Objective:To investigate the effect of the embryo accumulation strategy prior to embryo transfer on reproductive outcomes among advanced-age women undergoing IVF/ICSI treatment. Methods:This retrospective study included 970 advanced-age female patients undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment at the Second Hospital of Hebei Medical University from 2012 to 2022. Participants were stratified into two groups according to the implementation of the embryo accumulation strategy before embryo transfer. The embryo accumulation group comprised 325 patients who completed ≥2 consecutive oocyte retrieval cycles and yielded at least one transferable embryo. The control group included 645 patients who underwent a single oocyte retrieval cycle and received embryo transfer with available transferable embryos. To eliminate baseline confounding bias, 1:1 propensity score matching (PSM) was applied. Ultimately, 299 matched pairs (598 patients) were successfully matched. Baseline clinical characteristics, laboratory indicators, and pregnancy outcomes were compared between the two cohorts before and after PSM. Multivariable logistic regression models were constructed to assess the independent effect of embryo accumulation on pregnancy outcomes. Restricted cubic spline and threshold effect analyses were performed to explore the nonlinear association between cumulative embryo number and reproductive outcomes. The primary study endpoint was cumulative live birth rate (CLBR), and the secondary endpoint was cumulative clinical pregnancy rate (CCPR). Results:After PSM, the biochemical pregnancy rate, CLBR and CCPR in the embryo accumulation group were all significantly higher than those in the control group (P < 0.001). However, no statistically significant difference was observed in the miscarriage rate between the two groups (P = 0.583). Binary logistic regression analysis based on the fully adjusted model (Adjust II) demonstrated that embryo accumulation was correlated with increased CLBR (OR = 2.75, 95% CI: 1.87-4.05, P < 0.001) and CCPR (OR = 2.71, 95% CI: 1.87-3.92, P < 0.001). Smooth curve fitting and threshold effect analysis were performed within the embryo accumulation group. CLBR and CCPR increased with the rise in cumulative embryo number when the cumulative embryo number was ≤ 2 (OR = 3.11, 95% CI: 1.27-8.50, P = 0.0181; OR = 3.59, 95% CI: 1.47-9.74, P = 0.0073). When the cumulative embryo number was > 2, CLBR and CCPR still presented a mild upward trend, but such trends did not reach statistical significance (OR = 1.06, 95% CI: 0.91-1.23, P = 0.4216; OR = 1.11, 95% CI: 0.97-1.29, P = 0.1326). Conclusions:Among advanced-age women receiving IVF/ICSI treatment, embryo accumulation via consecutive stimulation cycles can significantly improve CLBR and CCPR, and the clinical benefits are prominent when the number of accumulated embryos does not exceed two. This strategy effectively optimizes reproductive outcomes for advanced patients undergoing assisted reproductive technology (ART). Nevertheless, due to the limitations of this retrospective study and unadjusted confounding factors, embryo quantity should not be the sole basis for clinical decisions. Individualized treatment strategies shall be developed based on a comprehensive assessment of patients' age, physical status and economic conditions.

