连续两个周期左右卵巢交替排卵可增加宫内人工受精和(或)体外受精自然周期内的妊娠概率

Identification of the ovary from which ovulation takes place in two consecutive menstrual cycles results in one of four ovulation patterns, contralateral and ipsilateral ovulations on the right or on the left ovary. Our data suggest that IVF and IUI treatment in cycles in which development of the dominant follicle occurs in the right- sided ovary- and ovulation took place from the left- sided ovary in the preceding cycle (contralateral rightsided ovulation)- is likely to show the best pregnancy outcome.

拟行宫内人工受精的夫妇禁欲时间对妊娠率的影响

To determine the optimal interval of ejaculatory abstinence for couples undergoing IUI. Design: Retrospective analysis. Setting: Reproductive endocrinology and infertility center. Patient(s): Infertile couples undergoing ovulation induction and IUI with partner’ s semen. Intervention(s): Ovulation induction with clomiphene citrate and a single IUI procedure per cycle. Main Outcome Measures(s): Clinical pregnancy rates as a function of abstinence intervals. Result(s): Four hundred seventeen women underwent 929 cycles from June 1999 to October 2002 for a median of 4 IUI attempts per couple. The median ejaculatory abstinence interval was 4 days (range 0- 30) with an overall pregnancy rate of 12% per cycle. Abstinence correlated positively with inseminate sperm count but negatively with motility. Variations in inseminate parameters did not correlate with pregnancy rates. However, abstinence intervals significantly affected pregnancy rates. The highest pregnancy rate was observed with an abstinence interval of 3 days or less (14% ) and the lowest pregnancy rate seen with an abstinence interval of 10 days or more (3% ). Conclusion(s): An abstinence interval of 3 days or less was associated with higher pregnancy rates following IUI. Prolonged abstinence decreases pregnancy rates, independent of other sperm parameters, perhaps as a result of sperm senescence and functional damage not readily identified by standard semen analysis. Abstinence intervals should be controlled for in studies examining pregnancy outcome in assisted reproduction.

在控制超排卵与宫内人工受精中,预防3胎以上多胎妊娠:应用低剂量重组卵泡刺激素与促性腺激素释放激素拮抗剂的3年经验

Objective: To employ protocols of mild ovarian stimulation to prevent an excessively elevated rate of high- order multiple pregnancies. Design: Case series. Setting: University hospital. Patient(s): Six hundred and twenty one consecutive patients undergoing 1,259 controlled ovarian hyperstimulation and intrauterine insemination cycles. Intervention(s): Patients received 50 IU per day of recombinant follicle- stimulating hormone (FSH) starting the third day of the cycle, then a gonadotropin- releasing hormone (GnRH) antagonist on the day in which a follicle<13 mm was visualized. Cycles were canceled if three or more follicles < 16 mm and/or five or more follicles < 11 mm were detected. Main Outcome Measure(s): Rate of high- order multiple pregnancies. Result(s): The clinical pregnancy rate per initiated cycle was 9.2% (95% confidence interval, 7.5- 11.1% ). The incidence of twins and high- order multiple pregnancies was 9.5% (95% CI, 5.3- 16.2% ) and 0 (0.0- 3.2% ), respectively. Conclusion(s): In controlled ovarian hyperstimulation and intrauterine insemination cycles, a protocol of 50 IU of recombinant FSH daily combined with the use of GnRH antagonists and a policy of strict cancellation based on echographic criteria are associated with a satisfactory pregnancy rate per initiated cycle and a low risk of high- order multiple pregnancies.

醋酸亮脯利特对控制下卵巢过度刺激和宫内人工受精的妇女黄体期功能的影响

Objective: To determine if the combination of leuprolide acetate (LA) and human menopausal gonadotropin (hMG) results in luteal phase dysfunction. Design: A prospective, randomized clinical trial. Setting: A tertiary care university fertility center. Patient(s): One hundred thirty- five couples with various etiologies of infertility. Intervention(s): Patients were prospectively randomized to receive either hMG and intrauterine insemination (IUI) or luteal phase down- regulation with LA, hMG, and IUI. Main Outcome Measure(s): Serum luteal phase progesterone (P) and luteal phase estradiol (E2) were obtained 9 days after hCG administration. Twenty- four- hour urinary P and luteinizing hormone (LH) were analyzed 9 days after human chorionic gonadotropin (hCG). Endometrial biopsies were performed 11 days after hCG and evaluated for luteal phase defects (LPD) using Noyes’ criteria. Result(s): No significant differences in the incidence of LPD (11.9% vs. 13.9% ), cycle fecundity (16.6% vs. 16.3% ), or luteal phase hormone profiles were observed between the groups receiving and not receiving LA. A significant difference in E2 levels (on the day of hCG administration) between cycles with a luteal phase defect (967 ± 106 pg/mL) and without a luteal phase defect (1,422 ± 83 pg/mL) was observed (P < .05). Conclusion(s): Pituitary down- regulation with LA combined with hMG did not result in luteal phase dysfunction. The E2 levels on the day of hCG administration in both groups were lower in women with documented luteal phase defects.

使用促性腺激素释放激素拮抗剂避免周末行宫内人工受精

Objective: To assess the usefulness of the GnRH antagonist cetrorelix to prevent LH surge and to avoid intrauterine insemination at weekends when a gynecologist on duty is not available and the ultrasound scan on Friday showed >1 and < 3 follicles ≥ 17 mm in diameter. Design: Open- label, randomized, prospective study. Setting: Reproductive medicine unit in an acute care teaching hospital in Barcelona, Spain. Patient(s): Infertile patients undergoing controlled ovarian hyperstimulation (COH) and IUI. Intervention(s): Treatment with recombinant FSH was started on day 3. In women assigned to the control group (n = 32), recombinant FSH was continued up to the day of hCG administration. In patients assigned to the GnRH antagonist group (n = 35), half of the dose of recombinant FSH was given for 2 more days in addition to cetrorelix (0.25 mg SC) until the day of hCG administration. Main Outcome Measure(s): Recombinant FSH doses, E2 level on the day of hCG administration, number and diameter of follicles, endometrial thickness, and number of pregnancies. Result(s): Only a case of premature ovulation occurred in the cetrorelix group. There were no significant differences between the study groups in the total mean number of follicles, follicles >10 mm and < 17 mm, and follicles ≥ 17 mm. The mean concentration of E2 on the day of hCG administration and the endometrial thickness were significantly higher in the cetrorelix group. Eleven pregnancies were achieved, 7 (20% ) in the cetrorelix group (4 singleton, 3 twins) and 4 (12.5% ) in controls (4 singleton). No case of ovarian hyperstimulation syndrome (OHSS) occurred. Conclusion(s): The use of cetrorelix to avoid IUI at weekends when the ultrasound scan on Friday shows > 1 and < 3 follicles ≥ 17 mm is a useful alternative for medical centers in which a gynecologist on call is not available.