Serum unconjugated bisphenol A concentrations in men may influence embryo quality indicators during in vitro fertilization

Here we assess bisphenol A (BPA) in couples undergoing in vitro fertilization (IVF) and indicators of embryo quality; embryo cell number (ECN) and embryo fragmentation score (EFS). Twenty-seven couples provided serum on the day of oocyte retrieval. Unconjugated BPA was measured by HPLC with Coularray detection. Odds ratios (OR) were generated using ordinal logistic regression including female and male BPA concentrations, age and race, and day of embryo transfer for ECN. Inverse associations are suggested for male BPA with ECN (OR = 0.70, P = 0.069), and EFS (OR = 0.54, P = 0.009), but not for women. Male BPA exposure may affect embryo quality during IVF.     

Hair mercury concentrations and in vitro fertilization (IVF) outcomes among women from a fertility clinic

Total hair mercury (Hg) was measured among 205 women undergoing in vitro fertilization (IVF) treatment and the association with prospectively collected IVF outcomes (229 IVF cycles) was evaluated. Hair Hg levels (median = 0.62 ppm, range: 0.03–5.66 ppm) correlated with fish intake (r = 0.59), and exceeded the recommended EPA reference of 1 ppm in 33% of women. Generalized linear mixed models with random intercepts accounting for within-woman correlations across treatment cycles were used to evaluate the association of hair Hg with IVF outcomes adjusted for age, body mass index, race, smoking status, infertility diagnosis, and protocol type. Hair Hg levels were not related to ovarian stimulation outcomes (peak estradiol levels, total and mature oocyte yields) or to fertilization rate, embryo quality, clinical pregnancy rate or live birth rate.     

卵巢低反应周期的受精方式对助孕结局的影响

目的比较常规体外受精(IVF)和卵胞浆内单精子注射(ICSI)两种受精方式对无明确男性因素的周期获卵数仅为1-3个患者的治疗结局的影响。方法回顾性分析IVF-胚胎移植周期中获卵数1-3个周期共403个,按受精方式分为常规IVF组(336个周期)与ICSI组(67个周期)。比较两组受精率、正常受精率、完全不受精周期率及临床妊娠率的差异。结果 IVF组正常受精率为71.54%,低于ICSI组的80.31%(P<0.05)。IVF组完全不受精周期率、受精率、卵裂率、种植率和妊娠率分别为10.42%、85.50%、97.93%、26.00%和34.93%,ICSI组分别为10.45%、82.68%、98.01%、19.10%和26.32%,两组间差异无统计学意义(P>0.05)。结论鉴于使用ICSI技术并不能提高种植率及妊娠率,建议对于无明确男性因素的周期获卵1-3个的仍可采用IVF。     

标准长方案治疗的不孕患者改行改良超长方案后对妊娠结局的影响

目的 探讨不孕症患者因长方案垂体降调不全改行改良超长方案联合人绝经期促性腺激素（HMG）促排卵后进行体外受精/卵胞浆内单精子注射-胚胎移植（IVF/ICSI-ET）对妊娠结局的影响。方法 回顾性分析2015年6月至2016年6月在安徽省立医院生殖中心接受标准长方案IVF或ICSI治疗的不孕患者218例临床资料。根据垂体是否达到降调标准及是否需再次降调,将218例患者分为A组（行标准长方案降调完全的患者）98例,B组（行标准长方案降调不全改行改良超长方案降调的患者）104例,C组（行标准长方案降调不全直接促排卵的患者）16例,统计分析这3组患者行IVF/ICSI-ET的促排卵参数（促排天数、促性腺激素用量、获卵数,受精率、卵裂率、优质胚胎率）及妊娠结局（临床妊娠率、胚胎着床率、流产率、双胎率）。结果 3组患者促排天数、Gn用量、获卵数比较,差异无统计学意义（P>0.05）;A组受精率（77.86%）高于B组（66.98%）,差异有统计学意义（P<0.01）;A组优质胚胎率（68.52%）高于B组（68.52%）,差异有统计学意义（P<0.01）。胚胎着床率、临床妊娠率及周期取消率3组比较,差异无统计学意义（P>0.05）。结论 不孕症患者因垂体降调不全而改行改良超长方案不影响胚胎着床率及临床妊娠率,具有可行性。     