ObjectiveThe aim was to study the impact of coronavirus disease 2019 (COVID-19) convalescence on female fertility and laboratory and clinical outcomes in fresh assisted reproductive technology (ART) cycles.MethodsIn this retrospective cohort study, we analyzed data from 294 patients who had recovered from COVID-19 and who underwent fresh ART cycles between January and March 2023 (COVID-19 group). This group was compared with 631 patients who underwent similar ART cycles in the same period in 2022 but without having been infected with COVID-19 (non-COVID-19 group). The analysis focused on comparison of basic demographic characteristics and laboratory parameters of patients in each group. The primary outcome measure was the clinical pregnancy rate, which was examined to assess the impact of COVID-19 infection on the efficacy of ART treatment.ResultsBasal follicle-stimulating hormone (FSH) levels were significantly lower and antral follicle count (AFC) was markedly higher in the COVID-19 group compared to the non-COVID-19 group (P<0.001 and P=0.004, respectively). The predominant ovarian stimulation protocol in the COVID-19 group was GnRH antagonists (64.85%, P<0.001), with a reduced gonadotropin (Gn) dosage and duration in comparison to the non-COVID-19 group (P<0.05). Although the number of blastocysts formed was lower in the COVID-19 group (P=0.017), this group also exhibited a higher blastocyst freezing rate and a higher rate of high-quality embryos per retrieved oocyte (P<0.001 and P=0.023, respectively). Binary logistic regression analysis indicated that COVID-19 convalescence did not significantly impact clinical pregnancy rates in fresh transfer cycles (odds ratio [OR] = 1.16, 95% confidence interval [CI] = 0.68-1.96, P=0.5874). However, smooth curve-fitting and threshold effect analysis revealed an age-related decline in clinical pregnancy rates in both groups, more pronounced in the COVID-19 group, for women aged over 38 years, with the likelihood of clinical pregnancy decreasing by 53% with each additional year of age (odds ratio [OR] = 0.81, 95% confidence interval [CI] = 0.61–1.08, P=0.1460; odds ratio [OR] = 0.47, 95% CI = 0.21–1.05, P=0.0647).ConclusionsOur findings present no substantial evidence of adverse effects on clinical pregnancy outcomes in fresh ART cycles in patients undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) during the period of convalescence from COVID-19. However, age emerges as a significant factor influencing these outcomes. Notably, for women above 38 years of age, the likelihood of clinical pregnancy in patients with a prior COVID-19 infection decreased by 53% with each additional year. This highlights the importance of considering maternal age, especially in the context of COVID-19, when evaluating the likelihood of successful pregnancy following ART treatments.

目的 探讨卵子玻璃化冷冻的可行性、安全性以及年龄对卵子玻璃化冷冻临床妊娠结局的影响.方法 回顾分析2012年1月至2019年12月在河北医科大学第二医院生殖医学科行卵子冷冻并解冻的患者59例61周期,女方平均年龄(30.69±5.39)岁.分析61周期患者卵子解冻后复活率、受精率、卵裂率、可利用胚胎率、胚胎种植率、临床妊娠率、流产率、活胎分娩率以及婴儿出生情况;按年龄的不同分2组,A组≤35岁的患者49周期,B组>35岁的患者12周期,统计分析2组卵子冷冻复活率、受精率、卵裂率、可利用胚胎率.统计分析A、B2组胚胎种植率、临床妊娠率、流产率、活胎分娩率.结果 61周期共冷冻卵子542枚,移植54周期,7周期未移植(5例全胚冷冻,2例无胚胎移植),卵子复活率95.2％(516/542),2PN受精率84.7％(437/516),2PN卵裂率95.9％(419/437),可利用胚胎率49.7％(217/437),种植率30.6％(34/111),临床妊娠率50.0％(27/54),流产率3.7％(1/27),活胎分娩率48.1％(26/54);冻卵冻胚移植10周期,其种植率33.3％(6/18),临床妊娠率60.0％(6/10),活胎分娩率60.0％(6/9).卵子玻璃化冷冻累积活胎分娩率59.3％(32/54),共出生38个婴儿,平均体重2886.2 g,其中男婴16例和女婴22例,男女性别比为1:1.375,未见婴儿出生缺陷.A、B组卵子复活率、受精率、可利用胚胎率、胚胎种植率、临床妊娠率、活胎分娩率比较差异无统计学意义(P>0.05),但A组卵裂率高于B组(P<0.01).B组胚胎种植率、临床妊娠率、活胎分娩率均有下降的趋势.结论 玻璃化冷冻卵子技术是较成熟可行的技术,是临床生育力保存较好的方法,可应用于取卵日任何原因不能提供精子行受精的患者;卵子冷冻尽量在患者≤37岁前进行,以获得较好的卵子复苏率和临床妊娠结局.

Adipose tissue, one type of loose connective tissue in the human body, maintains the primary task of energy storage. Adipose tissue is not only an energy reservoir but also plays a vital role as the largest endocrine organ of the whole body via releasing a variety of adipokines, which participate in many pathophysiological processes, such as energy metabolism regulation, glucose and lipid metabolism, and inflammation. Polycystic ovary syndrome (PCOS) is a disorder that mainly involves the female reproductive system, affecting women of childbearing age particularly. Insulin resistance (IR) and hyperandrogenemia (HA) have been implicated as a critical link involving the etiology and outcome of PCOS. A great deal of studies has bridged the gap between adipokines (such as Adiponectin, Chemerin, Metrnl, Apelin, Resistin, Visfatin, Leptin, Vaspin, Lipocalin 2, and Omentin) and reproductive fitness. In this review, we will focus on the adipokines’ functions on PCOS and come up with some points of view on the basis of current research.

