Low endometrial volume may predict early pregnancy loss in women undergoing in vitro fertilization

PURPOSE: To evaluate the role of 3-D US measurement of the endometrium during early IVF-pregnancy and before the appearance of gestational sac in the prediction of pregnancies outcome. METHODS: 60 pregnant women following IVF treatment were included in the study. The women underwent transvaginal 3D US measurements of endometrial volume and thickness on day 15-17 post ET. Patients were followed and classified according to pregnancy outcome into 2 further groups. The group with early pregnancy loss and the group with ongoing pregnancy. RESULTS: While no differences were observed between those who miscarried and those who did not in gestational age, endometrial thickness or volume, spontaneous early pregnancy loss was significantly higher in patients with endometrial volume <2 mL as compared to those with endometrial volume >2 mL. CONCLUSIONS: 3-D US measurement of endometrial volume of less than 2 mL during early IVF pregnancy and prior to the appearance of gestational sac is a powerful predictor of pregnancy loss.     

挽救ICSI的临床应用价值探讨

目的探讨挽救ICSI（R-ICSI）在临床应用的价值及可行性。方法常规IVF周期中,授精4-6 h后观察第2极体,对6 h后明确未排出第2极体的成熟卵母细胞达50%以上者实行R-ICSI,其实施33周期,并与同期113个常规ICSI周期进行比较。结果与常规ICSI比较,R-ICSI的受精率、3原核（3PN）发生率、优质胚胎率、妊娠率、种植率方面差异无统计学意义,1原核（1PN）发生率明显增高（P〈0.01）。结论R-ICSI可以获得较好的临床效果。     

不同剂量的曲普瑞林降调节方案在IVF-ET中的应用

目的　分析IVF ET中不同剂量的曲普瑞林 (达必佳 )降调节方案的效果 ,探寻最低而有效的达必佳剂量 ,从而降低IVF ET病人的药费。方法　将行IVF ET的 16 7例病人随机分为两组。A组 96例 ,其中长方案者 5 7例 ,即于前次月经周期的第 2 1天开始每日皮下注射达必佳 (短效 ) 0 .1mg(1支 )直至注射HCG日止 ;短方案者 39例即于本次月经周期的第 2天开始每日皮下注射达必佳 0 .1mg ,直至注射HCG日止。B组 71例 ,其中长方案者 4 4例 ,短方案者 2 7例 ,达必佳应用时间同A组 ,但用量减半 ,即每日半支皮下注射。比较A、B两组病人的FSH或 和HMG用量 (安瓿数 )、取卵个数、受精率、临床妊娠率、周期总药费。结果　B组病人的FSH或 和HMG用量明显少于A组 (P <0 .0 5 ) ;两组病人的取卵个数、受精率、临床妊娠率无显著差异 ;但B组病人的周期总药费明显低于A组 (P <0 .0 1)。结论　在IVF ET过程中 ,采用达必佳半量皮下注射降调节可减少FSH HMG用量 ,降低病人的总药费 ,且不影响临床妊娠率。     

TPO-Ab、TSH与体外受精-胚胎移植结局

目的 明确TPO-Ab、TSH与体外受精-胚胎移植结局的关系.方法 分析体外受精-胚胎移植患者助孕周期资料.依据TPO-Ab分组,TPO-Ab阳性且甲状腺功能正常患者作为研究组,TPO-Ab阴性且甲状腺功能正常患者作为对照组;TPO-Ab阳性并TSH ＜2.5 uIU/mL患者作为研究组,TPO-Ab阳性并TSH≥2.5 uIU/mL患者作为对照组;TPO-Ab阴性并TSH＜2.5uIU/mL作为研究组,TPO-Ab阴性并TSH≥2.5 uIU/mL患者作为对照组.结果 TPO-Ab阳性组IVF受精率（79.76％）、优质胚胎率（46.59％）明显低于TPO-Ab阴性组IVF受精率（84.08％）,优质胚胎率（54.49％）、TPO-Ab阳性组流产率（33.33％）明显高于TPO-Ab阴性组流产率（16.11％）,差异均有统计学意义（P ＜0.05）;TPO-Ab阳性且TSH ＜2.5组优质胚胎率（55.39％）、T4值（15.76±2.00）明显高于TPO-Ab阳性且TSH≥2.5组优质胚胎率（40.32％）、T4值（14.27±2.04）,差异均有统计学意义（P ＜0.05）;TPO-Ab阴性且TSH ＜2.5组优质胚胎率（58.19％）明显高于TPO-Ab阴性且TSH ≥2.5组优质胚胎率（52.19％）,差异有统计学意义（P＜0.05）;各分组间其他资料比较无统计学意义（P＞0.05）.结论 TPO-Ab阳性及TSH高值对IVF-ET结局存在不利关系.此类患者在接受IVF-ET治疗前应调节甲状腺功能有利于IVF-ET结局.     

