ObjectiveTo evaluate the efficacy and safety of the Peiyu Granules (PYG) compared with placebo on early miscarriage rates among women undergoing embryo transfer.MethodsA double-blind, parallel-group randomized clinical trial between February 15, 2017, and June 17, 2019, within 10 months of pregnancy follow-up until March 2020. This clinical trial was conducted at Beijing Obstetrics and Gynecology Hospital, Capital Medical University. A total of 886 women were included in this study. The intervention group (n = 443) received PYG on the night of Embryo Transfer (ET) until the day of the hCG test. If it was negative, the patient stopped taking medicine. In contrast, the treatment continued until 70 days after ET. The women in the control group (n = 443) consumed the same amount of placebo as the intervention group. All women enrolled were subject to the same follow-up protocols. The primary outcome was early miscarriage rate. The secondary outcomes were clinical intrauterine pregnancy rate and live birth rate.ResultsAmong the 886 randomized women (mean [SD] age, 32.8 [3.6] years), 854 women (96.4%) underwent ET and followed the treatment of random grouping. Early miscarriage occurred among 17 of 133 women (12.8%) receiving PYG compared with 35 of 156 women (22.4%) receiving placebo (relative risk[RR], 0.51 [95% CI, 0.27 to 0.95], P = 0.02). Clinical intrauterine pregnancy rates were 30.0% (133 of 443) in the intervention group and 35.2% (156 of 443) in the control group (relative risk[RR], 0.79 [95% CI, 0.60 to 1.05], P = 0.10). Live-birth rates were 25.3% (112 of 443) in the intervention group and 25.7% (114 of 443) in the control group (relative risk[RR], 0.98 [95% CI, 0.72 to 1.32], P = 0.88). Live birth rates in the clinical pregnant population were 84.2% (112/133) in the intervention group and 73.7% (115/156) in the control group (relative risk [RR], 1.14 [95% CI, 1.01 to 1.29], P = 0.03).ConclusionThe findings suggested that PYG reduced early miscarriage rates among women undergoing embryo transfer. However, there were no significant improvement in clinical pregnancy rates and live birth rates.Clinical trial registrationhttps://www.chictr.org.cn/showproj.html?proj=12343 identifier, ChiCTR-inr-16010087.

Objective To evaluate the effect of oral contraceptive (OC) pretreatment on in vitro fertilization (IVF) outcomes in women with polycystic ovary syndrome (PCOS) undergoing the GnRH agonist (GnRH-a) long protocol, compared with other ovarian stimulation protocols.Methods This retrospective study included 121 women with PCOS, diagnosed according to the Rotterdam criteria, who underwent IVF/intracytoplasmic sperm injection (IVF/ICSI) between January and September 2018 at Beijing Obstetrics and Gynecology Hospital. Patients were assigned to one of four protocols: the OC pretreatment + GnRH-a long protocol (three cycles of OC), the standard GnRH-a long protocol, the GnRH antagonist protocol, or the GnRH-a ultralong protocol. Ovarian stimulation characteristics, embryo development, and clinical outcomes were compared among the groups.Results The GnRH-a ultralong protocol required significantly higher total Gn doses and longer stimulation duration than the OC + GnRH-a long protocol. Compared with the standard GnRH-a long protocol, OC pretreatment showed trends toward lower rates of moderate-to-severe ovarian hyperstimulation syndrome (OHSS) and higher biochemical and clinical pregnancy rates, though these differences were not statistically significant. No significant differences were observed among the groups for the number of retrieved oocytes, mature oocytes, fertilized oocytes, or normally developing embryos.Conclusion In PCOS patients, OC pretreatment showed trends toward higher pregnancy rates and lower OHSS, without adverse effects on clinical outcomes. These findings highlight a potentially promising approach, warranting confirmation in larger, high-quality randomized controlled trials.

