输卵管切除术对促超排卵周期卵巢反应的影响

目的 探讨输卵管切除术对体外受精-胚胎移植(IVF-ET)周期促超排卵中卵巢反应的影响。方法对我院2001年1月至2001年12月间91例因异位妊娠切除输卵管的患者(观察组)接受体外受精-胚胎移植治疗时促超排卵中卵巢反应和结局进行分析。91例因男性因素或不明原因行IVF-ET术的患者为对照组。结果两组患者的年龄、促性腺激素用量、内膜厚度、卵泡数、取卵数、胚胎移植数及妊娠率问的差异无显著性。单侧输卵管切除的患者中输卵管切除侧卵巢与对侧卵巢的卵泡数和取卵数间的差异无显著性。双侧输卵管切除术后卵巢总卵泡数和取卵数与对照组相比差异无显著性(P>0.05)。结论 输卵管切除术对IVF-ET周期中卵巢反应和妊娠率无显著影响。     

输卵管手术对控制性超排卵时卵巢反应性的影响

目的:探讨IVF-ET中不同的输卵管手术方式对控制性超排卵(COH)过程中患者卵巢反应性的影响。方法:回顾性分析长方案超排卵IVF周期临床资料,选择397例因输卵管因素不孕患者,其中手术组176例,非手术组221例;手术组患者均因输卵管妊娠或输卵管阻塞、粘连或积水行单侧或双侧输卵管切除或输卵管修复整形手术,其中单侧输卵管切除组70例(A组),双侧输卵管切除组46例(B组),单侧输卵管整形组27例(C组),双侧输卵管整形组33例(D组);非手术组均未为双侧输卵管阻塞无积水患者,作为对照组(E组)。比较各组的临床资料、卵巢对促排卵的反应性和妊娠结局。结果:B组基础FSH值显著高于E组(P<0.05),卵泡数(直径≥15mm)、获卵数显著低于E组(P<0.05)。A组术侧卵巢卵泡数(直径≥15mm)和获卵数明显少于健侧卵巢(P<0.05)。但输卵管手术不影响IVF-ET,各组的的妊娠率和种植率无统计学差异。结论:输卵管切除降低了卵巢超排卵时的反应性,手术可能影响卵巢的血供进而影响卵巢对COH的反应。     

卵巢及输卵管术后患者超排卵治疗卵巢反应性的观察

目前，对输卵管切除术后对卵巢功能的影响尚认识不一，解剖学上卵巢与输卵管的血管神经相邻近，此为输卵管切除术损伤卵巢血液供应(血供)的理论依据。Hughes等观察11例绝经后行卵巢肿瘤剔除术妇女发现，手术后雄激素水平下降一半，雌激素水平无改变。绝经后卵巢主要分泌雄激素，雌激素主要由脂肪组织合成，说明手术损伤卵巢功     

输卵管切除术对体外受精—胚胎移植中控制性超促排卵的影响

目的 探讨输卵管切除后对卵巢功能的影响。方法 选择因异位妊娠行一侧输卵管切除的患者手术侧卵巢与对侧卵巢及行输卵管切除的患者与双侧输卵管健全的患者,在行体外受精-胚胎移植（IVF-ET）中其卵巢对控制性超促排卵的反应。结果 输卵管切除侧卵巢尽管其体积无明显改变,但其卵泡数及所获卵子数明显少于健侧卵巢,而存留一侧输卵管患者与对照组相比,在卵巢大小,用药量、用药天数、子宫内膜厚度、卵泡数及所获卵子数上并无显著差别。结论 输卵管切除术在短期内虽然不能影响卵巢的体积。但却降低了同侧卵巢的储备功能。因此,临床上对有生育要求的异位妊娠患者,应尽可能地保留患侧输卵管,对于输卵管积水行体外的储备功能。因此,临床上对有生育要求的异位妊娠患者,应尽可能地保留患侧输卵管,对于输卵管积水行体外受精-胚胎移植者,如对侧卵巢缺如或卵巢功能低下,不宜做预防性输卵管切除术。     

输卵管积水对子宫内膜容受性的影响

体外受精-胚胎移植（IVF—ET）最初是用于治疗输卵管因素引起的不孕。既往认为输卵管受损后可通过IVF—ET来解决妊娠问题。但是输卵管积水的不孕患者在实施IVF时，妊娠率受到极大挑战。1994年Strandel等首次报道了与无积水的输卵管性不孕患者相比，输卵管积水的患者在接受IVF治疗后妊娠率和分娩率都显著降低。     

