经阴道彩色多普勒观察卵巢血流灌注与卵泡发育的关系

目的:探讨不孕症患者在药物治疗过程中卵巢血流灌注与卵泡发育的关系。方法:应用阴道彩色多普勒超声对60例药物治疗中的不孕症患者84个排卵周期的卵泡发育及卵巢血流灌注情况进行观察。结果:随着卵泡发育,卵巢血流越来越丰富,血流阻力指数(RI)及动脉收缩期峰值流速(S)/舒张末期血流速度(D)比值越来越低。最佳受孕卵泡大小为21.0±2.5mm,至排卵前RI为0.57±0.05,S/D为2.20±0.50,妊娠组的卵泡大小及血流灌注明显优于非妊娠组。结论:不孕症患者治疗过程中卵巢内血流指标与卵泡的大小和受孕率有关。     

阴道超声窦卵泡计数预测卵巢反应性的价值

在控制性超排卵过程中，卵巢反应性是影响体外受精-胚胎移植（in vitro fertilization-embryo transfer，IVF—ET）结局的关键因素。评估卵巢储备功能，预测卵巢反应性有助于临床医生制定个体化治疗方案。我们对144例不孕患者的卵巢反应性预测指标进行前瞻性分析，探讨经阴道超声窦卵泡计数（antral follicle count，AFC）预测卵巢反应性的价值。     

多囊卵巢综合征不孕患者未成熟卵泡抽吸术的疗效分析

目的:探讨对克罗米芬抵抗的多囊卵巢综合征(PCOS)不孕患者在超声引导下行小卵泡抽吸术(IMFA)的治疗效果。方法:将42例PCOS合并克罗米芬(CC)抵抗的不孕患者,随机分为A组:19例,穿刺前用CC或来曲唑(LE)联合少量hMG促排卵;B组:23例,穿刺前用少量hMG促排卵。在阴道B超引导下进行未成熟卵泡抽吸术(IMFA),观察穿刺前及穿刺后第2周期患者的卵巢基础窦卵泡数(AFC)、抗苗勒氏管激素(AMH)、血中游离睾酮指数(FAI)、黄体生成素与卵泡刺激素的比值(LH/FSH),以及术后并发症、3个月促排卵情况和妊娠率。结果:42例患者治疗时均没有发生卵巢过度刺激综合征(OHSS)。与治疗前比较,穿刺术后A、B组AFC显著减少,AMH、FAI和LH/FSH显著降低(P<0.01)。A、B组间比较,FAI、LH/FSH、排卵率和妊娠率无统计学差异(P>0.05)。A、B组共21例妊娠,妊娠率为50%。42例患者均没有发生出血、感染、OHSS。结论:IMFA治疗克罗米芬抵抗的PCOS不孕患者有较好的疗效,本方法安全、有效。     

经阴道小卵泡抽吸术辅助宫腔内人工授精治疗多囊卵巢综合征的临床观察

<正>多囊卵巢综合征(polycystic ovarian syndrome,PCOS)患者通常用口服避孕药和双胍类降糖药物治疗,虽然能改善体内异常内分泌状态,提高促排卵的反应性,但仍然有多卵泡发育,卵巢过度刺激综合征及药物不良反应等。本研究目的在于观察经阴道小卵泡穿刺抽吸术后辅助宫腔内人工授精治疗此症的临床疗效,现将结果报告如下。     

基础雄激素及卵泡液雄激素水平与卵巢反应性及妊娠结局关系的探讨

目的:探讨基础雄激素及卵泡液雄激素水平与卵巢反应性及妊娠结局的关系。方法:选取行IVF/ICSI助孕治疗的130例不孕症女性,将研究对象分为卵巢储备功能低下组、卵巢储备功能正常组。ELISA法检测基础雄激素及卵泡液中睾酮浓度。结果:卵巢储备功能低下组中,卵巢低反应组与正常反应组的基础雄激素水平比较,差异有统计学意义(P=0.037);两组卵泡液中雄激素水平比较,差异无统计学意义(P=0.475)。卵巢储备功能正常组中,卵巢低反应组与正常反应组的基础雄激素水平及卵泡液雄激素水平比较,差异均无统计学意义(P=0.426,P=0.594)。20例进行新鲜周期移植的卵巢储备功能低下患者中,未妊娠组与妊娠组基础雄激素水平及卵泡液中雄激素水平比较,差异均无统计学意义(P=0.400,P=0.656)。89例进行新鲜周期移植的卵巢储备功能正常患者中,未妊娠组与妊娠组的基础雄激素水平及卵泡液中雄激素水平比较,差异均无统计学意义(P=0.380,P=0.930)。结论:卵巢储备功能低下患者,基础雄激素水平与卵巢反应性相关,而与妊娠结局无关;卵泡液中雄激素水平与卵巢反应性和妊娠结局无关。卵巢储备功能正常患者,基础雄激素和卵泡液中雄激素均与卵巢反应性及妊娠结局无关。     

