Evaluación de la tasa de blastocistos euploides en fase folicular y lútea (DuoStim) en mujeres con pobre respuesta ovárica: estudio preliminar en México / Euploid blastocyst rate in follicular vs luteal phase (DuoStim) in women with poor ovarian response: Preliminary study in Mexico

Resumen: OBJETIVO: Comparar la tasa de blastocistos euploides obtenida después de la estimulación ovárica en fase folicular con la fase lútea en un mismo ciclo menstrual en pacientes con deficiente respuesta ovárica. MATERIALES Y MÉTODOS: Estudio clínico, prospectivo y comparativo llevado a cabo en el Centro de Reproducción Arcos, Nascere, entre los meses de enero a julio de 2019. Se incluyeron pacientes con pobre respuesta ovárica según los criterios de Bologna y con indicación de PGT-A. Las estimulaciones en fase folicular y lútea se efectuaron con antagonista de la GnRH y FSHr/LHr (2:1) a partir del día 3 del ciclo y 5 días después de la primera recuperación de los ovocitos. Para completar el proceso de maduración ovocitaria se utilizaron análogos de GnRH, se tomó una biopsia de trofoectodermo en día 5-7. RESULTADOS: Se estudiaron 20 pacientes. Al comparar la fase folicular con la lútea la tasa de fertilización fue de 79% (IC95%: 29-46) vs 55% (IC95%: 34-53), la tasa de blastocistos 42% (IC95%: 19-44) vs 45% (IC95%: 24-55) y la tasa de blastocistos euploides 100% (IC95%: 44-53) vs 70% (IC95%: 38-46), respectivamente. Solo la tasa de recuperación de ovocitos en metafase II mostró diferencias significativas entre ambas fases 40% (IC95%: 18-37) vs 59% (IC95%: 31-59), p = 0.0333 en la fase folicular y lútea, respectivamente. CONCLUSIONES: La estimulación ovárica bifásica (folicular-lútea), en el mismo ciclo menstrual (DuoStim), resultó en mayor tasa de recuperación de ovocitos en metafase II durante la fase lútea. Sin embargo, las tasas de desarrollo embrionario a día 5-6 (blastocistos) y de embriones euploides fueron similares entre ambas fases.

Abstract: OBJECTIVE: Euploid blastocyst rate comparison between ovarian stimulation in follicular vs luteal phase performed in the same menstrual cycle in patients with poor ovarian response. MATERIALS AND METHODS: Clinical, prospective and comparative study conducted at Centro de Reproducción Arcos S.C., "Nascere", during january-july, 2019. Patients with PGT-A indication and poor ovarian response according to Bologna criteria were included. Under a short GnRH-antagonist protocol, stimulations, both in follicular and luteal phase were performed using rFSH/rLH (2:1) from day 3 of the cycle and 5 days after the first oocyte retrieval. In addition, ovulation trigger with an GnRH agonist was used, finally, on day 5-6 of embryo development, trophoctoctoderm biopsy was performed. RESULTS: In this study, 20 patients were included; when comparing follicular phase vs luteal phase, we found that fertilization rate was 79% (95%CI 29-46) vs 55% (95%CI 34-53), blastocysts rate was 42% (95%CI 19-44) vs 45% (95%CI 24-55) and euploid embryo rate was 100% (95%CI 44-53) vs 70% (95%CI 38-46). Only the oocyte recovery rate in metaphase II showed significant differences between both phases 40% (IC 95% 18-37) vs 59% (IC 95% 31-59), p=0.0333. CONCLUSION: Biphasic ovarian stimulation (follicular/ luteal) in the same menstrual cycle (DuoStim) resulted in a higher metaphase II ooctye recovery rate during the luteal phase in comparison with the follicular phase. However, the rates of blastocysts and euploid blastocysts were similar between both phases.