AimsThis study aims to determine the optimal number of oocytes retrieved so that patients with polycystic ovary syndrome (PCOS) receiving in vitro fertilization (IVF) can obtain the best cumulative live birth rate (CLBR) and live birth after fresh embryo transfer.MethodsThis is a retrospective study of 1,419 patients with PCOS who underwent their first IVF cycle at the Second Hospital of Hebei Medical University from January 2014 to December 2021. Multivariable regression analysis was performed to adjust for factors known to independently affect cumulative live birth aspiration. The number of oocytes retrieved to obtain the best cumulative live birth rate was explored through curve fitting and threshold effect analysis. The decision tree method was used to explore the best number of oocytes retrieved to achieve live birth in the shortest time.Results(1) The number of oocytes retrieved was found to be an independent protective factor for the cumulative live birth rate (OR = 1.09 (95% CI: 1.06, 1.12)). When the number of oocytes retrieved was less than 15, CLBR increased by 16% with each increase in the number of oocytes retrieved (OR = 1.16 (95% CI: 1.11, 1.22)); and when more than 15, CLBR tended to be stable. (2) Live birth after the first fresh embryo transfer was analyzed through a classification decision tree. For patients younger than 35 years old, those with less than 6 oocytes and those with 7–16 oocytes had a similar proportion of live births with fresh embryo transfer but higher than 16 oocytes (53.7% vs. 53.8% vs. 18.4%). Patients older than 35 years old had a similar proportion of live births with fresh embryo transfer (35.7% vs. 39.0%) to those younger than 35 years old, but the proportion of no live births after using up all embryos was higher than those younger than 35 years old (39.3% vs. 19.2%).ConclusionsIn PCOS patients, high CLBR can be obtained when the number of oocytes retrieved was 15 or more. The number of oocytes retrieved from 7 to 16 could achieve more chance of live birth after fresh embryo transfer.

ObjectiveWe aim to explore the effects of follicular output rate (FORT) on cumulative clinical pregnancy rate (CCPR) and cumulative live birth rate (CLBR) in polycystic ovary syndrome (PCOS) patients with different characteristics undergoing in vitro fertilization (IVF) treatment.MethodsThis retrospective study analyzed 454 patients with PCOS undergoing their first IVF cycle at our center from January 2016 to December 2020. FORT was calculated as pre-ovulatory follicle count (PFC) × 100/antral follicle count (AFC). Multivariate regression analyses were conducted to explore the relationships between FORT and CCPR and CLBR. Curve fitting and threshold effect analyses were established to find nonlinear relationships. Effect modification in different subgroups were examined by stratification analyses.ResultsBased on the FORT values, individuals were classified into the following three groups: low-FORT group, middle-FORT group and high-FORT group. Multivariate regression analyses revealed that FORT was an independent factor affecting the CCPR and CLBR significantly (OR = 1.015, 95% CI: 1.001, 1.030 and OR = 1.010, 95% CI:1.001, 1.020). Curve fitting and threshold effect analyses showed that the CCPR and CLBR had a positive correlation with FORT when the FORT was less than 70% (OR = 1.039, 95% CI: 1.013, 1.065 and OR = 1.024, 95% CI: 1.004, 1.044). Stratification analyses showed that the CLBR increased by 1.3% with each additional unit of FORT for patients with hyperandrogenic manifestations (OR = 1.013, 95% CI: 1.001, 1.025). Compared with the low-FORT group, in the high-FORT group, CCPR increased 1.251 times for patients with polycystic ovarian morphology, while CCPR and CLBR increased 1.891 times and 0.99 times for those with ovulation disorder, respectively (OR = 2.251, 95% CI: 1.008, 5.028 and OR = 2.891, 95% CI: 1.332, 6.323 and OR = 1.990, 95% CI: 1.133, 3.494).ConclusionIn patients with PCOS, cumulative IVF outcomes have a positive correlation with FORT when the FORT is less than 70%. For PCOS patients with polycystic ovarian morphology, ovulation disorder or hyperandrogenic manifestations, a high FORT could be conductive to achieving better pregnancy outcomes.

