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.

Beneficial effects of a decreased meal frequency on nutrient utilization,secretion of luteinizing hormones and ovarian follicular development in gilts

Background:Replacement gilts are typically fed ad libitum,whereas emerging evidence from human and rodent studies has revealed that time-restricted access to food has health benefits.The objective of this study was to investigate the effect of meal frequency on the metabolic status and ovarian follicular development in gilts.Methods:A total of 36 gilts(Landrace×Yorkshire)with an age of 150±3 d and a body weight of 77.6±3.8 kg were randomly allocated into one of three groups(n=12 in each group),and based on the group allocation,the gilts were fed at a frequency of one meal(T1),two meals(T2),or six meals per day(T6)for 14 consecutive weeks.The effects of the meal frequency on growth preference,nutrient utilization,short-chain fatty acid production by gut microbial,the post-meal dynamics in the metabolic status,reproductive hormone secretions,and ovarian follicular development in the gilts were measured.Results:The gilts in the T1 group presented a higher average daily gain(+48 g/d,P<0.05)and a higher body weight(+4.9 kg,P<0.05)than those in the T6 group.The meal frequency had no effect on the apparent digestibility of dry matter,crude protein,ether extract,ash,and gross energy,with the exception that the T1 gilts exhibited a greater NDF digestibility than the T6 gilts(P<0.05).The nitrogen balance analysis revealed that the T1 gilts presented decreased urine excretion of nitrogen(−8.17 g/d,P<0.05)and higher nitrogen retention(+9.81 g/d,P<0.05),and thus exhibited higher nitrogen utilization than the T6 gilts.The time-course dynamics of glucose,α-amino nitrogen,urea,lactate,and insulin levels in serum revealed that the T1 group exhibited higher utilization of nutrients after a meal than the T2 or T6 gilts.The T1 gilts also had a higher acetate content and SCFAs in feces than the T6 gilts(P<0.05).The age,body weight and backfat thickness of the gilts at first estrous expression were not affected by the meal frequency,but the gilts in the T1 group had higher levels of serum luteinizing hormone on the 18th day of the 3rd estrus cycle and 17β-estradiol,a larger number of growing follicles and corpora lutea,and higher mRNA expression levels of genes related to follicular development on the 19th day of the 3rd estrus cycle.Conclusions:The current findings revealed the benefits of a lower meal frequency equal feed intake on nutrient utilization and reproductive function in replacement gilts,and thus provide new insights into the nutritional strategy for replacement gilts,and the dietary pattern for other mammals,such as humans.

Application of cattle placental stem cells for treating ovarian follicular cyst

BACKGROUND High humidity and temperature in Taiwan have significant effects on the reproductivity of Holstein cattle,resulting in the occurrence of bovine ovarian follicular cyst(OFC).Because of economic loss from OFC,manual rupture and hormone injection have been advocated for the management of OFC.However,these incomplete treatments increase hormone resistance in cattle.Mesenchymal stem cells(MSCs)derived from placental stem cells(PSCs)demonstrate potential properties for the treatment of several diseases via promoting angiogenesis and immune modulation.AIM To establish the possibility of cattle placental stem cells(CPSCs)as a treatment modality for OFC of cows in Taiwan.METHODS The cows with OFC were divided into three groups:control(BC1 and BC2),hormone(H1 and H2),and CPSC(PS1 and PS2)treatment groups.In the hormone treatment group,the cows were given gonadotrophin-releasing hormone(GnRH)-prostaglandin-GnRH intramuscular injection with or without drainage of follicular fluid.In the CPSC treatment group,CPSCs were isolated from the placenta after labor.With the identification of surface antigen on stem cells,the cows were administered ovarian injection of 1×106 or 6×106 CPSCs with drainage.In all groups,OFC was scanned by ultrasound once a week for a total of seven times.The concentrations of estradiol and progesterone in serum were tested in the same period.The estrus cycle was analyzed by food intake and activity.If estrus was detected,artificial insemination was conducted.Then the cow was monitored by ultrasound for confirmation of pregnancy.RESULTS After 7 d of culture,CPSCs were successfully isolated from placental pieces.CPSCs significantly proliferated every 24 h and had high expression of MSC markers such as cluster of differentiation 44,as determined by flow cytometry.Ultrasound showed lower numbers of OFCs with drainage of follicular fluid.We achieved recovery rates of 0%,50%,50%,75%,75%and 75%in BC1,BC2,H1,H2,PS1,and PS2,respectively.Higher concentrations of progesterone were detected in the CPSC treatment groups.However,both hormone and CPSC treatment groups had no significant difference in the concentration of estradiol.The estrus rate was 0%,100%,25%,75%,75%and 75%in BC1,BC2,H1,H2,PS1,and PS2,respectively.The two fetuses were born in H2 and PS1.In brief,cows with CPSC injection achieved higher recovery,estrus,and inseminated conception rates.CONCLUSION CPSCs have efficacy in treating cows with OFC,and thus,may serve as an alternative treatment for reproductive disorders.

