经阴道输卵管插管行配子输卵管移植的临床初步研究

目的 了解经阴道配子输卵管移植治疗非输卵管性不孕症（子宫内膜异位症、男性少弱精症、不明原因不孕等）的效果。方法 对２１例（２３个周期）不孕症患者分别采用（１）绝经期促性腺激素（ｈＭＧ）／ｈＣＧ（７个周期）;（２）卵泡刺激素（ＦＳＨ）／ｈＣＧ（２个周期）;（３）短方案促性腺激素释放激素激动剂（ＧｎＲＨ－ａ）／ｈＭＧ／ｈＣＧ（２个周期）;（４）长方案ＧｎＲＨ－ａ／ＦＳＨ／ｈＭＧ／ｈＣＧ（１２个周期）进     

GnRH-a超短周期联合hMG方案与CC/hMG及单独hMG方案的比较

目前,促排卵药广泛地应用于排卵障碍性不孕症以及其他原因不孕的各种助孕技术。其中,各种促性腺激素释放激素激动剂（ＧｎＲＨ－ａ）联合人绝经期促性腺激素（ｈＭＧ）方案现已广泛应用于临床,为各大生殖医学中心所采纳。ＧｎＲＨ－ａ超短周期由于其疗程短,监测次数少...     

GnRH—a超短周期联合HMG方案在促排卵中的应用

促性腺激素释放激素激动剂（ＧｎＲＨ－ａ）超短周期联合人绝经期促性腺激素（ＨＭＧ）方案可抑制内源性黄体生成素（ＬＨ）峰值，降低周期取消率，提高卵细胞采集率，受精率及妊娠率。     

促性腺激素释放激素激动剂在多囊卵巢综合征促排卵高危周期中的应用

目的探讨促性腺激素释放激素激动剂（ＧｎＲＨａ）代替ｈＣＧ在多囊卵巢综合征（ＰＣＯＳ）中诱发排卵治疗的效果及并发症。方法对采用绝经期促性腺激素或卵泡刺激素促排卵治疗的１４例ＰＣＯＳ患者（１８个周期）,于卵泡≥１８ｍｍ时给予ＧｎＲＨａ,观测血清雌二醇（Ｅ２）水平、排卵率、妊娠率、卵巢过度刺激综合征（ＯＨＳＳ）和多胎妊娠发生情况。结果１４例１８个治疗周期给予ＧｎＲＨａ日血清Ｅ２为（８３７９±２９５８）ｐｍｏｌ／Ｌ,周期排卵率和妊娠率分别为８３３％和２２２％。中度ＯＨＳＳ和多胎妊娠各１例。结论在ＰＣＯＳ不孕患者中以ＧｎＲＨａ代替ｈＣＧ具有相似的排卵率和妊娠率,但能明显降低ＯＨＳＳ发生率,减少多胎妊娠。     

小剂量生长激素在体外受精超排卵周期中的作用

在体外受精－胚胎移植（ＩＶＦ－ＥＴ）超排卵周期中，对反应差的不育妇女２７例采用促性腺激紊释放激素激动剂（ＧｎＲＨ－ａ）／小剂量重组人生长激奈（ＧＨ）结合人绝经期促性腺激奈（ｈＭＧ）／人绒毛膜促性腺激素（ｈＣＧ）进行超排卵１２例（ＧＨ组），与采用ＧｎＲＨ－ａ／ｈＭＧ／ｈＣＧ的１５例（对照组）进行比较。结果表明，ＧＨ能促进卵母细胞成熟，提高受精率，增加移植胚胎数，明显提高妊娠率。但未能影响卵泡的招募及诱发排卵所需ｈＭＧ的剂量和用药时间。血清胰岛素样生长因子Ｉ（ＩＧＦ－Ｉ）的水平在使用ＧＨ期间从１５０±４４ｎｇ／ｍｌ升达２２２±６ｎｇ／ｍｌ（Ｐ＜０．０１），而对照组无类似变化。证实小剂量ＧＨ在体外受精超排卵周期中的使用是有效的。     

