卵胞浆内单精子注射对母儿妊娠结局的影响

目的 探讨不同辅助生殖技术(in vitro fertilization/ intracytoplasmic sperm injection, IVF/ICSI)妊娠后单胎分娩的新生儿出生缺陷和母体并发症的发生情况及影响因素。方法 回顾性分析2010年1月至2013年6月在同济大学附属第一妇婴保健院生殖医学中心接受体外受精(in vitro fertilization, IVF)、卵胞浆内单精子注射(intracytoplasmic sperm injection, ICSI)新鲜胚胎移植后单胎分娩的新生儿的临床资料,比较IVF与卵子透明带侵入性操作后出生的母体并发症、新生儿一般情况、出生缺陷及出生缺陷受累系统。结果 共有1016例新生儿分娩,其中13例有出生缺陷,出生缺陷发生率1.28%,其中IVF组、ICSI组的出生缺陷率分别1.12%、1.67%,差异无统计学意义(P>0.05)。IVF组与ICSI组分娩的新生儿的体质量、孕周、性别无明显差异(P>0.05);两组母体产科并发症发生率、早产率、低体质量儿率、极低出生体质量儿率、巨大儿发生率也无显著性差异(P>0.05)。ART子代发生出生缺陷可能与亲代低生育力、孕母年龄等有关。结论 不同助孕方式对母体产科并发症的发生、新生儿的一般情况及出生缺陷没有显著区别,有必要告知不孕患者辅助生殖技术的潜在风险。     

非男性因素不孕超促排卵低获卵周期IVF和ICSI效果比较

摘要：目的探讨非男性因素不孕超促排卵低获卵周期体外受精-胚胎移植（IVF）和卵子胞浆内单精子注射（ICSI）两种授精方式
对受精效果、胚胎发育潜能及助孕结局的影响,为明确ICSI指征提供临床依据。方法回顾分析南方医院生殖医学中心的220
个非男性因素不孕患者超促排卵低获卵周期,将其分为IVF组（151例）和ICSI组（69例）,对两组患者的一般情况、促排卵过程中
卵巢反应性指标、受精、胚胎质量和妊娠情况进行分析。结果两组受精率、正常受精率、完全受精失败率、卵裂率、优质胚胎率、
胚胎着床率、临床妊娠率及完全受精失败率无显著性差异,但IVF组受精率、正常受精率、卵裂率、优质胚胎率及临床妊娠率呈
增高趋势;完全受精失败率呈降低趋势。结论ICSI即无法改善非男性因素不孕超促排卵低获卵患者的受精情况,对提高其胚
胎发育潜能及改善最终妊娠结局也无益处,不建议对该部分患者常规行ICSI治疗。
     

体外受精-胚胎移植术后双胎妊娠自然减胎与初始单胎妊娠的分娩结局比较

目的比较体外受精-胚胎移植术后双胎之一孕早期自然减至单胎与初始单胎妊娠的产科结局。方法2010~2012年在广
州市妇女儿童医疗中心生殖医学中心行体外受精胚胎移植后获得单胎分娩患者409例,其中44例患者孕6周B超诊断为2个妊
娠囊,孕12周前其中一胎自然死亡;365例患者孕6周B超诊断为1个妊娠囊。比较两组患者分娩孕周、早产率、新生儿出生体
重、低体质量儿比例。结果在单胎分娩的患者中,10.8%（44/409）在孕6周B超时诊断为双胎,双胎自然减为单胎组与单胎组孕
妇平均分娩孕周为38.29±1.76和38.45±1.40周,两组比较差异无统计学意义（P=0.495）;早产率分别为15.9%（7/44）和10.13%
（37/365）,两组比较差异无统计学意义（P=0.298）;新生儿出生体质量分别为3086.8±527.01和3261.8±437.85 g,双胎自然减为
单胎组新生儿出生体质量低于初始单胎组（P<0.05）。低体质量儿（<2500 g）比例双胎自然减为单胎组为6.82%（3/44）,是初始
单胎组的2.74%（10/365）的2倍,但两组比较差异无统计学意义（P=0.316）。结论孕早期双胎自然减为单胎会导致剩余一胎新
生儿出生体质量低于单胎对照组。
     

