The effect of endometrial thickness on the day of hCG administration on pregnancy outcome in the first fresh IVF/ICSI cycle

The aim of this study was to investigate the effect of endometrial thickness (EMT) on human chorionic gonadotropin (hCG) day on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcome. A retrospective study was conducted on the clinical data of 756 patients in their first fresh IVF/ICSI cycle at the Wuxi Maternity and Child Health Hospital. Compared with the pregnancy failure group, the clinical pregnancy group had more transferable embryos and good-quality embryos and had a thicker endometrium (p?<?0.05). The endometrial pattern was not significantly different between the two groups. EMT was found to be an independent prognostic factor for clinical pregnancy (adjusted OR?=?1.25, 95% CI: 1.15–1.36, p?<?0.01). Seven hundred and fifty-six cycles were categorized into three groups upon EMT on the hCG day: group 1 (EMT??14?mm). Group1 had significantly lower clinical pregnancy, embryo implantation and live birth rates compared with group 2 and 3 (p?<?0.01), while there was no significant difference in either spontaneous abortion or multiple-birth rate among these three groups. It was concluded that EMT on the hCG day was associated with pregnancy outcome in the first fresh IVF/ICSI cycle. A higher clinical pregnancy rate could be achieved when EMT?≥?8?mm, and no adverse pregnancy outcome was observed when EMT?>?14?mm.     

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 effect of anti-thyroid antibodies on endometrial volume,embryo grade and IVF outcome

Thyroid auto-immunity (TAI) has been implicated as the most common cause of hypothyroidism in general population, especially in women. Many studies revealed that increased infertility incidences with TAI. The aim of the present article was to evaluate the effect of thyroid auto-antibody (TAA) positivity on embryological parameters, IVF-outcome and endometrial volume (EnV) in infertile patients who were applied for routine artificial reproductive technologies (ART) programme. This study included prospective, sequential, cross-sectional analyses of parameters obtained from 69 patients with unexplained infertility. It was the first ART application of patients. Patients were homogenous for age, body mass index, basal hormone measurements and underwent same ovulation induction protocol. They were evaluated for thyroid hormone profile and TAAs and divided into three groups; TAA negative group (n = 31), TAA positive group (n = 23) and TAA positive and euthyroid with medication group (n = 15). There were no differences among groups for the number of Grade-1 and Grade-2 embryos, distribution of embryo-grades, number of oocytes retrieved and fertilised, biochemical pregnancy ratios (PR), EnV and miscarriage ratio. However, the clinical PR was significantly lower in the TAA positive group (p = 0.024). In conclusion, the embryo grades and EnV did not differ among groups. But the clinical PR differs and the anti-thyroid peroxides positivity, above the cut-off point, affects the clinical PR.     

Successful pregnancies in the setting of exaggerated endometrial thickness

OBJECTIVE: To report successful pregnancies in the setting of exaggerated endometrial thickness. DESIGN: Case report. SETTING: Two infertility practices. PATIENT(S): Two IVF patients. INTERVENTION(S): IVF and ET. MAIN OUTCOME MEASURE(S): Endometrial thickness on the days of hCG injection, oocyte retrieval, and ET. RESULT(S): Two successful twin pregnancies, each after the transfer of two embryos, in the setting of an endometrial thickness of 16 mm in one case and 20 mm in the other. CONCLUSION(S): This report illustrates the possibility for a successful outcome in the setting of an exaggerated endometrial thickness, including for the first time a value of 20 mm on the day of egg retrieval.     

