两种短效达必佳方案在控制超排卵中的疗效比较

目的比较两种短效达必佳方案在控制超排卵中的治疗效果。方法回顾性分析2004年1月~2005年12月在本生殖中心接受体外受精-胚胎移植(IVF-ET)黄体中期长方案者130例,将启动日(月经第2~3d)促黄体生成素(LH)<2 IU/L者分为A、B两组,A组患者自启动日起停止使用达必佳,使用促性腺激素(Gn)促排卵,B组患者继续使用达必佳至绒毛膜促性腺激素(HCG)注射日,其余同A组,比较两组的治疗效果。结果A组的促性腺激素(Gn)用量明显少于B组(28.25±6.33支vs 30.86±7.44支,P<0.05);Gn使用时间、HCG注射日的血P、E2、LH水平及获卵率、受精率、卵裂率、妊娠率两组间均无显著性差异。两组均无内源性LH峰出现。结论对启动日LH<2 IU/L的患者给予停止达必佳的使用,可抑制内源性LH峰的出现,并能减少Gn用量及治疗费用。     

Triptorelin和Buserelin对不孕妇女体外受精—胚胎移植疗效的比较

目的 比较GnRH-a制剂Triptorelin和Buserelin的体外受精—胚胎移植治疗效果.方法 185例不孕妇女随机分成两组,A组:85例,黄体期应用Triptorelin(月经第21d皮下一次性注射1.25～1.60mg);B组:100例,黄体期应用Buserelin.两组均用长方案降调节.比较两组的高纯度促卵泡刺激素用药剂量、取卵数、受精率、卵裂率和妊娠率.结果 两组的取卵数、受精率、卵裂率和妊娠率无显著性差异(P＞0.05).A组平均每周期用高纯度卵泡刺激素40.3±18.2支,B组平均每周期用30.2±12.3支,有显著性差异(P＜0.01).结论 Triptorelin和Buserelin的长方案均可获得高质量的成熟卵子,对不孕妇女的体外受精—胚胎移植治疗效果相似.Triptorelin的降调节作用较Buserelin的强.黄体期一次性皮下注射Triptorelin1.25～1.60mg可简化治疗过程,患者易于接受.     

体外受精—胚胎移植患者超排卵期间的护理

目的探讨影响超排卵的外在因素,进行有效的护理干预,提高妊娠率。方法回顾性分析日常的护理行为,对护理方法进行归纳与总结。结果实施整体护理后全面提升了护理质量,使低反应放弃周期患者明显减少,获卵率、获卵数、临床妊娠率明显提高。结论做好心理护理、严格用药护理,加强饮食、睡眠护理及健康指导是超排卵成功的重要保证。     

辅助生育技术中常用的促超排卵药物

控制性促超排卵对获得一定数量的优质卵泡是重要环节，也是辅助生育技术取得成功的关键。本文综述了辅助生育技术中常用的促超排卵药物的种类，其作用机理及配伍应用方式。以供借鉴。     

输卵管切除对超排卵时卵巢反应性的影响

目的了解输卵管切除对卵巢储备功能影响.方法选择行一输卵管的患者58例为单侧切除组,行双侧输卵管切除患者11例为双侧切除组,同期双侧输卵管均健在患者286例为未切除组,比较三组超排卵效果.结果 3组在用药天数、受精率、卵裂率、妊娠率差异均无显著.双侧切除组在卵泡数、获卵数与单侧切除组、未切除组比较,差异有显著性.而单侧以双侧切除组在促性腺激素(Gn)的用量与未切除组比较,差异有显著性.结论输卵管切除将降低超促排卵时卵巢对Gn的敏感性,使Gn的用量增加,但对于卵子质量无影响,不降低临床妊娠率.     

Triptorelin和Buserelin对不孕妇女体外受精一胚胎移植疗效的比较

目的　比较GnRH -a制剂Triptorelin和Buserelin的体外受精—胚胎移植治疗效果。方法　 185例不孕妇女随机分成两组 ,A组 :85例 ,黄体期应用Triptorelin(月经第 2 1d皮下一次性注射 1.2 5～ 1.6 0mg) ;B组 :10 0例 ,黄体期应用Buserelin。两组均用长方案降调节。比较两组的高纯度促卵泡刺激素用药剂量、取卵数、受精率、卵裂率和妊娠率。结果　两组的取卵数、受精率、卵裂率和妊娠率无显著性差异 (P >0 .0 5 )。A组平均每周期用高纯度卵泡刺激素 4 0 .3± 18.2支 ,B组平均每周期用 30 .2± 12 .3支 ,有显著性差异 (P <0 .0 1)。结论　Triptorelin和Buserelin的长方案均可获得高质量的成熟卵子 ,对不孕妇女的体外受精—胚胎移植治疗效果相似。Triptorelin的降调节作用较Buserelin的强。黄体期一次性皮下注射Triptorelin1.2 5～ 1.6 0mg可简化治疗过程 ,患者易于接受。     