无明确原因原发性不孕患者行体外受精-胚胎移植治疗中受精方式的选择

摘要：目的探讨无明确原因原发不孕患者体外受精-胚胎移植(IVF-ET)周期如何选择合适的受精方式。方法回顾性分析无明
确原因原发不孕患者行IVF-ET 321周期,按不孕年限分为A组≥5年共165周期,B组不孕年限<5年共156周期,各组中又按受
精方式分为体外受精（IVF）、单精子卵细胞胞浆内注射（ICSI）,部分ICSI组,以同时期输卵管因素行常规IVF受精周期和男性因
素ICSI受精周期作为对照。分析比较各组间受精率、受精低下发生率和临床妊娠率。结果A组IVF受精率低于ICSI与部分
ICSI受精率（分别为67.5%,82.0%和77.7%,P<0.05）,且低于同期IVF对照组（76.3%）;A组IVF受精低下发生率明显高于ICSI
与部分ICSI（33.3%,8.3%与15.8%,P<0.05）,B组IVF受精低下发生率为12.3%,低于A组IVF受精方式,但与同组ICSI与half
ICSI间受精低下发生率无统计学差异(P>0.05);A组IVF临床妊娠率21.1%,低于同期IVF对照组与同组ICSI与部分ICSI受精
方式的临床妊娠率（分别为48%,43.3%与40.0%,P<0.05）,且低于B组IVF妊娠率（50.0%,P<0.05)。结论无明确病因原发不孕
患者行ICSI可改善受精率,对于不孕年限长患者,存在受精障碍的可能性高,行half ICSI或全部ICSI可以改善临床妊娠率。
     

体外受精/卵胞浆内单精子注射术后宫内单胎妊娠早期自然流产的相关因素

目的：探讨体外受精(in vitro fertilization,IVF)/卵胞浆内单精子注射(intracytoplasmic sperm injection,ICSI)术后宫内单胎妊娠病例发生早期自然流产的相关因素,为早期自然流产的预防提供可行依据。方法：采用成组病例-对照研究,对2013年1月至2014年5月在湘雅医院生殖医学中心行IVF/ICSI术后的单胎妊娠病例进行回顾性分析,以早期自然流产夫妇(96对)为病例组,足月活产分娩夫妇(593对)为对照组,分析早期自然流产的相关因素。结果：多因素分析显示女方年龄大、有自然流产史以及男方精子DNA碎片指数(DAN fragmentation index,DFI)高为IVF/ICSI术后早期自然流产的独立危险因素(P<0.05)。结论：IVF/ICSI术后发生早期自然流产受多因素的影响。女方年龄越大(>30岁)、有自然流产史或男方精子DFI越高(≥15%),IVF/ICSI术后发生早期自然流产的风险越大。     

使用time-lapse筛选早期IVF/ICSI 胚胎及其临床结局

目的通过比较使用time-lapse(延迟摄像)和传统形态学方法筛选IVF/ICSI胚胎的临床结局,评价time-lapse用于早期胚胎
观察和筛选的价值。方法回顾性分析139个IVF/ICSI 周期的资料,根据胚胎的筛选方法,分为time-lapse monitoring 组（TLM
组）（n=68）和对照组（n=71）,比较两组间的βHCG阳性率、临床妊娠率和胚胎着床率,并根据女方年龄、受精方式进行亚组分
析。结果TLM组的βHCG阳性率、临床妊娠率、胚胎着床率分别为：66.2%、61.8%、47.1%;对照组的βHCG阳性率、临床妊娠
率、胚胎着床率分别为：47.9%、43.7%、30.3%;TLM组的βHCG阳性率、临床妊娠率、胚胎着床率均高于对照组,且差异均有统计
学意义（P<0.05）。亚组分析显示：相较于年龄≤30岁的患者,年龄31~35岁的患者利用time-lapse更能明显改善临床结局;利用
time-lapse能明显提高IVF周期的βHCG阳性率、临床妊娠率、胚胎着床率,但对于ICSI和TESA周期,效果则不理想。结论使
用time-lapse动态监测胚胎并根据胚胎的形态动力学参数对胚胎进行评价和筛选,与传统方法相比,能获得更好的临床结局;年
龄较大的（>30岁）或者是进行IVF周期的患者更能从中获益。
     