Prediction of implantation by the sonographic appearance of the endometrium during controlled ovarian stimulation for in vitro fertilization (IVF)

The texture and the thickness of the endometrium as assessed by transvaginal sonography were prospectively evaluated in 123 patients undergoing IVF treatment. Three different types of endometrial patterns could be distinguished: (A) an entirely homogeneous, hyperechogenic endometrium; (B) an intermediate type characterized by the same reflectivity of ultrasound as the myometrium, with a nonprominent or absent central echogenic line; and (C) a multilayered endometrium consisting of prominent outer and midline hyperechogenic lines and inner hypoechogenic regions. On the day before oocyte retrieval, endometrial thickness was significantly greater in the group of patients who achieved pregnancy than in the group who did not (8.7±0.4 vs 7.5±0.2 mm, respectively; P<0.01) and significantly more patients had multilayered, pattern C, endometrium (75% in pregnant women vs 42.4% in nonpregnant women; P<0.01). No pregnancy occurred when the endometrial thickness was less than 6 mm. When type C endometrium >-6 mm thick was seen, the pregnancy rate per embryo transfer was 39%. When type A or B endometrial pattern was seen, the negative predictive value for the occurrence of pregnancy was 90.5%. Our results suggest that transvaginal sonographic evaluation of endometrial texture and thickness may be an indicator of the likelihood of achieving pregnancy.     

3种超促排卵方案对卵巢窦卵泡数不同患者体外受精-胚胎移植结局的影响

目的:通过研究卵巢窦卵泡数(AFC)与不同超促排卵方案对IVF-ET妊娠结局的影响,探讨更合理的促排卵方案.方法:选取2010年4月至10月在山东中医药大学第二附属医院生殖中心行IVF-ET的291例患者,291个周期,按卵巢AFC将患者分为3组:5～10个(A组,69例),10～15个(B组,134例)及15～20个(C组,88例).患者分别采取GnRH-a长方案(a方案)、GnRH-a短方案(b方案)和GnRH-ant(c方案)方案行促排卵治疗,其中A组中20例患者行a方案,28例行b方案,21例行c方案;B组中48例患者行a方案,57例行b方案,29例行c方案;C组中29例患者行a方案,37例行b方案,22例行c方案.比较3组患者分别采用3种促排卵方案治疗后的Gn量、HCG日LH、P、E2水平、获卵数、优质胚胎率、周期取消率、妊娠率.结果:A、C组患者行3种方案治疗的获卵数、优质胚胎数、周期取消率及临床妊娠率均无显著差异(P＞0.05).B组患者中行a方案治疗者的HCG日P水平显著低于行b、c方案者(P＜0.05),临床妊娠率显著高于行b、c方案者(P＜0.05);行b方案治疗者的LH、E2水平显著高于a、c方案者(P＜0.05).结论:AFC为5～10个及15 ～ 20个的患者,采用GnRH-a长方案、GnRH-a短方案和GnRH-ant方案的妊娠结局无显著差异;AFC为10 ～15个的患者,采用GnRH-a长方案超促排卵的临床效果较好.     

卵巢储备正常者COH不同阶段添加高纯度人绝经期促性腺激素对IVF-ET结局的影响

目的:探讨卵巢储备正常者在促排卵不同阶段添加高纯度人绝经期促性腺激素(highly purified human menopausal gonadotrophin,HP-h MG)对体外受精-胚胎移植(IVF-ET)结局的影响。方法:收集接受IVF或单精子胞质内显微注射技术(ICSI)治疗的25~35岁卵巢储备功能正常的患者(n=153),根据是否添加HP-h MG及添加时机分为A组(未添加HP-h MG),B组(Gn第1日添加HP-h MG)和C组(Gn第6~8日添加HP-h MG),分析三组妊娠结局。结果:A组h CG注射日LH、E_2水平低于B组及C组(P0.05),A组h CG注射日P水平高于B组及C组(P0.05),获卵数及M_Ⅱ卵子数A组及C组高于B组(P0.05),优质胚胎率B组高于A组及C组(P0.05),累积妊娠率,C组(85%)高于A组(59.3%)及B组(67.6%),差异有统计学意义(P0.05),3组受精率、成熟卵率、种植率差异无统计学意义(P0.05)。结论:卵巢储备功能正常者在采用标准长方案促排卵时,中晚期添加HP-h MG可改善累积妊娠结局;卵泡发育不同阶段添加HP-h MG,可能适用于不同的人群。     

