IVF失败者ICSI效果观察

目的观察常规体外受精（IVF）后8 h受精失败者行卵胞浆内单精子注射（ICSI）的效果。方法对65例642枚IVF后8 h未观察到第二极体的MⅡ期卵子实施ICSI。结果 ICSI后16 h观察到541枚卵子出现双原核及第二极体,判断为正常受精;第2天受精卵均出现卵裂,第3天观察到289个6～8个细胞的优质胚胎。移植胚胎152个,平均2.34个。移植后50 d行B超检查结果示临床妊娠29例（临床妊娠率44.6%）。结论 IVF后对未出现原核或未排出第二极体的卵子行ICSI妊娠率较高。     

超重/肥胖型PCOS患者IVF/ICSI-ET妊娠失败危险因素分析及预测列线图构建

目的 总结超重/肥胖型多囊卵巢综合征（PCOS）患者体外受精/卵胞质内单精子注射—胚胎移植（IVF/ICSI-ET）妊娠失败的危险因素,基于危险因素构建预测超重/肥胖型PCOS患者IVF/ICSI-ET妊娠失败风险列线图（列线图模型）。方法 131例拟行IVF/ICSI-ET的超重/肥胖型PCOS患者,均完成胚胎移植周期,收集其体成分特征变量、实验室检查特征变量及临床病例资料变量等。将131例患者分为训练集91例和验证集40例,采用LASSO回归分析法分析超重/肥胖型PCOS患者IVF/ICSI-ET妊娠失败的独立危险因素。基于独立危险因素,构建列线图模型,分别采用受试者工作特征曲线（ROC）、校准曲线、Hosmer-Lemeshow拟合优度检验评价列线图模型的预测能力、校准度、拟合度,采用临床决策曲线评价列线图模型的临床应用价值。结果 超重/肥胖型PCOS患者IVF/ICSIET妊娠失败的独立危险因素有年龄、身体质量指数、水合率和胰岛素抵抗（λ分别为-0.186、-0.947、-0.064、-0.290）。列线图模型的曲线下面积为0.934,校准曲线及拟合曲线预测列线图模型的校准度、...     

双子宫单阴道单宫颈IVF—ET助孕妊娠1例

患者30岁,自然流产后不孕3a。2005年11月妊娠1月余自然流产,体检及B超检查发现双子宫单阴道单宫颈,为左侧子宫妊娠流产,流产后同居不避孕一直未孕,2007年5月行子宫输卵管造影,示双子宫单宫颈,双侧输卵管梗阻并积水,曾用中药治疗未孕,2009年10月到本中心行体外受精-胚胎移植（IVF—ET）助孕。月经不规则,周期30-90d,经期3～4d,轻度痛经,孕1产0,体检一般情况正常,心肺无异常。妇科检查：外阴发育正常,单阴道,单宫颈,子宫后位,正常大小,质地中等,双侧附件未见异常,     

高龄孕妇妊娠晚期心电图异常情况及其对妊娠结局的影响

目的探讨高龄孕妇妊娠晚期心电图异常的情况对妊娠结局产生的影响。方法选取2018年1月-2019年1月我院收治的120例高龄孕妇妊娠晚期患者作为研究观察对象,通过电脑分组法将患者分为对照组和实验组,每组各60例,对照组为35岁以下的年轻孕妇,实验组为35岁以上的高龄孕妇。孕妇均进行心电图常规检查,统计分析两组妊娠结局,探讨高龄组妊娠晚期异常心电图变化及其对妊娠结局的影响。结果高龄孕妇妊娠晚期心电图异常情况会影响妊娠结局高龄组异常心电图,实验组心电图出现异常的几率比对照组多,孕妇胎儿不稳定的几率比对照组大(P<0.05)。结论因为高龄孕妇的抵抗力,及各个器官的机能都比较弱,所以出出现心电图异常的情况比较多,可能会影响妊娠结局,应该更加关注高龄孕妇,保证孕妇及胎儿的健康。     

不同不育类型患者精液质量比较及对补救卵胞浆内单精子注射术临床结局的影响分析

目的 探讨不同不育类型患者精液质量情况及其对补救卵胞浆内单精子注射术(R-ICSI)临床结局的影响.方法 回顾性研究2014-01～2018-12于广西壮族自治区人民医院生殖医学与遗传中心行常规体外受精-胚胎移植(IVF-ET)失败而进行R-ICSI治疗的98对不孕不育夫妇的临床资料.根据不育类型将98对夫妇分为原发性...     

