血清雌二醇水平对控制性超促排卵结局和妊娠的影响

目的探讨控制性超促排卵过程中人绒毛膜促性腺激素（hCG）日血清雌二醇水平及其对促排卵结局和妊娠的影响。方法回顾性分析因输卵管阻塞和／或男方少、弱精在我院生殖中心进行IVF／ICSI—ET助孕的患者的资料,比较不同E2水平患者的获卵数、受精率等促排卵相关参数及临床妊娠率。结果HCG日E2水平〉5000pg／ml组患者的获卵数明显高于HCG日E2水平较低的两组,但是HCG日E2水平〈3500pg／ml组患者的受精率及临床妊娠率高于E2水平较高的患者,差异有统计学意义。结论控制性超促排卵过程中HCG日E2水平对促排卵结局有影响,HCG日E2水平过高会影响促排卵患者的临床妊娠率。     

基础睾酮水平对卵巢储备功能下降患者体外受精-胚胎移植结局的预测

目的探讨基础睾酮水平对卵巢储备功能下降(DOR)患者控制性超促排卵(COH)及体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)结局的预测作用。方法回顾性分析2010年1月~2013年8月于我院生殖中心应用Gn RH拮抗剂(Gn RH-ant)方案促排卵行IVF/ICSI助孕的DOR患者138例,探讨基础睾酮与COH各参数的相关性及对IVF妊娠结局的影响。结果 DOR患者妊娠组的基础睾酮水平、窦卵泡数、HCG日E2水平和获卵数显著高于未妊娠组(P0.05);在相关分析中,体重指数、窦卵泡数及获卵数与基础睾酮水平呈正相关;ROC曲线显示,基础睾酮水平与DOR患者IVF妊娠结局存在相关性,曲线下面积为0.779(95%CI 0.704-0.855,P0.01),基础睾酮的最佳界值为20.86ng/dl,敏感度81.8%,特异度61.9%。结论基础睾酮水平能较好地预测DOR患者IVF妊娠结局,当DOR患者基础T水平高于20.86ng/dl时临床妊娠率较高。     

妇女血清抗精子抗体对IVF-ET结局的影响

目的探讨妇女血清中抗精子抗体对体外受精-胚胎移植（IVF-ET）结局的影响。方法采用酶联免疫吸附法（ELISA法）测定190例因输卵管因素不孕行IVF-ET助孕妇女血清中的抗精子抗体（AsAb）,AsAb阳性28例（A组）,AsAb阴性162例（B组）,观察两组受精率、卵裂率、优质胚胎率、种植率、临床妊娠率及早期妊娠流产率。结果受精率A组（84.12%）较B组（79.72%）高,但无统计学差异（P〉0.05）;两组卵裂率（A组98.28%、B组99.22%）、优质胚胎率（A组53.02%、B组46.97%）、种植率（A组21.31%、B组25.41%）、临床妊娠率（A组39.29%、B组40.12%）、早期妊娠流产率（A组18.18%、B组12.31%）均无统计学差异（P〉0.05）。结论妇女血清中的AsAb对IVF-ET的结局无明显影响。     

体外受精中精卵孵育时间对结局的影响

目的比较体外受精中精卵孵育不同时间(短时与过夜)对治疗结局的影响,进一步探讨短时受精的临床应用价值。方法90个体外受精(IVF)周期常规促排卵,将获得的患者同胞卵子随机分配到两组中,A组:短时受精组,精卵孵育2h后将卵子转移至新鲜培养基中;B组:过夜组,精卵孵育18h;比较两组的受精、卵裂及优质胚胎率。移植胚胎按来源又分1组:2个胚胎均来源于A组;2组:2个胚胎A、B组来源各1个;3组:2个胚胎均来源于B组;比较三组的妊娠率、种植率及单、双胎率。结果A、B两组的受精率、卵裂率差异无统计学意义,优质胚胎率A组高于B组(P<0.05)。1、2、3组妊娠率、种植率、双胎率差异无统计学意义,但从1、2到3组种植率、双胎率逐渐下降。结论缩短精卵孵育时间不影响受精及卵裂,相反能提高胚胎质量,从而提高胚胎的种植潜能。     

