卵母细胞玻璃化冷冻的临床结局分析

目的探讨卵母细胞玻璃化冷冻后解冻行体外受精-胚胎移植的临床结局。方法回顾性分析2010年1月至2014年10月北京大学第三医院生殖医学中心68例不孕症患者卵母细胞玻璃化冷冻后解冻行体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)的复苏率、2PN受精率、胚胎着床率、流产率和分娩率等临床结局。结果解冻玻璃化冻存的卵母细胞756枚,复苏率80.69%(610/756),其中MII卵母细胞519枚,2PN受精率53.56%(278/519)。68例患者中,12例无胚胎形成,占17.65%。56例患者共移植66个周期,其中新鲜胚胎移植51个周期,解冻胚胎移植15个周期。新鲜胚胎移植51个周期的临床妊娠率为54.90%(28/51),活胎分娩率为45.10%(23/51)。解冻胚胎移植15个周期的临床妊娠率为60.00%(9/15),活胎分娩率为46.67%(7/15)。累积妊娠率为55.88%(38/68)。每解冻一枚卵母细胞获得活胎分娩率为5.03%(38/756)。结论卵母细胞玻璃化冷冻技术在取卵日不能获得精子的患者中应用,可以获得良好的妊娠结局。     

人成熟卵母细胞玻璃化冻存时长对体外受精-胚胎移植结局的影响

目的:探讨玻璃化冷冻人成熟卵母细胞的时长是否会影响解冻后卵细胞的复苏率、受精率和临床妊娠结局。方法:回顾性分析2013年5月至2018年6月就诊于北京大学第三医院生殖医学中心行成熟卵母细胞玻璃化冷冻,随后进行解冻受精形成胚胎培养移植的110例患者114个冷冻卵母细胞周期的临床资料。根据卵细胞冻存时间分为3组,A组(冻存时间≤3个月)42例,B组(3个月<冻存时间≤12个月)42例,C组(冻存时间>12个月)30例,比较3组的卵细胞解冻复苏率、受精率、可利用胚胎率、优质胚胎率、临床妊娠率和活产率等指标。结果:114个冷冻卵母细胞周期中最短冻存时间4天,最长32个月,共行胚胎移植周期114个,其中新鲜胚胎移植周期77个,解冻胚胎移植周期37个。共解冻成熟卵母细胞1578枚,复苏率为77.69%(1226/1578)、受精率为69.35%(774/1116)、卵裂率为93.41%(723/774)、可移植胚胎率为42.19%(305/723)、优质胚胎率为33.06%(239/723)、每冻卵活产率为2.47%(39/1578)。3组年龄、不孕年限、基础卵泡刺激素(FSH)水平、窦卵泡数、解冻卵细胞数和男方精液情况等基本信息差异无统计学意义(P>0.05),而A组体质量指数(BMI)明显大于B组(P=0.038);3组的解冻复苏率、受精率、卵裂率、可利用胚胎率、优质胚胎率、临床妊娠率、早期流产率和活产率的差异均无统计学意义(P>0.05)。随访25例活产新生儿均未发现先天畸形。结论:人成熟卵母细胞的发育潜能不会随着冷冻时间的延长而减低,玻璃化冷冻卵母细胞可获得比较满意的复苏效果。     

