Infertility,defined as the inability to achieve a clinical pregnancy after 1 year of unprotected and regular sexual intercourse,affects approximately 8%–12%of couples worldwide during their childbearing years.Assiste...Infertility,defined as the inability to achieve a clinical pregnancy after 1 year of unprotected and regular sexual intercourse,affects approximately 8%–12%of couples worldwide during their childbearing years.Assisted reproductive technology(ART)offers interventions to facilitate conception in couples with infertility.Since the inception of traditional in vitro fertilization(IVF)in 1978,ART has facilitated the birth of millions of infants.Intracytoplasmic sperm injection(ICSI)is an effective technique for couples ineligible for traditional IVF.Individual female factors,such as age and endometrial thickness,have been shown to affect embryo development during the IVF process,resulting in unfavorable pregnancy outcomes[1-3].However,the influence of environmental and male factors on early reproductive outcomes cannot be ignored.As a novel form of environmental pollution,light at night(LAN)has intensified with the rapid pace of urbanization,potentially leading to reproductive health problems in both women and men.However,to our knowledge,no study has explored the effects of LAN exposure on the early reproductive outcomes of IVF.Furthermore,the normal development of embryos relies on the contributions of both partners,and the influence of male factors on the early reproductive outcomes of IVF should not be overlooked.展开更多
Women have been increasingly delaying the start of motherhood in recent decades. The same trend is seen also for men. The influence of maternal age on fertility, chromosomal anomalies, pregnancy complications, and imp...Women have been increasingly delaying the start of motherhood in recent decades. The same trend is seen also for men. The influence of maternal age on fertility, chromosomal anomalies, pregnancy complications, and impaired perinatal and post-natal outcome of offspring, has been thoroughly investigated, and these aspectsare clinically applied during fertility and pregestational counseling. Male aging and reproductive outcome has gained relatively less attention. The purpose of this review is to evaluate updated and relevant literature on the effect of paternal age on reproductive outcome.展开更多
BACKGROUND Malignant ovarian germ cell tumors(MOGCT)are rare and frequently occur in women of young and reproductive age and the oncologic and reproductive outcomes after fertility-sparing surgery(FSS)for this disease...BACKGROUND Malignant ovarian germ cell tumors(MOGCT)are rare and frequently occur in women of young and reproductive age and the oncologic and reproductive outcomes after fertility-sparing surgery(FSS)for this disease are still limited.AIM To evaluate the oncology and reproductive outcomes of MOGCT patients who underwent FSS.METHODS All MOGCT patients who underwent FSS defined as the operation with a preserved uterus and at least one side of the ovary at our institute between January 2005 and December 2020 were retrospectively reviewed.RESULTS Sixty-two patients were recruited for this study.The median age was 22 years old and over 77%were nulliparous.The three most common histology findings were immature teratoma(32.2%),dysgerminoma(24.2%),and yolk sac tumor(24.2%).The distribution of stage was as follows;Stage I,74.8%;stage II,9.7%;stage III,11.3%;and stage IV,4.8%.Forty-three(67.7%)patients received adjuvant chemotherapy.With a median follow-up time of 96.3 mo,the 10-year progressionfree survival and overall survival were 82.4%and 91%,respectively.For reproductive outcomes,of 43 patients who received adjuvant chemotherapy,18(41.9%)had normal menstruation,and 17(39.5%)resumed menstruation with a median time of 4 mo.Of about 14 patients who desired to conceive,four were pregnant and delivered good outcomes.Only one case was aborted.Therefore,the successful pregnancy rate was 28.6%CONCLUSION The oncology and reproductive outcomes of MOGCT treated by FSS are excellent.Many patients show a long survival time with normal menstruation.However,the obstetric outcome is not quite satisfactory.展开更多