多囊卵巢综合征(PCOS)是一种多系统生殖-代谢失调综合征,是无排卵性不孕的主要病因.尽管部分PCOS不孕症患者可通过生活方式干预、调经促排、中药等治疗获得妊娠,但对于通过上述治疗仍无法获得妊娠的PCOS患者,体外受精-胚胎移植(IVF-ET)是治疗的有效方法;但不少患者IVF治疗结果不尽如人意,因为内分泌及代谢紊乱、慢性炎症反应和氧化应激状态等病理生理改变常见于PCOS患者中,这些改变互为因果、形成恶性循环,导致IVF治疗周期卵母细胞质量及成熟度不佳、受精率低、胚胎质量差等,影响其辅助生殖治疗结局,增大了 IVF治疗难度.本文将基于PCOS的疾病及病理生理特点,对PCOS不孕患者IVF-ET治疗及其影响因素进行综述.

目的 探讨卵巢储备正常的不孕女性实施体外受精-胚胎移植(IVF-ET)时低获卵数的高危因素.方法 收集2019年1月至2021年10月于我院生殖医学科行IVF-ET的49例卵巢储备正常、控制性卵巢刺激(COS)后获卵数＜4枚的不孕女性为低获卵组,采用1:3比例配对同一时间段行IVF-ET治疗的卵巢储备正常且获卵数＞8枚的不孕患者147例为正常获卵组.比较两组患者的基本资料、既往病史、促排卵情况,并通过多因素回归分析影响卵巢储备正常患者获卵数低的主要影响因素.结果 两组患者的年龄、月经周期、基础LH(bLH)、基础窦卵泡计数(AFC)、抗苗勒管激素(AMH)均无显著性差异(P＞0.05);低获卵组的体质量指数(BMI)显著高于正常获卵组[(25.71±4.37)kg/m2 vs.(22.98±3.55)kg/m2](P＜0.05),基础 FSH(bFSH)亦显著高于正常获卵组[(7.23±2.09)U/L vs.(6.67±1.45)U/L](P＜0.05).两组患者既往妊娠史、宫腔手术史、不孕因素比例均无统计学差异(P＞0.05),低获卵组盆腔手术史比例显著高于正常获卵组(36.73％vs.17.01％)(P＜0.05).两组患者促排卵实验室指标比较均无显著性差异(P＞0.05).多因素回归分析结果显示,高BMI和盆腔手术史是卵巢储备正常患者获卵数＜4枚的主要危险因素(P＜0.05).结论 高BMI和盆腔手术史是卵巢储备正常患者COS后低获卵数的危险因素,临床实践中应关注不孕症患者的体重控制和既往病史的综合评估.

目的 探讨年龄、窦卵泡个数、基础血清促卵泡激素、抗苗勒管激素、基础卵泡刺激素/黄体生成素比值、卵巢反应预测指数评价卵巢反应功能的效果.方法 选取我院生殖医学科首次行体外受精/胞浆内精子注射治疗不孕症的490例患者作为研究对象,对以上指标进行测量和计算.用操作者特征曲线分析变量的预测精度,计算截断值及敏感度和特异度.结果 490例不孕症患者中卵巢低反应61例(12.45％),卵巢正常反应352例(71.84％),卵巢高反应77例(15.71％).年龄、窦卵泡个数、基础促卵泡激素、抗苗勒管激素、基础卵泡刺激素/黄体生成素比值和卵巢反应预测指数在卵巢高反应组的曲线下面积分别为0.674、0.964、0.674、0.842、0.716、0.915,敏感度分别为93.5％、92.2％、84.4％、79.2％、63.6％、83.1％,特异度分别为60.5％、97.7％、44.1％、77.0％、73.8％、89.5％;截断值分别为35.5岁、15个、7.75 U/L、4.325 mg/L、1.633、1.985;在卵巢低反应组的曲线下面积分别为0.616、0.844、0.589、0.789、0.573、0.834,敏感度分别为57.4％、75.4％、44.3％、70.5％、62.3％、78.7％,特异度分别为69.0％、99.8％、55.7％、84.8％、59.2％、85.3％,截断值分别为35.5岁、4个、8.945 U/L、1.085 mg/L、2.252、0.207.结论 对于不孕女性窦卵泡计数和卵巢反应预测指数在评估卵巢反应性方面优于其他变量,且在预测卵巢过度反应方面表现出更好的效果,在预测卵巢低反应方面还需要进一步探索更有预测价值的指标.

