcome in IVF only when there is no associated retained embryo(s). As increased vigilance in searching for extruded embryos may not be practical, we suggest that cervical mucus should be routinely aspirated and ET performed as atraumatically as possible.     

甲状腺自身抗体阳性对体外受精-胚胎移植结局的影响

目的：探讨抗甲状腺自身抗体（antithyroid autoantibodies,ATA）阳性对体外受精．胚胎移植泐vitro fertilization and embryo transfer,ⅣF—ET）结局的影响。方法：回顾性分析行IVF／ICSI治疗不孕的患者资料。选取甲状腺抗体阳性但甲状腺功能正常者65例（共71个周期）作为研究组（ATA＋组）,492例甲状腺抗体阴性患者（共512个周期）作为对照组（ATA组）。结果：ATA＋组与ATA-患者的一般情况、促排卵天数、促性腺激素使用总量（Gn总量）、hCG注射日E2水平、获卵数、ICSI受精率、可移植胚胎数和妊娠率,组间比较均无统计学差异（P〉0．05）。ATA＋组IVF受精率（59．73％）、优质胚胎率（26．94％）明显低于ATA-组（70．86％和36．31％）;ATA＋组的流产率（37．50％）明显高于ATA组（17．79％）,差异有统计学意义（P〈0．05）。结论：ATA＋对IvF—ET妊娠结局有不利的影响,因此,对于ATⅣ患者在接受IVF—ET治疗前调节甲状腺自身免疫功能可对妊娠结局有利。     

体外受精-胚胎移植后妊娠妇女的产科结局

目的 探讨体外受精－胚胎移植（ｉｎ ｖｉｔｒｏ ｆｅｒｔｉｌｉｚａｔｉｏｎ ａｎｄ ｅｍｂｒｙｏ ｔｒａｎｓｆｅｒ,ＩＶＦ－ＥＴ）后妊娠妇女的产科结局。方法 采用回顾性分析方法,对ＩＶＦ－ＥＴ后妊娠妇女１２８例（观察组）与１１３７２例自然妊娠妇女（对照组）的产科结局进行比较。结果 观察组早产发生率为２０．３％（２６／１２８）,多胎发生率为２０．３％（２６／１２８）,剖宫产率为８８．３％（１１３／１     

Abdominal Ultrasound-Guided Embryo Transfer Improves Clinical Pregnancy Rates After In Vitro Fertilization: Experiences from 330 Clinical Investigations

Purpose: To investigate the effect of ultrasound-guided embryo transfer on the rate of implantation and clinical pregnancy.Methods: A prospective randomized trial was performed to compare ultrasound-guided embryo transfer with the traditional method. A total of 330 patients were randomly divided into two groups on the day of embryo transfer. For the cases (n = 178), ultrasound-guided was used; controls (n = 152) was performed using routine methods.Results: The rate of implantation and clinical pregnancy for the cases (19.6 and 37.1%, respectively) was significantly higher than for the controls (12.6 and 25%, respectively; p < 0.05).Conclusion: Ultrasound-guided embryo transfer can significantly increase the rate of implantation and clinical pregnancy, and should be recommended as a routine procedure in the process of in vitro fertilization and embryo transfer (IVF-ET).     

Influence of Zona Pellucida Thickness of Human Embryos on Clinical Pregnancy Outcome Following In Vitro Fertilization Treatment

Purpose: To evaluate the correlation between the degree ofzona pellucida thickness variation (ZPTV) of transferredembryos with identical morphologies and subsequent clinicalpregnancy rates during 141 intracytoplasmic sperminjection (ICSI) treatment cycles. Methods: A total of 141 women participating in the studygroup comprising mostly male factor infertilities and somerepeat in vitro fertilization (IVF) failures were transferred,2 days after ovum pickup, with two to three embryos withidentical grades created by fertilization with ICSI. Allselected embryos were subjected to zona pellucida thicknessmeasurements immediately prior to transfer using a computerizedembryo measurement program from videocinematographyrecordings. Results: A total of 326 identical-grade transferredpre-embryos resulted in 70 clinical pregnancies with live-bornimplantation rate of 27.6%. A highly significant correlationwas observed between ZPTV of transferred embryos andthe IVF outcome with 77.1% and 83.64% of the clinicalpregnancies resulting from transferred embryos with ZPTVvalues greater than 20 and 25, respectively. The mean ZPTVvalues for 70 conceptual cycles and 62 nonconceptual cycleswere 28 ± 6.43 and 17.85 ± 8.11, respectively. No significantcorrelation between ZP thickness and number of blastomeresin the transferred embryos was evident, though embryoswith better scores had significantly thinner zonae and higherZPTV values. Though average zona thickness of embryosdeclined with age, the mean ZPTV value for women lessthan 30 years old was significantly higher (25.84 ± 8.57)as compared with those from women older than 35 years(20.72 ± 8.45). Conclusions: The degree of ZPTV of the transferred embryosexhibits a strong correlation with clinical pregnancy outcome following IVF treatment. This potentially reliable indicatorof IVF success rate could be used as a criteria forembryo selection during clinical transfers.     

