t the GP will see as normal for your general health). For donor egg
cycles, studies have suggested that if the lining is too old
(lining starts to grow shortly after the beginning of your period
on a natural cycle or, on from the start of estrogen (or stimms)
medication on a down regulated cycle), then implantation rates
fall.
A significant fall in pregnancy rates
has been observed if estrogen medication was started more than 7
weeks before embryo transfer 。
首先，治疗好可能导致内膜薄的内膜炎症，
其次，尝试用药提高内膜厚度，如：
1) 万艾可：每天4次每次25mg阴道给药；
2) 雌二醇：国内是补佳乐或芬吗通，准医嘱；
3)
特布他林：另外一种血管扩张药物，每日5mg每天三次口服同时新鲜周期促排后或人工解冻周期如补佳乐日开始每天25mg每日四次阴道给药，夜针日停
【新鲜周期】或移植前3天停【人工解冻周期】）、
4) G-CSF宫腔灌注；
5) 己酮可可碱：400mg每天2次，与ve同服，并可帮助内异患者免疫调节）；
6) Ve 精氨酸：ve（每天600mg）联合服用精氨酸（每天6g）；
7) 足够的蛋白质和硒的摄入：蛋白粉、硒片、高蛋白饮食；
8) 中药调理 泡脚；
再次，检查甲状腺激素，确保没有甲亢或甲减。即使是别人给你供卵，你的内膜长得慢一样影响受孕率。有研究表明，移植前运用雌激素药物超过7周将会大大降低妊娠率。
2) 卵巢反应不好
poor response i.e., less than 4 eggs recovered - 3 months DHEA
pretreatment (see supplements), estrogen priming protocols, higher
starting doses (often with a step down in dose after a few days),
short protocol with natural cycle start rather than from the pill,
long protocol if you have not already tried that,
agonist/antagonist conversion protocols - diminished ovarian
reserve can also be exacerbated by being subclinically hypothyroid
- its definitely worth checking your TSH and FT4 with your GP - see
Thyroid. Also, consider treatment with dexamethasone 0.5mg (or
equivalent dose of prednisolone) possibly for up to 3 months prior
to IVF, in case autoimmune activity (e.g., antiovarian antibodies)
are compromising ovarian response. For some ladies with poor
response/high AMH there is no advantage in using stimulated IVF and
they might actually have a slightly better chance with a natural
cycle IVF.
少于4个泡要提前吃3个月dhea。Ivf前吃3个月地米每天0.5mg（或同等剂量强的松）预防免疫亢奋影响卵巢反应。最好自然周期取卵。
3) 卵泡质量不好
poor egg quality - resveratrol and/or pycnogenol and/or lycopene
pretreatment (also antioxidant diets e.g., those with lots of
red/orange/green veg, wheatgrass, spirulina, beetroot powder etc),
melatonin, inositol or alpha lipoic acid (mainly for PCOS
sufferers), 3 months DHEA pretreatment (but not if there is a high
LH:FSH ratio, low SHBG, high testosterone, high antral follicle
counts or PCOS), assisted hatching, high protein/low GI diet,
limiting LH (by using only/mainly pure FSH until day 4 of stims,
and then using a limited dose of LH per day - e.g., using mainly
gonal-F, puregon or follistim with either menopur or luveris to add
LH) and by using long protocol or a short protocol with a half dose
of antagonist which starts on day 1 of stims. Poor egg quality
where eggs show thickened zona and none of the eggs recovered are
immature can indicate that the stimulation was continued for too
long and the eggs are over-mature/atresic (a good indicator of the
quality of a batch of eggs is to have 10-40% immature eggs in the
batch) - better quality eggs may result from doing a short
stimulation and not sacrificing the dominant (and probably best
quality) follicles in order to allow the rest of the batch to catch
up. Anti-inflammatory diet/supplements if elevated TNFa appears to
be involved. Natural cycle IVF or very low dose stimulation
protocols are worth considering to maximise egg quality, although
this will be at the expense of egg numbers, so you may need to see
this as more of a course of, say, 3 natural cycle IVFs before you
can decide whether the approach is working for you.