精子DNA完整率、精子顶体完整率及反应率对补救卵泡浆内单精子注射术的影响

目的探讨精子DNA完整率、精子顶体完整率及反应率对补救卵胞浆内单精子注射（ICSI）结局的影响。方法回顾性分
析我院生殖中心行常规试管受精（IVF）失败需行补救ICSI的97对不孕不育夫妇,根据妊娠情况分为妊娠组（41例）及未妊娠组
（56例）,分析两组患者精子DNA完整率(用精子DNA断裂指数DFI表示)、精子顶体完整率及反应率对ICSI结局的影响。结果
两组患者男方年龄、睾酮值、睾丸体积、FSH值、女方年龄、获卵数均无显著差异（P>0.05）,但不育年限未妊娠组长于妊娠组,差
异有统计学意义（P<0.05）。两组患者行补救ICSI时受精率及卵裂率无显著差异（P>0.05）,但优胚率妊娠组高于未妊娠组,差异
有统计学意义（P<0.05）。两组精子DNA完整率（DFI）、顶体反应率均无显著差异（P>0.05）,但顶体完整率妊娠组高于未妊娠
组,差异有统计学意义（P<0.05）;精子DNA完整率、顶体完整率、顶体反应率分别与受精率、卵裂率、优胚率均无显著相关性（P>
0.05）。补救ICSI临床妊娠率为42.3%,双胎率为10.3%,单胎率为32.0%。结论补救ICSI是体外受精-胚胎移植受精失败后有
效的补救方案,精子顶体完整率与其妊娠结局相关。
     

子宫腺肌病对体外受精-胚胎移植临床结局的影响

目的探讨子宫腺肌病对不孕患者体外受精-胚胎移植（IVF/ICSI-ET）临床结局的影响及其可能的原因。方法回顾性分
析南方医院经阴道超声诊断为子宫腺肌病患者61个IVF/ICSI周期作为研究组,对照组为164例单纯输卵管性不孕患者。对两
组的一般情况、控制性促排卵过程中的卵巢反应性、胚胎着床率、临床妊娠率、早期流产率、活产率等进行分析。结果研究组的
新鲜周期胚胎着床率、临床妊娠率、活产率均显著低于对照组（P<0.05）,早期流产率显著高于对照组（P<0.05）。研究组中,与
GnRHa降调节的长方案相比,GnRH拮抗剂方案对临床妊娠率、早期流产率均有不利影响（25.0% vs 45.0%,P=0.184;66.7% vs
27.8%,P=0.247）,但无统计学差异,而活产率显著低于长方案组患者（0% vs 30.8%,P=0.025）。结论子宫腺肌病降低不孕患者
IVF/ICSI-ET的胚胎着床率、临床妊娠率、活产率,且增加流产率,GnRH拮抗剂方案对子宫腺肌病患者IVF/ICSI-ET的临床结局
有负面影响,GnRHa长方案能够增加IVF/ICSI-ET的临床妊娠率、降低流产率。
     