Corticosteroids in patients with antiovarian antibodies undergoing in vitro fertilization: a prospective pilot study

Objective Antiovarian autoantibodies (AOA) have been associated with reproductive failure, especially in in vitro fertilization (IVF) patients. Thus, the success rate of IVF might be improved by the use of corticosteroids. However, therapeutic trials with these drugs have yielded conflicting results, particularly because of heterogeneous inclusion criteria. Among women with previous IVF failure, we selected those who presented with a positive serum AOA assay, and analysed the efficacy of corticosteroids in improving the IVF outcome in these patients.Methods One hundred patients with serum AOA detected by ELISA and at least two previously failed IVF attempts were selected. These patients underwent a further IVF cycle with 0.5 mg/kg prednisolone, started on the first day of the treatment cycle. In patients who became pregnant, corticosteroids were administered until the end of the first trimester of pregnancy and then progressively discontinued. AOA were assessed before and after oocyte retrieval. Clinical data of the corticosteroid-treated cycle were compared with data from the preceding IVF cycle for each patient.Results No adverse effects resulting from corticosteroids were observed. Post oocyte retrieval antiovarian IgG were significantly lower in corticosteroid-treated attempts when compared with the preceding cycles. Twenty-six pregnancies resulted in the birth of 30 healthy children. The pregnancy rate, implantation rate, and live birth rate were 38.8%, 17.8%, and 26.5% respectively in prednisolone-treated cycles.Conclusion This study confirms the usefulness of corticosteroids in improving the success rate in a subset of patients with previous IVF failure and significant serum AOA levels.     

继发性不孕患者卵泡液25-（OH）D水平与IVF卵母细胞发育关系的研究#br#

目的　探讨继发性不孕患者卵泡液25-（OH）D水平与体外受精（IVF）卵母细胞发育及临床结局的关系。方法　选取继发性不孕且需行体外受精（IVF）的192例患者作为研究对象,根据继发性不孕原因分为4组：输卵管因素组58例、子宫内膜异位症组45例、多囊卵巢综合征组47例、卵巢储备不足组42例。根据卵泡液25-（OH）D水平聚类分析分为2组,A组121例,B组71例。采用酶联免疫吸附测定（ELISA）法检测卵泡液25-（OH）D水平;采用化学发光免疫分析法测定外周血激素水平,包括雌二醇、孕酮、黄体生成素（LH）、卵泡刺激素（FSH）;行阴道彩超测量卵泡数及卵泡直径;在培养第3天（D3）及第5天（D5）进行胚胎评估。分析A组和B组卵泡液中25-（OH）D水平与IVF卵母细胞发育（IVF正常受精率、D3优质胚胎形成率、D5优质囊胚形成率）及临床结局（临床妊娠率）的关系。结果　4个不同病因组间年龄、体质量指数（BMI）、雌二醇、孕酮、LH、FSH及卵泡液25-（OH）D水平比较差异无统计学意义。B组卵泡液25-（OH）D水平显著高于A组（P＜0.05）;B组HCG日大卵泡数及雌二醇、孕酮水平较A组显著升高（P＜0.05）;B组IVF正常受精率、D3优质胚胎形成率、D5优质囊胚形成率、临床妊娠率均显著高于A组（P＜0.05）。结论　在继发性不孕行IVF治疗的女性中,卵泡液25-（OH）D高水平更易产生大卵泡及优质胚胎,其临床妊娠率也较高。     