The local Renin-Angiotensin System (RAS) has been demonstrated to exist in a wide range of tissues and organs, In the female reproductive system, it is mainly found in the ovary, uterus and placenta. The RAS system is made up of a series of active substances and enzymes, in addition to the circulating endocrine renin-angiotensin system. The active peptides Angiotensin II (Ang II) and Angiotensin (1-7) (Ang-(1-7)), in particular, appear to have distinct activities in the local RAS system, which also controls blood pressure and electrolytes. Therefore, in addition to these features, angiotensin and its receptors in the reproductive system seemingly get involved in reproductive processes, such as follicle growth and development, as well as physiological functions of the placenta and uterus. In addition, changes in local RAS components may induce reproductive diseases as well as pathological states such as cancer. In most tissues, Ang II and Ang- (1-7) seem to maintain antagonistic effects, but this conclusion is not always true in the reproductive system, where they play similar functions in some physiological and pathological roles. This review investigated how Ang II, Ang- (1-7) and their receptors were expressed, localized, and active in the female reproductive system. This review also summarized their effects on follicle development, uterine and placental physiological functions. The changes of local RAS components in a series of reproductive system diseases including infertility related diseases and cancer and their influence on the occurrence and development of diseases were elucidated. This article reviews the physiological and pathological roles of Ang II and Ang- (1-7) in female reproductive system,a very intricate system of tissue factors that operate as agonists and antagonists was found. Besides, the development of novel therapeutic strategies targeting components of this system may be a research direction in future.

Objective:We aimed to evaluate the future outcomes of patients undergoing their first IVF (in vitro fertilization) attempt with no oocyte retrieved, no normal zygotes formed, or no embryos available for transfer and to identify factors affecting the live birth rate.Methods:Patients who underwent no transplantable embryo in their first IVF cycles but carried out several consecutive cycles between January 2012 to December 2020 were retrospectively enrolled and divided into three groups:group A (no egg retrieval), group B (no normal zygotes formed), and group C (no embryos available to transfer). The patients were also divided into the live birth group and non-live birth group according to whether they got a live baby or not. The clinical data and the cumulative clinical outcomes of groups were compared.Results:496 patients met the inclusion criteria and enrolled, with 121 patients with no oocytes retrieved in group A, 138 patients with no normal zygotes formed in group B, and 237 patients with no embryos available to transfer in group C. The age [(34.75(5.82) vs 31.91(5.31), P<0.001; 34.75(5.82) vs 32.25(5.72), P<0.001)] and baseline FSH level [(13.04(8.82) vs 10.52(7.39), P=0.005; 13.04(8.82) vs 9.91(5.95), P<0.001)] of women in group A were significantly higher than those in groups B and C. The stable cumulative live birth rate/patient of three groups achieved 18.18% (after 5 cycles, group A), 28.98% (after 3 cycles, group B) and 20.25% (after 7 cycles, group C). Moreover, the multivariate regression analysis showed that female age and basic FSH were main factors affecting live birth outcome of patients with no embryo transfer in their first IVF cycle attempts.Conclusions:The future clinical outcome may be better in women with no normal zygotes than those with no oocyte retrieved or no available embryo at their first IVF cycle attempts. The main factors influencing the live birth are age and ovarian reserve.

