子宮內膜較薄IVF後子宮外孕機率較高?

子宮內膜較薄IVF後子宮外孕機率較高?

6465懷孕研究顯示
IVF植入前內膜<9mm子宮外孕機率是
內膜>12mm子宮外孕機率的4倍

卵子受孕方式會影響早期胚胎之分裂速度

卵子受孕方式(IVF vs ICSI)會影響早期胚胎之分裂速度
IVF速度慢於ICSI約1.5h

晚期胚胎影響較不明顯
可見晚期胚胎分裂速度主要取決於胚胎之品質

http://www.ncbi.nlm.nih.gov/pubmed/26307686

試管懷孕流產8成原因為胚胎染色體異常

試管懷孕流產最常見原因為胚胎染色體異常(占82%)
尤其是胚胎染色體3套數之異常(占83%)
染色體最常見之異常為15,16,18,21,22染色體

Fertil Steril. 2015 Sep 7. pii: S0015-0282(15)01761-6. doi: 10.1016/j.fertnstert.2015.08.007. [Epub ahead of print]

Embryo selection versus natural selection: how do outcomes of comprehensive chromosome screening of blastocysts compare with the analysis of products of conception from early pregnancy loss (dilation and curettage) among an assisted reproductive technology population?

Rodriguez-Purata J1, Lee J2, Whitehouse M2, Moschini RM2, Knopman J3, Duke M2, Sandler B3, Copperman A3.

Author information

Abstract

OBJECTIVE:

To compare the incidence of numerical chromosomal abnormalities (NCAs) reported after preimplantation genetic screening (PGS) analysis compared with that reported after cytogenetic analysis of products of conception after spontaneous abortion.

DESIGN:

Retrospective study.

SETTING:

Private academic in vitro fertilization center.

PATIENT(S):

Cytogenetic reports of patients who underwent an IVF cycle with PGS of at least one biopsied embryo were compared with cytogenetic analysis reported from patients who had dilation and curettage (D&C) for the treatment of a spontaneous abortion after assisted reproductive technology (ART) treatment.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Frequencies for each numerical chromosomal abnormality from both groups were compared.

RESULT(S):

A total of 1,069 NCAs were reported after PGS (trisomy 54.3%, monosomy 45.7%, no polyploidies), resulting in a trisomy/monosomy ratio of 0.82. A total of 447 NCAs was reported after D&C (trisomy 83%, polyploidy 10.7%, monosomy 6.3%). The aneuploidies most frequently identified were similar in both groups and included 15, 16, 18, 21, and 22. Monosomies (n = 28, 6.3%) were rarely observed in the group that underwent D&C after ART.

CONCLUSION(S):

This review provides an analysis of the most commonly identified NCAs after PGS and in first-trimester D&C samples in an infertile population utilizing ART. Although monosomies comprised >50% of all cytogenetic anomalies identified after PGS, there were very few identified in the post-D&C samples. This suggests that although monosomies occur frequently in the IVF population, they commonly do not implant. Despite this difference, this study demonstrated that the specific NCAs observed after PGS analysis and D&C were comparable.

IVF胚胎染色體正常比率

Day3前胚胎染色體正常率約30-35%
早期囊胚期染色體正常率約42%
成熟囊胚期染色體正常率約65%

性生活對於IVF胚胎植入懷孕率並無明顯影響

植入胚胎前後性生活，對於胚胎懷孕率並無明顯影響，甚至可能可提高胚胎著床率

http://humrep.oxfordjournals.org/content/15/12/2653.full

根據精蟲品質決定IVF時間長短

根據精蟲品質，活動力，數量，過去懷孕病史
決定IVF精蟲卵子受孕時間長短

http://www.ncbi.nlm.nih.gov/pubmed/22136561

IVF後6h未受孕卵施行rescue ICSI

IVF後6h 檢查PB以確定是否受孕
未受孕卵施行rescue ICSI, 懷孕率12%

http://www.ncbi.nlm.nih.gov/pubmed/16580372/

注射精漿於陰道可能可提高著床率

取卵當日注射0.5ml精漿於陰道可能可提高著床率

http://www.ncbi.nlm.nih.gov/pubmed/23812801

IVF overnight效果類似IVF 2h

IVF overnight效果類似IVF 2h，
控制sperm 濃度(10-20萬/ml)以達最佳狀況

http://www.ncbi.nlm.nih.gov/pubmed/12513887/

縮短IVF授孕時間可能可提高臨床懷孕率

縮短精蟲卵子IVF授孕時間，可能可提高臨床懷孕率，
但必須是非男性不孕症，精蟲活動力與數量在正常標準以上

http://www.ncbi.nlm.nih.gov/pubmed/?term=ime+of+insemination+culture+and+outcomes+of+in+vitro+fertilization

目前卵巢移植施行試管結果並不理想

目前卵巢切除冷凍保存後再移植後誘導排卵+IVF之結果並不理想，

取卵率，卵泡受孕率，胚胎形成率及懷孕率偏低, 30%病患取不到卵子，

原因可能在於卵組織於手術冷凍解凍移植過程受損，內分泌異常，卵細胞成熟異常，子宮化療放射治療受損, etc.

http://humrep.oxfordjournals.org/content/24/11/2778.full

反應佳 卵子多之病患應優先考慮囊胚培養植入與冷凍保存

反應佳 卵子多之試管嬰兒病患
應優先考慮囊胚培養植入與冷凍保存
比4-8細胞之植入與冷凍保存可達較高之累積懷孕率與活產率

過早服用黃體素不利試管懷孕率

 

過早服用黃體素不利試管懷孕率
於排卵針hCG施打前服用黃體素可能干擾
胚胎著床與懷孕率

三原核(3PN)胚胎 具染色體自我修復能力

三原核(3PN)胚胎 於體外培養顯示
50% 經精蟲顯微注射(ICSI)受孕之3PN胚胎具染色體自我修復能力
不到10%經傳統試管(IVF)懷孕之3PN胚胎具染色體自我修復能力

基礎濾泡可準確評估取卵之數量與品質

對多囊性卵巢病患
基礎濾泡可準確評估取卵之數量與品質
及試管懷孕率與活產率

胚胎植入前於子宮腔內注射hCG可提高懷孕率

高齡(>40歲)不孕症病患施行試管嬰兒胚胎植入過程前
於子宮腔內注射少量hCG (100-500IU)
可能可提高胚胎著床率與懷孕率

不明原因之不孕症病患之試管受孕方式

1. 優先採用傳統授精方式(IVF)取代精蟲顯微注射方式(ICSI)
2. 雖然IVF 與ICSI結果卵子受孕率類似
3. 但IVF可達較高活產率

 

精蟲活動力與玻尿酸篩選法(HBA)關連

雖然玻尿酸法可篩選出活動力與型態較佳之精蟲
玻尿酸法
使用玻尿酸篩選精蟲於傳統試管嬰兒治療之效果並不明確

from: http://humrep.oxfordjournals.org/content/21/6/1545.full.pdf

Hum Reprod. 2006 Jun;21(6):1545-50. Epub 2006 Apr 4.