Do food intake and food cravings change during the menstrual cycle of young women? / A ingestão de alimentos e os desejos por comida mudam durante o ciclo menstrual das mulheres jovens?

Abstract Objective The aim of the present study was to assess the anthropometric measures, food intake and food cravings during the menstrual cycle of undergraduate students of the faculty of nutrition. Methods A cross-sectional study was performed with 27 students from a public university in the state of Mato Grosso do Sul, Brazil, who had their food intake evaluated through a 24-hour food recall, their nutritional status evaluated based on anthropometric measures, and food cravings evaluated using the Food Desire Questionnaire. Data were collected during an evaluation in the follicular phase (between the 5th and the 9th day of the menstrual cycle) and another in the luteal phase (LP) (between the 20th and the 25th day of the menstrual cycle). For food intake variables, the analysis of variance (ANOVA) test was used, followed by the Tukey test. The Mann-Whitney test was used for the analysis of food cravings, considering a significance level of 5% (p< 0.05). Results The desire for foods rich in sugar, salt, and fat, such as chocolate, pastries, snacks and desserts were higher (p< 0.05) during the premenstrual period, although it did not reflect neither a higher energy intake nor an alteration in the distribution of macronutrients. A higher intake of carbohydrates, proteins, fibers, and calcium was observed during the LP; however, without statistical difference between the groups. There were no differences either in the intake of any food group or in the anthropometric measurements (p> 0.05). Conclusion Food cravings of nutrition students differed between the phases of the menstrual cycle; however, with no difference in food intake and in anthropometric measures.

Resumo Objetivo Verificar alterações de medidas corporais, consumo e desejos alimentares durante o ciclo menstrual de acadêmicas de nutrição. Métodos Estudo transversal com 27 estudantes de uma universidade pública do Mato Grosso do Sul, as quais tiveram seu consumo alimentar avaliado por meio de recordatório alimentar de 24 horas, estado nutricional avaliado com base em medidas antropométricas, e desejos alimentares avaliados utilizando-se o Questionário de Desejo Alimentar. Os dados foram coletados durante uma avaliação na fase folicular (entre o 5° e o 9° dia do ciclo menstrual) e outra na fase lútea (entre o 20° e o 25° dia do ciclo menstrual). Para as variáveis de consumo alimentar, utilizou-se o teste análise de variância (ANOVA, na sigla em inglês), seguido pelo teste de Tukey. Já para a análise dos desejos alimentares, utilizou-se o teste de Mann-Whitney. Foi considerado o nível de significância de 5% (p< 0,05). Resultados Os desejos por alimentos ricos em açúcar, sal e gordura, como chocolates, produtos de pastelaria, lanches e sobremesas foram maiores (p< 0,05) no momento pré-menstrual, apesar de não refletirem em maior consumo energético e tampouco em alteração na distribuição de macronutrientes. Observou-se maior consumo de carboidratos, proteínas, fibras e cálcio na fase lútea; no entanto, sem diferença estatística entre os grupos. Não foram encontradas diferenças no consumo de nenhum grupo alimentar, tampouco nas medidas antropométricas (p> 0,05). Conclusão Os desejos alimentares das acadêmicas de nutrição diferiram entre as fases; no entanto, sem diferença no consumo alimentar e nas medidas corporais.

Influence of Hormonal Changes on Audiologic Examination in Normal Ovarian Cycle Females: An Analytic Study

