二甲双胍、达因-35联合来曲唑治疗多囊卵巢综合征疗效观察

目的：观察二甲双胍、达因-35和来曲唑治疗PCOS的疗效。方法：PCOS患者60例,随机分成3组,A组服用二甲双胍和达因-35治疗3个月后,用来曲唑促排卵;B组服用二甲双胍和达因-35一个月后,用来曲唑促排卵;C组直接用来曲唑促排卵。观察三组优势卵泡数目、子宫内膜厚度、血清雌二醇水平、排卵率、妊娠率。结果：三组有排卵的周期中HCG日子宫内膜的厚度、优势卵泡数目及血雌二醇水平差异无显著性（P〉0．05）,三组排卵率、妊娠率比较,A组和B组差异无显著性（P〉0．05）,c组和A组及B组差异有显著性（P〈0．05）。结论：PCOS患者经二甲双胍和达因-35预处理1到3个月后,可以提高排卵率和妊娠率。     

克罗氯米芬与来曲唑治疗多囊卵巢不孕症患者的对比研究

目的探析克罗氯米芬与来曲唑治疗多囊卵巢不孕症患者的疗效。方法选取2014年1月~2014年12月我院收治的多囊卵巢不孕症患者94例作为研究对象,按患者意愿将其分为对照组与观察组,各47例。对照组给予克罗氯米芬治疗,观察组给予来曲唑治疗,对比分析两组患者的疗效。结果观察组的促排卵成功率、妊娠率、优质及成熟卵泡数量、宫颈粘液评分、子宫内膜厚度以及血清E2水平均优于对照组,差异均有统计学意义(P0.05);观察组的不良反应发生率为2.13%,低于对照组的21.28%,差异有统计学意义(P0.05)。结论来曲唑治疗多囊卵巢不孕症的疗效优于克罗氯米芬,可提高患者的妊娠率,且治疗后副作用小,值得推广应用。     

小剂量阿司匹林促排卵过程中对子宫内膜发育的研究

目的 探讨小剂量阿司匹林（aspirin）在促进诱发排卵过程中对子宫内膜发育的影响。方法 2000-09—2003-03郑州大学第三附属医院对不明原因的不孕妇女采用前瞻性随机双盲的方法，在氯米芬（CC）促排卵治疗同时，自月经第1—20天连续服用小剂量阿司匹林75mg／d。结果 阿司匹林组的子宫动脉血流阻力指数（RI）明显低于CC组（P〈0．01），子宫内膜厚度明显厚于CC组（P〈0．01），子宫内膜腺体面积、周长、间质面积、彬间比值及雌、孕激素受体的数目均明显大于CC组（P〈0．01）。排卵前后，阿司匹林组和CC组的E2、P质量浓度均高于对照组，阿司匹林组和CC组的E2、P质量浓度差异无显著性（P〉0．05）。结论 小剂量阿司匹林可改善促排卵时氯米芬所致的子宫内膜发育不良，但不能改善促排卵治疗时CC所致的内源激素紊乱状态。     

来曲唑、他莫昔芬和氯米芬治疗多囊卵巢综合征不孕疗效比较

目的比较多囊卵巢综合征(PCOS)不孕患者经纠正内分泌代谢紊乱后应用3种不同促排卵药物的效果及对子宫内膜的影响。方法选择2009年3月至2010年1月中山大学孙逸仙纪念医院妇产科生殖中心128例PCOS不孕患者,于本院行第1次促排卵,有高雄激素或胰岛素抵抗者经预处理至少3个月。随机分为3组,来曲唑44个周期、他莫昔芬40个周期和氯米芬44个周期。结果月经第10天的子宫内膜厚度,他莫昔芬组[(6.4±1.2)mm]高于来曲唑组[(5.4±1.7)mm]和氯米芬组[(5.4±1.3)mm](P=0.01);HCG日血雌二醇(E2)水平,来曲唑组[(838.6±678.2)pmol/L]低于他莫昔芬组[(2629.2±1931.5)pmol/L]和氯米芬组[(1971.2±1222.8)pmol/L](P<0.001);3组间加用尿促性腺激素(HMG)周期数,HCG日子宫内膜厚度、血黄体生成素及孕酮、直径≥18mm成熟卵泡数,妊娠率和早期流产率,差异无统计学意义(P>0.05);HCG日子宫内膜的厚度与注射HCG的月经周期日及月经第10天的子宫内膜厚度呈正相关(P<0.05),与药物的种类及HCG日血E2水平等无显...     

