Effect of Progestin-primed Ovarian Stimulation Protocol on Outcomes of Aged Infertile Women Who Failed to Get Pregnant in the First IVF/ ICSI Cycle： A Self-controlled Study

This study aimed to explore the outcomes of progestin-primed ovarian stimulation protocol （PPOS） in aged infertile women who failed to get pregnant in the first IVF/ICSI-ET cycles with GnRH-a long protocol. A self-controlled study was conducted to retrospectively investigate the clinical outcomes of 104 aged infertile patients who didn＇t get pregnant in the first IVF/ICSI-ET treatment by stimulating with GnRH-a long protocol （non-PPOS group）, and underwent PPOS protocol （PPOS group） in the second cycle between January 2016 and December 2016 in the Center for Reproductive Medicine, Renmin Hospital of Wuhan University. The primary outcomes included clinical pregnancy rate of frozen-thawed embryos transfer （FET） in PPOS group, and good-quality embryo rate in both groups. The secondary outcomes were fertilization rate, egg utilization rate and cycle cancellation rate. The results showed that there were no significant differences in basal follicle stimulating hormone （bFSH）, antral follicle count （AFC）, duration and total dosage of gonadotropin （Gn）, number of oocytes retrieved, intracytoplasmic sperm injection （ICSI） rate, fertilization rate, and cycle cancellation rate between the two groups （P〉0.05）. However, the oocyte utilization rate and good-quality embryo rate in PPOS group were significantly higher than those in non-PPOS group （P〈0.05）. By the end of April 2017, 62 FET cycles were conducted in PPOS group. The clinical pregnancy rate and embryo implantation rate were 22.58% and 12.70%, respectively. In conclusion, PPOS protocol may provide better clinical outcomes by improving the oocyte utilization rate and good-quality embryo rate for aged infertile patients who failed to get pregnant in the first IVF/ ICSI-ET cycles.

Flexible GnRH Antagonist Protocol versus Progestin-primed Ovarian Stimulation (PPOS) Protocol in Patients with Polycystic Ovary Syndrome: Comparison of Clinical Outcomes and Ovarian Response

Polycystic ovary syndrome (PCOS) is one of the most common causes of infertility in women. Progestin-primed ovarian stimulation (PPOS) protocol, which used oral progestin to prevent premature luteinizing hormone (LH) surges in ovarian stimulation, has been proved to be effective and safe in patients with PCOS. The aim of the present study was to compare the efficacy of PPOS protocol with that of the traditional gonadotropin-releasing hormone (GnRH) antagonist protocol in patients with PCOS. A total of 157 patients undergoing in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) were recruited into this study. The patients were divided into two groups by the stimulation protocols: the GnRH antagonist protocol group and the PPOS protocol group. There was no significant difference in the clinical characteristics between the two groups. Dose and duration of gonadotropin were higher in the PPOS protocol group. Estradiol levels on the day of human chorionic gonadotropin (hCG) administration were significantly lower in the PPOS protocol group. Fertilization rates and the number of good quality embryos were similar between the two groups. Remarkably, we found 6 patients with moderate ovarian hyperstimulation syndrome (OHSS) in the GnRH antagonist protocol group but 0 in the PPOS protocol group. A total of 127 women completed their frozen embryo transfer (FET) cycles. There were no significant differences between the two groups in terms of clinical pregnancy rate per transfer, implantation rate, first-trimester miscarriage rate and on-going pregnancy rate per transfer. To conclude, PPOS protocol decreased the incidence of OHSS without adversely affecting clinical outcomes in patients with PCOS.