基础窦卵泡数在评价卵巢的反应性及预测人类辅助生殖技术(ART)结局中的作用

目的:探讨基础总窦卵泡数(tAFC)在评价卵巢功能和预测ART结局中的作用。方法:回顾性分析1 353例接受常规体外受精(IVF)/卵母细胞质内单精子显微注射(ICSI)治疗的不孕患者早卵泡期窦卵泡计数的资料,按tAFC分组:A组<5个,B组5~10个,C组11~15个,D组>15个,分别统计各组促性腺激素(Gn)用量、hCG注射日直径≥14 mm卵泡数、获卵数、2原核(2PN)数、可利用胚胎数及妊娠结局。结果:tAFC对卵巢反应性和卵巢储备功能的预测价值优于年龄和基础卵泡刺激素(bFSH),tAFC<10个预示卵巢低反应性,>12个则预示卵巢高反应性;tAFC对ART结局的预测价值稍优于年龄和bFSH,tAFC>10个则预示临床妊娠可能性大,tAFC>15个或<5个则预示周期取消率增加。新鲜周期妊娠率随tAFC增多而上升(C组最高42.3%),周期取消率随tAFC增多而下降,但tAFC>15个时,周期取消率上升至24.2%,主要原因是卵巢过度刺激综合征(OHSS)。结论:基础tAFC与影响ART结局的各种因素密切相关,可作为预测ART结局的参考指标,并且直接有效地评价卵巢储备功能和卵巢反应性,是患者接受ART前的首选检查,临床应用中值得推广。     

超声下未成熟卵泡抽吸术治疗多囊卵巢综合征不孕的临床研究

目的　探讨超声下未成熟卵泡抽吸术(IMFA)对多囊卵巢综合征(PCOS)不孕患者卵巢窦卵泡计数及其内分泌功能的影响;观察IMFA后,应用人绝经期促性腺激素(hMG)促排卵治疗的效果、妊娠及并发症情况。方法　将71例PCOS不孕患者随机分为两组。组Ⅰ: 37例,穿刺前用少量hMG促排卵; 组Ⅱ: 34例,不用任何促排卵药物。在阴道超声引导下进行IMFA,检查穿刺后第2个周期患者的内分泌功能和卵巢基础窦卵泡计数,可连续2~3个周期进行穿刺。随后2组均用hMG常规促排卵治疗,随访其排卵及妊娠情况。结果　组Ⅰ进行了88个周期的穿刺治疗,经过2~3次穿刺后,睾酮水平、黄体生成素(LH )与卵泡刺激素(FSH)的比值均明显降低,与治疗前比较,差异有统计学意义(P<0. 01), 33例(89%, 33 /38)患者基础窦卵泡计数降至10个/卵巢以下。组Ⅱ进行了87个周期治疗,所有患者睾酮水平均显著降低,与治疗前比较,差异有统计学意义(P<0 01 ); 30例LH/FSH<2, 28例(82%, 28 /34)患者基础窦卵泡计数降到10个/卵巢以下。在IMFA之后, 诱发排卵时hMG用量组Ⅰ为(21±6)支,组Ⅱ(23±10)支,两组比较,差异无统计学意义(P>0 .05),在注射人绒毛膜促性腺激素(hCG)后均出现排卵, 组Ⅱ有2例发生轻度卵巢过度刺激综合征(OHSS)。连续促排卵治疗1 ~3个月后, 共36例(51% )     

