目的:旨在评估低体质量对中国女性体外受精-胚胎移植(IVF-ET)新鲜周期妊娠率及活产率的影响.方法:回顾性研究2013年1月—2018年10月于河北医科大学第二医院生殖中心首次接受IVF/胞浆内单精子注射(ICSI)助孕的新鲜周期共8171个周期.其中,低体质量组[体质量指数(BMI)<18.5 kg/m2]共774个周期,正常体质量组(BMI 18.5～23.9 kg/m2)共7397个周期.结果:低体质量组患者的生化妊娠率和种植率低于正常体质量组(均P<0.05),但2组的临床妊娠率、流产率、活产率、早产率和足月产率比较,差异均无统计学意义(均P>0.05).结论:低体质量可能对人类辅助生殖技术(ART)新鲜周期的妊娠结局存在负面影响.

目的 探讨来曲唑联合拮抗剂方案对体外受精-胚胎移植中低反应患者的着床率及妊娠结局的影响.方法 选取2011年5月至2017年6月收治的体外受精-胚胎移植中低反应患者150例,采用随机数字表法分为对照组和研究组.对照组应用拮抗剂方案,研究组应用来曲唑联合拮抗剂方案.比较2组周期特点、妊娠结局、着床率.结果 研究组Gn总用量、Gn起始量、Gn平均用量、E2、Gn使用时间、内膜厚度均低于对照组(P<0.05),而LH、P高于对照组(P<0.05;研究组临床妊娠率、活产率、胚胎种植率均高于对照组(P<0.05),自然流产率低于对照组(P<0.05);研究组着床率高于对照组(P<0.05).结论 来曲唑联合拮抗剂方案对体外受精-胚胎移植中低反应患者的妊娠结局以及着床率具有一定的正面影响,以改善卵巢功能.

目的 探讨卵泡期长效长方案在不同卵巢反应患者中的治疗效果.方法 回顾性分析2015年1月至2019年1月在本院生殖医学中心行IVF/ICSI-ET助孕第1周期鲜胚移植的患者资料共7323例(7323周期),根据促排卵方案不同分为黄体期短效长方案组(A组,n=4379)和卵泡期长效长方案组(B组,n=2944);各方案组再根据获卵数分为不同亚组:获卵数＜5者为A1组(n=346)、B1组(n=171),5≤获卵数≤15为A2组(n=3280)、B2组(n=2122),获卵数＞15者为A3组(n=753)、B3组(n=651).统计分析各组间患者基本资料、获卵移植情况及妊娠结局.结果 (1)与A1组相比,B1组基础窦泡数、Gn天数、Gn剂量显著升高,HCG日LH及孕酮值显著降低(P＜0.05);两组间胚胎情况与妊娠结局无显著性差异(P＞0.05).(2)与A2组相比,B2组的基础 LH水平、基础窦泡数、Gn天数、Gn总量显著升高,而HCG日LH、E2、P水平显著降低(P＜0.05);B2组的获卵数和MⅡ卵数较A2组显著升高,但可移植胚胎数及移植胚胎数显著下降(P＜0.05);B2组的临床妊娠率及活产率较A2组显著升高,而异位妊娠率显著下降(P＜0.05).(3)与A3组相比,B3组的基础LH、基础窦泡数、Gn天数和Gn总量显著升高,HCG日LH、E2、孕酮水平显著降低(P＜0.05);B3组的获卵数和MⅡ卵数显著高于A3组,而可移植胚胎数却显著低于A3组(P＜0.05);两组间妊娠结局无显著性差异(P＞0.05).结论 卵泡期长效长方案在各种卵巢反应的患者的新鲜周期治疗中均可取得不劣于经典长方案的治疗结果.

目的 探讨来曲唑改善体外受精-胚胎移植中卵巢慢反应患者的临床效果及机制.方法 选取2016年7月至2017年2月收治的使用常规长方案进行IVF/ICSI采卵周期并出现卵巢慢反应的患者40例,根据临床治疗方案不同将其分为来曲唑组和rLH组,每组20例.比较2组患者Gn用药数、用药时间、促排卵治疗反应情况、妊娠情况、血与卵泡液中雄烯二酮、睾酮、孕激素、雌二醇水平.结果 来曲唑组Gn用药数、用药时间短于rLH组,差异有统计学意义(P<0.05),促排卵治疗效果高于rLH组,差异有统计学意义(P<0.05);来曲唑组周期取消率、着床率高于rLH组,差异有统计学意义(P<0.05),获卵数多于rLH组,差异有统计学意义(P<0.05);来曲唑组继续妊娠、临床妊娠、妊娠率高于rLH组,差异有统计学意义(P<0.05);来曲唑组雄烯二酮、睾酮、孕激素水平高于rLH组,差异有统计学意义(P<0.05),雌二醇水平低于rLH组,差异有统计学意义(P<0.05).结论 体外受精-胚胎移植中卵巢慢反应患者治疗中,来曲挫的效果显著,值得应用.

