Outcome of in vitro fertilization-embryo transfer in treatment of polycystic ovarian syndrome / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To evaluate the outcome of in vitro fertilization embryo transfer (IVF-ET) in treatment of polycystic ovarian syndrome (PCOS) with infertility.</p><p><b>METHODS</b>A retrospective analysis was performed from 52 patients with PCOS (PCOS group) and 408 cases with tubal infertility (control group). Both groups underwent IVF-ET treatment from 2001 to 2004. The duration of stimulation, amps of gammaFSH, the level of serum E2, P on the day of HCG injection, the number of oocytes retrieved, the rates of fertilization, cleavage, implantation and pregnancy, the incidence of ovarian hyperstimulation syndrome (OHSS) and cancelled rate of ET were compared between the two groups.</p><p><b>RESULT</b>The duration of stimulation and amps of gammaFSH were not significantly different between the two groups. The concentration of serum E2, P on the day of HCG injection, the numbers of oocytes retrieved and cleavaged embryos were significantly higher in PCOS group (P <0.01, <0.05). Fertilization rate was significantly lower in PCOS group (P <0.01). The implantation, pregnancy and miscarriage rates per ET were not statistically significant. The OHSS rates and cancelled rates of ET were higher in PCOS group (P <0.01).</p><p><b>CONCLUSION</b>Women with PCOS have a lower fertilization rate compared with those with tubal-factor fertility during IVF-ET. However, more oocytes are recovered and the preimplanted embryo has a normal chance of implantation leading to similar pregnancy rates. The OHSS rates and cancelled rates of ET are higher in PCOS because of a greater number of oocytes developed and a higher level of E2.</p>

Effect of yangjing zhongyu decoction on matrix metalloproteinase-9 expression in endometrium and sex hormone regulation in women with cryptogenic infertility / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the effect of Yangjing Zhongyu decoction (YZD) on metalloproteinase-9 (MMP-9) and its inhibitor-1 (TIMP-1) expression and sex hormone regulation in mid-luteal phase endometrium of women with cryptogenic infertility.</p><p><b>METHODS</b>In situ hybridization and reverse transcription-polymerase chain reaction method was used to detect MMP-9 and TIMP-1 mRNA, and radioimmunoassay was used to determine levels of serum estradiol (E2) and progesterone (P) synchronously, of 22 infertile women during mid-luteal phase.</p><p><b>RESULTS</b>After treatment, the mid-luteal serum E2 and P level was 451.501 +/- 226.342 pmol/L and 46.502 +/- 19.948 nmol/L respectively, significantly higher than that before treatment (304.656 +/- 135.853 pmol/L and 33.782 +/- 15.459 nmol/L respectively), the difference was significant (P < 0.01). Staining of MMP-9 mRNA positive granules in cytoplasm and nuclei of adeno-epithelial cell mid-luteal phase endometrium deepened significantly, but the change in mesenchym was insignificant. The MMP-9 mRNA expression after treatment was 0.617 +/- 0.186 (grey level), significantly higher than the level before treatment (0.490 +/- 0.370), comparison between them showed significant difference (P < 0.05). Change of TIMP-1 mRNA expression in adeno-epithelial and mesenchym before and after treatment was insignificant (0.588 +/- 0.191 vs 0.621 +/- 0.146, P < 0.05). Correlation analysis showed that the quantitative difference of P value before and after treatment was positively correlated with the difference of MMP-9 mRNA before and after treatment (r = 0.682, P < 0.01).</p><p><b>CONCLUSION</b>YZD could soothen Gan and nourish Shen, raise the level of mid-luteal phase serum P, and further promote MMP-9 gene expression in endometrium to benefit the degradation of extracellular matrix of endometrium, and facilitate for blastocyst implantation.</p>

