Objective: To investigate the effect of body mass index (BMI) on progesterone (P) level on trigger day in gonadotropin-releasing hormone antagonist (GnRH-ant) cycles. Methods:This study was a retrospective cohort study. From October 2017 to April 2022, 412 in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) patients who were treated with GnRH-ant protocol for controlled ovarian hyperstimulation (COH) in the reproductive center of our hospital were selected as the research objects. Patients were divided into three groups according to BMI level: normal weight group (n = 230):18.5 kg/m(2)<= BMI < 24 kg/m(2); overweight group (n = 122): 24 kg/m(2)<= BMI < 28 kg/m(2); Obesity group (n = 60): BMI >= 28 kg/m(2). Variables with p < .10 in univariate analysis (BMI, basal FSH, basal P, FSH days, Gn starting dose and E-2 level on trigger day) and variables that may affect P level on trigger day (infertility factors, basal LH, total FSH, HMG days and total HMG) were included in the multivariate logistic regression model to analyze the effect of BMI on P level on trigger day of GnRH-ant protocol. Results: After adjustment for confounding factors, compared with that in normal weight patients, the risk of serum P elevation on trigger day was significantly lower in overweight and obese patients (OR = 0.434 and 0.199, respectively, p < .05). Conclusion: The risk of P elevation on trigger day in GnRH-ant cycles decreased with the increase of BMI, and BMI could be used as one of the predictors of P level on trigger day in GnRH-ant cycles.

Abstract Purpose This study aimed to assess the impact of coronavirus disease 2019 (COVID-19) inactivated vaccination doses on male fertility. Methods A retrospective cohort study was conducted, including 595 assisted insemination with husband's sperm (AIH) cycles involving 438 couples. Participants were categorized into three groups: the unvaccinated group, the 1 or 2 doses group, and the 3 doses group based on their vaccination status before insemination. Reproductive outcomes such as biochemical pregnancy, clinical pregnancy, ongoing pregnancy, and live birth were assessed across the different groups. Results The analysis revealed no significant differences in reproductive outcomes among the three groups. The rates of biochemical pregnancy, clinical pregnancy, ongoing pregnancy, and live birth were comparable among the unvaccinated group, the 1 or 2 doses group, and the 3 doses group (P = 0.433, P = 0.637, P = 0.583, and P = 0.539, respectively). Multivariate logistic regression analysis indicated that the doses of COVID-19 inactivated vaccine did not independently impact the reproductive outcomes of AIH cycles. Conclusion The administration of COVID-19 inactivated vaccine doses did not adversely affect male fertility in AIH cycles.

目的 探讨肥胖型多囊卵巢综合征(PCOS)患者卵泡液中同型半胱氨酸(Hcy)浓度对胚胎质量的影响.方法 选取 2021 年 1 月至 2022 年 7 月于运城市中心医院生殖医学科行体外受精助孕的 137 例PCOS患者为研究对象,将体质量指数(BMI)≥25 kg/m2 的患者纳入肥胖型PCOS组(n=76),BMI<25 kg/m2 的患者纳入非肥胖型 PCOS组(n=61).所有患者均采用拮抗剂方案促排卵,取卵前 1 日收集患者空腹静脉血清,取卵日留取第 1 管无血液和其他污染的卵泡液,采用酶联免疫吸附试验法检测两组患者卵泡液及血清中 Hcy含量.比较两组患者的基础资料、获卵数、胚胎发育情况、卵泡液及血清 Hcy水平;又根据卵泡液 Hcy水平不同进行亚组分析,比较不同 Hcy水平各组的胚胎发育情况.结果 肥胖型 PCOS组 BMI、不孕年限均显著高于非肥胖型PCOS组,基础 E2 水平显著低于非肥胖型 PCOS组(P<0.05);肥胖型 PCOS组受精率、优质胚胎率均显著低于非肥胖型PCOS组(P<0.05).肥胖型PCOS组患者卵泡液中 Hcy水平显著高于同组患者血清中 Hcy水平(P<0.05),亦显著高于非肥胖型PCOS组卵泡液中 Hcy水平(P<0.05),而非肥胖型 PCOS组患者卵泡液 Hcy水平与同组患者血清 Hcy水平无显著性差异(P>0.05).又根据卵泡液 Hcy水平不同利用四分位数将两组 PCOS患者分别分为高、中、低 3 个浓度组.非肥胖型PCOS患者高浓度组优质胚胎数、优质胚胎率均显著低于中、低浓度组(P<0.05);肥胖型 PCOS患者高浓度组的受精数、受精率、2PN数均显著低于中浓度组(P<0.05),高浓度组的 2PN 率、优质胚胎数、优质胚胎率均显著低于中、低浓度组(P<0.05).结论 对肥胖型和非肥胖型PCOS患者来说,卵泡液适宜的 Hcy浓度不同,但卵泡液高浓度 Hcy都对其胚胎质量有负面影响.