Abstract Introduction There is only limited information from previous studies that suggest that auditory function may be influenced by hormones. Recent advances in the field have exposed the potential role of hormones in modulating the auditory system. Objective This study aims to investigate the relationship between menstrual cycle and outer hair cell function with audiological examination. Methods This is an analytic study with a cross-sectional design. The sampling was a systematic random sampling. We found 49 women with normal menstrual cycle and collected their data through interviews, physical examination, and examination of the ear, with otoscopic and other routine otorhinolaryngology examinations. We evaluated Tympanometry, distortion-product otoacoustic emissions (DPOAE), and pure tone audiometry. Results We found the audiometric threshold worse in the follicular phase than other phases at 4000 Hz of the right ear, and in the ovulation was found best than any other phases at 1000 Hz of the left ear with significant difference. We found significant difference of DPOAE between ovulation time and follicular phase at 3000 Hz and 1000 Hz in the left ear and between ovulation and luteal phased at 2000 Hz, 3000 Hz and 5000 Hz in the right ear and at 1000 Hz in the left ear with p< 0.05. Conclusion The result of this study showed that only a small part of audiometry threshold had a significant difference between each menstrual phase. In other words, we found no correlation between menstrual and audiometry threshold. Nonetheless, there is a correlation between menstrual cycle phase and DPOAE amplitude.

Differential expression of microRNA in eutopic endometrium tissue during implantation window for patients with endometriosis related infertility / 中华妇产科杂志

Objective To predict the genes that affect endometrial receptivity through the differential expression of microRNA (miRNA) in eutopic endometrial tissues during implantation window in patients with endometriosis infertility. Methods Among infertile patients that received treatments at the Center for Reproductive Medicine,Peking University Third Hospital between May and December 2013, patients with endometriosis infertility were selected as endometriosis group (among the selected 17 cases, there were 6 cases with follicular phase endometrium and 11 cases with implantation window phase endometrium), and patients with tubal factor infertility were selected as control group (among the selected 19 cases, there were 7 cases with follicular phase endometrium and 12 cases with implantation window phase endometrium). (1)Implantation window phase endometrium was selected from 3 cases in each group. Using miRNA and mRNA joint gene sequencing and database for forecast results, as well as using the negative regulatory relationship between miRNA and mRNA, the intersection of target gene that negatively correlates with miRNA expression were obtained. The co-expression network of miRNA-mRNA wae constructed. Combined with the genes associated with endometrial receptivity found through bioinformatics method, the miRNA with core regulatory functionwas found. (2) Expand sample size to 14 cases for endometriosis group and 16 cases for control group.Reverse transcription (RT)-PCR technique was utilized to detect the expression of miR-142-5p, miR-146a-5p and miR-543 in endometrial tissues, and verify miRNA microarray results. Results (1) miRNA and mRNA microarray screening results showed that, among the endometrial tissues of patients with endometriosis infertility and with implantation window phase, 6 differentially expressed miRNA were indentified, among which miR-142-5p, miR-146a-5p, miR-1281, miR-940, miR-4634 showed significantly enhanced expression and miR-543 showed significantly inhibited expression. Sixty-three differentially expressed mRNA were indentified, among which 58 mRNA such as CADM1, IL-10RA, ITGAL and LPAR5 had significantly enhanced expression. Five mRNA such as HLA-DRB1,3,4,5 and SOHLH2 showed significantly inhibited expression. Thirty-six taget genes were found in consideration of negatively correlated miRNA expression with the genes, miRNA-mRNA co-expression network were constructed. The miR-543 was found at the core of the network. Targetscan and other database predicted that miR-142-5p, miR-146a-5p and miR-543 could act on various types of endometrial receptivity molecular corresponding marker genes such as HOX10, ITGAV, ITGB3, OPN, LIF, ESR, PGR, CDH1 and MMP. (2) RT-PCR test showed that the average levels of expression of miR-142-5p and miR-146a-5p in implantation window phase endometrium in endometriosis group were 8.3 ± 10.6 and 1.9 ± 0.8 respectively;the average levels of that in control group were 1.1±0.6 and 0.9±0.4, respectively. The difference was statistically significant (P=0.027, P=0.015), and was consistent with results from miRNA microarray test. The expression of miR-543 in tissues of follicular phase endometrium in endometriosis group (2.3±1.0) was significantly higher than that in control group (1.0 ± 0.4), and the difference was statistically significant (P=0.008). However, when comparing the expression of miR-543 implantation window phase endometrium in endometriosis group (1.2±0.6) with that in control group (1.5 ± 1.0), the difference was not statistical significant (P=0.890). Conclusions There are multiple differential expressions of miRNA in the implantation window phase endometrium tissues of endometriosis infertility patients, among which miR-142-5p and miR-146a-5p show significantly enhanced expression and may affect embryo implantation by acting on a variety of endometrial receptivity marker molecules. The expression of miR-543 in implantation window phase endometrium of endometriosis infertility patients is lower than that in the follicular phase, forewarned changes in the pattern of cyclic variation of miR-543, and may be the reason for affecting endometrial receptivity.