预测多囊卵巢综合征促排卵治疗结局的研究

目的 探讨影响多囊卵巢综合征（ＰＣＯＳ）患者促排卵治疗结局的相关因素,建立分类树分析（ＣＡＲＴ）模型。方法 采用放射免疫方法,测定１０３例ＰＣＯＳ患者及３１例正常妇女血清雌二醇（Ｅ２）、睾酮（Ｔ）、雄烯二酮（Ａ）、促卵泡激素（ＦＳＨ）、黄体生成素（ＬＨ）、垂体泌乳素（ＰＲＬ）水平,进行口服糖耐量试验及胰岛素释放试验,应用氯米芬（ＣＣ）／人绒毛膜促性腺激素（ｈＣＧ）、ＣＣ／人绝经期促性腺激素（ｈＭＧ     

体外受精周期中应用长效促性腺激素释放激素激动剂治疗多囊卵巢综合征

目的：观察长效促性腺激素释放激素激动剂（ＧｎＲＨ－ａ）治疗多囊卵巢综合征（ＰＣＯＳ）的疗效。方法：在体外受精－胚胎移植（ＩＶＦ－ＥＴ）周期中，应用长效ＧｎＲＨ－ａ（ｄｅｃａｐｅｐｔｙｌ，Ｆｅｒｉｎｇ）及促性腺激素（Ｇｎ）治疗２６例顽固性ＰＣＯＳ患者（Ｄｅｃａｐｅｐｔｙｌ组），并与其中前次常规ＩＶＦ－ＥＴ方案治疗的１９例（非Ｄｅｃａｐｅｐｔｙｌ组）进行比较。结果：（１）Ｄｅｃａｐｅｐｔｙｌ组受精率和妊娠率分别为７６．２％和３８．５％，明显高于非Ｄｅｃａｐｅｐｔｙｌ组（Ｐ＜０．０５）。（２）Ｄｅｃａｐｅｐｔｙｌ组用药２周后，子宫内膜厚度及卵巢面积明显缩小，用药第４周时，达最小值。（３）Ｄｅｃａｐｅｐｔｙｌ组黄体生成素（ＬＨ）、促卵泡激素、睾酮、雌二醇在用药１周后开始下降，至用药第４周达早卵泡期水平。结论：对在应用常规ＩＶＦ－ＥＴ周期或外源性促性腺激素治疗过程中，发生卵巢过度刺激综合征或过早ＬＨ峰，以及使用外源性Ｇｎ６个周期无受孕的ＰＣＯＳ患者，长效ＧｎＲＨ－ａ联合Ｇｎ超排卵，是较好的方案。     

尿促黄体生成激素峰与体外受精－胚胎移植结局的探讨

从１９９１年６月１日至１９９２年７月３０日，因输卵管因素造成不孕而进行体外受精－胚胎移植（ＩＶＦ－ＥＴ）共１５０个周期。经用克罗米酚及促性腺激素促超排卵，其中４１个周期（２７．３３％）于注射人绒毛膜促性腺激素（ｈＣＧ）前，尿中出现促黄体生成激素（ＬＨＭ）峰（ＬＨ＞４０ＩＵ／Ｌ），１６个周期（１０．６７％）表现为ＬＨ升高（ＬＨ＝４０ＩＵ／Ｌ），９３个周期（６２．００％）无ＬＨ峰（ＬＨ＜４０ＩＵ／Ｌ）。三组所获得的平均卵子数无明显差异。在有ＬＨ峰的周期中，卵裂率明显低于无峰周期，其临床妊娠率低于无ＬＨ峰者，两者比较差异无显著性。说明在注射ｈＣＧ前，尿中出现ＬＨ峰影响卵子质量，从而将影响受精卵的分裂，可导致临床妊娠率下降。     

卵巢储备的预测

卵巢储备与生殖潜能的关系愈来愈受到重视。对卵巢储备的预测技术主要有基础ＦＳＨ、氯Ｄｉ酚胺（ＣＣ）兴奋试验和促性腺激素释放激素增效剂（ＧｎＲＨ－ａ）刺激试验。前二种研究的开展相对较早而深入，当结果异常时，预测卵巢储备低下的价值较高，尤以ＣＣ兴奋试验的敏感性更高。但结果正常时的预测价值下降，需要同时考虑年龄因素对生殖潜能的影响。ＧｎＲＨ－ａ刺激试验的研究仅限于对ＧｎＲＨ－ａ加ＦＳＨ和ＨＭＧ超促排卵方案     

