B GIO DC V O TO B Y T TRNG I HC Y H NI CHU TH THU HNG SO SáNH KếT QUả KHởI ĐộNG TRƯởNG THàNH NOãN BằNG GNRH AGONIST Và hCG TRÊN BệNH NHÂN đợc KíCH THíCH BUồNG TRứNG BằNG PHáC Đồ GnRH ANTAGONIST bệnh viện bu điện LUN VN THC S Y HC H NI 2017 B GIO DC V O TO B Y T TRNG I HC Y H NI CHU TH THU HNG SO SáNH KếT QUả KHởI ĐộNG TRƯởNG THàNH NOãN BằNG GnRH AGONIST Và hCG TRÊN BệNH NHÂN đợc KíCH THíCH BUồNG TRứNG BằNG PHáC Đồ GnRH ANTAGONIST bệnh viện bu điện Chuyờn ngnh : Sn ph khoa Mó s : 60720131 LUN VN THC S Y HC Ngi hng dn khoa hc: TS H S Hựng H NI 2017 Lời Cảm Ơn Trong quỏ trỡnh hc tp, nghiờn cu v hon thnh lun ny, tụi ó nhn c nhiu s giỳp ca thy cụ, bn bố, ng nghip Vi lũng bit n sõu sc, tụi xin chõn thnh cm n: Ban giỏm hiu, Phũng sau i hc, B mụn Ph Sn Trng i Hc Y H Ni Ban giỏm c bnh vin, th cỏn b nhõn viờn Bnh vin Ph sn Trung ng ó to iu kin thun li cho tụi quỏ trỡnh hc v nghiờn cu Tụi xin t lũng kớnh trng v bit n ti: Tin s H S Hựng, Phú Giỏm c Trung Tõm H Tr Sinh Sn, B mụn Ph Sn trng i Hc Y H Ni, ngi thy kớnh yờu ó dỡu dt, giỳp , hng dn tụi sut quỏ trỡnh hc v nghiờn cu Cỏc Giỏo s, Phú giỏo s, Tin s hi ng khoa hc thụng qua cng, hi ng khoa hc bo v lun ó úng gúp nhiu ý kin quý bỏu cho tụi quỏ trỡnh nghiờn cu, hon chnh lun tt nghip thc s y khoa Tp th cỏn b nhõn viờn Trung Tõm H Tr sinh sn Bnh vin Bu in ó to iu kin cho tụi quỏ trỡnh hc v nghiờn cu lun Cui cựng tụi xin by t lũng bit n ti cha m, chng con, anh ch em gia ỡnh, bn bố ng nghip ó ng viờn, chia s vi tụi sut quỏ trỡnh hc v nghiờn cu Xin trõn trng cm n! H Ni, ngy 19 thỏng 08 nm 2017 Chu Th Thu Hng LI CAM OAN Tụi l Chu Th Thu Hng, hc viờn lp Cao hc khúa XXIV, Trng i hc Y H Ni, chuyờn ngnh Sn ph khoa, xin cam oan: õy l lun bn thõn tụi trc tip thc hin di s hng dn ca TS H S Hựng Cụng trỡnh ny khụng trựng lp vi bt k nghiờn cu no khỏc ó c cụng b ti Vit Nam Cỏc s liu v thụng tin nghiờn cu l hon ton chớnh xỏc, trung thc v khỏch quan, ó c xỏc nhn v chp nhn ca c s ni nghiờn cu Tụi xin hon ton chu trỏch nhim trc phỏp lut v nhng cam kt ny H Ni, ngy 19 thỏng 08 nm 2017 Ngi vit cam oan Chu Th Thu Hng CH VIT TT AFC : Antral Follicle Count AMH : Anti Mullerian Hormone E2 : Estradiol FSH : Follicle Stimulating Hormone GnRH : Gonadotropin Releasing Hormone GnRHa : GnRH ng GnRHanta : GnRH i Gran : Granularity GV : Geminal Vesicle GVBD : Geminal Vesicle Break Down hCG : Human Chorionic Gonadotropin HTSS : H tr sinh sn ICSI : Intracytoplasmic Sperm Injection IVF : In Vitro Fertilization KTBT : Kớch thớch bung trng LH : Luteinizing Hormone MI : Metaphase I MII : Metaphase II NMTC : Niờm mc t cung PB : Polar Body PN : Pronuclei PVS : Perivitelline space rFSH : Recombinant Follicle Stimulating Hormone TTTON : Th tinh ng nghim ZP : Zona pellucida MC LC PH LC DANH MC BNG DANH MC BIU DANH MC HèNH 10 T VN Khi ng trng thnh noón l giai on cui cựng nhng quan trng kớch thớch bung trng Khi ng