不同上游时间精子对体外受精-胚胎移植周期胚胎着床率的影响

目的比较不同上游时间精子对体外受精-胚胎移植（IVF—ET）妊娠结局的影响。方法选择2010年10月至2011年5月在本中心进行IVF-ET治疗的患者62例，随机分为两组：1组精子上游时间严格限制为20min（n=31），2组上游时间为40min（n=31）。比较两组的受精率、卵裂率、优质胚胎率、临床妊娠率及着床率。结果两组受精率、卵裂率、优质胚胎率、临床妊娠率差异均无统计学意义（75．46％ vs 76．04％；95．50％VS96．34％；55．07％VS54．37％；54．84％VS35．48％，P〉0．05），但1组着床率明显高于2组（36．36％VS20．00％，P=0．037）。结论在IVF—ET中，缩短精子上游时间有助于提高胚胎着床率。     

卵子玻璃化冷冻技术在IVF-ET中的应用(附7例报告)

目的探讨卵子玻璃化冷冻的临床应用价值。方法回顾性分析2011年1月-2012年12月体外受精周期取卵日因男方睾丸取精失败等原因行卵子冷冻的16对不孕夫妇的资料。其中,7例患者接受卵子解冻,并行夫精卵细胞胞质内单精子注射(ICSI),记录其受精、胚胎及临床结局。结果16例患者共冷冻卵子167枚,7例接受卵子解冻,共解冻卵子86枚,存活66枚,并行ICSI,正常受精率68.2%,优质胚胎率14.6%;1例患者取消移植,3例生化妊娠(50%),2例临床妊娠(33.3%),其中1例患者足月分娩1女婴。结论卵子玻璃化冷冻可作为取卵日取精困难及睾丸取精失败患者的临床补救措施。     

辅助生育技术治疗子宫内膜异位症不孕

目的探讨子宫内膜异位症不孕患者应用辅助生育技术治疗后妊娠及围产情况。方法81例子宫内膜异位症不孕患者,应用体外受精技术(IVF,52例)或卵胞浆精子注射术(ICSI,29例)治疗,观察治疗后的受精率、卵裂率、妊娠率、流产和围产情况。结果81例不孕患者治疗后的共妊娠30例,妊娠率37.64%;流产6例,流产率20%。各期子宫内膜异位症患者的流产率、活产率、足月产率、剖腹产率比较没有显著差异(P>0.05)。两种辅助生育技术治疗后的受精率、卵裂率、妊娠率比较没有显著差异(P>0.05)。结论辅助生育技术是治疗子宫内膜异位症不孕患者的有效疗法,IVF和ICSI的治疗效果相似。     

卵子玻璃化冷冻复苏后行卵母细胞胞浆内单精子显微注射27例临床结局

目的：探讨卵子玻璃化冷冻技术在辅助生殖中的临床应用价值。方法回顾性分析2013年1月－2015年12月在解放军174医院生殖医学中心行体外受精,取卵日因男方因素未取到精子而行卵子玻璃化冷冻保存的27对不孕夫妇的资料。卵子解冻后均行夫精卵母细胞胞浆内单精子显微注射,记录卵子受精情况及临床结局。结果27例患者共冷冻卵子245枚,并全部解冻,解冻后存活214枚,存活率84．79％;其中第二次减数分裂中期（ metaphase Ⅱ,MⅡ）卵198枚,并全部行ICSI,受精138枚,受精率74．49％;卵裂99枚,卵裂率71．74％;形成87枚2PN（原核,pronucleus）胚胎,优质胚胎34枚,优质胚胎率39?08％。20个移植周期移植胚胎41枚,临床妊娠6例,临床妊娠率34．82％。结论玻璃化冷冻技术应用于卵子冷冻保存,并对复苏卵子进行卵母细胞胞浆内单精子显微注射可以取得一定的临床妊娠率,在辅助生殖技术临床上具有很强的实用价值。     