Objective: Congenital uterine anomalies are common; however, their effects on artificial insemination by husband(AIH) and the period during which AIH is converted to in vitro fertilization(IVF) are unclear. We examine...Objective: Congenital uterine anomalies are common; however, their effects on artificial insemination by husband(AIH) and the period during which AIH is converted to in vitro fertilization(IVF) are unclear. We examined the influence of uterine malformations on reproductive outcomes following AIH and the optimum number of AIH cycles before resorting to IVF-embryo transfer(IVF-ET).Methods: We retrospectively recruited 168 patients with uterine malformations(anomalous group) undergoing AIH between January 2011 and December 2016. Meanwhile, 168 patients with infertility but with normal uteri(normal group) were matched as controls according to age.Results: The clinical pregnancy rate was similar in both groups(12.4% vs. 12.3%, P=0.950); the cancellation(21.6% vs. 4.4%, P< 0.001),early pregnancy loss(35.7% vs. 11.4%, P = 0.032), and preterm birth rates(21.4% vs. 2.9%, P = 0.038) were higher in the anomalous group,resulting in lower term birth(32.1 % vs. 74.3%, P =0.001) and live birth rates(50.0% vs. 77.1 %, P = 0.034). After two AIH cycles, the clinical pregnancy rate was lower(3.6% vs. 23.1%, P = 0.037) among women with uterine anomalies than among those with normal uteri. There was no difference in the pregnancy rates(52.5% vs. 53.7%, P= 0.908) between the two groups of patients with unsuccessful AIH who then underwent IVF-ET.Conclusions: IVF-ET can be performed immediately after two unsuccessful AIH cycles in patients with uterine malformations. In patients undergoing AIH or IVF, uterine malformations increase the risk of adverse obstetric outcomes.展开更多
Objective:Endometrial tuberculosis,which commonly affects women of reproductive age,is a significant cause of intrauterine adhesions(IUA),potentially leading to hypomenorrhea,amenorrhea,and infertility.Hysteroscopic a...Objective:Endometrial tuberculosis,which commonly affects women of reproductive age,is a significant cause of intrauterine adhesions(IUA),potentially leading to hypomenorrhea,amenorrhea,and infertility.Hysteroscopic adhesiolysis is the primary treatment for IUA;however,studies specifically addressing its efficacy in tuberculosisinduced IUA remain scarce.This study aims to evaluate the therapeutic outcomes of hysteroscopic adhesiolysis for IUA caused by endometrial tuberculosis.Methods:This retrospective cohort study included patients diagnosed with tuberculosisinduced IUA who underwent hysteroscopic adhesiolysis at the Third Xiangya Hospital of Central South University between May 2014 and October 2022.Clinical data including age,medical history,adhesion severity,surgical treatment,and reproductive outcomes were analyzed.Results:Among 39 patients identified,2 were lost to follow-up.A total of 37 patients were included,with a follow-up duration ranging from 6 months to 9 years.Hypomenorrhea was reported in 24(64.9%)patients,secondary amenorrhea in 10(27.0%)patients,and normal menstruation in 3(8.1%)patients.Most patients presented with primary infertility(59.5%),and only 2(5.4%)had secondary infertility.The median American Fertility Society(AFS)score at initial assessment was 10(range,8−12);8(21.6%)patients had moderate IUA,and 29(78.4%)had severe IUA.A total of 86 surgical procedures were performed across 37 patients,with 27 patients undergoing 2 or more surgeries.Postoperatively,25(67.6%)patients achieved normalization of the uterine cavity,while 12(32.4%)still had a reduced cavity.Only 7(18.9%)patients had a grossly normal endometrium at the final surgery,all of whom had moderate adhesions at the initial procedure.Menstrual flow returned to normal in 12(32.4%)patients,while 25(67.6%)continued to experience hypomenorrhea.Of 29 patients who attempted in vitro fertilization and embryo transfer(IVF-ET),only 6(20.7%)conceived.Among these,4(13.8%)delivered at term via cesarean section;one case was complicated by postpartum hemorrhage due to uterine atony and another by placental adhesion.Conclusion:Endometrial tuberculosis can lead to severe IUA.Hysteroscopic adhesiolysis facilitates cavity restoration and improvement of menstrual conditions,but the overall reproductive outcomes remain suboptimal.展开更多
<strong>Background: </strong>The rate of uterus is successfully conserved following the treatment of scar pregnancy which is high so pregnancy outcome following caesarean scar ectopics is getting more and ...<strong>Background: </strong>The rate of uterus is successfully conserved following the treatment of scar pregnancy which is high so pregnancy outcome following caesarean scar ectopics is getting more and more attention. <strong>Objectives: </strong>To assess pregnancy course and outcome after conservative treatment of cesarean scar pregnancy. <strong>Methods:</strong> A retrospective case series of 40 patients become pregnancy after conservative treatment of cesarean scar pregnancy by Foley or Methotrexate and aspiration. Patients in present study were treated at Hung Vuong and Tu Du Hospital between 2015 and 2017. A telephone follow-up was conducted after cesarean scar pregnancy (CSP) treatment. The outcomes of these subsequent pregnancies and mode of delivery were all recorded. <strong>Results:</strong> In 40 pregnancies, there are 22 cases of intrauterine pregnancy with childbirth (55%);all babies were born healthy, with no complications recorded in pregnancy. 12 Women had recurrent scar ectopic (30%). There were 2 abortion cases, 2 cases of ectopic pregnancy, and 2 cases of early miscarriage. <strong>Conclusions:</strong> Our study shows that reproductive outcomes following treatment of caesarean scar ectopic pregnancies are favourable. The risk of recurrent caesarean scar ectopic pregnancy is a concern.展开更多