培养液中添加不同促性腺激素对卵母细胞体外成熟的影响

目的:比较卵母细胞体外成熟培养液中添加不同促性腺激素对未成熟卵母细胞体外成熟结局的影响。方法:将行卵母细胞体外成熟(IVM)的35例患者共42个新鲜取卵周期,随机分成A组:22个取卵周期将重组人促卵泡激素(果纳芬,rFSH)和重组人绒毛膜促性腺激素(艾泽,hCG)按1∶1的比例混合添加,终浓度为75 mIU/ml;B组:20个取卵周期添加终浓度为75 mIU/ml的尿源性促性腺激素(hMG),进行未成熟卵母细胞体外成熟培养。35例患者中新鲜取卵周期未移植或移植后未孕者行解冻胚胎移植。比较组间患者的卵母细胞成熟率、受精率、卵裂率、优质胚胎率、累计临床妊娠率及胚胎着床率。结果:取卵均于月经周期第12日或最大卵泡发育至10￣12 mm时进行,故所获卵均为未成熟卵。A组获卵181枚,经培养后成熟84枚,行卵胞浆内单精子注射(ICSI)84枚,受精60枚,卵裂55枚,优质胚胎20枚;新鲜胚胎移植9例,获1例临床妊娠,解冻胚胎移植5例,获1例临床妊娠,累计临床妊娠率为14.29%,胚胎着床率为7.14%。B组获卵176枚,经培养后成熟120枚,行ICSI 120枚,受精97枚,卵裂90枚,优质胚胎41枚,新鲜胚胎移植6例,获4例临床妊娠,解冻胚胎移植9例,获3例临床妊娠,累计临床妊娠率为46.67%,胚胎着床率为33.33%。结论:卵母细胞体外成熟培养液中添加尿源性促性腺激素可获得较添加重组人促卵泡激素和重组人绒毛膜促性腺激素高的卵母细胞成熟率、临床妊娠率及胚胎着床率。     

卵子玻璃化冷冻在辅助生殖技术治疗中的临床应用

目的探讨卵子冷冻以及冻卵冻胚(卵裂胚及囊胚)双次冷冻在辅助生殖技术(ART)中临床应用的安全性和可行性。方法回顾性分析2014年1月—2017年12月期间行卵子玻璃化冷冻,随后解冻并后续培养移植共164个周期,其中新鲜胚胎移植组解冻卵88个周期,冻融胚胎移植卵裂胚组冻卵冻胚40个周期,冻融胚胎移植囊胚组冻卵冻囊胚36个周期,并分别以同期未行卵子冷冻的新鲜胚胎(n=1 480)、解冻胚胎(n=246)、解冻囊胚(n=304)移植作为对照,比较卵子受精率、卵裂率及可利用胚胎率,以及各组的复苏率、后续的着床率、临床妊娠率、早期流产率、活产率等指标。结果解冻卵复苏存活率为[94.00%(999/1 063)]。解冻卵受精率[84.00%(838/999)]优于新鲜卵子受精率[72.67%(10 703/14 729)],组间差异有统计学意义(P=0.00),第3日可利用胚胎率、冻融后存活率、着床率、临床妊娠率、早期流产率、活产率差异均无统计学意义(P0.05)。结论卵子冷冻不会降低卵子的发育潜能,冷冻后可获得比较满意的复苏效果,行卵胞质内单精子显微注射(ICSI)仍可获得较好的妊娠和活产结局,对于需要保存生育力的女性来说卵子冷冻是一种较为安全有效的方法。     

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.     

人工皱缩囊胚腔对囊胚玻璃化冷冻后妊娠结局的影响

目的 探讨人工皱缩囊胚腔对囊胚玻璃化冷冻的效果、妊娠结局及新生儿的影响.方法 2006年1月至2009年12月,选择在广西壮族自治区妇幼保健院生殖医学中心接受体外受精-胚胎移植(IVF-ET)或卵母细胞胞质内单精子注射(ICSI)治疗的患者,新鲜胚胎移植妊娠失败后要求行冻融囊胚移植的342个周期,其中,314个周期的囊胚在玻璃化冷冻前,用显微注射针刺入囊胚腔内抽出囊胚液使之皱缩,然后以玻璃微细管为载体行玻璃化冷冻(皱缩组),28个周期未行囊胚腔人工皱缩(未皱缩组).比较两组经冷冻、复苏及移植后的胚胎存活率、种植率、临床妊娠率和取消移植率等.在已妊娠者中,比较两组的流产率、活胎分娩率、分娩孕周、新生儿出生缺陷发生率、新生儿平均出生体质量等,并与同期新鲜移植周期(新鲜周期组,520个周期)进行比较.结果 皱缩组胚胎存活率、种植率及临床妊娠率分别为95.3%(403/423)、38.0%(153/403)、44.6%(140/314),未皱缩组分别为64.3%(27/42)、7.4%(2/27)、7.1%(2/28),分别比较,差异均有统计学意义(P＜0.05);皱缩组取消移植率为0,未皱缩组为25.0%(7/28),两组比较,差异也有统计学意义(P＜0.05).皱缩组的流产率[18.2%(10/55)]、活胎分娩率[80.0%(44/55)]、分娩孕周[(38.2±1.3)周]、新生儿出生缺陷发生率[2.1%(1/47)]、新生儿平均出生体质量[(2989±640)g]与新鲜周期组[17.5%(91/520)、74.0%(385/520)、(37.9±2.3)周、1.7%(8/479)、(2856±640)g]比较,差异均无统计学意义(P＞0.05).结论 人工皱缩囊胚腔能明显提高囊胚玻璃化冷冻效果,并且新生儿先天异常发生率无明显升高.     