小剂量生长激素在体外受精超排卵周期中的作用

在体外受精－胚胎移植（ＩＶＦ－ＥＴ）超排卵周期中，对反应差的不育妇女２７例采用促性腺激紊释放激素激动剂（ＧｎＲＨ－ａ）／小剂量重组人生长激奈（ＧＨ）结合人绝经期促性腺激奈（ｈＭＧ）／人绒毛膜促性腺激素（ｈＣＧ）进行超排卵１２例（ＧＨ组），与采用ＧｎＲＨ－ａ／ｈＭＧ／ｈＣＧ的１５例（对照组）进行比较。结果表明，ＧＨ能促进卵母细胞成熟，提高受精率，增加移植胚胎数，明显提高妊娠率。但未能影响卵泡的招募及诱发排卵所需ｈＭＧ的剂量和用药时间。血清胰岛素样生长因子Ｉ（ＩＧＦ－Ｉ）的水平在使用ＧＨ期间从１５０±４４ｎｇ／ｍｌ升达２２２±６ｎｇ／ｍｌ（Ｐ＜０．０１），而对照组无类似变化。证实小剂量ＧＨ在体外受精超排卵周期中的使用是有效的。     

卵巢基础状态对促超排卵结局避的预测

探讨病人的年龄、双侧卵巢基础状态及血清基础雌二醇水平与促超排卵后卵巢反应之间的关系。方法：对基础血清促卵泡激素＜２０ＩＵ／Ｌ、月经周期规律的女性不孕症病人１０２例、１０２个体外受精－胚胎移植周期，给予相同的促超排卵方案后，根据直径＞１０ｍｍ的卵泡数目将卵巢反应分为３种类型：低反应型、中反应型和高反应型。     

控制性超排卵中血清孕酮浓度升高对体外受精-胚胎移植的影响

目的 :探讨控制性超排卵 (COH)卵泡发育晚期血清孕酮浓度升高对体外受精 胚胎移植 (IVF ET)的影响。方法 :将 2 0 0 0年 1月至 2 0 0 1年 12月在本所接受IVF或卵细胞浆单精子显微注射 (ICSI)助孕的不孕症患者 5 41例 ,依注射绒毛膜促性腺激素 (HCG)日血清孕酮浓度的不同分为 4组 :1组 ,血清孕酮≤ 2 .86nmol/L者 198例 ;2组 ,血清孕酮 >2 .86～ <6 .36nmol/L者 2 0 9例 ;3组 ,血清孕酮≥ 6 .36～ <9.5 4nmol/L者 81例 ;4组 ,血清孕酮≥ 9.5 4nmol/L者 5 3例 ,回顾性地分析IVF/ICSI结局。结果 :第 4组种植率 (5 .2 3%)和临床妊娠率 (13.2 1%)明显低于其他组 (P <0 .0 1、P <0 .0 5 ) ,流产率 (5 7.14%)呈增高趋势 ,而HCG日血清雌二醇 (E2 )、黄体生成素 (LH)、平均获卵数、第 2次成熟分裂中期卵子数、受精率、卵裂率、优质胚胎形成率 ,4组之间差异无显著性。结论 :在COH卵泡发育晚期血清孕酮浓度≥ 9.5 4nmol/L ,IVF ET后胚胎种植率和临床妊娠率下降 ,流产率增加。     

腹腔镜下输卵管结扎术与切除术对输卵管积水患者IVF妊娠结局的影响分析

目的 分析腹腔镜下输卵管结扎术与切除术治疗输卵管积水后患者对体外受精（IVF）妊娠结局的影响。方法 选取98例输卵管积水并行IVF助孕患者,依据腹腔镜下不同手术方法分为参照组与分析组,各49例。参照组采用腹腔镜下输卵管结扎术,分析组采用腹腔镜下输卵管切除术。比较两组患者的相关指标、妊娠结局及手术前后生命体征变化情况。结果 两组患者的促性腺激素（Gn）使用总剂量、成熟卵子数量及冷冻胚胎个数比较,差异无统计学意义（P>0.05）。分析组成功妊娠率95.92%及多胎成功妊娠率51.02%均显著高于参照组的81.63%、30.61%,流产率6.12%及异位妊娠率4.08%明显低于参照组的20.41%、16.33%,差异具有统计学意义（P<0.05）。两组患者手术前后收缩压、舒张压及心率水平比较,差异无统计学意义（P>0.05）。结论 在输卵管积水治疗中,腹腔镜下输卵管结扎术与切除术对患者的IVF助孕相关指标、术后心率及血压并无显著差别,但输卵管切除术对妊娠结局具有更积极的影响,且成功妊娠率更高。     