Effect of Progestin-Primed Ovarian Stimulation Protocol in Infertile Women with Basal Follicle-Stimulating Hormone Levels ≥15 IU/L: A Retrospective Analysis

Objective:To evaluate the efficacy of progestin-primed ovarian stimulation(PPOS)protocol in infertile women with high basal follicle-stimulating hormone(FSH)levels≥15 IU/L.Methods:Patients with high basal FSH levels≥15 IU/L with autologous oocytes from September 2016 to March 2019 were reviewed.Either medroxyprogesterone acetate 4 mg/d or clomiphene citrate(CC)50 mg/d was administered daily from day 3 to the trigger day.When serum FSH levels decreased to≤15.0 IU/L,a low dose of human menopausal gonadotropin(hMG)75/150 IU/d was administered to promote late follicular development.Results:Two hundred and twenty women were retrospectively analyzed in this study.Among them,139 patients were administered with PPOS protocol as the study group,and 81 patients were administered with CC protocol as the control group.The numbers of received oocytes and viable embryos were higher in the study group than those in the control group(1.5±1.2 vs.1.2±0.8 and 0.8±0.8 vs.0.5±0.6,respectively,P<0.05).However,hMG duration and dosage were significantly higher in the study group than those in the control group(4.2±2.7 d vs.1.1±2.3 d and 609.1±424.5 IU vs.140.7±231.3 IU,respectively,P<0.01).Incidence of luteinizing hormone surge and cycle cancellation rate were lower in the study group than those in the control group with statistical difference(2.88%vs.16.05%and 36.50%vs.50.63%,respectively,P<0.05).Conclusions:PPOS protocol can effectively downregulate the endogenous FSH levels.Compared with CC protocol,treatment with PPOS protocol in patients with high basal FSH levels≥15 IU/L could receive more oocytes and more viable embryos.

Clinical Application of Double Ovulation Stimulation in Patients with Diminished Ovarian Reserve and Asynchronous Follicular Development Undergoing Assisted Reproduction Technology

Objective This study aimed to compare the clinical effects of double ovulation stimulation(DouStim)applied during the follicular and luteal phases with the antagonist protocol in patients with diminished ovarian reserve(DOR)and asynchronous follicular development undergoing assisted reproductive technology(ART).Methods The clinical data of patients with DOR and asynchronous follicular development receiving ART from January 2020 to December 2021 were retrospectively analyzed.The patients were divided into two groups according to their ovulation stimulation protocol:DouStim group(n=30)and antagonist group(n=62).Assisted reproduction and clinical pregnancy outcomes were compared between the two groups.Results In the DouStim group,the number of oocytes retrieved,metaphase II(MII)oocytes,two-pronuclei(2PN),day 3(D3)embryos,D3 high-quality embryos as well as blastocyst formation,implantation,and human chorionic gonadotropin-positive rates were significantly greater than those in the antagonist group(all P<0.05).No significant differences were found in MII,fertilization,or continued pregnancy rates at the first frozen embryo transfer(FET),in-vitro fertilization(IVF)cancellation,or early medical abortion rates between the groups(all P>0.05).Except for the early medical abortion rate,the DouStim group generally had favorable outcomes.In the DouStim group,the dosage and duration of gonadotropin and the fertilization rate were significantly greater in the first ovulation stimulation induction than in the second ovulation stimulation induction(P<0.05).Conclusion The DouStim protocol efficiently and economically obtained more mature oocytes and high-quality embryos for patients with DOR and asynchronous follicular development.

DS147 Improves Pregnancy in Mice with Embryo Implantation Dysfunction Induced by Controlled Ovarian Stimulation

Summary： The study examined the effect of DS147, the bioactive component of the traditional herbal recipe Bangdeyun, on pregnancy in mice with embryo implantation dysfunction induced by controlled ovarian stimulation （COS）, and the underlying mechanisms. Female mice were superovulated by intrap eritoneal injection of 7.5 IU of pregnant mare serum gonadotropin （PMSG） followed by an additional injection of 7.5 IU hCG 48 h later to establish embryo implantation dysfunction （EID） model. Pregnant mice were randomly divided into normal control group, COS group and DS147-treated groups. The pregnancy rate and the average implantation site were obtained on pregnancy day 8 （PD8）. The side effect of 200 mg/kg of DS147 on naturally pregnant mice was also observed. Further, the uterine and ovarian tissue samples were collected on PD5 for measuring their weights, observing the development of the endometrium and ovary, and detecting the endometrial expression ofMMP-2, TIMP-2, CD34 and angiogenin （ANG）. The female mice treated with DS147 at doses of 100 to 800 mg/kg showed a higher pregnancy rate than those in COS group, and the highest pregnancy rate of 83.3% occurred in the 200 mg/kg DS147-treated group. Moreover, no obvious side effect was found in mice treated with 200 mg/kg DS147 on PD8 and PD16. The ovarian and uterine weights, and the expression levels of MMP-2, ANG and CD34 were significantly increased in DS147-treated groups when compared with COS group. The TIMP-2 expression level was much lower in DS147-treated mice than in COS mice and the ratio of MMP-2/TIMP-2 was much higher in DS147-treated group than in COS group, and even higher than normal control group. In all, these findings suggest that DS147 may improve pregnancy in mice with COS-induced EID by promoting matrix degradation and angiogenesis, and improving the development of corpus luteum and endometrial decidualization around the implantation window.