玻璃化冷冻保存技术对体外成熟卵母细胞发育潜能和转录组的影响

目的探索玻璃化冷冻保存技术对体外成熟(in vitro maturation,IVM)卵母细胞发育潜能和转录组的影响。方法选择2014年9月—2016年3月期间在北京大学第三医院生殖医学中心接受腹腔镜手术联合经阴道穿刺取卵行卵母细胞IVM治疗的不孕症患者为研究对象进行前瞻性队列研究,将研究对象分为IVM组(A组,n=13)和IVM-冻卵组(B组,n=24)。分析卵母细胞的早期胚胎发育状况和单细胞水平的转录组学情况。结果 IVM后玻璃化冷冻-解冻对存活卵母细胞的早期胚胎发育没有明显影响,受精率、卵裂率、优质胚胎率和可移植胚胎率组间差异均无统计学意义。但IVM后行玻璃化冷冻-解冻对转录组存在一定影响,与A组相比,B组共有1 913个基因呈现差异表达,其中570个基因表达量升高,主要富集到59个生物学过程;1 343个基因表达量降低,主要富集到140个生物学过程,而且一些差异基因参与了卵母细胞质量、受精和胚胎发育潜能的调控。结论 IVM后行玻璃化冷冻-解冻对早期胚胎发育没有明显影响,但对转录组具有一定影响,且发生表达量变化的基因与卵母细胞质量、受精和胚胎发育潜能有关,提示玻璃化冷冻-解冻有可能影响子代安全性。     

雌孕激素水平与胚胎移植助孕后异位妊娠相关性探讨

目的 探讨超生理雌孕激素水平在胚胎移植助孕后异位妊娠发生中的意义.方法 对1997年9月至2006年10月在河北医科大学第二医院生殖医学科行新鲜胚胎和冻融胚胎移植获得妊娠407周期进行回顾性分析.结果 新鲜胚胎和冻融胚胎移植周期异位妊娠率分别为7.45%、1.18%,差异有统计学意义(X2=4.5958,P=0.0321).新鲜周期中异位妊娠组与非异位妊娠组输卵管因素比例分别为79.2%、56.4%.异位妊娠组胚胎移植后3d血清孕酮[(120.1±32.3)nmoL/L]明显高于非异位妊娠组[(89.7±43.7)nmol/L],差异均有统计学意义(P<0.05).结论 超生理雌孕激素水平及其比例失调可能与胚胎移植助孕后异位妊娠发生有关,并在异位妊娠的发生中与输卵管受损联合起作用.     

囊胚玻璃化冷冻复融移植的临床效果分析

目的:探讨全囊胚玻璃化冷冻的临床价值。方法:回顾分析2010年1月至2012年12月在河南省人民医院生殖医学研究所行体外受精-胚胎移植(IVF-ET),且因OHSS高危倾向行全胚玻璃化冷冻复融移植周期的不孕患者的临床资料。根据冷冻和培养方式分为A组(复融胚胎移植,784例)、B组(复融囊胚移植,199例)和C组(复融胚胎行囊胚培养后移植,124例)。比较3组患者的基本资料、IVF治疗的妊娠结局。结果:C组患者中3例因未形成囊胚而取消周期,其余121例患者移植后有33枚囊胚需再次冷冻。3组患者的平均移植胚胎数、种植率、临床妊娠率、多胎率、早期流产率比较,差异显著(P0.05)。B、C组患者的种植率、妊娠率、多胎率均显著高于A组(P0.05),平均移植胚胎数、早期流产率均显著少于A组(P0.05)。结论:对可能发生OHSS的全胚冷冻患者,胚胎个数较多时,行囊胚培养后玻璃化冷冻,择期复融移植能提高患者的种植率和妊娠率,同时也减少了患者的费用,是目前最佳的冷冻策略和最有益的冷冻方案。     