To analyze whether the serum concentration of estradiol on the day of progesterone conversion could predict the pregnancy outcome of frozen-thawed embryo transfer in hormone replacement cycle. In this paper, a case-control study was conducted to retrospectively analyze the 230 cycles of hormone replacement therapy-frozen thawed embryo transfer(HRT-FET)conducted by the Department of Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2018 to December 2020. The concentration of serum estradiol was between 139.5-3 941.0 pg/ml. According to the percentile of serum estradiol concentration on the day of endometrial transformation, patients were divided into three groups: control group (<25th percentile, n=58), high estradiol group (25th-75th percentile, n=112) and ultra-high estradiol group (>75th percentile, n=60). Comparing the basic characteristics and pregnancy outcome of the three groups, the main observation index was the live birth rate, and the secondary observation index was the clinical pregnancy rate. F test and Kruskal-Wallis (H) test were used to compare the measurement data, and χ2 test was used to compare the counting data. The results showed that there was no significant difference in age, anti-Müllerian hormone(AMH), antral follicle count(AFC), body mass index(BMI), years of infertility and the proportion of primary infertility among the three groups(F=2.375, H=5.479, H=5.374, F=1.391, H=4.779, χ²=1.969, P>0.05). FET cycle treatment: There was no significant difference in the concentration of progesterone (P) before transformation, the thickness of endometrium on the day of transformation, the proportion of single embryo transfer and blastocyst transfer among the three groups (H=5.359, H=5.957, χ²=0.626, χ²=4.532, P>0.05). The days of estrogen administration before endometrial transformation in the three groups during the FET cycle were 13.0 (12.0, 14.0) days in the high estradiol group and 13.0 (12.0, 15.0) days in the ultra-high estradiol group, which were significantly longer than those in the control group 13.0(12.0, 13.3)days. The E2 concentration before intimal transformation in high estradiol group was 1 560.4 (1 170.2, 1 848.2) pg/ml, while that in ultra-high estradiol group was 2 420.9 (2 131.0, 2 849.2) pg/ml, which was significantly higher than that in control group 238.8 (206.9, 287.0) pg/ml. The pregnancy outcome of the three groups: the clinical pregnancy rate of the three groups was 37.9% in the control group, 51.8% in the high estradiol group and 40.0% in the ultra-high estradiol group, of which the high estradiol group had the highest clinical pregnancy rate, followed by the ultra-high estradiol group. But there was no significant difference among the three groups (χ²=3.853, P>0.05). The embryo implantation rate of the three groups was 19.3%, 25.0%, 32.8%, respectively, and the embryo implantation rate of the ultra-high estradiol group was the highest, but there was no significant difference among the three groups (χ²=5.544,P>0.05).The live birth rate of the three groups was 37.9%, 39.3%, 40.0%, respectively, and the difference was not statistically significant (χ²=0.05, P>0.05). A total of 14(13.5%) abortions occurred in 104 clinical pregnancies, all of which occurred in the high estradiol level group. Of the 104 clinical pregnancies, 24 (23.1%) had twin pregnancies, which occurred in the high estradiol level group (10 cases) and the ultra-high estradiol level group (14 cases). There were no twin pregnancies in the control group. Ectopic pregnancy occurred in 4 of 230 FET cycles (1.7%), 2 in control group and 2 in high estradiol group, and no ectopic pregnancy in ultra-high estradiol group.

