Oocyte and embryo quality as well as pregnancy rate in intracytoplasmic sperm injection are not affected by high follicular phase serum progesterone

The effect of elevated serum progesterone concentrations (>1ng/1) on or before the day of human chorionic gonadotrophin(HCG) injection on the outcome of women receiving gonadotrophin-releasinghormone analogue (GnRHa)/ human menopausal gonadotrophin (HMG)for ovarian stimulation prior to intracytoplasmic sperm injection(ICSI) was evaluated. A total of 1275 ICSI cycles were analysedretrospectively. In 53 cycles (4.5%), serum progesterone concentrationswere > 1 ng/ml. Patients in the high progesterone group hadsignificantly higher oestradiol and luteinizing hormone concentrationson the day of HCG injection. The characteristics of the cumulus-coronacell complexes and the nuclear maturity of the oocytes weresimilar in the groups of patients with high and low serum progesteronelevels. Fertilization and cleavage rates as well as embryo qualitywere not different in the two groups. No difference in implantationor clinical pregnancy rates was observed between the high progesteroneand low progesterone groups. Moreover, the cumulative exposureto progesterone during the follicular phase, as expressed bythe area under the curve (AUC), and the duration of exposureto high serum progesterone levels (>1 ng/ml) were not significantlydifferent between pregnant and non-pregnant women in the highprogesterone group. We conclude that in ICSI cycles pretreatedwith GnRHa, increased serum progesterone concentrations on orbefore the day of HCG injection do not affect ICSI outcome.     

Simultaneous evaluation of basal FSH and oestradiol response to GnRH analogue (F-G-test) allows effective drug regimen selection for IVF

To determine whether preliminary assessment of ovarian reserve by simultaneous evaluation of basal follicle-stimulating hormone (FSH) and oestradiol response to gonadotrophin releasing hormone (GnRH) analogue (F-G-test) can be used to tailor individually the drug regimen for ovarian stimulation, the in-vitro fertilization (IVF) results of 238 patients were retrospectively analysed. Sixty-two women with abnormal response to the test (DeltaE2 <180 pmol/l and/or FSH >9.5 mIU/ml) had commenced buserelin nasal spray in the mid-luteal phase and discontinued it on cycle day 1. Ovarian stimulation was started on cycle day 3 with 375 IU/day of gonadotrophin. Fifty-three patients completed the treatment cycle (group A). A total of 176 women with normal response to the test (DeltaE2 >180 pmol/l and FSH <9.5 mIU/ml) had continued the GnRH analogue throughout the stimulation cycle and a starting dose of 225 IU/day of gonadotrophin was used from cycle day 3. A total of 158 patients completed the treatment cycle (group B). Group A had significantly higher age (34.9 +/- 4.2 versus 33.2 +/- 4.2) (P < 0.05) and basal FSH (9.2 +/- 3.8 versus 7.0 +/- 2.2) (P < 0.05) and required a higher total dose of gonadotrophin. The numbers of oocytes retrieved and embryos transferred were significantly lower. However, fertilization, clinical pregnancies, and implantation rates were similar in both groups. It was concluded that simultaneous evaluation of basal FSH and oestradiol response to GnRH analogue can be useful in identifying subcategories of women with reduced ovarian reserve who may benefit from reduced GnRH analogue administration and a higher starting dose of gonadotrophin.     

GnRHa对子宫肌瘤雌孕激素和表皮生长因子受体的影响

目的　探讨促性腺激素释放激素激动剂(GnRHa)对子宫肌瘤内雌、孕激素受体(ER、PR)、表皮生长因子受体(EGF-R)的影响。方法　测定13例子宫肌瘤患者经GnRHa治疗3月后肌瘤内雌、孕激素受体和EGF-R水平,并以28例未用药肌瘤作对照。结果　 GnRHa治疗组肌瘤内ER、PR、EGF-R水平明显低于对照组。结论　GnRHa除减少肌瘤内ER、PR外,使肌瘤内EGF-R的水平下降可能是GnRHa治疗子宫肌瘤的一个重要机制。     