不同光照制对小鼠超排卵的影响研究初报

目的 探讨不同光照制对小鼠卵母细胞成熟和激活的影响。方法 分别取四周和七周龄昆明种小鼠作短期持续光照，持续黑暗，反相光照1及24种光照制处理，观察小鼠超排卵母细胞数量。排极，存活率及乙醇孤雌激活率的变化。结果 4周龄，7周龄小鼠各实验组超排卵数目和乙醇孤雌激活率均显著低于对照组。反相光照1组（昼夜颠倒光照）卵母细胞存活率明显降低。但各实验组卵母细胞极体释放率与对照组相比均无显著性差异。结论 异常光照周期可影响小鼠卵母细胞的成熟和激活能力。     

短效达必佳两种剂量在超促排卵中的应用

目的寻求一种在体外受精-胚胎移植(IVF-ET)超排卵方案中既能使垂体降调节又不至于过度抑制卵巢功能的短效达必佳有效剂量.方法接受促超排卵长方案的149例患者,随机分为两组: A组73例,黄体中期予达必佳0.1mg,皮下注射7d后该为0.1mg,qod;B组76例,达必佳0.1mg,皮下注射,qod,至HCG日,比较促排卵治疗效果.结果B组取卵数明显大于A组(11.25±4.12:8.79±3.10),P＜0.05.Gn用量及用药时间、hCG注射日雌二醇(E2)水平、受精率、卵裂率、优质胚胎数、种植率、移植数、妊娠率等均无统计学差异(P＞0.05).二组均无内源性LH峰出现.结论减量达必佳能获得与常规剂量达必佳相同的治疗结果、且能提高取卵数及减少费用.     

长效曲普瑞林不同剂量在体外受精-胚胎移植中的治疗效果比较

目的探讨1/4支与1/2支长效曲普瑞林在体外受精-胚胎移植中的治疗效果。方法 290个长方案周期,根据基础窦卵泡数分为A组(15个)和B组(≥15个),两组内比较1/4支与1/2支长效曲普瑞林的治疗效果。结果促性腺激素(Gn)使用天数,两剂量无差异;Gn用量为1/4支组少于1/2支组,在A组有统计学意义(P0.05);hCG注射日血清LH水平为1/4支组高于1/2支组,无统计学意义,均无早发LH峰;hCG注射日血清E2为1/4支组显著高于1/2支组(P0.001),hCG注射日血清P水平为1/4支组高于1/2支组,胚胎种植率为1/4支组低于1/2支组,均在A组有统计学意义(P0.05);卵巢过度刺激综合症发生率为1/4支组高于1/2支组,在B组有统计学意义(P0.001);获卵数、正常受精数、优质胚胎数、妊娠率及流产率两剂量均无统计学意义。结论 1/4支和1/2支曲普瑞林均能达到可控制性超促排卵的降调效果;1/4支曲普瑞林在基础窦卵泡较少(15个)时能减少Gn用量;1/2支曲普瑞林在基础窦卵泡较多时(≥15个)能充分降调节,并能避免血清E2过高,减少卵巢过度刺激的风险,因此降调节时减少GnRHa的用量应当个体化。     

不同超排卵方案和小鼠品系来源的2-细胞期胚胎体外培养比较

目的比较激素注射间隔时间差异对昆明系小白鼠（KM小鼠）超数排卵的影响以及KM小鼠和ICR小鼠2-细胞胚胎的体外发育能力。方法29只KM小鼠随机分成两组,分别间隔48h和72h注射10IU的孕马血清（PMSG）和尿绒毛膜促性腺激素（HCG）,比较获取2-细胞胚胎数以及其体外发育能力的差异;分7次同时常规超排KM小鼠和ICR小鼠,体外培养2-细胞胚胎,记录囊胚形成数。结果48h超排卵组获取2-细胞期小鼠胚胎数目显著多于72h超排卵组（P〈0．01）,但前者的囊胚形成率却显著低于后者,两者间差异有统计学意义（P〈0．05）。KM小鼠和ICR小鼠2-细胞胚胎的囊胚形成率间无显著差异（P〉0．05）。结论间隔48h超排KM小鼠可获取较多胚胎,但间隔72h超排所获2-细胞期小鼠胚胎体外发育潜能好;小鼠品系不影响2-细胞胚胎的体外培养结果。     

