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.

Efficacy and Safety of the Chinese Herbal Compound TJAOA101 in Treating Diminished Ovarian Reserve: A Protocol for Multicenter, Prospective, and Pre-Post Study

Objective Diminished ovarian reserve(DOR)can lead to early menopause,poor fecundity,and an increased risk of disorders such as osteoporosis,cardiovascular disease,and cognitive impairment,seriously affecting the physical and mental health of women.There is still no safe and effective strategy or method to combat DOR.We have developed a novel Chinese herbal formula,Tongji anti-ovarian aging 101(TJAOA101),to treat DOR.However,its safety and efficacy need to be further validated.Methods In this prospective and pre-post clinical trial,100 eligible patients aged 18–45 diagnosed with DOR will be recruited.All participants receive TJAOA101 twice a day for 3 months.Then,comparisons before and after treatment will be analyzed,and the outcomes,including anti-mullerian hormone(AMH)and follicle-stimulating hormone(FSH)levels and the antral follicle count(AFC),the recovery rate of menopause,and the Kupperman index(KMI),will be assessed at baseline,every month during medication(the intervention period),and 1,3 months after medication(the follow-up period).Assessments for adverse events will be performed during the intervention and follow-up periods.Conclusion A multicenter,prospective study will be conducted to further confirm the safety and efficacy of TJAOA101 in treating DOR and to provide new therapeutic strategies for improving the quality of life in DOR patients.

Causes and Countermeasures for Fragrance Diminishing of Rice Cultivar Daohuaxiang 2 in Heilongjiang Province

High-quality fragrant rice Daohuaxiang 2 is a well-known variety in grain industry of Heilongjiang Province. However, its fragrance has weakened in recent years. In this paper, the causes for fragrance diminishing of Daohuaxiang 2 were discussed in depth. It was pointed out that variety degeneration, growth period influence, environmental factor influence, soil fertility influence and long drying time were the main causes for fragrance diminishing of Daohuaxiang 2. In addition, countermeasures for avoiding the fragrance diminishing were put forward.

Effect of Dual Trigger In Vitro Fertilization and Intracytoplasmic Sperm Injection During the Gonadotropin-releasing Hormone-Antagonist Cycle on Final Oocyte Maturation and Cumulative Live Birth Rate in Women with Diminished Ovarian Reserve

Objective It is well known that a dual trigger treatment can improve clinical outcomes of in vitro fertilization(IVF)in high or normal ovarian responders.However,it is not clear whether dual triggering also benefits patients with diminished ovarian reserve(DOR).The aim of this study was to investigate whether a dual trigger treatment of gonadotropin-releasing hormone(GnRH)agonist combined with human chorionic gonadotropin(hCG)for final follicular maturation improves the cumulative live birth rate(CLBR)during the GnRH-antagonist cycle in patients with DOR.Methods This retrospective study included patients with DOR who received a GnRH-antagonist protocol during IVF and intracytoplasmic sperm injection(IVF-ICSI)cycles at Peking University People’s Hospital from January 1,2017 through December 31,2017.Oocyte maturation was triggered by GnRH combined with hCG(n=110)or hCG alone(n=71).Embryos were transferred on the third day after oocyte retrieval or during a subsequent freeze-thaw cycle.Patients were followed up for 3 years.Results The dual trigger treatment did not affect CLBR,which is an overall determinant of the success rate of assisted reproductive technology(ART).Women in the dual trigger group had significantly higher rates of fertilization than those in the hCG group(90.1%vs.83.9%,P=0.040).Conclusion Dual trigger with GnRH agonist and hCG did not improve CLBR in patients with DOR,but did slightly improve fertilization rate,oocyte count,and embryo quality.

The Law of Diminishing Returns in Determining the Environmental Cost of Mining in the Eastern Mediterranean Sea

Environmental standards,as independent/explanatory variables of C21 capital costing functions,may refer to parts of space that we want to control in order to protect subsystems that are particularly sensitive and/or importance.In these cases,we need a quantitative relationship that links the environmental characteristics of the source of pollution to those of the reference/control points.In this article we will identify the capital cost functions C21=f(Sf),where Sf is a spatially distributed parameter(e.g.BOD),characteristic of an environmental model.

