微小RNA-21-5p、性激素结合球蛋白对多囊卵巢综合征患者促性腺激素释放激素受体激动剂长方案助孕结局预测价值分析

目的 探讨微小RNA-21-5p(miR-21-5p)、性激素结合球蛋白(SHBG)对多囊卵巢综合征患者促性腺激素释放激素受体激动剂(GnRH-a)长方案助孕结局的预测价值。方法 选取厦门大学附属中山医院自2019年3月至2021年3月收治的120例行GnRH-a长方案的多囊卵巢综合征患者为研究对象。根据临床是否妊娠将其分为临床未妊娠组与临床妊娠组,每组各60例。记录并比较两组患者的miR-21-5p、SHBG水平、促性腺激素(Gn)启动量、卵裂数、囊胚数、窦卵泡数、Gn总天数、Gn总量及获卵数。采用受试者工作特征(ROC)曲线及ROC曲线下面积(AUC)分析miR-21-5p联合SHBG对多囊卵巢综合征患者助孕结局的预测价值。结果 临床未妊娠组miR-21-5p水平、Gn启动量、卵裂数以及囊胚数均高于临床妊娠组,SHBG水平、窦卵泡数、Gn总天数以及Gn总量均低于临床妊娠组,差异均有统计学意义(P<0.05)。miR-21-5p、SHBG、窦卵泡数、Gn启动量、Gn总天数、Gn总量、获卵数、卵裂数、囊胚数均为影响多囊卵巢综合征患者助孕结局的危险因素(P<0.05)。miR...     

重组人生长激素在ART超排周期中的观察

目的 观察卵巢低反应患者行IVF／ICSI（体外受精／单精子卵泡浆内注射）治疗周期使用重组人生长激素（GH）辅助超排卵对其治疗结果的影响。方法回顾性分析2005年1月～2007年10月在我中心行IVF／ICSI治疗的卵巢低反应患者218例（218个周期）,按自愿原则分为两组,其中加用GH的86例（86个周期）为研究组,未用GH者132例（132个周期）为对照组,分析两组获卵数,受精数及妊娠率的差异。结果两组在获卯数,受精数上有明显差异（P〈0．05）,但妊娠率无明显差异（P〉0．05）。结论对卵巢低反应的患者在IVF／ICSI治疗周期使用GH辅助超排卵可以减少卵巢不良反应,可能提高获卵数和受精率。     

影响体外受精-胚胎移植临床妊娠的因素分析

目的 :探讨IVF -ET中影响临床妊娠率的因素。方法 :对 149例不孕夫妇 16 0周期IVF -ET治疗的资料进行回顾性分析。结果 :妊娠组与非妊娠组的女性患者平均年龄、使用促性腺激素 (Gn)量、移植优质胚胎数、移植后移植管带血率有显著性差异 ,P <0 0 5 ;两组的使用Gn天数、取卵数、hCC日子宫内膜厚度及类型、移植胚胎数、原发性不孕率、移植时困难度、血清免疫性抗体阳性率均无显著性差异 ,P >0 0 5。结论 :女性年龄、优质胚胎移植数目、移植后移植管带血是影响IVF -ET成功的重要因素。     

世界家畜繁殖及人工授精进展情况(续)

(一)卵巢与子宫内分泌学 1.家畜卵泡的发生及排卵的控制 家畜出生后,卵巢中含有卵厚细胞和卵母细胞。出生不久的仔畜的卵巢,对促性腺激素的诱发不敏感。小母犊在月龄以上,羔羊在6周龄以上,才能对促性腺激素表现出敏感性。     