ICSI胞质回吸程度对卵细胞受精及胚胎发育的影响

目的探讨卵胞质内单精子注射(ICSI)时胞质回吸程度对卵细胞受精及胚胎发育的影响。方法采用ICSI作为授精方式,且取卵后成熟卵子数量≥12个(不含无精子症患者)的不孕症患者36例。取使用达菲林长方案治疗的不孕症患者的同源卵细胞,根据ICSI中胞质回吸程度不同分等为A、B、C组。A组注射针回吸卵细胞胞质不超过透明带;B组超过透明带,但在距透明带65μm(约为卵子的半径)以内;C组超过透明带,且距透明带的位置>65μm。授精后3 d内连续观察卵细胞受精情况及胚胎发育情况。结果患者经达菲林长方案治疗后共获得卵子713枚,其中成熟卵子601枚,A、B、C组分别有199、217、185枚。C组的未受精率(13.51%)明显高于A组(6.53%)和B组(6%),P均<0.05;C组单原核出现率(0%)低于A组(4.52%)和B组(6.91%),P均<0.05。C组退化率(8.11%)略高于A组(5.53%)和B组(6%),P均>0.05。A、B、C组卵裂率分别为93.29%、92.49%、93.71%,优质胚胎率分别为64.05%、56.25%、59.7%,其中A组优质胚胎率分别高于B、C组(P均<0.05)。结论ICSI中不同程度回吸卵细胞胞质对卵细胞的受精均无明显影响,但大量回吸胞质可导致卵细胞退化率及不受精率增高,少量回吸胞质有利于卵细胞的受精及胚胎发育。     

不同取精方式对卵泡浆内单精子注射妊娠结局的影响

目的探讨不同取精方式对卵泡浆内单精子注射（ICSI）结局的影响。方法回顾性分析在本中心接受治疗的不育夫妇78例,共81个周期,根据精子来源不同分别治疗：射出精子严重少、弱、畸精症者,行ICSI53个周期;经附睾穿刺（PESA）或睾丸切开取精（TESE）者,行ICSI28个周期。比较ICSI后两组的受精率、优质胚胎率、卵裂率及临床妊娠率。结果两组分别穿刺MⅡ期成熟卵子457、359个,自取精液组受精率明显高于附睾或睾丸取精组,而优质胚胎率、卵裂率、临床妊娠率两组无显著差异。结论ICSI使用不同来源精子不影响其妊娠结局,是治疗男件不育的有效方法。     

短方案超促排卵中晚卵泡期LH水平与IVF-ET/ICSI助孕结局的关系

目的 探讨在短方案超促排卵中晚卵泡期黄体生成激素（LH）水平与体外受精-胚胎移植/卵泡浆内单精子注射（IVF-ET/ICSI）妊娠结局的关系.方法 研究对象为84例于我院生殖中心实施IVF-ET/ICSI助孕的患者,均采用短方案超促排卵,于肌注绒毛膜促性腺激素（HCG）日测定血清LH水平,并观察其妊娠结局.结果 血清LH水平不同者获卵数、受精率、优质胚胎率比较均无统计学差异,但＜2 mIU/L及＞5 mIU/L者临床妊娠率均显著低于2～5 mIU/L者（P均＜0.05）.结论 在短方案超促排卵中应注意调整LH水平,以提高临床妊娠率.     

精子质量对不孕不育患者辅助生殖技术选择的指导作用

目的探讨精子质量对不孕不育患者辅助生殖技术选择的指导作用。方法选择201对行常规体外受精胚胎移植术(IVF-ET)的不孕不育夫妇,其中行IVF-ET成功(二极体的胚胎数量占胚胎总数≥30%)者126对(IVF-ET组),IVF-ET失败(二极体的胚胎数量占总胚胎数<30%)后行补救卵胞浆内单精子注射术(R-ICSI)75对(R-ICSI组)。比较两组精液常规、精子DNA完整率、精子顶体完整率、顶体反应率;体外受精后比较两组受精率、优胚胎率。结果 IVF-ET组精子密度、活力及正常形态率均高于R-ICSI组(P均<0.05);R-ICSI组精子DNA断裂指数(DFI)明显高于IVF-ET组(P<0.05),顶体完整率、顶体反应率两组比较无统计学差异(P均>0.05);R-ICSI组受精率、优胚率低于IVF-ET组(P均<0.05)。结论当精子密度低于11.1×106/m L,正常形态率低于1.4%,DFI高于15.9%,顶体完整率低于77.3%,顶体反应率低于15.7%时建议直接行R-ICSI助孕。     

妊娠糖尿病的危险因素对母婴妊娠结局影响的临床分析

目的:分析孕产妇妊娠糖尿病的危险因素和临床上的妊娠结果影响.方法:在2019年1月—2019年12月我们医院总共有60例患妊娠糖尿病的病患,将其作为观察组进行研究.同时期,我们医院有150例健康产妇不患糖尿病,选择这些健康产妇作为对照组进行研究.对两组产妇在临床医学上的资料进行对比和分析,对照组平均在(38.12±3....     