Cumulative Live Birth Rate after Three Ovarian Stimulation IVF Cycles for Poor Ovarian Responders According to the Bologna Criteria

Summary： This study explored the cumulative live birth rate after three ovarian stimulation in vitro fer- tilization （IVF） cycles for poor ovarian responders according to the Bologna criteria. In this retrospec- tive cohort study, 479 poor ovarian responders according to the Bologna criteria in the first ovarian stimulation IVF cycle between July 2006 and January 2012 in our IVF centre were included. The cu- mulative live birth rate was calculated by optimistic and pessimistic methods. The cumulative live birth rate after three ovarian stimulation IVF cycles for poor ovarian responders according to the Bologna criteria was 12.7%-20.5%. The three-cycle cumulative live birth rate was 18.5%--24.5%, 13.2%-27.4% and 8.6%-14.9% for poor responders aged ≤35 years, 36-39 years and 〉40 years, re- spectively. In conclusion, poor responders according to the Bologna criteria can receive an acceptable cumulative live birth, rate after three ovarian stimulation IVF cycles, especially poor responders aged 〈40 years.

Variations in vascular endothelial growth factor levels during ovarian superovulation and reduction of ovarian hyperstimulation incidence in young women: A prospective study

Variations in Vascular Endothelial Growth Factor (VEGF) levels were prospectively evaluated in 18 young women undergoing in vitro fertilization treatments according to the “Long Protocol” and a typical pattern of VEGF levels was recorded. A significant increase in VEGF concentrations was observed only when the follicles reached a mean diameter of 15.3 mm in concurrence with mature oocyte retrieval. Since an increase in VEGF levels is related to follicular vascularity and oocyte developpment, our study supports the approach that oocyte retrieval may be performed when follicles > 15 mm in diameter appear. Anticipating egg retrieval in young patients with an optimal ovarian reserve may decrease the incidence of severe ovarian hyperstimulation, without compromising the treatment results.

Effect of Certain Toxicants on Gonadotropin-Induced Ovarian Non-Esterified Cholesterol Depletion and Steroidogenic Enzyme Stimulation of the Common Carp Cyprinus carpio in vitro

Isolated ovarian tissues from the common carp, Cyprinus carpio were incubated in vitro to obtain a discrete effect of four common toxicants of industrial origin, namely phenol, sulfide, mercuric chloride and cadmium chloride, on gonadotropin-induced alteration of nonesterified and esterified cholesterol and steroidogenic enzymes, △5-3β-HSD and 17β-HSD activity. Stage II ovarian tissue containing 30-40% mature oocytes were shown to be most responsive to gonadotropins in depleting only nonesterified cholesterol moiety and stimulating the activity of both. Safe doses of above mentioned toxicants when added separately to stage II ovarian tissue with oLH (1 μg/incubation) gonadotropin-induced depletion of nonesterified cholesterol and gonadotropin-induced stimulation of the activity of both enzymes was significantly inhibited. Esterified cholesterol remained almost unaltered. Findings clearly indicate the impairment of gonadotropin induced fish ovarian steroidogenesis by the four toxicants separately.