Relationship between imbalanced synthesis of human chorionic gonadotropin alpha and beta subunits and pregnancy-induced hypertension / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To study the relationship between imbalanced synthesis of human chorionic gonadotropin (hCG) alpha and beta subunits and the pathology of pregnancy-induced hypertension (PIH).</p><p><b>METHODS</b>Total hCG, free alphahCG and betahCG were measured in serum samples collected from 60 cases of PIH and 30 normal gravid women by radioimmunoassay. The ratio of total hCG/betahCG, betahCG/FalphahCG, (FalphahCG+betahCG)/betahCG were calculated. Immunohistochemical staining was performed in 13 placenta from each group.</p><p><b>RESULTS</b>In PIH group the levels of FalphahCG, total hCG and betahCG were significantly higher than those of normal group (FalphahCG: 528 +/-421 IU/L compared with 222 +/-129 IU/L; betahCG: 39396 +/-6412 IU/L compared with 24265 +/-5575 IU/L; total hCG: 66597 +/-9294 IU/L compared with 36078 +/-4767 IU/L, all P<0.001). The betahCG/FalphahCG ratio in PIH was lower than that of normal group (91.23 +/-53.38 Compared with 119.4 +/-80.1, P<0.05); (FalphahCG+betahCG)/betahCG ratio and total hCG/betahCG ratio in two groups were (1.022 +/-0.026 compared with 1.015 +/-0.011; 1.802 +/-0.339 compared with 1.807 +/-0.258, respectively P>0.05). The immunohistochemical intensity of betahCG and FalphahCG in syncytiotrophoblast was significantly increased in 13 PIH compared with the control.</p><p><b>CONCLUSION</b>These data suggested that the imbalanced synthesis of hCG alpha and beta subunits may cause hypertension.</p>

Effect of yangjing zhongyu decoction on expression of insulin-like growth factor II and its receptor in endometrium of women with unexplained infertility / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the effect of Yangjing Zhongyu Decoction (YJZYD) on expression of insulin-like growth factor II (IGF-II) and its receptor II (IGF-II R) in endometrium of women with unexplained infertility, and the relationship of which with the receptibility of endometrium to ovum implantation.</p><p><b>METHODS</b>Reverse transcription-polymerase chain reaction (RT-PCR) assay was used to detect quantitatively the expression of IGF-II and IGF-II R in 22 women with unexplained infertility before and after YJZYD treatment during mid-luteal phase.</p><p><b>RESULTS</b>The levels of IGF-II and IGF-II R before treatment were 0.794 +/- 0.453 and 0.725 +/- 0.354 (in grey level, the same below) respectively, which were significantly increased in the same phase after treatment, reaching 1.202 +/- 0.551 and 1.045 +/- 0.581 respectively (P < 0.01 and P < 0.05). Correlation analysis showed the level of IGF-II mRNA was positively correlated with the level of IGF-II mRNA either before or after treatment.</p><p><b>CONCLUSION</b>YJZYD could enhance the expression of IGF-II and IGF-II R in the endometrium during mid-luteal phase, promote the differentiation of endometrium and increase its reception to ovum implantation.</p>

Preimplantation genetic diagnosis: two successful cases / 浙江大学学报·医学版

OBJECTIVE: To establish a technology of preimplantation genetic diagnosis. METHODS: Intracytoplasm sperm injection and blastomere biopsy were performed on two women at the advanced age with the fallopian tube obstruction. Normal embryos were selected for embryo transfer after fluorescence in-situ hybridziation in biopsied blastomere. RESULTS: The levels of serum HCG were increased 20 days after embryo transfer and ultrasonography in 16 gestation weeks showed the fetal growth and structure are normal. CONCLUSION: Two successful clinical pregnancies achieved after preimplantation genetic diagnosis.

The effect of the expression of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 protein on the window phase of endometrial implantation in unexplained infertillie women / 浙江大学学报·医学版

OBJECTIVE: To explore the role of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 ( TIMP-1) protein on embryo implantation in unexplained infertile women. METHODS: Forty three women were divided into two groups: 29 unexplained infertile (study group) and 14 women with normal fertile function (control group).Immunohistochemical analysis was applied to measure the cell expression of MMP-9 and TIMP-1 in the endometrial implantation window phase of the two groups. RESULTS: The cells positive for these solu-ble proteinases were found in the epithelial and stromal cells in all endometrial samples. Semi-quantitative analysis showed that,MMP-9 and TIMP-1 were weaker in the endometrial glandular cells of infertile women then in those of the control group(MMP-9:230.79+/-43.92 compared with 307.78+/-44.25; TIMP-1:233.05+/-48.51 compared with 297.86+/-35.56,P<0.05). There was no statistical correlation between MMP-9 and TIMP-1 with blood estradiol(E(2)) and progesterone (P) in the two groups (P>0.05). But in control group, there was a negative correlation tendency in MMP-9/P and TIMP-1/P (MMP-9/P: r=-0.330,TIMP-1/P: r=-0.401). CONCLUSION: In unexplained inferrile women, the low expression of MMP-9 and TIMP-1 protein in the implantation window phase may be one of the important factors that affect the embryo impantation.

