不同输卵管手术方式对体外受精-胚胎移植治疗结局的影响

目的:探讨体外受精-胚胎移植(IVF-ET)中不同的输卵管手术方式对治疗结局的影响。方法:回顾性分析长方案超促排卵IVF周期378例输卵管因素不孕患者:双侧输卵管切除58例(A组);双侧输卵管造口45例(B组);双侧输卵管近端结扎+远端造口37例(C组);单侧输卵管整形42例(D组);单侧输卵管切除45例(E组);随机选取单纯双侧输卵管梗阻无积水患者151例作为对照组(F组);比较患者的一般情况、卵巢对促排卵的反应性和临床治疗结局。结果:①基础窦卵泡(bAFC)数、Gn使用总量、Gn用药时间、hCG注射日卵泡数目、获卵数及冷冻胚胎数,A组较其他手术组及对照组差异均有统计学意义(P<0.05);其他手术组与对照组比较,差异无统计学意义(P>0.05)。各组间受精率、优质胚胎率和移植胚胎数均无统计学差异(P>0.05)。B组妊娠率和种植率显著低于其他各组,而异位妊娠率和流产率显著高于其他各组(P<0.05)。②E组患侧(手术侧)hCG注射日卵巢体积(OVVOL)、卵泡数(直径≥15 mm)和获卵数明显少于健侧卵巢(P<0.05),而D组患侧与健侧上述指标差异无统计学意义(P>0.05)。结论:双侧输卵管切除术增大了促排卵Gn用量和使用天数,减少了获卵数;但不影响受精率、优质胚胎率及着床率,因而不影响IVF-ET单次临床妊娠率。单侧手术由于健侧输卵管的代偿作用对IVF治疗无明显影响。造口术再次发生输卵管积水风险升高,种植率、妊娠率下降,异位妊娠率和流产率升高。     

输卵管积水对体外受精-胚胎移植(IVF-ET)的影响

<正>输卵管在人类生殖过程中执行多种功能:配子转运、受精、营养和胚胎发育.任何影响输卵管转运和分泌功能的因素都会影响正常受孕.输卵管积水引起的不孕约占不孕症的2.5～6%,以往治疗主要采用各种重建再通手术,但术后自然妊娠率低.1978年第一例试管婴儿诞生,人们开始更注重不依赖于输卵管通畅的助孕技术.然而,许多研究者逐渐发现输卵管积水会影响IVF结果.     

输卵管积水及其预处理方式对体外受精-胚胎移植结局的影响

输卵管在生殖过程中具有多种功能，如配子转运、受精和胚胎发育。任何影响输卵管的转运和分泌功能的因素都会影响正常受孕。因此，体外受精一胚胎移植（in vitro fertilization and embryo transfer，IVF—ET）现已作为治疗输卵管性不孕症的首选方法。但是许多资料表明，输卵管积水可以降低胚胎种植率和妊娠率。因此，IVF—ET前对输卵管积水进行预处理显得非常必要，     

取卵后引流输卵管积水对体外受精-胚胎移植结局的影响

目的 探讨取卵后穿刺抽吸输卵管积水对体外受精-胚胎移植(IVF-ET)临床结局的影响.方法 回顾分析2003年1月至2008年6月期间郑州大学第二附属医院生殖中心145例患者因输卵管因素而行IVF-ET 157个周期的资料.根据子宫输卵管造影(HSG)和阴道超声诊断积水及处理方法的不同分为3组.A组:22例,HSG和阴道超声均可见输卵管积水,取卵后同时抽吸积水;B组:24例,HSG见积水,但阴道超声未见明显的积水,取卵时不穿刺积水;C组:111例,单纯输卵管阻塞不伴积水者,设为对照组.结果 各组间的妊娠率、植入率、流产率差异无统计学意义(P0.05).A组的受精率高于C组,差异有统计学意义(P<0.05).积水组(A、B组)的流产率略高于无积水组(C组),但差异无统计学意义(P0.05).B组的异位妊娠率高于A组和C组,但差异无统计学意义(P0.05).结论 对阴道超声可见的输卵管积水取卵后抽净积水,可取得与无输卵管积水患者相近的临床结局.HSG提示积水而阴道超声未显示积水,患者无阴道排液者(B组),对IVF-ET的临床结局影响不大,无需特殊处理.     