目的 通过观察辅助生殖技术中控制性超促排卵(COH)前后阴道微生态环境,探讨COH对阴道微生态的影响及阴道微生态对妊娠结局的影响.方法 纳入行体外受精-胚胎移植(IVF-ET)周期第1周期长方案COH患者150例,在COH前和人绒毛膜促性腺激素(HCG)日2次行阴道微生态检查,比较阴道微生态变化对妊娠结局的影响.结果 COH后阴道微生态失调者较COH前显著增加(15.3％vs 32.0％,P<0.05);COH前已有阴道微生态异常者更容易发生微生态失调(26.8％vs 60.9％,P<0.01);阴道微生态失调者生化妊娠率、临床妊娠率、种植率、活产率均降低,流产率增高,但差异无统计学意义(P>0.05).结论 COH可引起阴道微生态失调,这可能直接或间接改变胚胎种植环境而对妊娠结局产生一定程度的影响;可在HCG日对COH者行二次阴道微生态检查,并注意加强宣教及外阴清洁、护理,有助于改善妊娠结局.

Endometrial receptivity refers to a progesterone-mediated period in which the endometrial tissue undergoes cell proliferation and differentiation.It's crucial for the early stage of embryo implantation.Endocannabinoids system (ECS) participates in body's physiological metabolism,which has a wide distributing in central nervous system and plays an important role in regulating metabolism and reproduction.The dynamic changes of the main endocannabinoid-N-arachidonoylethanolamine (AEA) are involved in the early embryonic development.In this review,we briefly give an overview of the relationship between endometrial receptivity and ECS,to explore the effect of ECS in endometrial receptivity and pregnancy.

目的 研究不同剂量促性腺激素释放激素拮抗剂(GnRH-ant)对卵巢储备功能正常的IVF/ICSI-ET患者临床结局的影响.方法 回顾性分析2016年1月至2017年4月行IVF/ICSI-ET助孕的600例卵巢储备功能正常的患者的临床资料.其中GnRH激动剂(GnRH-a)长方案组200例,GnRH-ant 0.125 mg组(半量组)200例,GnRH-ant 0.25 mg组(全量组)200例,对3组患者临床和实验室资料进行比较.结果 半量组添加拮抗剂时血黄体生成素(LH)水平显著低于全量组,其所需的拮抗剂剂量也显著减少.两拮抗剂组ICSI卵子成熟率高于激动剂长方案组,OHSS发生率低于激动剂长方案组.3组间早熟的LH峰发生率相当,临床妊娠率和活产率无差异.结论 在卵巢储备功能正常的患者中应用拮抗剂方案可以提高ICSI卵子成熟率并降低OHSS发生的风险,但对临床结局无影响,可以作为卵巢功能正常患者的一个很好的促排卵选择,0.125 mg和0.25 mg拮抗剂组临床结局无差异,在适宜的患者中应用半量拮抗剂方案可以在保证治疗效果的前提下为患者减轻经济负担.