白藜芦醇和/或碧萝芷和/或番茄红素（或抗氧化剂饮食如红色、橙色、绿色蔬菜，螺旋藻等），褪黑素，肌醇或α新硫酸（尤其多囊患者），3个月dhea（高lh：fsh者，低SHBG，睾酮水平高，高窦卵泡计数或多囊卵巢综合征者不能吃），辅助孵化，高蛋白/低GI饮食，限制LH（前四天促排只用纯FSH药物，然后每天用限量的LH
-例如Gonal-F），等等。如果tnf高，要同时抗炎饮食或治疗；最好自然周期ivf或者低剂量促排。
GI（Glycemic
Index）是指食物的血糖生成指数，是反映食物引起人体血糖升高程度的指标,是人体进食后机体血糖生成的应答状况。GI值高的食物进入肠道后容易吸收，葡萄糖能够很快的进入血液，导致血糖升高的速度较快，容易出现高血压、高血糖的现象.而GI值低的食物进入肠道后释放缓慢，吸收的速度也较慢，所以不容易引起血糖的变化。多余的胰岛素还有利于帮助糖原、脂肪和蛋白质的分解，燃烧体内脂肪，起到瘦身的作用。低gi食物：
1. 谷类：极少加工的粗粮。如煮过的整粒小麦、大麦及黑麦；硬质的小麦粉面条、通心面；玉米面粥、强化蛋白质的苗条等；
2. 干豆类及其制品：豆类的GI值普遍较低，如绿豆、蚕豆、扁豆及其制品等；
3. 乳类及其制品：乳类产品大多都是低GI产品，如牛奶、全脂&脱脂牛奶、奶粉、酸奶等；
4. 薯类：生的薯类以及经过冷处理的舒蕾制品，如芋头、藕粉、马铃薯粉条等；
5. 水果类：含果酸较多的水果，如苹果、桃、李子、樱桃等；
6. 即食食品：全麦或高纤维产品，如大麦面包、闲趣饼干、荞麦方便面等；
7. 混合膳食：主要看食物的种类和比例，如包子、饺子、馄饨、猪肉炖粉条等；
8. 其他：含果糖、乳糖的农作物及其制品。如花生。
4)
多囊PCO - as
for poor egg quality, but also pill pre-treatment to try to calm
the ovaries, low
GI（Glycemic Index） diet/healthy BMI, short protocol
or agonist/antagonist conversion protocol, assisted hatching,
metformin pre-treatment, alpha lipoic acid pretreatment, inositol
pretreatment.
参考卵泡质量不好解决办法，进周后服用避孕药（如达英）让卵巢休息。低GI饮食、控制体重、短的促排方案或激动剂/拮抗剂方案、辅助孵化，提前2-3个月服用二甲双胍、肌醇&胆碱、α-硫辛酸。
5)内异/腺肌症
endometriosis/adenomyosis - pycnogenol/resveratrol pre-treatment,
prolonged pre-treatment down regulation, natural cycle FET, immune
treatment for NKa, anti-inflammatory supplements/diet,
letrozole/femara in-cycle treatment.
提前吃碧萝芷或白藜芦醇，自然周期移植，针对NKa的免疫治疗，抗炎饮食或治疗，周期中服用来曲唑。
6) 胚胎分裂不好：参考卵泡质量不好的解决办法
slow cleavage embryos - same as poor egg quality
7) 受精率低：
poor fertilisation rates with IVF - ICSI, possibly assisted
hatching, 3 months of antioxidants for the male partner, possibly
antibiotics if the male partner is carrying an infection
辅助孵化，同时男方提前三个月的抗氧化剂治疗（详见十全大补 精子调理方案）
8) 卵巢过度刺激OHSS - lower dose of stims, short protocol, alternate days
dose of stims (e.g., alternating between 150 iu and 75 iu), 3
months of birth control pill before starting, metformin, low GI
diet/healthy BMI, prolonged coasting (i.e., giving fairly low dose
stimms e.g., 150 iu and stopping it as soon at least 2 follicles
have attained a mean diameter of 18-22mm (on ultrasound) and 50% of
the remaining follicles have reached 14-16mm, and waiting (up to 5
days) until the blood estrodial level falls below 2,500pg/ml before
giving the HCG trigger shot), cabergoline tablets (a drug which has
been shown to reduce the severity of OHSS without damaging egg
quality/pregnancy rates), freezing all embryos and having a FET the
following month.