Case Report of Ectopic Pregnancy during Controlled Ovarian Stimulation without Oocytes Harvested and Late Ovarian Hyperstimulation Syndrome

Here we reported a rare case of misdiagnosed ectopic pregnancy (EP) due to unintended ovulation during controlled ovarian stimulation (COS) in GnRH agonist cycle, resulting in no oocytes harvested and late hyper-stimulation syndrome (OHSS). The patient was a 33-year old primary infertile woman due to male’s factors and underwent her second in vitro fertilization (IVF) cycle using GnRH agonist protocol, and no oocytes harvested on ovum picked-up (OPU) day. The start of gonadotropin usage was on day 8th of her period, and the P level increased rapidly and strangely high from day 8th after gonadotropin usage. The E2 level and follicles grew normally but finally no oocytes harvested. She was diagnosed as late ovarian hyper-stimulation syndrome (OHSS) 7 days after OPU. 20 days after OPU, no menstruation come and a positive urine test of hCG were reported. And the patient was diagnosed as EP by laparoscopy. In conclusion, rapidly increased P level, no oocyte retrieval and late onset of OHSS should be very important clues to diagnose this misdiagnosed EP.

Timed Intercourse versus Intrauterine Insemination with Mild Ovarian Stimulation for Unexplained Infertility

Background: Infertility is unexplained in about 22% - 28% of infertile couples. Spontaneous pregnancy may occur in them. If did not happen, Expectant management will be via clomiphene citrate (CC) administration, intrauterine insemination (IUI), and IVF & ICSI. Aim: to assess the effectiveness of intrauterine insemination with mild controlled ovarian stimulation compared with expectant management in couples with unexplained infertility more than one year. Methods: 160 couples with unexplained infertility were selected, The couples were randomly divided into two groups: Group (A) “80 couples”: Intrauterine insemination (IUI) with mild controlled ovarian stimulation (combination of CC + hMG) using prepared semen and was performed 36 hours after hCG injection, Group (B) “80 couples”: Couples had no ovulation induction. They encouraged for timed intercourse in the most fertile days of female cycle guided by folliculometry for 6 months. Data were collected quantitatively, coded and analyzed using SPSS. The power of study is 80% and 95% confidence interval. Result: The pregnancy rate was calculated in both groups: In group (A) (IUI/COS): OPR (Ongoing pregnancy rates) was 27.5% and PR (pregnancy rates)/cycle was 8.6%. In group (B) (Expectant management): OPR was 25% and PR/cycle was 5.3%. Conclusion: Mild controlled ovarian stimulation CC + hMG with IUI offers no statistical significance in terms of pregnancy outcomes over expectant management in this study however significance in the response to stimulation.

A Retrospective Study on the Use of High-Dose Letrozole while Undergoing Ovarian Stimulation for Oocyte and Embryo Cryopreservation in Cancer Patients

Objective: To determine the efficacy of letrozole in suppressing estradiol levels during ovarian stimulation in cancer patients. Methods: A retrospective chart review of cancer patients undergoing ovarian stimulation for fertility preservation between 2014-2019 at a private university-affiliated fertility clinic in Canada was conducted. Ovarian stimulation was completed with no letrozole (Group A, n = 10), and adjuvant daily letrozole use at 5.0 (Group B, n = 34) or 7.5 mg (Group C, n = 61). The primary outcomes were peak estradiol levels and oocyte yield. ANOVA with a post hoc two-tailed t-test assuming equal variance was utilized as a statistical method. Result(s): Patient age and AFC count were not different between groups. The yield of mature eggs was not different at each letrozole dose;9.2 ± 6.0, 13.9 ± 6.5 and 12.7 ± 7.2 for Groups A to C respectively (p = 0.18). Mean estradiol levels(pmol/L) were reduced in a dose-dependent manner;7432 ± 4553 for Group A, 2072 ± 1656 for Group B, and 1445 ±1238 for Group C (A vs. C, p vs. C, p Conclusion(s): The use of letrozole during ovarian stimulation for oocyte and embryo cryopreservation in cancer patients can maintain physiologic estradiol levels, while ensuring satisfactory oocyte and embryo yield. Letrozole can, therefore, minimize the theoretical risk of stimulating residual and metastatic diseases, while still optimizing future fertility outcomes.

