Martin J S, Nisker J A, Parker J I, Kaplan B, Tummon I S, Yuzpe A A
Department of Obstetrics and Gynaecology, University of Western Ontario, London, Canada.
Fertil Steril. 1995 Jul;64(1):98-102.
To determine causes of "idiopathic" infertility, the IVF-ET experience of three cohorts of couples with this diagnosis was examined.
Three cohorts of idiopathic infertility couples undergoing IVF-ET: a "failed IUI" group, three previous controlled ovarian hyperstimulation (COH)-IUI cycles with no pregnancies; a "conversion" group, patients converted during a COH-IUI cycle to IVF-ET because of excess follicle numbers; and a "direct IVF" group, patients proceeding directly to IVF-ET were compared.
A tertiary referral reproductive medicine unit.
Forty-one idiopathic infertility couples.
In vitro fertilization-ET.
Number of oocytes retrieved, percent oocytes fertilized, number embryos per ET, implantation rate, percent pregnancy per cycle.
The cohorts had similar fertilization rates and mean (+/- SD) number of pre-embryos transferred. The conversion group demonstrated a higher pregnancy rate (PR) per cycle and a higher E2 concentration than the other groups. The PR of 35.0% in the direct IVF group appeared higher than the 16.7% rate observed in the failed IUI group.
Our observation of a lower PR in couples in the failed IUI group (16.7%) than in couples in the direct IVF group (35.0%) suggests pre-embryo developmental problems or implantation problems as likely important etiologies for a large proportion of idiopathic infertility couples. However, as the conversion group demonstrated both a significantly higher E2 concentration ([E2]) and per cycle PR than the other cohorts with similar fertilization and pre-embryo transfer rates. Subjects converted in a COH-IUI cycle to IVF-ET are thus either more likely to produce pre-embryos more genetically capable of continued development to implantation stage (i.e., better oocytes recruited and fertilized) or due to the higher [E2] to have endometrium more receptive to implantation. Neither undiagnosed tubal factors nor fertilization problems appear to be major etiologic contributors.
为确定“特发性”不孕症的病因，对三组诊断为此类病症的夫妇进行体外受精 - 胚胎移植（IVF - ET）的情况进行了检查。
三组特发性不孕症夫妇接受IVF - ET治疗：“宫内人工授精（IUI）失败”组，此前进行过三个控制性卵巢过度刺激（COH）-IUI周期但未怀孕；“转换”组，在COH - IUI周期中因卵泡数量过多而转换为IVF - ET的患者；以及“直接IVF”组，直接进行IVF - ET的患者，并对这三组进行比较。
一家三级转诊生殖医学单位。
41对特发性不孕症夫妇。
体外受精 - 胚胎移植。
取出的卵母细胞数量、卵母细胞受精率、每次胚胎移植的胚胎数量、着床率、每个周期的妊娠率。
三组的受精率以及移植的平均（±标准差）前胚胎数量相似。“转换”组每个周期的妊娠率（PR）和雌二醇（E2）浓度均高于其他组。“直接IVF”组35.0%的妊娠率似乎高于“IUI失败”组观察到的16.7%的妊娠率。
我们观察到“IUI失败”组夫妇（16.7%）的妊娠率低于“直接IVF”组夫妇（35.0%），这表明前胚胎发育问题或着床问题可能是很大一部分特发性不孕症夫妇的重要病因。然而，由于“转换”组的E2浓度（[E2]）和每个周期的PR均显著高于其他受精率和前胚胎移植率相似的组。因此，在COH - IUI周期中转换为IVF - ET的受试者要么更有可能产生在遗传上更有能力持续发育到着床阶段的前胚胎（即募集和受精的卵母细胞更好），要么由于[E2]较高而使子宫内膜更易接受着床。未诊断出的输卵管因素和受精问题似乎都不是主要的病因。