Redução da reserva ovariana em pacientes adultas com dermatomiosite

Objetivo: Avaliar os marcadores de reserva ovariana e anticorpos anti-corpo lúteo (anti-CoL) em pacientes com dermatomiosite (DM). Métodos: Todos as 40 pacientes do sexo feminino com DM, idade entre 18 e 42 anos, foram convidadas a participar. Os critérios de exclusão foram uso de contraceptivos hormonais nos últimos seis meses (n=13), associação de neoplasia (n=3), doenças autoimunes sistêmicas sobrepostas (n=3), gravidez atual (n=2), cirurgia ginecológica (n=1) e não concordância em participar do estudo (n=2). Dezesseis pacientes com DM e 23 controles saudáveis selecionados para participar deste estudo transversal foram avaliados na fase folicular precoce do ciclo menstrual. Anti-CoL IgG (immunoblotting), hormônio folículo estimulante (FSH), estradiol, inibina B, níveis séricos do hormônio anti-mülleriano (HAM) (ELISA) e contagem de folículos antrais (CFA) por ultrassonografia foram determinados. Resultados: Pacientes e controles tiveram média de idade, etnia e classe socioeconômica comparáveis (P > 0,05). A média de idade das pacientes foi de 29,1±4,7 anos e duração da doença de 5,6±3,2 anos. O ciclo menstrual, comorbidade e estilo de vida foram semelhantes em ambos os grupos (P > 0,05). HAM <= 1ng/mL (P=0,027) e número da CFA (P=0,017) foram significativamente reduzidos em pacientes com DM quando comparados ao grupo controle, enquanto que níveis séricos de estradiol (P < 0,001) foram maiores em pacientes com DM. Em contraste, os níveis de FSH no soro e inibina B, volumes de ovários, assim como a frequência de anticorpos anti-CoL foram semelhantes em ambos os grupos. Conclusão: O presente estudo foi o primeiro a identificar a reserva ovariana diminuída em pacientes com DM em idade reprodutiva. Mais estudos são necessários para avaliar os fatores envolvidos no prejuízo da reserva ovariana de pacientes com a miopatia inflamatória.

Objectives: To assess ovarian reserve markers and anti-corpus luteum (anti-CoL) antibodies in dermatomyositis (DM) patients. Methods: All 40 female patients with DM, aged between 18 and 42 years, were invited to participate. Exclusion criteria were hormonal contraceptive use in the last six months (n=13), neoplasia associations (n=3), overlapped systemic autoimmune diseases (n=3), current pregnancy (n=2), gynecological surgery (n=1) and did not agree to participate of this study (n=2). Sixteen DM patients and 23 healthy controls were evaluated at early follicular phase of menstrual cycle were selected to participate in this cross-sectional study. IgG anti-CoL (immunoblotting), follicle stimulating hormone (FSH), estradiol, inhibin B, anti-müllerian hormone (AMH) serum levels (ELISA) and sonographicantral follicle count (AFC) was determined. Results: DM patients and controls had comparable mean age, ethnicity and socioeconomic class (P > 0.05). DM mean age of onset was 29.1±4.7 years and disease duration of 5.6±3.2 years. The menstrual cycles, comorbidity and life style were similar in both groups (P > 0.05). AMH<=1ng/mL (P=0.027) and number of the AFC (P=0.017) were significantly reduced in DM patients when compared to control groups, whereas serum estradiol level (P < 0.001) was higher in DM patients compared to controls. In contrast, serum FSH and inhibin B levels, ovarian volumes, as well as the frequency of anti-CoL antibody were alike in both groups. Conclusions: The present study was the first to identify diminished ovarian reserve in DM patients of reproductive age. Further studies are necessary to assess the idiopathic inflammatory myopathy-related factors involved in the ovarian impairment of patients.