玻璃化冷冻法和程序化冷冻法对人卵裂期胚胎冷冻复苏效果的比较

目的:比较辅助生殖技术中玻璃化和程序化2种冷冻方法对卵裂期胚胎的冷冻复苏效果。方法:对265个玻璃化冷冻周期和276个程序化冷冻周期的相关资料进行回顾性统计学分析,比较冷冻胚胎复苏后的胚胎存活率、胚胎种植率和临床妊娠率等指标。结果:玻璃化冷冻复苏265个周期,解冻809个胚胎,存活710个(87.8%),移植259个周期,临床妊娠98个周期(37.8%),其中双胎妊娠26例,三胎妊娠3例。程序冷冻复苏276个周期,解冻968个胚胎,存活532个(55.0%),移植246个周期,临床妊娠70例(28.5%),其中双胎妊娠4例,三胎妊娠1例。玻璃化冷冻后的胚胎存活率和完整性胚胎存活率均显著高于程序化冷冻,复苏周期移植取消率显著低于程序化冷冻,而临床妊娠率则明显高于程序化冷冻,差异均有统计学意义(P<0.05)。但2种方法的胚胎种植率无统计学差异(P>0.05)。结论:玻璃化法能够较好地避免冷冻引起的损伤,适用于卵裂期胚胎的冷冻保存。     

Timing of human chorionic gonadotrophin (hCG) hormone administration in IVF protocols using GnRH antagonists: a randomized controlled trial

This randomized controlled trial investigated whether delaying human chorionic gonadotrophin hormone (hCG) administration within an IVF cycle impacts upon clinical outcomes. Participants included 125 women undergoing IVF/ICSI cycles at Leeds Centre for Reproductive Medicine. Subjects were aged 20-36 years, body mass index (BMI) 20-30?kg/m(2) with a normal FSH level (<8 IU/l). Administration of hCG took place 35-36?h prior to oocyte retrieval when there were ≥3 follicles ≥17?mm in diameter (Group A), delayed by 1 day (Group B) or 2 days (Group C). Outcomes included the number of oocytes retrieved per cycle, fertilization rate and live birth rate. On the day of oocyte retrieval, women in Groups B and C had significantly more mature follicles than Group A, although the number of oocytes retrieved did not differ (median = 12 in each group). Fertilization rates and embryo quality were comparable between groups. Pregnancies and live births per cycle were higher in Groups B and C (A = 30.8%, B = 54.1%, C = 38.7%; A = 17.9%, B = 27.0%, C = 25.8%), but did not reach statistical significance. Delaying hCG administration had no significant negative impact upon morphological quality of embryos, availability of surplus embryos for freezing or pregnancy outcomes. Postponing hCG may enable increased flexibility of cycle scheduling to avoid weekend procedures.     

Freezing spermatozoa obtained by testicular fine needle aspiration: a new technique

Testicular fine needle aspiration (TEFNA) of spermatozoa in azoospermic patients in advance of intracytoplasmic sperm injection could be useful to avoid the possibility of no recovery of spermatozoa on the day of oocyte retrieval. The conventional freezing procedure for these spermatozoa is not appropriate because of their very low number and poor in-situ motility. This article presents a new procedure for the freezing of TEFNA-recovered spermatozoa. A total of 1063 spermatozoa (10-340 cells/sample) were frozen by this method for research purposes. Before freezing, 13.7% were motile. The recovery rate after thawing was 100%. After thawing, 3.6% motility was observed. In a separate study group, the total number of frozen spermatozoa was 431 (2-300 cells/sample). Before freezing, the sperm motility rate was 3.5%. After thawing, 100% of the spermatozoa were retrieved with a motility rate of 2.3%. One biochemical pregnancy was obtained. The procedure yielded excellent recovery and good motility rates after thawing. However, because of the low number of cases, any conclusion about the efficiency of the technique is premature.     