In Vitro Fertilization and Embryo Transfer

The technique of in vitro fertilization and embryo transfer is explained, and nurses are given an overview of this new technique for treating infertility. The role of the nurse in each phase of the process is described, with emphasis on meeting the educational and emotional needs of couples.     

Seasonal Influences on In Vitro Fertilization and Embryo Transfer

Purpose: The study was aimed to investigate the influence of time factors (day, week, month) on pregnancy rates and in vitro fertilization (IVF) and embryo transfer (ET) parameters.Methods: 8184 IVF–ET cycles, taking place in two IVF centers from 1992 to 1999, were analyzed. Multiple logistic and linear regression methods were performed as statistical analyses.Results: Oocyte pickup on Tuesdays achieved a significantly higher mean number of oocytes (median: 7) and the highest pregnancy rate (PR) (33.4%) per ET. There was a significant variation over the year, with the lowest PR/ET in July (25.71%) and the highest in December (35.5%). Concerning outcomes, the age factor and the number of embryos transferred had the highest significant (p < 0.0001) influence.Conclusions: The observed weekly rhythm for oocyte pickups is certainly due to preprogrammed ovarian stimulation used in our IVF programs. Age as well as the number of embryos transferred are the main influencing factors on a positive outcome and more predictive than seasonal aspects.     

In Vitro Fertilization and Embryo Transfer

In vitro fertilization and embryo transfer now provide an acceptable therapeutic alternative for some infertile couples. The University of Texas/Houston Medical School uses a nurse-coordinated, in vitro fertilization computer program that combines a variety of nursing interventions. The nurse specialist functions to coordinate clinical and laboratory steps and to interpret the complex process to the couple.     

Bilateral Ovarian Pregnancy After in Vitro Fertilization and Embryo Transfer in a Patient with Tubal Factor Infertility

Primary ovarian pregnancy is very rare event after natural pregnancy or assisted reproductive technology (ART) procedures. Although there are a few reports about unilateral ovarian pregnancy after in vitro fertilization and embryo transfer (IVF-ET), there has been no report about bilateral ovarian pregnancy. Moreover, it is difficult to diagnose an ovarian pregnancy following in vitro fertilization and embryo transfer because of enlarged ovary, fluid collection in pelvic cavity, and its low incidence. We present a case of a patient who underwent IVF-ET due to tubal factor infertility, but the patient developed bilateral ovarian pregnancy and was performed both ovarian wedge resection through laparotomy.     

Clinical Assisted Reproduction: Effects of Mullerian Anomalies on In Vitro Fertilization Outcome

Purpose: To assess the effect of Mullerian anomalies on pregnancy rates in women undergoing in vitro fertilization (IVF).Methods: The records of 37 patients with and 819 patients without Mullerian anomalies undergoing a first cycle of IVF between December 1995 and July 1998 were included in this retrospective study. Outcome variables included maximal estradiol level, number of days of stimulation, number of follicles, number of oocytes, fertilization rate, and ongoing/livebirth pregnancy rate.Results: Patients with Mullerian anomalies had a significantly lower ongoing pregnancy rate (8.3%) than did controls (24.8%). No patients with diethylstilbestrol (DES)-related anomalies had an ongoing pregnancy.Conclusions: Among women with Mullerian anomalies, those with DES exposure in utero demonstrated the poorest outcome.     

单侧输卵管切除术对体外受精-胚胎移植周期卵巢反应性和结局的影响

目的:研究单侧输卵管切除术对体外受精-胚胎移植(IVF-ET)周期卵巢反应性和妊娠结局的影响。方法:以行IVF-ET单侧输卵管切除的106例不孕患者为研究组,同期双侧输卵管梗阻的患者360例为对照组,比较研究组输卵管切除后术侧和健侧超促排卵启动日卵巢的大小和窦卵泡数、hCG注射日卵巢的大小、≥12mm卵泡数和获卵数,同时比较研究组和对照组≥12mm卵泡数、获卵数、受精数、优质胚胎数以及Gn用量、用药天数、妊娠率。结果:研究组中术侧和健侧启动日卵巢的大小无显著性差异,然而超促排卵启动日窦卵泡数、hCG注射日双侧卵巢大小、≥12mm卵泡数和获卵数均有统计学差异。研究组无论是hCG注射日≥12mm卵泡数、获卵数、Gn用量、用药天数,还是受精数、优胚数和妊娠率与对照组比较,均无显著性差异。结论:单侧输卵管切除术降低同侧卵巢的反应性,但总体上不影响卵巢对Gn的反应和IVF-ET妊娠结局。     