Effects of Antisense Oligodeoxynucleotide to Follicle-stimulating Hormone Receptor on the Cell Proliferation and Apoptosis in Cells Derived from Human Ovarian Mucinous Cystadenocarcinoma in Vitro

The human ovarian mucinous cystadenocarcinoma （hOMC） cells were co-cultured with antisense oligodeoxynucleotide （antisense ODN）, nonsense ODN, and follicle-stimulating hormone （FSH） at different concentrations for the purpose of observing the effects of antisense ODN to FSH receptor （FSHR） on the proliferation and apoptosis of cultured hOMC cells in vitro. The inhibitory rates of growth were measured by using MTT method on the 2nd, 4th, 6th, 8th and 10th days after the interference of antisense ODN, nonsense ODN, and FSH, respectively. The apoptotic rates and the cell cycles were determined by means of flow cytometry, the apoptosis indexes were detected by using TUNEL, and the expression of caspase-3 was measured by using SP immunohistochemistry. Compared with that in the control group, the proliferative activity of hOMC cells was increased obviously in FSH groups （P〈0.05 or P〈0.01）, decreased distinctly in antisense ODN groups （P〈0.05 or P〈0.01）, and unchanged in nonsense ODN groups, respectively. Meanwhile, antisense ODN could significantly antagonize the FSH-promoted cell proliferative activity （P〈0.01）. Compared with those in the control group, the apoptotic rates and the expression of caspase-3 were dramatically increased in the mid- and high-dose antisense ODN groups （P〈0.05 or P〈0.01）, while the number of cells in G1/G0 phase was significantly decreased and that in S phase distinctly increased （P〈0.01）, There was no change in nonsense ODN groups （P〉0.05）, It was suggested that FSH may improve the development of hOMC cells, However, antisense ODN could inhibit proliferative activity and the FSH-promoted proliferative activity in hOMC cells, at the same time, antisense ODN could inhibit hOMC cell growth by inducing apoptosis.

Expression of VEGF165 and VEGF165b during ovarian follicular development

Objective:To investigate the role of vascular endothelial growth factor(VEGF)165a,VEGF165b,and VEGF receptor(VEGFR)in the development of bovine follicles.Methods:We cultured follicular cells that were collected from small,medium,and large sized bovine follicles with estrogen and measured the expression of VEGF,VEGFR2 and VEGF165b by Western blot analysis and immunofluorescence.Results:The expression of VEGF165 increased in all follicle sizes and the expression of VEGF165b was increased in the small and large follicles after culturing in an estrogen containing medium.The expression of VEGFR2 was increased in the medium and large follicles after culturing with estrogen for 96 h.VEGF165 was activated at 100 ng/mL estrogen in the large follicles for 96 h.In addition,VEGFR2 was upregulated in the medium and large follicles after treated with 100 ng/mL estrogen for 96 h.Conclusions:This evidence suggests that the expression of VEGF165 and VEGFR is associated with estrogen stimulation during the development of bovine follicles and in an autocrine or paracrine manner.This reveals an advantage during oocyte maturation in vitro.