Comment on Marx's Theory of the Law of Diminishing Land Fertility

Marx＇s theory of the law of diminishing land fertility is an indispensable part of Marx＇s theory of rent. Marx not only denied the non-scientific component of the theory, but also affirmed the scientific component of the theory. China＇s theoretical circles have held a total negative attitude towards the theory for a long term, which has brought serious consequences to research on agricultural economic theory and agricultural production practice. Comprehensively understanding the scientific connotation of Marx＇s theory of the law of diminishing land fertility has extremely important theoretical and practical significance for reducing the blindness of land investment and improving the investment efficiency of land.

Analysis of uterine artery and sex hormones in treating diminished ovarian reserve with tiaojing decoction

Objective: To observe the effect of tiaojing decoction and climen on diminished ovarian reserve patients with de ficiency of Kidney-Yin by sex hormone and uterine artery blood flow parameters. To verify the e ffectiveness of tiaojing decoction on diminished ovarian reserve and uterine artery blood flow parameters, explore the correlation between uterine artery blood flow parameters and sex hormones. Methods: Total 60 diminished ovarian reserve patients with deficiency of Kidney-Yin were randomly divided into the experimental group (n=30, taking tiaojing decoction and climen) and the control group (n=30, taking climen) and they were treated in 3 months. Observe bFSH, bE2, uterine artery PSV, EDV, S/D, RI before and after the treatment in the 2-4 day of menstruation. Results: After treatment, serum sex hormone levels and uterine artery blood flow parameters of the two groups were significantly different (P < 0.05), and the experimental group was significantly better than the control group. There was a linear correlation between PSV and FSH, PSV and E2, FSH and E2. Conclusion: Tiaojing decoction combined with climen has significant effect on diminished ovarian reserve patients with deficiency of Kidney-Yin. Uterine artery blood flow parameters can reflect the sex hormone levels.

Treatment Progress in Diminished Ovarian Reserve:Western and Chinese Medicine

Diminished ovarian reserve(DOR),generally defined as a decreased number or quality of oocytes,has a significant impact on quality of life and fertility in women.In recent years,the incidence of DOR has been increasing and the ages of patients are younger.The search for an effective DOR treatment has emerged as one of the preeminent research topics in reproductive health.An effective DOR therapy would improve ovarian function,fertility,and quality of life in patients.In this review we evaluated DOR treatment progress both in Western medicine and Chinese medicine,and elucidated the characteristics of each treatment.

Effects of Zishen Yutai Pills on in vitro Fertilization-Embryo Transfer Outcomes in Patients with Diminished Ovarian Reserve:A Prospective,Open-Labeled,Randomized and Controlled Study

Objective:To explore the effects of Zishen Yutai Pills(ZYPs)on the quality of oocytes and embryos,as well as pregnancy outcomes in patients with diminished ovarian reserve(DOR)receiving in vitro fertilizationembryo transfer(IVF-ET).The possible mechanisms,involving the regulation of bone morphogenetic protein 15(BMP15)and growth differentiation factor 9(GDF9),were also investigated.Methods:A total of 120 patients with DOR who underwent their IVF-ET cycle were randomly allocated to 2 groups in a 1:1 ratio.The patients in the treatment group(60 cases)received ZYPs from the mid-luteal phase of the former menstrual cycle by using gonadotropin-releasing hormone(Gn RH)antagonist protocol.The patients in the control group(60 cases)received the same protocol but without ZYPs.The primary outcomes were the number of oocytes retrieved and high-quality embryos.Secondary outcomes included other oocyte or embryo indices as well as pregnancy outcomes.Adverse events were assessed by comparison of the incidence of ectopic pregnancy,pregnancy complications,pregnancy loss,and preterm birth.Contents of BMP15 and GDF9 in the follicle fluids(FF)were also quantified with enzymelinked immunosorbent assay.Results:Compared with the control group,the numbers of oocytes retrieved and high-quality embryos were significantly increased in the ZYPs group(both P<0.05).After treatment with ZYPs,a significant regulation of serum sex hormones was observed,including progesterone and estradiol.Both hormones were up-regulated compared with the control group(P=0.014 and 0.008),respectively.No significant differences were observed with regard to pregnancy outcomes including implantation rates,biochemical pregnancy rates,clinical pregnancy rates,live birth rates,and pregnancy loss rates(all P>0.05).The administration of ZYPs did not increase the incidence of adverse events.The expressions of BMP15 and GDF9 in the ZYPs group were significantly up-regulated compared with the control group(both P<0.05).Conclusions:ZYPs exhibited beneficial effects in DOR patients undergoing IVF-ET,resulting in increments of oocytes and embryos,and up-regulation of BMP15 and GDF9 expressions in the FF.However,the effects of ZYPs on pregnancy outcomes should be assessed in clinical trials with larger sample sizes(Trial reqistration No.Chi CTR2100048441).