来曲唑联合促性腺激素用于行宫腔内人工授精的排卵障碍者的促排卵研究

目的:探讨来曲唑在促排卵过程中的功效。方法:100例不孕症常规检查确诊为女性排卵障碍并接受超促排卵及IUI的不孕患者,随机分为A组(50例):口服来曲唑(LE)+hMG,B组(50例):口服氯米芬(CC)+hMG,分别监测hCG注射日子宫内膜的厚度、形态、血E2、P水平,分别统计排卵率及妊娠率。结果:A组血清中雌激素水平明显较低,hCG注射日子宫内膜较厚。直径>17mm卵泡数组间无明显差异,临床妊娠率也无明显差异。结论:对因女性排卵障碍引起的不孕,用LE或CC促排卵,其获卵数和临床妊娠率无差异,但用LE促排卵,可以减少CC抗雌激素样作用对子宫内膜的不良影响,使子宫内膜有较好的容受性,有利于妊娠。     

来曲唑用于多囊卵巢综合征患者诱导排卵的系统评价

目的:系统评价来曲唑用于多囊卵巢综合征(polycystic ovary syndrome,P-COS)诱导排卵的疗效和安全性。方法:全面检索相应的中英文数据库,收集来曲唑用于PCOS患者诱导排卵的临床随机对照试验(randomized controlled trials,RCTs)。按Co-chrane系统评价方法,用系统评价专用处理软件RevMan5.0合并分析入选研究。结果:共纳入10个RCT,包括1854例患者。Meta分析显示:(1)来曲唑组周期排卵率高于克罗米芬组,HCG日子宫内膜厚度较薄,每周期成熟卵泡数少于克罗米芬组,差异有统计学意义;妊娠率、流产率两组差异无统计学意义;(2)克罗米芬抵抗的PCOS患者使用来曲唑后,周期排卵率>60%、妊娠率>30%;(3)来曲唑组周期排卵率低于促性腺激素组;妊娠率、HCG日子宫内膜厚度、流产率两组相似;来曲唑组每周期成熟卵泡数、多胎率、OHSS发生率低于促性腺激素组。结论:目前无充分证据证明,来曲唑对PCOS患者的促排卵效果优于克罗米芬,但可用来曲唑促排卵治疗对克罗米芬抵抗或促性腺激素高敏的PCOS患者,并可有效预防卵巢过度刺激综合征和多胎妊娠发生。     

人工授精周期中诱发排卵方法选择

在人工授精周期促排卵治疗时,为了减少卵巢的过度刺激,降低多胎妊娠发生率,必须进行卵巢微刺激的控制性促排卵方案,主要通过控制早卵泡期的启动数及优势卵泡的排卵数来完成。氯米芬、来曲唑是一线方案,人绝经期促性腺激素（HMG）或卵泡刺激素（FSH）低剂量渐增方案是比较容易达到控制目的的方案。在促排卵周期中,监测自发性黄体生成激素（LH）峰形成后产生的级联效应,可以获得最佳妊娠率。注射人绒毛膜促性腺激素（HCG）扳机后36h完成人工授精手术可能是最佳时机。     

人绝经期促性腺激素联合氯米芬或来曲唑用于多囊卵巢综合征患者促排卵疗效比较

的探讨人绝经期促性腺激素（HMG）＋氯米芬（CC）、HMG和来曲唑（LE）＋HMO对多囊卵巢综合征（PCOS）患者宫腔内供精人工授精的治疗效果。方法将2007年12月-2008年5月期间在我中心就诊的114例PCOS妇女的114个宫腔内人工授精（AID）周期分为3组：CC＋HMG周期组38个周期，HMG周期组38个周期，LE＋HMG周期组38个周期。分析比较3组的年龄、血清T水平、绒毛膜促性腺激素肌肉注射日（HCG日）平均卵泡直径（MFD）≥14mm的卵泡（成熟卵泡）个数、平均卵泡E2水平、子宫内膜厚度、HCG日单优势卵泡发育成熟百分率、HMG用量和周期妊娠率。结果CC＋HMG组、HMG组和LE＋HMG组患者年龄和血清T水平比较，差异无显著性（P〉0．05），CC＋HMG组HCG日成熟卵泡个数为（2．9±1．6）个，明显多于其他两组[HMG组为（1．6±1．0）个，LE＋HMG组为（1．9±1．2）个]，差异有显著性（P〈0．05），而内膜厚度较其他两组薄，差异有显著性（P〈0．05），HMG组与LE＋HMG组HCG日成熟卵泡个数和子宫内膜厚度比较，差异无显著性（P〉0．05）。3组HCG日单优势卵泡发育成熟百分率分别21．05％、78．95％和52．63％，差异有显著性（P〈0．05）。CC＋HMG组、HMG组和LE＋HMG组HMG用量分别为（4．89±1．59）支和（9．88±4．59）支、（9．68±4．67）支（75IU／支），CC＋HMG组与后两组比较，差异有显著性（P=0．00）。HMG组、LE＋HMG组HMG用量比较，差异无显著性（P〉0．05）。3组的周期妊娠率分别为36．84％、39．48％和31．57％，差异无显著性（P〉0．05）。结论HMG促排卵周期更易得到单优势卵泡发育成熟；CC＋HMG促排卵HMG用药量最少；CC＋HMG、HMG和LE＋HMG均可获得满意的周期妊娠率。     