Follicular Aspiration Is Superior to Coasting as Effective Prophylactic Procedure against Ovarian Hyperstimulation Syndrome

Objectives: Evaluation of outcome follicular aspiration compared to coating procedure for infertile women undergoing ICSI regarding frequency and severity of ovarian hyperstimulation syndrome (OHSS). Patients & Methods: Infertile PCOS women underwent controlled ovarian stimulation with luteal phase GnRH-agonist long down-regulation protocol. Women developed serum E2 level > 4000 pg/ml and/or >20 follicles of ≥10 mm in diameter were randomly divided to receive coasting strategy (Coasting group) or TVU-guided aspiration (Aspiration group). When ≥3 follicles were ≥18 mm and serum E2 level was and 10,000 IU was administered 36 h before oocyte retrieval, and ICSI was performed 72-hr thereafter and the frequency of moderate-to-severe OHSS was determined. Results: 82 women developed criteria for categorization and 21 women (25.6%) developed moderate-to-severe OHSS;5 women of aspiration and 16 of Coasting group;with significantly (P = 0.005) lower frequency in aspiration group. Twenty women developed ascites;3 women had clinically detectable, while 17 women had US detected ascites with significantly (P = 0.039) higher frequency among women that had coasting. All other manifestations of OHSS were significantly lower with aspiration procedure. Both coasting and aspiration therapy significantly reduced serum E2 and ovarian diameter on day of hCG injection compared to estimates taken at time of categorization. Conclusion: Coasting procedure prior to hCG injection could decrease incidence of OHSS and lessens its manifestation. Follicular aspiration provided more superior results and improved outcome of these women. Any of these modalities could be provided to infertile high-risk women according to the availability of experiences and patients’ selection.

Determination of the ovine ovarian reserve during the prenatal and neonatal periods

Objective:To determine the ovine ovarian histomorphology and follicular staging at various age periods in Awassi breed.Methods:Ovaries were collected from prenatal fetuses[gestational age(95±5)days],neonatal(day 0),and prepubertal ewe lambs(two and four months of age);each age group included six animals.Ovaries(n=12,each group)were dissected and processed for hematoxylin and eosin staining.Stained sections(n=24,each group)were imaged and utilized for histomorphology assessment,follicle measurement,and classification.Results:Prenatal ovaries were mainly enriched with primordial follicles accompanied by a lower proportion of primary follicles.In addition to primordial and primary follicles,neonatal ovaries demonstrated a proportion of centrally located multilayered and antral follicles.In comparison with neonatal ovaries,the proportion of multilayered and antral follicles was significantly higher in the ovaries of two-month-old lambs;conversely,the proportion of peripherally situated primordial follicles dramatically declined compared to that of earlier age of lamb.Although there was no statistical variation in the sizes of primordial follicles across groups,the mean diameter of the primary follicle in the prenatal ovaries was substantially smaller than in postnatal ovaries.Compared to the neonatal ovaries,the size of the multilayered and antral follicles in the prepubertal ovaries was substantially larger.Conclusions:The earliest follicular developmental stages were established prenatally whereas the advanced growth stages started in the neonatal period and greatly increased in the prepubertal period.