控制性超促排卵刺激中子宫内膜息肉对体外受精-胚胎移植妊娠结局的影响

目的:探讨在控制性超促排卵(controlled ovarian hyperstimulation,COH)刺激过程中新诊断的子宫内膜息肉(endometrial polyp,EP)对体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)新鲜周期妊娠结局的影响。方法:选择行IVF/ICSI-ET新鲜周期的3 003例患者的3 003个周期进行回顾性分析。IVF/ICSI-ET术前行相关检查诊断宫腔形态正常,根据在COH过程中是否新发现EP将其分为研究组(新发现息肉,n=60)和对照组(未发现息肉,n=2 943)。观察患者妊娠结局。结果:患者的临床妊娠率、自然流产率、继续妊娠率组间比较,差异均无统计学意义(P0.05)。研究组和对照组生化妊娠率(20.0%vs 9.8%)、异位妊娠率(3.3%vs 0.1%),差异有统计学意义(P=0.035,P0.000 1)。结论:在COH刺激过程中新诊断的与生化妊娠和异位妊娠的发生相关,但不影响IVF-ET新鲜周期的最终临床妊娠率、继续妊娠率以及早期流产率的发生。     

Influence of endometrial thickness and pattern on pregnancy rates inin vitro fertilization-embryo transfer

Aim : Our aim was to investigate the role of endometrial thickness and pattern in the pregnancy rate during an in vitro fertilization-embryo transfer (IVF-ET) cycle.
Methods : Records of patients who underwent IVF-ET at the Jichi Medical School Hospital during May 1995–December 1999 were evaluated retrospectively. Only cycles, in which endometrial thickness and pattern on the day of human chorionic gonadotrophin (HCG) administration were recorded, were analyzed in this study. Endometrial thickness was divided into three categories (A: < 10 mm, B: 10–14 mm, C: > 14 mm), and endometrial pattern was divided into two categories: triple line and non-triple line. A total of 156 IVF-ET cycles from 120 patients was evaluated.
Results : There were no significant differences for both the endometrial thickness and pattern in the pregnancy rate during the IVF-ET cycle ( P  > 0.05). Among the study groups, the triple-line endometrial pattern was found to be 58.7% in group A, 84.0% in group B and 70% in group C. We found that in the triple-line endometrial pattern, there was a significant difference between group A and group B ( P  < 0.01). Triple-line endometrial pattern appeared significantly in younger women (33 ± 5.4 years) than in non-triple-line endometrial pattern (36 ± 5.2 years; P  = 0.047). The minimum and maximum endometrial thickness where pregnancy occurred was 6.5 mm (two pregnancies) and 19 mm (one pregnancy), respectively.
Conclusion : Endometrial thickness and pattern have no influence on the pregnancy rates in an IVF-ET cycle, but patients with triple-line endometrial pattern and group B endometrial thickness showed a better pregnancy outcome in the IVF-ET treatment. (Reprod Med Biol 2002; 1 : 17–21)     

The role of sonographic endometrial patterns and endometrial thickness in the differential diagnosis of ectopic pregnancy

OBJECTIVE: The purpose of this study was to examine the usefulness of the endometrial trilaminar pattern and thickness in the diagnosis of ectopic pregnancy. STUDY DESIGN: We reviewed patient records for clinical and ultrasonographic data for patients with the suspicion of ectopic pregnancy. The trilaminar pattern and endometrial thickness were tested as predictors for the diagnosis of ectopic pregnancy. RESULTS: The trilaminar pattern had a specificity of 94% and sensitivity of 38% (n = 403 women). The mean endometrial thickness was thinner in patients with ectopic, compared with normal pregnancy (9.5 +/- 5.7 mm vs 12.4 +/- 5.9 mm; P = .035). Patients with normal pregnancy or first-trimester losses had comparable thicknesses (12.4 +/- 5.9 mm vs 12.5 +/- 8.0 mm). The receiver operator curve showed that there was no thickness value useful for the diagnosis of ectopic pregnancy. CONCLUSION: The trilaminar pattern is specific for the diagnosis of ectopic pregnancy, but it is associated with low sensitivity. The endometrial thickness tends to be thinner in patients with an ectopic pregnancy.     

