腹腔镜下子宫腺肌瘤局灶切除术联合GnRH-a治疗的效果研究

目的:比较腹腔镜下子宫腺肌瘤局灶切除术与术后联合促性腺激素释放激素激动剂(GnRH-a)在子宫腺肌瘤合并不孕症患者治疗中的效果。方法:根据治疗方法的不同将研究对象分为两组:行腹腔镜下子宫腺肌瘤局灶切除术联合GnRH-a治疗者为研究组(72例),仅行腹腔镜下局灶切除术为对照组(70例)。分别于术后6个月、12个月、24个月进行电话随访,比较两组患者妊娠率、痛经症状缓解及子宫腺肌病复发情况。结果:研究组术后24个月累计妊娠率(27.78%)高于对照组(12.86%),差异有统计学意义(P0.05)。研究组和对照组患者术后痛经缓解有效率分别为86.11%、81.43%,差异无统计学意义(P0.05)。2年随访期间研究组复发率(8.33%)低于对照组(18.57%),差异有统计学意义(P0.05)。结论:腹腔镜下局灶切除术后联合GnRH-a药物治疗可以改善子宫腺肌病患者的痛经症状,与单纯行腹腔镜下局灶切除术相比,联合治疗的妊娠率更高,短期内降低复发。     

Sexual functioning and quality of life of Hong Kong Chinese women with infertility problem

Infertility is estimated to affect 10–15% of couples in industrialized countries and many of them are under tremendous stress. Stress can lead to poor quality of life and sexual dysfunction in general, but little is known about their prevalence in infertile women. We, therefore, conducted this cross-sectional survey in two primary care subfertility clinics between August 2012 and April 2013. A total of 159 women completed two validated Chinese questionnaires: Female Sexual Function Index and core Fertility Quality of Life. The overall Female Sexual Function Index score (mean?±?SD) of the whole group was 24.99?±?4.22. Using the urban Chinese cut-off, the prevalence of female sexual dysfunction, low desire, arousal disorder, lubrication disorder, orgasmic disorder and sexual pain were 32.5%, 15.7%, 19.3%, 22.3%, 33.1% and 15.1%. The core Fertility Quality of Life score of the whole group was 59.76?±?13.59 and the subgroup of infertile women with sexual dysfunction (n?=?50) had significantly lower mean core Fertility Quality of Life score than those without sexual dysfunction (n?=?109) (55.03 versus 61.88) (p?=?0.005). Among the subscales, the relational score had the strongest correlation with sexual dysfunction. Infertile women with sexual dysfunction had significantly worse quality of life especially in the relational aspect.     

Anti‐Müllerian hormone as a marker of ovarian reserve: What have we learned,and what should we know?

Ovarian reserve reflects the quality and quantity of available oocytes. This reserve has become indispensable for the better understanding of reproductive potential. Measurement of the serum anti‐Müllerian hormone (AMH) level allows quantitative evaluation of ovarian reserve. It has been applied to a wide range of clinical conditions, and it is well established that the measurement of serum AMH levels is more useful than qualitative evaluation based on the menstrual cycle. AMH levels are monitored during infertility treatments; in patients undergoing medically assisted reproductive technology; and in the diagnosis of ovarian failure, polycystic ovarian syndrome, and granulosa cell tumor. It is also useful in the evaluation of iatrogenic ovarian damage. Population‐based studies have indicated a potential role for serum AMH in the planning of reproductive health management. While AMH is currently the best measure of ovarian reserve, its predictive value for future live births remains controversial. Furthermore, there is a serious practical issue in the interpretation of test results, as currently available assay kits use different assay ranges and coefficients of variation due to the absence of an international reference standard. The pros and cons of the serum AMH level as a definitive measure of ovarian reserve merits further review in order to guide future research.     

中医综合治疗排卵障碍性不孕症中促排卵效应的临床疗效研究

目的:观察中医综合治疗排卵障碍性不孕症中促排卵效应的临床疗效。方法:95例排卵障碍性不孕症患者随机分成中医综合组、中西医结合组及西医组,中医综合组采用中药人工周期、针灸及耳穴压豆促排卵,中西医结合组用中药人工周期及氯米芬促排卵,西医组用氯米芬促排卵。结果:中医综合组33例中,排卵29例,占87.88%,妊娠25例,占75.76%;中西医结合组30例中,排卵24例,占80.00%,妊娠15例,占50.00%;西医组32例中,排卵18例,占56.25%,妊娠8例,占25.00%;3组比较妊娠率有显著差异(P0.05);中医综合组、中西医结合组与西医组比较排卵率有显著差异(P0.05)。结论:中医综合治疗促排卵疗效好,可明显提高受孕率。     

GnRH拮抗剂方案与激动剂超短方案应用于卵巢低反应患者的临床效果比较

目的探讨GnRH拮抗剂方案和激动剂超短方案在卵巢低反应(POR)患者中的临床效果。方法回顾性分析了171例POR的184个IVF/ICSI周期,根据促排卵方案不同分为GnRH激动剂超短方案组(110个周期)和拮抗剂方案组(74个周期)。比较两组的基本资料及临床结局。结果两组HCG日雌激素值及子宫内膜厚度、获卵数、卵裂率、可移植胚胎率、优质胚胎率、周期取消构成比、流产率等差异均无统计学意义(P均0.05);拮抗剂组促性腺激素(Gn)使用时间、Gn总量、HCG日LH值均低于激动剂超短方案组,而2PN受精率高于激动剂超短方案组,差异有统计学意义(P0.05)。拮抗剂组周期取消率略低于激动剂超短方案组(23.0%vs.36.4%),胚胎种植率、移植周期妊娠率略高于超短方案组,但差异不具有统计学意义(P0.05)。结论在POR患者中,GnRH拮抗剂方案可节约Gn用量、缩短Gn时间,降低经济成本,因此拮抗剂方案也是POR可以选择的、比较理想的促排卵方案。     