Sperm DNA damage is prevalent among infertile men and is known to influence natural reproduction. However, the impact of sperm DNA damage on assisted reproduction outcomes remains controversial. Here, we conducted a m...Sperm DNA damage is prevalent among infertile men and is known to influence natural reproduction. However, the impact of sperm DNA damage on assisted reproduction outcomes remains controversial. Here, we conducted a meta-analysis of studies on sperm DNA damage （assessed by SCSA, TUNEL, SCD, or Comet assay） and clinical pregnancy after IVF and/or ICSI treatment from MEDLINE, EMBASE, and PUBMED database searches for this analysis. We identified 41 articles （with a total of 56 studies） including 16 IVF studies, 24 ICSI studies, and 16 mixed （IVF ＋ ICSI） studies. These studies measured DNA damage （by one of four assays： 23 SCSA, 18 TUNEL, 8 SCD, and 7 Comet） and included a total of 8068 treatment cycles （3734 IVF, 2282 ICSI, and 2052 mixed IVF ＋ ICSI）. The combined OR of 1.68 （95% Ch 1.49-1.89; P 〈 0.0001） indicates that sperm DNA damage affects clinical pregnancy following IVF and/or ICSI treatment. In addition, the combined OR estimates of IVF （16 estimates, OR = 1.65; 95% CI： 1.34-2.04; P 〈 0.0001）, ICSI （24 estimates, OR = 1.31; 95% Ch 1.08-1.59; P = 0.0068）, and mixed IVF ＋ ICSI studies （16 estimates, OR = 2.37; 95% Ch 1.89-2.97; P〈 0.0001） were also statistically significant. There is sufficient evidence in the existing literature suggesting that sperm DNA damage has a negative effect on clinical pregnancy following IVF and/or ICSI treatment.展开更多
BACKGROUND Despite advances in the use of in vitro fertilization-embryo transfer(ET)in couples with infertility,recurrent implantation failure(RIF)after ET is still a major problem affecting women,with great psycholog...BACKGROUND Despite advances in the use of in vitro fertilization-embryo transfer(ET)in couples with infertility,recurrent implantation failure(RIF)after ET is still a major problem affecting women,with great psychological and economic burdens for the patient and his/her family.AIM To investigate the psychological burden(anxiety and depression)and evaluate the clinical benefits of endometrial receptivity testing(ERT)in patients experiencing RIF following frozen-thawed ET.METHODS A retrospective cohort study analyzed 371 patients experiencing RIF after assisted reproductive treatment at the First People’s Hospital of Changde City between January 2021 and June 2024.Demographic and clinical data were systematically collected through standardized questionnaires.Psychological assessment utilized validated instruments:The Self-Rating Depression Scale for depression evaluation and the Self-Rating Anxiety Scale for anxiety assessment.Participants were stratified by psychological status(anxiety/non-anxiety and depression/nondepression)to analyze influencing factors for anxiety and depression.The cohort was further categorized into the ERT and non-ERT groups based on ERT implementation to comparatively analyze their clinical outcomes.Additionally,they were divided into clinical and nonclinical pregnancy groups to identify factors affecting clinical pregnancy using univariate and multivariate logistic regression models.Compared with the non-ERT group,the 226 patients who underwent ERT-guided ET achieved a higher clinical pregnancy rate,thicker endometrium on transfer day,fewer embryos transferred,and a lower miscarriage rate.RESULTS The study identified a substantial psychological burden,with anxiety prevalence at 55.0%(mean Self-Rating Anxiety Scale score,50.89±9.34)and depression at 61.2%(mean Self-Rating Depression Scale score,55.55±9.48).Multivariate analysis identified annual household income>100000 yuan as protective factors against both anxiety and depression,whereas advanced maternal age(>35 years)and multiple implantation failures(≥3)served as risk factors.Additionally,anxiety-specific risk factors included prolonged infertility treatment(>5 years)and the spouse’s status as an only child.As to depression-specific risks,chronic infertility(>3 years)and higher educational attainment(college/bachelor’s degree or higher)were key determinants,whereas urban residence was a protective factor.Age>35 years was a risk factor for clinical pregnancy in patients experiencing RIF,whereas blastocyst-stage ET,a higher number of embryos transferred,and thicker endometrium were protective factors.CONCLUSION Patients experiencing RIF are particularly susceptible to anxiety and depression,and advanced maternal age and multiple implantation failures represent salient risk factors.Clinicians should implement proactive and evidencebased interventions to mitigate these psychological burdens.For patients experiencing RIF,ERT-guided ET demonstrates significant potential to improve assisted reproductive outcomes.展开更多