输卵管积液不同处理方案对IVF-ET助孕患者妊娠结局的影响分析

目的探究输卵管积液不同处理方案对体外受精-胚胎移植(IVF-ET)助孕患者妊娠结局的影响。方法选取本院2017年4月至2019年2月期间收治的124例IVF-ET合并输卵管积液患者作为研究对象,根据处理方案不同分组,A组59例患者采用输卵管远端造口术治疗,B组65例患者采用输卵管远端造口术+近端结扎术治疗,IVF-ET方案相同。对比两组患者的卵巢储备功能及促排卵药物用量以及妊娠结局情况。结果两组患者的FSH、AMH、AFC水平以及促排卵药物用量均无显著差异(P0.05);A组患者妊娠率为25.4%(15/59),显著低于B组患者的47.7%(31/65);A组患者流产率为20.3%(12/59),异位妊娠率为10.6%(6/59),显著高于B组患者的9.2%(6/65)、1.5%(1/65),差异具有统计学意义(P0.05)。结论输卵管积液是影响IVF-ET患者妊娠率及不良妊娠结局的重要因素,输卵管远端造口术+近端结扎术能够更彻底的处理输卵管积液问题,是改善输卵管积液IVF-ET患者妊娠结局的有效手段。     

孕产妇血清生长激素及睾酮水平变化的观察

为了解孕立妇分娩前后生长激素（ＧＨ）及睾酮（Ｔ）水平的变化，本文用放射免疫法对６４例年龄在２２－３５岁，孕期３７－４２周，出生均为健康儿的孕产妇分娩前及分娩后２４小时血甭进行了检测，结果显示：血清ＧＨ及Ｔ水平分娩前无效均明显高发娩后及正常未孕组，差异非常显著，而分娩后ＧＨ及Ｔ水平淙不孕组无性差异。这是因为一则孕产妇为满足胎儿正常生长发育的需要，分娩前母体垂体及肾上腺功能亢进，ＧＨ及Ｔ分泌代偿性增高     

十堰地区行辅助生殖手术妇女的TORCH检测结果分析

目的了解来本院就诊需行辅助生殖手术[体外受精一胚胎移植（IVF—ET）]的育龄妇女TORCH（TOX、RUV、CMV、HSVII）感染情况。方法用酶联免疫法对2754例妇女进行TORCH—IgM及tgG抗体的检测。结果TOX—IgM、RUV—IgM、CMV—IgM及HSV—IgM的阳性率分别为1．63％、1．56％、0．94％及0．29％;TOX—I舀、RUV—IgG、CMV—IgG及HSV—IgG的阳性率分别为6．20％、59．01％、60．86％及1．13％。结论行辅助生殖手术的妇女应进行TORCH感染的检测与治疗,以提高辅助生殖手术的成功率,减少有缺陷新生儿的出生。     

妊娠贫血对产科结局的影响

目的：了解妊娠中、晚期贫血的发生率及其对产科结局的影响。方法：对951例孕妇产前及产后血红蛋白(Hb)检测结果与产科结局的关系进行回顾性分析。Hb＜100g／L的孕妇为贫血组，Hb≥100g／L的孕妇为正常对照组，分别对孕中期及孕晚期贫血与产科结局进行对照分析。结果：孕中期贫血导致孕晚期贫血、产后贫血、早产、过期妊娠、胎盘功能欠佳发生率增加(P＜0．05)。孕晚期贫血导致产后贫血、早产、低体重儿的出生、胎盘早剥发生率增加(P＜0．05)，孕晚期贫血可增加妊高征、死胎、胎膜早破的发生率(P＞0．05)。双胎妊娠增加妊娠贫血的发生率。结论：妊娠中、晚期贫血对产科结局有不良影响，应加强妊娠期贫血的防治，从妊娠中期常规补铁，降低妊娠期贫血的发生率，保障母婴健康。     

降调后基础血清雌激素水平预测IVF-ET结局的价值探讨

目的 探讨在IVF—ET过程中，对垂体进行降调节后，基础血清雌激素的水平对预测IVF—ET结局的评价意义。方法 回顾分析320个IVF—ET临床妊娠周期，均采用黄体中期长方案或者卵泡早期长方案对垂体进行降调节，按降调后启动日基础血清雌激素水平分为3组，分别为A组：E2≤25pg／ml，B组：25pg／ml〈E2≤50pg／ml，C组：E2〉50pt,／ml。结果 25pg／ml〈E2≤50pg／ml组用药量最少，且受精率及妊娠率最高。E2〉50pg／ml组病人的用药量最高、获卵数及受精率、妊娠率都是最低。结论 启动日病人25pg／ml〈E2≤50pg／ml将会有低的用药量和好的妊娠结局，而E2〉50pg／ml则会有不良的卵巢反应及妊娠结局。但是三组病人在一般状况、取卵数等方面无统计学差异。     