Intermittent spontaneous ovulation in patients with premature ovarian failure:Three case reports and review of literature

BACKGROUND Premature ovarian failure(POF)is the end-stage of a decline in ovarian function prior to the age of 40 years that involves symptoms associated with low estradiol(E2)levels and a minimal probability of pregnancy.This increases the physical and psychological burden experienced by young women of reproductive age,particularly with regards to over-diagnosis.CASE SUMMARY Here,we report three cases(29,22,and 33 years-of-age)diagnosed with POF after experiencing secondary amenorrhea for more than one year,serum levels of follicle-stimulating hormone(FSH)>40 IU/L on two occasions with an interval of more than 4 wk,and negative progesterone withdrawal tests.All three patients were intermittently administered with drugs to create an artificial cycle.During the subsequent discontinuation period,the patients experienced intermittent follicular growth and spontaneous ovulation.One patient experienced two natural pregnancies(both with embryo arrest).CONCLUSION Our findings suggest that young patients with POF can experience unpredictable and intermittent spontaneous follicular development,ovulation,and even natural pregnancy.Clinicians should provide appropriate medical guidance and individualized treatments according to fertility requirements,genetic risks and hypoestrogenic symptoms as soon as possible.

西曲瑞克联合阿司匹林预防早发型卵巢过度刺激综合征的疗效观察

目的观察西曲瑞克联合阿司匹林预防早发型卵巢过度刺激综合征(OHSS)的疗效。方法回顾性收集2022年1月1日至7月1日于我院治疗的38例早发型OHSS患者资料,根据用药方案的不同分为对照组(19例)和干预组(19例)。取卵术后第1天,对照组患者给予阿司匹林肠溶片100 mg,口服至月经来潮;干预组患者给予注射用西曲瑞克0.25 mg,连续3 d皮下注射+阿司匹林肠溶片(用法用量同对照组)。观察并检测两组患者的首个黄体期、OHSS严重程度分级及取卵术后卵巢体积、腹水体积、血清雌二醇(E_(2))、白细胞计数(WBC)、红细胞比容(HCT)、中性粒细胞百分比(NEUT%)、D-二聚体(DD)、凝血酶原时间(PT)、纤维蛋白原(Fib)。结果干预组患者的首个黄体期显著短于对照组,中、重度患者比例显著低于对照组(P<0.05或P<0.01)。取卵术后,干预组患者的卵巢体积、腹水体积、血清E_(2)、WBC、NEUT%、HCT、DD、Fib总体低于对照组,PT显著高于对照组(P<0.05)。结论西曲瑞克联合阿司匹林预防早发型OHSS的疗效较单用阿司匹林更好。

年轻卵巢储备功能减退患者卵泡期与黄体期应用高孕激素状态超促排卵方案效果比较

目的:比较卵泡期和黄体期启动高孕激素状态超促排卵(PPOS)方案在35岁及以下卵巢储备功能减退(DOR)患者中的应用效果。方法:回顾性分析2018年6月至2021年12月在温州医科大学附属第一医院生殖医学中心采用PPOS方案行体外受精/卵胞质内单精子注射-胚胎移植的483例35岁及以下DOR患者的资料,其中采用卵泡期PPOS方案226例(FPPOS+CC组),黄体期PPOS方案257例(LPPOS+CC组)。比较两组的基线特征、超促排卵结果和实验室相关指标,并比较获得第三天(以下简称D3)优质胚胎的患者超促排卵后第一次冻融胚胎移植的妊娠结局。结果:两组间年龄、不孕年限、继发不孕占比、既往治疗周期数、体重指数、抗米勒管激素、窦状卵泡数、基础黄体生成素、基础孕酮水平、平均获卵数、MⅡ卵率、D3优质胚胎率、深度垂体抑制发生率、活产率和早产率等差异均无统计学意义(均P>0.05)。与FPPOS+CC组比较,LPPOS+CC组诱发排卵日黄体生成素(LH)水平[分别为4.0(2.7,5.3)和5.1(3.2,7.2)IU/L]、早发LH峰发生率(分别为3.13%和10.67%)、卵胞质内单精子注射双原核受精率(分别为72.16%和79.56%)均更低(P<0.05或P<0.01),而促性腺激素(Gn)天数[分别为11(9,12)和9(8,11)d]、Gn总量[分别为2213(1650,2700)和2000(1575,2325)IU]、诱发排卵日孕酮水平[分别为1.3(0.8,2.9)和0.9(0.6,1.2)ng/mL]、冻融胚胎移植的临床妊娠率(分别为61.88%和46.84%)和着床率(分别为42.20%和31.07%)均更高(均P<0.01)。结论:35岁及以下DOR患者采用LPPOS+CC方案后冻融胚胎移植临床妊娠结局更佳。