内源性抗氧化剂PRDX4及其在生殖系统作用的研究进展

过氧化物还原酶4（PRDX4）是过氧化物还原酶家族成员,是一种细胞内源性抗氧化剂,可锚定在内质网调节蛋白质氧化折叠,也可分泌到细胞外基质发生抗氧化作用。在女（雌）性生殖系统,氧化应激影响卵巢的功能状态,定位在颗粒细胞及卵母细胞的体细胞型PRDX4（PRDX4s）通过抗氧化应激机制促进卵泡发育成熟、抑制卵母细胞老化,并参与多囊卵巢综合征（PCOS）和卵巢功能减退的病理过程。在睾丸组织内同时表达两种PRDX4亚型,PRDX4s和睾丸特异型PRDX4（PRDX4t）。PRDX4通过抑制内质网应激、清除胞质和细胞外基质活性氧簇（ROS）保护睾丸组织结构与细胞功能,参与调节精子发生和精子形成,抑制生精细胞凋亡。综述PRDX4的结构与功能,及其在调节配子发生中的作用。     

人工流产后早产、低出生体重和继发不孕发生风险的研究进展

人工流产十分常见,大约四分之一的女性会经历人工流产。自从全球许多国家人工流产合法化以来,关于人工流产对再次妊娠早产、低出生体重和继发性不孕症的影响引起广泛关注。因为已发表文章的研究结果不甚一致,且高质量的研究证据有限,故关于人工流产后是否存在上述生育风险尚未得出明确的结论。本文就人工流产对再次妊娠早产、低出生体重和不孕症的影响进行综述,为进一步做好相关研究工作,获得人工流产对女性生育力和妊娠结局影响的高质量研究证据提供一定依据。     

宫腔镜手术联合黄体酮胶囊诊治子宫内膜息肉的临床分析

目的探讨宫腔镜手术联合黄体酮胶囊诊治子宫内膜息肉的临床疗效。方法回顾性的分析我院2009年1月至2013年6月收治的258例子宫内膜息肉患者,所有患者是采用宫腔镜检查发现子宫内膜息肉转行宫腔镜子宫内膜息肉电切术同时予行诊刮术,术中电切出组织及刮出组织全部送病理检查。经病理确诊为子宫内膜息肉者随机分为两组,对照组122例为单纯行子宫内膜息肉电切术组;研究组136例为子宫内膜息肉电切术加服黄体酮胶囊组。比较分析两组的治疗效果。结果对照组复发率13.12%(16/122);异常子宫出血发生率20.49%(25/122);研究组复发率3.68%(5/136);异常子宫出血发生率5.15%(7/136)。两组比较有显著差异性。子宫内膜息肉不孕症患者25例行宫腔镜检查及宫腔镜子宫内膜息肉电切术后联合黄体酮胶囊治疗后19例成功妊娠。宫腔镜诊断与病理诊断比较符合率为91.5%。结论 1宫腔镜诊断和治疗子宫内膜息肉有较高的临床价值;2宫腔镜子宫内膜息肉电切术后应用黄体酮胶囊可以抑制子宫内膜局部过度增生,改善症状和降低子宫内膜息肉的复发;可以提高子宫内膜息肉导致不孕患者的生育能力。值得临床推广应用。     

中西医结合治疗少精子症的临床研究

目的：观察补肾益精汤联合枸橼酸他莫西芬、甘草锌和维生素E对肾精亏虚证少精子症患者精子密度的影响及临床疗效。方法将450例少精子症患者按数字表法随机分为三组,治疗组150例采用补肾益精汤联合枸橼酸他莫西芬、甘草锌、维生素E治疗;对照Ⅰ组150例采用补肾益精汤、甘草锌和维生素E治疗;对照Ⅱ组150例采用枸橼酸他莫西芬、甘草锌和维生素E治疗。三组均治疗3个月,治疗不足3个月其配偶受孕者终止治疗,治疗3个月后其配偶仍未受孕,继续观察3个月统计受孕率,统计分析三组治疗前后精子密度等精液质量其他指标（精液量、pH值、活动力、活动率、正常形态率）的变化。结果治疗组、对照Ⅰ组、对照Ⅱ组总有效率分别为90．21％、85．11％、72．22％,治疗组总有效率高于对照Ⅰ组（χ2＝9．53,P＜0.05）和对照Ⅱ组（χ2＝23．38,P＜0．01）;治疗组、对照Ⅰ组、对照Ⅱ组配偶受孕率分别为42．66％、25．53％、20．83％,治疗组患者配偶受孕率明显优于对照Ⅰ组（χ2＝9．26,P＜0．01）和对照Ⅱ组（χ2＝15．78,P＜0．01）;治疗组治疗后精子密度、活动力、活动率、精子正常形态率明显优于治疗前（ t＝-22．22、-18．07、-33．48、-28．46,均P＜0．01）。结论补肾益精汤联合枸橼酸他莫西芬、甘草锌和维生素E能明显改善肾精亏虚证少精子症患者的精子密度及精液质量,显著提高其配偶受孕率。