目的 探讨夫精宫腔内人工授精(AIH)临床结局是否受男性禁欲天数的影响,寻找AIH治疗的最佳禁欲天数.方法 回顾性分析2018年1月至2022年1月在运城市中心医院生殖医学科接受AIH治疗患者的312个AIH周期的临床资料,按取精前禁欲天数分为A组(2～3 d,n=186)、B组(4～5 d,n=91)和C组(6～7 d,n=35).比较3组的女方基础资料、男方基础资料、精液情况和AIH治疗的临床结局,主要结局指标为临床妊娠率,采用多因素Logistic回归方程校正混杂因素,分析禁欲天数对临床妊娠的影响.结果 3组患者组间男女双方基础资料比较均无统计学差异(P＞0.05).3组患者组间男性精子浓度、正常精子形态率、DNA碎片指数(DFI)、处理后前向运动精子总数比较均无统计学差异(P＞0.05);B组和C组精液量显著高于A组(P≤0.05);C组精子活动率、前向运动精子率最低,且与另两组比较均有统计学差异(P≤0.05);B组和C组的前向运动精子总数均较A组显著增加(P≤0.05),而B、C两组间前向运动精子总数比较无统计学差异(P＞0.05).3组间的HCG阳性率、临床妊娠率和活产率比较有统计学差异(P≤0.05),其中C组HCG阳性率、临床妊娠率和活产率均显著高于另外两组(P≤0.05),A、B组间HCG阳性率、临床妊娠率和活产率比较均无统计学差异(P＞0.05);3组间流产率比较无统计学差异(P＞0.05).多因素Logistic回归分析校正年龄、体质量指数(BMI)、抗苗勒管激素水平(AMH)、AIH日内膜厚度、前向运动精子总数等混杂因素后结果显示,C组的临床妊娠率较A组显著提高[OR=2.872,95％CI(1.190,6.927),P=0.019]. 结论 男性禁欲6～7 d取精可明显改善AIH的临床结局.

Aims: To investigate the association between the number of oocytes and the polyspermy rate following in vitro fertilization (IVF) treatment. Materials and methods: 376 IVF cycles with gonadotropin-releasing hormone (GnRH) antagonist protocol in the reproductive center of our hospital were retrospectively included in the analysis, which were divided into five groups according to the number of oocytes retrieved. Group A (78 cases):1-5 oocytes, group B (118 cases): 6-10 oocytes, group C (94 cases): 11-15 oocytes, group D (55 cases): 16-20 oocytes, group E (31 cases): ≥21 oocytes. According to polyspermy rate, 376 IVF cycles were then divided into two groups. Normal level polyspermy group (170 cases): polyspermy rate<6%, and high level polyspermy group (206 cases): polyspermy rate ≥ 6%. The variables with p < .10 in univariate analysis were incorporated into the multiple logistic regression model to control the confounding, and the effect of the number of oocytes on the increase of polyspermy rate was analyzed. Results: Multiple logistic regression analysis showed that after adjustment for confounding factor, the increase risk of polyspermy rate in group B, C, D and E was 1.763, 3.804, 2.021 and 3.208 times of that in group A respectively (OR = 1.763, p = .085; OR = 3.804, p = .001; OR = 2.021, p = .158; OR = 3.208, p = .068, respectively). Conclusion: This result demonstrated that when the oocyte number is 15 or less, the more the oocyte number, the greater the increase risk of polyspermy rate. While, there appears to be little increase risk of polyspermy rate when the oocyte number is more than 15.