慢性子宫内膜炎(chronic endometritis,CE)是一种非特异性的慢性炎症,常见于育龄期女性,因其症状轻微很容易被忽视,故为临床诊断带来难度.子宫内膜间质存在浆细胞为CE诊断的金标准;宫腔镜检查可以辅助提高CE的诊断符合率.CE与胚胎反复种植失败有着紧密联系,通过对CE进行治疗可提高胚胎种植率和临床妊娠率.本文就CE的诊断、治疗及其与胚胎反复种植失败关系的研究进展进行综述,为临床诊疗提供循证医学证据.

Background: Previous literature proposed that the herbal formula Peiyu granules (PYG) can play a certain degree of role in the prevention and treatment of threatened abortion by enhancing the invasion and proliferation of human chorionic trophoblasts. Nevertheless, the heterogeneity of the researches do not allow one to draw unambiguous conclusions on the therapeutic effect of PYG.Methods: A double-blind, parallel-group randomized clinical trial between February 15, 2017, and June 17, 2019, within 10 months of pregnancy follow-up until March 2020. This clinical trial was conducted at the Center of Reproductive Medicine of Beijing Obstetrics and Gynecology Hospital, Capital Medical University. A total of 886 women who met the inclusion criteria and voluntarily signed informed consent form to undergo ET were included in this study. The intervention group (n = 443) received PYG [a dose of 3 bags (10.1 g/bag), 2 times a day] on the night of ET until the day of the hCG test. If it was negative, the patient stopped taking medicine. In contrast, the treatment continued until 70 days after ET. The women in the control group (n = 443) consumed the same amount of placebo as the intervention group. All women enrolled were subject to the same follow-up protocols. The primary outcome was early miscarriage rate, defined as the loss of a viable intrauterine pregnancy up to and including gestational weeks 12 + 0. The secondary outcomes were clinical intrauterine pregnancy rate (fetal heart activity seen at sonography observation on the 28th ~ 35th day after embryo transfer) and live birth rate (at least one live birth after 28 weeks of gestation). Chinese Clinical Trial Registry: ChiCTR-inr-16010087.Results: Among the 886 randomized women (mean [SD] age, 32.8 [3.6] years), 854 women (96.4%) underwent ET and followed the treatment of random grouping. Early miscarriage occurred among 10 of 126 women (7.9%) receiving PYG compared with 25 of 148 women (16.9%) receiving placebo (risk difference, -9.00% [95% CI, -16.66% to -1.34%]; relative risk, 0.47 [95% CI, 0.23 to 0.94], P = 0.03). Clinical intrauterine pregnancy rates were 28.4% (126 of 443) in the intervention group and 33.4% (148 of 443) in the control group (risk difference, -5.00% [95% CI, -11.08% to 1.08%]; relative risk, 0.85 [95% CI, 0.70 to 1.04], P = 0.11). Live-birth rates were 25.3% (112 of 443) in the intervention group and 26.0% (115 of 443) in the control group (risk difference, -0.70% [95% CI, -6.45% to 5.05%]; relative risk, 0.97 [95% CI, 0.78 to 1.22], P = 0.11). In this randomized clinical trial of 886 women undergoing embryo transfer (ET), the early miscarriage rates were 7.9% among women receiving PYG vs 16.9% among women receiving placebo control, a significant difference.Interpretation: Our results show that PYG significantly reduced early miscarriage rates among women undergoing ET compared with placebo and was generally well tolerated. PYG could be an important new treatment option for patients undergoing ET.Trial Registration: Chinese Clinical Trial Registry: ChiCTR-inr-16010087Funding: Beijing Municipal Administration of Hospitals.Declaration of Interest: We declare no competing interests.Ethical Approval: This single-center, randomized, double-blind, placebo-controlled superiority trial, in which ethical approval was obtained from the Ethics Committee, was conducted at the reproductive center in Beijing Obstetrics and Gynecology Hospital, Capital Medical University