Effects of triploidy incidence on clinical outcomes for IVF-ET cycles in different ovarian stimulation protocols

Abstract

Purpose: To discuss the relationship between triploidy incidence and clinical outcomes of embryos derived from normally fertilized oocytes from the same cohort for in vitro fertilization-embryo transfer (IVF-ET) cycles in different ovarian stimulation protocol.

Methods: This study included 2070 in vitro fertilization (IVF) cycles with long-term protocol, 802 IVF cycles with ultra short-term protocol and 508 IVF-D (in vitro fertilization by donor semen) cycles with long-term protocol from January 2013 to September 2014. According to the different 3PN rate, patients were divided into three groups as follows: Group 1 included patients with 0% 3PN zygotes, Group 2 included patients with 1–25% 3PN zygotes and Group 3 included patients with >25% 3PN zygotes. Main outcome measure: female age, no. of retrieved oocytes, normal fertilization rate, day-3 grade I?+?II embryos rate, day-3 grade I?+?II?+?III embryos rate, implantation rate, pregnancy rate and early abortion rate.

Results: Triploidy cycle incidence rate in IVF and IVF-D cycles with long-term protocol were significantly higher than in IVF cycles with ultra short-term protocol (p?<?0.001). Triploidy fertilization rate found no significant difference between the three groups (p?>?0.05). In three protocols, normal fertilization rate in 3PN?=?0% and 3PN?=?1–25% groups were significantly higher compared to 3PN?>?25% group (p?<?0.001). In IVF cycles with long-term protocol, the day-3 grade I?+?II embryos, implantation and pregnancy rate in 3PN?>?25% group were significantly lower than other two groups (p?<?0.05). The day-3 grade I?+?II?+?III embryos and early abortion rate found no significant difference between the three groups (p?>?0.05). In IVF cycles with ultra short-term protocol, there were no significant differences found in day-3 grade I?+?II embryos, day-3 grade I?+?II?+?III embryos, implantation, pregnancy and early abortion rate (p?>?0.05). In IVF-D cycles with long-term protocol, the day-3 grade I?+?II embryos, day-3 grade I?+?II?+?III embryos and implantation rate in 3PN?>?25% group were significantly lower than other two groups (p?<?0.05). The pregnancy and early abortion rates found no significant difference in the three groups (p?>?0.05).

Conclusion: We observed that high proportion of triploid zygotes made a negative effect on clinical outcomes for IVF-ET cycles with long-term protocol.     

Increased endometrial thickness on the day of human chorionic gonadotropin injection does not adversely affect pregnancy or implantation rates following in vitro fertilization-embryo transfer

OBJECTIVES: To investigate the controversy whether an increased endometrial thickness has an effect on pregnancy, implantation, or abortion rates in in vitro fertilization-embryo transfer (IVF-ET) cycles. DESIGN: Retrospective analysis. SETTING: A university-based IVF center. PATIENT(S): Five hundred seventy women under the age of 40. INTERVENTION(S): Measurements of endometrial thickness on day of human chorionic gonadotropin (hCG) administration. Cycles were compared by endometrial thickness of 14 mm in 60 women. MAIN OUTCOME MEASURE(S): Implantation, pregnancy, and abortion rates. RESULT(S): Implantation, pregnancy, and abortion rates were similar in each group. In cycles where the endometrial thickness was 14 mm. CONCLUSION(S): No adverse effects of a thickened endometrium were demonstrated on implantation, pregnancy, or abortion rates in the first IVF-ET cycle. These findings fail to corroborate with those of Weissman et al. and support those of Yakin et al.     