目的:探讨激素替代周期(HRT)内膜转化日血清雌二醇(E2)水平对冻融胚胎移植(FET)临床结局的影响.方法:回顾性分析首次行激素替代周期冻融胚胎移植(HRT-FET)的374个周期的临床资料,根据内膜转化日血清E2水平中位数将374个周期分为低水平组(n=194,E2<400 pg·mL-1)和高水平组(n=180,E2≥400 pg·mL-1).比较2组临床结局指标,包括生化妊娠率、临床妊娠率、流产率、活产率.结果:高水平组和低水平组的生化妊娠率、临床妊娠率和流产率差异无统计学意义(P>0.05);低水平组的活产率(61.86％)高于高水平组(51.67％),差异有统计学意义(P<0.05).结论:HRT内膜转化日血清高E2水平会降低FET的活产率.

目的 分析应用促性腺激素释放激素拮抗剂(GnRH-ant)方案促排卵时HCG日血清孕酮(P)水平升高的发生情况及其影响因素.方法 回顾性分析2018年10月至2021年10月在我院生殖医学科采用拮抗剂方案促排卵的391个IVF/IC-SI-ET周期的临床资料,按照本周期HCG日血清P水平不同分为两组:正常水平组(HCG日P水平＜4.77 nmoL/L,306个周期)和高水平组(HCG日P水平≥4.77 nmoL/L,85个周期).比较两组患者的基本情况和促排卵实验室参数,并采用多因素Logistic回归模型分析HCG日P水平的影响因素.结果 本研究中,HCG日P水平≥4.77 nmoL/L的发生率为21.7％(85/391).两组患者的年龄、不孕年限、基础FSH(bFSH)、基础LH(bLH)、基础E2(bE2)及抗苗勒管激素(AMH)水平均无显著性差异(P＞0.05);与正常水平组比较,高水平组的体质量指数(BMI)显著降低,基础孕酮(bP)水平显著升高(P＜0.05).两组患者的Gn启动剂量、Gn总剂量、Gn天数及HCG日LH水平均无显著性差异(P＞0.05);高水平组的HCG日E2和P水平均显著高于正常水平组(P＜0.05).多因素Logistic回归分析结果显示,BMI≥24 kg/m2患者HCG日P水平升高的风险较BMI＜24 kg/m2的患者显著降低(OR=0.446,P＜0.05);bP≥1.91 nmoL/L患者HCG日P水平升高的风险较bP＜1.91 nmoL/L的患者显著升高(OR=1.961,P＜0.05);HCG 日 E2≥11 010 pmoL/L 患者 HCG 日 P 水平升高的风险较 HCG 日 E2＜11 010 pmoL/L 的患者显著升高(OR=3.303,P＜0.05).结论 BMI＜24 kg/m2、bP和HCG日E2水平较高是HCG日P水平升高的独立危险因素.促排卵中晚期应综合权衡基础BMI、bP、HCG日E2水平调整Gn用量,降低HCG日P水平升高的风险.

目的 探讨小鼠卵母细胞体内成熟过程中细胞周期蛋白依赖性激酶-1(CDK1)蛋白和CDK1 mRNA表达的动态变化.方法 将6～8周龄SPF级ICR雌性小鼠68只随机分为4组,根据获取卵母细胞的时期分为GV组、GVBD组、MⅠ组和MⅡ组,每组17只.腹腔注射10U孕马血清促性腺激素(PMSG)48h后,颈椎脱臼处死法处死小鼠,获取GV期卵母细胞;注射PMSG 48 h后注射10 U人绒毛膜促性腺激素(HCG),分别于注射HCG后4 h、8 h和12 h后获取GVBD、MⅠ和MⅡ期卵母细胞.Western blot检测各阶段卵母细胞CDK1蛋白的表达,实时荧光定量PCR(qRT-PCR)检测各阶段卵母细胞中CDK1 mRNA的表达,并采用Spearman相关分析检验CDK1 mRNA和蛋白表达的相关性.结果 Western blot结果显示,CDK1蛋白在GV、GVBD、MⅠ 和MⅡ期卵母细胞均有表达,且随着卵母细胞的体内成熟,CDK1蛋白表达量持续增加(P＜0.05).qRT-PCR结果显示,CDK1 mRNA在GV、GVBD、M Ⅰ和MⅡ期卵母细胞均有表达;与GV期比较,GVBD期和MⅠ期CDK1 mRNA表达水平均显著下调(P＜0.05),而MⅡ期CDK1 mRNA表达水平显著上调(P＜0.05).Spearman相关分析显示,卵母细胞体内成熟过程中CDK1蛋白与CDK1 mRNA表达的相关性较差(R=0.200).结论 卵母细胞体内成熟过程中CDK1蛋白的增加并不完全是由转录水平的变化引起的,其他一些机制可能在转录后水平上影响CDK1蛋白的翻译.本研究为进一步深入探讨卵母细胞成熟的分子机制奠定了一定基础.