目的 分析多囊卵巢综合征(PCOS)患者卵泡液中游离脂肪酸(FFA)的代谢差异,筛选差异FFA标志物,探索相关代谢途径.方法 采用气相色谱-质谱联用(GC-MS)技术对PCOS患者(n=13)和对照组(n=8)的卵泡液样本进行51种FFA的高通量靶向定量检测,根据定量结果利用OriginPro 2022软件和SMPDB代谢物数据库进行代谢组学分析.结果 PCOS组和对照组间卵泡液的FFA代谢具有差异性,共筛选出28种差异FFA.其中有21种FFA在PCOS组中的表达显著上调(P＜0.05),包括亚油酸、γ-亚麻酸、α-亚麻酸、花生四烯酸等;7种FFA表达显著下调(P＜0.05),包括月桂酸、顺-9-肉豆蔻烯酸、反油酸等.SMPDB数据库富集分析后,筛选出α-亚麻酸和亚油酸代谢、脂肪酸生物合成、花生四烯酸代谢等6条脂肪酸代谢通路.结论 筛选出28种PCOS相关的差异FFA,以及6条脂肪酸代谢通路,可为今后PCOS的预防、治疗提供一定的依据和治疗靶点的参考.

To evaluate the effectiveness of bromocriptine for prevention of ovarian hyperstimulation syndrome (OHSS).

女性生育力保护技术的需求急剧增长.全球每年新增恶性肿瘤患者超过1400万例 [1],抗癌治疗在显著降低患者死亡率的同时,其性腺毒性却对患者的卵巢功能造成严重损伤,尤其在造血干细胞移植后,卵巢早衰的发生率可达100％[2].随着发病年龄的年轻化与生育年龄的推迟,78.3％的年轻恶性肿瘤患者有强烈的生育需求 [3].

全球每年新增女性恶性肿瘤患者约920万例 [1],抗癌治疗的性腺毒性可导致卵巢功能严重受损 [2-3],因此开展生育力保护技术尤为重要.卵巢组织冻存是青春期前女童与疾病治疗无法延迟的患者惟一的生育力保护方法 [4],自2004年全球首例活产报道至今 [5],累计出生的婴儿数已超过200例 [6],其有效性与安全性得到广泛的验证,成为一项临床常规技术[7].首都医科大学附属北京妇产医院阮祥燕团队建立了首个卵巢组织冻存库 [8],并于2016年完成了中国首例卵巢组织冻存移植 [9],至今已成功移植10例,术后患者卵巢功能均得以恢复 [10].2021年,阮祥燕团队报道了中国首例自体卵巢组织冻存移植后自然妊娠病例 [11-12],该患者现已顺利分娩,报道如下.

Background: The ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication associated with controlled ovarian hyperstimulation (COS) during assisted reproductive technology (ART) treatment, and effective preventive measures are urgently needed. The dopamine agonist can mitigate OHSS incidence through a decreased vascular permeability via reduced vascular endothelial growth factor (VEGF) production. This study evaluated the clinical effectiveness of bromocriptine, an alternative DA, for prevention of OHSS in high risk women. Methods: The retrospective study population consisted of women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles with GnRH antagonist protocols, at risk of OHSS. The study group included 52 women given 2.5 mg bromocriptine daily by rectal insertion for 5 days beginning on the day of oocyte retrieval; the control group included 52 women given 500 ml intravenous (I.V.) hydroxyethyl starch (HES) daily for 5 days also beginning on the day of oocyte retrieval. The outcomes of ovarian stimulation, incidence and severity of OHSS, blood-related indicators, biochemical indicators (liver and renal function), and coagulation and fibrinolytic activities were compared. Results : The groups were not significantly different in age, estradiol concentration on the day of human chorionic gonadotropin injection, or number of retrieved oocytes. The occurrence of mild (13.46% vs 15.48%) and moderate (7.69% vs 5.77%) OHSS were not significantly different between bromocriptine and HES groups ( P >0.05). No cases of severe or late OHSS were recorded in either group. Only hemocratin levels were significantly higher and activated partial thromboplastin time was significantly lower in the bromocriptine group ( P <0.05) compared to the HES group on Day 5 after oocyte retrieval. No difference in liver or renal function was found between groups. Conclusions: Prophylactic rectal administration of bromocriptine was as effective as I.V. HES for prevention of OHSS.