电针干预对肾虚型PCOS患者影响机制的研究

目的探讨电针干预对肾虚型多囊卵巢综合征(PCOS)患者体外受精-胚胎移植(IVF-ET)中卵细胞质量及妊娠结局的影响,并探讨其作用机理。方法将接受IVF-ET的肾虚型PCOS患者66例随机分为观察组34例,对照组32例,观察组加用电针干预。观察两组患者血清及卵泡液中干细胞因子(SCF)含量以及周期结局的不同。结果1、观察组治疗后肾虚症状改善明显(P(0.05),受精率、卵裂率、优质胚胎率均高于对照组,差异有显著性(P(0.05)。2、观察组取卵日血清、卵泡液SCF水平明显高于对照组(P(0.05)。妊娠组血清、卵泡液SCF水平高于非妊娠组,差异有显著性(P(0.05)。3、观察组临床妊娠率高于对照组,但差异无统计学意义(P0.05)。4、两组患者年龄、不孕年限、体重指数、基础内分泌、治疗前肾虚症状积分、hCG日子宫内膜厚度、血LH、E2、P水平、获卵数、OHSS发生率、周期取消率均无显著性差异(P0.05)。结论对PCOS患者IVF-ET中进行电针干预,可从整体上调节机体内分泌和卵巢局部微环境,提高了卵子质量和临床妊娠率,取得较高的临床效果。     

体外受精-胚胎移植中卵巢低反应80例分析

目的探讨体外受精-胚胎移植（IVF—ET）中卵巢低反应的预测及结局。方法回顾性分析2005—2007年在本生殖中心首次接受IVF—ET治疗的不孕患者,以促性腺激素（Gn）刺激后两侧卵巢发育卵泡≤3个,或经阴道超声引导取卵,获卵数≤4个为卵巢低反应判断标准,符合卵巢低反应标准的80例为低反应组,取同期获卵5—20个的80个IVF—ET治疗周期为对照组。分析两组平均年龄,年龄≥35岁、双侧卵巢窦卵泡数≤5个、基础促卵泡素（bFSH）≥8IU／L、基础雌二醇（bE2）≥80μg／L患者的比例,周期取消率,平均Gn用量及临床妊娠率。结果低反应组平均年龄,年龄≥35岁、bFSH≥8IU／L患者的比例均明显高于对照组（P〈0．05）;低反应双侧卵巢窦卵泡数≤5个及周期取消率明显高于对照组,相差非常显著（P〈0．01）;两组bE：≥80μg/L患者的百分比及平均Gn用量无显著性差异（P〉0．05）;低反应组临床妊娠率（21．25％）明显低于对照组（41．03％）,差异有统计学意义（P〈0．05）。结论患者年龄≥35岁、bFSH≥8 IU／L及窦卵泡≤5个均可作为预测卵巢低反应的指标。     

体重指数对PCOS患者体外受精-胚胎移植妊娠结局的影响

目的探讨体重指数对多囊卵巢综合征患者体外受精一胚胎移植妊娠结局的影响。方法回顾性分析2010年1月至2011年11月于哈尔滨医科大学附属第一医院接受IVF／ICSI治疗的PCOS（polycystie ovarian syndrome）患者64例共67个周期,按照体重指数分为正常体重组（A组）、超重组（B组）、肥胖组（C组）。比较三组之间基本临床资料;促排卵过程、卵子、胚胎情况及妊娠结局情况。结果FSH值C组低于A组、B组,空腹胰岛素及胰岛素抵抗指数C组高于其他两组,差异均有统计学意义;HCG日E2水平A组高于B组、C组,GN用量A组低于其余两组,差异有统计学意义;受精率、胚胎种植率、临床妊娠率、流产率及活产率三组问差异没有统计学意义。结论超重和肥胖增加了PCOS患者体外受精一胚胎移植促排卵过程中促性腺激素的用量,但对妊娠结局没有显著影响。     

改良超长降调节方案用于体外受精-胚胎移植卵巢低反应患者的临床研究

目的探讨改良超长降调节方案在既往体外受精一胚胎移植失败的卵巢低反应患者中的应用效果。方法回顾性分析本中心58例连续两周期行体外受精一胚胎移植术的卵巢低反应患者,其中第一周期采用拮抗剂方案,第二周期采用改良超长方案。自身对照比较两组临床及实验室结果。结果第二周期获得了38．2％的临床妊娠率,两组Gn启动剂量、HCG日E2、LH及P值、HCG日子宫内膜厚度、获卵数、移植胚胎数比较无统计学差异（P〉0．05）,可移植胚胎数、冷冻胚胎数第二周期均较第一周期高,但无统计学差异（P〉0．05）;Gn天数、优质胚胎率、周期取消率第二周期组较第一周期组高,均有统计学差异（P〈0．05）。结论对于既往采用拮抗剂方案失败的卵巢低反应患者,再次行体外受精-胚胎移植可尝试采用改良超长降调节方案。     