PREGNANCY: Triple-Test Screening in In Vitro Fertilization Pregnancies

Purpose: To determine whether the results of triple-test analysis differ between spontaneous and IVF pregnancies.Methods: The study population consisted of 140 women with singleton pregnancies, 70 by IVF, and 70 by spontaneous conception. The groups were matched for maternal age, gestational week, and laboratory batch. The levels of all triple-test markers—alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and unconjugated estriol (u-E₃)—were compared between the groups.Results: Significantly higher HCG levels were detected in the patients with IVF pregnancies than in the control group (1.31 ± 0.8 vs. 0.95 ± 0.5 multiple of the medians, respectively, (p < 0.006), but there were no significant differences in AFP or u-E₃ levels. Overall, 18.5% of the IVF group were found to be screen-positive as compared with 11.4% of the control group (difference not statistically significant). Only 8 IVF pregnancies (11.4%) reached the lowest calculated risk possible (1:9999) compared with 17 (24.2%) in the control group (p < 0.05).Conclusions: Our findings support previous data demonstrating elevated maternal serum HCG in IVF patients in comparison with spontaneous ones.     

体外受精-胚胎移植术后复合妊娠研究进展

复合妊娠（heterotopic pregnancy,HP）是一种极其危险的异位妊娠,自然受孕者中HP的发生率并不高,但随着近年体外受精-胚胎移植（in vitro fertilization and embryo transfer,IVF-ET）术以及促排卵技术的普及,HP的发生率较前有所上升。HP患者早期一般仅有腹痛、阴道出血等非特异性症状,且由于宫内妊娠囊的存在使得宫外妊娠囊特别容易误诊和漏诊,从而易导致患者宫外妊娠囊继续发展,引起腹腔内大出血甚至休克等危及生命的严重后果。因此,充分了解HP的相关危险因素,在行ET术或促排卵技术前采取相应的预防HP发生的措施、发生HP后尽早进行确诊及确诊后采取有效的治疗对改善患者的预后显得尤为重要。综述近年IVF-ET后HP的诊断及管理措施进展。     

体外受精—胚胎移植后异位妊娠58例分析

目的:探讨体外受精-胚胎移植(IVF-ET)后异位妊娠(EP)的高危因素。方法:对接受体外受精胚胎移植(IVF-ET)助孕后发生异位妊娠病例的助孕指征、助孕方式等进行回顾性分析。结果:2009年1月至2010年12月佛市妇幼保健院行体外受精胚胎移植(IVF-ET)2445个周期,1153个周期临床妊娠,发生率47.16%,异位妊娠58个周期,发生率为5.03%。年龄、促性腺激素总量、取卵数、移植胚胎个数及优质胚胎率与本次助孕后异位妊娠的发生无关(P>0.05)。49例患者助孕指征为输卵管因素和/或盆腔粘连,占84.48%。2种助孕方式(IVF-ET,ICSI)比较,总妊娠率差异无统计学意义(P>0.05),2种助孕方式异位妊娠率比较,差异亦无统计学意义(P>0.05)。结论:输卵管因素是异位妊娠发生的高危因素,与年龄、促性腺激素总量、取卵数、移植胚胎个数、优质胚胎率、助孕方式无关。     

Body Mass Index,Follicle-Stimulating Hormone and Their Predictive Value in In Vitro Fertilization

Purpose: The objective was to explore whether body mass and day 3 follicle-stimulating hormone have predictive value on odds of pregnancy after in vitro fertilisation. Few studies show that obesity produces a variety of alterations in the reproductive system, and that women with an elevation of day 3 FSH have declining ovarian function.Methods: The data of one-hundred-seventy-one women who underwent a standard regime of controlled ovarian hyperstimulation was analyzed with particular reference to variations in body mass and hormone levels.Results: By raising BMI and FSH (mIU/mL) by one unit, the odds for pregnancy were decreased by the respective factors 0.84 (95% confidence interval 0.73–0.97) and 0.77 (95% confidence interval 0.59–1.00).Conclusions: The results demonstrate that for the purpose of raising the odds of pregnancy BMI should be reduced. A low FSH value may cause the same effect. Nontheless, obesity and hormonal function may be independent risk factors for failure in assisted reproduction.     

