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.

夫精宫腔内人工授精导管排气对周期妊娠率的影响

目的观察夫精宫腔内人工授精（IUI）导管排气对周期妊娠率的影响,为临床医护人员采取措施提高IUI周期妊娠率提供依据。方法将200例不孕患者进行IUI的417个周期随机分为排气组（221周期）与未排气组（196周期）。两组行IUI时操作者将1 ml注射器去除针头,先抽取0.35 ml空气,再吸取处理好的精子悬液0.30~0.50 ml,进而连接IUI导管。此时未排气组直接将连接好的IUI导管置于宫腔内,然后将处理好的精液和抽取的0.35 ml空气缓缓注入宫腔（约3 min）,停留1 min缓慢取出IUI导管。排气组则将连接好的IUI导管先排气（约排出空气0.35 ml）后再置于宫腔内,其他步骤同未排气组。结果 417个IUI周期共有50例临床妊娠,总周期妊娠率为11.99%。其中排气组周期妊娠率为12.22%,未排气组为11.73%,两组比较,差异无统计学意义（P〉0.05）。结论 IUI导管排气与否对周期妊娠率的影响无统计学差异,但排气组周期妊娠率略高于未排气组,有待于扩大样本进一步研究。

显微镜下精索静脉曲张修复术改善精子质量降低辅助生殖技术级别的临床研究

目的:探讨显微镜下精索静脉曲张修复术治疗男性不育精液质量改善的程度,以及是否可以降低需要试管婴儿或者人工授精的夫妇辅助生殖技术的级别。方法:回顾性分析确诊为左侧精索静脉曲张,接受了显微镜下精索静脉曲张修复术的男性不育患者。按照男性前向运动精子总数的评估标准分为三组:自然妊娠组(NP组)>40×10~6;人工授精组(IUI组)(30～40)×10~6;试管婴儿组(IVF组)(10～30)×10~6。分析比较术前术后的前向运动精子总数的情况。结果:总共137例患者接受了显微镜下精索静脉曲张修复术。术前术后比较:137例总体前向运动精子总数[(40.33±20.56)×10~6与(57.89±30.67)×10~6](P<0.05);IVF组术前术后比较:[(11.24±32.45)×10~6与(35.67±23.45)×10~6](P<0.05),有52.94%的患者无需试管婴儿治疗,改为人工授精或者尝试自然受孕;IUI组术前术后比较:[(35.33±18.48)×10~6与(50.43±23.67)×10~6](P<0.05),有58.33%的患者尝试自然受孕;建议自然妊娠组活动精子总数术前术后显著增加[(46.26±28.36)×10~6与(67.89±32.47)×10~6](P<0.05)。结论:显微镜下精索静脉曲张修复术在男性不育治疗中具有重要的作用,可以增加前向运动精子的总数。显微镜下精索静脉曲张修复术可以减少不育症夫妇对IVF或IUI的需要,降低辅助生殖技术的级别。