精子正常形态率、顶体完整率、顶体反应率与卵子体外受精率的相关性研究

目的:通过检测常规体外受精中(in vitro fertilization IVF)精液常规分析正常男性的精子正常形态率、顶体完整率、顶体反应率并分析其与卵子的体外受精率之间的关系,旨在为辅助生殖技术提供几种可靠的判断精子生育力的参数与指标。方法:选择2008年7月1日到2009年12月30日间在广西医科大学第三附属医院生殖医疗中心进行控制性长方案超排卵下行常规IVF-ET的100对夫妻,共100个周期的资料做前瞻性分析,男方精液常规分析属正常范围,分析100份标本精子正常形态率、精子顶体完整率以及精子顶体反应率;观察并记录获卵个数、成熟卵个数、受精卵个数、未受精卵个数,计算其受精率。然后应用计量资料t检验,F检验以及线性相关等统计学方法对精子各项参数与卵子受精率之间的相关性进行分析。结果:实验组1,精液标本按其正常精子形态百分率分为3组,A组:≥5%而<10%、B组:≥10%而<15%、C组:≥15%,卵子体外受精率分别为67.05%、74.51%、82.49%,各组间两两相比差异有统计学意义(P<0.05)。实验组2,按顶体完整率分为两组,A组:≤85%组、B组:>85%组,卵子体外受精率分别为74.25%和82.14%,两组间比较差异有统计学意义(P<0.05)。实验组3,按顶体反应率分为三组,A组:<14%、B组:≥14%而≤25%、C组:>25%,其卵子体外受精率分别为73.45%、77.19%、82.74%,各组间的差异有统计学意义(P<0.05)。实验组4,按精子正常形态百分率分为两组<15%和>15%组,所对应的顶体完整率分别为79.51%、87.27%,两组间比较差异有统计学意义(P<0.05)。实验组5,用多重线性回归分析,精子正常形态率、顶体完整率、顶体反应率的标准化系数和P值分别为0.352、0.497、0.271;0.045、0.005、0.017,各个系数均有统计学意义。其中又以顶体完整率的标准化系数最大。结论:1.对于精液常规分析正常的男性,约有50%存在着不同程度的精子形态异常。卵子的受精率随正常形态精子所占百分率的升高而增高;其正常精子形态率≥5%,仍可得到一个较好的体外受精率,因此可行常规体外受精助孕。2.对于精液常规分析正常的男性,约有65%男性的精子顶体完整率>85%,随着精子顶体完整率的增加,卵子的受精率也明显增高;3.对于精液常规分析正常的男性,其78%男性精子顶体反应率≥14%,在体外受精中卵子的受精率随着精子顶体反应率所占百分比的增加而增高;4.上述三者都是影响卵子受精的重要因素,卵子体外受精率与以上三项指标间存在较强的相关关系,而其中又以顶体完整率对卵子体外受精率的影响程度最大。5.对于精液常规分析正常的男性,若正常精子形态率≥5%,在体外受精助孕前,精子顶体完整率和精子顶体反应率的检测,可不作为常规检查项目。     

Growth hormone replacement improved oocyte quality in a patient with hypopituitarism: A study of follicular fluid

