观察受体鼠妊娠和胚胎着床情况,并检测胚胎移植时小鼠子宫内膜中白血病抑制因子(Lif)表达水平,探讨超排卵对小鼠胚胎着床潜能的影响。方法:建立超排周期胚胎和自然周期胚胎移植小鼠模型,比较妊娠率、胚胎着床率的差异及其与Lif蛋白的表达水平之间的关系。结果:超排卵周期受体组的妊娠率(20.00%)和胚胎着床率(8.33%)显著低于自然周期组的妊娠率(55.00%)和胚胎着床率(35.00%)(P＜0.05)。自然周期胚胎和超排周期胚胎受体组内膜中Lif蛋白的表达水平相似(P＞0.05),妊娠受体组Lif蛋白的表达水平显著高于未孕受体组(P＜0.05),但单胎妊娠和多胎妊娠受体组内膜中Lif蛋白的表达水平相似(P＞0.05)。结论:超排卵可能降低胚胎的着床潜能,Lif蛋白的表达水平与胚胎着床有关,但与着床胚胎的数目无比例关系。
Objective To analyze the efficacy and safety of different acupuncture methods on outcome of in vitro fertilization-embryo transfer (IVF-ET). Methods The PubMed, EMbase, Cochrane Library, CNKI, VIP, WanFang Data and CBM databases were searched to collect randomized controlled trials (RCTs) related to the objectives of the study from the inception to April 16, 2023. After two investigators independently screened the literature, extracted the data and evaluated the risk of bias of the included studies, a network meta-analysis was performed using Stata 16.0 software. Results There were 62 trials total with 9844 patients, involving 7 interventions. Network meta-findings analysis revealed the following: ① Clinical pregnancy rate (CPR): needle warming > auricular acupressure > transcutaneous electrical acupoint stimulation (TEAS) > electroacupuncture > acupuncture > sham acupuncture > no adjunctive treatment; ② Live birth rate (LBR): electroacupuncture > auricular acupressure > TEAS > acupuncture > sham acupuncture > no adjunctive treatment. Conclusion Needle warming assisted IVF-ET is superior to other acupuncture therapies in improving CPR, especially during the promotion period of excretion, and the selection of Zusanli, Guanyuan and uterine acupoints for 3-month cycles may have the best effect. And for the LBR, the effect of electroacupuncture is better than that of other therapies. Besides, auricular acupressure may have good therapeutic potential. Due to the limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusions.
ObjectivesTo systematically review the efficacy and safety of local endometrial mechanical stimulation in patients with recurrent embryo implantation failure in vitro fertilization.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect clinical controlled studies on the efficacy and safety of local endometrial mechanical stimulation in patients with recurrent embryo implantation failure from inception to March 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 10 studies, including 8 randomized controlled trials and 2 case-control studies, and involving 1 274 patients were included. The results of meta-analysis showed that: the clinical pregnancy rate of endometrial mechanical stimulation group was higher than that of control group (RR=1.40, 95%CI 1.04 to 1.89, P=0.03). However, no significant differences were found in implantation rate (RR=0.75, 95%CI 0.50 to 1.13, P=0.17), live births rate (RR=1.38, 95%CI 0.99 to 1.93, P=0.06), miscarriage rate (RR=0.83, 95%CI 0.55 to 1.24, P=0.36) and rate of multiple pregnancy (RR=0.90, 95%CI 0.61 to 1.35, P=0.63).ConclusionCurrent evidence shows that, for patients with repeated implantation failure, mechanical endometrial stimulation before re-transplantation may help to improve the clinical pregnancy rate of test-tube infants, however, it has no significant effects on implantation rate, live birth rate, abortion rate, multiple pregnancy rate and ectopic pregnancy rate. Due to limited quality and quantity of the included studies, more high quality studies are needed required to verify above conclusions.
