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目的了解体外受精-胚胎移植(IVF-ET)周期治疗中患者甲襞微循环的变化及其与获卵数、胚胎质量、IVF结局之间的关系。方法监测103名不孕女性患者总共112个IVF-ET周期治疗中和56例正常健康妇女甲襞微循环积分在月经期、增殖期及分泌期的变化,同时用放射免疫法测定患者各期血清中的雌二醇和孕酮水平。结果(1)促排卵治疗患者和正常健康妇女甲襞微循环状况随着月经期、增殖期及分泌期的演进逐渐好转,但不孕患者甲襞微循环积分较正常对照组积分值明显偏高,差异具有极显著意义。(2)体外受精-胚胎移植人群的甲襞微循环积分与雌二醇、孕酮水平无相关;(3)治疗组中根据获卵数分为高反应组(获卵数>10个),中反应组(获卵数6~10个)及低反应组(获卵数<5个)。在月经期及分泌期,高反应组(获卵数≥10个)的微循环积分较其它两组明显低,分别为2.908±1.471 vs 4.068±1.218,3.319±1.348和1.243±0.522 vs 1.937±0.853,1.892±1.097,差异具有显著意义,而增殖期无差异。(4)在促排卵过程中微循环状况与胚胎质量呈正相关;(5)妊娠组的微循环状况好于未妊娠组;(6)在增殖期及分泌期,年龄≤35岁组的微循环状况好于年龄>35岁组。结论促排卵周期中微循环状况与月经周期密切相关,微循环状况关系促排卵效果、胚胎质量及着床,进而影响IVF结局。
Objective To investigate the changes of microcirculation and its relationship with the numbers of retrieved oocytes, the quality of embryos and the outcomes of IVF in patients undergoing in vitro fertilization-embryo transfer (IVF-ET) cycles. Methods A total of 112 infertile women were monitored in 112 cycles of IVF-ET and 56 normal controls. The changes of microcirculation scores of formazan during menstruation, proliferative and excretory phases were observed. The serum levels of each stage of the patients were measured by radioimmunoassay In the estradiol and progesterone levels. Results (1) The microcirculation status of formazan in patients with ovulation induction and normal healthy women gradually improved as the menstrual period, proliferative phase and secretory phase evolved. However, the score of microcirculation of formazan in infertile patients was significantly higher than that of the normal control group , The difference has extremely significant meaning. (2) The scores of nailfold microcirculation in IVF-ET patients were not correlated with the levels of estradiol and progesterone; (3) The treatment group was divided into high-response group (number of oocytes> 10) In the reaction group (6 to 10 oocytes) and low response group (oocytes <5). In the menstrual phase and secretory phase, the microcirculation scores of high response group (number of oocytes≥10) were significantly lower than the other two groups, which were 2.908 ± 1.471 vs 4.068 ± 1.218, 3.319 ± 1.348 and 1.243 ± 0.522 vs 1.937 ± 0.853 , 1.892 ± 1.097, the difference was significant, but no difference in proliferative phase. (4) There was a positive correlation between microcirculation and embryo quality during ovulation induction; (5) Microcirculation in pregnancy group was better than that in non-pregnant group; (6) Microcirculation in group <35 years old during proliferative and secretory phase Condition is better than the age> 35-year-old group. Conclusion Ovulation cycle in microcirculation and menstrual cycle are closely related to the relationship between microcirculation promote ovulation, embryo quality and implantation, thereby affecting the outcome of IVF.