Objective: to explore and analyze the effect of laparoscopic and open surgery in the treatment of ectopic pregnancy patients, and analyze its clinical application value. Methods: 120 cases of ectopic pregnancy patient...Objective: to explore and analyze the effect of laparoscopic and open surgery in the treatment of ectopic pregnancy patients, and analyze its clinical application value. Methods: 120 cases of ectopic pregnancy patients admitted by our hospital from September 2017 to September 2019 were randomly selected as the research object. They were divided into control group and experimental group by computer sequencing method, with 60 patients in each group. The control group was treated with traditional open surgery, while the experimental group was treated with laparoscopic surgery. The difference of operation and prognosis between the two groups was observed. The follow-up period of half a year was conducted to compare the intrauterine pregnancy rate between the two groups. Results: the operative and prognostic indexes of the experimental group were lower than those of the control group (P < 0.05), and the intrauterine pregnancy rate of the experimental group was significantly higher than that of the control group (P < 0.05) after 6 months follow-up. Conclusion: laparoscopic ectopic pregnancy surgery has the characteristics of high efficiency, minimally invasive, high safety and less impact on patients' long-term reproductive outcomes, so it should be applied in clinical practice.展开更多
Objective:Optimal luteinizing hormone(LH)levels forin vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)patients following the gonadotropin-releasing hormone(GnRH)antagonist protocol remain controversial.T...Objective:Optimal luteinizing hormone(LH)levels forin vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)patients following the gonadotropin-releasing hormone(GnRH)antagonist protocol remain controversial.This study aimed to estimate the association between serum LH levels on the triggering day(LHLOT)and clinical pregnancy outcomes in IVF/ICSI patients following the GnRH antagonist protocol.Methods:We enrolled 4743 IVF/ICSI cycles using flexible or fixed GnRH antagonist protocols between January 2017 and June 2021.The patients were stratified into four groups according to the LHLOT quartiles(Q1–Q4).Each group was further divided into two subgroups according to the median basal LH/LHLOT.The main outcomes were clinical pregnancy,birth,and miscarriage rates.Secondary outcomes were oocyte yield,number of MII,fertilized oocytes(2PN),and high-quality embryos.Results:Serum LHLOT levels were negatively correlated with oocyte yield and the numbers of MII,2PN,and high-quality embryos.Reproductive outcomes were compared among the different quartiles and subgroups.The absolute difference in the clinical pregnancy rates between the Q4 and Q1 groups was 6.4%(47.2%vs.40.8%,P<0.05).Clinical pregnancy rates between the subgroups with basal LH/LHLOT>3.04 and≤3.04 were 32.7%and 48.6%(P<0.01),respectively,in Q1.Within Q3,the clinical pregnancy rates between the subgroups with basal LH/LHLOT>2.14 and≤2.14 were 50.2%and 41.9%,respectively(P<0.05).The greater the decrease in LH levels,the lower the oocyte maturation rate across all quartiles.Conclusions:According to the LHLOT quartiles,the Q1 of serum LHLOT<1.43 IU/L may result in a higher number of oocytes but reduced oocyte maturation and lower clinical pregnancy rates.A decrease in LH levels by approximately 2.14 to 3.04 times compared to basal LH levels may lead to higher clinical pregnancy rates in IVF/ICSI patients following the GnRH antagonist protocol.展开更多
Objective:Recurrent ectopic pregnancy(REP)is rare,but can have severe consequences for patients.The aim of this study was to report outcomes of laparoscopic management of REP in our center.Methods:Retrospective cohort...Objective:Recurrent ectopic pregnancy(REP)is rare,but can have severe consequences for patients.The aim of this study was to report outcomes of laparoscopic management of REP in our center.Methods:Retrospective cohort study including REP treated surgically at a single,tertiary-care academic medical center between 2009 and 2018.All patients undergoing laparoscopic salpingostomy or salpingectomy were included.Patients were then followed up to monitor outcomes of future reproductive events.Results:Of 41 eligible