改良精子上游法用于体外受精-胚胎移植

本文报告一种用以收集高活动力精子的改良上游枝术,并在体外受精-胚胎移植中与常规洗涤法相比较。用上游法获得的精子悬液平均精子活动力为93.36±8.44%(X±SD),Ⅰ、Ⅱ级前向运动精子比例占75%以上。比较两种精子分离方法的体外受精率:上游法为45.65%,洗涤法为30.30%,p<0.05。在8例以上游精子授精所得胚胎行胚胎移植中,2例获得妊娠并已足月顺产出“试管婴儿”。     

改良原核期胚胎评分系统在常规体外受精-胚胎移植中的应用

目的　探讨原核期胚胎评分 (原核评分 )系统在常规体外受精 胚胎移植 (IVF ET)中的应用价值。方法　应用改良的原核评分系统对受精后 1 6～ 1 8h的受精卵进行评分 ,然后在受精后第3天根据卵裂期胚胎的形态 ,并参考原核评分选择移植胚胎。结果　在 1 78个常规IVF ET周期中 ,当移植胚胎的平均原核评分 (移植胚胎的原核评分总和 /移植胚胎的数目 )达 1 3分时 ,临床妊娠率和胚胎植入率分别为 49 1 %和 2 6 5 % ,显著高于原核评分 <1 3分的 2 9 4%和 1 5 0 %。随着移植胚胎中原核评分为满分 (1 5分 )的数目增加 ,临床妊娠率、胚胎植入率和多胎妊娠率也随之增加 ,但差异无显著性 (P >0 0 5)。可供冷冻的胚胎比例也与原核评分有关。当原核评分≥ 1 1分时 ,77 2 %的胚胎在受精后第 3天可供移植或符合冷冻标准 ;而 <1 1分时 ,仅有 46 1 %的胚胎符合标准 (P <0 0 0 1 )。结论　原核评分是辅助选择移植胚胎的有效参数 ,但原核期胚胎形态只能部分反映胚胎发育的潜能 ,因此必须与卵裂期胚胎评分结合使用     

黄体酮在体外受精中的应用及安全性

诱发超排卵是体外受精 (ＩＶＦ)的重要步骤之一 ,但它同时也可能导致黄体功能异常[1] ,因此 ,支持黄体功能已成为大多数ＩＶＦ中心治疗的常规。但是否所有的ＩＶＦ周期都需要补充黄体功能目前观点仍不一致。此外 ,由于在 2 0世纪 70年代前后 ,较多文献报道了性激素与胎儿畸形的关系 ,因此 ,人们对孕期较大剂量使用黄体酮是否会引起胎儿畸形还心存疑虑。显然 ,了解黄体酮在ＩＶＦ中的应用情况和安全性十分必要。1　促性腺激素释放激素类似物 (ＧｎＲＨ -ａ)与黄体功能异常1984年Ｐｏｉｒｔｅｒ等首先报道 ,联合使用ＧｎＲＨ -ａ诱发超排卵可…     

配子赠送在体外受精—胚胎移植中的应用

本文报道２例配子赠送体外受精－胚胎移植（ＩＶＦ－ＥＴ）妊娠成功，并分娩正常婴儿。１例染色体异常，１例丈夫染色体异常。２例均有反复流产史。本文对这２例染色体平衡易位者形成配子的情况进行讨论，说明这２例为获得健康后代都有应用赠送配子的必要性。同时，赠送卵子必须应用ＩＶＦ－ＥＴ技术，其中１例赠送精子应用ＩＶＦ－ＥＴ技术，是因其他助孕技术屡次失败。     

