Severe ovarian hyperstimulation syndrome: is it really preventable by prophylactic intravenous albumin?

ObjectiveTo evaluate the effectiveness of IV albumin in preventing severe ovarian hyperstimulation syndrome (OHSS) in patients at risk.Design: Retrospective review and data analysis.Setting: University-based tertiary referral center for assisted reproductive technologies (ART).Patient(s): Sixty women at high risk of developing severe OHSS after superovulation for ART.Intervention(s): One liter of albumin (4.5%) administered IV during oocyte retrieval and immediately afterward.Result(s): Of the 60 women who had prophylactic IV albumin, 5 (8%) developed severe OHSS, which led to hospitalization. Eight (13%) developed moderate OHSS. Forty-seven (78%) did not develop any symptoms. Four of the 5 women who developed severe OHSS had ET and 3 of them (75%) were pregnant (1 twin and 2 singletons).Conclusion(s): Intravenous albumin administered at oocyte retrieval does not prevent the occurrence of severe OHSS, especially in cases associated with pregnancy. It is important that clinicians are not lured into a false sense of security by the early report, full of promise, on the use of IV albumin to prevent severe OHSS.     

使用GnRH-a超促排卵时卵泡发育数与妊娠相关血浆蛋白-A的关系

目的:探讨超排卵周期卵泡发育数与卵泡颗粒细胞妊娠相关血浆蛋白-A(PAPP-A)的关系。方法:根据取卵时卵泡发育数不同,将卵巢对超排卵药物的反应分为低反应型(卵泡数≤3个,A组,n=5)、中反应型(卵泡数4-13个,B组,n=20)和高反应型(卵泡数≥14个,B组,n=14)。采用RT-PCR法和ELISA法测定卵泡颗粒细胞PAPP-A mRNA的表达量及其蛋白含量。结果:A组PAPP-A mRNA表达量显著低于B、C组(分别为0.368±0.084、0.572±0.187、0.605±0.188,P<0.05和P<0.01)。A组与B、C组相比,PAPP-A蛋白含量减少,差异有显著性(分别为0.371±0.111mIU/ml、0.531±0.181mIU/ml、0.503±0.154mIU/ml,P<0.05)。结论:颗粒细胞中的PAPP-A含量可能影响超排卵周期卵泡发育数。     

Basal follicle stimulating hormone (FSH) predicts response to controlled ovarian hyperstimulation (COH)-intrauterine insemination (IUI) therapy

Purpose This work investigates the relationship of basal follicle stimulating hormone (FSH) measurements and age to ovarian responsiveness and pregnancy occurrence following controlled ovarian hyperstimulation and intrauterine insemination (COH-IUI).Method Basal FSH was measured retrospectively in sera from infertility patients obtained on cycle day 2,3, or 4 of a COH-IUI treatment cycle. Basal FSH was then correlated with COH response parameters and treatment outcome in ovulatory (n =98) and anovulatory (n =33) patients. Clinical data were collected from retrospective chart review. In the ovulatory group, increasing basal FSH was associated with fewer follicles (P = 0.01) and lower peak estradiol (P =0.0001).Results No age related effects were detected in the anovulatory group. Also, there were no pregnancies in this group when basal FSH was >22.1 mIU/ml. Increasing age in the ovulatory group was associated with fewer follicles (P=0.0001), lower peak estradiol (P =0.0001), and fewer pregnancies (P =0.04). In the anovulatory group, basal FSH did not correlate with follicle numbers or peak estradiol, although more ampoules of hMG were used for stimulation (P =0.03).Conclusions Increasing basal FSH and patient age both correlated inversely with ovarian responsiveness to COH in ovulatory patients. Basal FSH can be used in clinically to identify patients undergoing COH who are unlikely to respond to superovulatory drugs and unlikely to become pregnant.Presented in part at the American Fertility Society 47th Annual Meeting, Orlando, Florida, October 21–24, 1991.     

Timing intrauterine insemination either 33 or 39 hours after administration of human chorionic gonadotropin yields the same pregnancy rates as after superovulation therapy

OBJECTIVE: To compare a short and long interval between hCG administration and IUI after superovulation for the treatment of infertility. DESIGN: Prospective, randomized clinical trial. SETTING: University hospital-based fertility clinic. PATIENT(S): Patients planning superovulation and IUI for the treatment of infertility. INTERVENTION(S): Patients with >or=2 years of infertility enrolled for superovulation and IUI treatment were randomized to IUI after a short (32-34-hour) or long (38-40-hour) interval after hCG injection. Superovulation was accomplished with hMG or recombinant FSH, with dose adjustment until the maturation of two to five follicles, at which time hCG was given. Sperm was prepared with a gradient centrifugation technique, with IUI performed high up in the uterine fundus. MAIN OUTCOME MEASURE(S): Pregnancy rates. RESULT(S): Of the 348 patient cycles randomized, 270 treatment cycles were initiated. Eighty-one initiated cycles were canceled, leaving 189 completed randomized cycles from 75 patients for analysis. Pregnancy rates were not significantly different between groups. There were pregnancies in 20 of the 96 short hCG-IUI interval cycles (21%) and in 14 of the 93 long hCG-IUI interval cycles (15%) (odds ratio = 0.673, 95% confidence interval 0.297-1.518). CONCLUSION(S): Pregnancy rates are the same after superovulation therapy whether IUI is done after a short or a long interval after hCG injection.     