The Effect of Phase of Menstrual Cycle on Sympathetic Skin Response Among Healthy Young Indian Women.

This descriptive study was undertaken to investigate the influence of menstrual cycle on sympathetic skin response (SSR) during different phases of menstrual cycle in young healthy Indian women. A comparison of SSR latencies and amplitudes were done in the follicular, ovulatory and mid luteal phases of menstrual cycle. Fifty women in age group of 18 – 25 years having regular menstrual cycles were chosen for this study. After confirming the regularity of menstrual cycle, SSR was performed on them. The recording was done under standardized conditions using standardized procedure. Amplitude of SSR was found to vary in the three phases, but the differences were statistically not significant. Latency of SSR was found to be greatest in the follicular phase (1.54 ± 0.22 s) and least in the mid-luteal phase (1.35 ± 0.18 s). Statistically significant differences were found between mean SSR latency in the follicular phase and the other two phases (p < 0.01). This study concludes that SSR is enhanced during the mid-luteal phase in women with regular menstrual cycles indicating sympathetic dominance.

Avaliação morfológica e morfométrica de ovários, tubas uterinas e útero de fêmeas suínas pré-púberes em diferentes fases do ciclo estral / Morphological and morphometric evaluation of prepubertal gilt ovaries, uterine tubes and uterus at different oestrus cycle stages

Studies are performed in developing techniques/procedures that provide greater reproductive performance in farm animals, including pigs. In this sense, the study of gilts reproductive organs at different oestrus cycle stages for assessing the presence of abnormalities and/or other parameters that may affect the future animal fertility is important. In order to evaluate the morphological, morphometric and histomorphometric features of ovaries, uterus and uterine tubes (UTs) characteristics of prepubertal gilts at different oestrus cycle stages, reproductive tracts from 48 animals immediately after slaughter were obtained. After, the structures were dissected and removed, and the ovaries were used for classification of oestrus cycle stage of each gilt in follicular phase (FP) and luteal phase (FL). Then, morphometric evaluations of ovaries, UTs, uterine horns and uterine body were performed. Besides that, medial segments of UTs and uterus were fixed in Bouin solution, processed and included in paraffin, when histological sections of 5.0 micrometers (µm) were obtained and stained with Hematoxylin and Eosin. Histomorphometric analyzes using image capture system and specific software were performed. Afterwards, data were submitted to Student's t test for assessment the statistical differences (P<0.05) between the two different oestrus cycle stages (FP × LP) and between the placement of reproductive structures (right × left antimer). Among the gilts evaluated, 35 were in the FP and 13 in LP. There was no difference (P>0.05) between morphometric parameters of ovaries, UTs and uterus of gilts in FP and LP. Likewise, in respect to the placement of reproductive structures, both in the oestrus cycle stages, as in the general average, there was no difference (P>0.05). Regarding the histomorphometric variables, gilts classified in FP presented a higher (P<0.05) height of glandular and UT epithelium compared to animals in LP...