促性腺激素释放激素拮抗剂在卵巢过度刺激综合征治疗中应用价值研究

目的探讨促性腺激素释放激素拮抗剂在卵巢过度刺激综合征治疗中的应用价值。方法选取北部战区总医院生殖医学中心2016年1—4月收治的36例卵巢过度刺激综合征患者为研究对象。按照随机数字表法将患者分入两组,每组18例。A组患者接受常规治疗,B组患者在常规治疗基础上加用促性腺激素释放激素拮抗剂。比较两组患者促黄体激素、雌二醇及获卵数、受精数、优质胚胎数。结果两组患者均未出现严重并发症。B组促黄体激素为(2. 6±1. 3)的U/L,明显低于A组的(4. 1±1. 5) U/L,差异有统计学意义(P <0. 05)。B组雌二醇为(986. 4±648. 5) U/L,明显低于A组的(1623. 5±632. 6) U/L,差异有统计学意义(P <0. 05)。B组获卵数、受精数、优质胚胎数分别为(36. 5±4. 1)个、(22. 8±5. 2)个、(9. 5±2. 2)个,均多于A组的(22. 1±4. 3)个、(13. 4±5. 3)个、(6. 4±2. 3)个,差异有统计学意义(P <0. 05)。结论促性腺激素释放激素拮抗剂治疗卵巢过度刺激综合征安全有效,可控制疾病进展,也可用于疾病预防。     

牛羊排卵数的控制

自然状态下，动物卵泡的发育是一个多种机制控制的复杂的过程，从而保证了一个种或品种自然排卵数的稳定。在动物生产中，为了获得更大的经济效益，人们不断干预家畜的繁殖过程，以期获得更多的成熟卵和后代。有关牛羊诱发多排卵、多产羔（犊）问题已有广泛的研究，不乏成功的例子。１　外源性促性腺激素处理长期以来，动物科学工作者和生产者一直认为，促性腺激素可促进家畜多排卵，这样的认识已经在不同家畜，特别是在牛的超数排卵和胚胎移植中获得广泛应用。然而，不同品种、不同个体对特定剂量的促性腺激素的反应性有极大差异，大大地限…     

促性腺激素分泌的调控

垂体前叶分泌的卵泡刺激素(FSH)和促黄体生成素(LH)作用于靶器官—卵巢,调节类固醇激素的分泌,促进卵泡的生长发育和排卵。促性腺激素的分泌受前馈及反馈机制的调控,这一过程涉及到中枢神经、垂体及性腺三个层次的内分泌。外部环境因素(如光照、温度、食物等)和内在因素(如体代谢、体重、脂肪等)作用于中枢神经系统,通过影响下丘脑促性腺激素释放激素(GnRH)的分泌来调节促性腺激素的分泌;性腺分泌的类固     

人绒毛膜促性腺激素注射后取卵时间对卵子及胚胎质量的影响

目的探讨人绒毛膜促性腺激素(hCG)注射后不同取卵时间对辅助生殖技术(ART)周期中卵子及胚胎质量的影响。方法回顾性分析2012年8月—2013年6月在我院行体外受精/卵胞浆内单精子注射-胚胎移植术(IVF/ICSI-ET)长长方案治疗的1 500个取卵周期。按注射hCG后取卵时间的不同,分为A组(注射hCG后35.0~35.5 h),B组(注射hCG后35.6~36.0 h)和C组(注射hCG后36.1~36.5 h),比较三组的基本情况、促排卵情况、获卵率、成熟卵率、受精率、卵裂率及优质胚胎率。结果女方年龄、体质量指数、不孕年限、基础激素水平等一般情况比较三组间无统计学差异(P>0.05),促性腺激素(Gn)的使用、hCG日激素水平及hCG日内膜厚度等促排卵情况比较三组间也无统计学差异(P>0.05),三组的获卵率(80.3%、80.4%、81.4%)、2PN胚胎卵裂率(98.3%、98.2%、98.5%)、优质胚胎率(72.2%、72.4%、70.9%)比较差异均无统计学意义(P>0.05)。成熟卵率和正常受精率分别为85.1%、87.4%、87.7%和75.8%、77.3%、80.8%,三组间比较差异均有统计学意义(P均<0.05)。结论 35.0~36.5 h的时间范围内,延迟注射hCG后取卵的时间能够改善卵子成熟率及正常受精率,但对获卵率、卵裂率、优质胚胎率没有影响。     