The number of previous failed embryo transfer cycles is an independent factor affecting implantation rate in women undergoing IVF/ICSI treatment: A retrospective cohort study

The implantation rate (IR) in assisted reproductive technologies such as in vitro fertilization (IVF) and intracytoplasmic sperm injection is affected by many different factors such as age, quality of embryo, and stage of embryo development. This study aimed to investigate to what extent the number of previous failed embryo transfer cycles is an independent factor affecting IR.This was a single-center, retrospective cohort study of a consecutive series of 6376 day-3 embryo transfer (ET) cycles following IVF between January 2012 and August 2018. None of the subjects underwent endometrial scratch/injury prior to the treatment cycle, or received intravenous immunoglobulin, steroid, dehydroepiandrosterone, intralipid or heparin during the treatment with the aim of improving implantation rates.Multiple regression analysis showed that the 3 most important independent factors affecting the IR, in decreasing of importance: age, frozen or fresh embryo transfer and the number of previous ET cycles. Having controlled for 2 of the more important confounding variables including maternal age and the type of embryo, the IR in women who had 0, 1, 2, and 3 or more previous failed ET cycles were 45.8%, 35.9%, 31.2%, 21.0%, respectively (P < .001).Repeated implantation failure is a significant independent factor affecting the IR. The number of previous failed ET cycles should be considered in counselling women regarding the prognosis of a further IVF-ET treatment cycle.     

Hypogonadotrophic Hypogonadism and Diminished Gonadal Reserve Accounts for Dysfunctional Gametogenesis in Thalassaemia Patients with Iron Overload Presenting with Infertility

Improved care of β-thalassemia major (β-TM) patients has brought with it new challenges for the patient to have a family. We report our 15-year experience with 30 couples with 28 pregnancies following artificial reproductive techniques (ART). Sixty percent of females had hypogonadotrophic hypogonadism (HH) with diminished ovarian reserve and responded favorably to gonadotrophins with 80% success rate within three cycles. Pulsatile gonadotrophin-releasing hormone (GnRH) infusion was used in one and clomiphene in another patient which resulted in successful pregnancies. Males responded less favorably than females. Gonadotrophins were used in 14 pulsatile HH patients for 6-24 months with variable outcomes. Although successful paternity did not occur, successful spermatogenesis with oligoasthenospermia occurred in six men. Two had in vitro fertilization (IVF) and intracytoplasmic injections (ICSI), which resulted in healthy offspring. In conclusion, successful pregnancy and fertility are feasible in β-TM patients with diminished gonadal reserves. Better outcome is expected in females than males. We report the first two cases of paternity following IVF and ICSI in β-TM patients with HH.     

Effects of hepatitis B virus infection on the treatment outcomes following in vitro fertilization/intracytoplasmic sperm injection: An analysis of 21,999 first embryo transfer cycles

To investigate the effects of hepatitis B virus (HBV) infection on the outcomes of Chinese couples undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and the clinical data of their neonates. A total of 21,999 first embryo transfer cycles were included. They were categorized into four groups based on the couple's hepatitis B surface antigen (HBsAg) result (Group A = female HBsAg⁻ and male HBsAg⁻; Group B = female HBsAg⁺ and male HBsAg⁻; Group C = female HBsAg⁻ and male HBsAg⁺; Group D = female HBsAg⁺ and male HBsAg⁺). The fertilization rate (FR), cleavage rate (CR), implantation rate (IPR), clinical pregnancy rate (CPR), live birth rate (LBR) and miscarriage rate (MCR) were analysed. Multilevel logistic regression was applied to evaluate the association. The total prevalence of HBV infection was 5.74% (2526/43998). There were no statistically significant differences in CRs (98.69%, 98.76%, 98.66%, 98.72%, p > .05), IPRs (45.86%, 47.33%, 45.19%, 39.61%, p > .05), CPRs (62.84%, 65.05%, 61.80%, 56.81%, p > .05), MCRs (12.70%, 11.99%, 12.58%, 4%, p > .05) and LBRs (53.43%, 55.38%, 52.70%, 54.54%, p > .05) among the four groups. However, there were significant differences in FRs (66.25%, 66.55%, 66.32%, 61.92%, p < .05). Group D had the lowest FR. After adjusting for confounders, the multilevel logistic regression showed that HBsAg⁺ had no impact on the LBR, CPR or MCR. We also analysed the data of 14,465 newborns, including 8593 singletons and 2936 twins. Among the four groups, no variables reached statistical significance, including neonatal birth weight (NBW), twin ratio, gestational age, premature birth, delivery type, fetal macrosomia or low birth weight (p > .05). Our study demonstrates that, although biparental HBV infection may affect the FR, neither single-parent infection nor biparental HBV infection affects IVF/ICSI outcomes or neonatal outcomes.     