Minimal ovarian hyperstimulation for in vitro fertilization using sequential clomiphene citrate and gonadotropin with or without the addition of a gonadotropin-releasing hormone antagonist

OBJECTIVE: To compare the results of a minimal-stimulation protocol with those of a standard protocol used for IVF. DESIGN: Retrospective, controlled study. SETTING: University center. PATIENT(S): Fifty-five patients undergoing IVF using a minimal-stimulation protocol with or without adjuvant therapy with a GnRH antagonist. A control group consisted of age- and diagnosis-matched patients undergoing a standard long GnRH agonist (GnRH-a)-gonadotropin stimulation during the same time period. INTERVENTION(S): Clomiphene citrate and gonadotropins, with or without the GnRH antagonist ganirelix. MAIN OUTCOME MEASURE(S): Oocytes recovered and pregnancy rates. RESULT(S): The number of oocytes retrieved was significantly lower for the minimal-stimulation regimen compared with the case of the long GnRH-a protocol (4.8 +/- 2.6 vs. 16.2 +/- 7.5, respectively). The clinical pregnancy rate per transfer, however, was not significantly different between the two regimens (37% vs. 41%, minimal stimulation vs. long GnRH-a protocol, respectively). The addition of ganirelix resulted in at least the same pregnancy outcome as compared with the case of cycles without the antagonist. CONCLUSION(S): Minimal stimulation using clomiphene citrate followed by gonadotropin for IVF results in pregnancy rates equal to the standard long GnRH-a-gonadotropin protocol. The addition of ganirelix resulted in at least similar results with the advantage of eliminating the occurrence of a premature endogenous LH surge.     

厚度偏薄的子宫内膜对体外受精-胚胎移植及冻融胚胎移植妊娠率的影响

目的探讨厚度偏薄的子宫内膜对体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)及冻融胚胎移植(freezing-thawing embryo transfer,FET)临床妊娠率的影响。方法 2008年12月至2010年4月在河南省人民医院对218周期子宫内膜厚度在6～7.9mm之间的IVF-ET及FET患者进行回顾性分析,比较子宫内膜厚度在6～7.9mm之间的IVF-ET及FET患者的临床妊娠率有无差异。结果子宫内膜厚度在6～7.9mm之间的IVF-ET组与FET组患者的临床妊娠率分别为35.6%和50.7%,差异有统计学意义(P﹤0.05)。结论子宫内膜偏薄患者FET的临床妊娠率高于IVF-ET的临床妊娠率。     

The effect of first trimester subchorionic hematoma on pregnancy outcomes in patients underwent IVF/ICSI treatment

Objective: The aim of this retrospective cohort study was to assess the effect of subchorionic hematoma (SCH) on pregnancy outcomes in IVF/ICSI patients.

Methods: We retrospectively analyzed 1097 pregnancies achieved by in vitro fertilization and embryo transfer (IVF-ET) or frozen-thawed embryo transfers (FETs) between January 2013 and June 2013 at the IVF center of Nanjing Drum Tower Hospital. The prevalence of SCH was 12.1% in this group (133/1097). We compared the pregnancy outcomes between the SCH group and non-SCH group, while the risk factors for SCH were also evaluated.

Results: There was no significant difference between SCH group and non-SCH group with regard to patients’ age, spouse’s age, endometrial thickness, miscarriage rate (5.6% versus 6.2%, p?>?0.05), second trimester fetus loss rate (5.6% versus 7.7%, p?>?0.05) or live birth rate (89.5% versus 86.1%, p?>?0.05). While the birth weight in singleton pregnancy in SCH group was significant lower (3207.8?±?595.7?g versus 3349.2?±?59.7?g, p =?0.03). SCH was more common in fresh embryo transfer patients than that in FET patients (16.6% versus 5.1%, p?Conclusion: We concluded that SCH was associated with lower birth weight in singleton pregnancy, but SCH did not increase pregnancy loss rate in IVF/ICSI patients, and fresh embryo transfer may contribute to SCH onset.     