种植窗口期宫腔镜检查对原因不明不孕症患者子宫内膜容受性及妊娠结局的预测价值

目的 探讨种植窗口期官腔镜检查用于预测原因不明不孕症患者子宫内膜容受性及妊娠结局的价值.方法 选择2007年10月-2009年3月在广东省计划生育专科医院就诊的原因不明不孕症患者93例,在排卵后7～9 d(即种植窗口期)行宫腔镜检查,将其中未发现官腔病变的79例患者根据宫腔镜下子宫内膜腺体开口和血管的形态分为佳型内膜组19例、差型内膜组60例.比较两组患者子宫内膜的形态、厚度、分泌情况、胞饮突形态及数量、血管分布等,以及两组患者的血性激素水平、宫腔冲洗液中白血病抑制因子(LlF)及妊娠相关子宫内膜蛋白glycodelin水平、妊娠结局等.结果 (1)佳型内膜组患者种植窗口期血雌二醇、孕酮水平分别为(518±176)pmol/L、(40±20)nmol/L,分别与差型内膜组[分别为(513±244)pmoL/L、(37±19)nmol/L]比较,差异均无统计学意义(P>0.05).B超检查显示,佳型内膜组排卵日、种植窗口期子宫内膜厚度分别为(1.06±0.10)cm和(1.16±0.08)cm,分别与差型内膜组[分别为(0.93±0.12)cm和(1.02±0.10)cm]比较,差异均无统计学意义(P>0.05);佳型内膜组患者排卵日内膜形态为A、B、C型者分别占63%(12/19)、37%(7/19)和0(0/19),差型内膜组分别占23%(14/60)、77%(46/60)和0(0/60),两组A、B型内膜百分率分别比较,差异均有统计学意义(P<0.05);两组患者种植窗口期内膜形态均为B型.(2)佳型内膜组患者中89%(17/19)子宫内膜分泌正常,差型内膜组患者中仅7%(4/60)子宫内膜分泌正常,两组比较,差异有统计学意义(P<0.01).(3)佳型内膜组患者中,胞饮突形态为成熟期者占84%(16/19),胞饮突数量丰富者占89%(17/19),均明显高于差型内膜组[分别为42%(25/60)和57%(34/60),P<0.05].(4)佳型内膜组内膜中CD_(34)表达水平及微血管密度(MVD)分别为(40.1±1.2)阳性单位(PU)和(21.7±4.0)条/高倍视野(HP),均明显高于差型内膜组[分别为(18.1±1.3)PU和(8.5±1.3)条/HP,P均<0.01].(5)佳型内膜组宫腔冲洗液中LIF、glycodelin水平分别为(72±54)ng/L和(196±20)μg/L,均明显高于差型内膜组[分别为(15±16)ng/L和(116±26)μg/L,P均<0.05].(6)佳型内膜组患者临床妊娠率、自然流产率、足月分娩率分别为74%(14/19)、0(0/14)和100%(14/14),差型内膜组分别为23%(14/60)、14%(2/14)和86%(12/14),佳型内膜组的临床妊娠率及足月分娩率均明显高于差型内膜组(P<0.01).结论 种植窗口期宫腔镜检查能反映子宫内膜血管及腺体的发育水平,是一种较好的评估子宫内膜容受性的方法,对预测妊娠结局有一定的价值.     

Optimal embryo transfer strategy in poor response may include freeze-all

Purpose

In this retrospective cohort study, we investigated the best embryo transfer strategy in ICSI cycles with ≤4 oocytes collected at oocyte retrieval.