年龄对卵巢低反应患者辅助生殖技术治疗后活产率的影响及其阈值效应分析

背景卵巢低反应（POR）患者较差的妊娠结局一直是生殖医学领域难题之一,但目前关于年龄对POR患者辅助生殖技术（ART）治疗后活产率的阈值效应的研究少见。目的分析年龄对POR患者ART治疗后活产率的影响及其阈值效应。方法商丘市第一人民医院妇产科和新疆医科大学第一附属医院生殖助孕中心2014年8月至2018年12月共收治接受常规体外授精/卵胞质内单精子注射-胚胎移植（IVF/ICSI）助孕治疗的女性共19 185例,选取其中诊断为POR者共3 337例为研究对象。所有患者采用控制性促排卵方案,同时采用IVF/ICSI进行胚胎移植并给予黄体支持治疗。分析所有患者活产婴儿情况,年龄对POR患者ART治疗后活产婴儿的影响采用单因素和多因素Logistic回归分析,并建立平滑拟合曲线、进行阈值效应分析。结果3 337例POR患者ART治疗后活产婴儿1 134例,未活产婴儿2 203例,活产率为33.98%（1 134/3 337）。多因素Logistic回归分析结果显示,年龄是POR患者ART治疗后活产婴儿的独立影响因素〔OR=0.920,95%CI（0.902,0.939）,P<0.01〕。建立平滑拟合曲线发现,年龄与POR患者ART治疗后活产率呈负相关,但二者之间并非简单的线性关系;阈值效应分析结果显示,POR患者ART治疗后活产率下降的折点为32岁,即年龄≤32岁的POR患者ART治疗后活产率不受年龄影响〔OR=1.000,95%CI（0.998,1.012）,P=0.38〕,但年龄>32岁的POR患者ART治疗后活产率随年龄增长而降低〔OR=0.800,95%CI（0.799,0.823）,P<0.01〕。结论年龄是POR患者ART治疗后活产婴儿的独立影响因素,年龄>32岁的POR患者ART治疗后活产率随年龄增长而降低。     

A retrospective analysis of 139 half-ICSI cycles in secondary infertile females.

目的 探讨继发不孕患者行部分卵子单精子卵泡浆内显微注射(half intracytoplasmic sperm injection,half-ICSI)的适应证.方法 回顾性分析继发不孕患者行部分卵子单精子卵泡浆内显微注射共139个周期,按体外授精(IVF)受精率≤50% 和＞50%分组,比较两组患者年龄、不孕年限、受精率、临床妊娠率等情况;分析IVF受精失败12周期的相关情况.结果 IVF受精率≤50%组的女方年龄较大,男方因素比例高,ICSI受精率低,获卵数及冷冻胚胎均少于受精率>50%组(P<0.05).IVF受精失败的12周期与IVF受精率>50%组比较也得出相似结果.结论 对于继发不孕患者,女方年龄大,男方精液为临界值,若为原发不育者,行half-ICSI可能帮助其减少受精失败的概率.     

Twin births in the university of Portharcourt teaching hospital Portharcourt: a 6 year review

Objective:To provide information on twin births and associated factors in Port barcourt South South Nigeria.Methods:Data on twin deliveries from 1st January 2003 to 31st December 2008 were collected and analysed.This included the maternal age and parity,gestation age,Apqar scores,sex and birth weight of twins.Results:A total of 11042 deliveries occurred over the study period with 333 being twins giving a twin rate of 1∶33.Male twins constituted 48% of twin births with male to female ratio of 1∶1.08.The mean age and parity of mothers were 29.6 years and 2.5 respectively.Presentation of the cephalic/cephalic for the first and second twins was the most common(63.4%).Severe birth asphyxia(first minute Apgar score 1-3)occurred in 3.9% of twins.Male-male twin pair occurred in 28.5% of twins,male-female in 39% while female-female occurred in 32.5%.The Caesarian section rate was 48%.Conclusion:The twining rate in this study is high.In this locality,there is a need for early ultrasound scanning of pregnant women particularly those of parities 1 to 3 and those aged 25-34 years in whom highest rates of twinning occurred to detect twinning when present and refer them to sufficiently equipped centres for adequate antenatal and perinatal care.     

