Objective To investigate patients in gynecological endocrinology clinic with the following three pieces of information: how did they provide their symptom information, how did they understand diagnostic and therapeutic information, and what was their attitude towards the visit, and to get to know about the situation and problems in doctor-patient communication, so as to aim directly at improving the efficiency of diagnosis and treatment. Methods A total of 403 patients, who visited Prof. HAN Zi-yan’s clinic in the hospital from April to August 2010, were evaluated using self-edited Assessment on Doctor-patient Communication in Gynecological Endocrinology Outpatient Clinic. Results a) As to the situation of patients providing symptom information as well as understanding diagnostic and therapeutic information, when doctor asked, only 29% (118/403) of patients could narrate their treatment history clearly, and 38% (152/403) could tell their examination history exactly. After doctors’ explanation, only 21% (86/403) understood their examination results correctly, and 27% (108/403) understood management and therapeutic advice. The result of correlation analysis showed the accuracy of patients in providing disease information and accepting diagnostic and therapeutic information was higher in patients aged from 21 to 40 rather than those younger than 20, in patients well- educated rather than those with little education at the primary school, and in patients who were also engaged in medical work, All differences were significant (all Plt;0.05); and b) As to patients’ attitude towards visit, 55% (222/403) of patients hoped to get more attention from doctor, and 37.5% (151/403) overly expected the visit. Conclusion In the professor’s gynecological endocrinology outpatient clinic, many patients can’t clearly provide their treatment and examination history, neither understand exam situation and therapeutic advice at that visit, which are influenced by their age, education and occupation. In addition, psychological needs of patients should be concerned, too
目的 探讨3种不同助孕方案在≥40岁妇女体外受精-胚胎移植（IVF-ET）周期中的临床效果。 方法 回顾性分析2010年8月－2012年2月期间，于四川大学华西第二医院生殖中心行IVF-ET助孕、年龄≥40岁妇女共245个周期的临床资料，排除一侧卵巢缺如患者3例，余242个周期根据助孕方案不同分为3组：拮抗剂组（GnRH-A方案组）44个周期、长方案组109个周期及短方案组89个周期，比较3种方式助孕的临床效果。 结果 3组均无早发黄体生成素峰；长方案组应用促性腺激素（Gn）的时间最长，应用Gn数量最多，获得最高的获卵数及获胚数（P＜0.05）；3组的受精率、优胚率、冷冻胚胎数、周期取消率、卵巢过度刺激综合征发生率、早期流产率均无统计学意义（P＞0.05），短方案组的种植率及临床妊娠率最低（P＜0.05）。 结论 GnRH-a长方案在≥40岁妇女的IVF-ET周期中具有较好的临床结局，在≥40岁妇女IVF-ET周期中具有与长方案相似的结局，并且可以减少Gn使用量，提高卵泡及胚胎质量，短方案组对≥40岁妇女临床效果较差。
【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.
ObjectiveTo compare the clinical outcomes of different pituitary down regulation protocols with gonadotropin-releasing hormone agonist (GnRH-a) in patients undergoing in vitro fertilization and embryo transfer (IVF-ET) treatment. MethodsThe clinical data of 358 IVF cycles in women at 40 years old or younger from November 2012 to January 2013 in the West China Second University Hospital were analyzed retrospectively. All the 358 cycles were divided into two groups, according to whether the leading follicle diameter was <14 mm (group A, 158 cycles) or ≥14 mm (group B, 200 cycles) after discontinuing the GnRH-a. The clinical outcomes were compared between the two groups. ResultsCompared with group B, the amount of gonadotropins used was significantly more, and the time of gonadotropin use was also significantly longer in group A (P<0.05). However, the serum level of estradiol (E2), progesterone (P) and Luteinizing hormone (LH), incidence of premature P rise, retrieved ovum number, the rates of implantation, clinical pregnancy, miscarriage and live birth did not significantly differ between the two groups (P>0.05). ConclusionDiscontinuing the use of GnRH-a in early stage of controlled ovarian stimulation can keep effective pituitary down regulation and it has the same optimal clinical outcomes in patients undergoing IVF-ET.
ObjectiveTo explore the effect of chronic unpredictable mild stress (CUMS) on the reproductive function of mice and provide a suitable animal model for reproduction and stress. MethodsA total of 240 female Kunming mice were feed for 5 days, and then divided randomly into the control group (n=90) and experimental group (n=150). The mice in the experimental group were stressed by 9 chronic mild unpredictable stress factors for 4 weeks and validated by open field test and sucrose consumption test. We administrated pregnant mare serum gonadotropin (PMSG)/human chorionic gonadotropin (HCG) for induction of superovulation and observed the ovarian response and embryo development potential. ResultsAfter 4-week CUMS stimulation, the weight gain, 2% sugar consumption test and open field test were significantly different between the mice in two groups (P>0.05). After PMSG/HCG was administrated, the antra follicles and preovulatory follicles significantly reduced significantly in the experiment group than that in the control group (P<0.05); the number of oocytes, fertilization rate, 2-cell embryos, D4 embryos, blastocysts, high quality embryo rate and D5 bed points were all significantly decreased in the experiment group than those in the control group (P<0.05). ConclusionThe CUMS female Kunming mice model is a kind of emotional stress animal model with low reproductive function, which is effective, operable and repeatable; it could be used for further study on the mechanism of reproductive medicine.
ObjectiveTo quantify cytokine and chemokine mRNA expression in follicular fluid cells obtained at the time of oocyte retrieval before IVF in women with and without polycystic ovary syndrome (PCOS). MethodsBetween January and August 2014, 80 subjects undergoing IVF-ET were chosen to be studied. Among them, 40 had PCOS, and the other 40 were controls. Follicular fluid cells were subjected to quantitative RT-PCR to evaluate growth-regulated oncogene-α (GRO-α), tumor necrosis factor-α (TNF-α), interleukins (IL-6, IL-8) expression relative to β-actin. And the chemokine was measured in serum and follicular fluids by immunoassays. These mRNA transcriptions production was proved by sequencing. ResultsGRO-α, TNF-α, IL-6 and IL-8 mRNA were expressed in follicular fluid cells. Their expressions were significantly higher in PCOS compared with controls (P<0.05). They were also detected higher in PCOS than controls in serum and follicular (P<0.05), but the difference of IL-6 level between PCOS and controls in lean patients was not statistically significant (P>0.05). ConclusionGRO-α, IL-8, TNF-α, and IL-6 may play important roles in the occurrence and development of PCOS. PCOS may be a chronic immunological inflammatory disease.