低剂量促排，短方案，混合使用促排挤，提前三个月避孕药，二甲，低GI饮食，控制体重指数，滑行方案（低剂量促排，如150iu，暂停，当最少2个卵泡达到18-22mm和50%的卵泡在14-16mm的时候停5天，等到血雌二醇低于2500pg/ml时打hcg），卡麦角林片方案（一种药物已被证明可以降低OHSS的严重程度而不破坏卵子的质量/妊娠率），冷冻胚胎次月移植。
9)移植后抽筋 cramping after embryo transfer - see Tocolytics
10) 移植问题implantation problems - clotting (see thrombophilia),
infection (see chlamydia, mycoplasma and ureaplasma), natural
killer cells (see NK cells), elevated cytokines (see cytokines),
lack of blocking antibodies (see LAD), short implantation window
(consider starting progesterone at a lower dose then stepping up
the dose after a week, and/or switching to a day 3 transfer instead
of a blast transfer) - treatments to consider are empirical
treatment with clexane and steroids (see Treating empirically),
going down the immune testing route and having treatment with
steroids/humira/LIT/IVIG/intralipids/clexane and/or newer
treatments like PBMC (see PBMC) and neupogen (see G-CSF) or if
endometriosis/adenomyosis is suspected 3 months pre-treatment with
down reg or in-cycle treatment with femara/letrozole.
Also consider hysteroscopy to rule out hard-to-detect
scarring in the uterus, to do a mild D&C
and maybe a scratch biopsy or fundus cut - and/or a saline wash 2
days before ET.
凝血（血栓危险）、感染（衣原体、支原体、尿素），nk细胞，高细胞活性，封闭抗体缺乏，窗口期短（考虑低剂量孕酮支持，后一周逐步加量，和/或移植前3天孕酮支持）。
治疗支持：类固醇/阿达木/LIT/IVIG/脂肪乳/肝素和/或新疗法G-CSF或提前3个月来曲唑（内异和腺肌症患者）。同时考虑宫腔镜检查排除子宫瘢痕，做温和的D&C宫腔镜检查或组织活检，或移植前2天生理盐水冲洗宫腔。
11)、空泡：
不是说卵泡里没有卵子或提前排了，而是说医生取卵的时候没有吸到卵子，那么，卵子在哪里？为什么拿不出来？如果你看卵子周期发展的挂图，你就知道，当时卵子是和卵泡壁粘在一起的，到后面才进入卵泡中间，浮里液体当中。所以空泡发生的时候多数情况就是卵泡还粘在上面没下来。成因不明，可能是：1、卵子本身没有长熟，2、病人受体对HCG不敏感导致卵子与卵泡壁没有分离。
排除医生对取卵时间把握不准这一选项，这里有几种办法来解决这个问题：
1、打两次HCG针。在两次针之间查血值看HCG的吸收情况。
2、换一批HCG药，看看是否人体接受会好些。
3、使用不同的促排卵药（比如LUPRON）来进行TRIGGER。
4、使用加拮抗剂（antagonist）的试管方案。让每一卵子长得更平均些成熟些。
5、用HCG 稀释LUPRON双“击”（Double trigger）的方式来促排卵。
6、如果是LUPRON
TRIGGER的，加大LUPRON用量。比如原来医生嘱咐15IU，改为30IU。（60IU以下都是安全TRIGGER剂量。）
结论：空泡是有卵子但取不出来。可能跟卵子质量和医生取卵时间把握有关，也可能跟病人对排卵针不敏感不关。目前有效的的方式是用第五–DOUBLE
TRIGGER的方式。