单侧输卵管切除术对体外受精-胚胎移植周期卵巢反应性和结局的影响

目的:研究单侧输卵管切除术对体外受精-胚胎移植(IVF-ET)周期卵巢反应性和妊娠结局的影响。方法:以行IVF-ET单侧输卵管切除的106例不孕患者为研究组,同期双侧输卵管梗阻的患者360例为对照组,比较研究组输卵管切除后术侧和健侧超促排卵启动日卵巢的大小和窦卵泡数、hCG注射日卵巢的大小、≥12mm卵泡数和获卵数,同时比较研究组和对照组≥12mm卵泡数、获卵数、受精数、优质胚胎数以及Gn用量、用药天数、妊娠率。结果:研究组中术侧和健侧启动日卵巢的大小无显著性差异,然而超促排卵启动日窦卵泡数、hCG注射日双侧卵巢大小、≥12mm卵泡数和获卵数均有统计学差异。研究组无论是hCG注射日≥12mm卵泡数、获卵数、Gn用量、用药天数,还是受精数、优胚数和妊娠率与对照组比较,均无显著性差异。结论:单侧输卵管切除术降低同侧卵巢的反应性,但总体上不影响卵巢对Gn的反应和IVF-ET妊娠结局。     

低氧对体外受精-胚胎移植胚胎发育潜能的影响

目的:探讨低氧环境(体积分数5%O2)对体外受精-胚胎移植(in vitro fertilization-em-bryo transfer,IVF-ET)中胚胎发育潜能及临床结局的影响。方法:将接受IVF-ET长方案治疗的265名不孕症患者随机分为研究组(n=156):患者取卵后受精及整个胚胎培养过程全部在三气培养箱(体积分数5%O2)中进行,对照组(n=109):患者取卵后受精及整个胚胎培养过程全部在常规培养箱(体积分数20%O2)内进行,所有患者均移植授精第2日或第3日胚胎。比较组间受精率、正常受精率、卵裂率、正常卵裂率、优质胚胎率、可用胚胎率、生化妊娠率、临床妊娠率和异位妊娠率。结果:组间患者年龄、不孕年限、体质量指数、基础性激素、获卵数、成熟卵数、授精至移植时间和移植胚胎数均无统计学差异(P>0.05)。研究组受精率(84.4%)、正常受精率(72.0%)、卵裂率(97.6%)、优质胚胎率(43.3%)和可用胚胎率(72.5%)均显著高于对照组(分别为80.8%、68.7%、96.1%、35.1%、59.5%)(P<0.01或P<0.05),研究组与对照组正常卵裂率(97.7%vs 98.0%)、生化妊娠率(50.0%vs 39.4%)、临床妊娠率(44.9%vs 35.8%)、异位妊娠率(8.6%vs 12.8%)均无统计学差异(P>0.05)。结论:低氧环境(5%O2)似乎能够提高胚胎的发育潜能,获得更多优质胚胎和可用胚胎。     

Short Communication: In Vitro Fertilization in Patients with Ovarian Endometrioma

PURPOSE: To assess the influence of ovarian endometrioma during IVF. METHODS: Patients were submitted to cystectomy by the laparoscopic route for exeresis of ovarian endometrioma. Group I (n = 28) consisted of patients without ovarian endometrioma and group II (n = 14) consisted of patients with recurrence of ovarian endometrioma during IVF. RESULTS: Fertilization and cleavage rates were higher in group I and the pregnancy rate per transfer was similar in the two groups. CONCLUSIONS: The presence of endometrioma during IVF causes a worsening of oocyte fertilization and embryo cleavage but does not affect the pregnancy rate per transfer.     

Cancer incidence in a cohort of infertile women who underwent in vitro fertilization

OBJECTIVE: To assess whether ovarian hyperstimulation and IVF increase the risk for cancer. DESIGN: Historical cohort analysis. SETTING; IVF units of two medical centers in Israel. PATIENT(S): Five thousand twenty-six women who underwent IVF between 1981 and 1992. INTERVENTION(S); Cancer incidence rates were determined through linkage to the National Cancer Registry and were compared with expected rates with respect to age, sex, and place of birth. MAIN OUTCOME MEASURE(S): Development of cancer. RESULT(S): Twenty-seven cases of cancer were observed, and 35.6 were expected (standardized incidence ratio, 0.76 [95% CI, 0.50-1.10]). Eleven cases of breast cancer were observed, whereas 15.86 were expected (standardized incidence ratio, 0.69 [95% CI, 0.46-1.66]). One case of ovarian cancer and 1 case of cervical cancer were observed, compared with 1.74 and 1.73 cases expected, respectively. The type of infertility, number of IVF cycles, and treatment outcome did not significantly affect risk for cancer. CONCLUSION(S): In a cohort of women treated with IVF, no excess risk for cancer was noted.     