用人绝经期尿促性腺激素治疗无排卵性不孕症110例分析

１９９０年１１月至１９９２年３月上海四家医院用国产人绝经期尿促性腺激素（ｈＭＧ）治疗无排卵性不孕症１１０例。患者平均３１．２岁，平均闭经时间５．９年，原发不孕症者占７９％。用ｈＭＧ－ｈＣＧ序贯法治疗１９８个周期，平均每个周期用药３３针。结果：１００例排卵率１００％，周期排卵率９４％，妊娠率５０％，周期妊娠率２７％。卵巢过度刺激综合征发生率３４．３％（轻度１０．９％，中度１９％，重度４．５％），双胎发生率１４．５％。表明国产ｈＭＧ对低促性腺激素性团经和无排卵性稀发月经的治疗效果令人满意。     

Ultrasonographic and clinical correlates of menotropin versus sequential clomiphene citrate: menotropin therapy for induction of ovulation

Forty-six women remaining infertile with clomiphene citrate (CC) with or without human chorionic gonadotropin (hCG) were treated by either human menopausal gonadotropin (hMG, 44 cycles) or CC + hMG (33 cycles) and monitored by serum estradiol (E2) and ultrasonography. Ovarian hyperstimulation syndrome (OHS) and pregnancy outcome were compared in both regimens. In the presence of dominant follicles (greater than or equal to 18 mm) alone or with a single secondary follicle (14 to 16 mm) at hCG administration, OHS did not develop. A significant increase in OHS was noted when three or more secondary follicles were observed. Overall pregnancy rates were similar in both regimens but significantly higher when hCG was injected before rather than after the E2 peak. The results suggest secondary follicles rather than dominant follicles are a valuable sign of possible OHS development; and CC + hMG should be considered in CC-failure patients.     

促排卵治疗对多囊卵巢综合征患者子宫内膜整合素αv,β3表？…

目的 了解促排卵药物对多囊卵巢综合征（ＰＣＯＳ）患者黄体中期子宫内膜整合素αｖ、β３表达的影响。方法 应用单克隆抗体,采用免疫组织化学技术对２２例正常妇女、４０例无排卵ＰＣＯＳ患者促排卵治疗后黄体中期的子宫内膜整合素αｖ、β３进行测定。结果正常妇女子宫内膜整合素αｖ、β３表达在“着床窗口期”呈现强阳性;而氯米芬（ＣＣ）及绝经期促性腺激素（ｈＭＧ）抑制αｖ、βｂ的表达,使其表达呈弱阳性;而促性腺素释     

IVF中三种促超排卵方案效果的比较

目的：探讨IVF中最佳促超排卵方案。方法：将IVF对象随机分为3组。BFh组：23例126个周期,按BFh长方案（Buserelin／FSH／hCG）进行;Chh组：13例14个周期,以CC／hMG／hCG方案进行;Fhh组：55例57个周期,按FSH／hMG／hCG方案进行。结果：每周期平均促性腺激素（Gn）用量BFh组为18．62±5．95支;Chh组16．57±5．70支;Fhh组25．56±8．08支。每周期获成熟卵子数分别为10．23±5．80个;6．07±3．22个;10．96±6．45个。Gn用量BFh组与Chh组差异无显著性（P＞0．05）,但取到的卵子数,差异有显著性（P＜0．05）。BFh组与Fhh组比较,BFh组Gn用量少于Fhh组（P＜0．05）,但取到的卵子数差异无显著性（P＞0．05）,且BFh组无过早的LH峰出现,另二组则各有1例过早的出现内源性LH峰。结论：IVF中BFh方案是较为理想的促起排卵方案。     

The use of the GnRH analogue buserelin for IVF--does it improve fertility?

OBJECTIVE--To determine the effect of a short course of the GnRH analogue buserelin and human menopausal gonadotrophin (hMG), for ovarian stimulation in our IVF programme, on reproductive endocrinology and pregnancy rates compared with conventional clomiphene citrate and hMG treatment. DESIGN--Prospective randomized allocation to one of two ovulation stimulation regimens. SETTING--Fertility clinic. SUBJECTS--373 infertile couples with various factors associated with their subfertility. All the women were less than 46 years of age and had normal menstrual cycles. INTERVENTION--The first group (n = 151) was given clomiphene citrate (CC) from days 2-6 of the menstrual cycle and hMG from day 5 onwards (CC/hMG). The second group (n = 222) was given buserelin from days 1-3 and hMG from day 2 (buserelin/hMG). MAIN OUTCOME MEASURES--Concentration of plasma luteinizing hormone (LH), oestradiol (E2) and progesterone, number of ovulatory follicles induced and the occurrence of pregnancy. RESULTS--Plasma LH, E2 and progesterone concentrations were reduced in the late follicular phase after buserelin/hMG compared with CC/hMG. Buserelin/hMG promoted the development of more follicles than CC/hMG. The overall pregnancy rate after buserelin/hMG was not significantly different from that following CC/hMG treatment. CONCLUSION--The chance of pregnancy is not improved by the short-term use of buserelin with hMG, provided adequate follicular phase management is maintained.     