The aim of this study was to investigate the correlation between CDK1 protein and CDK1 mRNA during oocyte maturation in vivo in mouse. GV, GVBD, MI and MII oocytes were obtained from mice, respectively. Western blot validated that the CDK1 protein expression increased continuously and significantly with oocyte maturation in vivo (P<0.05). Real-time qRT-PCR showed that CDK1 mRNA expression was down-regulated significantly during transformation from GV to MI stages (P<0.05), and up-regulated significantly during transformation from MI to MII stages (P<0.05). The level of CDK1 mRNA peaked at MII stages. Spearman correlation analysis indicated that CDK1 protein expression was poor correlation with CDK1 mRNA expression during oocyte maturation in vivo (R=0.200). This finding suggested that the increase of CDK1 protein during oocyte maturation in vivo was not entirely caused by the change of transcription level. The results provide new food for thought for further research on the molecular mechanism of oocyte maturation in vivo.

目的 评价首次新鲜或冷冻单囊胚移植失败后,再次行单囊胚解冻移植时使用阿托西班对妊娠结局的影响及其安全性.方法 选取移植新鲜或冷冻单囊胚失败仅一次,并于2019年1月至2020年6月在运城市中心医院及西北妇女儿童医院辅助生殖中心再次接受单囊胚解冻移植的患者140例为研究对象,随机进行分组,其中试验组有76例,对照组有64例.移植前30 min试验组给予阿托西班注射液,对照组进行生理盐水滴注,30 min后移植,移植后将余下药物约2 h滴完.分析两组患者单囊胚解冻移植的HCG阳性率、临床妊娠率、异位妊娠率、流产率和活产率.结果 试验组与对照组的不孕年限、女方年龄、体质量指数(BMI)、基础激素(FSH、LH、E2、P)水平、窦卵泡数、原发不孕占比、不孕原因、FET对应新鲜周期HCG日内膜厚度、FET对应新鲜周期IVF受精占比、第1次FET周期占比、移植D5囊胚占比、移植优质囊胚占比等比较均无显著性差异(P>0.05);试验组的HCG阳性率、临床妊娠率、异位妊娠率、流产率和活产率与对照组比较均无统计学差异(P>0.05).结论 首次使用新鲜或冷冻单囊胚进行移植治疗失败后,使用阿托西班并不能改善下次单囊胚解冻移植时不孕患者的妊娠结局;使用阿托西班不增加流产和异位妊娠的风险.

透明带(ZP)在卵母细胞发育、受精及早期胚胎发育过程中发挥重要作用,ZP基因突变可能引起卵母细胞异常或受精异常.本文报道了 1例不孕患者,因原发不孕4年、排卵障碍、卵巢功能减退、双侧输卵管通而不畅,于我院行体外受精助孕治疗,共获卵10枚,脱颗粒后其中6枚卵母细胞的ZP不完整,对患者基因进行测序,其ZP3基因新发杂合变异;其余4枚卵母细胞形成两枚可移植胚胎,冻融周期移植2枚D3卵裂期胚胎.孕37+3周经剖宫产分娩2女婴,均活产,未见明显出生缺陷.本文结合患者的临床资料及相关文献展开讨论.

Objective:To investigate the diagnosis, treatment and prevention of intrauterine pregnancy with intramural pregnancy (IMP) after in vitro fertilization-embryo transfer (IVF-ET). Methods:A retrospective clinical study and literature review were performed to analyze one intrauterine pregnancy with intramural pregnancy after IVF-ET.Results:After double embryo transfer, the patient got conceived. Ultrasound showed early pregnancy in utero with intramural pregnancy on the 40th day of her pregnancy. So the patient underwent laparoscopic hysterectomy in Northwest Women's and Children's Hospital. The patient is now 20 weeks pregnant, and has a intrauterine singleton pregnancy.Conclusion:IVF-ET increases the risk of ectopic pregnancy. The treatment of intrauterine pregnancy with intramural pregnancy should take clinical manifestations, examination results and the patient's own wishes into account.