IVF-ET患者卵巢颗粒细胞COX-2的表达与妊娠结局的相关性研究

目的探讨体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)患者卵巢颗粒细胞中环氧合酶-2(cyclooxygenase-2,COX-2)的表达,分析其与妊娠结局的关系。方法荧光半定量real-time PCR检测48例行IVF-ET患者卵巢颗粒细胞中COX-2的mRNA表达,分析COX-2与注射hCG日血清雌二醇(estradiol,E_2)水平、获卵率、受精率、优质胚胎率及妊娠率的关系。结果卵巢颗粒细胞COX-2的表达量与hCG日血清E_2水平及获卵率无关,与受精率、优质胚胎率及妊娠率相关。结论 PCOS患者卵巢颗粒细胞COX-2的表达与胚胎质量相关,研究卵巢颗粒细胞的COX-2的表达可以作为预测IVF-ET妊娠结局指标之一。     

卵巢低反应者体外受精-胚胎移植的临床结局分析

目的评估首次体外受精-胚胎移植时表现为卵巢低反应的患者接受再次体外受精-胚胎移植治疗的实际意义和调整临床处理过程的价值。方法回顾性分析2004年1月至12月间在北京大学第三医院生殖中心进行体外受精-胚胎移植的206个卵巢低反应病例,共288个周期的临床资料。结果206例卵巢低反应病例首次IVF-ET时临床妊娠率为22%。其中82例接受了再次IVF-ET,临床妊娠率为40.6%,高于首次IVF-ET,经统计学检验差异有显著性(P<0.05),再次IVF-ET的E2峰值,取卵数以及移植胚胎数均高于首次IVF-ET,经统计学检验差异有显著性(P<0.05)。结论首次IVF-ET卵巢低反应的患者经过调整促排卵方案,接受再次IVF-ET时临床妊娠率有所提高。     

Repeated testing of basal FSH levels has no predictive value for IVF outcome in women with elevated basal FSH

BACKGROUND: It is a common practice to repeatedly test the level of basal FSH early in the cycle and to start IVF treatment only when the FSH level is below a certain threshold value. This is based on the idea that these women will respond better to ovarian stimulation when the basal FSH level is lower at the start of the cycle. The aim of this study is to assess the value of this practice. METHODS: Between January 1995 and January 2003, 39 women were identified. These women underwent two IVF treatment cycles within a 12 month period. The basal FSH level prior to each of these cycles was known to have changed. The treatment cycles were divided into cycles with a high basal FSH (> or =10 IU/l) and cycles with a low basal FSH (<10 IU/l). RESULTS: The 39 women underwent a total of 78 treatment cycles (in the first cycle 20 had elevated level of FSH and 19 had low FSH and vice versa in the second cycle). Therefore, there were 39 cycles with high FSH and 39 cycles with low FSH. There was obviously no live birth in the first treatment cycle, hence the reason for the patient undergoing another treatment cycle within 12 months of the first one. In the high FSH group, six became pregnant [pregnancy rate (PR) = 15.4%] and five delivered [live birth rate (LBR) = 12.8%]. In the low FSH group, three became pregnant (PR = 7.7%) and two delivered (LBR = 5.1%). The difference in PR and LBR, however, was not significant. Neither were there significant differences between the two groups with regard to the number of oocytes collected, oocytes fertilized, embryos transferred or miscarriage rate. CONCLUSION: The results of this study reveal that women who are poor responders or with reduced ovarian reserve have a poor outcome and repeatedly testing them will add no value. Cycling women with a history of elevated FSH should be offered treatment without further delay. Delaying treatment for these women could be counterproductive, as they may have to wait for many months, during which time they are getting older and closer to their menopause.     

