Gindoff P R, Hall J L, Stillman R J
Department of Obstetrics and Gynecology, George Washington University Medical Center, Washington, D.C. 20037.
Fertil Steril. 1994 Aug;62(2):237-41. doi: 10.1016/s0015-0282(16)56871-x.
To compare stimulation and outcome variables for IVF in stimulated cycles when ova are retrieved during diagnostic infertility laparoscopy versus transvaginal ultrasound (US) directed retrieval and to investigate the presence of unexpected failed fertilization in the diagnostic laparoscopy group, which allows an opportunity to diagnosis an etiology of infertility based on gamete interaction.
Consecutive patients who needed infertility diagnostic laparoscopy and agreed to combination with IVF were compared with concurrent patients undergoing transvaginal US IVF. Male factor screening parameters (semen analysis, sperm penetrating assay) and resultant fertilization were analyzed for these patients.
The George Washington University Hospital, a tertiary referral center offering assisted reproductive technologies. Patients for diagnostic laparoscopy combined with IVF were enrolled in the Program of Oocyte Retrieval at Diagnostic Laparoscopy (PORDL).
One hundred twenty-four women enrolled for diagnostic laparoscopy combined with IVF; 237 women were concurrently enrolled for transvaginal US IVF.
Response variables (number of follicles, days of monitoring, ampules of hMG, maximum E2) between the two groups were similar. Outcome variables (ova retrieved, ova fertilized, ova cleaved, clinical pregnancy rate per embryo transferred) were similar despite a significantly higher number of embryos transferred for the transvaginal US group. The clinical pregnancy rate per cycle was similar, 26% versus 28% for the women in the transvaginal US versus those women in the PORDL group, as was the clinical pregnancy rate per ET, 31% versus 34%, respectively. The number of fertilized ova for each group was not significantly different: 5.5 +/- 0.3 for the transvaginal group versus 4.8 +/- 0.4 for the PORDL group. Patients in the PORDL group with a known male factor (group B) had a lower fertilization rate than those with no male factor (group A). Within the group A with no detectable male factor prospectively, 17.2% had unexpectedly poor fertilization (group A1), whereas the rest of the group A patients had higher fertilization rates as was expected (group A2). The clinical pregnancy rate per ET for group A1 was 0% compared with 43.4% for the group A2 patients.
In vitro fertilization can be successfully performed during diagnostic laparoscopy yielding comparable results to transvaginal ultrasound IVF while gaining diagnostic information concerning sperm-ova interaction (i.e., fertilization).
比较在诊断性不孕腹腔镜检查期间取卵与经阴道超声引导取卵时，体外受精（IVF）刺激周期的刺激变量和结局变量，并调查诊断性腹腔镜检查组中意外受精失败的情况，该组可根据配子相互作用诊断不孕病因。
将需要进行不孕诊断性腹腔镜检查并同意联合IVF的连续患者与同期接受经阴道超声IVF的患者进行比较。对这些患者的男性因素筛查参数（精液分析、精子穿透试验）和受精结果进行分析。
乔治华盛顿大学医院，一家提供辅助生殖技术的三级转诊中心。诊断性腹腔镜检查联合IVF的患者纳入诊断性腹腔镜检查取卵计划（PORDL）。
124名女性登记接受诊断性腹腔镜检查联合IVF；237名女性同期登记接受经阴道超声IVF。
两组间反应变量（卵泡数量、监测天数、hMG安瓿数、最大雌二醇水平）相似。尽管经阴道超声组移植的胚胎数量明显更多，但结局变量（取卵数、受精卵子数、卵裂卵子数、每个移植胚胎的临床妊娠率）相似。每个周期的临床妊娠率相似，经阴道超声组女性为26%，PORDL组女性为28%；每个胚胎移植的临床妊娠率分别为31%和34%。每组受精卵子数无显著差异：经阴道组为5.5±0.3，PORDL组为4.8±0.4。已知有男性因素的PORDL组患者（B组）受精率低于无男性因素的患者（A组）。在预先未检测到男性因素的A组中，17.2%的患者受精情况出乎意料地差（A1组），而A组其余患者的受精率如预期较高（A2组）。A1组每个胚胎移植的临床妊娠率为0%，而A2组患者为43.4%。
在诊断性腹腔镜检查期间可成功进行体外受精，其结果与经阴道超声IVF相当，同时可获得有关精卵相互作用（即受精）的诊断信息。