An audit of deliveries and outcome at Queen Elizabeth Central Hospital,Blantyre, in 1999

A one-year audit of deliveries at Queen Elizabeth Central Hospital, Blantyre, was undertaken for 1999. The main objective of the audit was to obtain baseline data on forms of deliveries and pregnancy outcome. A total of 12,293 births occurred during the study period. Of these, 11,565 were singleton deliveries, 349 twin deliveries and 10 triplets. Characteristics of singleton deliveries were analysed further when data were available. The age distribution of the mothers ranged from 10 to 55 years with a mean age of 23.4 years. Of 10,314 singleton deliveries, 8710 (84.4%) were spontaneous vertex deliveries, 1121 (10.8%) were caesarian section, 304 (2.94%) were vacuum extraction and 169 (1.63%) were assisted breech deliveries. Breech deliveries had the worst outcome. The maternal mortality rate for the year 1999 was 1224 per 100,000 live births and the perinatal mortality rate was 49.3 per 1000 live births.     

Relationship of maternal factors and obstetric complications with term singleton vs term twin neonatal outcomes: A retrospective study in China

BackgroundNeonatal birth weight and length are important indicators of neonatal survival and morbidity during later life and are influenced by maternal factors and obstetrical complications. Therefore, we aimed to determine the relationship of maternal factors and obstetric complications with term singleton vs term twin neonatal outcomes in Wuhan University Renmin Hospital, Hubei, China.MethodsA total of 10517 neonatal births were recorded in a tertiary-hospital-based retrospective study and term singleton (n=7787) and term twins (n=169) were included for data analysis. Birth weight and birth length were measured immediately after birth. Correlation, independent student t-test, and backward multiple linear regression were used for statistical analysis.ResultsWomen with singleton gestation have an increased rate of obstetric complications compared to women with twin gestation. However, a higher frequency of cesarean section and breech were found in twin gestation compared to singleton gestation. Weight before pregnancy, gestational weight gain, and gestational diabetes mellitus were significantly positive (p<0.05) associated with singleton neonatal birth length and weight. In contrast, preeclampsia, placenta previa, oligohydramnios, premature rupture of membrane, breech, and multiparity had a significantly negative (p<0.05) association with singleton neonatal birth length and weight. Maternal age was significantly positive (p<0.05) associated with only singleton neonatal birth weight. Moreover, the nuchal cord was significantly positive (p<0.05) associated with singleton neonatal birth length. On the other hand, maternal age and multiparity were significantly positive (p<0.05) associated with twins'' neonatal birth length and weight. Furthermore, gestational weight gain was significantly positive (p<0.05) associated with only twins'' neonatal birth weight.ConclusionIn term gestation, obstetric complications were significantly associated with singleton birth size rather than twin birth size.     

单纯男性因素不育患者行形态选择性卵胞浆内单精子注射对胚胎发育及临床结局的影响

目的使用放大系统对不育男性患者的精子进行形态选择性卵母细胞浆内单精子注射术（IMSI）,观察IMSI技术能否改善
因男性精液问题而不孕不育夫妇的助孕结局。方法回顾分析本中心2013年1月~2014年11月共82例梗阻性无精子症患者,将
行TESA（经皮睾丸穿刺抽吸精子术）获得的睾丸精子通过放大系统（×6600）挑选后行卵母细胞注射（IMSI组）,2013 年1 月~
2014年11月共91例梗阻性无精子症患者经TESA取精术后行常规卵母细胞浆内单精子注射（ICSI组）;2014年1月~11月共44
例畸精子症患者行形态选择性包浆内单精子注射治疗（IMSI组）,2014年1月~11月共71例畸精子症患者行常规ICSI治疗（ICSI
组）。统计分析ICSI组和IMSI组患者的实验室结局和临床结局。结果梗阻性无精子症患者中正常受精率IMSI组显著高于
ICSI 组（84.3% vs 77.0%）（P<0.05）;ICSI 组的卵裂率95.5%,优胚率28.2%,囊胚形成率54.8%,种植率26.4%,临床妊娠率
47.3%,流产率14%,梗阻性无精子症IMSI组患者的卵裂率96.7%,优胚率29.2%,囊胚形成率54.3%,种植率32.3%,临床妊娠率
50.0%,流产率7.3%,两组无显著性差异（P>0.05）。畸精子症患者的正常受精率IMSI组显著高于ICSI 组（68% vs 75.5%）（P<
0.05）,囊胚形成率IMSI组显著高于ICSI组（54.6% vs 67.9%）（P<0.05）,ICSI组的卵裂率96.2%,优胚率27.6%,种植率28.2%,
临床妊娠率43.7%,流产率9.7%;IMSI组患者的卵裂率95.2%,优胚率27.1%,种植率30.7%,临床妊娠率43.2%,流产率10.5%,
两组无显著性差异（P>0.05）。结论梗阻性无精子症患者的睾丸精子经放大系统选择后行ICSI,正常受精率较传统ICSI有显著
性提高;畸精子症患者射出的精液标本经放大系统挑选后行ICSI,正常受精率、囊胚形成率较传统ICSI有显著性提高。
     