目的:黄体酮联合雌激素黄体支持方案对自然周期冻融胚胎移植(NC-FET)妊娠结局的影响.方法:回顾性收集2015年7月—2017年12月在本院接受冻融胚胎移植的306例不孕不育患者临床资料,按照治疗方法的不同分为对照组(78例)与观察组(228例),根据雌激素支持剂量的不同将观察组分为低、中、高剂量3个组各76例.对照组给予黄体酮支持,口服黄体酮胶囊及阴道黄体酮软胶囊给药,观察组在对照组基础上联合雌二醇(黄体)支持,分别每天给予补佳乐2mg、4mg、6mg.比较各组患者排卵期血清卵泡刺激素(FSH)、促黄体生成素(LH)、雌二醇(E2)、孕酮(P)水平,移植(ET)日血清P、E2水平及子宫内膜厚度、胚胎移植数目;比较两组胚胎种植率、临床妊娠率、持续妊娠率、早期流产率、异位妊娠率.结果:观察组排卵期E2、P水平,ET日E2水平均高于对照组(P＞0.05),但各剂量组间排卵期FSH、LH、E2、P水平,ET日E2、P、子宫内膜厚度、胚胎移植数目及平均移植优质胚胎数、胚胎种植率、临床妊娠率、持续妊娠率、早期流产率、异位妊娠率等无差异(P＞0.05).临床妊娠率、持续妊娠率、活产率、胚胎种植率及新生儿出生体重,以及早期流产率、异位妊娠率等观察组与对照组均无差异(P＞0.05).结论:黄体酮联合雌激素支持方案较单独黄体酮支持对NC-FET妊娠结局影响未见差异.

目的 调查分析北京市和长治市三级妇幼专科医院女性不孕症患者的病因和特点,为不同级别城市的妇幼医疗保健机构开展更有针对性的不孕症诊治提供参考依据.方法 选取2019年3～6月在首都医科大学附属北京妇产医院生殖医学科(A组,3 652例)和长治医学院附属长治市妇幼保健院妇科(B组,196例)就诊的不孕不育夫妇为调查对象,比较两组女性患者的一般情况、不孕症的病因构成及男女方不孕不育病因特点等.结果 A组女性患者的平均年龄和不孕年限显著高于B组(P＜0.05).不孕病因上,A组女性患者由盆腔因素和男方因素引起不孕的比例显著高于B组(分别为32.12％vs.13.27％和51.23％vs.21.94％,P＜0.05);排卵障碍引起不孕的比例显著低于B组(42.61％vs.77.55％,P＜0.05).两组女性患者均以卵巢性闭经或月经失调引起的不孕症为首位,A组显著低于B组(70.24％vs.80.92％,P＜0.05).男方因素中两组患者均以弱精子症占首位,且A组显著高于B组(98.24％vs.90.70％,P＜0.05).A组患者由2个病因引起不孕的比例显著高于B组(P＜0.05).A组患者由男方因素及男女双方因素引起不孕的比例均显著高于B组(P＜0.05).结论 北京市和长治市三级妇幼专科医院的不孕症病因构成有显著差异,应在现有优势医疗资源的情况下,分别开展有侧重、有针对性的诊治.