经阴道彩超在小剂量GNRH-a诱导排卵中的应用价值

促性腺激素释放激素激动剂(GNRH-a)常用于治疗子宫内膜异位症、子宫腺肌病、控制性超促排卵、性早熟等。近年来国内外研究表明,在促排卵周期应用小剂量GNRH-a类药物能诱导排卵,在卵巢过度刺激综合征高危期应用GN-Rh-a类药物诱导排卵有明显的预防作用,但黄体功能不足发生率增加。我国育龄期妇女不孕症发生率约为10%,排卵障碍引起的不孕约占25%[1]。我院不孕门诊将小剂量GNRH-a用于促排卵治疗卵泡成熟时诱导排卵,现将彩超追踪观察结果报道如下。     

游离睾酮指数及Irisin对多囊卵巢综合征不孕患者体外受精-胚胎移植治疗妊娠结局预测价值分析

目的 探讨游离睾酮指数(FTI)及血清Irisin对多囊卵巢综合征(PCOS)不孕患者体外受精-胚胎移植(IVF-ET)妊娠结局的预测价值。方法 选取自2019年6月至2021年6月文昌市人民医院收治的92例PCOS患者为研究对象,均采取IVF-ET治疗。根据PCOS患者的妊娠结果将其分为妊娠成功组(n=44)与妊娠失败组(n=48)。比较两组患者的年龄、体质量指数、不孕年限、卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E₂)、睾酮(T)、游离睾酮(FT)、性激素结合球蛋白(SHBG)、游离睾酮指数(FTI)、抗苗勒管激素(AMH)值、血清Irisin、窦卵泡数(AFC)、促性腺激素(Gn)用量、获卵总数。采用多因素Logistic回归分析探讨PCOS患者IVF-ET的妊娠结局影响因素。基于各影响因素构建评分模型,绘制评分模型预测PCOS不孕患者IVF-ET后妊娠结局的受试者工作特征(ROC)曲线。结果 妊娠成功组患者的年龄、LH/FSH、FT、FTI、Irisin、Gn用量低于妊娠失败组,血清FSH、SHBG、获卵总数高于妊娠失败组,差异有统计学意义(P&...     

Establishing institutional critical values of follicle-stimulating hormone levels to predict in vitro fertilization success

Elevated follicle-stimulating hormone (FSH) levels during the early follicular phase or in response to the clomiphene citrate challenge test indicate diminished ovarian reserve and poor reproductive potential. We performed a retrospective analysis of 413 infertile women, 23 to 40 years of age, who underwent 523 cycles of in vitro fertilization (IVF) to identify the critical FSH values that would predict a poor likelihood of success in our military IVF program. Each woman underwent a clomiphene citrate challenge test within 1 year of each IVF cycle. The overall live birth and implantation rates were 43% and 24%, respectively. The critical values for day 3 and day 10 FSH levels were 14.1 and 16.9 mIU/mL, respectively, with a 0% live birth rate and a 5% implantation rate above these levels. There were no differences in the live birth/implantation rates when stratified for FSH levels below the critical values. Medical centers offering IVF should determine their critical FSH values, to help identify patients unlikely to benefit from IVF and to ensure appropriate allocation of resources and realistic expectations for infertile couples.     

中重度卵巢过度刺激综合征临床特点及治疗

目的：探讨中重度卵巢过度刺激综合征的临床特点及治疗、预防的方法。方法：回顾性分析我院生殖中心自2007-06～2009-06发生的35例中重度卵巢过度刺激综合征的临床资料。结果：在500个超排卵周期中有35例发生中重度卵巢过度刺激综合征（发生率为7%）,临床表现为腹痛、腹胀、恶心、呕吐、体重增加,重度出现胸水、腹水、呼吸困难、血液浓缩,卵巢增大等,经综合治疗,均缓解好转出院,无1例终止妊娠。结论：在实施药物超促排卵过程中要坚持个体化方案,及早预防,对中重度患者严密观察、合理治疗。     