trng thnh noón to nh LH cho phộp noón giai on GV tip tc hon thnh quỏ trỡnh gim phõn, to noón MII (noón trng thnh) cú kh nng th tinh vi tinh trựng Trong nhiu nm trc õy, ng trng thnh noón c thc hin bng tiờm hCG hCG cú tỏc dng ging LH nhng thi gian bỏn hy di hn LH ni sinh Tuy nhiờn thi gian bỏn hy di, hCG kớch thớch hong th kộo di, lm tng nguy c quỏ kớch bung trng, nng estradiol v progesterone cao trờn mc sinh lý tỏc dng kộo di ca hCG cng gõy tỏc ng bt li trờn cht lng noón v s chp nhn ca niờm mc t cung [1], [2] hoc cht lng phụi [3],[4] Phỏc GnRH antagonist kớch thớch bung trng ó cho phộp ng trng thnh noón bng GnRH agonist thay cho hCG GnRH ng kớch thớch tuyn yờn to nh LH v FSH sinh lý hn so vi ch cú nh LH dựng hCG iu ny khỏ ging vi sinh lý trc ni tit sinh sn Khi ng trng thnh noón bng GnRH agonist c ghi nhn lm gim ỏng k, gn nh loi tr hon ton quỏ kớch bung trng [5] Vỡ vy, ban u ng trng thnh noón bng GnRH ng ch ỏp dng cho nhng trng hp nguy c cao quỏ kớch bung trng Hin ti, hiu qu gõy trng thnh noón ca GnRH ng trờn cỏc nhúm i tng khỏc cũn ớt c quan tõm Vỡ vy, chỳng tụi tin hnh nghiờn cu: So sỏnh kt qu ng trng thnh noón bng GnRH agonist v hCG trờn bnh nhõn c kớch thớch bung trng bng phỏc GnRH antagonist ti Bnh vin Bu in 69 KIN NGH Qua kt qu nghiờn cu chỳng tụi a khuyn ngh nh sau: Liu u v tng liu FSH cao chu k kớch thớch bung trng cú th nh hng n cht lng noón thu c Trng thnh noón bng GnRHa cú th lm gim t l cú thai chu k chuyn phụi ti vỡ lm gim chc nng hong th, nhng cng lm gim nguy c quỏ kớch bung trng Do vy cỏc trng hp TTTON, nu bnh nhõn cú ch nh ụng phụi ton b t trc thỡ nờn la chn trng thnh noón bng GnRHa vỡ s gim nguy c quỏ kớch bung trng m s noón v cht lng noón thu c tng ng nhúm trng thnh noón bng hCG TI LIU THAM KHO Forman R, Fries N, Tastart J et al (1998) Evidence of an adverse effect of elevated serum estradiol concentrations on embryo implantation Fertility and Sterility, 49:11822 Simon C, Garcia Velasco JJ, Valbuena D et al (1998) Increasing uterine receptivity by decreasing estradiol levels during the preimplantation period in high responders with the use of a folliclestimulating hormone step-down regimen Fertility and Sterility, 70: 2349 Tavaniotou A, Albano C, Smitz J et al (2002) Impact of ovarian stimulation on corpus luteum function and embryonic implantation Journal of Reproductive Immunology, 55:12330 Valbuena D, Martin J, de Palbo JL et al (2001) Increasing levels of estradiol are deleterious to embryonic implantation because they directly affect the embryo Fertility and Sterility, 76:9628 Youssef MAFM, Van der Veen F, Al-Inany HG et al (2014) Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist-assisted reproductive technology Cochrane Database of Systematic Reviews, Issue 10 Art No.: CD008046 DOI: 10.1002/14651858.CD008046.pub4 Nguyn Vit Tin, Ngụ Vn Ton, Ngụ Th Ngc Phng (2012) Khỏi nim v vụ sinh, Dch t hc vụ sinh v cỏc phng phỏp iu tr, Nh xut bn Y hc, H Ni Zegers Hochschild, G.D Adamson, J de Mouzon, et al (2009) The Intematinal Committee for Monitoring Assisted Reproductive Technology (IMART) and the World Health Organization (WHO) Revised glossary on ART Terminology Human Reproduction, vol 24, No 11, 2683-2687 Vng Th Ngc Lan, H Mnh Tng (2011), Him mun nhng iu cn bit, m mm hnh phỳc, Nh xut bn Tng hp TP H Chớ Minh, tr 11-13 Nguyn Khc Liờu (1999) Cỏc thi k hot ng sinh dc ngi ph n, Sinh lý ph khoa, Bi ging sn ph khoa, NXB Y hc, 222-234 10 Phan Trng Duyt (2001) Th tinh ng nghim, Ti liu dch, NXB y hc, 8-12; 53-69; 75-76 11 kớnh (1998), S to giao t, Nh xut bn y hc, Tr 21 12 Nguyn Th Ngc Phng (2000) S phỏt trin nang noón, s trng thnh ca noón v rng trng, Him mun vụ sinh v k thut h tr sinh sn, Nh xut bn Y hc 13 Nguyn Th Ngc Phng (1999) Kớch thớch bung trng, Him mun, vụ sinh v k thut h tr sinh sn, Nh xut bn TP H Chớ Minh, 179-186 14 Nguyn Vit Tin (2003) Kớch thớch bung trng, Chn oỏn v iu tr vụ sinh, Nh xut bn Y hc, H Ni, 203-210 15 Trn Th Phng Mai, Nguyn Th Ngc Phng, Nguyn Song Nguyờn v cng s (2002) Nguyờn lý ca s kớch thớch bung trng, Him mun - vụ sinh v k thut h tr sinh sn, NXB Y hc, 191-196 16 Nguyn Th Ngc Phng (2013) Kớch thớch bung trng iu tr vụ sinh, Ni tit sinh sn, NXB Y hc, TP HCM 17 Nguyn Khc Liờu (2003) "i cng v vụ sinh", "Sinh lý kinh nguyt", "Thm dũ ni tit n", "S phỏt trin ca nang noón v s phúng noón", "Thm dũ s phúng noón", "Kớch thớch phúng noón", "Hi chng bung trng a nang", Chn oỏn v iu tr v sinh, Vin BVBMVTTSS, NXB y hc, 1-7; 77-80; 88-99; 100-108 18 Lu th Hng, Lờ Th Thanh Võn (2003) Cỏc phng phỏp h tr sinh sn, Chn oỏn v iu tr vụ sinh, Vin BVBMTSS, NXB y hc, 173-187 19 Nguyn Song Nguyờn (1999) Cỏc phng phỏp HTSS, Him mun vụ sinh v k thut HTSS, NXB TP HCM, 256- 259 20 Nguyn Vit Tin (2003) Kớch thớch bung trng, Tỡnh hỡnh ng dng ca mt s phng phỏp HTSS ti Vin BVBMTSS, Chn oỏn v iu tr vụ sinh, Vin BVBMTSS, NXB y hc, 203-216 21 H Mnh Tng (2002) Cỏc phỏc KTBT HTSS, Thi s y hc dc, VII(5), 277-280 22 Vng Th Ngc Lan (2011) Kớch thớch bung trng v cỏc tỏc ng trờn kt qu k thut h tr sinh sn, Th tinh ng nghim, NXB Giỏo dc Vit Nam, 343-345 23 Phm Thỳy Nga (2012) Nghiờn cu kt qu th tinh ng nghim ca phỏc GnRH antagonist ti bnh vin Ph sn Trung ng, Lun bỏc s chuyờn khoa cp i hc Y H Ni H ni 24 Daya s (2002) Gonadotropin releasing hormone agonist for pituitary desensitization in In Vitro Fertilization and gamete intrafallopian transfer cycles (Cochrane review), The cochrane library, Issue 25 James McK Talbot and Lawrence M (1997) In-Vitro Fertilization: indications, stimulation and clinical techniques 26 Gonen Y, Balakier H, Powell W et al (1990) Use of gonadotropinreleasing hormone agonist to trigger follicular maturation for in vitro fertilization J ClinEndocrinolMetab, 71: 918-922 27 Fritz MA, Speroff L (2011) Clinical Gynecologic Endocrinology and Infertility Philadelphia: Lippincott Williams & Wilkins Regulation of the Menstrual Cycle 28 Raoul Orvieto (2015) Triggering final follicular maturation- hCG, GnRH-agonist or both, when and to whom? J Ovarian Res 8: 60 PMCID: PMC4546254 29 Kolibianakis E.M, Schultze-Mosgau A, Schroer A et al (2005) A lower ongoing pregnancy rate can be expected when GnRH agonist is used for triggering final oocyte maturation instead of hCG in patients undergoing IVF with GnRH antagonists Human Reproduction Vol.20, No.10 pp 28872892 doi:10.1093/humrep/dei150 30 Griesinger G, Diedrich K, Devroey P et al (2006) GnRH agonist for triggering final oocyte maturation in theGnRH antagonist ovarian hyperstimulation protocol: a systematic review and meta-analysis Human Reproduction Update, Vol.12, No.2 159168 doi:10.1093/ humupd/dmi045 31 Fauser B.C, Jong D, Olivennes F, et al (2002) Endocrine Profiles after Triggering of Final Oocyte maturation with GnRH Agonist after Cotreatment with the GnRH Antagonist ganirelix during Ovarian hyperstimulation for in Vitro fertilization, The Journal of Clinical Endocrinology & Metabolism, 87 (2): 709 715 32 Hi ph sn khoa v Sinh cú k hoch Vit Nam (VINAGOFPA), chi Hi y hc sinh sn Vit Nam (VSRM) (2012) ỏnh giỏ cht lng noón, ng thun ỏnh giỏ v phõn loi noón, phụi h tr sinh sn, tr 11 33 Vng Th Ngc Lan, Giang Hunh (2012) S dng GnRH ng thay th hCG ng trng thnh noón chu k kớch thớch bung trng bng phỏc GnRH i vn, Tp Y Hc TP H Chớ Minh, Vol 16 S 1/2012-pp: 175 179 34 P.Humaidan, H.Ejdrup Bredkjổr, L.Bungum et al(2005) GnRH agonist (buserelin) or hCG for ovulation induction in GnRH antagonist IVF/ICSI cycles: a prospective randomized study, Human Reproduction Vol.20, No.5 12131220 35 Nguyn Th Tho (2011), Nghiờn cu mt s yu t nguy c v nh hng ca vụ sinh vũi t cung n ph n ti Thanh Húa Lun Tin S Y Hc, trng i Hc Y H Ni, 6-64 36 Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology (2012) Assisted Reproductive Technology Fertility Clinic Success Rates Report Atlanta (GA): US Dept of Health and Human Services; 2014, 23 37 Cao Ngc Thnh, Lờ Minh Tõm, Nguyn Th Dim Th v cng s (2014), Kt qu ng dng k thut th tinh ng nghim ti bnh vin i Hc Y Dc Hu, Tp Chớ Ph Sn 12(3)/2014, 88-94 38 Nguyn Xuõn Huy (2004) Nghiờn cu kt qu ca th tinh ng nghim ti Bnh vin ph sn trung ng nm 2003 Lun tt nghip bỏc s chuyờn khoa cp 2, trng i hc Y H Ni 3-52 39 Nguyn Xuõn Hi, Lờ Hong (2016) Thi im ti u chc hỳt noón th tinh ng nghim bng phỏc Antagonist, Tp Nghiờn cu Y Hc, 99(1), 16-23 40 Helle Ejdrup Bredkjổr, Peter Humaidan, Lars Grabow W et al (2010) 1,500 IU human chorionic gonadotropin administered at oocyte retrieval rescues the luteal phase when gonadotropin-releasing hormone agonist is used for ovulation induction: a prospective, randomized, controlled study, Fertility and Sterility Vol 93, No 