口服黄体酮在体外受精-胚胎移植中的应用

目的 验证口服黄体酮胶囊-益玛欣的孕激素活性；探讨其应用于体外受精-胚胎移植（IVF—ET）的临床意义。方法 2006-06—2006-09对福建省妇幼保健院8例非子宫性闭经患者行人工周期治疗，口服益玛欣前后取血查孕酮，个别患者口服益玛欣后取子宫内膜活检。另将IVF—ET患者52例，随机分为2组。研究组26例，给予益玛欣＋黄体酮；对照组26例，单纯给予黄体酮。所有患者于注HCG日及取卵后8d取血查孕酮。结果 （1）8例人工周期治疗患者，益玛欣用药后与用药前比较。血孕酮明显升高（P〈0．01），其中1例用药后子宫内膜活检提示中分泌期子宫内膜。（2）IVF—ET两组患者血孕酮水平及妊娠率差并无显著性（P〉0．05）。结论 口服黄体酮胶囊-益玛欣具有明显的孕激素活性；用于IVF—ET的临床疗效与黄体酮针剂效果相似，是IVF—ET周期补充黄体功能的另一可供选择的药物。     

两种精子优化处理方法在体外受精中的应用选择

目的:评价Isolate密度梯度离心法和上游法两种活动精子处理方法在体外受精-胚胎移植(IVF-ET)中的效果。方法:本中心2003.01-12完成的253个IVF-ET周期为研究对象,回顾性地比较了两种精子分离方法的受精率、卵裂率、优质胚胎率和临床妊娠率。结果:Isolate离心法和上游法两组比较,受精率分别为84.13%和94.06%,有显著差异(P<0.01);卵裂率93.81%和97.01%,有显著差异(P<0.01);优秀胚胎率62.80%和56.62%,差异显著(P<0.05);临床妊娠率53.5%和48.0%,差异无统计学意义(P>0.05)。结论:在IVF-ET治疗不孕不育中,Isolate离心法分离的活动精子在受精和卵裂上不如上游法,在优质胚胎率上优于上游法,但两者的临床妊娠率无显著差异,故两者同样适用于IVF精子处理。     

序贯培养在体外受精-胚胎移植技术中的应用

目的: 试用序贯培养方法延长胚胎体外培养时间,以获得８细胞胚及囊胚进行移植,提高体外受精－胚胎移植（ＩＶＦ－ＥＴ）的成功率,方法：将行ＩＶＦ－ＥＴ的１６１例患者１８２３个卵子分为序贯培养（使用Ｐ１液、Ｂ液系列培养液,４７例,４７个]周围）与传统培养（１１例,１１４个周期）两组进行培养,分析受精率,卵裂率,卵裂速率,优质胚胎比率及率及临床妊娠率,采用x^2体验进行统计学分析,结果：序贯培养组卵裂率,优质胚胎比率,胚着床率及妊娠率分别为９７．９％,６４．４％,１９．１％和４６．７％,结论：采用适事的培养组分别为８９．７％,４０．２％,１１．０％和２８．２％,两组比较,差异有显著性（Ｐ＜０．０５）,结论：采用适合的培养液进行贯培养,更适合于卵子及胚胎的体外发痛,方法安全可行。     

桑葚期胚胎玻璃化冷冻在体外受精-胚胎移植中的应用

目的:探讨用玻璃化冷冻法冷冻桑葚期胚胎的可行性.方法:选择2010年6月至2012年9月在河北医科大学第二医院生殖医学门诊行体外受精-胚胎移植患者784例(829个周期)为研究对象,对照组(606例)为前期采用玻璃化冷冻法冷冻第3天卵裂期胚胎637个周期;研究组A(145例)采用玻璃化冷冻法冷冻第4天桑葚期胚胎159个周期;研究组B(33例)为前期采用玻璃化冷冻法冷冻胚胎在第3天评分较差,介于冷冻和非冷冻之间的胚胎,通过继续培养至第4天采用玻璃化冷冻法冷冻桑葚期胚胎33个周期.3组均解冻以后行冻融胚胎移植,比较3组复活周期的胚胎完整率、周期临床妊娠率、种植率以及流产率.结果:①研究组A的完整胚胎存活率、周期临床妊娠率和流产率高于对照组,但差异无统计学意义(P＞0.05).而研究组A的胚胎种植率(33.2％)高于对照组(27.0％),差异有统计学意义(P＜0.05);②研究组B和对照组比较,完整胚胎存活率、种植率、周期临床妊娠率和流产率方面,差异均无统计学意义(P＞0.05).结论:桑葚期胚胎较原核期胚胎和早期卵裂期胚胎处于胚胎发育的更晚阶段,是胚胎的进一步选择,其玻璃化冷冻是可行的,能获得较好的妊娠率和种植率,值得临床推广应用.     