目的 探讨冷冻微量精子相关参数与体外受精周期实验室及临床结局的关系.方法 回顾性分析2016年1月至2020年12月在生殖医学科行稀少精子冷冻复苏后卵胞浆内单精子显微注射(ICSI)的118个周期相关资料.根据冷冻精子的冷冻方法分为微量冷冻组、传统常规冷冻组;按精子来源分为丈夫射精组、附睾穿刺组、睾丸穿刺组;根据精子质量分为Ⅰ型、Ⅱ型、Ⅲ型严重少弱组.分别比较各组之间一般资料、实验室及临床结局等;采用多因素二元Logistic回归分析冷冻精子相关参数对临床结局的影响.结果 ①一般资料:按冷冻精子的冷冻方法、精子来源和精子质量分组,女方的年龄、体质量指数、不孕年限、基础促卵泡素(FSH)、抗苗勒氏管激素(AMH)、Gn天数、Gn总量、人绒毛膜促性腺激素(HCG)日雌二醇(E2)水平、获卵数、MⅡ卵数各组之间差异均无统计学意义(P>0.05);②实验室指标及临床结局:微量冷冻组与传统常规冷冻组两组组间胚胎利用率、临床妊娠率之间差异均无统计学意义(P>0.05),2PN率(P=0.002)、2PN卵裂率(P=0.036)、优胚率(P=0.002)差异均有统计学意义.丈夫射精组、附睾穿刺组和睾丸穿刺组组间比较,2PN率、临床妊娠率差异均无统计学意义(P>0.05);2PN卵裂率(P<0.001)、胚胎利用率(P=0.048)、优胚率(P=0.002)差异均有统计学意义.Ⅰ型、Ⅱ型和Ⅲ型严重少弱组3组间比较,2PN率、胚胎利用率、优胚率之间差异均无统计学意义(P>0.05);2PN卵裂率(P<0.001)、种植率(P=0.005)、临床妊娠率(P=0.048)差异均有统计学意义;③多因素二元Logistic回归分析结果显示,Ⅲ型严重少弱精组相对Ⅰ型严重少弱精组是低临床妊娠率危险因素[OR:0.259,95％CI、0.075～0.887].结论 微量冷冻和常规冷冻可获得相似临床妊娠率,精子来源不影响临床妊娠率,极严重少弱精可能降低临床妊娠率,但还需要扩大样本量进一步证实.

Objective:To explore the relationship between different gestational weeks of transvaginal ultrasound-guided fetal reduction and abortion in patients with multiple pregnancies after embryo transfer, and to seek the best gestational age for fetal reduction.Methods:The datas of 486 pregnant women with multiple pregnancies after embryo transfer in the Second Hospital of Hebei Medical University from January 2012 to December 2020 were retrospectively analyzed. The relationship between gestational weeks of fetal reduction and abortion rate was analyzed by curve fitting, threshold effect and multivariate logistic regression analysis.Results:After adjusting for age, infertility type, infertility years, number of births, abortion times, body mass index(BMI), various infertility and sterility factors, endometrial thickness on the day of transformation, monozygotic twins and reduction methods, when the gestational age was less than 8.43 weeks, the abortion rate increased significantly with the increase of reduction gestational age, and the abortion rate increased by 221% ( OR=3.21, 95% CI=1.47-6.99, P=0.003 3). When the gestational age of reduction ≥8.43 weeks, the abortion rate tended to be stable and did not increase ( OR=0.81, 95% CI=0.54-1.22, P=0.317 7); meanwhile, in stratified analysis, the OR value of the BMI ≥24 kg/m 2 was 12.38, and that of BMI <24kg/m 2 was 1.91, P=0.053 9. Conclusions:There is a non-linear relationship between gestational age and abortion rate of ultrasound-guided multiple pregnancy reduction in patients with embryo transfer. The abortion rate increases significantly with the increase of gestational age before 8.43 weeks of gestation. It is recommended to carry out the operation as early as possible before 8 weeks of pregnancy. The effect of BMI on the abortion rate of patients with fetal reduction needs further study.

目的探讨胚胎移植三胎妊娠后于孕早期行不同减灭数目减胎术对围产期母婴的影响。方法回顾性分析胚胎移植后三胎妊娠患者于孕早期行多胎妊娠减胎术后保留单胎和保留双胎共282例孕妇的资料,依据保留胎儿数将减胎组分为减至单胎组28例、减至双胎组254例。同时采用倾向性评分匹配法（PSM）与同期胚胎移植后未行减胎的单胎或双胎妊娠研究对象分别进行1∶3匹配。匹配完成后,共846例作为对照组,其中单胎对照组84例、双胎对照组762例。对4组患者的一般资料、妊娠结局、新生儿体质量及围产期并发症进行比较,并采用Logistic回归进一步做敏感性分析。结果 （1）减胎组的流产率、晚期流产率、围产期并发症发生率高于对照组（P均＜0.01）,平均分娩孕周短于对照组（P=0.01）,平均足月产儿体质量（P＜0.01）、足月产率（P=0.016）,剖宫产率（P=0.037）低于对照组;（2）减至单胎组剖宫产率低于减至双胎组（P=0.001）,平均分娩孕周长于减至双胎组（P＜0.01）,平均足月产儿体质量高于减至双胎组（P＜0.01）;单胎对照组流产率、早期流产率、足月产率、足月产儿及早产儿体质量高于双胎对照组（P均＜0.01）,早产率低于双胎对照组（P＜0.01）。结论妊早期行多胎妊娠减胎术并未增加早产、出生缺陷风险,但流产、围产期并发症及低体质量儿的发生风险增加。三胎妊娠后行多胎妊娠减胎术保留至单胎者比保留至双胎者,有更好的妊娠结局。