patients,14 suffered from ipsilateral recurrence including 5 cases of tubal stump pregnancy.In the other 27 cases,the REP occurred in the contralateral tube that was previously unaffected.All patients with ipsilateral recurrence underwent salpingectomy.In patients with contralateral recurrence,salpingectomy was carried out in 21 patients(77.8%)and salpingostomy in 6 patients(22.2%).32 patients(78%)subsequently sought to conceive either spontaneously or by in vitro fertilization.The subsequent live birth rates were 51.8%(14/27)in the salpingectomy group and 60.0%(3/5)in the salpingostomy group.Conclusion:Where trained laparoscopists and adequate facilities are available,it is possible to achieve acceptable reproductive outcomes after REP irrespective of the surgical approach.展开更多
基金supported by grants from the National Key Research and Development Program of China(No.2018YFC1004201)National Natural Science Foundation of China(No.82473642)+3 种基金Research Funds of the Center for Big Data and Population Health of IHM(No.JKS2023017)Natural Science Foundation of Anhui Province(No.2408085QH278)Research Fund of the Anhui Institute of Translational Medicine(No.2022zhyx-C05)Anhui Medical University National Undergraduate Innovation and Entrepreneurship Training Program(No.S202410366070).
文摘Infertility,defined as the inability to achieve a clinical pregnancy after 1 year of unprotected and regular sexual intercourse,affects approximately 8%–12%of couples worldwide during their childbearing years.Assisted reproductive technology(ART)offers interventions to facilitate conception in couples with infertility.Since the inception of traditional in vitro fertilization(IVF)in 1978,ART has facilitated the birth of millions of infants.Intracytoplasmic sperm injection(ICSI)is an effective technique for couples ineligible for traditional IVF.Individual female factors,such as age and endometrial thickness,have been shown to affect embryo development during the IVF process,resulting in unfavorable pregnancy outcomes[1-3].However,the influence of environmental and male factors on early reproductive outcomes cannot be ignored.As a novel form of environmental pollution,light at night(LAN)has intensified with the rapid pace of urbanization,potentially leading to reproductive health problems in both women and men.However,to our knowledge,no study has explored the effects of LAN exposure on the early reproductive outcomes of IVF.Furthermore,the normal development of embryos relies on the contributions of both partners,and the influence of male factors on the early reproductive outcomes of IVF should not be overlooked.
文摘Women have been increasingly delaying the start of motherhood in recent decades. The same trend is seen also for men. The influence of maternal age on fertility, chromosomal anomalies, pregnancy complications, and impaired perinatal and post-natal outcome of offspring, has been thoroughly investigated, and these aspectsare clinically applied during fertility and pregestational counseling. Male aging and reproductive outcome has gained relatively less attention. The purpose of this review is to evaluate updated and relevant literature on the effect of paternal age on reproductive outcome.
文摘BACKGROUND Malignant ovarian germ cell tumors(MOGCT)are rare and frequently occur in women of young and reproductive age and the oncologic and reproductive outcomes after fertility-sparing surgery(FSS)for this disease are still limited.AIM To evaluate the oncology and reproductive outcomes of MOGCT patients who underwent FSS.METHODS All MOGCT patients who underwent FSS defined as the operation with a preserved uterus and at least one side of the ovary at our institute between January 2005 and December 2020 were retrospectively reviewed.RESULTS Sixty-two patients were recruited for this study.The median age was 22 years old and over 77%were nulliparous.The three most common histology findings were immature teratoma(32.2%),dysgerminoma(24.2%),and yolk sac tumor(24.2%).The distribution of stage was as follows;Stage I,74.8%;stage II,9.7%;stage III,11.3%;and stage IV,4.8%.Forty-three(67.7%)patients received adjuvant chemotherapy.With a median follow-up time of 96.3 mo,the 10-year progressionfree survival and overall survival were 82.4%and 91%,respectively.For reproductive outcomes,of 43 patients who received adjuvant chemotherapy,18(41.9%)had normal menstruation,and 17(39.5%)resumed menstruation with a median time of 4 mo.Of about 14 patients who desired to conceive,four were pregnant and delivered good outcomes.Only one case was aborted.Therefore,the successful pregnancy rate was 28.6%CONCLUSION The oncology and reproductive outcomes of MOGCT treated by FSS are excellent.Many patients show a long survival time with normal menstruation.However,the obstetric outcome is not quite satisfactory.