【摘要】 目的 探讨不同年龄段和不同内膜准备方法对冻融胚胎移植（FET）妊娠率的影响。 方法 回顾性分析2007年3月-2009年8月107例患者131个FET周期，比较不同年龄段、不同内膜准备方法的妊娠情况。 结果 ①lt;29岁、30～34岁、≥35岁患者的周期临床妊娠率分别为45.28%、37.88%、33.33%，比较无统计学意义（Pgt;0.05）。②自然周期和激素替代周期内膜准备，两种方法患者平均年龄、平均移植胚胎数、胚胎评分及胚胎细胞数比较无统计学意义（Pgt;0.05），但自然周期的胚胎种植率及周期临床妊娠率均明显低于激素替代周期（16.78%比29.21%；29.51%比50.00%），比较有统计学意义（Plt;0.05）。 结论 患者年龄不影响FET周期临床妊娠率，激素替代周期内膜准备的FET胚胎种植率及周期临床妊娠率明显高于自然周期。【Abstract】 Objective To analyze the effect of age and method of preparing endometrium on the pregnancy rate of frozen-thawed embryo transfer (FET) among infertile women. Methods Retrospective analysis was made on 131 FET cycles in 107 patients from March 2007 to August 2009. The relationship between pregnancy rate of FET and following factors were analyzed: age, the method of preparing uterus endometrium. Results ①There was no significant difference in pregnancy rate of FET among ＜29, 30 - 34, and ≥35 years old patients (45.28%, 37.88%, and 33.33%, respectively) (Pgt;0.05). ②There was no significant difference in patients’ age, the average embryo amount, embryo score, the cell amount in every embryo between the FET with hormone replacement therapy (HRT) and the FET with natural cycle (NC). The embryo implantation rate and pregnancy rate of FET with NC were lower significantly than those of FET with HRT (16.78% vs 29.21%; 29.51% vs 50.00%) (P＜0.05). Conclusion Age might not influence pregnancy rate of FET. FET with HRT has higher implantation rate and pregnancy rate than FET with NC.
【摘要】 目的 探讨各种不同体外受精（IVF）助孕方案对子宫腺肌病伴不孕症患者的疗效。 方法 对2006年1月-2009年6月进行IVF助孕治疗的子宫腺肌病伴不孕症患者63例的临床资料进行回顾性分析。根据是否应用长效促性腺激素释放激素激动剂（GnRH-a）及启动促性腺激素（Gn）时间分为超长方案、长效GnRH-a后长或短方案、常规长方案3组，对IVF助孕疗效进行分析。 结果 3种治疗方案的Gn刺激天数、Gn总量、获卵数、不良反应发生率和流产率比较无统计学意义（Pgt;0.05）；3种治疗方案的周期取消率为20.0%、7.7%、30.0%，比较有统计学意义（χ2=5.74，Plt;0.05），方案2的周期取消率低于方案1和方案3，有统计学意义（χ2=7.21，Plt;0.05）；3种治疗方案的继续妊娠率为23.0%、37.0%、15.3%，有统计学意义（χ2=11.31，Plt;0.05），方案2的继续妊娠率高于方案1和方案3，有统计学意义（χ2=8.52，Plt;0.05）。 结论 与超长方案和常规长方案相比，子宫腺肌病伴不孕症患者采用长效GnRH-a治疗后长方案或短方案行IVF助孕治疗，妊娠率升高，周期取消率降低。【Abstract】 Objective To investigate the effect of different in vitro fertilization (IVF) treatment protocols on infertile women with adenomyosis. Methods Sixty-four infertile women with adenomyosis who had IVF treatment cycles from January 2006 to June 2009 were retrospectively analyzed. According to administration of long course gonadotropin-releasing hormone agonist (GnRH-a) and the start time of gonadotropin (Gn), all participants were divided into three groups: the first group with ultra-long term protocol, the second group with long or short term protocol after administration of long course GnRH-a and the third group with routine long term protocol. Results There were no differences among the three groups with regard to days of Gn administration, amounts of Gn administration, numbers of retrieved oocytes, prevalence of poor response and miscarriage (Pgt;0.05). The cancelation rates of the three groups were 20.0%、7.7% and 30.0% respectively. There were significant differences in cancelation rates among the groups (χ2=5.74, Plt;0.05), and the cancelation rate in the second group was significantly lower than the other groups (χ2=7.21, Plt;0.05). The ongoing pregnancy rates of the groups were 23.0%、37.0% and 15.3% respectively. There were significant differences in ongoing pregnancy rates among three groups (χ2=11.31, Plt;0.05), and the ongoing pregnancy rate in the second group was significantly higher than the other groups (χ2=8.52, Plt;0.05). Conclusion Compared with the ultra-long term and routine long term protocol of IVF treatment in infertile woman with adenomyosis, the ongoing pregnancy rate might be higher and the cancelation rate might be lower in the long or short term protocol after administration of long course GnRH-a.