FOXL2对IVF周期卵巢反应性的影响

目的:探讨FOXL2在人卵巢黄素化颗粒细胞表达与IVF周期超促排卵过程中卵巢反应性的关系。方法:采用半定量逆转录聚合酶链反应(RT-PCR)技术测定84例体外受精-胚胎移植(IVF-ET)周期中卵巢黄素化颗粒细胞FOXL2 mRNA的表达。结果:卵巢低反应型(卵泡数≤3个)FOXL2 mRNA表达量显著低于中反应型(卵泡数4~13个)和高反应型(卵泡数≥14个)(P<0.05);FOXL2表达强度与血清基础FSH呈负相关(r=-0.46,P<0.05)。结论:卵巢颗粒细胞上FOXL2水平影响体外受精-胚胎移植过程中卵巢对促性腺激素的反应。卵巢颗粒细胞上FOXL2表达水平与卵巢储备功能有关,卵巢功能下降可能与卵巢颗粒细胞上FOXL2表达水平降低有关。     

卵巢反应性对IVF-ET妊娠结局的影响

目的:探讨IVF-ET促排卵周期中卵巢反应性对妊娠结局的预测能力。方法:回顾性分析402个长方案促排卵周期中所需外源性重组卵泡刺激素总量(rFSH)/成熟卵母细胞数(n)的比值(rFSH/n)与妊娠结局的关系。结果:随着rFSH/n比值升高,基础窦卵泡数(AFC)减少、rFSH总用量增大、获卵数减少、平均胚胎评分下降(P<0.05)。当rFSH/n>450时,临床妊娠率明显下降(P<0.05)。结论:卵巢反应性是影响IVF结局的重要因素,妊娠率随着rFSH/n的增加而下降的截点为rFSH/n>450。     

卵巢慢反应患者控制性超促排卵相关因素分析:一项多中心回顾性研究

目的探讨控制性超促排卵(COH)过程中发生卵巢慢反应可能的相关因素。方法回顾性分析2014年1月—2016年1月期间于兰州大学第一医院、新疆佳音医院、青海省人民医院、银川市妇幼保健院、广西玉林市妇幼保健院进行促性腺激素释放激素激动剂(GnRH-a)长方案体外受精-胚胎移植(IVF-ET)的144例卵巢慢反应患者的临床资料,与132例卵巢正常反应患者(正常对照组)进行对比。结果与正常对照组相比,慢反应组患者体质量指数(BMI)、促甲状腺激素(TSH)较高,降调节及促排卵时间较长,促性腺激素(Gn)使用后7d平均卵泡直径偏小,雌二醇(E_2)、黄体生成素(LH)低,hCG注射日E_2低,IVF双原核(2PN)卵裂率较高,临床妊娠率低,差异均有统计学意义(P0.05)。患者年龄、不孕年限、基础卵泡刺激素(FSH)、LH、催乳素(PRL)、E_2、基础卵泡数、hCG注射日孕酮(P)、获卵率、胚胎质量、胚胎种植率、流产率、宫外孕率、继续妊娠率及取消移植率组间均无统计学差异(P0.05)。结论卵巢慢反应可能与患者BMI过高、甲状腺功能降低及GnRH-a过度抑制相关,较长的Gn天数仍可使慢反应患者获得较好的妊娠结局。     

应用AAFA卵巢储备评估模型探究不同促排卵方案对卵巢储备下降患者结局的影响

目的:应用AAFA卵巢储备评估模型探讨不同促排卵方案在卵巢储备下降(DOR)患者中的结局差异.方法:回顾性收集2017年1月至2018年12月在北京大学第三医院生殖医学中心行体外受精/卵胞浆内单精子注射(IVF/ICSI)的患者资料,筛选符合AAFA模型定义且符合入组标准的DOR患者共697个周期,根据促排卵方案分为拮...     

卵巢及输卵管术后患者超排卵治疗卵巢反应性的观察

目前，对输卵管切除术后对卵巢功能的影响尚认识不一，解剖学上卵巢与输卵管的血管神经相邻近，此为输卵管切除术损伤卵巢血液供应(血供)的理论依据。Hughes等观察11例绝经后行卵巢肿瘤剔除术妇女发现，手术后雄激素水平下降一半，雌激素水平无改变。绝经后卵巢主要分泌雄激素，雌激素主要由脂肪组织合成，说明手术损伤卵巢功     