两种不同治疗方案对70例多囊卵巢综合征不孕患者的治疗效果研究

目的 探讨多囊卵巢综合征不孕患者体外受精-胚胎移植(IVF/ICSI)技术辅助生育时不同的降调节方案对于助孕治疗结局的影响。方法 纳入2016年10月～2018年2月在我院生殖中心助孕治疗的70例多囊卵巢综合征(PCOS)不孕女性作为研究对象,根据控制性超促排卵(COS)所应用的降调节方案的不同将患者随机分为两组：长效长方案组(A组)35例,经典长方案组(B组)35例。A组降调节是于早卵泡期注射长效GnRHa,B组降调节是于黄体中期使用短效GnRHa。对比研究两组方案的刺激天数(Gn天数)、以及促性腺激素使用的总剂量(Gn量)、HCG扳机日子宫内膜厚度、激素水平、取卵后的获成熟卵率(MII卵率)、优质胚胎率、移植后的种植率、临床妊娠率及全胚胎冷冻率。结果 (1)两组比较A组的Gn量和优胚率高于B组,HCG扳机日雌二醇、孕酮水平低于B组,差异均有统计学意义(P＜0.05);(2)两组的Gn天数、HCG扳机日的子宫内膜厚度、获成熟卵率、种植率以及临床妊娠率相比较,差异无统计学意义(P＞0.05)。结论 长效长方案较经典长方案可以达到充分降调节的目的,抑制了黄体生成素(LH)峰在超促排卵前及过程中的出现,可以提高多囊卵巢综合征患者的优胚率、降低HCG扳机日孕酮水平,改善其妊娠结局,可以成为多囊卵巢综合征不孕患者控制性超促排卵的一个理想选择。     

子宫内膜癌保留生育功能治疗的进展

子宫内膜癌为女性生殖道常见三大恶性肿瘤之一,近年以来在世界范围内其发病率均有上升趋势.虽然子宫内膜癌大多发生在绝经后妇女,但25%左右患者为绝经前女性,且3%～5%发生在40岁以下妇女.由于年轻子宫内膜癌患者常常因有不孕史而未育,因此,强烈要求保留生育功能.所幸的是这些年轻患者的子宫内膜癌多为高分化,进展缓慢,无肌层浸润或肌层浸润浅,预后较好,这使保留生育功能的治疗成为可能.该文就子宫内膜癌保留生育功能治疗的现状进行综述.     

66例小剂量GnRHa用于IVF-ET术卵巢反应不良患者的临床研究

目的在IVF-ET术中,针对卵巢反应欠佳的患者,采用小剂量GnRHa进行降调节,探讨其临床效果。方法所有患者66例均于使用Gn的前次月经周期优势卵泡排卵后肌肉注射长效GnRHa 0.34mg,达到降调节标准后,开始每日皮下注射短效GnRHa 0.05mg,同时肌肉注射rFSH或HMG,丽珠公司生产,常规取卵及移植。对Gn用量、Gn天数、获卵率、受精率、优质胚胎率及妊娠情况进行观察和统计分析。结果行IVF/ICSI的66例不孕病例共66个治疗周期中,无一出现内源性LH峰,获得较好的临床妊娠率,且所有患者均未出现卵巢过度刺激综合征等其它并发症。结论小剂量的GnRHa方案既可以在黄体晚期募集到质量较高的卵子,又可以在适量的垂体分泌的LH作用下促进卵泡发育和成熟,同时可以防止LH峰提前出现。因此今后临床对于年龄较大和卵巢反应不良的病人考虑使用小剂量的GnRHa进行降调节可能会有较好的治疗效果。     