基金supported by the emergency management project of the National Natural Science Foundation of China(No.31741094).
文摘Objective: Congenital uterine anomalies are common; however, their effects on artificial insemination by husband(AIH) and the period during which AIH is converted to in vitro fertilization(IVF) are unclear. We examined the influence of uterine malformations on reproductive outcomes following AIH and the optimum number of AIH cycles before resorting to IVF-embryo transfer(IVF-ET).Methods: We retrospectively recruited 168 patients with uterine malformations(anomalous group) undergoing AIH between January 2011 and December 2016. Meanwhile, 168 patients with infertility but with normal uteri(normal group) were matched as controls according to age.Results: The clinical pregnancy rate was similar in both groups(12.4% vs. 12.3%, P=0.950); the cancellation(21.6% vs. 4.4%, P< 0.001),early pregnancy loss(35.7% vs. 11.4%, P = 0.032), and preterm birth rates(21.4% vs. 2.9%, P = 0.038) were higher in the anomalous group,resulting in lower term birth(32.1 % vs. 74.3%, P =0.001) and live birth rates(50.0% vs. 77.1 %, P = 0.034). After two AIH cycles, the clinical pregnancy rate was lower(3.6% vs. 23.1%, P = 0.037) among women with uterine anomalies than among those with normal uteri. There was no difference in the pregnancy rates(52.5% vs. 53.7%, P= 0.908) between the two groups of patients with unsuccessful AIH who then underwent IVF-ET.Conclusions: IVF-ET can be performed immediately after two unsuccessful AIH cycles in patients with uterine malformations. In patients undergoing AIH or IVF, uterine malformations increase the risk of adverse obstetric outcomes.
基金supported by the Wisdom Accumulation and Talent Cultivation Project of Third Xiangya Hosipital of Central South University,China(YX202112).
文摘Objective:Endometrial tuberculosis,which commonly affects women of reproductive age,is a significant cause of intrauterine adhesions(IUA),potentially leading to hypomenorrhea,amenorrhea,and infertility.Hysteroscopic adhesiolysis is the primary treatment for IUA;however,studies specifically addressing its efficacy in tuberculosisinduced IUA remain scarce.This study aims to evaluate the therapeutic outcomes of hysteroscopic adhesiolysis for IUA caused by endometrial tuberculosis.Methods:This retrospective cohort study included patients diagnosed with tuberculosisinduced IUA who underwent hysteroscopic adhesiolysis at the Third Xiangya Hospital of Central South University between May 2014 and October 2022.Clinical data including age,medical history,adhesion severity,surgical treatment,and reproductive outcomes were analyzed.Results:Among 39 patients identified,2 were lost to follow-up.A total of 37 patients were included,with a follow-up duration ranging from 6 months to 9 years.Hypomenorrhea was reported in 24(64.9%)patients,secondary amenorrhea in 10(27.0%)patients,and normal menstruation in 3(8.1%)patients.Most patients presented with primary infertility(59.5%),and only 2(5.4%)had secondary infertility.The median American Fertility Society(AFS)score at initial assessment was 10(range,8−12);8(21.6%)patients had moderate IUA,and 29(78.4%)had severe IUA.A total of 86 surgical procedures were performed across 37 patients,with 27 patients undergoing 2 or more surgeries.Postoperatively,25(67.6%)patients achieved normalization of the uterine cavity,while 12(32.4%)still had a reduced cavity.Only 7(18.9%)patients had a grossly normal endometrium at the final surgery,all of whom had moderate adhesions at the initial procedure.Menstrual flow returned to normal in 12(32.4%)patients,while 25(67.6%)continued to experience hypomenorrhea.Of 29 patients who attempted in vitro fertilization and embryo transfer(IVF-ET),only 6(20.7%)conceived.Among these,4(13.8%)delivered at term via cesarean section;one case was complicated by postpartum hemorrhage due to uterine atony and another by placental adhesion.Conclusion:Endometrial tuberculosis can lead to severe IUA.Hysteroscopic adhesiolysis facilitates cavity restoration and improvement of menstrual conditions,but the overall reproductive outcomes remain suboptimal.