输卵管切除术对体外受精—胚胎移植中控制性超促排卵的影响

目的 探讨输卵管切除后对卵巢功能的影响。方法 选择因异位妊娠行一侧输卵管切除的患者手术侧卵巢与对侧卵巢及行输卵管切除的患者与双侧输卵管健全的患者,在行体外受精-胚胎移植（IVF-ET）中其卵巢对控制性超促排卵的反应。结果 输卵管切除侧卵巢尽管其体积无明显改变,但其卵泡数及所获卵子数明显少于健侧卵巢,而存留一侧输卵管患者与对照组相比,在卵巢大小,用药量、用药天数、子宫内膜厚度、卵泡数及所获卵子数上并无显著差别。结论 输卵管切除术在短期内虽然不能影响卵巢的体积。但却降低了同侧卵巢的储备功能。因此,临床上对有生育要求的异位妊娠患者,应尽可能地保留患侧输卵管,对于输卵管积水行体外的储备功能。因此,临床上对有生育要求的异位妊娠患者,应尽可能地保留患侧输卵管,对于输卵管积水行体外受精-胚胎移植者,如对侧卵巢缺如或卵巢功能低下,不宜做预防性输卵管切除术。     

控制性超促排卵过程中添加低剂量人绒毛膜促性腺激素的效果分析

目的:探讨在控制性超促排卵(COH)过程中添加低剂量人绒毛膜促性腺激素(hCG)的效果。方法:回顾性分析77例在COH过程中不同时间添加低剂量hCG进行促排卵患者的促排卵效果。结果:P水平在诱发排卵日[1.15(0.65,1.90)ng/ml]显著高于添加hCG日[0.30(0.20,0.56)ng/ml](P<0.05)。39个新鲜胚胎移植周期的生化妊娠率为46.2%(18/39),种植率为24.4%(20/82),临床妊娠率为35.9%(14/39);61个冻融胚胎移植周期的生化妊娠率为41.0%(25/61),种植率为18.4%(23/125),临床妊娠率为32.8%(20/61);无1例发生卵巢过度刺激综合征(OHSS);未孕患者中仍有10个周期还余有优质胚胎未移植。根据促排卵日不同时间添加低剂量hCG(50~200 mg/d)分组(A组≤5 d,n=9;B组6~8 d,n=26;C组9 d,n=19;D组≥10 d,n=23),各组的获卵率、受精率、卵裂率、优质胚胎数均无统计学差异。A~D组诱发排卵日P水平分别为1.00(0.5,1.6)ng/ml、1.32(0.7,2.6)ng/ml、1.30(0.6,2.2)ng/ml、1.09(0.7,1.5)ng/ml,均显著高于添加hCG日[分别为0.20(0.1~0.2)ng/ml、0.30(0.2,0.7)ng/ml、0.30(0.2,0.5)ng/ml、0.44(0.2,0.63)ng/ml](P<0.05或P<0.01)。结论:因卵泡生长缓慢、卵泡大小不均匀、卵泡数量过多,在COH过程中添加低剂量hCG对促排卵结局无影响,虽然诱发日的P水平会有所升高,但对新鲜胚胎移植周期的妊娠结局影响不显著,后续冻融胚胎移植的妊娠结局也较理想。     

卵巢肿瘤剔除术对体外受精-胚胎移植中卵巢反应性影响

目的 探讨卵巢肿瘤剔除后对卵巢功能的影响。方法 选择因卵巢肿瘤行剔除术的患者为实验组，输卵管阻塞性不孕患者作为对照组，对两组患者在行体外受输—胚胎移植(IVF—ET)中，卵巢对控制性超排卵的反应进行研究。结果 卵巢肿瘤行剔除术的患者卵巢大小与对照组无显著性差异，窦卵泡数，HCG日直径≥14mm，＜14mm的卵泡数，回卵数均明显少于对照组，促性腺激素用量明显多于对照组，用药天数无明显差异；患者手术侧卵巢与未手术侧相比，卵巢明显小于未手术侧，窦卵泡数，HCG注射日直径≥14mm，＜14mm的卵池数均明显少于未手术例；手术患者健侧卵巢与对照组对应卵巢相比，卵巢虽小，但无显著性差异，窦卵池数，HCG注射日直径≥14mm的卵泡数均明显少于对照组。结论 卵巢肿瘤剔除术影响卵巢功能，减低卵巢储备能力。     

卵巢非功能性囊肿对短方案超促排卵结局的影响

目的:探讨短方案超促排卵(COH)启动日卵巢非功能性囊肿对COH结局的影响。方法:回顾性分析行短方案COH治疗的4 317例患者的资料,其中COH启动日有卵巢非功能性囊肿的307例为研究组,其余4 010例为对照组,比较分析患者的COH结局。结果:研究组与对照组在促性腺激素的用药天数、用药量、hCG注射日雌二醇(E2)水平、hCG注射日子宫内膜厚度、获卵数、受精卵数、可用胚胎数、优质胚胎数、种植率及临床妊娠率均无显著性差异(P>0.05)。结论:卵巢非功能性囊肿不影响短方案COH治疗的结局。     