Pesquisas são realizadas no desenvolvimento de técnicas/procedimentos que propiciem maior eficiência reprodutiva em animais de produção, dentre esses, os suínos. Nesse sentido, o estudo dos órgãos reprodutivos das fêmeas suínas em diferentes fases do ciclo estral é importante para avaliação da presença de anomalias e/ou demais parâmetros que possam afetar a fertilidade futura do animal. Objetivando-se avaliar as características morfológicas, morfométricas e histomorfométricas dos ovários, útero e tubas uterinas (TUs) de fêmeas suínas pré-púberes em diferentes fases do ciclo estral, tratos reprodutivos foram obtidos de 48 animais imediatamente após o abate. Posteriormente, as estruturas foram dissecadas e retiradas, sendo os ovários utilizados para a classificação da fase do ciclo estral de cada fêmea em fase folicular (FF) e fase luteínica (FL). Em seguida, foram realizadas avaliações morfométricas dos ovários, TUs, cornos uterinos e corpo uterino. Após, segmentos mediais das TUs e útero foram fixados em solução de Bouin, processados e incluídos rotineiramente em parafina, quando cortes histológicos de 5,0 micrômetros (µm) foram obtidos e corados com Hematoxilina e Eosina. Análises histomorfométricas foram realizadas utilizando sistema de captura de imagens e software específico. Posteriormente, os dados obtidos foram submetidos ao teste t de Student para a avaliação de diferenças estatísticas (P<0,05) entre as diferentes fases do ciclo estral (FF × FL) e entre a localização das estruturas reprodutivas (antímero direito × esquerdo). Dentre as fêmeas avaliadas, 35 encontravam-se na FF e 13 na FL. Não houve diferença (P>0,05) entre os parâmetros morfométricos dos ovários, TUs e útero das fêmeas nas FF e FL. Da mesma forma, em relação à localização das estruturas reprodutivas, tanto nas duas fases do ciclo estral, como na média geral, não houve diferença (P>0,05)...

A prospective survey study on premenstrual syndrome in young and middle aged women with an emphasis on its management.

Premenstrual syndrome (PMS) is defined as the recurrence of psychological and physical symptoms in the luteal phase, which remit in the follicular phase of the menstrual cycle. Symptoms of which fall in three domains: emotional, physical and behavioural e.g. irritability, anger, headache, fatigue, food cravings etc. The survey study of was conducted among 50 young & 50 middle aged women of S.B.K.S Medical Institute and Research Centre to find the prevalence of premenstrual syndrome with an emphasis on its management. Responses to a feedback questionnaire covering various aspects related PMS were obtained from 50 participants belonging to each group. The participants belonged to different range of literacy. It was found that 42% faced PMS regularly, while 58% occasionally. Of the 100 participants 68% suffered with backache, 64% leg cramps, 62% fatigue, breast tenderness and anger whereas 58% suffered with anxiety and generalized body ache. Of all the sufferers only 34% had received the treatment for PMS. Irrespective of the age PMS is common problem faced by women. With our study we observed that literacy has not mattered in the management of this health problem. Since there are reports stating that the severity of PMS can hamper the daily routine and even lead to suicidal tendency, it is essential that awareness programs need to be conducted to address the importance of managing the issue by pharmacological and non-pharmacological methods.

Relationship Between Parasympathetic Nerve Function and Ovarian Hormones During Different Phases of Ovarian Cycle In Healthy Young Women.

Background: Women having regular ovarian cycle often experience premenstrual syndrome which may be associated with alterations of autonomic nerve function due to fluctuation of ovarian hormones during different phases of ovarian cycle. Objective: To observe the parasympathetic nerve function status and their relationships with ovarian hormones during different phases of ovarian cycle in healthy young women. Methods: This cross sectional study was carried out in the department of Physiology at BSMMU, Dhaka in 2007 on 30 eumenorrhogic healthy females aged 20 to 30 years. Serum estrogen and progesterone were measured by MEIA method and parasympathetic nerve functions were assessed by valsalva, deep breathing test and orthostatic test during follicular and luteal phases of ovarian cycle. Data were analyzed by paired student ‘t’ test, and Pearson’s Correlation coefficient test where applicable. Results: Mean resting HR,SBP,DBP and all measures of parasympathetic nerve function were similar in all phases of ovarian cycle. With serum estrogen level, deep breathing showed significant (p<0.05) positive correlation in follicular and luteal phase and valsalva showed significant positive correlation during luteal phase. Conclusion: The results this study suggest that estrogen has got positive influence on parasympathetic nerve function which support cardioprotective role of estrogen in premenopausal females.