腹水型晚期血吸虫病实施临床路径的效果评价

目的 评价临床路径（CP）在腹水型晚期血吸虫病（晚血）诊疗中的实施效果。方法 从湖北省晚血救治绩效评估管理系统中,随机抽取2011-2013年救治的无合并症的腹水型晚血患者1 129例, 其中采用CP治疗754例（CP组）,采用传统治疗375例（NCP组）,比较两组患者住院天数、住院费用、药占比、治疗转归、满意度和健康知识知晓率差异,并观察CP的变异情况。结果 CP组平均住院时间为（13.85 ± 5.60） d、平均住院费用为（4 699.14 ± 1 520.59）元,NCP组分别为 （17.92 ± 5.80） d和（5 692.01 ± 1 616.66）元,差异均有统计学意义（P 均< 0.05）;两组住院费用结构亦有显著不同,CP组检查费、床位费构成比低于NCP组,但检验费、诊疗费、药品费及其他费用构成比高于NCP组（ P均 < 0.05）。CP组健康知识知晓率较NCP组高（P < 0.05）,两组患者治疗转归及满意度差异均无统计学意义（P均 > 0.05）。CP变异率为9.02%（68/754）。结论 实施CP能减少腹水型晚血患者的住院时间、降低医疗费用、提高患者健康知识知晓率。CP治疗变异率较低,适用于无合并症的腹水型晚血患者。     

Effects of chromosomal abnormalities on pregnancy outcomes in female undergoing artificial insemination with donor's sperm

This study aimed to evaluate the clinical characteristics, pregnancy outcomes and prognostic factors for pregnancy of female with chromosomal abnormalities (CAs) after artificial insemination with donor''s sperm (AID) treatment.A retrospective case–control study was analyzed by using the data of 29 female patients with CA and 116 controlled patients with normal karyotype (1:4 ratio) who underwent AID cycles at Guangdong Family Planning Special Hospital from January 2011 to December 2017. In all cases, reproductive histories were collected, and the cytogenetic analysis was performed by Trypsin-Giemsa banding and karyotyping. The embryos were fertilized via intracervical or intrauterine insemination. Clinical characteristic variables were compared.The prevalence of CA was found to be 0.29% in the whole AID population. The live birth rates of CA group and controlled group were 41.4% and 31.0% (P = .29) respectively. Compared to normal karyotype group, patients with CA showed higher rate of primary infertility (93.1% vs 75.9%, P = .049); Multivariate analysis demonstrated that ovarian stimulation (odds ratio, 3.055; 95% confidence interval, 1.421–6.568; P = .004) was associated with adverse pregnancy outcomes in female patients with AID treatment.For the infertility CA patients who were phenotypically normal, AID was a suitable choice, whereas ovarian stimulation results in an improvement in the pregnancy rate.     

46例育龄女性应用人工生物瓣膜置换临床效果分析

目的分析育龄女性心脏瓣膜疾病异种心脏生物瓣膜置换治疗的临床效果,评价生物瓣膜在育龄女性患者中的应用效果及趋势。方法回顾性分析2005年7月起至2010年1月接受生物瓣膜置换术的46例育龄女性术后生活质量及生育情况。结果平均随访35个月,随访率97．8％。随访病例生存良好,心功能Ⅰ级35例、Ⅱ级9例、Ⅲ级1例。心脏彩超示瓣膜功能良好,无明显衰败迹象。术后怀孕女性33例,自然流产4例,死胎1例,足月顺产21例,早产4例,剖宫产7例,畸胎0例。结论异种心脏生物瓣膜置换对育龄女性疗效确切,在保证手术技术的情况下,术后生活质量及生育情况较好。     

全民普食碘盐对育龄、妊娠和哺乳妇女尿碘水平的影响

目的了解湖南省在实现全民普食碘盐7年后育龄、妊娠、哺乳期妇女碘营养状况，为持续消除碘缺乏病防治工作提供科学的决策依据。方法随机抽样，对城乡的育龄、妊娠、哺乳期妇女采取随意尿样，检测尿碘值，并以8～10岁儿童作对照。结果新婚育龄、妊娠、哺乳期妇女人群尿碘中位数正常，但妊娠、哺乳期妇女的尿碘水平低于8～10岁儿童尿碘水平。结论需加强对育龄、妊娠和哺乳期妇女的碘营养监测。