目的 分析多囊卵巢综合征(PCOS)患者卵泡液代谢组差异,找寻相关生物学标志物,探讨相关代谢通路变化.方法 利用超高液相色谱-四级杆飞行时间质谱联用技术(UHPLC-QTOFMS)对PCOS患者(n=7)及对照组(n= 6)的卵泡液进行代谢组学分析.结果 PCOS组和对照组组间代谢物分布具有差异性,共计有60种差异代谢物,其中有20种代谢物水平下降(P＜0.05),40种代谢物水平增加(P＜0.05),主要有氨基酸类、脂肪酸类、有机化合物、有机氧化合物等.其中24种物质为脂质类物质,9种物质为氨基酸类.此外,血清睾酮水平与脯氨酸及多种脂肪酸(包括5-羟色胺、PS(22:0/18:4(6Z,9Z,12Z,15Z))、PC(P-18:0/22:4(7Z,10Z,13Z,16Z))、PC(15:0/20:2(11Z,14Z))、24-Epibrassinolide、LysoPI(18:0/0:0)具有相关性(P＜0.05).结论 本研究鉴定出了60种差异代谢物,其中有1种氨基酸、5种脂肪酸与睾酮水平呈正相关;分析了在PCOS中可能发挥重要作用的2种代谢通路:性激素合成代谢和嘧啶代谢通路,可为今后PCOS的治疗、诊断提供一定的依据和治疗靶点参考.

目的 评价体外受精治疗前血清抗苗勒管激素(AMH)水平和窦卵泡计数(AFC)不一致的患者卵巢反应和胚胎情况.方法 选择2020年1月—11月首次在北京妇产医院生殖医学科接受体外受精/卵胞浆内单精子注射(IV F/IC-SI)治疗的424例不孕患者,于月经周期的第2～3天检测血清AM H水平和AFC个数,并根据卵巢高低反应的血清AM H水平和A FC截断值将患者分为9组,比较各组的获卵数和可移植胚胎数.结果 137例患者(第2、4、6、7、8组)出现不一致的AFC和AMH水平,占比32.3％(137/424).AFC值相同而AMH水平不同的组间比较,发现AMH较高组(第1组对第4组、第2组对第5组、第5组对第8组、第6组对第9组)有较高的获卵率及可移植胚胎率,差异有统计学意义(P<0.05).AMH和AFC水平不一致的组间比较,卵巢储备功能偏低人群的血清AMH水平较高组比AFC较高组(第2组对第4组)有更高的获卵数及可移植胚胎数,而卵巢储备功能较好人群的AFC较高组比血清AM H水平较高组(第6组对第8组)有更高的获卵数及可移植胚胎数,差异均有统计学意义(P<0.05).结论 当AMH和AFC不一致时,卵巢反应性介于两者一致时的卵巢高低反应之间.当卵巢储备偏低时,AM H更有预测价值;而卵巢储备较高时,AFC则更有预测价值.

目的 探讨不明原因不孕女性是否存在不同的临床特征及IV F相关指标差异,寻找不明原因不孕的潜在影响因素.方法 选取2019年1～5月于我院生殖医学科首次行IVF/ICSI-ET且年龄≤38岁的66例不明原因不孕患者作为研究对象(U I组),选择同时间段就诊且同年龄分布的因输卵管阻塞因素或单纯男性因素不孕患者76例为对照组,比较两组患者的临床基本资料、促排卵、受精及胚胎发育情况的差异.再根据既往是否有妊娠史对两组患者进行亚分组,分别进行上述指标的单因素比较,并将单因素分析P<0.05的变量和临床认为可能与不明原因不孕相关的变量进行多因素Logistic回归分析,筛选不明原因不孕的独立影响因素.结果 两组患者基本资料比较,除UI组无既往妊娠史比例显著高于对照组外,其余指标均无显著性差异(P>0.05);两组的促排卵情况及受精与胚胎发育情况均无显著性差异(P>0.05).亚组分析中,无既往妊娠史不孕患者中UI组的扳机日直径>17 mm卵泡数量[(3±2)vs.(5±2)个]、优质胚胎数[1(0,4)vs.4(2,5)个]和优质胚胎率(44.19％vs.62.71％)均显著低于对照组(P<0.05);多因素Logistic回归分析结果显示,校正混杂因素后基础窦卵泡计数(AFC)[OR=0.790,95％CI(0.702,1.068),P=0.049]、扳机日>17 mm卵泡数[OR=1.172,95％CI(0.550,1.050),P=0.023]及优质胚胎数[OR=0.496,95％CI(0.762,1.488),P=0.039]是无既往妊娠史不明原因不孕的独立影响因素.有既往妊娠史不孕患者中UI组和对照组的基本资料、促排卵情况、胚胎发育情况均无显著性差异(P>0.05);多因素Logistic回归分析结果显示,各项指标均不是有既往妊娠史不明原因不孕的硬性因素.结论 潜在的卵巢储备功能下降和胚胎质量下降可能与无既往妊娠史的不明原因不孕相关.