卵巢组织冻存与移植技术新进展

卵巢组织冻存与移植技术不仅保护女性生育力,还可保存卵巢内分泌功能,有效防治医源性早发性卵巢功能不全,尤其适用于青春期前女童与亟需原发病治疗的女性。卵巢组织冻存的有效性与安全性已得到了广泛验证,目前的临床金标准为慢速冻存,而玻璃化冻存仅适用于研究。尽管该技术近年来发展迅速,但仍面临超低温冻存损伤、冷冻保护剂毒性、卵泡储备量的评估、冻存与移植的安全性等问题。本文针对以上问题的研究进展进行综述。

猪卵泡液外泌体处理卵巢颗粒细胞的SNP/Indel筛选分析

旨在分析卵泡液外泌体对卵巢颗粒细胞基因的影响,了解卵泡液外泌体在卵泡发育过程中的调控机理,为母猪繁殖研究提供理论依据。本研究选取6月龄、健康状态良好且体重相近的二元母猪为材料,屠宰后收集卵巢150枚,利用梯度离心法获取卵泡液外泌体与猪卵巢颗粒细胞(porcine ovarian granulosa cells,POGCs),并在体外将卵泡液外泌体与猪卵巢颗粒细胞共培养。通过RNA-seq技术对猪卵巢颗粒细胞(granulosa cell samples,GC,n=3)和与外泌体共培养的猪卵巢颗粒细胞(granulosa-exosome co-culture samples,GCE,n=3)进行测序。结果显示,在GC和GCE组中平均每个样品获得5.54×10^(7)条clean reads,Q20和Q30质量得分均在92%以上。在GC和GCE组的6个样品中共获得1310979个SNPs突变和104498个InDel突变,其中纯合型SNP/Indel突变数量为170426个,杂合型SNP/Indel突变数量为1245052个,突变杂合子数目明显高于纯合子且SNP的发生率较高。另外,在突变类型中,转换类型共计973003个,颠换类型339974个,转换的类型显著高于颠换类型。经基因注释,突变主要发生在基因3′UTR、5′UTR、内含子区域,其次为外显子和基因间隔区。另外,通过与差异基因对比后,够筛选出1583个候选基因,经GO和KEGG功能富集发现,候选基因主要与细胞周期以及细胞增殖/凋亡过程相关。此外,共发现14个与细胞周期、增殖/凋亡通路相关的关键候选基因,其中11个基因存在互作关系。本研究获得的这些SNP/Indel信息可为后续研究外泌体在母猪生殖上的调控奠定科学基础。