Objective To explore the clinical effect and safety of Kuntai Jiaonang (坤泰胶囊) in treating patients with hypofunction of ovarian reserve infertility.Methods Sixty-eight patients with hypofunction of ovarian reserve infertility were randomized into a treatment group (33 cases) and a control group (35 cases).The treatment group was given oral Kuntai Jiaonang,2.0 g each time,3 times each day.The control group was given oral dehydroepiandrosterone,25 mg each time,3 times each day.The course in both groups was 3 menstrual cycles.During treatment,patients' medication,side effect and pregnancy were examined.At the end of treatment,follow-up was carried out for 4 cycles of in vitro fertilization and embryo transfer.Patients' serum levels of basal follicle stimulate hormone (FSH),basal estradiol (E2),luteinizing hormone (LH) and follicular stage anti-Mullerian hormone (AMH),as well as basal antral follicle number (AFC),clinical pregnancy rate of in vitro fertilization and embryo transfer during follow-up and periodic clinical pregnancy rate were compared between two groups before and after treatment.Results Compared between patients in two groups before and after treatment,there were no significant differences in levels of FSH,E2,LH and AFC (P ＞ 0.05).In the treatment group,5 patients did not go through in vitro fertilization and embryo transfer.The clinical pregnancy was 5 cases in the treatment group,and 9 cases in the control group.In the first cycle,the clinical pregnancy was 3 of 17 cases in the treatment group,and 1 of 21 cases in the control group.In the second cycle,the clinical pregnancy was 1 of 9 cases in the treatment group,and 2 of 20 cases in the control group.In the third cycle,one of two patients in the treatment group,and 4 of 6 patients in the control group were pregnant.In the forth cycle,there was no transfer patient in the treatment group,and the pregnancy in the control group was 2 of 2 cases.During the research,some patients in the control group had facial acne.No side effect was found in the treatment group.Conclusion The improvement of ovarian reserve function and clinical pregnancy rate in patients with hypofunction of ovarian reserve infertility by Kuntai Jiaonang was equivalent to that by dehydroepiandrosterone.Moreover,Kuntai Jiaonang seems to be safe.

目的 探讨卵母细胞玻璃化冷冻复苏后行ICSI授精前培养最佳的时间.方法 回顾分析行卵母细胞解冻患者32例共33周期,根据卵母细胞解冻后不同培养时间将33周期分两组:A组卵母细胞解冻后培养4h行ICSI 20周期,解冻卵母细胞202枚,20周期均移植;B组3h≤卵母细胞解冻后培养时间＜4 h行ICSI 13周期,解冻卵母细胞109枚,其中11周期移植,另外2周期因受精后胚胎质量差未移植.比较两组卵母细胞存活率、受精率、卵裂率、可利用胚胎率、种植率以及临床妊娠率.结果 A、B两组患者平均年龄、平均移植胚胎数差异无统计学意义(P＞0.05);A、B两组卵母细胞存活率分别为94.6％、93.6％,受精率和2PN受精率分别为95.3％、90.1％和89.2％、78.4％,卵裂率和2PN卵裂率分别为95.1％、90.7％和94.5％、82.4％,可利用胚胎率分别为55.2％、51.3％,种植率分别为27.3％、40.9％,解冻周期临床妊娠率分别为55.0％、46.2％,移植周期妊娠率分别为55.0％、54.5％;A、B两组卵母细胞存活率、受精率、卵裂率、可利用胚胎率、种植率、解冻周期临床妊娠率以及移植周期临床妊娠率差异均无统计学意义(P＞0.05),但两组2PN受精率、2PN卵裂率A组高于B组,差异有统计学意义(P＜0.05).结论 ①卵母细胞解冻后培养3～4h行ICSI授精可以获得较好的妊娠结局.②A组2PN受精率、2PN卵裂率高于B组且解冻周期临床妊娠率有增高的趋势,是否卵母细胞解冻后培养时间接近4h即3.5～4h行ICSI有更好的妊娠结局需要以后加大样本量进一步证实.

目的：研究来曲唑（LE）联合尿促性素（HMG）在超重的多囊卵巢综合征（PCOS）促排卵中的效果，探讨其在PCOS促排卵中的优势。方法有生育要求的PCOS患者112例，共152个促排卵周期，随机分为3组。1组：LE与HMG顺序使用组；2组：LE与HMG联合使用组；3组：单纯HMG组。比较3组患者绒促性素（ HCG）注射日成熟卵泡（卵泡直径≥14 mm）的数量、多于3个卵泡的例数、排卵率、卵泡不破裂黄素化综合征（ LUFS）发生率、HCG注射日子宫内膜的厚度、尿促性素用量、诱导排卵时间、周期妊娠率。结果2组患者HCG注射日成熟卵泡的数量显著低于3组（ P ＜0 U．05），多于3个卵泡的例数也显著低于3组（ P ＜0．05）；1、2、3组患者排卵率、LUFS的发生率、HCG注射日子宫内膜的厚度差异均无统计学意义（ P ＞0．05）；2组尿促性素用量和诱导排卵时间均低于1、3组（ P ＜0．05或＜0．01）；1、2组妊娠率均显著高于3组（ P ＜0．05或＜0．01）。结论 LE联合HMG在PCOS促排卵中显示出了单卵泡发育率高，妊娠率高，节约促排卵时间和费用的优势。