目的 比较拮抗剂方案和早卵泡期高孕激素促排卵方案在POSEIDON 3型卵巢低反应(POR)不孕患者进行体外受精-胚胎移植(IVF-ET)中的获卵情况及胚胎情况.方法 回顾了2019年3-12月于首都医科大学附属北京妇产医院生殖医学科行IVF-ET进行助孕治疗的POSEIDON 3型卵巢低反应患者的临床资料,其中拮抗剂方案114例,高孕激素促排卵方案36例,比较两组患者的基本资料:促排用药量、取卵数、成熟卵子数、成胚数、优质胚胎数、成熟卵率、可移植胚胎率和优质胚胎率.结果 两组患者的临床基础资料无显著性差异.促性腺激素(Gn)起始剂量、天数及总用量、HCG日雌二醇水平、获卵数、成熟卵子数、可用胚胎数、优质胚胎数两组间无显著性差异;早卵泡期高孕激素促排卵方案中的成熟卵率、优质胚胎率显著高于拮抗剂方案组(P＜0.05).结论 对于POSEIDON 3型POR患者,早卵泡期高孕激素促排卵方案较拮抗剂方案具有更高的成熟卵率和优质胚胎率,因此,早卵泡期高孕激素促排卵方案可以作为POSEIDON 3型POR患者促排卵方案的选择之一.

BACKGROUND:To evaluate the effects of controlled ovarian hyperstimulation (COH) on ovarian reserve function during in vitro fertilization and embryo transfer (IVF-ET). METHODS:From August 2018 to August 2020, the medical records of patients who received IVF-ET in the Department of Reproductive Medicine, Beijing Gynaecology and Obstetrics Hospital, Capital Medical University were analyzed retrospectively. Among them, 372 patients received 2 cycles of COH, 54 patients received 3 cycles, and 13 patients received 4 cycles. The levels of follicle-stimulating hormone (FSH), the number of antral follicles, levels of anti-Müllerian hormone (AMH), the total amount of gonadotropin (GN), the time of ovulation induction, the number of eggs obtained, the number of available embryos, and the number of high-quality embryos cycles were compared in different treatment. RESULTS:The age of female patients did not significantly affect the levels of AMH or FSH during menstruation, nor the number of antral follicles before ovulation induction (P>0.05). However, with an increase in age, an increase in the number of controlled COH cycles was observed. In patients who underwent 2 COH cycles, the number of high-quality embryos in the second cycle increased significantly compared to the first cycle (P<0.05). However, there were no significant differences in the ovulation induction time, the number of eggs, the GN dosage, and the number of available embryos (P>0.05). In patients with 3 treatment cycles, the GN dose used in the third cycle was significantly lower than that used in the first cycle (P<0.05). There were no significant differences in the ovulation induction time, the number of eggs obtained, and the quality of embryos (P>0.05). In patients with 4 treatment cycles, significant differences were observed in the ovulation induction time between the first and the fourth controlled COH cycle (P<0.05). However, no significant differences were detected in GN dosage, ovulation induction time, the number of eggs obtained, the number of available embryos, and the quality of embryos (P>0.05). CONCLUSIONS:Ovarian reserve function was not significantly affected in patients with up to 4 ovarian stimulation cycles.