目的 探讨玻璃化冷冻的成熟卵母细胞解冻受精移植后,患者的临床因素或卵母细胞冻融过程中的实验室因素对妊娠结局的影响.方法 对2012年5月至2018年3月在河北医科大学第二医院生殖医学科接受卵子冷冻,并随后行卵子解冻的90个周期进行回顾性分析.按照妊娠结局分为妊娠组和未妊娠组,比较两组患者卵子冷冻周期的临床指标和实验室指标及其与冻融过程参数的相关性.结果 (1)妊娠组和未妊娠组的女方年龄[(28.10±4.90)vs.(32.40±5.90)]、不孕年限[(4.50±3.50)vs.(6.80±3.60)]、雌二醇峰值[(14598.60±5181.67)pmol/L vs.(9392.81±6868.41)pmol/L]、获卵数[(21.70±14.80)vs.(12.10±10.90)]、成熟卵数[(19.50±13.10)vs.(11.00±10.80)]差异均有统计学意义(P<0.05);(2)妊娠组和未妊娠组脱颗粒至冷冻时间(T2)分别为(2.82±1.25)h和(3.66±1.06)h,差异有统计学意义(P<0.05);妊娠组和未妊娠组卵子解冻周期的卵子存活率[(98.54±2.86)％vs.(84.24±30.38)％]、正常受精率[(89.91±11.00)％vs.(70.07±32.77)％]、优胚数[(3.90±2.60)vs.(1.60±2.00)]、优胚率[(52.25±20.57)％vs.(31.06±34.96)％]、移植胚胎评分[(8.55±2.02)vs.(5.50±2.19)],差异均有统计学意义(P<0.05);(3)取卵至脱颗粒时间(T1)与脱颗粒至冷冻时间(T2)呈负相关(r=-0.615,P=0.000),与取卵至冷冻时间(T3)呈正相关(r=0.615,P=0.000);T1与优胚数、优胚率呈正相关(r=0.351,P=0.021;r=0.302,P=0.049);T2与卵子存活率、优胚数、优胚率呈负相关(r=-0.378,P=0.010;r=-0.469,P=0.002;r=-0.423,P=0.005);T3与卵子存活率呈负相关(r=-0.325,P=0.029);解冻至ICSI时间(T4)与正常受精率呈负相关(r=-0.313,P=0.041).结论 卵子冷冻周期女方年龄及成熟卵数对卵子解冻周期的妊娠结局有重要影响.适当延长取卵至脱颗粒时间、缩短脱颗粒至冷冻时间可能通过使卵胞质进一步成熟、降低脱颗粒后卵子老化程度来提高卵子解冻存活率及发育潜能.

目的 探讨生长激素(growth hormone,GH)在子宫内膜异位症(endometriosis,EMs)患者中的意义及其对卵巢黄素化颗粒细胞凋亡的影响.方法 选择进行体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)助孕的EMs不孕患者(EMs组)40例,单纯输卵管因素不孕患者(对照组)40例,比较2组实验室指标及妊娠结局;放射免疫分析法检测2组取卵当日血清、卵泡液GH水平,密度梯度法提取颗粒细胞体外培养贴壁后,免疫细胞化学检测2组患者Bcl-2、Bax蛋白表达水平;将贴壁后EMs患者颗粒细胞按干预方式分为空白组和GH组,免疫细胞化学检测Bcl-2、Bax蛋白的表达水平.结果 EMs组血清、卵泡液GH水平和颗粒细胞Bcl-2表达水平低于对照组,EMs组Bax表达水平高于对照组,差异均有统计学意义(P＜0.05).GH组较空白组Bcl-2表达水平升高,Bax表达水平下降,差异有统计学意义(P＜0.05).结论 EMs患者的低GH水平可能引起颗粒细胞凋亡增加,从而影响卵母细胞质量及胚胎的发育潜能.一定浓度的GH可能改善EMs患者颗粒细胞凋亡状态.