心理护理在体外受精—胚胎移植术中的应用效果分析

目的 分析心理护理在体外受精—胚胎移植术中的应用效果。方法 选取154例接受体外受精—胚胎移植术的治疗患者,通过随机分配法将患者分为观察组与对照组,每组77例。对照组患者接受常规护理干预,观察组患者接受心理护理干预。比较两组患者护理前后的焦虑、抑郁评分、护理依从性、护理满意度、获卵数、可移植胚胎数及妊娠率。结果 护理前,两组患者焦虑、抑郁评分对比,差异无统计学意义（P>0.05）;护理后,观察组患者焦虑、抑郁评分均低于对照组（P<0.05）。观察组护理依从性高于对照组（P<0.05）。观察组护理满意度高于对照组（P<0.05）;观察组获卵数（14.37±1.25）个、可移植胚胎数（5.22±0.84）个及妊娠率59.74%均高于对照组的（8.49±1.02）个、（1.08±0.21）个、38.96%(P<0.05)。结论 心理护理应用于体外受精—胚胎移植患者中,在一定程度上可提高临床疗效,值得临床大力推广。     

4种短效达必佳降调节方案诱发排卵效果比较

目的比较4种短效达必佳方案在诱发排卵中的效果。方法2000~2001年华中科技大学同济医学院附属同济医院采用以下4种短效达必佳方案,比较其在诱发排卵中的效果方案1月经第2天开始用达必佳01mg皮下注射,直至注射HCG时止;方案2上次月经第21天开始皮下注射达必佳01mg共7d;方案3上次月经的21天开始隔日1次皮下注射达必佳01mg直至注射HCG时止;方案4上次月经第21天开始每日皮下注射达必佳005mg直至注射HCG时止。结果4种方案的总取消率差异无显著意义(P>005),方案3的妊娠率和继续妊娠率最高(429%,356%),但与方案4比较差异无显著性意义(389%,311%)(P>005),方案2的妊娠率低于方案3和方案4,而且流产率较高,校正了不同治疗时间的差别后,妊娠率和继续妊娠率仍低于方案3和方案4;方案1的效果最差,妊娠率低而流产率高。结论月经第21天隔日皮下注射达必佳0.1mg进行垂体降调节效果最好,使用方便,值得推广。     

Counselling needs,emotional and relationship problems in couples awaiting IVF

Medically unexplained (gynecological) symptoms can be viewed as an indication of the somatization of negative emotions. Most studies regarding psychological correlates of medically unexplained gynecological symptoms have paid attention only to certain personality characteristics of women with these symptoms. In this study the reporting of physical symptoms and the resulting illness behavior is explained in terms of information processing or a perception process, i.e. the process by which people detect and interpret physical sensations as symptoms of illness (symptom perception). Symptom perception is in part determined by environmental characteristics and cognitive and emotional processes, such as variation in daily life, (coping with) emotional threat and the use of cognitive illness schemes. Differences in symptom perception and illness behavior of women with medically unexplained and explained gynecological symptoms, compared to women with medically explained gynecological symptoms and a control group, were established with the help of a questionnaire, containing a number of scales. As expected, women with medically unexplained gynecological symptoms had higher reports of common symptoms and sensations and showed also more other illness behavior than the other two groups.

They reported less variation and more threat in daily life than the other two groups. These variables together with the use of illness schemes contributed most to symptom reporting of women with medically unexplained symptoms. It is concluded that defence against threat is probably an important determinant. Suggestions for further research and some practical implications are discussed.     