Effect of salpingectomy on ovarian response to superovulation in an in vitro fertilization–embryo transfer program

Objective: To investigate the effect of salpingectomy on the response of each ovary in patients undergoing an IVF-ET treatment cycle and to compare the results with those of patients who had not had surgery and were undergoing IVF-ET during the same period.

Design: A prospective study.

Setting: Tertiary referral academic IVF unit.

Patient(s): Twenty-nine ET cycles were evaluated in 29 patients who previously had undergone unilateral salpingectomy because of ectopic pregnancy (study group). Seventy-three patients with unexplained or male factor infertility served as controls.

Intervention(s): Ovulation induction and IVF-ET.

Main Outcome Measure(s): In the study group, mean ovarian volume, number of follicles, and number of oocytes recovered from each ovary were assessed and compared. The overall results, cycle characteristics, and pregnancy rates of the two groups were compared.

Result(s): Among the patients who had undergone salpingectomy, significantly fewer follicles developed and consequently fewer oocytes were retrieved from the ovary on the operated side (4.4 versus 8.2 follicles and 3.8 versus 6.0 oocytes). There were no differences in the total numbers of follicles and oocytes recovered from both ovaries, the cycle characteristics, or the pregnancy rates between study and control groups.

Conclusion(s): Salpingectomy has no detrimental effect on the total ovarian performance during IVF-ET treatment or on the outcome of IVF-ET. However, the ipsilateral ovary could be adversely affected. This could be detrimental in selected patients undergoing IVF-ET, in whom the second ovary already is compromised or missing.     

In vitro fertilization outcomes in patients experiencing a premature rise in luteinizing hormone during a gonadotropin-releasing hormone antagonist cycle

Patients undergoing controlled ovarian hyperstimulation and pituitary suppression with a GnRH antagonist who experienced a transient premature rise in LH were compared with those who did not have an early surge. Those experiencing a premature LH surge had equivalent clinical and ongoing pregnancy rates per ET.     

IVF-ET中促性腺激素释放激素激动剂的超促排卵应用与剂量研究

促性腺激素释放激素激动剂(GnRH-a)是体外受精-胚胎移植(IVF-ET)技术中重要用药。GnRH-a与GnRH受体结合后,早期"突发"作用可刺激垂体促性腺激素急剧释放,持续应用后使垂体受抑制,内源性促性腺激素(Gn)水平下降,即所谓的降调节作用。利用这种生物学特性,GnRH-a联合Gn超促排卵可预防早发黄体生成素(LH)峰,避免卵泡过早黄素化。另外,GnRH-a代替人绒毛膜促性腺激素诱发排卵可降低卵巢过度刺激综合征(OHSS)发生率。探索既能有效抑制LH峰,又不使垂体过度抑制的GnRH-a有效低剂量对于超促排卵有重要意义。     

A randomized prospective study on the effect of short and long Buserelin treatment in women with repeated unsuccessful in vitro fertilization (IVF) cycles due to inadequate ovarian response

Fifty four women with repeated unsuccessful in vitro fertilization (IVF) cycles due to inadequate ovarian response to stimulation with human menopausal gonadotropins (hMG) participated in this study. They were randomized to receive either gonadotropin releasing hormone agonist (GNRHa), Buserelin, prior to and during induction of ovulation by hMG (Group I—long protocol), or GnRHa starting on the first day of the cycle together with induction of ovulation by hMG (Group II—short protocol). Mean follicular phase serum luteinizing hormone (LH) and progesterone (P) levels were significantly lower in Group I than in Group II (P<0.01). Cancellation rate was significantly lower in Group I than in Group II (P<0.01). The long GNRHa protocol resulted in statistically significant lower cancellation rates, more oocytes per pickup (OPU), more embryos trans-ferred per patient, and a higher pregnancy rate. Significantly more hMG ampoules and more treatments days were required in the long GNRHa protocol. Our data demonstrate that the use of GNRHa prior to and during ovarian stimulation with hMG offers a very good alternative for patients with repetitive unsuccessful IVF cycles due to inadequate response.     

Clinical strategies to avoid multiple pregnancies in assisted reproduction

Multiple pregnancies following assisted reproductive techniques (ART) became an epidemic in the early nineties. Since then, most European countries have tried to apply restrictive policies to avoid multiples and high order multiples as far as possible. Those pregnancies may cause severe consequences to both the fetuses and mother. Economic, social and ethical dilemmas are also avoidable if caution is exercised when using ART to achieve those pregnancies. When restrictive policies are used in ovulation induction and in vitro fertilization, the results show a clear reduction in the number of MP maintaining satisfactory rates.