A Comparison of Early Pregnancy Failure and Ongoing Pregnancy Rates Between Fresh and Frozen Embryo Transfer Following In Vitro Fertilization

Summary: In order to compare pregnancy outcomes following fresh and frozen embryo transfer after invitro fertilization (IVF), a retrospective analysis of data from the Royal North Shore IVF Programme was performed. Six hundred and sixty seven embryo transfers following routine IVF were performed during 1991 and 1992. Four hundred and twenty fresh embryo transfers were performed during that period, resulting in a clinical pregnancy rate of 21%. In comparison, 247 frozen transfers, where the initial procedure was routine IVF, were performed, resulting in a clinical pregnancy rate of 16.6%. This difference was not significant. When varying numbers of transferred embryos in the 2 groups were taken into account, there was a significant difference in the proportion of ongoing viable fetuses per embryo returned for 1991, but not for 1992. Although there were a greater number of abortions and ectopic pregnancies in the fresh transfer group, these differences did not achieve statistical significance. The implications of improving results from frozen embryo transfer are discussed.     

女性生殖器结核对体外受精-胚胎移植妊娠结局的影响

目的:探讨女性生殖器结核(FGTB)对体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法:选择2006年1月至2009年12月于河北医科大学第四医院生殖医学科行IVF-ET助孕的双侧输卵管梗阻患者,其中结核性输卵管梗阻(结核组)66例,非结核性输卵管梗阻(非结核组)240例,比较两组促性腺激素(Gn)用量、获卵数、受精率、优质胚胎率、种植率、临床妊娠率、流产率和分娩率的差异。结果:两组Gn用量、获卵数、受精率、优质胚胎率比较,差异无统计学意义(P>0.05)。结核组种植率、临床妊娠率、分娩率显著低于非结核组(P<0.05),流产率显著高于非结核组(P<0.05)。结论:结核性输卵管梗阻患者IVF-ET临床妊娠率降低,流产率增高,应重视女性生殖器结核对IVF-ET妊娠结局的影响。     

输卵管远端积水对体外受精-胚胎移植治疗效果的影响

目的:探讨输卵管远端积水对体外受精-胚胎移植(IVF-ET)治疗结局的影响。方法:回顾性分析2013年1~12月就诊于本院生殖中心,选取单侧输卵管远端积水且对侧阻塞或双侧输卵管远端积水且未经处理直接行IVF-ET的患者54例为积水组,双侧输卵管近端梗阻且无积水直接行IVF-ET的患者93例为对照组,比较两组患者的一般情况、超促排卵治疗情况和妊娠结局。结果:两组患者的一般情况及超促排卵治疗情况比较,差异均无统计学意义(P0.05);两组患者的受精率、优质胚胎率、胚胎种植率、妊娠率、活产率比较,差异均无统计学意义(P0.05),但是积水组的卵裂率(93.64%)低于对照组(96.47%),差异有统计学意义(P0.05)。结论:输卵管远端积水可能并不影响IVF-ET的妊娠率和活产分娩率,但可能降低卵子质量,从而影响受精卵的卵裂。     

高龄妇女体外受精-胚胎移植助孕结局分析

目的：探讨高龄妇女接受体外受精－胚胎移植（IVF-ET）治疗后的助孕结局。方法：对2001年7月—2009年7月中山大学孙逸仙纪念医院生殖中心行IVF-ET治疗的高龄妇女（≥35岁）的753个取卵周期的临床资料进行回顾性分析。按妇女年龄分为4组：A组（35～36岁）,B组（37～38岁）,C组（39～40岁）,D组（≥41岁）,分析不同组的IVF-ET结局。结果：724个移植周期（另外29个周期无胚胎移植）,97个周期获活产,活产率为13.4%。随年龄增长,获卵数明显减少,各组分别为（9.8±6.0）,（8.6±5.4）,（6.7±4.3）,（5.3±4.4）个;胚胎种植率明显下降,分别为17.9%,12.8%,10.0%和4.3%;活产率明显下降,分别为16.7%,13.3%,12.4%和2.3%。各组上述指标差异均有统计学意义（P分别为0.001,0.001和0.006）。年龄≥43岁的45例患者中无一例获得活产。结论：随年龄增长,高龄妇女接受IVF-ET治疗后的胚胎种植率和活产率明显下降,40岁以后下降更为明显。IVF治疗是否应设定年龄上限有待进一步研究。