血清与卵泡液中血管内皮生长因子在控制性超排卵周期中的变化

目的 本研究通过观察控制性超排卵患者的血清及卵泡液中血管内皮生长因子的变化,探讨血管内皮生长因子与卵泡发育的关系。方法 50个行体外受精-胚胎移植治疗周期的患者为研究对象。分别于月经周期第2天、取卵日抽取静脉血20例,收集取卵日卵泡直径≥18mm或≤16mm卵泡的卵泡液各25例,用酶联免疫吸附试验方法测定VEGF的浓度。结果 取卵日血清VEGF水平(116.9±17.1)mg/L较月经第2天的(92.0±17.2)ng/L明显增高(P<0.001);取卵日卵泡直径≥18mm卵泡液中VEGF水平(1630.6±144.8)ug/L较卵泡直径≤16mm(1475.9±155.5)ng/L高(P<0.05);20例取卵日卵泡液水平(1492.8±184.9)ng/L显著高于同期血清的(116.9±17.1)ng/L(P<0.001)。结论 控制性超排卵周期中血清及卵泡液中VEGF水平均升高,可能参与卵泡发育、卵母细胞成熟。     

女性年龄与体外受精胚胎移植结果的关系

目的　探讨女性年龄与体外受精 胚胎移植结果的关系。方法　分析IVF ET 10 6个起始周期、90个移植周期的临床资料 ,按女性年龄≤ 30岁 ,31～ 34岁 ,≥ 35岁分Ⅰ ,Ⅱ ,Ⅲ组 ,比较取消率、Gn用量、卵泡数、回收卵子数、受精数、卵裂数、优质胚胎数、受精率、卵裂率、优质胚胎率及临床妊娠率的差别。结果　 3组的取消率分别为 12 .5 0 % ,2 .78% ,33 .33 % ,三组间相比差异显著 (P <0 .0 5 ) ;Gn用量分别为 (2 8.71± 5 .45 )支、(33 .46± 7.5 1)支、(34.0 5± 5 .78)支 ,3组相比 ,Ⅰ组与Ⅱ ,Ⅲ组差异显著 (P <0 .0 5 ) ,Ⅱ组与Ⅲ组之间差异不显著 (P >0 .0 5 ) ;各组间卵泡数、周期取卵数、受精数、卵裂数、优质胚胎数无显著性差异 (P >0 .0 5 ) ;3组受精率分别为 74.49% ,6 8.0 7% ,6 7.82 % ,各组间相比 ,Ⅰ组与Ⅱ ,Ⅲ组差异显著 (P <0 .0 5 ) ,Ⅱ组与Ⅲ组间差异不显著 (P >0 .0 5 ) ;而卵裂率、优质胚胎率无显著性差异 (P >0 .0 5 ) ;3组的每移植周期妊娠率分别是 45 .71% ,2 5 .71% ,15 .0 0 % ,各组间相比差异显著 (P <0 .0 5 )。结论　女性年龄是影响IVF ET成功的重要因素     

Angiogenesis in ectopic ovarian xenotransplantation: multiparameter characterization of the neovasculature by dynamic contrast-enhanced MRI.

It has been suggested that ovarian cryopreservation and xenotransplantation can be used to preserve oocytes from damage during anticancer treatments. The main obstacle to subsequent ovarian grafting is loss of oocytes due to impaired perfusion. The aim of this study was to characterize angiogenic events following ovary xenotransplantation. Rat ovaries were transplanted into or onto the muscle of immunocompromised CD1-nude mice. Ovariectomy (OVX) of host mice prior to transplantation supported the resumption of follicular development, as manifested by the prevalence of antral follicles and corpora lutea. Two days after transplantation, the grafts were devoid of blood supply. Functional vessels within the graft were detected by MRI and histology from day 7 and on. By 2-3 weeks, both blood volume fraction and permeability in the graft, as measured with the use of albumin-based MR contrast material, were significantly elevated relative to the adjacent muscle. Extravasation of contrast material from the graft neovasculature was followed by interstitial convection in the muscle surrounding the graft, and draining toward the proximal popliteal lymph node. Development of the vasculature was monitored noninvasively, providing a time scale for revascularization and recovery of ovarian function following xenotransplantation of ovarian grafts.     