Methods

Women who underwent antagonist co-treatment COS for ICSI treatment between January 2010 and December 2015 at a private ART clinic (N?=?2263). Eight hundred seventy-nine women (group 1) had ≤4 oocytes collected at oocyte retrieval, of whom 645 (group A) had cleavage stage embryo transfer (ET), and 234 (group B) had blastocyst ET. One thousand three hundred eighty-four women (group 2) had 10–15 oocytes collected at oocyte retrieval, of whom 676 (group C) had cleavage stage ET, and 708 women (group D) had blastocyst ET. Blastocyst vitrification was performed using the Cryotop method and FET using artificial cycles.

Results

In group 1, the cancellation rate was significantly lower in group A (25.2 vs 38 %). The pregnancy rate (PR), clinical PR, implantation rate (IR), and live birth rate (LBR) per ET and per oocyte retrieval were all lower in group A. The clinical PR, IR, and LBR per ET of vitrified-warmed blastocyst ET were significantly the highest. In group 2, the cycle cancellation rate was significantly lower in group C (3.5 vs 13.4 %). The PR, clinical PR, and IR per ET and per oocyte retrieval were all lower in group C. The LBR per ET was significantly lower, but the LBR per oocyte retrieval was not significantly lower in group C. Again, the PR, clinical PR, and IR per ET of vitrified-warmed blastocyst ET were significantly the highest.

Conclusions

Day 5 ET strategy has been reserved for normal or high responders. The improved pregnancy outcomes from blastocyst culture and cryopreservation may challenge ART to extend this benefit to poor responders.

     

不同促排卵方案对子宫内膜异位症妊娠结局的影响因素分析

目的:了解不同促排卵方案对行体外受精-胚胎移植( IVF-ET)子宫内膜异位症(EMT)患者妊娠结局的影响.方法:回顾性分析安徽医科大学第一附属医院生殖医学中心2008年1月至2010年3月因EMT行IVF-ET共262周期的临床资料,根据超促排卵方案不同分为超长方案组、短方案组和长方案组,比较3组间年龄、不孕类型、不孕年限、降调前CA125值、基础FSH、LH、E2水平、基础窦卵泡数、Gn启动量、Gn天数、Gn总量、取卵日E2、P、LH水平、子宫内膜厚度、获卵率、优质胚胎率和临床妊娠率,以及超长方案组降调后血清CA125水平与临床妊娠率的关系.结果:①短方案组年龄大于超长方案组和长方案组(P＜0.05),而3组患者不孕类型和不孕年限比较,差异无统计学意义(P＞0.05);②短方案组基础FSH水平、Gn启动量、取卵日LH值均较超长方案组及长方案组高(P＜0.05);短方案组基础窦卵泡数、Gn天数、Gn用量、取卵日子宫内膜厚度及获卵数均少于其他两组(P＜0.05);超长方案组降调前CA125值大于短方案组及长方案组(P＜0.05).③超长方案组降调后CA125值≤10 KU/L的妊娠率(40.91％)与10～20 KU/L和＞20 KU/L水平的妊娠率(18.31％和17.65％)比较,差异有统计学意义(P＜0.05).结论:对于轻度EMT患者早期发现、早期选择辅助生殖技术治疗可以有效增加临床妊娠率,中重度患者采用超长方案同时检测血清CA125水平,对判断妊娠结局有辅助指导意义.     

The Effect of Endometrial Polyps on Outcomes of In Vitro Fertilization (IVF) Cycles

Purpose: Our purpose was to investigate the effect of endometrial polyps on pregnancy outcome in an in vitro fertilization (IVF) program. Methods: Endometrial polyps less than 2 cm in diameter were suspected by transvaginal ultrasound before oocyte recovery in 83 patients. Forty-nine women (Group I) had standard IVF–embryo transfer, while in 34 women (Group II) hysteroscopy and polypectomy were performed immediately following oocyte retrieval, the suitable embryos were all frozen, and the replacement cycle took place a few months later. Results: Of the 32 hysteroscopies, a polyp was diagnosed in 24 cases (75%) and polypoid endometrium in another 5 patients (15.6%). An endometrial polyp was confirmed by histopathological examination in 14 women (58.3%). The pregnancy rate in group I was similar to the general pregnancy rate of our unit over the same period (22.4 vs 23.4%) but the miscarriage rate was higher (27.3 vs 10.7%, P = 0.08). In Group II, the pregnancy and miscarriage rates were similar to those of the frozen embryo cycles at Bourn Hall (30.4 and 14.3 vs 22.3 and 12.1%, respectively). Conclusions: Small endometrial polyps, less than 2 cm, do not decrease the pregnancy rate, but there is a trend toward increased pregnancy loss. A policy of oocyte retrieval, polypectomy, freezing the embryos, and replacing them in the future might increase the take-home baby rate.     