输卵管远端积水对体外受精-胚胎移植治疗效果的影响

目的:探讨输卵管远端积水对体外受精-胚胎移植(IVF-ET)治疗结局的影响。方法:回顾性分析2013年1~12月就诊于本院生殖中心,选取单侧输卵管远端积水且对侧阻塞或双侧输卵管远端积水且未经处理直接行IVF-ET的患者54例为积水组,双侧输卵管近端梗阻且无积水直接行IVF-ET的患者93例为对照组,比较两组患者的一般情况、超促排卵治疗情况和妊娠结局。结果:两组患者的一般情况及超促排卵治疗情况比较,差异均无统计学意义(P0.05);两组患者的受精率、优质胚胎率、胚胎种植率、妊娠率、活产率比较,差异均无统计学意义(P0.05),但是积水组的卵裂率(93.64%)低于对照组(96.47%),差异有统计学意义(P0.05)。结论:输卵管远端积水可能并不影响IVF-ET的妊娠率和活产分娩率,但可能降低卵子质量,从而影响受精卵的卵裂。     

介入性输卵管栓塞术对体外受精-胚胎移植结局的影响

目的探讨介入性输卵管栓塞术对输卵管积水患者行体外受精-胚胎移植(IVF-ET)治疗结局的影响。方法对2009年5月至2010年5月因输卵管性不孕于盛京医院辅助生殖中心行IVF-ET200例临床资料进行回顾性分析。分为3组。A组:输卵管阻塞,无积水(92例);B组:有输卵管积水,经腹腔镜行输卵管切除术或造口术(31例);C组:有输卵管积水,行介入性输卵管栓塞术(77例)。结果各组间临床妊娠率差异无统计学意义(P>0.05)。介入治疗组获卵数略高于腹腔镜治疗组。结论介入性输卵管栓塞术是一种值得推荐的IVF-ET前输卵管积水的治疗方法。     

体外受精—胚胎移植前切除积水输卵管的意义

目的探讨体外受精-胚胎移植 (in vitro fertilization-embryo transfer,IVF-ET) 前切除积水的输卵 管的意义。方法回顾性分析因输卵管积水导致不孕而要求接受IVF-ET的32例患者,其中17例病人在 IVF-ET切除了积水的输卵管,共接受IVF-ET27个周期,为观察组;有15例病人未切除积水输卵管,共接 受IVF-ET26个周期,为对照组。比较两组病人卵巢对超排卵的反应、受精率、卵裂率、累计胚胎评分(cumula tive embryo score,CES)、胚胎种植率、临床妊娠率。结果观察组受精率、卵裂率、胚胎种植率、临床妊娠率分别 为76.9％、75.0％、11.6％、33.9％,均显著地高于对照组的69.2％、66.7％、2.3％、7.7％,P＜0.05;观察组CES 为(43.4±11.2),非常显著地高于对照组(36.6±13.1),P＜0.01;观察组和对照组的获卵数分别为(13.1±9.7) 个和(12.9±8.2)个,无显著差异。结论IVF-ET前切除积水的输卵管可改善IVF-ET的结局,并且不影响 卵巢对超排卵的反应。     

胚胎遗留补插管对体外受精-胚胎移植治疗结局的影响

目的:探讨胚胎遗留后再插管对体外受精-胚胎移植(IVF-ET)治疗结局的影响。方法:回顾性分析2001.08-2003.08在本中心进行IVF-ET患者的临床资料。结果:胚胎移植周期共1301例,胚胎遗留后补插管30例,发生率2.3%。胚胎遗留组补插管后患者的临床妊娠率为33.33%,无胚胎遗留组患者的临床妊娠率为38.55%,两者差异无统计学意义。结论:胚胎遗留补插管可能不影响IVF-ET的治疗结局。     

输卵管病变对体外受精-胚胎移植结局的影响

输卵管病变可导致受精失败。在体外受精-胚胎移植（IVF—ET）的有关研究中发现，输卵管的病变及状态也可影响IVF—ET的结局，尤其是输卵管积水。本研究回顾性分析284例因输卵管病变行IVF—ET患者的临床资料，探讨输卵管病变对IVF—ET结局的影响，以期指导临床治疗。     

体外受精-胚胎移植(IVF-ET)输卵管积水预处理后冻融胚胎解冻移植结局分析

目的:探讨体外受精-胚胎移植(IVF-ET)中输卵管积水患者积水处理(单侧或双侧输卵管切除/结扎)后冻融胚胎移植结局和影响因素。方法:回顾分析2012年6月~2014年6月在兰州大学第一医院生殖医学专科医院因输卵管积水行IVF-ET的117例患者的临床资料。117例患者中,取卵后因积水返流宫腔行全胚冷冻取消移植者69例,不良结局者48例。比较行输卵管积水处理后的117例患者(研究组)和因输卵管因素行冻融胚胎解冻移植(FET)的212例患者的妊娠结局。结果:研究组117例患者中111例行积水单侧或双侧结扎/切除,6例行输卵管栓塞,FET 115例后妊娠70例,妊娠率60.87%,早期流产8例,流产率11.42%,宫角妊娠2例。对照组212例完成206个解冻移植周期,妊娠114例,妊娠率55.33%,早期流产12例,早期流产率10.52%,异位妊娠3例,异位妊娠率2.63%。两组的受精率、可利用胚胎率、临床妊娠率等无统计学差异(P0.05)。结论:体外受精-胚胎移植(IVF-ET)取卵后输卵管积水切除或结扎或栓塞后行冻融胚胎解冻移植,可获得良好的妊娠结局。     