Evaluation of serum CA 125 concentration before and during hormonal induced cycles as predictor of IVF/ET outcome

PROBLEM: To evaluate the role of CA 125 in prediction of in vitro fertilization and embryo transfer (IVF/ET) outcome. METHOD OF STUDY: Serum CA 125 concentrations were evaluated in the spontaneous and stimulated cycles of 33 patients. CA 125 was measured using a microparticle enzyme immunoassay (MEIA) (Abbott, Diagnostics, USA). Follicular growth, endometrial thickness and subendometrial blood flow were evaluated by transvaginal color Doppler ultrasound. Statistical analysis was performed by Wilcoxon rank-sum test and Friedman test. RESULTS: There was no statistically significant difference (P > 0.05) of CA 125 values between spontaneous and stimulated cycles, and between pregnant and non-pregnant patients. A CA 125 rise from the late proliferative to the early secretory phase (P < 0.05) was obtained only in the stimulated cycles. There was no relationship between CA 125, follicle number, endometrial thickness and resistance index of the subendometrial vessels. CONCLUSION: CA 125 levels are not predictive of ovarian and endometrial response. Hormonal stimulation does not effect serum CA 125 concentration. There was no influence of CA 125 levels on IVF/ET outcome in stimulated cycles.     

囊胚序贯培养在体外受精-胚胎移植中的应用

目的 探讨囊胚序贯培养系统在体外受精-胚胎移植技术（IVF—ET）中的临床应用。方法 进行了17个周期的囊胚序贯培养，将胚胎体外培养至第5—6天，达囊胚期后移植。结果 共取卵250枚，受精率68％，囊胚形成率为52％，囊胚种植率为28％，获8例临床妊娠。结论 序贯培养囊胚移植更适合卵子和胚胎的体外发育，对提高临床妊娠率，降低多胎率有良好的应用前景。     

Expression of intracellular Th1 and Th2 cytokines in women with recurrent spontaneous abortion,implantation failures after IVF/ET or normal pregnancy

PROBLEM: We aimed to investigate absolute counts of intracellular T helper 1 (Th1) and Th2 cytokine expressing T-cell subpopulations in women with three or more recurrent spontaneous abortions (RSA), multiple implantation failures after in-vitro fertilization and embryo transfer (IVF/ET) (three or more) or during normal pregnancy. METHOD OF STUDY: Absolute cell counts and percentages of CD3+, CD3+/CD4+, and CD3+/CD8+ T-cell populations expressing intracellular cytokines [interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-4 and IL-10] was studied by four-color flow cytometry in 15 RSA and 13 implantation failure patients. Eighteen fertile non-pregnant and 47 normal pregnant women were also compared with regard to intracellular cytokine expression. RESULTS: Interleukin-10 producing CD3+/CD8+ T-cell counts were significantly lower in women with RSA (P < 0.05) and implantation failures (P < 0.05), and TNF-alpha producing CD3+/CD4+ T-cell counts were higher in women with RSA (P < 0.05) and implantation failures (P < 0.005) than those of non-pregnant fertile controls. During normal pregnancies, first trimester IL-4 expressing CD3+, CD3+/CD4+ T-cell counts (P < 0.05) and IFN-gamma expressing CD3+ T-cell counts (P < 0.05) were significantly higher than those of third trimester (P < 0.05). First trimester TNF-alpha expressing CD3+/CD8+ T-cell counts were significantly higher than those of second and third trimester women (P < 0.05). However, there are no differences in cytokine expression between non-pregnant and first trimester pregnant women. CONCLUSION: Absolute counts of IFN-gamma, IL-4, and TNF-alpha expressing T cells decrease with the progress of gestation (third trimester) during normal pregnancies. In women with implantation failures, absolute cell counts of TNF-alpha expressing CD3+/ 4- cells reflects the presence of dominant Th1 immune response. A significantly increased Th1 cytokine expression may be the underlying immune etiology for reproductive failures.     

Pretreatment with transdermal testosterone may improve ovarian response to gonadotrophins in poor-responder IVF patients with normal basal concentrations of FSH

BACKGROUND: Treatment of poor-responder patients to controlled ovarian stimulation for assisted reproduction, who have normal basal FSH concentrations, is one of the most difficult challenges in reproductive medicine. This study investigated the usefulness of testosterone pretreatment in such patients. METHODS: Prospective, therapeutic, self-controlled clinical trial including 25 consecutive infertile patients who had a background of the first and second IVF treatment cycle cancellations due to poor follicular response, in spite of vigorous gonadotrophin ovarian stimulation and having normal basal FSH levels. In the third IVF attempt, all patients received transdermal testosterone treatment (20 microg/kg per day) during the 5 days preceding gonadotrophin treatment. RESULTS: Twenty patients (80%) showed an increase of over fivefold in the number of recruited follicles, produced 5.8+/-0.4 (mean+/-SEM) oocytes, received two or three embryos and achieved a clinical pregnancy rate of 30% per oocyte retrieval. There were 20% cancelled cycles. CONCLUSION: Pretreatment with transdermal testosterone may be a useful approach for women known to be low responders on the basis of a poor response to controlled ovarian stimulation but having normal basal FSH concentrations.