三氯化铬对小鼠卵母细胞成熟和体外受精的影响

采用小鼠卵母细胞体外培养 ,体外受精的方法研究了三氯化铬对小鼠卵母细胞成熟和受精能力的影响 .结果表明 ,三氯化铬可以抑制卵母细胞第一极体的释放 ,降低小鼠超排卵数和卵母细胞的存活率和体外受精率 .对小鼠体内生发泡破裂没有影响 ,但可以抑制体外培养卵母细胞的生发泡破裂 ;随着在正常培养液中培养时间的延长 ,卵母细胞的第一极体的释放率和体外受精率 (除了 6.0 mg· kg-1组外 )均有显著提高 ,且与对照组相比已经无显著性差异 .结果提示 ,三氯化铬可以破坏卵母细胞的成熟 ,降低卵母细胞的受精能力 ,具有明显的生殖毒性     

单纯多囊卵巢患者两种体外受精超促排卵方案的比较

目的探讨两种超促排卵方案对单纯多囊卵巢患者接受体外受精-胚胎移植(IVF-ET)或卵胞浆内单精子显微注射(ICSI)治疗过程及结局的影响。方法 72例接受IVF-ET或ICSI的单纯多囊卵巢患者中,口服避孕药(OC)预处理组28例,应用常规长方案组44例。比较两组病例在超促排卵过程中各项指标及妊娠结果。结果两组在促性腺激素用量、获卵数、受精率、种植率、临床妊娠率、自然流产率、异位妊娠率、卵巢过度刺激发生率等方面比较,差异均无统计学意义(P>0.05)。结论单纯多囊卵巢患者IVF超促排卵时可以选择常规长方案,不必要OC预处理。     

卵巢低反应获卵患者常规体外受精与卵胞浆单精子注射技术对妊娠结局的影响

目的比较卵巢低反应获卵患者常规体外受精与卵胞浆单精子注射技术对妊娠结局的影响。方法选择卵巢低反应获卵患者200例,将其分为两组,各100例。观察组采用卵胞浆单精子注射技术,对照组则实施常规体外受精技术,比较两组的移植结果及继续妊娠情况,并对着床患者随访1年,统计妊娠结局。结果观察组的受精率、可移植胚胎率、着床率、继续妊娠率均分别显著高于对照组（P〈0.05）;观察组的单胎妊娠率高于对照组,双胎妊娠、异位妊娠率低于对照组（P〈0.05）。结论对卵巢低反应获卵的不孕患者行卵胞浆单精子注射技术,相对于常规体外受精,具有更高的卵裂率和继续妊娠率,为卵巢低反应获卵的不孕患者采取何种受精方式提供了一个选择依据。     

常规IVF受精失败后补救ICSI与直接ICSI的对比研究

目的 研究常规体外受精失败或受精率低于20%时实施补救性ICSI的妊娠结局.方法 常规体外受精培养18 h后受精失败或卵母细胞受精率低于20%的16个周期（共16例）为观察组,直接ICSI的39个周期（共39例）为对照组,比较两组患者的结局.结果 两组患者的可移植胚胎率及卵裂率差异无统计学意义（P 〉 0.05）.对照组患者正常受孕率[（80.4±14.8）%]显著高于观察组[（70.4±14.5）%],差异具有统计学意义（P 〈 0.05）.临床妊娠率方面,对照组为38.5%,观察组进行补救ICSI后,有1例女性成功分娩1个健康婴儿.结论 常规进行体外受精失败或受精率低于20%的患者进行补救性ICSI,临床妊娠率较低,有待进一步研究以改善妊娠结局.     

