激光辅助孵化在前次IVF-ET失败患者中的应用

【目的】探讨激光辅助孵化（laser-assisted hatching，LAH）对前次体外受精-胚胎移植（in vitro fertilization—embryo transfer，IVF-ET）失败患者的临床妊娠率和胚胎种植率的影响。【方法】对前次IVF-ET失败并排除子宫内膜、胚胎质量等因素的90例患者，根据是否采用激光辅助孵化分为LAH组和对照组，对LAH组患者的胚胎采用部分透明带薄化后进行移植。比较两组的临床妊娠率和胚胎种植率。【结果】LAH组和对照组的临床妊娠率分别为48．8％（20／41）和34．7％（17／49）（P〉0．05）；胚胎种植率分别为25．8％（30／116）和15．7％（22／140）（P〈0．05）；两组比较胚胎种植率有差异。【结论】激光辅助孵化可以提高前次IVF-ET失败患者的胚胎种植率。     

Impact of assisted hatching on ART outcome in women with endometriosis

BACKGROUND: Assisted hatching can improve the implantation rate in cycles with poor outcome. The impact of assisted hatching in embryos from women with endometriosis is not known. Therefore, the hypothesis that the implantation potential of embryos obtained from women with endometriosis can be improved with assisted hatching was tested. METHODS: In a prospective randomized study, transfer embryos obtained from 60 women with endometriosis were hatched using a laser system and compared to embryos obtained from patients with the same diagnosis which were left intact (n = 30). RESULTS: The characteristics of cycles were similar between groups. The pregnancy (40% zona intact, 28.3% assisted hatching), and implantation rates (19.4% zona intact, 17.8% assisted hatching) did not differ in endometriosis cycles regardless of assisted hatching. CONCLUSION: Assisted hatching does not improve outcome in women with endometriosis undergoing assisted reproduction.     

Healthy twin delivery after day 7 blastocyst transfer coupled with assisted hatching

OBJECTIVE: To report a normal twin delivery after transfer of two fresh day 7 blastocysts. DESIGN: Case report. SETTING: Private infertility clinic. PATIENT(S): A 35-year-old woman with a 6-year history of primary infertility with significant pelvic adhesions. INTERVENTION(S): Review of individual IVF-ET therapy cycle. MAIN OUTCOME MEASURE(S): Full-term delivery after day 7 blastocyst transfer. RESULT(S): During the patient's first IVF-ET cycle, the decision was made to undertake blastocyst transfer after extended culture. No blastocysts had formed until late on day 6, by which time the patient had been hospitalized with a renal stone. Subsequently, on day 7, the patient was asymptomatic and presented for embryo transfer, and after assisted hatching, two expanded blastocysts were transferred to her uterus under ultrasound guidance. After confirmation of implantation of a viable twin, pregnancy was uneventful with no obstetrical complications, and a dizygotic twin was delivered vaginally at 38 weeks of gestation. CONCLUSION(S): Few reports have been made regarding viability of more slowly developing blastocysts; however, this case indicates that blastocysts that did not fully expand until day 7 of extended in vitro culture are still able to implant after superovulation and IVF-ET therapy. Assisted hatching of these embryos may have been beneficial in achieving this successful outcome by hastening the blastocyst hatching, allowing more rapid contact with the endometrium.     

Laser zona pellucida thinning--an alternative approach to assisted hatching

BACKGROUND: The purpose of this study was to assess the efficacy and hatching characteristics of in-vitro cultured human embryos subjected to laser zona pellucida thinning. METHOD: Zona thinning was performed on 110 embryos using a non-contact 1.48 microm diode laser and the hatch rate in vitro was compared with 42 control embryos. Variation of zona thickness and degree of zona expansion was assessed. Scanning electron microscopy was performed on embryos entrapped during hatching to identify the site of hatching. RESULTS: The rate of hatching was significantly higher in laser thinned blastocysts compared with control embryos (68 versus 33% respectively, P < 0.01). Laser thinning increased the variation of zona thickness in embryos from 11.6-27.3%. Natural zona thinning occurred in 92% of laser thinned hatching blastocysts and 100% of control embryos. CONCLUSION: These results suggest that laser zona thinning is effective and may provide significant advantages over conventional assisted hatching techniques, which create holes.     

Clinical Assisted Reproduction: An Analysis of Spontaneous Hatching in a Human Endometrial Epithelial Coculture System: Is Assisted Hatching Justified?

Purpose: To evaluate spontaneous embryo hatching in an endometrial epithelial coculture system, and compare it with cases where coculture was performed because of maternal age, previous repeated implantation failures, or both. To clarify in which cases assisted hatching would be appropriate.Methods: Individual human embryos were cocultured on an endometrial epithelial cell monolayer until Day 6.Results: Blastocyst hatching rate at Day 6, depending on maternal age, was 9.1% (age <37 years) and 3.4% (age 37 years). However, blastocyst hatching rates depending on number of previous IVF failures were similar.Conclusions: Maternal age and previous implantation failures are factors affecting the ability of human embryos to reach the blastocyst stage in coculture. However, assisted hatching is not justified in these populations because of the absence of hatching rate differences between blastocysts obtained from these two groups and the control group.     