基础窦卵泡数与高生育年龄患者IVF/ICSI-ET结局的关系及经济学评价

目的:探讨40岁以上女性进行体外受精/单精子卵胞浆内注射-胚胎移植(IVF/ICSI-ET)时基础窦卵泡数(bAFC)预测助孕结局的价值及所需的医疗成本。方法:将2007年1月至2010年5月于本院行IVF/ICSI-ET治疗不孕症的101例高生育年龄女性按bAFC分为3组:A组(bAFC<6个),B组(6个≤bAFC<10个)和C组(bAFC≥10个),回顾性分析各组的助孕结局及治疗成本。结果:A组45例,47个周期;B组35例,41个周期;C组21例,24个周期。3组患者的年龄、不孕年限、体重指数、促性腺激素总量、促性腺激素刺激时间和流产率比较,差异无统计学意义(P>0.05);C组的基础卵泡刺激素较低、促性腺激素启动剂量较小,人绒毛膜促性腺激素日血清E2水平较高,而获卵数、2原核期个数(2PN)、成熟卵子个数、优质胚胎数和移植胚胎数明显增加,周期临床妊娠率和着床率明显升高,与A组和B组比较,差异有统计学意义(P<0.05)。3组患者首次助孕的各项治疗费用及总费用比较,差异均无统计学意义(P>0.05)。结论:bAFC对高生育年龄女性的助孕结局具有一定的预测价值,bAFC≥10个具有较好的临床结局,而不同bAFC个数的治疗费用相似。     

不孕妇女卵巢血供彩色多普勒特点与卵巢功能的相关性研究

目的:研究不孕妇女卵巢血供彩色多普勒特点与卵泡发育及卵巢功能的相关性,为不孕症的诊治提供依据.方法:经阴道彩超监测68例不孕妇女和60例正常育龄妇女的排卵情况,测量卵泡发育期、围排卵期、黄体期卵巢血流,同期测定血激素并对比分析.结果:①不孕妇女卵巢干动脉、卵巢基质动脉、卵泡壁动脉、黄体血流收缩期最大血流速度(S)、舒张期最低血流速度(D)均显著低于正常育龄妇女,而阻力指数(RI)则相反(P＜0.05);②优势卵泡壁动脉血流S、D与卵泡直径、血雌二醇(E2)正相关,RI则负相关(P＜0.05);③黄体血流S、D与血孕酮(P)和黄体功能正相关,RI则负相关(P＜0.05).结论:不孕妇女不孕与其卵巢血供显著降低有关,观察不孕妇女卵巢血供可提示并预测卵巢功能状态,利于诊治.     

The Antral Follicle Count Predicts the Outcome of Pregnancy in a Controlled Ovarian Hyperstimulation/Intrauterine Insemination Program

Purpose: Our purpose was to test whether age-related changes in antral follicle counts can predict the pregnancy outcome in the early follicular phase of a controlled ovarian hyperstimulation/intrauterine insemination (COH/IUI) program. Methods: A selected group of 107 women (36 healthy women requesting child sex preselection, 52 women with unexplained infertility, and 19 with minimal endometriosis) who underwent controlled ovarian hyperstimulation with clomiphene citrate (CC) plus human menopausal gonadotrophin (hMG) and subsequent intrauterine insemination were enrolled in the study. Transvaginal ultrasonography (7.0 MHz) was used to determine the total number of antral follicles (2–8 mm) in the right and left ovaries. The association among the antral follicle count, age, dominant follicle, and estradiol (E ₂ ) level on the day of human chorionic gonadotropin (hCG) was analyzed. The association of the pregnancy rate and OHSS with the antral follicle count, dominant follicle count, and age was also examined. Results: The total antral follicle number decreased with age (P<0.0001). Dominant follicle number increased with total antral follicle number in women who received CCplus hMG/ IUI (P<0.0001). The pregnant group had a higher number of antral follicle and dominant follicles in comparison with the nonpregnant group (P<0.01 and P<0.02, respectively). The E ₂ level on the day of hCG injection increased positively with the total number of antral follicles (P<0.0001) and the total number of dominant follicles (P<0.0001). In women aged younger than 35 years, the pregnancy rate and dominant follicle number rose as the number of antral follicles increased (P<0.03 and P<0.0001, respectively). The pregnancy rate was low (2/39) in women aged older than 35 years regardless of the number of antral follicles (P<0.05) and the extent of hMG administration (P<0.02). Women aged older than 35 also produced fewer dominant follicles (P<0.001). No pregnancy was achieved in a patient with an antral follicle number of less than five (17 cases). Conclusions: Age-related changes in antral follicle count significantly predicted the dominant follicle count and the pregnancy outcome. In women with antral follicle counts of less than five or who are older than 35 years, the application of COH/IUI may not be indicated.     