体外受精超促排卵治疗中单用促性腺激素和拮抗剂方案临床结局的比较

目的探讨体外受精(IVF)治疗中单用促性腺激素(Gn)对妊娠结局的影响。方法月经第3日开始给予重组卵泡刺激素(rFSH)促排卵,促排卵第6日开始监测血激素水平和阴道超声监测卵泡大小。将达到思则凯添加标准者[黄体生成素(LH)5 IU/L,或LH/基础LH≥3]设为对照组,每日给予思则凯0.125 mg直至人绒毛膜促性腺激素(hCG)注射日;以未达到标准不使用思则凯者设为研究组。结果研究组(n=31)和对照组(n=49)患者在Gn剂量、促排卵天数、hCG注射日血清内分泌水平、获卵数、受精率、着床率、临床妊娠率和活产率方面均无统计学差异(P0.05)。结论在IVF促排卵治疗中,通过对血清LH的监测,如果LH维持在低水平可以不给予拮抗剂治疗,单纯使用Gn是一种经济有效的促排卵方案。     

A comparative study of three ovulation induction protocols in polycystic ovarian disease patients in an in vitro fertilization/embryo transfer program

Purpose This study compares the results of three ovulation induction protocols in polycystic ovarian disease (PCOD) patients undergoing an in vitro fertilizationembryo transfer (IVF-ET) program. A total of 85 cycles was studied. The patients were treated with clomiphene citrate (CC) plus human menopausal gonadotropin (hMG) (CC/hMG group), with purified menofollitropin (pFSH) plus hMG (pFSH/hMG group), and with pFSH/hMG plus gonadotropin releasing hormone analogue (GnRH-a) (analogue group). In the analogue group the suppression of luteinizing hormone (LH) with GnRH-a decreased the number of follicles <12 mm on the day of human chorionic gonadotropin (hCG) administration and the number and percentage of immature oocytes retrieved and increased the percentage of mature oocytes retrieved.Results However, fertilization rates of oocytes, cleaved embryo rates, pregnancy rates following replacement, and pregnancy outcomes were not different.Conclusion Although the suppression of the hypothalamic-pituitary-ovarian axis with GnRH-a in PCOD patients improved follicular synchrony and oocyte maturity, none of the ovulation induction protocols was superior to the others with respect to pregnancy rates and pregnancy outcomes.     

促排卵周期PCOS妇女子宫内膜纤维粘连蛋白及层粘连蛋白的表达

目的:了解促排卵药物氯米酚(CC)、hMG及GnRH-a对黄体中期子宫内膜内膜纤维粘连 蛋白(FN)及层粘连蛋白(LN)表达的影响。方法:应用单克隆抗体,采用免疫组织化学技术检测50 例正常妇女自然周期以及50例正常妇女,45例多囊卵巢综合征妇女应用CC／hCG,CC／hMG／hCG 及GnRH-a／hMG／hCG方案促排卵治疗后黄体中期子宫内膜FN和LN的表达。结果:子宫内膜FN 和LN表达在正常妇女自然周期着床窗口时呈现强阳性;而CC、hMG抑制FN和LN的表达,使 其阳性强度减弱,有显著性统计学差异P<0．01;GnRH-a对FN和LN抑制不明显。同时妊娠者较 未妊娠者FN和LN表达强度高。结论:CC／hCG及CC／hMG／hCG方案促排卵后黄体中期子宫内膜 中FN和LN表达下降或缺失,内膜容受性下降,妊娠率降低。     

Sequential clomiphene citrate/hMG versus hMG for ovulation induction in clomiphene citrate-resistant women

Objective

This study was designed to compare sequential clomiphene citrate/hMG regimen to hMG regimen for ovulation induction in clomiphene citrate-resistant women.