补肾活血方治疗肾虚血瘀型卵巢储备功能下降患者的临床疗效观察

目的观察补肾活血方对肾虚血瘀型卵巢储备功能下降(DOR)患者的治疗效果。方法选取北京妇产医院中医科2021年1月至2022年12月就诊的180例诊断为DOR的肾虚血瘀型患者作为研究对象,采用计算机随机分组法分为雌二醇片/雌二醇地屈孕酮片组(西药组)、补肾活血方组(中药组)和补肾活血方联合雌二醇片/雌二醇地屈孕酮片组(联合组),各60例。观察三组治疗前后卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E_(2))、抗米勒管激素(AMH)、窦卵泡数(AFC)、卵巢体积、卵巢动脉和子宫动脉阻力指数(RI)、子宫内膜厚度的变化,比较三组中医证候评分及疗效。结果11例患者(4例来自西药组,3例来自中药组,4例来自联合组)退出研究。6个月后,三组FSH和LH均显著降低,E_(2)和AMH升高(P<0.05);西药组和联合组较中药组FSH降低更显著,E_(2)升高更显著(P<0.01)。治疗后,中药组和联合组卵巢体积增加(P<0.05),AFC显著增加(P<0.01),卵巢动脉RI显著降低(P<0.01);西药组卵巢体积增加不显著(P>0.05),AFC显著增加(P<0.05),卵巢动脉RI显著降低(P<0.05);三组子宫动脉RI均无显著改善(P>0.05)。三组子宫内膜厚度均显著增加(P<0.05),西药组和联合组较中药组增加更显著(P<0.01)。与治疗前相比,三组治疗后中医证候评分均显著降低(P<0.05),且中药组和联合组中医证候评分降低的程度大于西药组(P<0.05)。西药组总有效率为71.43%,中药组为82.46%,联合组为85.96%;联合组的疗效优于西药组(P<0.05)。结论补肾活血方能够通过平衡激素水平、促进排卵和修复子宫内膜对DOR患者产生良好的治疗效果,联合应用雌二醇片/雌二醇地屈孕酮片可能是治疗DOR的一种行之有效的治疗策略。

补肾益冲方对卵巢储备功能减退大鼠卵巢组织形态及性激素的影响

目的:研究补肾益冲方对卵巢储备功能减退(DOR)模型大鼠卵巢功能的影响。方法:选取雌性未孕SD大鼠40只,随机分为空白组、模型组、补肾益冲方组、补佳乐组。除空白组外,其余大鼠采用雷公藤多苷片混悬液灌胃制备DOR大鼠模型,造模成功后分别给予补肾益冲方及补佳乐进行相应的治疗干预。药物干预结束后,采用酶联免疫吸附试验法(ELISA)检测大鼠血清中抗苗勒管激素(AMH)、促卵泡生成素(FSH)、雌二醇(E_(2))、促黄体生成素(LH)的水平;HE染色观察大鼠卵巢组织的病理学形态变化。结果:与空白组比较,模型组大鼠血清FSH和LH水平升高(P<0.05),AMH和E_(2)水平降低(P<0.05);卵巢中原始卵泡和生长卵泡的数量减少,闭锁卵泡增加;卵巢间质增生并纤维化。补肾益冲方干预后,DOR大鼠血清中FSH和LH激素水平降低(P<0.05),AMH和E_(2)激素水平升高(P<0.05);卵巢组织形态得到改善,原始卵泡和生长卵泡增多,闭锁卵泡减少。结论:补肾益冲方对DOR大鼠卵巢组织形态、卵母细胞的数量和质量具有改善作用,能调节AMH、FSH、E_(2)和LH从而提高DOR大鼠的卵巢储备功能。