GnRH拮抗剂和激动剂方案中扳机日子宫内膜厚度对新鲜移植周期妊娠结局的影响

目的:研究促性腺激素释放激素拮抗剂(GnRH-ant)和激动剂(GnRH-a)方案中扳机日子宫内膜厚度(EMT)对新鲜移植周期妊娠结局的影响。方法:选择2015年1月至2021年12月在郑州大学第二附属医院生殖中心接受体外受精/卵胞浆内单精子显微注射(IVF/ICSI)助孕的患者,共纳入新鲜移植2 559周期,其中GnRH-ant方案298周期,GnRH-a方案2 261周期。根据扳机日EMT分为7~9 mm、>9~12 mm和>12 mm组。比较两种方案中3组的临床特征和妊娠结局。结果:GnRH-ant方案中EMT 7~9 mm组的临床妊娠率、持续妊娠率和活产率均低于其他两组(P<0.017);GnRH-a方案中扳机日EMT 7~9 mm组的临床妊娠率、持续妊娠率和活产率低于>9~12 mm组,>9~12 mm组低于>12 mm组(P<0.017)。Logistic回归分析结果显示扳机日EMT较高的患者临床妊娠、持续妊娠和活产增加[GnRH-ant方案:>9~12 mm组的OR(95%CI)分别为2.243(1.173~4.288)、3.995(1.891~8.438)、3.814(1.810~8.036),>12 mm组的OR(95%CI)分别为3.298(1.490~7.299)、6.637(2.742~16.065)、5.249(2.184~12.616);GnRH-a方案:>9~12 mm组的OR(95%CI)分别为1.561(1.266~1.925)、1.378(1.112~1.707)、1.448(1.166~1.798),>12 mm组的OR(95%CI)分别为2.266(1.747~2.940)、2.257(1.736~2.933)、2.254(1.732~2.933)]。结论:扳机日EMT增加可改善妊娠结局;无论是GnRH-ant方案,还是GnRH-a方案,随着扳机日EMT增加,妊娠成功率升高。

分期针刺任督经穴治疗早发性卵巢功能不全的临床观察

目的观察分期针刺任督经穴治疗早发性卵巢功能不全(POI)的临床疗效。方法选取2021年6月至2022年12月就诊于上海市静安区中医医院的104例POI患者作为研究对象,按照完全随访化方法分为分期组、任脉组、督脉组、西药组,各26例。比较各组患者治疗前后血清性激素水平、窦卵泡计数(AFC),以及治疗和随访过程中共5个访视点的Kupperman(K)表和月经不调症状分级量化(MDQ)表评分。结果治疗后,四组血清卵泡刺激素(FSH)水平下降,雌二醇(E_(2))水平上升(P<0.05);西药组、督脉组和分期组AFC升高(P<0.01),分期组AFC改善优于任脉组(P<0.05)。西药组K表和MDQ表评分在治疗期间下降(P<0.01);随访期间K表不再下降(P>0.05),MDQ表上升(P<0.01)。任脉组K表评分在1MC和随访期间下降(P<0.05),MDQ表评分在3MC下降(P<0.01)。督脉组K表和MDQ表评分在3MC下降(P<0.01);随访期间MDQ表评分下降(P<0.05)。分期组K表评分在每个访视点均下降(P<0.05),MDQ表评分在3MC和随访期间下降(P<0.01)。结论分期针刺任督经穴治疗POI的临床疗效显著。

关元命门序贯针刺激活FSHR/cAMP/PKA通路促进早发性卵巢功能不全模型大鼠颗粒细胞增殖的机制研究

【目的】观察关元命门序贯针刺方案对早发性卵巢功能不全(POI)模型大鼠的治疗作用及机制。【方法】将雌性SD大鼠分为空白组、模型组、蛋白激酶A(PKA)抑制剂(H89)+针刺组、针刺组各12只。除空白组,其他3组大鼠采用雷公藤多苷片灌胃制备POI模型。模型成功建立后,空白组和模型组每日捆绑一次;针刺组大鼠在动情间期取关元穴针刺,在动情前期取命门穴针刺;H89+针刺组按照针刺组针刺方案干预,在每次针刺前30 min内腹腔注射H89。连续干预20 d。各组大鼠分别在干预后第1个动情间期和动情前期取材。酶联免疫吸附分析(ELISA)检测动情间期促卵泡激素(FSH)、雌二醇(E2)水平,Western Blot法检测动情间期促卵泡激素受体(FSHR)、芳香化酶P450(P450arom)蛋白表达,细胞计数试剂盒8(CCK-8)法检测动情间期和动情前期颗粒细胞活性,免疫组织化学法检测动情前期增殖细胞核抗原(PCNA)蛋白表达水平。【结果】(1)与空白组比较,模型组和H89+针刺组血清FSH水平显著升高(P<0.01),E2水平显著降低(P<0.001);H89+针刺组FSH水平与模型组无差异(P>0.05),E2水平低于模型组(P<0.05);针刺组FSH水平低于模型组和H89+针刺组(P<0.05),与空白组无差异(P>0.05),E2水平显著高于模型组和H89+针刺组(P<0.01),仍低于空白组(P<0.05)。(2)模型组和H89+针刺组FSHR、P450arom蛋白表达均低于空白组(P<0.01);H89+针刺组FSHR蛋白表达水平与模型组无差异(P>0.05),P450arom蛋白表达水平低于模型组(P<0.05);针刺组FSHR、P450arom蛋白表达水平均高于模型组和H89+针刺组(P<0.05),但仍低于空白组(P<0.05)。(3)模型组和H89+针刺组GCs活性和PCNA平均光密度值均低于空白组(P<0.05);H89+针刺组GCs活性和PCNA平均光密度值均低于模型组(P<0.05);针刺组的GCs活性和PCNA平均光密度值显著高于模型组和H89+针刺组(P<0.05或P<0.01)。【结论】关元命门序贯针刺方案可通过上调促卵泡激素受体(FSHR)/环磷酸腺苷(cAMP)/蛋白激酶A(PKA)通路FSHR、P450arom蛋白的表达,调控性激素水平,提高GCs活性和促进GCs细胞增殖,从而改善POI。