子宫内膜异位症影响体外受精-胚胎移植结局的初步探讨

目的　探讨子宫内膜异位症的严重程度对体外受精 胚胎移植 (IVF ET)各个环节的影响。方法　对1999年 1月至 2 0 0 2年 4月在中山大学附属第一医院 10 7例已明确分期的子宫内膜异位症不育患者共 139周期IVF ET与同期输卵管因素不育患者 139例进行的 139周期IVF ET的控制性超排卵 (COH)治疗、受精率、卵裂率、每周期胚胎植入率和临床妊娠率、流产率等进行回顾性对照分析。结果　中、重度子宫内膜异位症不育患者与对照组相比进行IVF治疗时使用促性腺激素的总量增加而获卵数减少。重度患者雌二醇 (E2 )峰值下降 ,流产率增加 ,差异有统计学意义 (P <0 0 5 )。子宫内膜异位症不育患者IVF ET治疗时随着病情加重 ,卵巢对控制性超排卵的反应性下降 ,重度患者流产率增高。结论　子宫内膜异位症影响了卵子与胚胎的发育。     

Effects of the intensity of downregulation on outcome of in vitro fertilization and embryo transfer

Gonadotropin releasing hormone agonists (GnRHa) are commonly used during in vitro fertilization and embryo transfer (IVF/ET) treatment cycles to downregulate the hypothalamic-pituitary-ovarian axis prior to ovarian stimulation with gonadotropins. It has been suggested that profound downregulation may have an adverse effect on IVF/ET outcome. The aim of this study was to examine the relationship between the degree of downregulation and IVF/ET outcome. A retrospective analysis was performed on 151 IVF/ET cycles conducted over a six month period. Intensity of downregulation was assessed using measurements of serum concentrations of luteinizing hormone (LH) and estradiol (E₂) made at the end of a two week downregulation period. There was no correlation between serum concentration of LH (whether used alone or in combination with E₂) and IVF/ET pregnancy rates. However, those subjects who were more suppressed according to the E₂ concentration (< 148 pmol/l, [median]) required significantly more gonadotropins (3306 IU versus 2863 IU, p < 0.05) and took longer for follicles to reach maturity (10.9 days versus 9.7 days, p < 0.05). They also had a lower pregnancy rate per embryo transfer (10.4% versus 28.6%, p < 0.05) compared with those having a higher basal E₂ concentration. We conclude from this study that the basal serum E₂ concentration rather than the LH concentration is a more sensitive indicator of the intensity of downregulation by GnRHa and it may be a better predictor of IVF outcome.     

两种不同胚胎装载技术对体外受精-胚胎移植及冻融胚胎移植临床结局的影响

目的探讨两种不同胚胎装载技术对体外受精-胚胎移植(IVF-ET)和冻融胚胎移植(FET)临床妊娠率及胚胎种植率的影响。方法回顾性分析了543个新鲜胚胎移植周期及658个FET周期。根据移植时胚胎装载方法分为A组(含胚培养液体积周围空气体积)和B组(含胚培养液体积周围空气体积)。比较两种胚胎装载方法对妊娠结局的影响。结果新鲜周期中,B组的临床妊娠率(64.52%)显著高于A组(54.62%)(P0.05),种植率组间虽无统计学差异(P0.05),但B组明显高于A组。FET周期中卵裂胚移植B组的临床妊娠率(49.43%)明显高于A组(38.24%),但没有统计学差异(P0.05),B组(34.62%)的种植率显著高于A组(23.61%)(P0.05)。囊胚移植两组的妊娠率和种植率均没有统计学差异(P0.05),但B组比A组有增高的趋势。结论胚胎移植时含胚培养液体积周围空气体积会显著提高IVF-ET和FET的临床妊娠率和种植率。     

Multiple attempts at embryo transfer: Effect on pregnancy outcome in an in vitro fertilization and embryo transfer program