Follicle-stimulating hormone receptor gene polymorphism and ovarian responses to controlled ovarian hyperstimulation for IVF-ET

This study was performed to investigate the association between FSH receptor (FSHR) gene polymorphism at position 680 and the outcomes of controlled ovarian hyperstimulation (COH) for in vitro fertilization and embryo transfer (IVF-ET) in Korean women. Two hundred and sixty-three patients under 40 years of age who underwent IVF-ET procedures were included in this study. Patients with polycystic ovary syndrome, endometriosis, or a previous history of ovarian surgery were excluded. Following extraction of genomic DNA, the FSHR polymorphism at position 680 was determined by polymerase chain reaction and restriction fragment length polymorphism analysis. The FSHR genotype distribution was 41.8% for Asn/Asn, 45.6% for Asn/Ser, and 12.5% for Ser/Ser FSHR genotype groups. Although there was no difference among the three genotype groups in terms of the age and infertility diagnosis of study subjects, the basal levels of FSH (day 3) were significantly different [5.7 ± 0.3 IU/l (mean±SEM), 6.0 ± 0.3 IU/l, and 8.2 ± 0.9 IU/l for Asn/Asn, Asn/Ser, and Ser/Ser groups, respectively. The Ser/Ser group tended to require a higher dose of gonadotropins for COH, and tended to show lower serum estradiol levels at the time of hCG administration than the other two groups, though these differences did not reach statistical significance. The numbers of oocytes retrieved tended to be different for the three groups (9.6 ± 0.6, 10.2 ± 0.6, and 7.9 ± 0.8 for Asn/Asn, Asn/Ser, and Ser/Ser groups, respectively). Clinical pregnancy rate was significantly higher in Asn/Asn, compared to the others (45.7 vs. 30.5%, P=0.013). The homozygous Ser/Ser genotype of FSHR polymorphism at position 680 may be associated with a reduced ovarian response to COH for IVF-ET, while Asn/Asn genotypes showed a higher pregnancy rate.     

促超排卵时相与临床妊娠率关系的初步研究

目的研究IVF-ET及ICSI过程中控制性促超排卵的时相与临床妊娠率之间的关系,及其对胚胎质量、子宫内膜状态的影响.方法选取本院生殖中心的112个IVF-ET及ICSI周期,包括黄体中期长方案、短方案、超短方案等模拟自然周期的促超排卵方案,研究促性腺激素(Gn)启动日、Gn使用天数、hCG日等时相性因素与临床妊娠率之间的关系,并分析Cn使用天数对胚胎质量及hCG日对子宫内膜状态的影响.结果Gn启动日与临床妊娠率无显著相关性,Gn使用天数为9～10d或hCG日在月经第12～14d的临床妊娠率显著升高(P分别＜0.01及=0.001),而且,Gn使用天数为9～10d所获得的胚胎质量提高(P＜0.05).结论IVF-ET及ICSI的临床妊娠率与促超排卵的时相相关,适当的Gn使用天数可以提高胚胎质量、适宜的hCG日则通过同步胚胎与子宫内膜的发育发挥作用.     

Vascular endothelial growth factor levels in serum and plasma from patients undergoing controlled ovarian hyperstimulation for IVF

BACKGROUND: Vascular endothelial growth factor (VEGF) has been investigated as a marker of ovarian response to controlled ovarian hyperstimulation and as a predictor of ovarian hyperstimulation syndrome (OHSS) in IVF cycles. In most studies, serum has been used for circulating VEGF concentration measurement, but it has been suggested that plasma is the preferred medium to measure VEGF levels because of the potential contribution of VEGF released from platelets during blood clotting. This study investigated VEGF concentrations in paired serum and plasma samples from patients undergoing controlled ovarian hyperstimulation for IVF. METHODS: Serum and plasma VEGF levels, as well as the number of platelets, were measured in 30 IVF patients who comprised three study groups delineated according to the estradiol (E(2)) serum concentration reached on the day of HCG administration: 10 patients having low E(2) serum levels (<1500 pg/ml, group L), 10 patients having intermediate E(2) serum levels (1500-3000 pg/ml, group I) and 10 patients having high E(2) serum levels (>3000 pg/ml, group H). RESULTS: There was a statistically significant correlation between plasma and serum VEGF levels (rho = 0.61; P < 0.005) for the entire population studied, although serum values were higher by a factor of approximately 6-fold. No significant correlation was found between peripheral blood VEGF concentrations and serum E(2) or follicle number on HCG day or the number of oocytes collected. Similarly, paired serum and plasma VEGF measurements did not correlate with platelet count. CONCLUSIONS: Serum and plasma VEGF concentrations are strongly correlated in paired samples from infertile patients undergoing controlled ovarian hyperstimulation. However, neither serum nor plasma VEGF levels were correlated with parameters associated with ovarian follicular activity. Peripheral blood VEGF levels were not correlated with platelet count.     