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。

视觉感知中的边际效应递减现象

边际效应递减法则是经济学基本理论,在管理、环境、教育等很多领域都实证了该法则的存在性.文中通过实验验证视觉感知中是否存在边际效应递减现象.首先选取随机生成的散点图作为实验数据,选取散点图相关性作为感知对象,招募参与者并设计了实验流程;然后让参与者根据视觉感知估计散点图相关系数大小,并记录参与者在多次测试中的感知偏差和完成时间等量化指标;最后用基数效应理论计算散点图相关性视觉感知偏差的总效应曲线和边际效应曲线,并选取边际效应作为评价指标.实验结果表明,参与者在实验中出现了边际效应递减现象,即随着测试次数的增加,参与者相关性视觉感知偏差的减小幅度呈现降低趋势;同时,参与者容易低估相关性,有可视化专业知识的参与者和其他参与者在感知偏差与完成时间上不存在显著性差异.

卵巢储备功能减退不孕中医药联合辅助生殖临床诊疗专家共识

不孕症是育龄期女性常见的难治病之一,世界卫生组织将其定为仅次于肿瘤和心脑血管病的第三大疾病。随着社会发展、人类生活环境和精神压力的改变,不孕症发病率逐年增高,卵巢储备功能在其中起到了重要作用。随着年龄增加,女性生育能力下降,这与卵母细胞的数量减少、质量下降有关,称为卵巢储备功能减退(diminished ovarian reserve,DOR)[1]。DOR在不孕症人群中的发病率为10%,其发病率有逐年上升及年轻化的趋势,约占女性卵巢疾病的20%。

年轻女性卵巢储备功能减退的现状及影响因素分析

目的:分析年轻女性(<35岁)卵巢储备功能减退(DOR)的影响因素。方法:选取2018年1月至2021年12月就诊于西安交通大学第二附属医院生殖医学中心的1250例年轻女性(<35岁)。收集患者的一般情况[体质量指数(BMI)、流产史、月经史、分娩史、职业、教育程度、婚姻状态、居住地、运动、睡眠及工作情况等]及实验室数据[血脂、血糖、D-二聚体(D-D)、维生素D、同型半胱氨酸(HCY)、抗苗勒管激素(AMH)、窦卵泡数(AFC)、基础卵泡刺激素(bFSH)等]。根据有无DOR发生,将研究对象分为DOR组与对照组,对两组患者的各项指标进行单因素分析,进一步行多因素logistic回归确定年轻女性DOR的影响因素。结果:1250例年轻女性中,DOR者87例,占6.96%。单因素分析显示,BMI、月经周期、流产次数、运动规律、睡眠周期、睡眠时长、睡眠质量、饮食口味、工作类型、夜班工作、精神因素、吸烟、既往史、血清TC值及LDL值是具有统计学意义的DOR的影响因素。多因素logistic回归分析显示,BMI异常、流产次数(≥2次)、油炸/油腻饮食、血清TC值、夜班工作、脑力工作、既往史是年轻女性DOR的危险因素(P<0.05),月经周期规律、运动规律、睡眠质量及睡眠时长(>8h)是年轻女性DOR的保护因素(P<0.05)。结论:BMI异常、流产次数(≥2次)、油炸/油腻饮食、夜班工作、脑力工作、既往史及血清TC值是年轻女性DOR的危险因素,月经周期规律、运动规律、睡眠质量及睡眠时长(>8h)是年轻女性DOR的保护因素。建议年轻女性,保持健康的生活方式,同时积极治疗并发症,防止日后DOR的发生及生育困难。