小于胎龄早产儿及其发生因素分析

分析４５１例产妇分娩的５００例活产早产儿，其中小于胎龄的早产儿９２例，适于胎龄的早产儿３９０例（对照组）。二组对比，ＰＳＧＡ的合并症发生率及病死率均高于ＰＡＧＡ。孕母有六种因素可导致ＰＳＧＡ的发生：妊娠高血压综合征、疾病、双胎、有早产或自然流产史、文化程度低及重体力劳动者。     

A Bahraini Registry of Assisted Reproductive Technology for Period of 2000-2006: Hoping to Stave off Reporting Stalemate

Objective To report the first Bahrain national registry for ART treatments initiated from January 1, 2000 to December 31, 2005. Methods The ＂World Report on ART＂ forms, prepared by the International Committee for Monitoring Assisted Reproductive Technology （ICMART）, were filled from database records of all procedures and their respective outcome carried out at Banoon ART Centre, the Military Hospital, Bahrain during the period of 2000-2006. Results A total of 1490 completed cycles were performed. ICSI constituted 42.68% （636）, IVF constituted 35.50% （529）, while frozen-thawed embryo replacement cycles represented only 21.18% （325） of all ART cycles. The clinical pregnancy rates per transfer for IVF and ICSI cycles were 26.65% and 21.70%, respectively. The distribution of singleton, twin and triplet deliveries for IVF,, ICSI and FET combined were 80. 0%, 16.3% and 3.7%, respectively. The average delivery rate per clinical pregnancy for fresh and frozen cycles was 57.3%. As a result of ART services, 266 neonates were born. Complications of ART were solely due to ovarian hyperstimulation syndrome （OHSS） which constituted 2.26% of all aspirated cycles. Conclusion Multiple pregnancy rate was high due to transferring 〉3 embryos. Pregnancy loss and OHSS were relatively high thus preventative measures were recommended. This report paves the way for the other IVF centers in Bahrain to provide their own data for the national ART registry.     

Congenital malformations in singleton and twin births in rural Nigeria

BACKGROUND: The presence of a congenital malformation at birth is a cause of anxiety at an otherwise joyous occasion. Congenital malformations are a significant contributor to perinatal mortality. STUDY DESIGN: A retrospective study of external congenital abnormalities in singleton and twin births in rural eastern Nigeria over a 20 year period. RESULT: The incidence of congenital defects for all deliveries was 110.8/10,000 births. Of 1453 twins and 32206 singleton births, there were 58 and 315 congenital abnormalities, with incidence of 97.8/10,000 births and 399.2/10,000 births respectively. Twins were significantly (x(2) =115.22; p< 0.0000) more likely to have a congenital malformation than singletons (RR 4.08, 95% CI 3.10 - 5.7). The pattern of defects was similar for singleton and twin births and the leading system affected was the musculo-skeletal system, distantly followed by the central nervous system. For both groups the commonest malformation was ulnar polydactyly, followed by hydrocephaly and ankyloglossia. Surprisingly no conjoined twins were recorded and there were only 7 cases of congenital umbilical hernia, abnormalities previously considered to be very common in Nigerians and Africans respectively. CONCLUSION: Twins are about four times more likely to have congenital malformations than singletons. The overall prevalence of congenital malformations recorded is comparatively low. There is need for more detailed routine documentation of all birth defects including post-mortem report and the conduct of prospective population-based epidemiological surveys of birth defects in Nigeria.