Polycystic ovarian syndrome (PCOD) women, in a normal ovarian stimulation cycle, often accompanied by the Hyper respone strong reaction, the women often cause too much of follicular and ovarian hyperstimulation syndrome, especially the high blood sugar, the cycle cancellation rate is very high, with high estrogen and high in its blood ovarian hyperstimulation complications, often caused by high blood sugar high insulin, and make the lining expansion of intravascular factor increases, thus causing adverse outcomes in patients with PCOD, so often combined use of some auxiliary drugs is as follows:
1. Pioglitazone(Actos)- hypoglycemia.
Can through the cell receptors (PPARS) effect on fatty acid metabolism, so that they don’t compete with glucose oxide generation x, and make the local tissue to insulin resistance force is reduced, achieve the result that fall blood sugar, can also reduce the happening of the vicarious high insulin.
2. Spironolactone-ru- healthy male.
It’s against the male sex effect. The main function is to inhibit DHT receptors in hair follicle cells. There is also a inhibitory effect on dhea-s (male).
3. Glucophage (Metformin)- glucagon.
A dramatic reduction in the risk of OHSS(ovarian hyperstimulation), by reducing insulin resistance (a major stimulator of VEGF), and increasing the success rate. In addition, Metformin is used to modify the ovary reaction, mainly through the following two machines.
Reduce non-ovulatory follicles.
2. The amount of E2 produced by follicles during ovulation reduction.
A comprehensive study suggests that Metformin does not increase pregnancy rates but decreases the incidence of OHSS.
4. Bromocriptine(parlodel)- prolactin.
Can effectively reduce OHSS cases by reducing the number of receptors for VEGF(angiectins).
A high concentration of myo-inosital (MI) in human egg is representative of a high quality egg, and inositol combined with folic acid can obtain more mature eggs in the ivf treatment of PCOS.
Other auxiliary drugs:
6. Growth Hormone
In a 2010 retrospective study, the additional use of growth hormone in test-tube infants could improve the rate of clinical pregnancy and live births (25% versus 8%). However, there is no significant difference between the number of eggs and the rate of fertilization. The authors point out that the sample size of this study is too small to be further discussed on a large scale.
(including testosterone, Androstenedione(Androstenedione),Dihydrotestosterone(Dihydrotestosterone) can theoretically promote early follicular development and enhance the effect of FSH stimulation. The conventional use of DHEA in low responders is still controversial. In this paper, there is considerable debate about the decrease of FSH demand and the increase of live yield, which still requires extensive research.
Repeating failure (RIF) in a test tube baby bed failure is a major obstacle to the bed, it is often complex and difficult to explore potential factor, although reproductive technology have significant progress, but in the bed rate and pregnancy rate of progress is not obvious, low rate of the bed is often a challenge of reproductive technology.
Clinically, there are three main reasons for pregnancy failure:
In vitro fertilization (IVF) women repeat failure in an effective bed.
Women who were able to conceive had repeated miscarriages, and they were observed:
Thirty percent of the embryos had disappeared in the early stages of the bed.
About 30 per cent of the embryos disappeared before their periods after the bed, and they could detect positive pregnancies.
About 10% of the pregnancy after the expiration of menstruation.
In short more than about 60% before and after pregnancy aborted in the bed, from embryo and dialogue between maternal disorders (contact), all of the infertility couples accept reproductive technology, after each take egg implanted in only about 30% to pregnant production, it has also been observed in the previous three ivf pregnancy rate is the same, but after four attempts to a marked decline in
What is a duplicate bed failure (RIF)?
Failure means there is no obvious reason to repeat the bed, the good hormone response, good quality embryos, good pathological endometrium development and no known reason, failed to reach perfection of endometrium acceptance is considered to be the failure of the bed, there is a mutual dialogue between embryonic and maternal (contact) caused no embryo can contact, even invade the lining inside
How to define RIF:
The patient had three IVF failures, despite the good embryos.
2. After the implantation of IVF, more than 10 high-quality embryos have been accumulated.
But this definition is rather subjective, as each laboratory defines a high-quality embryo.
There are three main reasons for this.
1) reduction of endometrial receptivity:
A) abnormality and deformity of the uterine cavity.
B) myoma (more than 4 cm or resulting in uterine cavity deformation and uterine fibroids may affect pregnancy)
C) uterine polypectomy (increased pregnancy rate)
D) the uterine endometrium is not sufficiently thick, and the endometrium of the endometrium is more than 9 to 10mm or more than 7mm in the uterus, and the endometrium with three shallow lines can increase the pregnancy rate.
F) adenoma of the uterus.
G) abnormal performance of bed factors.
H) increase the ratio of Th2 / Th1 cytokines to increase successful pregnancy.
I) immune factors and coagulants.
J) polycystic ovary syndrome.
2) obstacles to embryonic development.
A) an embryo of bad quality: a developing embryo with a mutation of a grain gland; The abnormality of chromosomes is also associated with age; Spermatozoa is abnormal or b) no spermatorrhea. Chromosomal abnormalities are also common in the microinjection of embryos.
C) the sclerosis of the egg shell.
D) poor training environment.
E) the pregnancy rate of frozen thawed embryos will decrease slightly.
3) multiple factors
B) obstruction of the fallopian tube.
C) ovarian hyperstimulation.
D) poor ovarian stimulation.
E) poor embryo implantation.
4) the fragmentation of the chromatin of the spermatozoa.
A) increase endometrial receptivity.
I) uterine mirror adjustment to improve uterine cavity lesions.
Ii) hysteromyoma resection.
Iv) increased endometrial thickness.
V) increased receptivity (mild injury to the uterus and increased pregnancy rate) in the uterus
Vi) endometrial transplantation of stem cells.
B) treatment of abnormal fetal development.
I) pre-bed chromosomal screening.
Ii) assisted incubation
Iii) oviduct egg implantation.
Iv) embryo co-incubation.
V) blastocyst implantation.
C) improve the technique of implantation.
D) improvement of multilevel surfaces.
I) endometriosis treatment.
Ii) resection of fallopian tube obstruction.
Iii) use the CIF (Leukemia Inhibitory Factory)
Iv) change the method of medication.
5) to treat the fragmentation of sperm and chromatin.
Increase and improve the acceptance of the bed.
In general, there are many known factors for RIF (repeated bed failure), but there are still more unknown factors affecting RIF. Often in these unknown factors are various and often at the molecular level, operation and treatment is quite limited, known level there are always multiple factors, in addition to improve the level of factors known, choose good embryos and improve the endometrial environment for implants, increase the rate of the bed is still the most important factor