目的:研究双酚A (bisphenol A,BPA)暴露对诱导型一氧化氮合酶(inducible nitric oxide synthase,iNos)基因缺失(iNos-/-)的实验鼠卵母细胞染色体不分离的影响.方法:给野生型雌鼠(iNos-/-)和iNos基因敲除(iNos-/-)的雌鼠强饲(oral gavage) BPA 100 μg/(kg·d)或200 μg/(kg·d)连续13d.结果:在iNos“组实验鼠卵细胞MⅡ期非整倍体卵母细胞数量没有显著增加.在iNos-/-组实验鼠卵母细胞染色体分离错误和染色单体提前分离增加.基因表达的特性表明polo样激酶1(PLK1)和RAN GTPase蛋白(RAN)水平在iNos-/-组实验鼠卵细胞的细胞周期和纺锤体的调控大幅下降.结论:iNos可能通过维持蛋白PLK1和蛋白RAN在哺乳类动物卵细胞稳定地表达,直接或间接地保护染色体减数分裂中精确分离;低水平的BPA暴露可能引起具有iNos-/-遗传背景卵细胞染色体畸变.

Objective: To evaluate the efficacy of intravenous calcium infusion on ovarian hyperstimulation syndrome( OHSS) and the effect on early pregnancy outcome of IVF patients. Methods: A randomly prospective clinical trial including 67 patients with high risk of OHSS was performed from December 2012 to January 2013. The patients were randomly divided into two groups after ovum pickup( OPU). The patients in calcium group( n = 34)were intravenously administered with 10 ml of 10% calcium gluconate and 200 ml of saline on the day of OPU,day 1 and day 2 after OPU. The control group( n =33) were intravenously administered with saline 200 ml accordingly. Results: There was no difference in the baseline characteristics,including age,BMI,infertility duration,or basal FSH level between two groups( P 0. 05). The number of retrieved oocytes in calcium group was significantly higher than that in control group( P 0. 05). The depth of ascites on day 3 after OPU in the calcium group was significantly lower than that in the control group( 38. 41±15. 42 mm vs 48. 55±19. 95 mm,P =0. 023). There was no significant difference in the early pregnancy outcome,including clinical pregnancy rate,between two groups( P 0. 05).Conclusions: Intravenous calcium infusion could effectively reduce the ascites of patients with high risk of OHSS,and no side effect was observed on the early pregnancy outcomes of ART.

Objective:To observe the effects of Traditional Chinese Medicine Heshouwuyin on nitric oxide(NO) and inducible nitric oxide synthase(iNOS) content in testis of aging rats.Methods:The subacute aging model rats were made by injecting D-gal into the abdominal cavity continuously;And Heshouwuyin was lavaged for ageing model rats.The NO and iNOS content in testis of rats were respectively detected.Results:Compared with normal control rats,the NO and iNOS content in testis of aging model rats increased significantly(P0.01).Heshouwuyin could inhibit increasing of NO and iNOS content in testis of ageing model rats,there had significant differences between model group and Heshouwuyin pretreatment group,Heshouwuyin anti-aging group(P0.01).Conclusions:Heshouwuyin has fairly anti-aging effects on testis,the mechanisms may be related with decreasing effects on NO and iNOS content in testis.

Objective To explore the effect of bushenfang,huoxuefang,and bushenhuoxuefang on ability of learning and memory,and the content of basic fibroblast growth factor(bFGF) and brain-derived neurotrophic factor(BDNF)in brain tissue of vascular dementia(VD) mouse.Methods Operation of cerebral ischemia reperfusion was used to reproduct the VD model,and the praxiological changes were observed by the means of water maze and the contents of bFGF and BDNF in brain tissue were observed.Results Compared with normal group,the ability of VD model mouse for learning and memory were reduced,which showed extending the time for swimming the whole process,and increasing times of mistakes(P<0.01),and the contents of bFGF and BDNF were increased(P<0.05 or P<0.01).Compared with model group,the learning and memorizing performance record were improved(P<0.05 or P<0.01),and the contents of bFGF and BDNF were increased(P<0.05 or P<0.01) in each treatment group;the learning and memorizing performance record and the contents of BDNF of the bushenhuoxue group were better than those of other treatment group(P<0.05 or P<0.01),the content of bFGF of the bushenhuoxue group was better than that of huoxuefang(P<0.05).Conclusions The bushen,huoxue,and bushenhuoxue traditional Chinese medicine could increase the contents of bFGF and BDNF,and improve the learning and memory capability.Bushenhuoxue is better than bushenfang and huoxuefang in improving learning and memory and increasing BDNF,and better than huoxuefang in increasing bFGF.