仿生电刺激联合人工周期对卵巢储备功能减退患者子宫容受性及血清生长分化因子-9、抑制素B、骨形态发生蛋白-10水平的影响

目的探讨仿生电刺激联合人工周期对卵巢储备功能减退(DOR)患者子宫容受性及血清生长分化因子-9(GDF-9)、抑制素B(INHB)、骨形态发生蛋白-10(BMP-10)水平的影响。方法选取2019年1月至2022年3月广西壮族自治区妇幼保健院收治的87例DOR患者作为研究对象。采用随机数字表法分为A组、B组、C组,每组29例。A组采用仿生电刺激治疗,B组采用人工周期治疗,C组采用仿生电刺激联合人工周期治疗。比较三组治疗前后子宫容受性,血清GDF-9、INHB、BMP-10水平,子宫内膜血流参数及卵巢体积;随访1年,比较三组的妊娠情况;比较三组治疗期间不良反应发生情况。结果与治疗前比较,治疗后A组、B组、C组初级卵泡数、优势卵泡数、排卵数及血清GDF-9、INHB、BMP-10水平均升高,卵巢体积均增大,且A组、B组、C组呈增高趋势(P<0.05)。与治疗前比较,治疗后A组、B组、C组子宫内膜血流搏动指数(PI)、子宫内膜血流阻力指数(RI)均减小,且A组、B组、C组呈下降趋势(P<0.05)。随访1年,C组妊娠率高于A组、B组(P<0.05)。治疗期间,三组不良反应发生率比较,差异无统计学意义(P>0.05)。结论仿生电刺激联合人工周期可提高DOR患者子宫容受性,改善子宫内膜血流参数及卵巢体积,也可改善血清GDF-9、INHB、BMP-10水平,提高自然妊娠率,且安全性好。

仿生物电刺激联合戊酸雌二醇、地屈孕酮治疗卵巢早衰患者的回顾性研究

目的以回顾性研究方法分析仿生物电刺激联合戊酸雌二醇、地屈孕酮治疗卵巢早衰(POF)效果。方法收集2018年5月至2020年5月郑州市第一人民医院收治的75例POF患者临床资料进行回顾性分析,根据治疗方案分组,对照组37例采取戊酸雌二醇+地屈孕酮,实验组38例基于对照组采取仿生物电刺激。观察两组疗效、月经情况、治疗前后性激素水平、T淋巴细胞亚群水平、卵巢影像学指标、不良反应。结果实验组治疗有效率(86.84%)高于对照组(64.86%),差异有统计学意义(P<0.05)。实验组月经恢复正常时间短于对照组,月经来潮次数、经期持续时间大于对照组,差异有统计学意义(P<0.05)。治疗后,实验组血清抗苗勒管激素(AMH)、黄体生成素(LH)、水平高于对照组,卵泡刺激素(FSH)、黄体生成素(LH)水平低于对照组,收缩期峰值血流速度(PSV)、卵巢体积、子宫内膜厚度、窦卵泡数大于对照组,阻力指数(RI)、搏动指数(PI)小于对照组,差异有统计学意义(P<0.05)。治疗后实验组CD3^(+)、CD4^(+)/CD8^(+)水平高于对照组,CD8^(+)水平低于对照组,差异有统计学意义(P<0.05)。实验组不良反应发生率与对照组比较,差异无统计学意义(P>0.05)。结论仿生物电刺激联合戊酸雌二醇、地屈孕酮可调节POF患者性激素水平,改善月经状况及卵巢影像学指标,增强免疫功能,提高治疗效果,且安全性较高。