To evaluate the involvement of autonomic nervous system during pre and post menstrual phases in young women.

Background: During reproductive life, Women undergo many types of behavioural and hormonal changes, which influence various functions of body. ANS provides physiological adaptive background for these changes. The main aim of this study is to carry out autonomic function tests during various phases of menstrual cycle. Method: Different Methods were used to evaluate sympathetic and Parasympathetic activity. This study was carried out in two different phases of menstrual cycle viz. premenstrual phase (late luteal phase-LL) and post menstrual phase (early follicular phase –EF). Results: The autonomic function tests and heart rate variables were recorded and data was tabulated for Statistical evaluation with student paired “t” test. P 0.05 was considered as statistically significant. The tests for sympathetic activity were compared during pre and post menstrual phases. It was observed that pulse rate, blood pressure and cold pressor test were statistically more significant (p<0.01), while orthostatic variation in arterial blood pressure was statistically significant (p<0.05) in premenstrual phase as compared to post menstrual phase of menstrual cycle. For parasympathetic activity it was observed that heart rate response, expiratory: inspiratory ratio and valsalva ratio were statistically not significant (p>0.05) in both pre and post menstrual phases of menstrual cycle. Conclusion: In this study the responses to various sympathetic tests were significantly altered in premenstrual phase as compare to that of postmenstrual phase, reflecting the significant increase in the sympathetic activity. These changes may be due to gonadal steroids imbalance during post menstrual phase (EF) and premenstrual phase (LL) of menstrual cycle which in turn affects HPA axis and ANS significantly. Significant increased sympathetic activity responses indicate an augmented stress system.

Investigation on the effect of promoting ovulation of tamoxifen in clomiphene resistant polycysitic ovary Syndrome / 中国基层医药

Objective To explore the effect of domoxifen combined with tamoxifen on ovulation in clomiphene-resistant patients with polycystic ovary syndrome. Methods 100 patients who was resistant to CG were randomly divided into two groups:the treatment group (group A) and control group (group B). Oral dosing CC 100mg/d to the patients of group A in the first 3th to 7th days of menses,at the same time,oral dosing tamoxifen 40mg/d in the first 3th to 7th days of menstrual cycle. The dose of CC to group B was same as group A. Beginning to monitor the case of follicular growth during the 8th day of menses. When a ovarian follicle' s diameter beyond 18mm or 2 ovarian follicle' s diameter beyond 17mm, intramuscular injection hCG 10 000IU, sexing after 36 hours later. Observing the two groups of the mature ovarian number,the endometrial thickness, the days of promoting ovulation ,the level of progesterone in serum about the 22th day of menstrual cycle, ovulation rate and pregnancy rate, after injecting hCG.Results The day after injecting hCG, the mature ovarian follicle number,the endometrial thickness, the level of progesterone in serum about the 22th day of menstrual cycle,ovulation rate and pregnancy rate,group A was significantly different from group B( P ＜0.05 ～ P ＜0. 01 ) ,the days of promoting ovulation have no statistically significant differences between the groups (P ＞ 0. 05). Conclusion In the clomiphene-resistant patients with polycystic ovary syndrome,tamoxifen could promote ovulation,improve the effect of CC on the uterus' s anti-estrogen,increase endometrial thickness, elevate ovulation rate and pregnancy rate.