两种剂量来曲唑与克罗米芬对多囊卵巢综合征患者子宫卵巢血流动力学的影响

目的:探讨2种剂量来曲唑(LE)与克罗米芬(CC)对多囊卵巢综合征(PCOS)患者子宫卵巢血流动力学的影响。方法:2种剂量LE与CC治疗90例PCOS不孕症患者,随机分CC组(A组,n=32,50 mg/d)、低剂量LE组(B组,n=30,2.5 mg/d)和高剂量LE组(C组,n=28,5.0 mg/d)。同时以28例正常育龄妇女作为对照组(D组)。经阴道超声监测子宫卵巢血流的参数,比较排卵率、妊娠率。结果:①LE的2个剂量组子宫卵巢血流均出现类似正常育龄妇女的周期性血流变化;②C组方案治疗PCOS有较高的排卵率和妊娠率。结论:来曲唑改善了PCOS患者的子宫卵巢血流供应,5.0 mg可能有更好的促排卵效果。     

常见的染色体多态性与IVF-ET治疗的效果

目的:探讨染色体多态性与体外受精-胚胎移植(IVF-ET)治疗结局之间的关系。方法:回顾性分析1768对IVF-ET治疗对象染色体核型,将其分为染色体多态性组与染色体核型正常组,对2组的临床资料进行比较,同时分析染色体多态性在具少弱精症或不良孕产史的特定人群中的检出率。结果:①多态性组与正常组相比,临床妊娠率(45.25% vs 40.85%)、早期流产率(8.39% vs 9.17%)和活产率(34.37%% vs 29.14%)无统计学差异。②在男方少弱精子症、夫妇有不良孕产史的情况下,染色体多态性的检出率与无此类表现者相比无统计学差异(16.95% vs 16.39%,19.42% vs 16.46%)。结论:①染色体多态性对于IVF-ET患者的临床妊娠率、早期流产率、活产率无明显影响。②临床表现为少弱精或具不良孕产史人群的染色体多态性检出率与无此类临床表现者无差异。     

卵巢血流与获卵情况相关性研究

目的:探讨卵巢血流变化与卵子质量、胚胎质量的关系。方法:在体外受精-胚胎移植(IVF-ET)过程中应用阴道彩色多普勒超声成像技术(TV-CDS)监测人绒毛膜促性腺激素(hCG)注射日双侧卵巢动脉血流的收缩期与舒张末期流速比值(S/D)、阻力指数(RI)、搏动指数(PI)的变化,分析行IVF-ET治疗的82例患者,获得159组血流指数数据(因为有5例患者只有一侧卵巢有成熟卵泡)。根据S/D、RI、PI不同值分组,A组:S/D≤2.0,B组:S/D=2.1~2.9,C组:S/D≥3.0;D组:RI≤0.50,E组:RI=0.51~0.69,F组:RI≥0.70;G组:PI≤1.00,H组:PI=1.01~1.49,I组:PI≥1.50。分别比较各组间获卵数,获卵率、MⅡ卵数、受精率、卵裂率及优质胚胎数。结果:C组的获卵数、获卵率、MⅡ卵数、受精率均高于A组和B组,但无统计学差异(P>0.05);B组的卵裂率及优质胚胎数均高于A组和C组,但无统计学差异(P>0.05)。F组的获卵数、获卵率、MⅡ卵数均高于D组和E组,但无统计学差异(P>0.05)。E组的受精率、卵裂率及优质胚胎数均高于D组和F组,差异无统计学意义(P>0.05)。I组的获卵率高于G组和H组,与G组相比,有统计学差异(P<0.05)。H组的优质胚胎数明显高于G组和I组,差异有统计学意义(P<0.05);H组的获卵数、MⅡ卵数及受精率均高于G组和I组,但无统计学差异(P>0.05)。G组的卵裂率高于H组和I组,但无统计学差异(P>0.05)。结论:hCG注射日卵巢血流PI与获卵率及优质胚胎数有密切关系。     