波塞冬组4卵巢低反应患者促排卵策略研究进展

随着晚婚晚育人群的逐年增加,高龄孕妇占比亦随之增加。高龄妇女卵巢储备功能降低,往往需要借助辅助生殖技术来助孕。卵巢低反应(POR)指的是在控制性促排卵过程中卵巢对促性腺激素反应差,且周期结局差。2016年基于博洛尼亚标准提出的波塞冬标准对POR患者进行了分层个体化管理,在一定程度上利于改善POR患者的妊娠结局。其中年龄≥35岁且卵巢储备功能低下[基础窦卵泡数(AFC)<5个,抗苗勒管激素(AMH)<1.2 ng/ml]的波塞冬组4 POR患者管理始终是辅助生殖技术中面临的主要难题之一。目前应用于波塞冬组4 POR患者的促排卵方案有微刺激/温和刺激方案、黄体期促排卵方案、重组黄体生成素+拮抗剂方案、高孕激素促排卵方案等,本文主要对波塞冬组4卵巢低反应患者的促排卵策略以及辅助治疗的研究进展进行综述。

两种重组人卵泡刺激素注射液在不同人群中的促排卵效果分析

目的探究具有不同糖修饰谱的两种重组人卵泡刺激素(rFSH)在不同人群中行控制性促排卵(COH)临床应用的有效性和安全性。方法回顾性分析2022年1—12月期间本中心的320个COH周期的临床资料,按照COH中使用的rFSH种类不同分为A组(芳乐舒,95个周期)和B组(Puregon,225个周期)。比较两组患者在起始剂量、刺激时间、HCG日激素水平和内膜厚度、获卵数、减数分裂Ⅱ期(MⅡ)卵率、受精率、卵裂率、有效胚胎率、卵母细胞利用率和胚胎利用率等方面的差异。结果在A、B两组患者的年龄[(34.9±4.9)岁vs.(33.3±4.5)岁,P=0.006]、体质量指数(BMI)[(22.5±3.2)kg/m^(2) vs.(21.6±2.6)kg/m^(2),P=0.027]存在一定差异的前提下,A组获卵数与B组相当[(11.2±7.0)vs.(12.9±7.3),P=0.059]。在拮抗剂方案COH周期,两组患者年龄相近(P>0.05),此时两组的获卵数[(13.7±7.1)vs.(14.8±7.6),P=0.340]及其他结局指标均无统计学差异(P>0.05)。将所有患者根据年龄分层分析,高龄(≥35岁)亚组中,A组患者受精率[(78.1±19.6)%vs.(69.1±25.8)%,P=0.039]、卵裂率[(98.9±3.2)%vs.(93.7±22.1)%,P=0.039]和卵母细胞利用率[(44.9±30.6)%vs.(34.1±23.5)%,P=0.037]显著高于B组;低龄(<35岁)亚组中,A、B两组患者各项结局指标均无统计学差异(P>0.05)。通过逐步多元回归分析,确定COH方案和年龄是获卵数的预测因素(P<0.001),最终回归模型可解释28.8%的反应变异性。结论芳乐舒与Puregon两种rFSH具有相似的获卵数和获胚结局,在高龄人群中芳乐舒诱导的卵母细胞质量可能较高。