Results of prednisolone given to improve the outcome of in vitro fertilization-embryo transfer in women with antinuclear antibodies

OBJECTIVE: To evaluate the association of antinuclear antibodies (ANA) with outcome of in vitro fertilization-embryo transfer (IVF-ET) as well as the effect of short-term immunosuppression with prednisolone on implantation, clinical pregnancy and live birth rates following IVF-ET. STUDY DESIGN: The study group consisted of 120 women, 22-42 years old, in whom IVF-ET was performed and whose ANA could be measured. Prednisolone (15-60 mg/d for 5 days) was administered starting 1 day after oocyte retrieval to some women with or without ANA, without randomization. The 223 IVF-ET cycles were divided into prednisolone-nontreated ANA-negative cycles, prednisolone-treated ANA-negative cycles, prednisolone-nontreated ANA-positive cycles and prednisolone-treated ANA-positive cycles. Retrospective analysis of rates of implantation, clinical pregnancy, and live birth were evaluated in the four groups. RESULTS: Overall, ANA positivity was noted in 20.0% of subjects (24/120) and 25.1% of cycles (56/223). Implantation and clinical pregnancy rates in the prednisolone-nontreated ANA-positive group were 0% (0/41 transplanted embryos) and 0% (0/15 cycles), significantly lower than in the other groups. The live birth rate in this group was significantly lower than in the prednisolone-nontreated ANA-negative group and non-significantly tended to be lower than in the other 2 CONCLUSION: Implantation, clinical pregnancy and live birth rates following IVF-ET were low when ANA was detected. Implantation and clinical pregnancy rates were improved significantly by prednisolone, but the live birth rate was not.     

超声引导下经阴道卵巢内激光治疗多囊卵巢综合征的剂量研究

目的 评价不同激光剂量对超声引导下经阴道卵巢内激光治疗多囊卵巢综合征(PCOS)排卵障碍患者的临床及内分泌效果的影响.方法 选择2005年1月至2007年7月就诊于深圳市妇幼保健院的对枸橼酸氯米芬治疗无反应的PCOS不孕患者56例,随机分为A、B、C、D共4组,行超声引导下经阴道卵巢内激光治疗,激光治疗的剂量以卵巢内凝固点数表示,每个凝固点采用功率为3～5 W的激光持续作用1～3 min,直径约为10 mm.其中A组为1个点,B组为2个点,C组为3个点,D组为4～5个点.比较治疗后6个月内各组患者自发排卵率、妊娠率及月经周期情况,并比较治疗前后各组患者血清性激素水平的变化.结果 (1)C组和D组治疗后自发排卵率分别为71%(10/14)和79%(11/14),均高于A组(0)和B组(21%,3/14),差异均有统计学意义(P<0.05).C组和D组治疗后6个月累积临床妊娠率分别为43%(6/14)和36%(5/14),均高于A组(0),差异均有统计学意义(P<0.01、P<0.05);与B组(14%,2/14)比较,差异无统计学意义(P>0.05).C组与D组的自发排卵率及累积临床妊娠率分别比较,差异均无统计学意义(P>0.05).(2)治疗前的各项性激素水平,各组患者之间分别比较,差异均无统计学意义(P>0.05);治疗后的黄体生成素(LH)、睾酮水平及LH/卵泡刺激素(FSH)比值,A组[分别为(11.9±3.1)U/L、(3.9±1.6)nmol/L和2.1±0.5]、B组[分别为(10.4±3.9)U/L、(3.3±1.1)nmol/L和2.0±0.6]分别与C组[分别为(6.3±2.6)U/L、(2.2±0.7)nmol/L和1.1±0.3]、D组[分别为(5.8±2.5)U/L、(2.1±0.4)nmol/L和1.0±0.4]比较,差异均有统计学意义(P<0.05);C组与D组分别比较,差异均无统计学意义(P>0.05).C、D组治疗后的平均LH、睾酮水平及LH/FSH比值分别较治疗前下降了42%、39%、42%和53%、40%、58%,均高于A组(分别下降了4%、9%和16%)和B组(分别下降了11%、6%和5%),差异均有统计学意义(P<0.05);C组与D组之间比较,差异均无统计学意义(P>0.05).结论 每侧卵巢内选择1～2个激光凝固点的临床效果较差,3个激光凝固点是卵巢内激光治疗PCOS排卵障碍的有效剂量,在此基础上增加凝固点数不能提高治疗效果.     