3, February, 847-854 41 Maria Elisabetta, Francesca Rizzello (2008) Ovarian Reserve, Ann N.Y Acad Sci 1127: 2730 42 Belen Acevedo, Jose Luis Gomez-Palomares, Elisabetta Ricciarelli et al (2006) Triggering ovulation with gonadotropin-releasing hormone agonists does not compromise embryo implantation rates, Fertility and Sterility Vol 86, No 6, December, 1682-1687 43 A.Sismanoglu, H.I.Tekin, H F Erden et al (2009) Ovulation triggering with GnRH agonist vs hCG in the same egg donor population undergoing donor oocyte cycles with GnRH antagonis t: a prospective rando mized cross-over trial, J Assist Reprod Genet, No 26, 251 256 44 Nguyn Th Thu Phng, Nguyn Quc Tun (2006) Mi liờn quan gia dy ni mc t cung vi kt qu cú thai bng th tinh ng nghim Lun thc s Y Hc, i hc Y H Ni 45 V Vn Tõm (2016) Khi ng trng thnh noón th tinh ng nghim bng GnRH ng thay th hCG ti bnh vin ph sn Hi Phũng, Tp Y Dc Hc Quõn S, 8, 62-67 46 on Xuõn Kiờn, Nguyn Thanh Tựng, Qun Hong Lõm (2016) GnRH ng gõy trng thnh noón cỏc chu k IVF s dng phỏc GnRH i vn, Tp Y Dc Hc Quõn S, 5, 35-40 47 D Griffin, C Benadiva, N Kummer, et al (2012), Dual trigger of oocyte maturation with gonadotropin-releasing hormone agonist and low-dose human chorionic gonadotropin to optimize live birth rates in high responders, Fertil Steril, 97(6), 1316-1320 48 Eichenlaub-Ritter U, Schmiady H, Kentenich H, Soewarto D et al (1995) Recurrent failure in polar body formation and premature chromosome condensantion in oocytes from a human patient, indicators of asynchrony in nuclear and cytoplasmic maturation Human Reprod, 10(9), 2343-2349 49 Kahraman S, Yakin K et al (2000) Relationship between granular cytoplasm of oocytes and pregnancy outcome following intracytoplasmic sperm injection Human Reproduction, 15(11), 2390-2393 50 Eppig J J., Schultz R M., OBrien M et al (1994) Relationship between the developmental programs controlling nuclear and cytoplasmic maturation of mouse oocytes Developmental Biology, 164(1), 19 51 Sundstrom P and Nilsson B O (1988) Meiotic and cytoplasmic maturation of oocytes collected in stimulated cycles is asynchronous Human Reproduction, 3(5), 613619 52 Kubiak J Z (1989) Mouse oocytes gradually develop the capacity for activation during the metaphase II arrest Developmental Biology, 136(2), 537545 53 Balakier H., Sojecki A., Motamedi G et al (2004) Time dependent capability of human oocytes for activation and pronuclear formation during metaphase II arrest Human Reproduction, 19( 4), 982987 54 Hassa H, Aydn Y, Taplamacolu F (1998) Perivitelline space granularity, a sign of human menopausal gonadotrophin overdose in intracytoplasmic sperm injection Human Reproduction, 13(12), 3425-3430 55 Ciotti1 P.M, Notarangelo1 L , Morselli-Labate A.M et al (2004) First polar body morphology before ICSI is not related to embryo quality or pregnancy rate Human Reproduction, 