黄体酮阴道缓释凝胶在胚胎移植术后黄体支持中的应用效果及安全性观察

目的:探讨黄体酮阴道缓释凝胶(雪诺酮)在胚胎移植术后黄体支持(LPS)中的应用效果及安全性。方法:采用随机数字表法将2016年10月—2018年10月采用体外受精-胚胎移植(IVF/ICSI-ET)辅助生殖技术治疗的106例不孕患者均分为雪诺酮组和常规组,每组53例。雪诺酮组给予雪诺酮治疗,常规组给予黄体酮联合地屈孕酮治疗。比较两组促排卵结果、妊娠结局及不良反应。结果:雪诺酮组和常规组卵泡刺激素(FSH)剂量、FSH疗程、取卵数量、移植胚胎数量及优质胚胎比例比较差异均无统计学意义(P>0.05)。雪诺酮组临床妊娠率和活产率明显高于常规组(P<0.05)。两组胚胎着床率和自然流产率比较差异无统计学意义(P>0.05)。雪诺酮组注射部位硬结发生率和不良反应发生率明显低于常规组(P<0.05)。结论:雪诺酮用于IVF/ICSI-ET术后黄体支持可明显提升临床妊娠率和活产率,减少注射部位硬结等不良反应发生率,疗效和安全性均具有明显优势。     

Associations between paternal urinary phthalate metabolite concentrations and reproductive outcomes among couples seeking fertility treatment

IntroductionLimited evidence suggests that male exposure to ubiquitous environmental phthalates may result in poor reproductive outcomes among female partners.MethodsThis analysis included male–female couples undergoing in vitro fertilization (IVF) and/or intrauterine insemination (IUI). We evaluated associations between the geometric mean of paternal specific gravity-adjusted urinary phthalate concentrations prior to the female partners’ cycle and fertilization, embryo quality, implantation, and live birth using generalized linear mixed models.ResultsTwo-hundred eighteen couples underwent 211 IVF and 195 IUI cycles. Trends were observed between paternal urinary mono-3-carboxypropyl phthalate (MCPP; P = 0.01) and mono(carboxyoctyl) phthalate (MCOP; P = 0.01) and decreased odds of implantation. MCPP and MCOP were also associated with decreased odds of live birth following IVF (P = 0.01 and P = 0.04, respectively), and monobutyl phthalate above the first quartile was significantly associated with decreased odds of live birth following IUI (P = 0.04). However, most urinary phthalate metabolites were not associated with these reproductive outcomes.ConclusionSelected phthalates were associated with decreased odds of implantation and live birth.     

血脂异常对非PCOS患者体外受精-胚胎移植妊娠结局的影响

目的　探讨血脂异常对非多囊卵巢综合征（polycystic ovarian syndrome,PCOS）患者体外受精-胚胎移植妊娠结局的影响。方法　收集2016年12月至2020年12月就诊于厦门大学附属第一医院生殖医学科,进行体外受精（in vitro fertilization,IVF）或卵胞浆内单精子注射（intracytoplasmic sperm injection,ICSI）治疗的677对非PCOS不孕夫妇的临床资料,按女方血脂水平进行分为血脂正常组［556例,年龄（29.32±3.03）岁］和血脂异常组［121例,年龄（29.68±2.83）岁］,分析两组一般资料和妊娠结局。组间比较采用独立样本t检验、χ²检验或Fisher确切概率法。结果　血脂异常组患者的体质量指数（BMI）、不孕年限、促性腺激素（Gn）天数和Gn总量高于血脂正常组,差异均有统计学意义（均P<0.05）,女方年龄、男方年龄、基础卵泡刺激素（FSH）、基础黄体生成素（LH）、基础雌二醇（E₂）、人绒毛膜促性腺激素（HCG）日E₂水平、HCG日孕酮（P）水平、HCG日内膜厚度、受精方式和不孕情况在两组间比较,差异均无统计学意义（均P>0.05）。血脂异常组的活产率（41.89%,31/74）低于血脂正常组（55.32%,156/282）、流产率（22.50%,9/40）高于血脂正常组（10.86%,19/175）,两组比较,差异均有统计学意义（χ²=4.238、4.896,均P<0.05）。获卵数、MII卵数、受精率、移植胚胎数、婴儿体质量、妊娠率、种植率、早产率、移植胚胎类型、新生儿性别、新生儿体质量比例在两组间之间比较,差异均无统计学意义（均P>0.05）。结论　血脂异常可导致非PCOS不孕患者活产率降低和流产率增高,在接受辅助生殖治疗之前,将血脂水平控制在正常水平可获得较好的妊娠结局。     