Study design

A comparative prospective study.

Patients and methods

Ninety infertile women were randomized to receive either sequential CC/hMG regimen (45 women) or low-dose step-up protocol of hMG (45 women). All participants had received at least six consecutive cycles of clomiphene citrate for ovulation induction within the last year before inclusion in this study, but they did not conceive. The CC/hMG regimen group received clomiphene citrate 100 mg/day for 5 days, followed by hMG 75 IU for 4 days. The hMG group received low-dose step-up protocol for 10–14 days. To detect the number and size of the follicles, TVS was done on cycle day 8 and repeated daily or every other day according to follicular development. When one to three follicles reached a diameter ≥18 mm, hCG injection was scheduled. Before hCG injection, the E2 level and endometrial thickness were evaluated. β-hCG levels were measured on cycle day 22.

Results

There was no significant difference between the two studied groups regarding the demographic data, sperm parameters, and day 3 FSH, LH and estradiol. Also, there was no significant difference between the two studied groups regarding endometrial thickness, number of mature follicles, peak of E2 before hCG injection and number of cases that developed ovarian cyst or OHSS. The dose of gonadotropins used was significantly low in the CC/hMG group compared to the hMG group (295.2 ± 75.5 vs. 625.3 ± 65.0, respectively), and the pregnancy rate was significantly high in the CC/hMG group compared to the hMG group [12 (26.7 %) vs. 3 (6.7 %), respectively, p < 0.05].

Conclusion

The sequential CC/hMG regimen is as effective as hMG regimen for ovulation induction, produces satisfactory pregnancy results and reduces the treatment cost.     

The impact of adding hp-hMG in r-FSH started GnRH antagonist cycles on ART outcome

Abstract

While luteinizing hormone (LH) activity is believed to play a role in follicle maturation, human chorionic gonadotropin (hCG) might play an important role in implantation process. We aimed to investigate whether addition of human menopausal gonadotropin (hMG) in recombinant-follicle-stimulating hormone (r-FSH) started GnRH antagonist controlled ovarian hyperstimulation (COH) cycles might enhance implantation rate and improve in vitro fertilization (IVF) success. A total of 246 patients undergoing GnRH antagonist IVF cycles were analyzed. One hundred and twenty-three cycles (%50) were treated with only r-FSH and 123 cycles were treated with r-FSH plus hp-hMG combination. Total gonadotropin doses, total number of oocytes retrieved, metaphase 2 (MII) oocytes, top quality embryos, fertilization and implantation rates, clinical pregnancy rates (CPRs) and ovarian hyperstimulation syndrome (OHSS) rates were compared between the groups. Both groups were comparable in terms of demographic details and baseline characteristics. Peak estradiol and progesterone levels in hCG trigger day, number of retrieved oocytes and top quality embryo counts, fertilization rates were similar between the groups. In r-FSH?+?hp-hMG group, significantly higher implantation rates (35.3% vs 24.3%, p=.017), CPRs (51.2% vs 35.8%, p=.015) and lower OHSS rates (1.6% vs 7.4%, p?=?.03) were observed respectively compared to r-FSH only treated patients. In conclusion, addition of hp-hMG on the day of antagonist initiation might increase CPRs. A better endometrial receptivity associated with higher implantation rates might be achieved due to hCG component in hp-hMG.     

Ovarian hyperstimulation for in vitro fertilization preceded by prolonged administration of a gonadotropin-releasing hormone agonist

In 51 patients, controlled ovarian hyperstimulation with clomiphene citrate (CC)/human menopausal gonadotropin (hMG), or hMG only, in 102 IVF cycles had previously resulted in a cancellation rate of 52% and no pregnancies. In 54 subsequent cycles the women were treated with prolonged administration of a gonadotropin-releasing hormone agonist (GnRHa) followed by hMG stimulation, the GnRHa group. The results were compared with the outcome of 47 cycles in patients who came for their first IVF attempt. In this group a CC/hMG regimen was used, the CC/hMG group. In the GnRHa group, 17 pregnancies were achieved, compared with 10 in the CC/hMG group. Only four cycles were cancelled in the GnRHa group, vis-à-vis 13 in the CC/hMG group, a significant difference. The study showed that prolonged use of GnRHa as a preparatory treatment is effective following previous failures of IVF.