Are there predictive criteria of complicated ovarian hyperstimulation in IVF?

Among 599 trials of in-vitro fertilization (IVF) treatment, complicated ovarian hyperstimulation (OHSS) was diagnosed in 14 cases (2.5%) on the basis of heavy abdominal discomfort and echographic findings (ascites, ovarian enlargement with cysts). Among eight hospitalized patients, four presented with a haemoconcentration and/or electrolytic disturbances. OHSS cases were compared with two control groups for a series of criteria: age, aetiology of infertility, total dose of human menopausal gonadotrophin (HMG), day of oocyte collection, oestradiol (E2) peak level, rate of E2 increase, number of oocytes, number of embryos transferred and embryonic vitality scores. Comparison with a random group of normal IVF trials showed a significant difference for the following parameters: E2 peak level and rate of increase, E2/dose of HMG, E2/day of egg collection and number of oocytes. When OHSS cases were compared to another control group consisting only of high E2 responders (peak E2 greater than 2700 pg/ml), no significant difference was found for any of the above-mentioned criteria. In view of this lack of predictive power of individual criteria, stepwise discriminant analysis was applied, showing that this method might provide a predictive mathematical function for evaluating the risk of OHSS before human chorionic gonadotrophin (HCG) administration. Such a formula, however, should be validated by a multicentric study in which a greater number of OHSS cases would be tested.     

Increased early pregnancy loss in IVF patients with severe ovarian hyperstimulation syndrome.

BACKGROUND: Since severe ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication of assisted reproduction, the focus of attention in such cases is placed firmly upon the health of the patient, with the endeavour to achieve a pregnancy being considered of secondary importance. The aim of this study was to focus on the pregnancy rate and pregnancy outcome in IVF patients hospitalized for severe or critical OHSS, in one centre, during a period of 6 years. METHODS: We compared the characteristics of patients with severe OHSS: those who conceived with the ones who did not conceive, and among pregnant IVF patients, those with ongoing pregnancies with those that miscarried. RESULTS: Pregnancy was achieved in 60 of 104 (58%) patients with severe OHSS. Pregnancy continued until delivery in 37 of these 60 patients (62%), whereas the remaining 23 (38%) aborted. The pregnancy and abortion rates in patients with severe OHSS were significantly higher than those of IVF patients without OHSS, during the same time period [23% (1138/4922) and 15% (169/1138) respectively, P < 0.001]. The mean duration of hospitalization for OHSS was significantly shorter in those who delivered compared with those who aborted (5.9 +/- 3.2 versus 10.5 +/- 9.6 days, P < 0.01) and in the non-pregnant patients compared with the pregnant patients (5.2 +/- 3.2 versus 7.6 +/- 6.6 days, P < 0.02). CONCLUSIONS: The clinical pregnancy rate of IVF patients with severe OHSS was significantly higher than that of patients without the syndrome. A longer stay in hospital-reflecting a more severe form of OHSS-was correlated with a higher frequency of abortions. OHSS, necessitating hospitalization, is a detrimental clinical situation not only for the mother but also for the developing pregnancy.     

Metabolic characteristics of women who developed ovarian hyperstimulation syndrome

BACKGROUND: The aim of this study was to investigate whether a higher incidence of hyperinsulinism is found in women who have suffered from ovarian hyperstimulation syndrome (OHSS) as compared with other IVF patients. Additionally, we also assessed whether any abnormalities in the haemostatic system were more frequent in women with a past history of OHSS. METHODS: A pilot study was carried out involving OHSS patients and matched IVF patients. Homeostasis model assessment (HOMA) of insulin sensitivity was calculated. The main outcome measures were: insulin sensitivity, coagulation anomalies, factor V Leiden mutations, methylene tetrahydrofolate reductase (MTHFR) polymorphism and prothrombin gene mutation, protein C and protein S deficiency. RESULTS: No increased incidence in hyperinsulism nor in abnormalities of the haemostatic system were observed. CONCLUSIONS: This pilot study does not provide evidence for an increased prevalence of hyperinsulinism among women who have developed OHSS in the past.     