针刺对卵巢储备功能减退大鼠血清激素及PI3K/Akt/mTOR信号通路蛋白表达的影响

目的:观察针刺对卵巢储备功能减退(DOR)大鼠血清激素、卵巢形态学变化及卵巢组织中p-PI3K、p-Akt及p-mTOR蛋白表达的影响,探索针刺治疗DOR的可能机制。方法:18只SPF级SD雌性大鼠随机分为空白组、模型组和针刺组,每组6只;模型组、针刺组采用腹腔注射环磷酰胺制备DOR大鼠模型,空白组仅腹腔注射同等量生理盐水。造模后针刺组取肾俞、关元、中极、气海、太溪、双侧三阴交和双侧子宫穴进行针刺,每次留针20 min,1次/d,连续21 d。空白组、模型组:仅抓取不进行干预,1次/d,连续21 d。观察比较各组间大鼠的血清激素改变情况,HE染色法观察大鼠卵巢形态学改变、卵巢中各级卵泡及黄体的数目变化,颗粒细胞层厚度改变;免疫组织化学法、Western blot法检测卵巢组织中p-PI3K、p-Akt及p-mTOR的蛋白表达。结果:与空白组比较,模型组血清FSH、LH水平升高(P<0.05),血清E2、AMH水平降低,差异具有统计学意义(P<0.05);卵巢组织中各级卵泡数明显减少,差异具有统计学意义(P<0.05);卵巢组织中PI3K、Akt及mTOR蛋白表达水平升高,差异具有统计学意义(P<0.05)。与模型组比较,针刺组血清FSH、LH水平显著降低,差异具有统计学意义(P<0.05);血清E2、AMH水平显著升高,差异具有统计学意义(P<0.05);卵巢组织中各级卵泡数明显增多,差异具有统计学意义(P<0.05);卵巢组织中p-PI3K、p-Akt及p-mTOR蛋白表达水平降低,差异具有统计学意义(P<0.05)。结论:针刺可以有效改善DOR大鼠卵巢储备功能,促进卵泡数量增加。作用机制可能与针刺调节卵巢组织中p-PI3K、p-Akt及p-mTOR蛋白表达有关。