LASIK术后质量分数0.5％氯替泼诺滴眼液应用的随机对照研究

背景 近视性准分子激光角膜原位磨镶术(LASIK)后需局部使用糖皮质激素滴眼液已成为共识,具有良好抗炎效果且不良反应小的糖皮质激素滴眼液有利于术后角膜上皮的快速修复.目的 评估质量分数0.5％氯替泼诺滴眼液在LASIK术后的临床应用效果.方法 采用前瞻性随机对照研究设计.本研究经中山大学中山眼科中心伦理委员会批准,所有患者纳入前均充分了解本研究的内容并签署知情同意书.112例224眼纳入研究,其中共97例194眼完成随访.双眼接受近视性LASIK的患者以随机数字表法分为0.5％氯替泼诺滴眼液点眼组(试验组)54例108眼和对照组43例86眼,两组患者年龄及术前等效球镜度差异均无统计学意义(P＞0.05).两组的基础治疗方法一致.试验组从术后第1天开始局部点用0.5％氯替泼诺滴眼液,每日4次,共1周,对照组以同样的方法点用妥布霉素地塞米松滴眼液.分别于术后1d、1周、1个月对2个组患者的主观症状进行评分,并行裸眼视力、最佳矫正视力(BCVA)、眼压、中央角膜厚度、角膜荧光素染色检查,同时观查术眼的术中和术后并发症情况,以评价0.5％氯替泼诺滴眼液点眼的安全性.结果 在随访过程中,未观察到与药物相关的全身和眼部严重并发症.术后1d、1周和1个月,试验组和对照组主观症状评分(包括眼痛、异物感、视物模糊评分)比较,差异均无统计学意义(P＞0.05).术后1周,试验组和对照组校正后的实际眼压分别为(16.27±3.31)mmHg和(17.49±4.48)mmHg,差异有统计学意义(t=-2.113,P=0.036);术后1个月,试验组和对照组校正后的实际眼压分别为(15.01±3.22)mmHg和(15.30±4.17)mmHg,差异无统计学意义(t=-0.532,P=0.595).术后1d,试验组发生轻度弥漫性层间角膜炎(DLK)者7眼,对照组为5眼,差异无统计学意义(x2 =0.153,P=0.926),术后1周和1个月两组中均未发现DLK.术后1d、1周和1个月两组间的角膜荧光素染色评分差异均无统计学意义(Z=-0.566,P=0.571;Z=-0.689,P=0.491;Z=-1.628,P=0.103).结论 0.5％氯替泼诺滴眼液用于LASIK术后可以有效控制术后炎症反应和DLK,并且减少了传统糖皮质激素升高眼压的风险.     

激光辅助孵化对冻融双胚胎移植后胚胎存活及双胎子代发育的影响

目的 通过分析来自激光辅助孵化(LAH)的冻融D3卵裂期双胚胎移植后胚胎存活情况、双胎新生儿发育及周岁婴幼儿发育情况,评估LAH技术对胚胎存活及新生儿与婴幼儿发育的影响。方法 选取2017年1月至2019年12月浙江省人民医院收治的843例双胚胎移植不孕症患者,根据移植前是否需激光辅助孵化(LAH)分为LAH组381例和非LAH组462例。LAH组移植前采用LAH处理,非LAH组移植前无LAH处理步骤。比较两组妊娠结局,并选择双胚胎存活的156例患者(其中LAH组65例,非LAH组91例)双胎出生后代的生长发育指标,包括出生孕龄、体重、畸形情况及周岁时身高、体重等,分析LAH对胚胎及婴幼儿发育的长期影响。结果LAH组与非LAH组胚胎存活率比较,差异无统计学意义(P0.05);LAH组与非LAH组A胎出生体重、B胎出生体重、先天性畸形的比例比较,差异均无统计学意义(P0.05);两组双胎婴幼儿1周岁时均无身高、体重、认知、出牙、运动能力的异常,差异无统计学意义(P0.05)。结论 LAH的应用对冻融双胚胎移植后的胚胎存活率、双胎子代新生儿发育及1周岁婴幼儿发育影响均无明显影响,对于双胎新生儿畸形率的影响尚需更多病例的研究。     

激光辅助孵化对冻融胚胎移植临床结局的影响

目的 探讨激光削薄法辅助孵化(AH)对冷冻第3天胚胎移植结局的影响.方法 选取行第3天冷冻胚胎移植患者的1 024周期,其中964个周期行常规的第3天冻存胚胎移植(非AH组),60个周期于第3天冻存胚胎复苏后,用激光将1/4透明带削薄2/3后移植(AH组);分析两组的种植率、临床妊娠率、多胎率、活产率、流产率及生化妊娠率.结果 两组的种植率、临床妊娠率、多胎率、活产率、流产率及生化妊娠率分别为43.2％和24.2％、58.3％和43.2％、45.7％和26.9％、78.4％和77.7％、21.6％和22.3％、6.7％和4.4％;其中AH组的种植率、临床妊娠率及多胎率与非AH组比较,差异有统计学意义(P＜0.05);而活产率、流产率及生化妊娠率高于非AH组,但差异无统计学意义(P＞0.05).结论 采用激光削薄方法进行AH可以提高冷冻复苏第3天胚胎移植后的种植率及临床妊娠率,而对活产率无明显影响.