卵巢基质动脉血流测定及其与体外受精-胚胎移植结局的关系研究
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摘要
目的探讨在体外受精-胚胎移植(in-vitro fertilization,IVF-ET)周期中卵巢基质动脉血流对卵巢反应性的预测价值及与优质胚胎发生情况、临床妊娠结局的关系。方法选取于我院生殖医学科首次行IVF/ICSI-ET治疗的不孕患者85例,运用无创经阴道彩色多普勒超声成像技术检测控制性超促排卵(C0H)周期用药第1天(D1)卵巢基质动脉血流的阻力指数(RI)、收缩期峰值(PSV),观察Gn用量、获卵率、优质胚胎率及临床妊娠结局间的相关性。根据获卵总数将病人分为正常反应组(获卵数5～15枚间) 47例及高反应组(获卵≥15枚) 38例;根据优质胚胎率分成A组(优质胚胎率0～49.99%) 49例、B组(优质胚胎率50.00%～100.00%) 36例;根据临床妊娠结局分为妊娠组40例、未妊娠组45例,比较各组间卵巢基质动脉血流的RI、PSV的差异。结果卵巢高反应组较正常反应组PSV高、RI低(P<0.05);正常反应组优质胚胎率高于高反应组(P<0.05)。按优质胚胎率分组看,各组间卵巢血流参数无显著差异(P>0.05);按妊娠结局分组看,妊娠组与非妊娠组卵巢各血流参数无统计学差异(P>0.05)。结论卵巢基质动脉血流RI、PSV对于卵巢反应性有预测价值,单用卵巢基质动脉血流参数对于胚胎质量预测价值不大,且其与妊娠结局无明显相关性。
Objective To investigate the correlations between blood flow parameters of the ovarian stromal artery and ovarian reactivity,embroyic development and IVF outcomes using color Doppler ultrasound.Methods Eighty-five infertile women who underwent IVF/ICSI treatment in our reproductive center were selected,whose resistance index(RI) and peak systolic velocity(PSV) of ovarian stromal blood flow were measured using non-invasive color Doppler flow image(CDFI) on the first day(D1)of the controlled hyperovulation cycle. The correlations of these parameters with the dosage of Gn consumption,retrieval rate of oocytes and number of transplantable embryos were observed. The relationships between ovarian artery blood flow and good embryos and clinical pregnancy outcomes were also analyzed. According to the number of oocytes retrieved,these patients were divided into two groups: the normal response group(5-15 oocytes) with 47 patients and the high response group(≥15 oocytes) with 38 patients. Moreover,according to the high quality embryo rate,these patients were again divided into two groups: group A(0-49.99% high quality embryo rate) with 49 patients and group B(50%-100% high quality embryo rate) with 36 cases. Then,according to clinical outcomes,the patients were assigned to the pregnant group and the non-pregnant group.The differences of RI,PSV and AMH were compared between these groups.Results PSV and AMH were higher while RI was lower in the high response group than in the normal response group(P<0.05). There was no significant difference in blood flow parameters between group A and Group B(P>0.05),or between the pregnant group and the non-pregnant group(P> 0.05). Conclusion RI and PSV can help predict ovarian reactivity but are not obviously related to clinical outcomes. Blood parameters contribute little to the prediction of the quality of embryos.
Objective To investigate the correlations between blood flow parameters of the ovarian stromal artery and ovarian reactivity,embroyic development and IVF outcomes using color Doppler ultrasound.Methods Eighty-five infertile women who underwent IVF/ICSI treatment in our reproductive center were selected,whose resistance index(RI) and peak systolic velocity(PSV) of ovarian stromal blood flow were measured using non-invasive color Doppler flow image(CDFI) on the first day(D1)of the controlled hyperovulation cycle. The correlations of these parameters with the dosage of Gn consumption,retrieval rate of oocytes and number of transplantable embryos were observed. The relationships between ovarian artery blood flow and good embryos and clinical pregnancy outcomes were also analyzed. According to the number of oocytes retrieved,these patients were divided into two groups: the normal response group(5-15 oocytes) with 47 patients and the high response group(≥15 oocytes) with 38 patients. Moreover,according to the high quality embryo rate,these patients were again divided into two groups: group A(0-49.99% high quality embryo rate) with 49 patients and group B(50%-100% high quality embryo rate) with 36 cases. Then,according to clinical outcomes,the patients were assigned to the pregnant group and the non-pregnant group.The differences of RI,PSV and AMH were compared between these groups.Results PSV and AMH were higher while RI was lower in the high response group than in the normal response group(P<0.05). There was no significant difference in blood flow parameters between group A and Group B(P>0.05),or between the pregnant group and the non-pregnant group(P> 0.05). Conclusion RI and PSV can help predict ovarian reactivity but are not obviously related to clinical outcomes. Blood parameters contribute little to the prediction of the quality of embryos.