Clustering of monozygotic twinning in IVF

Purpose

The aim of this analysis was to study whether monozygotic twinning (MZT) events occur in clusters after IVF and, if so, to explore possible explanations for this clustering.

Methods

This is a retrospective cohort study carried out in a single, large university-affiliated reproductive medicine practice. Medical records of all patients who had undergone fresh IVF cycles, resulting in a viable clinical pregnancy, from Jan 2002 to Dec 2013 were reviewed. The incidence of MZT in 6-month intervals and the association with independent risk factors such as maternal age, extended embryo culture, PGD/intracytoplasmic sperm injection (ICSI)/assisted hatching performed were analyzed.

Results

Over the 12-year study period, 25,502 fresh IVF cycles were performed, resulting in 8598 clinical pregnancies. Ninety-five cycles (1.1 %) resulted in MZ twins. The percentage of MZT was >2 standard deviations (SD) higher than the overall percentage of MZT in 4 of the 24 6-month intervals. PGD, extended embryo culture (≥4 days), and more recent cycles (2005 or later) were independent risk factors for MZT. The use of multivariable logistic regression modeling to control for risk factors for MZT did not correct for this clustering effect, with both high-risk interval (clustering) and extended embryo culture remaining significant.

Conclusion

This study supports our hypothesis that MZT occurs in clusters and that this clustering effect could not be explained by demographics and cycle characteristics alone. Although we are unable to explain the clustering phenomenon, this study is important as it highlights high-risk intervals for MZT and opens the door to performing a more detailed investigation, to identify the mechanisms responsible for the spikes of MZT incidence.

     

Obesity and IVF: weighing in on the evidence

Obesity is associated with serious health risks, and its rising prevalence represents a growing public health emergency. Ongoing research into the association of obesity and assisted reproductive technology (ART) outcomes aims to disentangle selective detrimental effects of obesity on the oocyte and the endometrium. More translational studies involving women with severe obesity and in the third-party reproduction setting will help improve the standard of care in the provision of ART services for obese patients.     

长效和短效GnRH-a在IVF/ICSI周期长方案中的应用比较

目的:探讨长效和短效促性腺激素释放激素激动剂(GnRH-a,曲普瑞林)在体外授精/卵细胞浆内单精子注射(IVF/ICSI)周期长方案中的应用及其对临床结局的影响。方法:对排卵正常者采用黄体中期降调长方案,无排卵者行口服避孕药(OC)预处理长方案,根据采用不同的剂型分为长效GnRH-a组和短效GnRH-a组,对两组在应用过程中的检测值进行比较。结果:无论黄体中期降调长方案,还是OC预处理长方案,其长效GnRH-a组的Gn用量和Gn天数,注射绒促性素(HCG)日血孕酮水平均明显高于短效GnRH-a组(P<0.05,P<0.01),长效GnRH-a组妊娠率和种植率明显低于短效GnRH-a组(P<0.05)。两种方案中,长效和短效GnRH-a组间按主导卵泡平均直径范围(≥18mm～≤20mm、>20mm～≤22mm和>22mm)比较,各直径范围中周期所占比例差异无统计学意义(P>0.05)。结论:长方案中使用长效GnRH-a降调比短效会增加Gn用量,使孕酮水平升高,妊娠率和种植率降低,对临床结局有不利影响。     

荧光原位杂交检测精子上游时间对XY精子

目的运用荧光原位杂交(fluorescent in situ hybridization,FISH)技术检测精子改良上游过程中,不同上游时间对含X/Y精子的分离作用,探讨较长上游时间跨度(0～150分钟)对上游后XY精子比例的影响.方法分析从志愿者取得的正常精液标本10份,每份均进行精子不同时间分批改良上游、固定和荧光原位杂交分析,计数分析X精子占XY精子总数的比例.结果杂交区域内精子总杂交率为98.33%.未上游时X精子比例为平均为50.03%.通过SPSS方差分析分时间段检测的X精子占XY精子总数的比例与未上游时差异无显著性(P＞0.05),不同组间差异无显著性(P均＞0.05).结论改良上游法对XY精子的分离没有显著效果,没有直接证据表明人工授精和体外受精-胚胎移植过程中精子的上游处理会影响到出生婴儿的性别比例.     