控制性超排卵的异常反应-41例宫腔积液临床分析

目的探讨控制性超排卵（COH）中宫腔积液的发生因素及其对精子运动功能的影响。方法回顾性分析54例出现宫腔积液的临床资料，其中13例进行宫腔积液抽吸，并将抽吸液作为培养基（实验组）与精子培养液（对照组）共同培养精子，观察精子的运动功能变化情况。结果控制性超排卵1091个周期，41个周期出现宫腔积液，发生率为3．76％。其中19个周期存在促性腺激素的减量，减量周期共197个，发生率为9．64％；无减量周期共894个，22个周期出现宫腔积液，发生率为2．46％，有显著性差异（P〈0.05=。培养精子结果两纽间比较，试验组的活力、活率较对照组降低（P〈0．05）。结论控制性超排卵中的药物剂量的调整-减量是导致宫腔积液的高发因素；宫腔内积液对精子的运动功能存在影响（P〈0．05=。     

Controlled ovarian hyperstimulation (COH) parameters associated with euploidy rates in donor oocytes

Although oocyte donors are young and are expected to provide a high rate of euploid oocytes, significant differences of euploidy rates for donor embryos exist between different IVF centers (1). Laboratory conditions can lead to differences of euploidy (2,3,4,5,6,7); but, the role of COH has not been investigated. In this study, we investigated whether euploidy rates in the embryos created from donor oocytes are influenced by controlled ovarian hyperstimulation parameters used during assisted reproduction. Euploidy rates in egg donor cycles undergoing PGT-A (N = 423) were examined retrospectively for associations with donor age, gonadotropin doses (dose per day), the fraction of gonadotropin provided by hMG (F(hMG)), days of stimulation, estradiol per mature oocyte on day of trigger, number of mature oocytes retrieved, number of embryos biopsied, incidence of euploidy and physician of record. Differences in euploidy rates between physicians were examined using analysis of variance. The proportion of euploid embryos per donor cycle was examined for associations with COH parameters using pairwise post-hoc comparisons, adjusting for multiple testing. The set of variables from this analysis was then submitted to a principal component analysis. Linear regression analysis was used to assess the relationships between stimulation parameters and the incidence of euploidy (the dependent variable). Euploidy rates and cycle parameters varied significantly among treating physicians. Euploidy rates (expressed as a fraction of biopsied embryos) were associated (p = 0.01) only with the F(hMG) but not with the number of MII retrieved or other variables. On the other hand, the number of euploid embryos (in contrast to the euploidy rate) was associated with the number of MII produced. Donor euploidy rates are significantly associated with the fraction of total gonadotropin comprising human menopausal gonadotropin (or F(hMG)) during controlled ovarian hyperstimulation but are not associated with other cycle parameters. The study provides the first suggestion that patient stimulation parameters can affect the incidence of euploidy in embryos generated through the use of standard assisted reproductive techniques. The study is limited by its retrospective approach and because the aCGH analysis used is less sensitive than more recent NGS technology. Further, it provides a suggestion that the use of hMG is beneficial for obtaining euploid embryos.     

Serum anti-Mullerian hormone levels during controlled ovarian hyperstimulation in women with polycystic ovaries with and without hyperandrogenism

BACKGROUND: Anti-Mullerian hormone (AMH) is expressed in pre- and small-antral follicles. High serum levels are found in women with polycystic ovaries (PCO), accordant with their increased content of small follicles. To evaluate the relationship between AMH, folliculogenesis and hyperandrogenism, we compared serum AMH levels between women with PCO with and without hyperandrogenism and normal controls during controlled ovarian hyperstimulation (COH). METHODS: Nineteen women with PCO and hyperandrogenism (group A), 10 women with PCO but no hyperandrogenism (group B) and 23 ovulatory women with normal ovarian morphology (group C, controls) underwent COH with the long protocol. Serum levels of AMH, estradiol, androstenedione and follicular tracking were determined before gonadotropins treatment (day 0) and every 2-4 days up to the day of HCG administration. RESULTS: AMH levels declined gradually throughout COH in the three groups, but remained higher in groups A and B compared with the controls. Significantly higher levels were found in group A compared with group B, despite comparable numbers of small follicles. Multiple regression analysis revealed that both the number of small follicles and serum androgens were correlated to AMH. CONCLUSIONS: Women with PCO have higher serum AMH levels during COH than controls. Hyperandrogenism is associated with an additional increase in AMH. It is conceivable that hyperandrogenism may reflect more severe disruption of folliculogenesis in women with PCO or may affect AMH secretion.