目的 观察辅助卵母细胞激活(assisted oocyte activation,AOA)技术在体外受精周期中的应用,并对受精、胚胎发育情况、临床结局等激活效果进行评价.方法 回顾性分析进行卵胞浆内单精子显微注射(intracytoplasmic sperm injection,ICSI)联合AOA处理的23例助孕者的临床资料,观察卵母细胞激活后的原核形成、胚胎发育情况及临床结局等.结果 23例共进行23周期的ICSI+ AOA,全部采用钙离子载体A23187进行激活处理,9例获得临床妊娠,临床妊娠率为39.1％.其中至少有1次ICSI完全受精失败8例(A组),AOA周期的2PN受精率、2PN卵裂率、优质胚胎率和可利用胚胎率分别为50.0％、93.3％、39.3％和71.4％,临床妊娠率和胚胎种植率分别为12.5％和7.1％;精子严重畸形(如圆头精子症等)15例(B组),AOA周期的2PN受精率、2PN卵裂率、优质胚胎率和可利用胚胎率分别为53.9％、98.8％、48.8％和65.9％,临床妊娠率和胚胎种植率分别为53.3％和40.7％.结论 AOA可以改善ICSI完全受精失败者的受精率及胚胎发育质量,并可用于严重精子畸形如圆头精子症的ICSI,对临床应用有一定的价值.

目的 通过超声观察接受控制性促排卵方案(control ovarian stimulation,COS)助孕患者子宫内膜容受性及卵巢内卵泡储备影像学特点,分析超声评估对不孕患者妊娠结局的预测作用.方法 回顾性分析接受COS治疗的不孕症患者209周期的相关资料.根据妊娠结局分为妊娠组(30周期)和未妊娠组(未妊娠者中随机选取30周期),比较2组子宫内膜厚度、子宫内膜类型、子宫内膜容积、卵巢体积、窦卵泡数以及排卵前最大卵泡直径.根据内膜厚度分为＜8 mm、8～14 mm、＞14 mm组,根据内膜类型分为A型、B型、C型组,根据内膜容积分为＜2mL、2～4 mL、＞4 mL,根据卵巢体积分为＜3 cm3、3～6 cm3、＞6 cm3,根据窦卵泡数分为＜5个、5～15个、＞15个,比较各组妊娠率.结果 妊娠组子宫内膜厚度和内膜容积均大于未妊娠组,妊娠组子宫内膜形态A型较多,未妊娠组子宫内膜形态C型较多,妊娠组卵巢体积、窦卵泡数明显大于或多于未妊娠组,差异有统计学意义(P＜0.05);2组人绒毛膜促性腺激素日最大卵泡直径差异无统计学意义(P＞0.05).子宫内膜厚度8～14 mm组妊娠率明显高于＜8 mm、＞14 mm组,子宫内膜A型组妊娠率明显高于B型、C型组,子宫内膜容积＞4 mL组妊娠率明显高于＜2 mL、2～4 mL组,卵巢体积3～6 cm3组妊娠率明显高于＜3 cm3、＞6 cm3组,卵泡数5～15个组妊娠率明显高于＜5个、＞15个组,差异均有统计学意义(P＜0.05).结论 对于接受COS治疗的不孕患者,超声监测子宫内膜厚度8～14 mm、子宫内膜容积＞4 mL、子宫内膜类型A型、卵巢体积3～6 cm3、窦卵泡数5～15个时妊娠的概率更大.