波塞冬1组患者重复周期应用早卵泡期长效长方案和拮抗剂方案的疗效比较及自身对照研究

目的探讨早卵泡期长效长方案和拮抗剂方案在波塞冬1组患者重复周期中的应用疗效及优化策略。方法选择2018年6月至2022年6月于安徽省妇幼保健院生殖中心行体外受精(IVF)/卵胞浆内单精子注射(ICSI)治疗、采用常规控制性促排卵(COH)方案发生非预期卵巢低反应(uPOR)、且助孕失败后再次助孕的波塞冬1组患者286例为研究对象,根据重复周期COH方案不同分为早卵泡期长效长方案组(简称早长方案组,n=119例)和拮抗剂方案组(n=167例),比较两组实验室指标及临床妊娠结局;并将其中前后两个周期均采用相同COH方案的124例患者分为双早长方案组(n=70例)和双拮抗剂方案组(n=54例),采用自身对照研究分析两组临床资料。结果(1)再次COH周期早长方案组与拮抗剂方案组患者间基础资料比较无统计学差异(P>0.05)。早长方案组促性腺激素(Gn)总量、Gn天数、HCG日E_(2)水平、获卵数、可用胚胎数及优质胚胎数均显著高于拮抗剂方案组(P<0.05),HCG日LH水平显著低于拮抗剂方案组(P<0.05),其鲜胚种植率、鲜胚临床妊娠率及累积妊娠率较拮抗剂方案组有升高趋势,但无统计学差异(P>0.05);两组患者间周期取消率、中重度卵巢过度刺激综合征(OHSS)发生率、HCG日孕酮(P)水平、HCG日内膜厚度、再次uPOR发生率及早期流产率等比较均无统计学差异(P>0.05)。(2)双早长方案组的自身对照比较结果显示,再次早长方案组Gn启动剂量、LH添加量、HCG日E_(2)水平、获卵数、可用胚胎数、优质胚胎数、正常受精率、优质胚胎率、鲜胚种植率和临床妊娠率均显著高于首次早长方案组(P<0.05),早期流产率显著低于首次早长方案组(P<0.05)。(3)双拮抗剂方案组的自身对照比较结果显示,再次拮抗剂方案组Gn启动剂量、LH添加量、获卵数、可用胚胎数、优质胚胎数、鲜胚种植率及临床妊娠率等均显著高于首次拮抗剂方案组(P<0.05)。结论对于波塞冬1组患者来说,早卵泡期长效长方案和拮抗剂方案均可作为重复周期的促排卵方案;从获卵数及鲜胚临床妊娠结局考虑,早卵泡期长效长方案优于拮抗剂方案;从经济成本考虑,拮抗剂方案优于早卵泡期长效长方案。重复周期可根据两个方案的劣势采取优化措施来改善患者对于促排卵方案的反应性及卵母细胞质量和数量等问题,从而改善IVF/ICSI预后。

褪黑素埋植138 d对水貂血清主要生殖激素含量和卵巢发育的影响

为探究褪黑素(MLT)埋植剂对准备配种中期水貂血清主要生殖激素含量和卵巢发育的影响,试验在埋植MLT 138天时,随机选取试验组(埋植MLT 1粒,18 mg/粒)和对照组(不做任何处理)水貂各3只,采集血液测定血清主要生殖激素含量,采集卵巢测量长径、宽径、厚径和重量,计算体积,并制备石蜡切片观察卵巢组织结构。结果表明:与对照组相比,试验组水貂血清促卵泡激素(follicle-stimulating hormone,FSH)含量极显著升高(P≤0.01),促性腺激素释放激素(Gonadotropin-releasing hormone,GnRH)、促黄体生成素(luteinizing hormone,LH)和孕酮(progesterone,P4)含量均显著升高(P≤0.05);卵巢表面出现可视卵泡,卵巢长径、宽径、厚径、重量、体积均不同程度增大,其中宽径和体积增加显著(P≤0.05);卵巢皮质中提前出现成熟卵泡,且三级卵泡的数量、直径和卵母细胞直径均显著升高(P≤0.05)。说明埋植MLT埋植剂138 d可使准备配种中期水貂血清GnRH、FSH、LH和P_(4)含量升高,并促进卵巢形态学参数增加和有腔卵泡发育。