Severe spontaneous ovarian hyperstimulation syndrome with MR findings

We describe a case of severe spontaneous ovarian hyperstimulation syndrome (OHSS) with MR findings. MR scans showed bilateral symmetric enlargement of ovaries with multiple cystic changes, giving the classic "wheel-spoke" appearance. There was no definite abnormally thickened or enhanced wall, but there was internal hemorrhage in some chambers. To avoid unnecessary laparotomy, we emphasize the importance of careful diagnosis to differentiate spontaneous OHSS from ovarian cystic neoplasms.     

Metastatic choriocarcinoma with hemorrhagic complications and spontaneous ovarian hyperstimulation syndrome: A case report

Gestational choriocarcinoma is a malignant trophoblastic tumor arising from any gestational event, even with a long latency period, generally in the reproductive female. It is associated with a high level of beta-human chorionic gonadotropin. Its primary site is usually the uterus but not all patients have a detectable lesion in this site. Regression of the primary tumor after it has metastasized is not uncommon, and one-third of cases manifest as complications of metastatic disease. In this report we present an uncommon case of gestational choriocarcinoma with lung, liver and jejunal metastases at the time of diagnosis without evidence of pelvic disease, in 34-year-old woman. The main points of interest of our case were the development of the ovarian hyperstimulation syndrome with massive multicystic ovarian enlargement induced by high level of beta-human chorionic gonadotropin and the bleeding of jejunal and liver metastases, due to the high vascularity of the tumor tissue, a condition known as “Choriocarcinoma Syndrome”. We will focus on the radiological findings of metastases, bleeding complications and ovarian hyperstimulation syndrome.     

Induction of ovulation monitored by ultrasound

Eighty menstrual cycles were induced by the administration of human menopausal gonadotropin (hMG), and the induction of ovulation was evaluated by serial ultrasound scanning. Ovulation occurred in 57 of these cycles, and pregnancy occurred in 17 patients. No pregnancy occurred if the follicle size was below 15 mm at the time that human chorionic gonadotropin (hCG) was administered. A 15-mm follicle size is, therefore, regarded as a minimum size for a mature ovum. Multiple follicles were present in seven of the cycles where pregnancy occurred, but only two patients had multiple pregnancies. Ovarian hyperstimulation (OHS), which is characterized by cystic ovarian enlargement of greater than 5 cm after ovulation, was present in 25 cycles. This is a considerably higher incidence than previously documented, but since it is not possible to predict reliably its occurrence, and in no patients were the symptoms severe, it is considered an acceptable and inevitable sequela of ovulation induction. The present role of ultrasound is to establish whether the ovary responds to gonadotropin stimulation, to ensure that the follicle has reached a minimum size, to determine the number of preovulatory follicles to inform better the patient about the possibilities of multiple pregnancies, to establish that ovulation has occurred after administration of hCG, and to document the presence or absence of OHS.     

58周期高泌乳素血症体外受精-胚胎移植的临床研究

目的　探讨高泌乳素对体外受精 -胚胎移植的影响。方法　回顾性分析 5 8周期高泌乳素血症及 5 0周期输卵管因素不孕患者的取卵数、受精率、卵裂率、胚胎种植率、妊娠率及流产率等。结果　两组患者取卵数、受精率、卵裂率、胚胎种植率、妊娠率及流产率均无显著性差异。结论　高泌乳素血症不影响卵巢超促排卵反应 ;与输卵管不孕比较 ,高泌乳素对体外受精 -胚胎移植结果无明显不良影响