曲普瑞林对化疗药物引起卵巢损伤的预防作用

目的:探讨化疗对卵巢的损害和促性腺激素激动剂(GnRHa)曲普瑞林对化疗中卵巢的保护作用及机制。方法:选用2～3月龄、体重(250±10)g的SD雌性大鼠40只,随机分为正常对照组、顺铂(DDP)组、GnRHa组及GnRHa+DDP组,比较用药后4组大鼠卵巢、子宫湿重和形态学变化,采用放射免疫法测大鼠血清雌二醇(E2)、卵泡生成素(FSH)水平,免疫组织化学方法检测4组大鼠卵巢中Bcl-2、Caspase-3的表达。结果:DDP组与对照组比较大鼠体重明显减轻(P<0.05),卵巢、子宫重量明显下降(P<0.05);光镜下DDP组各期卵泡总数显著减少,GnRHa使生长卵泡数、成熟卵泡数减少,初级卵泡数及总卵泡数增加。GnRHa+DDP组可见GnRHa能明显改善化疗药物对卵巢的损害,保存了大部分初级卵泡且总卵泡数增加。结论:GnRHa的先期预防性应用对化疗所致的大鼠卵巢损伤有一定的保护作用。     

Biological differences between focal and diffuse adenomyosis and response to hormonal treatment

Research question

Is there any difference in ovarian steroid receptor expression and pattern of fibrosis in focal and diffuse adenomyosis and response to hormonal treatment?

Comparison of short and long ovulation induction protocols used in ART applications according to the ovarian response and outcome of pregnancy

This retrospective study was designed to determine whether there is any difference between short and long protocol ovulation induction with Gonadotropin Releasing Hormone agonist (GnRHa) and gonadotropins used in Assisted Reproductive Technology (ART) applications according to the number of retrieved oocytes, oocyte maturity, fertilization rates, embryo quality and the outcome of pregnancies. 240 cycles consisting of in vitro fertilization (IVF) cycles without andrologic factor and intracytoplasmic sperm injection (ICSI) cycles were evaluated. 112 cycles which were induced by short protocol GnRHa and Follicle Stimulating Hormone (FSH) + Human Menopausal Gonadotropin (HMG) combinations and 128 cycles which were induced by long protocol GnRHa and FSH + HMG combinations were compared according to the number of retrieved oocytes, cancellation rate of cycles, oocyte maturity, fertilization rates, embryo quality and pregnancy rates. The cancellation rate for short protocol cycles were found to be significantly higher than those with long protocol. The number of retrieved oocytes, mature oocytes and fertilized oocytes were also found significantly lower. The quality of embryos did not show any significant difference between these groups. The clinical pregnancy rates were evidently found to be high in the long protocol cycles. As a conclusion we have found that while the number of retrieved oocytes, mature oocytes, fertilized oocytes and clinical pregnancy rates were increasing, the cancellation rate of cycles were decreasing significantly in ART cycles induced by long protocol. Received: 26 October 2000 / Accepted: 23 January 2001     

Long-term follow-up of children born after inadvertent administration of a gonadotrophin-releasing hormone agonist in early pregnancy.

Our objective was to evaluate long-term outcome of children born after inadvertent administration of a gonadotrophin-releasing hormone agonist (GnRHa) in early pregnancy, compared to a control group of children born to matched women undergoing in-vitro fertilization and children born after spontaneous pregnancies. Six children from six pregnancies, exposed to a long-acting gonadotrophin agonist, comprised the study group and 20 children were included in the control groups. Pre-, peri- and postnatal data were collected and the children were followed and examined at a mean age of 7.8 +/- 2.0 years. All children underwent physical and neurological examination, and psychological tests. In the study group, one child was born with a major congenital malformation (cleft palate), and four children subsequently demonstrated neurodevelopmental abnormalities, including epileptic disorder (n = 1), attention deficit hyperactivity disorder (n = 3), motor difficulties (n = 3) and speech difficulties (n = 1). In the control groups, one child had attention deficit hyperactivity disorder. This observation of neurodevelopmental abnormalities in four of six children in the study group justifies the need for long-term follow-up of more children previously exposed to gonadotrophin-releasing hormone agonist.