Comparison of GnRH agonists and antagonists in unselected IVF/ICSI patients treated with different controlled ovarian hyperstimulation protocols: a matched study

OBJECTIVES: To evaluate the results of the use of GnRH antagonist (GnRHant) and GnRH analog (GnRHa) in two matched groups of unselected IVF/ICSI patients in a retrospective matched pair analysis. STUDY DESIGN: Patients (n=52) were stimulated with human menopausal gonadotropin (hMG) and/or recombinant FSH (rFSH). In Group I (n=26) a daily dose of 0.25mg of Cetrorelix (GnRHant) was administered when follicles reached a diameter of > or = 14 mm. Patients in Group II (n=26) were first desensitized with GnRHa triptorelin long protocol, which was continued during the gonadotropins treatment until the induction of ovulation. RESULTS: In both groups, serum LH levels remained low during the stimulation. The mean length of stimulation, and the dose of FSH required per patient were similar in both groups. The mean E2 level on day of hCG administration was significantly higher in the patients of Group II (2076+/-1430 versus 1145+/-605 pg/ml), however, a progressive increase in serum E2 concentration during the cycle was noted in both groups. A median of 5.38 and 6.34 mature oocytes per patient was obtained, and the fertilization rate was 59.3% in Group I and 63.6% in Group II. Pregnancy rate (PR) were better in Group II (15 versus 5%), and no severe or moderate ovarian hyperstimulation syndrome (OHSS) occurred. CONCLUSIONS: GnRHant and GnRHa provide comparable results in unselected patients, while GnRHant allows a higher flexibility in the treatment.     

血管内皮生长因子与抑制素B和促排卵结局的相关研究

目的探讨不同控制性超促排卵(controlled ovarian hyperstimulation,COH)方案中血清及卵泡液(follicular fluid,FF)中血管内皮生长因子(vascular endothelial growth factor,VEGF)与抑制素B(inhibin B,INHB)及COH结局的相关性。方法应用酶联免疫吸附方法分别检测长方案组(A组,n=38)及非降调节方案组(B组,n=38)患者血清及FF中VEGF和INHB水平并行相关性分析。结果 1降调节足够长时间(≥18 d)时,血清VEGF水平显著下降,且促性腺激素(Gn)启动日A组VEGF水平[(81.50±32.59)ng/L]明显低于B组[(123.64±53.90)ng/L](P0.01)。2 Gn启动后A、B组血清VEGF水平呈上升趋势,h CG注射日后A组继续上升,而B组先下降后上升;且h CG注射次日A组VEGF水平[(165.69±38.25)ng/L]明显高于B组[(136.49±39.19)ng/L](P=0.002);A、B组其它时间血清VEGF水平无统计学差异(P0.05)。3 Gn第5日血清VEGF水平与COH结局相关性最好(P0.01)。4 A、B组FF中VEGF水平随卵泡直径增大而升高,大、中卵泡VEGF水平无统计学差异(P0.05),但B组小卵泡VEGF水平[(889.86±268.95)ng/L]明显高于A组[(728.45±291.88)ng/L](P=0.014);且大卵泡VEGF水平与COH结局显著呈负相关。5 A、B组血清及FF中VEGF水平与INHB呈显著负相关。结论 COH过程中,血清及大、中卵泡VEGF水平与卵巢反应性及COH结局负相关,并且可能对INHB分泌起抑制作用。     

Detection of endometrial and subendometrial vasculature on the day of embryo transfer and prediction of pregnancy during fresh in vitro fertilization cycles