子宫内膜异位症患者IVF促排卵不同降调节方案的比较

目的:探讨子宫内膜异位症(EMs)患者合适的降调节方案。方法:收集因中-重度EMs接受IVF-ET治疗的139例不孕患者的资料,按不同的降调节方案分为超长方案(A组)、GnRHa长方案(B组)、GnRHa短方案(C组)3组,回顾性比较分析3组患者的治疗结局。结果:A组的促性腺激素(gonadotropic hormone,Gn)用量(尤其是hMG)显著多于B组和C组,差异有统计学意义(P<0.05);而冷冻周期率、临床妊娠率与种植率显著高于C组(P<0.05),与B组比较有上升趋势,但差异无统计学意义(P>0.05)。结论:EMs患者接受IVF/ICSI-ET治疗时,建议采用超长方案和常规长方案诱导排卵,以提高患者的临床妊娠率。     

Poor ovary response to the controlled ovarian hyperstimulation

One of the greatest challenges in clinical reproductive endocrinology is assessment of patients who respond badly to exogenous gonadotropins in controlled ovarian hyper stimulation (COH). Low response is a result of diminished ovarian reserve. Identifying potential low responders is of critical clinical importance. This paper will review varies form of "poor response" definition and a series of tests to analyses in order to discover a patient's ovarian functional reserve.     

Ovarian response to controlled ovarian stimulation in women with different polycystic ovary syndrome phenotypes

Controlled ovarian stimulation (COH) in PCOS is a challenge for fertility expert both ovarian hyperstimulation syndrome (OHSS) and oocytes immaturity are the two major complication. Ovarian response to COH vary widely among POCS patients and while some patients are more likely to show resistance to COH, other experienced an exaggerated response. The aim of our study is to investigate a possible correlation between PCOS phenotypes and the variety of ovarian response to COH and ART outcomes in patients with different PCOS phenotypes. We retrospectively analyzed a total of 71 cycles performed in 44 PCOS infertile patients attending ART at Centre of Infertility and Assisted Reproduction of Pisa University between January 2013 and January 2016. Patientsundergoing IVF with GnRH-antagonist protocol and 150–225?UI/days of recombinant FSH; triggering was carried out using 250 mg of recombinant hCG or a GnRH analogous on the basis of the risk to OHSS. We observed that Phenotype B had a tendency to have a greater doses of gonadotropins used respect to all phenotypes. Phenotype A group showed a greater serum estrogen levels compared to all phenotypes groups, a greater number of follicles of diameter between 8–12?mm found by ultrasound on the day of triggering and a greater mean number of freeze embryo. Additionally serum AMH and antral follicles count (AFC) follow the same trend in the different phenotypes ad they were significantly higher in phenotype A and in phenotype D. In conclusion this study shows that the features of PCOS phenotypes reflect the variety of ovarian response to COH as well as the risks to develop OHSS. Serum AMH and AFC are related to the degree of ovulatory dysfunction making these ‘added values’ in identifying the different PCOS phenotypes. Phenotype A seems to be the phenotype with the higher risk to develop OHSS and the use of GnRH as a trigger seems to improve oocyte quality. To classify PCOS phenotype at diagnosis might help clinicians to identify patients at greater risk of OHSS, customize therapy and subsequently plan the trigger agent.     

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 risk of poor ovarian response during repeat IVF

Research questionWhat are the incidence and risk factors for poor ovarian response (POR) during repeat IVF?DesignA retrospective analysis of 1224 consecutive patients who underwent at least two IVF stimulations in a single centre over a 6-year period. Risk factors from the initial treatment were assessed for association with POR during repeat IVF using logistic regression analysis. A simple, practical predictive model was constructed and evaluated for accuracy and calibration, based on the factors that demonstrated significant association with subsequent POR. POR during repeat IVF was defined as ≤3 retrieved oocytes or cancellation before retrieval following recruitment of ≤3 mature follicles.ResultsThe risk of POR during repeat IVF was approximately 11.5%. A higher POR risk during repeat IVF is associated with a reduced oocyte yield during the initial treatment (≤3 oocytes: odds ratio [OR] 14, 95% confidence interval [CI] 6.42–30.24; 4–9 oocytes: OR 4.13, 95% CI 2.00–8.54; 10–15 oocytes: OR 1) and low ovarian reserve (anti-Müllerian hormone [AMH] <5.4 pmol/l: OR 3.54, 95% CI 2.24–5.59; AMH 5.4–25 pmol/l: OR 1). Women with low ovarian reserve who experience POR during the initial IVF have the highest risk of suffering POR again during repeat IVF (57% within 1 year). Other groups, such as women with unexpected POR or expected poor responders with suboptimal ovarian response during the initial IVF, are also at risk of exhibiting POR during a subsequent treatment (28% within 1 year).ConclusionsAs there is a clear association between POR and lower live birth rates, this practical model may help manage patients’ expectations during repeat IVF treatment.     