Endometrial insulin-like growth factor II and type I receptor in unexplained infertility and its steroid regulation / 浙江大学学报·医学版

OBJECTIVE: To investigate the endometrial expression of insulin-like growth factor II(IGF-II) and type I receptor(IGF-1R) in unexplained infertility. METHODS: Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect and quantify endometrial IGF-II and IGF-I R mRNA experession in the mid-luteal phase. Serum concentrations of estradiol(E(2)) and progesterone (P) were measured by radioimmunoassays. Thirty-four women with unexplained infertility were included in the study group. Twenty-one women with normal fertility were selected as the control group. RESULTS: Endometrial IGF-II and IGF-I R mRNA experession during the midluteal phase were significantly lower in the study group than in the control group (0.662 +/- 0.371 compared with 0.961+/- 0.389, P< 0.05; 0.582 +/- 0.257 compared with 0.829 +/-0.341, P< 0.05 respectively). The average serum P level in the study group was significantly lower than in the control group (23.782 +/-15.459 compared with 43.142 +/- 16.549nmol/L, P< 0.005). IGF-II mRNA expression correlated positively with IGF-I R mRNA expression in the two groups. Serum P level correlated positively with IGF-II and IGF-I R mRNA expression in the two groups. CONCLUSION: IGF-II and IGF-I R may play an important role in the implantation process. Their decreased expression relating to decreased P level may be important in unexplained infertility.

Gonadotropin-releasing hormone agonist stimulation test in anovulatory women / 浙江大学学报·医学版

OBJECTIVE: To evaluate the predictive value of ovarian response to the gonadotropin-releasing hormone agonist (GnRH-alpha) stimulation test (GAST) in anovulatory women during ovulation induction treatment. METHODS: Thirty-five patients entered and completed the study. Following administration of GnRH-alpha during the early follicular phase, the relationship between estradiol (E(2)) response, ovarian response and subsequent pregnancy was investigated. RESULTS: Three patterns of E(2) response were noted. Pattern A patients were hyper responders in induction treatment;their peak E(2) levels were the highest (14426.6 pmol/L) and they produced the most mature follicales (27.3 +/- 9.7 ). Thus pattern A patients had the highest risk of ovarian hyperstimulation syndrome (OHSS). (81.8 % ), cancellation cycle rate(72.7 % )and low pregnancy rate(18.2 % ). Pattern B patients had a favorable ovarian response with the highest pregnancy rate(62.5 % ). Pattern C was associated with a poor ovarian response. CONCLUSION: During ovulation induction treatment, GAST can be used to predict ovarian response of anovulatory women. This technique may enable us to design an ovarian induction protocol that would both reduce OHSS and increase pregnancy rate.

Free alpha hCG--a serum marker for pregnancy-induced hypertension / 浙江大学学报·医学版

OBJECTIVE: To evaluate the free alpha subunit of human chorionic gonadotropin (FalphahCG) as a marker for pregnancy-induced hypertension (PIH). METHODS: The study group consisted of 74 pregnant women with hypertension. PIH admitted at 21-43 weeks of gestation. The control group was 37 non-PIH women. Serum FalphahCG was measured by radioimmunoassay with monoclonal technology. Using Youden's index of the receiver operator characteristic curve(ROC), a threshold value was determined. RESULTS: FalphahCG levels in PIH women were significantly higher than in the control group women [(556+/-428)IU/L compared with (232+/-131)IU/L,P<0.001].Using 260 IU/L of FalphahCG as the threshold value yields a sensitivity of 81.1% and specificity of 75.7% with a Youden's index of 0.57 for predicting PIH. CONCLUSION: Serum FalphahCG may serve as a useful marker to predict PIH.