早发性卵巢功能不全患者外周血Tfh占比、功能相关细胞因子表达变化及其与性激素水平的相关性

目的观察早发性卵巢功能不全(POI)患者外周血滤泡辅助性T细胞(Tfh)占比、功能相关细胞因子表达变化,并分析其与性激素水平的相关性。方法POI患者29例(观察组),同期健康体检者31例(对照组),采用流式细胞术检测全血Tfh占比,免疫印迹实验检测外周血单个核细胞(PBMC)CXCR5、BCL-6蛋白,酶联免疫吸附法检测血清IL-6、IL-21,电化学发光法检测血清促卵泡刺激素(FSH)、促黄体生成素(LH)、泌乳素、孕酮、睾酮、雌二醇(E_(2))、抗缪勒管激素(AMH)水平,Spearman相关分析法分析Tfh、CXCR5蛋白、BCL-6蛋白、IL-6、IL-21与性激素的相关性。结果与对照组比较,观察组全血Tfh占比增加,血清IL-6、IL-21水平升高,PBMC CXCR5、BCL-6蛋白表达升高,血清FSH、LH水平升高,血清E_(2)、AMH水平降低,P均<0.05。全血Tfh占比与血清FSH、LH水平呈正相关(r分别为0.75、0.63,P均<0.05),与血清E_(2)、AMH水平呈负相关(r分别为-0.35、-0.82,P均<0.05);血清IL-6水平与血清FSH、LH水平呈正相关(r分别为0.75、0.62,P均<0.05),与血清E_(2)、AMH水平呈负相关(r分别为-0.47、-0.77,P均<0.05);血清IL-12水平与血清FSH、LH水平呈正相关(r分别为0.68、0.56,P均<0.05),与血清E_(2)、AMH水平呈负相关(r分别为-0.25、-0.73,P均<0.05);PBMC BCL-6蛋白表达与血清FSH、LH水平呈正相关(r分别为0.73、0.60,P均<0.05),与血清E_(2)、AMH水平呈负相关(r分别为-0.27、-0.76,P均<0.05);PBMC CXCR5蛋白表达与血清FSH、LH水平呈正相关(r分别为0.72、0.58,P均<0.05),与血清E_(2)、AMH水平呈负相关(r分别为-0.27、-0.70,P均<0.05)。结论POI患者全血Tfh占比增加,PBMC CXCR5、BCL-6蛋白表达升高,血清IL-6、IL-21、FSH、LH水平升高及E_(2)、AMH水平降低,Tfh及其相关因子与性激素呈正相关或负相关,Tfh及其相关因子可能参与了POI发生过程。

青春期卵巢囊肿二次蒂扭转术后复发一例

卵巢囊肿为妇科常见疾病,可见于育龄期各个年龄段,其中卵巢滤泡囊肿属于卵巢瘤样病变,其缺乏特异性症状。儿童期、青春期可表现为附件扭转。对于复发性卵巢滤泡囊肿,短效避孕药可有效促使滤泡囊肿消退,有效阻止滤泡囊肿的再次形成。报道1例短效避孕药治疗青春期卵巢囊肿二次蒂扭转术后复发的病例,该患者两次入院均为卵巢囊肿蒂扭转,均行手术治疗,两次手术治疗后短期内再次复发,均为多房、巨大囊肿,较为少见。考虑患者年龄及短期内两次卵巢囊肿手术史,出于生育力保护及长期管理的观念,二次术后复发后未选择再行手术治疗,给予该例患者口服短效避孕药5个月,期间囊肿逐渐减小直至消失。后规律随访复查,未见卵巢囊肿再次复发。

通瘀促孕汤治疗子宫内膜异位症不孕的意义

目的探究分析通瘀促孕汤治疗子宫内膜异位症不孕的效果。方法选取于2022年1月至2022年12月期间,院内子宫内膜异位症不孕患者共62例,作为本次研究对象。以患者入院序列是为基础,采用随机数字分组的方式,将62例患者随机分为对照组与观察组,每组31例。对照组采用西药治疗,观察组采用通瘀促孕汤治疗,对比两组的治疗效果,卵巢功能;卵泡状态以及生活质量。结果在治疗效果方面,观察组高于对照组(P<0.05)。在卵巢功能方面,治疗后观察组抗苗勒氏管激素水平高于对照组,卵泡刺激激素水平低于对照组(均P<0.05)。在卵泡状态方面,治疗前两组对比无明显差异(P>0.05),治疗后观察组最大卵泡直径以及成熟卵泡个数均高于对照组(均P<0.05)。在生活质量方面,观察组生理职能分、心理职能、社会功能、环境领域以及情感职能评分均高于对照组(均P<0.05)。结论通瘀促孕汤能够改善患者的卵巢功能、卵泡状态,确保最终治疗效果以及生活质量的提升。

