目的探讨人第10号染色体缺失的磷酸酶及张力蛋白同源基因(phosphatase and tensin homolog deleted on chromosome 10,PTEN)对子宫内膜腔上皮细胞极性的调控及对胚胎着床的影响。方法通过实时荧光定量PCR、Western blotting、细胞免疫荧光实验比较非容受态子宫内膜腔上皮细胞HEC-1A与容受态子宫内膜腔上皮细胞RL95-2之间PTEN的表达及定位差异;PTEN干扰质粒转染HEC-1A细胞,检测紧密连接相关蛋白质表达水平,透射电子显微镜检测紧密连接结构,Transwell实验检测细胞运动能力,与绒毛膜癌细胞JAR共培养检测HEC-1A细胞与JAR细胞之间的黏附水平;向体外培养的HEC-1A细胞分别加入二甲基亚砜、17β-雌二醇、孕酮、17β-雌二醇+孕酮,检测卵巢激素对PTEN表达的影响。结果相较HEC-1A细胞,RL95-2细胞PTEN基因及蛋白质表达水平均显著降低(P均=0.003);PTEN主要定位于RL95-2细胞核,而在HEC-1A细胞中,PTEN主要定位于细胞质;与质粒载体对照组相比,敲降PTEN基因后,HEC-1A细胞紧密连接相关蛋白ZO-1、Occludin和Claudin-4表达水平显著降低(P<0.001,P=0.038,P<0.001),细胞间紧密连接长度降低(P=0.046),迁移与侵袭能力增强(P均<0.001),与JAR细胞之间黏附率增强(P=0.016);与空白对照组(二甲基亚砜组)相比,17β-雌二醇组、孕酮组及17β-雌二醇+孕酮组的PTEN蛋白表达水平均显著降低(P均<0.001),17β-雌二醇+孕酮组的PTEN蛋白表达水平显著低于17β-雌二醇组和孕酮组(P均=0.001),孕酮组与雌二醇组的PTEN蛋白表达水平差异无统计学意义(P>0.05)。结论不同容受状态的子宫内膜细胞PTEN表达存在差异,雌二醇和孕酮可能通过抑制PTEN在子宫内膜的表达,进一步调控子宫内膜上皮细胞间紧密连接结构及细胞极性,从而增强子宫内膜容受性。
目的探讨高孕激素下促排卵方案和黄体期长方案对平衡易位携带行PGD周期治疗效果的比较。方法回顾性分析2016年5月至2018年4月在武汉大学人民医院生殖医学中心因染色体平衡易位行PGD助孕的51例患者的临床资料,根据患者促排卵方案的不同将其分为高孕激素下促排卵方案组(PPOS方案组)和黄体期长方案组(LP方案组),其中PPOS方案组24例患者,LP方案组27例患者。比较两组患者的一般特点、促排卵情况、胚胎发育情况和子代胚胎染色体情况。结果两组患者的一般情况,包括双方年龄、不孕年限、BMI、基础窦卵泡数、基础FSH、基础LH、FSH/LH比值和基础E2比较,其差异均无统计学意义(均P>0.05)。促排卵过程中,PPOS方案组患者促排天数显著低于LP方案组患者(9.21±1.67 vs 11.22±2.87,P=0.003),PPOS方案组患者获卵数少于LP方案组患者[10.50(8.25,17.50)vs 14.00(12.00,20.00),P=0.096)],PPOS方案组患者M2卵子数少于LP方案组患者[9.50(7.00,13.00) vs 12.00(8.00,18.00),P=0.219)],PPOS方案组患者2PN数少于LP方案组患者[8.00(6.00,12.00) vs 9.00(5.00,14.00),P=0.583)],PPOS方案组患者第5天囊胚比例高于LP方案组患者(56.12%vs 45.65%,P=0.149),两组差异均无统计学意义;但PPOS方案组患者可活检囊胚形成率显著高于LP方案组患者(44.34%vs 34.40%,P=0.023),其差异具有统计学意义。两组患者胚胎染色体形成情况中,正常/平衡胚胎比例(32.65%vs 36.08%,P=0.614))、不平衡胚胎比例(40.82%vs 32.99%,P=0.495))、非整倍体胚胎比例(37.76%vs 41.24%,P=0.619))等比较,其差异均无统计学意义。2种方案均有约30%的患者无可移植胚胎(29.17%vs 29.63%,P=0.971)。结论对于染色体平衡易位行PGD助孕的患者,PPOS方案能够获得与黄体期长方案相似的促排卵效果,而且可活检囊胚形成率更高。通过分析二代测序结果显示,PPOS方案对子代染色体形成没有不利影响。所以,对于染色体平衡易位行PGD�
Polycystic ovary syndrome (PCOS) is one of the most common causes of infertility in women. Progestin-primed ovarian stimulation (PPOS) protocol, which used oral progestin to prevent premature luteinizing hormone (LH) surges in ovarian stimulation, has been proved to be effective and safe in patients with PCOS. The aim of the present study was to compare the efficacy of PPOS protocol with that of the traditional gonadotropin-releasing hormone (GnRH) antagonist protocol in patients with PCOS. A total of 157 patients undergoing in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) were recruited into this study. The patients were divided into two groups by the stimulation protocols: the GnRH antagonist protocol group and the PPOS protocol group. There was no significant difference in the clinical characteristics between the two groups. Dose and duration of gonadotropin were higher in the PPOS protocol group. Estradiol levels on the day of human chorionic gonadotropin (hCG) administration were significantly lower in the PPOS protocol group. Fertilization rates and the number of good quality embryos were similar between the two groups. Remarkably, we found 6 patients with moderate ovarian hyperstimulation syndrome (OHSS) in the GnRH antagonist protocol group but 0 in the PPOS protocol group. A total of 127 women completed their frozen embryo transfer (FET) cycles. There were no significant differences between the two groups in terms of clinical pregnancy rate per transfer, implantation rate, first-trimester miscarriage rate and on-going pregnancy rate per transfer. To conclude, PPOS protocol decreased the incidence of OHSS without adversely affecting clinical outcomes in patients with PCOS.