成熟卵泡获卵率对体外受精结局的影响

目的比较在体外受精-胚胎移植/卵细胞浆内单精子注射（IVF-ET/ICSI）过程中,控制性超促排卵（COH）后成熟卵泡获卵率对IVF-ET/ICSI的实验室和临床结局的影响。方法回顾性分析2010年5月至2010年12月四川大学华西第二医院行IVF-ET/ICSI治疗的693例患者,共746个周期,根据获卵率将患者分为A组：获卵率≥80%;B组：获卵率50%～79%;C组：获卵率30%～49%;D组：获卵率〈30%。比较4组患者的临床和实验室结局。结果 A、B组卵子成熟率、受精率、卵裂率和可移植胚胎形成率等各项临床和实验室结局比较,差异均无统计学意义（P〉0.05）。随着获卵数的减少,获卵数最低的D组的卵子成熟率、受精率、卵裂率和可移植胚胎形成率与A组和B组比较,差异有统计学意义（P〈0.05）;同时,D组的临床妊娠率、胚胎种植率和累积妊娠率明显低于其他各组（P〈0.05）。C组受精率、卵裂率、可移植胚胎形成率和临床妊娠率也显著低于A组（P〈0.05）,C组卵裂率、临床妊娠率低于B组（P〈0.05）,但C组的累积妊娠率与A组和B组相似（P〉0.05）。结论获卵率减少可导致卵子成熟率、受精率、卵裂率和可移植胚胎形成率下降,直接导致临床妊娠率下降。     

Expression of sHLA-G in supernatants of individually cultured 46-h embryos: a potentially valuable indicator of 'embryo competency' and IVF outcome

A retrospective cohort study was conducted on 201 women aged 28-44 years, each of whom underwent one cycle of IVF-embryo transfer with fresh, intracytoplasmic sperm injection (ICSI)-derived 7- to 10-cell embryos, transferred 72 h after oocyte retrieval. Samples of media surrounding separately cultured embryos were collected 46 h post-ICSI and stored for subsequent specific enzyme-linked immunosorbent assay. A total of 594 embryos (from own or donor oocytes) were transferred to 201 women. Group A comprised 159 recipients under 39 years and group B compromised 42 recipients aged 39-44 years. Groups A-1 and B-1 recipients had at least one embryo that tested above the geometric mean for soluble human leukocyte antigen-G (sHLA-G) ('positive expression') transferred. In groups A-2 and B-2, all embryos transferred expressed sHLA-G below the geometric mean ('negative expression'). In group A-1, 72/101 women (71%) achieved ultrasound confirmed (clinical), viable (cardiac activity observed) pregnancies. The implantation rate per embryo (IR) was 38%. In group A-2, 13/58 (22%) achieved viable clinical pregnancies. The IR was 9%. In group B-1, the viable clinical pregnancy rate was 52% (15/29) and the IR was 25% compared with a viable clinical pregnancy rate of 15% (2/13) and an IR of 5% in group B-2. The results of this study suggest that by selecting specific embryos for transfer based on their individual sHLA-G expression, pregnancy and implantation rates can be maximized while the number of embryos transferred can be reduced, thereby minimizing the incidence of high-order multiple pregnancies.