19(10), 2334-2339 56 Begueria R, Garcia D (2014) Paternal age and assisted reproductive outcomes in ICSI donor oocytes: is there an effect of older fathers? Human Reproduction, 29(10), 2114-2122 PH LC NH GI HèNH THI NON V CHT LNG PHễI NGY Phn 1: ỏnh giỏ mt s c im hỡnh thỏi noón trng thnh [32]: Cht lng ca noón trng thnh c ỏnh giỏ thụng qua mt s c im v hỡnh thỏi noón + Mng sut: L cu trỳc c bit bao quanh ngoi noón, hỡnh thnh s ch tit ca c noón bo v t bo ht Mng sut cú th dao ng t 10 àm n 30 àm, trung bỡnh 13 - 15àm Tớnh cht mng sut rt a dng v hỡnh dng, mu sc, dy, c chia thnh theo VSRM ZP1 ZP2 ZP3 ZP4 ZP 1: dy v mu sc bỡnh thng (13 - 15àm) ZP 2: Mng sut mng ZP 3: Dy, hai lp hoc dy mng khụng u ZP 4: Dy, sm mu hay bt thng + Khoang quanh noón: L khong khụng bao quanh noón c gii hn bi mng sut v mng bo tng noón rng ca khong quanh noón cú liờn quan ti trng thnh ca noón noón bo 1, khong quanh noón rt hp v bt u tng kớch thc noón tỏi ng quỏ trỡnh gim phõn Khong quanh noón cú rng hp khỏc nhau, cú th xut hin ht khong quanh noón, ngun gc ca ht cha rừ rng Theo rng v s xut hin ht, hỡnh thỏi khong quanh noón chia thnh : PSV1 PSV3 PSV2 PSV4 PSV 1: Bỡnh thng, rng va phi, khụng cú ht PSV 2: Rng mt phn quanh noón v khụng cú ht PVS 3: Rng ht ton b chu vi quanh noón PVS 4: Rng v xut hin ht khoang quanh noón + Th cc th nht: S xut hin ca th cc th nht khong quanh noón l du hiu cho thy noón trng thnh v nhõn Vo nm 1995, Eichenlaub v cng s ó a gi thuyt hỡnh thỏi th cc th nht cú th phn ỏnh thi gian tn ti ca noón sau phúng noón, th cc th nht phõn mnh cú th noón quỏ trng thnh [48] Hỡnh thỏi th cc th nht c ỏnh giỏ da trờn cỏc tiờu chớ: hỡnh dng (trũn, bu dc), kớch thc (to, nh), b mt (trn, nhỏm) v s nguyờn vn, chia thnh theo phõn ca VSRM PB1 PB2 PB3 PB4 PB 1: Dng trũn hoc oval, b mt trn lỏng PB 2: Dng trũn hoc bu dc, b mt nhn PB 3: Th cc phõn mnh PB 4: To, bt thng, thoỏi húa hoc cú nhiu hn hai th cc + mn ca bo tng: Bo tng noón cú ht thụ l c im thng gp TTTON Thụng thng cỏc ht phõn b ng u khp bo tng noón cú th sỏng mu hoc sm mu Trong mt s trng hp biu hin rừ hn thỡ cỏc ht thụ trung thnh tng ỏm vựng trung tõm (Centrally Located Granular - CLG) Nguyờn nhõn v s xut hin qung ht thụ trung tõm hin cha c bit rừ, cú gi thuyt cho rng CLG cú liờn quan n s cha trng thnh ca t bo cht noón [49] Theo phõn ca VSRM, mn ca bo tng c chia thnh : Gran Gran Gran Gran Gran 1: Bo tng mn, sỏng mu Gran 2: Cú ht, hi thụ v sỏng mu Gran 3: Qung ht thụ, sm mu Gran 4: Qung ht thụ, chim t 3/4 th tớch b mt tr lờn, trung vựng trung tõm noón v cỏc dng bt thng khỏc S noón th tinh S phụi thu c Phn 2: ỏnh giỏ cht lng phụi ngy 2-3 theo VSRM 2012 chỳng tụi chia lm mc : - 1: Phụi tt - 2: Phụi trung bỡnh - 3: Phụi xu Cht lng phụi hin c ỏnh giỏ ch yu da trờn yu t hỡnh thỏi quan sỏt trờn kớnh hin vi quang hc, bao gm cỏc yu t: tc phỏt trin ca phụi, ng u ca cỏc phụi bo, t l mnh v bo tng + Tc phỏt trin ca phụi: Theo ng thun VSRM 2012, phụi c coi l phỏt trin ỳng tc cú t bo vo ngy v t bo vo ngy ph thuc vo thi im th tinh Theo mt s nghiờn cu, phụi cú tc phõn chia chm hn tc mong i thng cú kh nng lm t thp, nhng phụi cú tc phõn chia nhanh hn mong i thng cú bt thng v cng cú kh nng lm t thp + ng u ca phụi bo: Phụi giai on 2, v t bo nờn cha nhng phụi bo cú kớch thc bng Kớch thc phụi bo ch khỏc phụi cha hon tt phõn chia Cỏch ỏnh giỏ kớch thc phụi bo cng s dng h nh phõn ghi nhn tt c phụi bo cú kớch thc hp lý vi giai on phỏt trin hay khụng + Mnh v bo tng: L mt bo tng cú mng bao, khụng cú nhõn nm bờn ngoi t bo Cỏc mc mnh v bo tng bao gm: nh (< 10%), va (15 - 20%), nng (25%) Giỏ tr t l mnh v c tớnh da trờn th tớch ca phụi bo, vớ d phụi t bo, 25% mnh v bo tng s tng ng vi phụi bo Bng Cỏc tiờu chun ỏnh giỏ hỡnh thỏi phụi ngy Phõn loi S phụi bo t bo t bo < t bo >4 t bo < t bo t bo a nhõn ng u phụi bo u hoc tng i u Phụi n nhõn Khụng u n nhõn ng u n nhõn ng u n nhõn ng u n nhõn ng u PHIU THU THP S LIU Phõn mnh 0-10% 0-10% 15-20% 0-10% 15- 20% >20% Tờn ti: So sỏnh kt qu ng trng thnh noón Bng GnRH Agonist v hCG trờn bnh nhõn c kớch thớch bung trng bng phỏc GnRH Antagonist ti Bnh vin Bu in I Hnh chớnh H tờn: a ch: Nm sinh: Ngh nghip: II - c im bnh nhõn A Thụng tin nn Cõu hi PARA Thi gian vụ sinh Tr li Phõn loi vụ sinh Nguyờn nhõn vụ sinh Vụ sinh Vụ sinh Vụ sinh nam Tai vũi Ri lon phúng noón / PCOS Cha rừ nguyờn nhõn Khỏc AFC Cõn nng Chiu cao B c im chu k kớch thớch bung trng Cõu hi [ ] Ln [ ] Ln / / 201 Chu k iu tr Ngy bt u KTBT Xột nghim c bn Tr li FSH LH E2 S nang noón th cp (AFC) Liu u FSH Tng liu FSH S ngy KTBT Nng E2 ngy gõy trng thnh noón S nang trờn 14 mm ngy gõy trng thnh noón NMTC ngy gõy trng thnh noón Ngy gõy trng thnh noón Loi gõy trng thnh noón / / 201 [ ] hCG [ ] GnRH agonist C Kt qu th tinh ng nghim - Ngy chc hỳt noón: - S noón chc hỳt: - S noón trng thnh: - S 2PN: - S phụi: - S phụi 1:Phụi 2:Phụi 3: - Quỏ kớch bung trng: [ ] Cú [ ] Khụng - Mc quỏ kớch bung trng [ ] Nh [ ] Trung bỡnh [ ] Nng - Mt s c im hỡnh thỏi noón trng thnh: Mng sut TT noón 4 10 11 12 13 14 15 16 10 11 12 13 14 15 16 10 11 12 13 14 15 16 10 11 12 13 14 15 16 Th cc th nht TT noón Khoang quanh noón TT noón mn bo tng TT noón Ngy thỏng nm Ngi thu thp ... H NI CHU TH THU HNG SO SáNH KếT QUả KHởI ĐộNG TRƯởNG THàNH NOãN BằNG GnRH AGONIST Và hCG TRÊN BệNH NHÂN đợc KíCH THíCH BUồNG TRứNG BằNG PHáC Đồ GnRH ANTAGONIST bệnh viện bu điện Chuyờn ngnh :... tiờu nghiờn cu: So sỏnh s lng v cht lng noón gia hai nhúm ng trng thnh noón bng GnRH agonist v hCG So sỏnh t l th tinh, cht lng phụi gia hai nhúm ng trng thnh noón bng GnRH agonist v hCG 12 CHNG... dng GnRH agonist s khụng cú tỏc dng trờn tuyn yờn na tuyn yờn ang b tỏc dng c ch thụng qua c ch tr húa v ni húa th th Tuy nhiờn, phỏc antagonist, th th ca GnRH ti tuyn yờn ch b GnRH antagonist