基于相关细胞凋亡途径探讨补肾健脾方调控大鼠卵巢储备功能减退的机制研究

目的观察补肾健脾方对环磷酰胺诱导的卵巢储备功能减退大鼠模型卵巢功能的影响,并基于肿瘤坏死因子诱导相关细胞凋亡途径探讨补肾健脾方调控大鼠卵巢储备功能减退的机制研究。方法60只动情周期正常的健康雌性SD大鼠,随机分成正常组10只和造模组50只,造模组采用环磷酰胺75 mg/kg单次腹腔注射造模。造模成功的大鼠再随机分为模型组、西药组[戊酸雌二醇0.103 mg/(kg·d)+黄体酮胶囊2.575 mg/(kg·d)]、补肾健脾方低剂量组[3.21 g/(kg·d)]、补肾健脾方中剂量组[6.43 g/(kg·d)]、补肾健脾方高剂量组[12.85 g/(kg·d)],每组10只。正常组及模型组均予等体积蒸馏水灌胃,每组干预1次/d,干预14 d。检测各组大鼠动情周期、体质量、卵巢脏器指数、子宫脏器指数;ELISA法检测大鼠血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、γ干扰素(interferon-γ,IFN-γ)含量;免疫荧光法检测大鼠卵巢颗粒细胞内B细胞淋巴瘤-2(B-cell lymphoma-2,Bcl-2)、Bcl-2相关X蛋白(Bcl-2 associated X protein,Bax)蛋白表达情况;HE染色检测卵巢组织病理情况;Western blot法检测卵巢磷酸化蛋白激酶B(posphorylated-proteinkinase B,p-AKT)、磷酸化哺乳动物雷帕霉素靶蛋白(p-mammalian target of rapamycin,p-mTOR)、自噬蛋白苄氯素-1(Beclin-1)表达情况。结果与正常组比较,模型组大鼠动情周期紊乱,可见卵巢结构紊乱、各级卵泡数量不同程度的减少、未见成熟卵泡,卵巢间质中见到明显炎细胞浸润;大鼠体质量、卵巢脏器指数和子宫脏器指数无明显变化;血清TNF-α、IFN-γ水平升高(P<0.05,P<0.01);卵巢颗粒细胞Bcl-2、Bax、Beclin-1蛋白表达水平升高(P<0.05,P<0.01),p-AKT、p-mTOR蛋白表达水平降低(P<0.01)。与模型组比较,西药组及补肾健脾方低、中剂量组血清TNF-α、IFN-γ水平降低(P<0.05,P<0.01);补肾健脾方中剂量组Bax蛋白表达水平降低(P<0.05);补肾健脾方高剂量组Bcl-2蛋白阳性表达升高(P<0.05);西药组、补肾健脾方低剂量组Beclin-1蛋白表达水平降低(P<0.05,P<0.01),p-AKT、p-mTOR蛋白表达水平升高(P<0.01)。与西药组比较,补肾健脾方高剂量组TNF-α水平升高(P<0.01);补肾健脾方低、高剂量组IFN-γ水平降低(P<0.05);补肾健脾方低剂量组Bax蛋白表达水平升高(P<0.05),补肾健脾方中剂量组Bcl-2蛋白水平表达升高(P<0.05);补肾健脾方中、高剂量组Beclin-1蛋白表达水平升高(P<0.05,P<0.01),p-AKT、p-mTOR蛋白表达水平降低(P<0.01)。结论补肾健脾方可改善卵巢病理变化、提高卵巢储备功能,其机制可能通过抑制肿瘤坏死因子TNF-α、IFN-γ表达,增强Bcl-2蛋白表达水平,降低Bax蛋白表达水平,激活mTOR通路抑制大鼠卵巢颗粒细胞的自噬与凋亡,从而改善环磷酰胺造模所致的大鼠卵巢储备功能减退的影响。

卵巢功能减退患者多周期累积与非累积胚胎移植临床结局比较

目的探讨卵巢功能减退(DOR)患者多周期累积与非累积胚胎移植体外受精-胚胎移植(IVF-ET)临床结局的差异。方法回顾性分析2019-01至2022-12于首都医科大学附属北京妇产医院生殖医学科进行IVF-ET治疗的卵巢储备功能减退的不孕患者174例的临床资料,纳入患者均已完成所有胚胎移植及最终随访。收集患者的基础内分泌、抗苗勒管激素水平及窦卵泡计数,记录促排卵治疗后的卵巢反应参数及妊娠结局等相关临床资料,比较多周期累积胚胎移植(累积组)与非累积胚胎移植(非累积组)两种IVF-ET治疗的临床结局。结果DOR患者多周期累积胚胎移植与非累积胚胎移植两组间的累积妊娠率(35.24%vs.27.54%)、早期流产率(32.43%vs.26.32%)及累积活产率(21.90%vs.18.84%)差异无统计学意义(P>0.05);纳入移植策略、BMI、首次取卵年龄、AMH、胚胎移植数、优质胚胎移植数、累积获卵数等多个因素后进行logistic回归分析,两种不同的胚胎移植策略(OR=1.522,95%CI 0.608~3.814)对活产无明显影响(P>0.05)。结论对于DOR患者,进行多周期重复取卵后的累积胚胎移植并不能提高患者的累积妊娠率及活产率。

基于海派特色的中医药治疗卵巢储备功能减退不孕症专家共识

随着社会经济的发展,人们的生育观念发生改变,晚婚晚育的人群增多,女性生育年龄不断延后,高龄女性的生育需求逐步增加。但随着年龄的增长,女性卵巢内卵母细胞的数量和质量随之下降,血清卵泡刺激素(FSH)水平升高、抗苗勒管激素(AMH)水平下降、窦卵泡计数(AFC)减少,既而出现月经紊乱、雌激素缺乏相关症状、生育能力降低甚至不孕等临床表现,即卵巢储备功能减退(DOR)[1],人群中DOR的发生率为10%~35%[2]。