Urinary bisphenol A concentrations and cytochrome P450 19 A1 (Cyp19) gene expression in ovarian granulosa cells: An in vivo human study

BackgroundExposure to bisphenol A (BPA), a chemical widely used in consumer products, has been associated with in vitro Cyp19 gene expression.ObjectiveTo evaluate an in vivo human model of Cyp19 gene expression in granulosa cells.Study DesignA subset of an ongoing prospective cohort study of women undergoing in vitro fertilization (IVF) at Massachusetts General Hospital.MethodsMixed effect models were used to evaluate the association of urinary BPA concentrations with granulosa cell Cyp19 mRNA expression.ResultsIn 61 women undergoing 76 IVF cycles, adjusted changes in mean Cyp19 expression (β estimate (95% CI)) for quartiles 2, 3 and 4 as compared to the lowest quartile were: −0.97 (−2.22, 0.28); −0.97 (−2.18, 0.24) and −0.38 (−1.58, 0.82).ConclusionsAn in vivo model for evaluation of Cyp19 gene expression was developed for use in epidemiologic studies. In this pilot study, we found no statistically significant linear association between urinary BPA concentrations and Cyp19 expression.     

卵巢低反应不孕患者行IVF助孕不同促排卵方案妊娠结局的比较

目的探讨不同促排卵方案在接受体外受精/卵胞浆内单精子显微注射-胚胎移植（IVF/ICSI-ET）助孕的卵巢低反应患者中的应用价值。方法对在我院接受IVF/ICSI-ET助孕治疗的卵巢低反应患者的310个周期的临床资料进行回顾性分析,其中未移植的取消周期有97个,移植周期213个,根据这些患者的基础FSH和Gn用量进行分层分组,按bFSH〈8和bFSH≥8将患者分成两个组群,再将Gn用量〈40支的为组1和≥40支的为组2,比较不同bFSH组群中不同Gn用量对促排卵结局的影响;并观察3种不同促排卵方案：常规长方案（A组）、拮抗剂方案（B组）和超长方案（C组）对临床结局的影响。结果3种方案的周期取消情况相比差异无统计学意义。不同bFSH组群中不同Gn用量组间结果比较差异无统计学意义（P〉0.05）。3种促排卵方案相比,超长方案的临床妊娠率和胚胎着床率最高,且着床率和拮抗剂方案组相比差异有统计学意义（P〈0.05）。结论加大Gn总量不能改善卵巢低反应患者的妊娠结局,对于卵巢低反应患者,超长方案不失为一种较好的选择。     

Background exposure to toxic metals in women adversely influences pregnancy during in vitro fertilization (IVF)

Low-level environmental exposure to Hg, Pb and Cd may interfere with pregnancy during in vitro fertilization (IVF). The aim of this study was to generate hypotheses concerning associations between background exposures and pregnancy. In modified Poisson regression models including 24 women and adjusted for urine Cd and creatinine, blood Pb, age, race and smoking, 1μg/L increases in blood Hg are associated with decreases of 35% (P=0.03) and 33% (P=0.01) in clinical and biochemical pregnancies, respectively. In alternate Poisson models including 26 women and adjusted for blood Pb, blood Hg, age, race and smoking, 1μg/L increases in blood Cd are associated with decreases of 94% (P=0.01) and 82% (P=0.04) in clinical and biochemical pregnancies, respectively. No effects are detected in 15 men, although inverse associations are suggested for urine cadmium and pregnancy. These data suggest that low-level, background exposures to Hg and Cd may interfere with pregnancy following IVF.