The probability of successful IVF outcome after poor ovarian response

BACKGROUND: To evaluate the relationship between age and poor ovarian response to pregnancy and cancellation rate after IVF stimulation. METHODS: Poor ovarian response was defined as 37 years, who were poor responders, had a significantly lower pregnancy rate per OPU (3.0%) compared to normal to high responders in the same age group (22.1%, p<0.05). Also, 43.6% of women >37 years, who were classified as poor responders, did not receive an embryo transfer (ET), compared to 13.2% of normal to high responders in this age group (p<0.05). Poor responders who were 37 years, who receive high doses of FSH have a significantly poorer treatment outcome than can be explained by either age or FSH dose alone. CONCLUSIONS: Poor ovarian response after IVF stimulation requires thorough counselling prior to OPU, regardless of the woman's age. In poor responders >37 years of age, especially those who require high FSH doses, we suggest that the decision whether or not to proceed to OPU should include the couple after thorough counselling, even though the chance of successful outcome is extremely low.     

GnRH-antagonists in ovarian stimulation for IVF in patients with poor response to gonadotrophins, polycystic ovary syndrome, and risk of ovarian hyperstimulation: a meta-analysis

This article is a systematic review of the literature on utilization of gonadotrophin-releasing hormone antagonists (GnRH-ant) for ovarian stimulation for IVF in special patient groups. Summarized by meta-analysis are the data from randomized controlled trials (RCT) in which GnRH-agonist (GnRH-a) and GnRH-ant were compared (eight RCT for poor response, four RCT for PCOS). Also reviewed are the data from two RCT and 13 retrospective or observational trials in which patients at risk of ovarian hyperstimulation syndrome (OHSS) were triggered with GnRH-agonist instead of HCG. For poor responders, no differences in clinical outcomes were found, except a significantly higher number of cumulus-oocyte complexes in GnRH-antagonist multiple dose protocol as compared to GnRH-agonist long protocol (P=0.05). For PCOS patients, no differences in outcomes were found, except a significantly shorter duration of stimulation, when GnRH-antagonist multiple dose protocol and GnRH-agonist long protocol are compared (P<0.01). However, sample sizes are still small and power to detect subtle differences is therefore limited. For OHSS risk patients triggered with GnRH-agonist, reports on the efficacy of this measure vary in the literature. GnRH-agonist triggering appears to be associated with a reduction in the incidence of mild and moderate OHSS. For prevention of severe OHSS, as yet, only very limited evidence is available.     

Prospective analysis of ovarian reserve markers as determinant in response to controlled ovarian stimulation in women undergoing IVF cycles in low resource setting in India

Introduction

The objective of this study was to determine whether ovarian reserve markers can predict ovarian response in women undergoing their first cycle of assisted reproduction.

Materials and methods

This prospective observational study included 292 infertile patients undergoing their first IVF trial in the Assisted Reproductive Unit in a tertiary care hospital. Day 2 follicle stimulating hormone (FSH), Inhibin B, anti-Mullerian hormone (AMH), antral follicle count (AFC) and ovarian volume was measured before commencement of controlled ovarian hyperstimulation. The main outcome measures were oocytes retrieved and this was correlated with ovarian reserve markers.

Results

The mean age was 31.8 (±4.4) years and mean duration of infertility 8.2 (±3.9) years. The correlation between oocytes retrieved and age, day 2 FSH, Inhibin B, AMH, AFC and volume of the ovary was calculated. A negative correlation was found with age (r = ?0.22, p < 0.001) and day 2 FSH (r = ?0.35, p < 0.001). A positive correlation was seen with AMH (r = 0.15, p = 0.022), AFC (r = 0.48, p < 0.05) and volume (r = 0.17, p = 0.009). In the bivariate analysis, 1 year increase in age was found to decrease the oocytes retrieved count by 0.37 with a significant p value. The independent significant factors found in multiple linear regression analysis were day 2 FSH and AFC.

Discussion

The present study concludes that day 2 FSH and AFC are promising biomarkers for ovarian reserve in predicting ovarian response to gonadotropin stimulation in IVF patients.