Differences in the expression of inhibin receptors and activin receptors in normal human ovaries and their significance / 中华妇产科杂志

Objective To explore the differences in the expression of inhibin(INH)receptors and activin (ACT)receptors in the follicular/luteinic phase in normal human ovaries and their relationship with female endocrine hormone levels.Methods Real time PCR and immunohistochemistry were used to determine the expression of inhibin receptors(INHR)genes,activin receptors(ACTR)genes.Serum estradiol(E2),follicle stimulating hormone(FSH),luteinizing hormone(LH),INHB,ACTA levels were determined by a solid quantitative sandwich enzyme immunoassay technique(Sandwich ELISA)in 21 women during follicular phase and another 21 women during luteinic phase,the correlations between each gene and each hormone were analyzed.Results(1)ACT type Ⅰ and Ⅱ receptors genes(ACTR Ⅰ A,ACTR Ⅰ B,ACTRⅡA,ACTR Ⅱ B)and INH receptor β-glycan genes were expressed higher in the follicular phase than in the luteinic phase:ACTR Ⅰ A(0.50±0.17 vs 0.36±0.18;P＜0.05),ACTR Ⅰ B(0.050±0.019 vs0.036±0.020;P＜0.05),ACTRⅡ A(0.10±0.04 vs 0.07±0.04;P＜0.05),ACTR Ⅱ B(0.28±0.10vs 0.19±0.11;P＜0.05),β-glycan(0.26±0.10 vs 0.17±0.09;P＜0.01).(2)The intensities of ACTR I A,ACTR Ⅱ A,β-glycan immunostaining in human normal ovaries in the follicular phase were significantly stronger compared to those in luteinic phase.In the follicular phase β-glycan expression was positively correlated with serum E2,FSH,LH,INHB levels.The correlation coefficient was 0.53(P＜0.05).0.74(P＜0.01),0.85(P＜0.01)and 0.76(P＜0.01)respectively.Conclusion In normal human ovary in the follicular phase INH and ACT bind their receptors and down-regulate or up-regulate FSH,thus influencing the follicular development.

Transvaginal follicular aspiration in follicle phase in the management of anovulation associated with polycystic ovary syndrome / 中华妇产科杂志

Objective To investigate the follicle development and pregnancy in clomiphene citrate-resistant patients with polycystic ovary syndrome (PCOS) after transvaginal follicular aspiration and gonadotropin administration. Methods Seventeen clomiphene citrate-resistant patients with PCOS failed to gonadotropin treatment associated with ovarian hyperstimulation syndrone(OHSS). They are anovulatory infertility with normal tubal and husbands'sperm condition. In this treatment regimen,all patients was administered with gonadotropin from day 5 of menstrual cycle(or withdrawal bleeding) and were asked to undergo ultrasound-guided transvaginal follicular aspirations for 5 days later. Only one or two follicles for every ovary were remained and gonadotropin administration was continued. A follicle development,ovulation rate,pregnancy rate and sex hormone were monitored. Results Fifteen of the 17 patients experienced dominant follicles development and ovulation. 9 of them with one(52.9%) ,4 with two(23.5%) and 2 with three(11.8%) dominant follicles ovulated and pregnancy occurred in 7 patiends(41.2%). All of pregnancy are singleton. Conclusion A single follicle development and singleton pregnancy can be realized in clomiphene citrate-resistant PCOS patients by combined ultrasound-guided transvaginal follicular asperation with gonadotropin administration.

The length of the follicular phase influences normal fertilization rates in assisted reproduction.

Factors affecting normal fertilization rates (NFR) were studied in 1,776 IVF patients having 3383 treatments during 1990-1992. Interestingly, the longer the follicular phase (LFP) the higher the fertilization rate: LFP <12, 12, 13, and >13 days, NFR 49.6%, 53.8, 53.9 and 56.1% respectively. Higher fertilization rates were also related to normal semen analysis results, older females, the use of frozen husband and donor sperm, the diagnosis of tubal disease and the use of ovarian stimulation protocols other than clomiphene citrate plus human menopausal gonadotrophin.