BackgroundGrowth hormone (GH) is known to be involved in ovarian folliculogenesis and oocyte maturation. In patients with poor ovarian response without growth hormone deficiency (GHD), adjuvant GH treatment improves in-vitro fertilization (IVF) results. Improvement of oocyte quality in IVF by GH replacement was reported in only a few patients with GHD. We report on a new case with study of follicular fluid.MethodsA 29-year-old patient with hypopituitarism was referred to our infertility center. She was undergoing hormonal replacement for hypogonadotropic hypogonadism and diabetes insipidus, and did not consider at first GH replacement. Four IVF procedures were performed between 2011 and 2014. Growth hormone replacement (somatotropin 1.1 mg/day) was initiated before the fourth IVF procedure and unmasked central hypothyroidism; levothyroxine (75 mg/day) was introduced. It took 10 months to reach the treatment objectives for insulin-like growth factor 1 (IGF1), free triiodothyronine (fT3) and free thyroxine (fT4). GH, IGF1 and thyroid hormones were measured in the blood and follicular fluid before and after GH and thyroid hormone replacement. Oocyte and embryo quality were also compared.ResultsThe first 3 IVF procedures were performed without GH replacement. 62% to 100% of mature oocytes presented one or more morphologic abnormalities: diffuse cytoplasmic granularity, large perivitelline space with fragments, fragmentation of the first polar body, ovoid shape, or difficult denudation. Embryo quality was moderate to poor (grade B to D), and no pregnancy was obtained after embryo transfer. After GH replacement, hormones levels increased in follicular fluid: GH [7.68 vs. 1.39 mIU/L], IGF1 [109 vs. < 25 ng/mL], fT3 [3.7 vs. 2.5 pmol/L] and fT4 [1.45 vs. 0.84 ng/mL]. Concomitantly, there was dramatic improvement in oocyte quality (no abnormal morphologies) and embryo quality (grade A), allowing an embryo transfer with successful pregnancy.ConclusionsThis is the first report illustrating changes in hormonal levels in follicular fluid and the beneficial effect of GH replacement on oocyte and embryo quality during an IVF procedure in a patient with hypopituitarism. These results suggest that GH replacement is beneficial for oocyte quality in patients with GHD.     

Obstetric outcomes in women with polycystic ovary syndrome and isolated polycystic ovaries undergoing in vitro fertilization: a retrospective cohort analysis

Objective: This retrospective cohort study evaluated the obstetric outcomes in women with polycystic ovary syndrome (PCOS) and isolated polycystic ovaries (PCO) undergoing in vitro fertilization (IVF) treatment.

Methods: We studied 104 women with PCOS, 184 with PCO and 576 age-matched controls undergoing the first IVF treatment cycle between 2002 and 2009. Obstetric outcomes and complications including gestational diabetes (GDM), gestational hypertension (GHT), gestational proteinuric hypertension (PET), intrauterine growth restriction (IUGR), gestation at delivery, baby’s Apgar scores and admission to the neonatal intensive care unit (NICU) were reviewed.

Results: Among the 864 patients undergoing IVF treatment, there were 253 live births in total (25 live births in the PCOS group, 54 in the PCO group and 174 in the control group). The prevalence of obstetric complications (GDM, GHT, PET and IUGR) and the obstetric outcomes (gestation at delivery, birth weight, Apgar scores and NICU admissions) were comparable among the three groups. Adjustments for age and multiple pregnancies were made using multiple logistic regression and we found no statistically significant difference among the three groups.

Conclusion: Patients with PCO?±?PCOS do not have more adverse obstetric outcomes when compared with non-PCO patients undergoing IVF treatment.     

Mortality outcomes based on ED qSOFA score and HIV status in a developing low income country

Objective

To evaluate the utility of the quick Sepsis-related Organ Failure Assessment (qSOFA) score to predict risks for emergency department (ED) and hospital mortality among patients in a sub-Saharan Africa (SSA) setting.

Hair mercury concentrations and in vitro fertilization (IVF) outcomes among women from a fertility clinic

Total hair mercury (Hg) was measured among 205 women undergoing in vitro fertilization (IVF) treatment and the association with prospectively collected IVF outcomes (229 IVF cycles) was evaluated. Hair Hg levels (median = 0.62 ppm, range: 0.03–5.66 ppm) correlated with fish intake (r = 0.59), and exceeded the recommended EPA reference of 1 ppm in 33% of women. Generalized linear mixed models with random intercepts accounting for within-woman correlations across treatment cycles were used to evaluate the association of hair Hg with IVF outcomes adjusted for age, body mass index, race, smoking status, infertility diagnosis, and protocol type. Hair Hg levels were not related to ovarian stimulation outcomes (peak estradiol levels, total and mature oocyte yields) or to fertilization rate, embryo quality, clinical pregnancy rate or live birth rate.