输卵管手术对体外受精-胚胎移植患者卵巢血流及反应性的影响

目的:探讨在体外受精-胚胎移植(IVF-ET)中输卵管手术对控制性超排卵(COH)患者卵巢的血流及卵巢储备功能的影响。方法:选择因异位妊娠或输卵管阻塞粘连行一侧输卵管切除或修复整形(单侧手术组)、双侧输卵管切除或双侧输卵管修复整形(双侧手术组)以及双侧输卵管均未行手术(对照组)的输卵管性不孕患者共70例,观察其在IVF-ET控制性超排卵中卵巢的血流变化及卵巢对COH的反应。结果:①3组患者的年龄、不育年限、用药天数及用药量均无统计学差异(P>0.05),单侧手术组术侧卵巢月经d3卵巢基质血流的搏动指数(PI)、收缩期峰流速(PSV)及hCG注射日(dhCG)PI与健侧卵巢差异无统计学意义(P>0.05)。但术侧卵巢d3血流阻力指数(RI)、RI(dhCG)明显大于健侧卵巢,PSV(dhCG)则明显小于健侧卵巢(P<0.05)。术侧卵巢的基础窦卵泡数(AFC)、dhCG≥14mm卵泡数以及获卵数明显少于健侧卵巢(P<0.05);②3组患者在d3的PI、RI、PSV,PI(dhCG)、RI(dhCG)差异无统计学意义(P>0.05)。但双侧手术组PSV(dhCG)明显低于对照组(P<0.05),其基础AFC、hCG注射日≥14mm卵泡数及获卵数也明显少于对照组(P<0.05)。结论:输卵管手术会影响卵巢的血运,降低卵巢的储备功能。     

来曲唑联合氯米芬对PCOS患者子宫卵巢血流动力学影响

目的:经阴道超声观察来曲唑联合氯米芬(CC)治疗多囊卵巢综合征(PCOS)的血流动力学变化,探讨来曲唑联合CC治疗PCOS的临床价值。方法:来曲唑联合CC治疗49例PCOS患者,经阴道超声观察子宫内膜厚度,优势卵泡个数,子宫动脉和优势侧卵巢基质收缩期血流峰值(PSV)、舒张末期血流速(EDV)、搏动指数(PI)、阻力指数(RI)及卵巢基质血流信号数。结果:来曲唑联合CC治疗PCOS有较高排卵率和妊娠率,使PCOS患者形成了子宫卵巢血流的周期性变化。结论:来曲唑联合CC用药能改善PCOS的子宫卵巢血流,促进PCOS患者排卵,利于妊娠并能减少流产的发生。     

Single and Repeated GnRH Agonist Stimulation Tests Compared With Basal Markers of Ovarian Reserve in the Prediction of Outcome in IVF

Purpose: To study the value of a single or repeated GnRH agonist stimulation test (GAST) in predicting outcome in IVF compared to basal ovarian reserve tests.Methods: A total of 57 women was included. In a cycle prior to the IVF treatment, on day 3, an antral follicle count (AFC) was performed and blood taken for basal FSH, inhibin B and E₂ measurements, followed by a subcutaneous injection of 100 g triptorelin for the purpose of the GAST. Twenty-four hours later blood sampling was repeated. All the tests were repeated in a subsequent cycle. From the GAST E₂ and inhibin B response were used as test parameters. The outcome measures were poor ovarian response and ongoing pregnancy. Group comparisons were done using the Mann– Whitney or chi-square test. Univariate and multivariate logistic regression was applied to assess which test revealed the highest predictive accuracy as expressed in the area under receiver-operating characteristic curve (ROC_AUC). Clinical value was compared by calculating classical test characteristics for the best logistic models.Results: All the basal and GAST variables were significantly different in the poor responders (n = 19) compared to normal responders (n = 38). In the univariate analysis on cycle 1 tests the AFC was the best predictor for poor ovarian response, while in cycle 2 the E₂ response in the GAST performed best (ROC_AUC of 0.91 for both). Multivariate analysis of the basal variables led to the selection of AFC and inhibin B in cycle 1, yielding a ROC_AUC of 0.96. Mean E₂ response was selected in a multivariate analysis of the repeated GAST variables (ROC_AUC 0.91). At a specificity level of 0.90, several logistic models including GAST variables appeared to have a sensitivity (0.80), positive predictive value (0.82) and false positive rate (0.18), comparable to a logistic model containing AFC and inhibin B. None of the test variables showed a significant relation with ongoing pregnancy.Conclusions: The GAST has a rather good ability to predict poor response in IVF. However, comparing the predictive accuracy and clinical value of the GAST with a day 3 AFC and inhibin B, it appeared that neither a single nor a repeated GAST performed better. In addition, the predictive ability towards ongoing pregnancy is poor. Therefore, the use of the GAST as a predictor of outcome in IVF should not be advocated.