目的 回顾性分析在常规体外受精中发生受精障碍的病历资料,探讨与完全受精失败和低受精率密切相关的临床和实验室因素.方法 选择首次在河北医科大学第二医院生殖医学科行常规体外受精(in vitrofertilization,IVF)的2 046个周期进行回顾性分析,根据IVF的受精情况分为A组(完全受精失败,受精率=0)56周期、B组(低受精率,受精率＜30％)91周期、C组(受精率≥30％)1 899周期,对短时受精后行补救单精子注射周期、部分行卵胞浆内单精子注射周期,根据卵子常规受精情况分别归入A组、B组和C组.比较3组女方的年龄、不孕年限、基础卵泡刺激素(follicle stimulating hormorne,FSH)、黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E2)水平以及原发继发不孕比例、不孕原因构成比;比较3组应用促性腺激素(gonadotropin,Gn)天数、Gn用量以及人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)注射日LH、E2、孕酮(progesterone,P)、每卵血清E2水平和获卵数;比较3组治疗方案、成熟卵子比例、不正常卵子和获得1～4枚卵子比例;比较取卵日处理前后精液参数.结果 A组、B组和C组年龄及基础激素FSH、LH、E2水平差异均无统计学意义(P＞0.05);A组、B组不孕年限、原发不孕比例、男性因素、不明原因不孕比例高于C组,差异均有统计学意义(P＜0.05);A组、B组输卵管因素比例低于C组,差异均有统计学意义(P＜0.05);A组、B组和C组应用Gn天数、Gn用量以及HCG注射日LH、E2、P水平和每卵E2水平差异均无统计学意义(P＞0.05);3组获卵数目比较,A组少于B组和C组,差异有统计学意义(P＜0.05);A组、B组和C组治疗方案比较,差异无统计学意义(P＞0.05);获卵数1～4枚的比例,A组高于C组,同时高于B组,差异均有统计学意义(P＜0.05);A组、B组和C组成熟卵和不正常卵子的比例分别为46.4％、60.4％、89.2％和16.1％、8.8％、0.5％,差异均有统计学意义(P＜0.05);A组、B组和C组取卵日精子浓度A组、B组低于C组,精子活动率、处理前的前向运动精子比例、前向运动精子中A级精子比例A组低于B组和C组,差异均有统计学意义(P＜0.05);3组处理后的前向运动精子比例、前向运动精子中A级精子比例A组、B组低于C组,差异均有统计学意义(P＜0.05).结论 IVF受精时受精障碍的影响因素很多,高风险因素可能有原发不孕、较长的不孕时间、原因不明及男方因素的不孕等;卵子成熟程度差、卵子形态不正常、精子运动参数降低可能与IVF受精障碍有关.

Objective To investigate the ovarian response, embryo quality and others outcomes of patients with ovarian endometriosis cyst and no surgery performed treatment before in vitro fertilization-embryo transfer(IVF-ET).Methods The clinical data in infertility women of ovarian endometriosis cyst with no surgery treatment performed in reproductive medicine center in the second hospital of Hebei medical university undergoing IVF-ET were performed by retrospective analysis.Fifty-eight cases of ovarian endometriosis cyst with no surgical treatment was used as endometriosis(EM)group,with the same period 5 5 cases of tubal factor in IVF was used as control group.GnRH-a super long protocol was used for the ovarian stimulation.Clinical indexes(such as ovarian response to gonadotropin,number of oocytes),laboratory indexes(such as number of good quality embryos)and IVF pregnancy outcome were observed and compared&nbsp;between the EM group and the control group.Results There were no significant difference in the mean age,the duration of infertility,the base follicle stimulating hormone level,the duration of goadotropins,the goadotropins consumption,the number of transferred embryos between the EM group and control group (P>0.05 ).The serum estradiol level on the human chorionic gonadotropin inj ection day,the number of retrieval oocytes in EM group,were lower than those in the control group,and the differences were statistically significant(P<0.05).In the EM group the fertilization rate,the high quality embryo rate were lower than those in the control group, the difference was statistically significant(P<0.05).The clinical pregnancy rate in the EM group was lower than that in the control group,but there was no statistically significant difference. Conclusion Endometriosis cyst may have certain negative effects of ovarian response and embryo quality in IVF.It may reduce the number of retrieval oocytes and good quality embryos,which could eventually affect pregnancy outcomes.

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.

生长分化因子9（growth differentiation factor 9，GDF-9）是卵源性的生长因子，亦是由卵母细胞通过旁分泌方式产生，在卵泡生长和发育的调节中具有重要作用，属于转化生长因子β（transforming&nbsp；growth factor-β，TGF-β）超家族。现对 GDF-9在卵泡生长发育中的调控作用、甾体激素的合成及其在不孕治疗过程中对卵母细胞质量的影响等进行综述。