目的探讨Y染色体长臂异染色质区延长（Yqh+）对体外受精/卵胞浆内单精子注射-胚胎移植（IVF/ICSI-ET）妊娠结局和新生儿健康情况的影响。方法采用单中心回顾性研究,收集2014年1月至2017年12月期间在西北妇女儿童医院辅助生殖中心行IVF/ICSI-ET助孕的不育症患者为研究对象,根据Y染色体核型分析结果分为Yqh+组和对照组。又根据男方精液分析结果分别行IVF或ICSI人工授精,比较IVF周期和ICSI周期中Yqh+组和对照组的妊娠结局和新生儿健康情况。结果研究共纳入1 705对不育夫妇,其中Yqh+组67例,对照组1 638例。（1）在IVF治疗周期中,Yqh+组和对照组患者一般资料比较无显著性差异（P＞0.05）。新鲜移植周期中,Yqh+组的临床妊娠率、活产率略低于对照组,但均无显著性差异（P＞0.05）;Yqh+组的异位妊娠率显著高于对照组（11.11%vs. 1.63%,P=0.04）;两组的新生儿Apgar评分、出生缺陷率和男婴出生率比较亦均无显著性差异（P＞0.05）。（2）在ICSI治疗周期中,两组患者的一般资料比较无显著性差异（P＞0.05）;新鲜移植周期的妊娠结局（包括临床妊娠率和活产率）和新生儿出生情况各观察指标比较均无显著性差异（P＞0.05）。结论 Yqh+可能对IVF/ICSI-ET妊娠结局和新生儿健康情况无明显影响。Yqh+是否增加IVF新鲜移植周期中异位妊娠的风险,尚需要更大样本量的研究加以探讨。

随着辅助生殖技术(ART)的广泛应用,控制性超促排卵方案取卵过程中往往会观察到部分胞质完整的无透明带卵母细胞(zona-free oocytes,ZFO),本文就其产生原因、受精方式、培养方法 、利用价值等作全面综述.

目的 研究降调节联合雌孕激素替代治疗(HRT)对多囊卵巢综合征(PCOS)患者冻融胚胎移植(FET)临床结局的影响. 方法 回顾性分析2017年1月至2018年12月在山西省运城市中心医院生殖医学科接受FET治疗的70例PCOS患者(70个周期)的临床资料,根据子宫内膜准备方案的不同,分为降调节联合雌孕激素替代组(降调节+HRT组,32个周期)和雌孕激素替代组(HRT组,38个周期),比较分析两组患者的一般资料及妊娠结局. 结果 降调节+HRT组和HRT组患者的年龄、不孕年限、基础性激素水平、体重指数(BMI)、移植胚胎数等比较均无显著性差异(P＞0.05).两组的胚胎种植率、临床妊娠率、异位妊娠率、早期流产率比较亦无显著性差异(P＞0.05).降调节+ HRT组的补佳乐使用时间及使用剂量、转化日E2水平显著低于HRT组,而转化日内膜厚度及移植日内膜厚度显著高于HRT组(P均＜0.05). 结论 降调节联合雌孕激素替代方案用于PCOS患者FET周期的内膜准备,可以减少雌激素的使用时间和剂量,改善子宫内膜厚度,可以获得较为满意的临床结局.

抗精子抗体(anti-sperm antibodies,ASA)是男女均可遇到的复杂病理产物,其确切原因尚不完全清楚. 当男性的血睾屏障被破坏或女性的血液接触男性的精子和精浆时,可引起免疫反应并产生相应的抗体. 随着生殖免疫学的发展,研究人员通过免疫学等方法, 发现男性免疫不育血清中有多种ASA[1]. Naz和Menge[2]证实,机体中ASA的存在导致不育者占总不孕症的10％～30％. 不育患者中ASA的检出率与可生育人群的检出率显著不同[3].日常工作中,我们发现一些尿液标本中经常可见到有活跃的精子, 因此我们想知道在没有ASA的血清中精子活力是否受到影响.本研究的目的是探索精子在无ASA的血清中的活力是否受到影响,随着血清中抗精子抗体浓度的增加是否对精子活力影响加大.