卵巢低反应预处理后对IVF-ET结局的影响

目的 探讨在超排卵前补佳乐人工周期处理3个周期后对卵巢反应不良患者IVF-ET结局的影响.方法 选择2005年1月～2006年12月在我中心接受IVF-ET或ICSI治疗中预测将出现卵巢低反应的患者,21例设为研究组,在超排卵前给予补佳乐行人工周期3个周期;22例作为对照组,分析两组超排卵前不孕原因、不孕时间、基础内分泌以及超排卵时所用Gn天数、Gn支数、获卵数、受精数、优质胚胎数、妊娠率、早期流产率.结果 两组在不孕原因、不孕时间、基础内分泌无统计学差异性(P＞0.05);两组Gn天数、Gn支数、获卵数、受精数和优胚数亦无统计学差异性(P＞0.05),研究组妊娠率高于对照组,早期流产率低于对照组(P＜0.05).结论 补佳乐预处理后,可以提高卵巢反应不良患者的妊娠率,降低流产率.     

激素剂量及周龄对小鼠超数排卵的影响

目的：探讨不同剂量激素和不同周龄小鼠对超数排卵数量和囊胚率的影响,以期确定最适剂量和最佳周龄小鼠,获得更好的超数排卵效果。方法采用不同剂量孕马血清促性腺激素（ PMSG）和人绒毛膜促性腺激素（ hCG）对不同周龄小鼠进行超数排卵,统计胚胎个数及囊胚率。结果激素剂量为PMSG与hCG各7．5 IU组的超数排卵显著多于5．0 IU组（P＜0．05）,但与10．0 IU 组差异无统计学意义,激素剂量为5．0 IU组囊胚率优于7．5 IU组和10．0 IU组,差异无统计学意义;不同周龄小鼠间超数排卵效果和囊胚率有一定差异,8周龄小鼠的超数排卵数量和囊胚率均高于其他各组。结论采用PMSG与hCG各7．5 IU对8周龄小鼠进行超数排卵处理效果最佳。     

生长分化因子-9与超排卵周期卵巢低反应的相关性研究

目的:研究超排卵周期卵巢低反应与颗粒细胞中生长分化因子(GDF)-9表达的相关性。方法:选取行体外受精-胚胎移植(IVF-ET)的患者70例,采用本中心常规方案进行超排卵,依据取卵时获得平均直径>14mm的卵泡数分为卵巢低反应组21例,中反应组25例,高反应组24例。应用实时荧光定量聚合酶链反应(Real-timePCR)技术检测卵巢不同反应组患者卵泡壁颗粒细胞和卵丘颗粒细胞GDF-9mRNA的表达,分析其与卵巢低反应的关系。结果:卵巢不同反应组患者年龄、不孕年限、基础卵泡刺激素(FSH)、雌二醇(E2)水平及促性腺激素(Gn)用量差异均无统计学意义(P>0.05)。卵巢低反应组卵泡壁颗粒细胞和卵丘颗粒细胞的GDF-9mRNA表达均低于中反应组和高反应组(P<0.05),GDF-9在卵泡壁颗粒细胞和卵丘颗粒细胞中的表达与获卵数呈正相关(r分别为0.508、0.632,均P<0.01)。结论:超排卵周期卵巢低反应与颗粒细胞GDF-9表达有关。     

超促排卵并发中、重度卵巢过度刺激综合征的护理

目的探讨超促排卵治疗过程中并发中、重度卵巢过度刺激综合征(ovarian hyper-stimulation syndrome,OHSS)的护理对策。方法回顾性总结2010年6月至2011年6月在接受体外受精-胚胎移植治疗的患者中,80例因超促排卵并发中、重度卵巢过度刺激综合征患者的临床资料及护理体会。结果 80例患者经积极治疗及护理后,均全部康复,其中32例获得妊娠、48例终止妊娠。结论中、重度卵巢过度刺激综合征患者的护理重点应包括预防性监测及护理、心理护理、饮食及用药护理、腹胀及腹痛的护理、腹水引流的护理及出院后指导等。     

Relationship between stem cell factor and gonadotropin in ovarian follicles development during superovulation cycles

Objective: To study whether stem cell factor (SCF) and gonadotropin work synergisticly in super-ovulation stimulation of an in-vitro fertilization and embryo transfer (IVF-ET) program. Methods: Total cycles of 30 IVF-ET patients with regular menstrual period were studied. The same superovulation regimen was employed. Enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay (RIA) were used to determine the levels of SCF, follicular-stimulating hormone (FSH) and luteinizing hormone (LH) in follicu-lar fluid (FF) during oocyte pick-up (OPU) and in serum before and after superovulation. Results: FF-SCF levels were significantly higher in high and moderate reactive groups [(564±64) ng · L-1, (532±55) ng · L-1, respectively] than that in low reactive group [(352±78) ng · L-1, P<0. 01]; FF-FSH levels were significantly different in three groups [(23. 7±5. 7) U · L-1, (24. 5±8. 9) U · L-1, and (15. 4±4.1) U · L-1, respectively, P<0. 05]. FF-LH levels were lower in low reactive group (33. 0±7.     

Pregnancy after direct intraperitoneal insemination

Direct intraperitoneal insemination (DIPI) and superovulationare simple procedures which may together represent a good alternativeto gamete intra-Fallopian transfer (GIFT) in infertile womenwith patent Fallopian tubes. In the present study, pregnancyoccurred in 25 of 96 couples (26%) and six (24%) of these aborted.The pregnancy rate for all cycles was 19.6% and multiple pregnancieswere found in six of 25 (24%) patients. We observed no ectopicpregnancy. The combination of these techniques is concludedto be useful in achieving pregnancy in infertile women withpatent Fallopian tubes.