ObjectivesSuccessful implantation depends on interaction between a blastocyst and a receptive endometrium. Endometrial vasculature is important in the early endometrial response to blastocyst implantation, and vascular changes can affect uterine receptivity. This study aims to investigate whether vascular parameters measured using three-dimensional power Doppler ultrasound (3D PD-US) could predict pregnancy following fresh in vitro fertilization and embryo transfer (IVF–ET) using a gonadotropin releasing hormone (GnRH) agonist long protocol.Materials and methodsThis prospective observational study enrolled 236 nulliparous women who underwent a first IVF–ET using a GnRH long protocol with stimulation by recombinant FSH (rFSH) from May 2009 to April 2012. After excluding two cases of tubal pregnancy, 234 women were in either a pregnant group (n = 113) or a nonpregnant group (n = 121). Color Doppler ultrasound and 3D PD-US examinations were performed on the day of embryo transfer. Main outcomes were pulsatility index (PI), resistance index (RI), systolic/diastolic ratio (S/D) of the uterine artery, vascularization index (VI), flow index (FI), and vascularization flow index (VFI) of the endometrium and subendometrial region. Measurements were analyzed relative to IVF–ET outcome (pregnant vs. nonpregnant).ResultsNo significant differences were observed in patient age, infertility duration, body mass index (BMI), basal FSH levels, number of retrieved oocytes or good quality embryos, or endometrial thickness or volume between the two groups. The pregnant group had higher endometrial VI, FI, and VFI scores than the nonpregnant group (p = 0.001, p = 0.000, p = 0.021, respectively). By contrast, neither subendometrial region VI, FI, and VFI scores (p = 0.770, p = 0.252, p = 0.451), nor uterine artery PI, RI, or S/D scores (p = 0.256, p = 0.527, p = 0.365) differed between groups. Cut-off values of endometrial VI, FI, and VFI scores were 0.95, 12.94, and 0.15 for pregnancy achievement.ConclusionThree dimensional PD-US was a useful and effective method for assessing endometrial blood flow in IVF cycles. Good endometrial blood flow on the day of embryo transfer might be associated with high pregnancy success with a GnRH long protocol, because this is indicative of endometrial receptivity in fresh IVF cycles.     

血清及卵泡液中抑制素B动态变化及其与促排卵结局的相关性研究

目的:探讨不同控制性超促排卵(controlled ovarian hyperstimulation,COH)方案中血清及卵泡液(follicular fluid,FF)中抑制素B(inhibin B,INHB)的动态变化及其与COH结局的相关性。方法:收集因输卵管因素和/或男方因素首次接受体外受精/卵细胞质内单精子注射-胚胎移植(IVF/ICSI-ET)助孕患者COH过程各时间节点的血清及取卵(ovum pick up,OPU)日不同大小卵泡的FF,按筛选要求选取长方案组(A组,n=38)及非降调节方案组(B组,n=38)患者,对其血清及FF中INHB水平进行检测并行相关性分析。结果:①降调节过程中,血清INHB水平显著下降(P0.01),且Gn启动日A组血清INHB水平较B组明显下降(P=0.000)。②A组和B组Gn启动后血清INHB水平呈上升趋势,至h CG注射日达高峰后下降,OPU后2 d显著下降(P0.01);A组和B组基础及Gn启动后的血清INHB水平无统计学差异(P0.05)。③ Gn第5日血清INHB水平与COH结局相关性最强,且Gn启动日血清INHB水平与Gn用量呈高度负相关(P0.01)。④A组和B组FF中血清INHB水平随卵泡直径增大而升高,大卵泡的FF中INHB水平无统计学差异(P0.05),但A组中小卵泡的FF中INHB水平显著高于B组(P0.01);且大卵泡的FF中INHB水平与COH结局相关性最好。结论:①降调节后血清INHB水平预示降调节对卵泡同步化作用较好;②COH过程中血清及大中卵泡的FF中INHB水平能很好地预测卵巢反应性及COH结局。