GH联合卵泡期PPOS方案在波塞冬标准组4 POR患者IVF-ET助孕中的应用

目的 探讨生长激素(GH)联合卵泡期高孕激素状态下促排(PPOS)方案对波塞冬标准组4卵巢低反应(POR)患者促排及妊娠结局的影响。方法 选取2019年1月至2021年12月在徐州市中心医院生殖医学中心行体外受精-胚胎移植(IVF-ET)治疗的86例波塞冬标准组4 POR患者进行回顾性分析,根据是否采用GH联合PPOS方案治疗分为研究组(n=43,共43个周期)和对照组(n=43,共43个周期)。比较两组基线资料、促排及妊娠情况。结果 两组基线资料比较,差异无统计学意义(P>0.05);研究组获卵数、MⅡ卵数、可利用胚胎数、D3优胚数、临床妊娠率均高于对照组,差异具有统计学意义(P<0.05);研究组D3优胚率高于对照组,但差异无统计学意义(P>0.05);两组早期流产率比较,差异无统计学意义(P>0.05)。结论 GH联合PPOS方案有助于改善波塞冬标准组4 POR患者的妊娠结局。

补肾调泡周期疗法组方对大鼠原代卵巢颗粒细胞增殖、分泌及AMH、AMHR2、Smad4表达的影响

目的研究补肾调泡周期疗法组方(逍遥散、三子汤)对大鼠原代卵巢颗粒细胞增殖、分泌功能及抗苗勒氏管激素(AMH)、抗苗勒氏管激素Ⅱ型受体(AMHR2)、Smad同源物4(Smad4)表达的影响。方法6~8周龄SD雌鼠20只随机分为空白组、阳性药物组(7.8 IU·kg^(-1)FSH)、逍遥散组(12 g·kg^(-1))、三子汤组(16 g·kg^(-1))各5只,连续给药4 d后采血,制备含药血清。选取21~25日龄SD雌鼠提取大鼠卵巢颗粒细胞,贴壁生长至70%,用免疫荧光法进行大鼠卵巢颗粒细胞纯度鉴定。培养成功的大鼠原代卵巢颗粒细胞分别用各组含药血清培养液培养,CCK-8法筛选各组含药血清最佳干预浓度;各组采用最佳干预浓度培养细胞,CCK-8法检测各组颗粒细胞24、48、72、96 h增殖情况;ELISA法检测各组颗粒细胞培养液上清AMH、雌二醇(E_(2))及孕酮(P)浓度;Western Bolt法检测各组颗粒细胞AMH、AMHR2和Smad4蛋白表达;实时荧光定量PCR(qRT-PCR)检测各组颗粒细胞中AMH、AMHR2和Smad4 mRNA表达水平。结果与空白组比较,各组含药血清对大鼠卵巢颗粒细胞增殖均有促进作用(P<0.05,P<0.01);与阳性药物组比较,三子汤组促进颗粒细胞增殖作用最佳(P<0.01),逍遥散次之(P<0.05);各组颗粒细胞增殖与含药血清干预时间呈正相关,干预48 h启动细胞增殖活性,96 h细胞增殖达到高峰。与空白组比较各组颗粒细胞培养液上清AMH、E_(2)及P的浓度均明显升高(P<0.05,P<0.01);与阳性药物组比较,逍遥散组促P分泌效果更佳(P<0.05)。与空白组比较各组卵巢颗粒细胞AMH、AMHR2、Smad4蛋白表达水平明显升高(P<0.05,P<0.01),阳性药物组AMHR2蛋白表达较逍遥散、三子汤组升高明显(P<0.01)。与空白组比较各组卵巢颗粒细胞AMH、AMHR2、Smad4 mRNA表达水平明显升高(P<0.05,P<0.01),其中三子汤组AMH、AMHR2 mRNA表达明显优于阳性药物组与逍遥散组(P<0.01)。结论补肾调泡周期疗法组方逍遥散、三子汤能促进大鼠原代卵巢颗粒细胞增殖并与干预时间呈正相关性,促进颗粒细胞分泌甾体激素和AMH,并可能通过上调AMH、AMHR2、Smad4蛋白及mRNA表达,促进卵泡发育和成熟,并以此改善卵巢生殖和内分泌功能。