常规体外受精与卵胞浆单精子注射技术妊娠及分娩结果比较

目的通过比较接受常规体外受精技术(IVF)及卵胞浆单精子注射技术(ICSI)治疗后妊娠的病例,分析临床资料、妊娠及产科结局,从而评估其安全性。方法对中山大学附属第一医院1998年1月至1999年12月接受体外受精-胚胎移植治疗后妊娠的533例临床资料进行回顾性分析。结果ICSI组受精率明显高于IVF组,IVF和ICSI两组早期胚胎发育情况、产科结局、围生情况及出生后婴儿的健康情况差异无显著性意义。结论与常规IVF相比,ICSI并不增加胎儿畸形率及新生儿并发症,但仍需要长期的大量的随访以排除可能的危险性。     

The effect of performing hysteroscopy prior to the first in vitro fertilization (IVF) cycle on live birth rate

Abstract

In this retrospective cohort study, a total of 707 couples underwent in vitro fertilization (IVF) at Hacettepe University Hospital between 01 January 2010 and 01 November 2014 with their chronologically first cycle were evaluated. Patients who have diagnostic hysteroscopy prior to first IVF cycle served as a study group (n?=?42) and patients without diagnostic hysteroscopy served as control group (n?=?282). In study group in all patients, diagnostic hysteroscopy was performed at the follicular phase of previous menstrual cycle, namely immediately before ovarian stimulation (OS) cycle. Demographic features, clinical characteristics and treatment outcomes were compared between the groups. The logistic regression analysis was performed in order to assess independent predictors of live birth rates (LBRs). There was no statistically significant difference between the groups for demographic features and OS cycle characteristics. Implantation rate (22.2% vs. 21.5%, p=.840), clinical pregnancy rate (33.3% vs. 28.7%, p=.541), and LBRs (23.8% vs. 18.5%, p=.420) were comparable. In logistic regression analysis, performing hysteroscopy prior to first IVF cycles per se without correcting anatomic abnormalities was not an independent predictor of LBRs (OR: 0.72, 95% CI: 0.310–1.68, p=.45). In conclusion, performing diagnostic hysteroscopy prior to first IVF treatment cycle without correcting any anatomic abnormalities did not improve LBRs.     

The association between polypronucleate zygote formation with certain motion characteristics of sperm and IVF outcome

Purpose To determine the efficiency of sperm motion characteristics as predictors for normal (2PN) and polypronulceate (PPN) zygotes in IVF. Methods A retrospective cohort analysis for a total of 230 couples undergoing IVF treatment in a single infertility center. Result(s) Subsequent to semen analysis and hemizona assay, unexpected fertilization failure would appear to have occurred only extremely rarely (1/236, 0.4%). The rate of PPN, however, did arise and appeared to be related to certain sperm motion characteristics, such as lateral head displacement and concentration of progressive motile sperm. Interestingly, the patients featuring a high PPN rate (>20%) was associated with a greater pregnancy rate than those featuring a low PPN rate (<20%). Conclusion The sperm motion characteristics examined herein could be utilized to predict the rate of PPN in IVF. In order to enhance the rate of 2PN and maintain the relative high rate of clinical pregnancy, an efficient method needs further investigation and development. Financial support This study was supported by the Chinese Infertility Foundation. Capsule The combination of CASA and hemi-zona assay is adequate for directing IVF or ICSI treatment; further, sperm motion characteristics correlate with the polypronucleate zygote formation.     

A pelvic pseudoaneurysm (a rare complication of oocyte retrieval for IVF) treated by arterial embolization

This is a case report of the diagnosis and treatment of a pelvic pseudoaneurysm in a patient. Her history leads to the conclusion that this developed following egg retrieval during in vitro fertilization six years earlier.