来曲唑等4种促排卵药物用于宫腔内人工授精的疗效比较

目的:比较来曲唑等4种促排卵药物用于宫腔内人工授精的疗效。方法:回顾分析南方医院生殖医学中心2006年1月至2010年6月采用自然周期(NC)和来曲唑(LE)、氯米芬(CC)、尿促性素(HMG)、尿促卵泡素(u-FSH)4种促排卵药物用于夫精宫腔内人工受精(IUI),共565个周期的临床资料进行比较分析。结果:5组临床妊娠率分别为4.1%、13.4%、8.7%、16.1%、13.8%,促排卵各组妊娠率均高于自然周期组(P均<0.05)。各促排卵组之间,妊娠率差异无统计学意义(P>0.05)。LE组优势卵泡数、排卵数及绒促性素(HCG)日子宫内膜厚度与NC组比较差异均无统计学意义(P>0.05)。结论:促排卵治疗增加IUI妊娠率。LE促排卵作用温和,妊娠率与低剂量HMG和u-FSH方案相当,用于IUI促排卵安全有效。     

口服妈富隆并延长氯米芬用药时间治疗耐氯米芬的无排卵患者

目的评价常规服用氯米芬促排卵失败的妇女口服避孕药妈富隆配合延长氯米芬服用时间促排卵的治疗效果。方法114例患者在采用传统方法促排卵连续3个周期失败后,改服妈富隆2个周期以上。自停药后月经第5天开始服用氯米芬(50mg/d)促排卵,阴道B超(TVS)监测记录卵泡生长,至出现优势卵泡停服。B超监测排卵经过以及子宫内膜厚度的变化。结果114例患者在服用氯米芬5天后有37例出现优势卵泡,35例成功排卵,2例出现卵泡黄素化未破裂综合征(LUFS);延长服药时间后又有34例成功排卵,17例出现LUFS,13例出现卵泡发育,但未形成优势卵泡即闭锁;13例无卵泡发育。结论对于耐氯米芬的无排卵患者口服妈富隆联合延长氯米芬服药时间,是一种有效的促排卵方案。     

Differences in female and male perception of information and decision-making in single-embryo transfer in in vitro fertilization in Sweden

Purpose The aim of this study was to evaluate the information and the factors that contribute to the decision to accept and choose single embryo transfer (SET) in females and males. Materials and methods Fifty-four females and males undergoing SET were interviewed separately using a structured questionnaire. Results The women were significantly more satisfied with the information than the men (odds ratio 3.3), but the decision to accept SET was nevertheless more difficult for women (OR 3.1). Only one-third of both female and males were aware of the increased maternal risks with twin pregnancies. There was a tendency that the women who accepted SET had previous children, shorter duration of infertility, and were younger. Cryopreservation of embryos and a good pregnancy chance were important irrespective of gender. Conclusion The female needs more support to choose SET. The male needs better information and further involvement in decision-making. The females were more aware of the fetal risks, but the awareness of the increased maternal risks with twin pregnancies was low. The female need more support to accept and choose single embryo transfer, compared to the male and information should in some areas be directed differently to females and males.     

Non-persistent pesticides in breast milk in an agricultural area in Turkey

Background: Organophosphates, pythyreoids, carbamate pesticides and fungicides are heavily used in agriculture. They may have dangerous effects on newborn health especially on immune system and growth via prenatal transmission by placenta or postnatal transmission by breastfeeding.

Methods: In 2015, 144 non-persistent pesticides in 64 milk samples of 32 mothers were studied by OuEChERS method in liquid chromatography/tandem mass spectrometer in neonatal Intensive Care Unit in Adana, a city in Cukurova region which is an important agricultural area in Turkey.

Results: Pesticides were detected in milk samples of 11 mothers (34.3%) and 21 (32.8%) of milk samples. In five mothers, fungicides (in 5/10 samples propicanozole-PP, in 4/10 samples bromucanozole-BM), in five mothers, organophosphates (in 10/10 samples primyphosphomethyl-PPM), in one mother, both organophosphates and fungicide (in 1/2 samples PPM and in 1/2 samples buprimate) were detected. However, the estimated daily intakes (EDI) were less than acceptable daily intakes (ADI) for PPM, PP and BM, respectively.

Conclusions: Although pesticides levels in human milk did not exceed the ADIs, we suggest monitoring pesticides in human breast milk especially for newborn health.     