卵泡输出率与血清let-7g、let-7f联合评估超促排卵卵巢反应及临床意义

目的:研究卵泡输出率(FORT)与血清let-7g、let-7f联合评估超促排卵患者卵巢反应价值及临床意义。方法:收集本院2020年1月-2021年12月行体外受精-胚胎移植术(IVF-ET)患者97例临床资料,根据患者获卵数分为卵巢低反应组、中反应组及高反应组,比较3组FORT、血清let-7g、let-7f水平,分析不同妊娠结局及FROT水平患者临床特征、促排卵效果、实验室指标及治疗结局,分析FORT、血清let-7g及let-7f评估患者卵巢反应性价值。结果:血清let-7g、let-7f水平卵巢中反应组高于低反应组及高反应组(P<0.05),低反应组与高反应组无差异(P>0.05);FORT水平在低反应组、中反应组及高反应组依次升高(P<0.05)。妊娠组血清let-7g、let-7f、FORT、获卵数、受精率及优质胚胎率均高于非妊娠组(P<0.05);低FROT组AFC数低于中FROT组及高FROT组(P<0.05),低FROT组、中FROT组及高FROT组获卵数、受精率、优质胚胎率及临床妊娠率依次升高(P<0.05)。患者血清let-7g与let-7f水平呈正相关,两者与TORF无明显相关性。FORT、血清let-7g及let-7f单独应用时,预测卵巢低反应性或高反应性的价值均以let-7f最高(AUC=0.754、0.767),其次是FORT(AUC=0.750、0.734),3项指标联合应用(AUC=0.859、0.848)提高了评估效能。结论:FORT及血清let-7g、let-7f miRNA表达在反映卵巢反应性中均具一定效能,可作为指导控制性超排卵方案制定的潜在指标。

针药结合治疗抗米勒管激素相关卵泡发育障碍性不孕症疗效观察

目的:观察针药结合治疗抗米勒管激素(AMH)相关卵泡发育障碍性不孕症的临床效果。方法:选取符合纳入标准的肾虚肝郁型AMH相关卵泡发育障碍性不孕症120例作为研究对象,其中多囊卵巢综合征(PCOS)患者60例,卵巢早衰(POF)患者60例,将2类患者分别随机分为观察组和对照组,每组30例。观察组给予中药补肾疏肝方联合针灸治疗,对照组给予枸橼酸氯米芬片治疗,疗程为3个月经周期。观察各组治疗前后排卵情况、促黄体素(LH)、促卵泡素(FSH)、雌二醇(E_(2))、睾酮(T)、AMH和、空腹血糖(FPG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、三酰甘油(TG)。结果:PCOS患者2组的LH、T、AMH水平较治疗前明显下降,E_(2)水平较治疗前明显升高(均P<0.05),观察组FSH水平较治疗前升高(P<0.05),且观察组在改善LH、AMH水平方面明显优于对照组(均P<0.05)。POF患者观察组LH、FSH水平较治疗前明显下降,E_(2)、AMH水平较治疗前明显升高(均P<0.05)。PCOS及POF患者观察组HDL水平较治疗前均升高,TC、LDL、TG水平较治疗前均下降(均P<0.05)。观察组妊娠率高于对照组,流产率低于对照组(均P<0.05)。结论:针药结合治疗肾虚肝郁型的AMH相关卵泡发育障碍性不孕症患者疗效显著,能改善内分泌状况,降低血脂水平,提高临床妊娠率,降低流产率。

卵巢早衰发生机制及其防治策略的研究进展

卵巢早衰是指女性在40岁以前出现卵巢功能减退的现象。卵巢早衰可导致女性妊娠率下降,流产、早产及出生缺陷率增加,在女性不孕的原因中所占的比例有逐年上升的趋势,同时也增加了全身各系统与此相关疾病的发生率。研究发现,通过干扰相关基因的表达水平或是给予褪黑素、槲皮素等抗氧化剂可以加强对卵巢的保护,从而提前对卵巢早衰进行干预和预防,有助于提高卵母细胞质量、防治卵巢早衰以及改善女性生活质量。本文就卵巢早衰发生机制及防治策略的研究进展进行了综述,以期为进一步预防和治疗卵巢早衰提供新思路。