Purpose This study derives from the observation that a correlation exists between failed first attempts (FFA) at embryo transfer caused by one or more embryos remaining in the catheter and reduced pregnancy rates (20.3 vs 3.0%). The aim of this study was to examine the relationship between failed first attempts at transfer and contamination of the transfer set; the related aspects of cervix dilatation and late embryo transfer were also investigated.Results The following observations were made. Retention of embryos in the transfer sets significantly reduced the pregnancy rate (P =0.015); catheters contaminated with blood and cervical mucus indirectly contributed to this effect by increasing the incidence of failed first transfer attempts. Even though cervical dilatations, if indicated by uterus sounding, were done 2 days before embryo transfer, no pregnancies were effected in these 18 cases (P =0.0001). Late transfers of embryos, due to delayed fertilization or slow cleavage rates, yielded a pregnancy rate of 10.5%. Conclusion The approach of immediately retransferring retained embryos does not solve the problem of reduced pregnancy rates in FFA cases. It is suggested that ET should be repeated 1 day later in FFA cases in an attempt to improve pregnancy rates.     

Effects of the intensity of downregulation on outcome of in vitro fertilization and embryo transfer.

Gonadotropin releasing hormone agonists (GnRHa) are commonly used during in vitro fertilization and embryo transfer (IVF/ET) treatment cycles to downregulate the hypothalamic-pituitary-ovarian axis prior to ovarian stimulation with gonadotropins. It has been suggested that profound downregulation may have an adverse effect on IVF/ET outcome. The aim of this study was to examine the relationship between the degree of downregulation and IVF/ET outcome. A retrospective analysis was performed on 151 IVF/ET cycles conducted over a six month period. Intensity of downregulation was assessed using measurements of serum concentrations of luteinizing hormone (LH) and estradiol (E2) made at the end of a two week downregulation period. There was no correlation between serum concentration of LH (whether used alone or in combination with E2) and IVF/ET pregnancy rates. However, those subjects who were more suppressed according to the E2 concentration (< 148 pmol/l, [median]) required significantly more gonadotropins (3306 IU versus 2863 IU, p < 0.05) and took longer for follicles to reach maturity (10.9 days versus 9.7 days, p < 0.05). They also had a lower pregnancy rate per embryo transfer (10.4% versus 28.6%, p < 0.05) compared with those having a higher basal E2 concentration. We conclude from this study that the basal serum E2 concentration rather than the LH concentration is a more sensitive indicator of the intensity of downregulation by GnRHa and it may be a better predictor of IVF outcome.     

A preliminary study on in vitro fertilization and embryo transfer

Forty-two women with infertility were enrolled in an in vitro fertilization and embryo transfer (IVF/ET) program, from July, 1986 to February, 1988, at the First Affiliated Hospital, Human Medical University. CC/hMG/hCG and hMG/hCG regimens for ovulation induction were used for 35 and 7 patients. Monitoring methods consisted of daily follicular ultrasonography and serum estradiol measurements. Human chorionic gonadotropin 10,000IU was administered when the leading follicle reached 18mm in diameter and serum E2 level was equal to or more than 1,480 pmol/L (400 pg/ml). Twenty-one laparoscopies and nineteen laparotomies for oocyte retrieval were performed. The IVF/ET results using CC/hMG/hCG for ovarian stimulation were as follows: an average of 6.1 follicles were aspirated and 3.5 oocytes recovered for one case. The recovery rate and fertilization rate was 57.0% and 60.1% respectively. In twenty-five women one to five embryos were transferred and a clinical pregnancy occurred in one who received three embryos. Laparotomy for oocyte retrieval showed that more oocytes could be obtained than laparoscopy. The purity of CO2 used for laparoscopy was considered to affect the IVF results.     

Influence of hormonal stimulation on in vitro fertilization/embryo transfer outcome

OBJECTIVE: To compare efficacy and efficiency of ovarian stimulation therapy. STUDY DESIGN: Retrospective study compares ovarian response as number of retrieved oocytes, fertilization rates, endometrial patterns, number of pregnancies and pregnancy rates to different stimulation protocols. RESULTS: The least number of cancelled cycles was in long protocols with buserelin. There was no difference in overall number of retrieved oocytes between the rFSH and HMG protocols, but 75% of the patients undergoing both protocols had higher number of oocytes after rFSH. The highest pregnancy rate (35.13%) was with rFSH. There was no statistical correlation between endometrial pattern and type of protocol used. Data showed the 9 mm cut-off value for endometrial thickness, and RI = 0.58 for subendometrial blood flow between the pregnant and non-pregnant group of patients. Nitriderm patches significantly decreased (P < 0.05) subendometrial RI of the patients with impaired uterine perfusion, increased endometrial thickness and achieved better morphology. CONCLUSIONS: These findings demonstrate that rFSH alone and in long protocol gives better results in wide patient population. Nitriderm patches seem to have good impact on pregnancy rate, but further studies are necessary before making any statements.