Ovulation induction in in vitro fertilization

The main goal of an in vitro fertilization (IVF) program is to maximize the number of women who become pregnant in any treatment cycle. In order to achieve pregnancy, many steps should be successfully accomplished. The number of mature oocytes that are retrieved and fertilized in a treatment cycle has the major impact on the success rate of the IVF program. The chances of achieving conception increases dramatically when the number of embryos replaced into the uterus increases^1-3. Hence, most IVF treatment programs currently use some combination of ovulation induction agents in order to stimulate and aspirate as many follicles as possible.     

Heterogeneity in alpha-thalassemia interactions in Malays, Chinese and Indians in Malaysia

AIM: Interactions between different determinants of alpha-thalassemia raises considerable problems, particularly during pregnancies where antenatal diagnosis is necessary. This study aims to determine the different types of deletional alpha-thalassemia and Hemoglobin Constant Spring (HbCS), and their frequency in Malays, Chinese and Indians in Malaysia. METHODS: DNA from 650 pregnant women from the Antenatal Clinic of the University of Malaya Medical Center in Kuala Lumpur, Malaysia who showed mean cell volume < or =89 fL and/or mean cell hemoglobin < or =28 pg were analyzed for the double alpha-globin gene South-East Asian deletion (--SEA), the -alpha3.7 and -alpha4.2 single alpha-globin gene deletions and HbCS. RESULTS: One hundred and three (15.8%) of the pregnant women were confirmed as alpha-thalassemia carriers: 25 (3.8%) were alpha-thalassemia-1 carriers with the --SEA/alphaalpha genotype, 64 (9.8%) were heterozygous for the -alpha3.7 rightward deletion (-alpha3.7/alphaalpha), four (0.6%) were heterozygous for the -alpha4.2 leftward deletion (-alpha4.2/alphaalpha), nine (1.4%) were heterozygous for HbCS (alphaCSalpha/alphaalpha) and one (0.2%) was compound heterozygous with the -alpha3.7/alphaCSalpha genotype. The double alpha-globin gene --SEA deletion was significantly higher in the Chinese (15%) compared to the Malays (2.5%) and not detected in the Indians studied. The -alpha3.7 deletion was distributed equally in the three races. HbCS and -alpha4.2 was observed only in the Malays. CONCLUSION: The data obtained gives a better understanding of the interactions of the different alpha-thalassemia determinants in the different ethnic groups, thus enabling more rapid and specific confirmation of alpha-thalassemia in affected pregnancies where antenatal diagnosis is necessary.     

缺氧缺血性脑病的性别差异性研究进展

新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)是指围产期窒息缺氧导致的脑缺氧缺血性损害,可遗留不同程度的神经系统后遗症。动物研究表明,缺氧缺血性损伤后,炎性反应、氧化应激和细胞死亡途径等关键病理生理过程中存在明显的性别差异,雌性动物对亚低温、促红细胞生成素、脑源性营养因子和别嘌呤醇等治疗效果也明显优于雄性。临床研究发现男性HIE患儿病情更重、预后更差。基于性别的治疗干预很有可能在围产期脑损伤中提供更好的神经保护。本文总结了目前HIE性别差异性的相关证据,以期为临床治疗提供新思路。     

Trends in preterm birth in singleton deliveries in a Hong Kong population

Objective

To examine trends in preterm birth and its relationship with perinatal mortality in Hong Kong.

Methods

In a retrospective cohort study, data were reviewed from singletons delivered between 1995 and 2011 at a university teaching hospital. Trends in preterm birth (between 24 and 36 weeks of pregnancy), perinatal mortality, and subtypes of preterm birth (spontaneous, iatrogenic, and following preterm premature rupture of membranes [PPROM]) were examined via linear regression.

Results

There were 103 364 singleton deliveries, of which 6722 (6.5%) occurred preterm, including 1835 (1.8%) early preterm births (24–33 weeks) and 4887 (4.7%) late preterm births (34–36 weeks). Frequency of preterm birth remained fairly consistent over the study period, but that of spontaneous preterm birth decreased by 25% (β = –0.83; P < 0.001), from 4.5% to 3.8%. Frequency of preterm birth following PPROM increased by 135% (β = 0.82; P < 0.001), from 0.7% to 1.7%. The perinatal mortality rate decreased from 56.7 to 37.0 deaths per 1000 deliveries before 37 weeks (β = –0.16; P = 0.54). Early preterm birth contributed to 16.0% of all deaths.

Conclusion

Although the overall rate of preterm birth in Hong Kong has remained constant, the frequencies of its subtypes have changed. Overall perinatal mortality is gradually decreasing, but early preterm birth remains a major contributor.