引文
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[10]陈钰仪,赵萍,贾节,等.不孕症患者卵巢血流灌注预测卵泡发育的三维超声研究[J].广东医学,2017,38(21):3287.
[11]JADAON J E,BEN-AMI M,HADDAD S,et al.Prospective evaluation of early follicularovarian stomal blood flow in infertile women undergoing IVF-ET treatment[J].Genecol Endocrinol,2012,28(5):356.
[12]LAKHANI K,SEIFALIAN A M,ATIOMO W U,et al.Polycystic ovaries[J].Br J Radiol,2002,75(889):9.
[13]田莉,马淳,周寒鹰,等.重组生长激素应用于IVF前次失败患者的初步探讨[J].生殖医学杂志,2017,26(5):468.
[14]江成龙,张昌军.降调节后雌孕激素替代内膜准备方案对改善PCOS患者FET结局的临床研究[J].中国计划生育学杂志,2015,23(7):455.
[15]李娜,师娟子,施文浩,等.GnRH激动剂方案适宜获卵数的探讨:9188例新鲜周期胚胎移植回顾性分析[J].生殖医学杂志,2017,26(6):511.
[16]潘荣,师娟子,于玲,等.获卵数与IVF/ICSI累积活产率的相关性研究[J].生殖医学杂志,2018,27(2):117.
[17]李娜,施文浩,师娟子,等.GnRH激动剂方案适宜获卵数的探讨:9188例新鲜周期胚胎移植回顾性分析[J].生殖医学杂志,2017,26(6):511.
[18]林小鸳,刘玉兰,等.经阴道彩色多普勒评价补肾活血方对改善腹腔镜术后卵巢储备功能下降的疗效[J].中国实用医药,2015,10(2):174.
[2]刘艳丽,李君芳,张玉超,等.冻融胚胎移植周期临床结局的影响因素[J].郑州大学学报(医学版),2017,52(4):435.
[3]MASCARENHAS M N,CHEUNG H,MATHERS C D,et al.Measuring infertility in populations:constructing a standard definition for use with demographic and reproductive health surveys[J].Popul Health Metrics,2012,10(1):17.
[4]王兴玲,张文娟,蔡鹏飞,等.卵泡液中游离DNA含量与卵母细胞成熟度及胚胎质量的关系[J].郑州大学学报(医学版),2016,51(3):375.
[5]LUKE B,BROWN M B,WANTMAN E,et al.Cumulative birth rates with linked assisted reproductive technology cycles[J].N Engl J Med,2012,366(26):2483.
[6]刘浩.彩超在预测FSH正常不孕症患者的超排卵期中卵巢反应的研究[J].临床与病理杂志,2015,35(5):779.
[7]唐淮云,汤丽莎,许娟,等.卵泡输出率、窦卵泡计数结合年龄评估卵巢反应性及预测体外受精临床结局的研究[J].中国性科学,2017,26(11):108.
[8]吕晓燕,杨晓东.阴道彩色多普勒超声监测卵巢及子宫血流的临床意义探讨[J].中国实验诊断学,2015,19(5):795.
[9]陈霞,陈智毅,王伟群.Gn启动日经阴道彩色多普勒超声对卵巢反应性的预测价值[J].热带医学杂志,2016,16(8):1016.
[10]陈钰仪,赵萍,贾节,等.不孕症患者卵巢血流灌注预测卵泡发育的三维超声研究[J].广东医学,2017,38(21):3287.
[11]JADAON J E,BEN-AMI M,HADDAD S,et al.Prospective evaluation of early follicularovarian stomal blood flow in infertile women undergoing IVF-ET treatment[J].Genecol Endocrinol,2012,28(5):356.
[12]LAKHANI K,SEIFALIAN A M,ATIOMO W U,et al.Polycystic ovaries[J].Br J Radiol,2002,75(889):9.
[13]田莉,马淳,周寒鹰,等.重组生长激素应用于IVF前次失败患者的初步探讨[J].生殖医学杂志,2017,26(5):468.
[14]江成龙,张昌军.降调节后雌孕激素替代内膜准备方案对改善PCOS患者FET结局的临床研究[J].中国计划生育学杂志,2015,23(7):455.
[15]李娜,师娟子,施文浩,等.GnRH激动剂方案适宜获卵数的探讨:9188例新鲜周期胚胎移植回顾性分析[J].生殖医学杂志,2017,26(6):511.
[16]潘荣,师娟子,于玲,等.获卵数与IVF/ICSI累积活产率的相关性研究[J].生殖医学杂志,2018,27(2):117.
[17]李娜,施文浩,师娟子,等.GnRH激动剂方案适宜获卵数的探讨:9188例新鲜周期胚胎移植回顾性分析[J].生殖医学杂志,2017,26(6):511.
[18]林小鸳,刘玉兰,等.经阴道彩色多普勒评价补肾活血方对改善腹腔镜术后卵巢储备功能下降的疗效[J].中国实用医药,2015,10(2):174.