文摘<strong>Background: </strong>The rate of uterus is successfully conserved following the treatment of scar pregnancy which is high so pregnancy outcome following caesarean scar ectopics is getting more and more attention. <strong>Objectives: </strong>To assess pregnancy course and outcome after conservative treatment of cesarean scar pregnancy. <strong>Methods:</strong> A retrospective case series of 40 patients become pregnancy after conservative treatment of cesarean scar pregnancy by Foley or Methotrexate and aspiration. Patients in present study were treated at Hung Vuong and Tu Du Hospital between 2015 and 2017. A telephone follow-up was conducted after cesarean scar pregnancy (CSP) treatment. The outcomes of these subsequent pregnancies and mode of delivery were all recorded. <strong>Results:</strong> In 40 pregnancies, there are 22 cases of intrauterine pregnancy with childbirth (55%);all babies were born healthy, with no complications recorded in pregnancy. 12 Women had recurrent scar ectopic (30%). There were 2 abortion cases, 2 cases of ectopic pregnancy, and 2 cases of early miscarriage. <strong>Conclusions:</strong> Our study shows that reproductive outcomes following treatment of caesarean scar ectopic pregnancies are favourable. The risk of recurrent caesarean scar ectopic pregnancy is a concern.
文摘Sperm DNA damage is prevalent among infertile men and is known to influence natural reproduction. However, the impact of sperm DNA damage on assisted reproduction outcomes remains controversial. Here, we conducted a meta-analysis of studies on sperm DNA damage （assessed by SCSA, TUNEL, SCD, or Comet assay） and clinical pregnancy after IVF and/or ICSI treatment from MEDLINE, EMBASE, and PUBMED database searches for this analysis. We identified 41 articles （with a total of 56 studies） including 16 IVF studies, 24 ICSI studies, and 16 mixed （IVF ＋ ICSI） studies. These studies measured DNA damage （by one of four assays： 23 SCSA, 18 TUNEL, 8 SCD, and 7 Comet） and included a total of 8068 treatment cycles （3734 IVF, 2282 ICSI, and 2052 mixed IVF ＋ ICSI）. The combined OR of 1.68 （95% Ch 1.49-1.89; P 〈 0.0001） indicates that sperm DNA damage affects clinical pregnancy following IVF and/or ICSI treatment. In addition, the combined OR estimates of IVF （16 estimates, OR = 1.65; 95% CI： 1.34-2.04; P 〈 0.0001）, ICSI （24 estimates, OR = 1.31; 95% Ch 1.08-1.59; P = 0.0068）, and mixed IVF ＋ ICSI studies （16 estimates, OR = 2.37; 95% Ch 1.89-2.97; P〈 0.0001） were also statistically significant. There is sufficient evidence in the existing literature suggesting that sperm DNA damage has a negative effect on clinical pregnancy following IVF and/or ICSI treatment.
文摘BACKGROUND Despite advances in the use of in vitro fertilization-embryo transfer(ET)in couples with infertility,recurrent implantation failure(RIF)after ET is still a major problem affecting women,with great psychological and economic burdens for the patient and his/her family.AIM To investigate the psychological burden(anxiety and depression)and evaluate the clinical benefits of endometrial receptivity testing(ERT)in patients experiencing RIF following frozen-thawed ET.METHODS A retrospective cohort study analyzed 371 patients experiencing RIF after assisted reproductive treatment at the First People’s Hospital of Changde City between January 2021 and June 2024.Demographic and clinical data were systematically collected through standardized questionnaires.Psychological assessment utilized validated instruments:The Self-Rating Depression Scale for depression evaluation and the Self-Rating Anxiety Scale for anxiety assessment.Participants were stratified by psychological status(anxiety/non-anxiety and depression/nondepression)to analyze influencing factors for anxiety and depression.The cohort was further categorized into the ERT and non-ERT groups based on ERT implementation to comparatively analyze their clinical outcomes.Additionally,they were divided into clinical and nonclinical pregnancy groups to identify factors affecting clinical pregnancy using univariate and multivariate logistic regression models.Compared with the non-ERT group,the 226 patients who underwent ERT-guided ET achieved a higher clinical pregnancy rate,thicker endometrium on transfer day,fewer embryos transferred,and a lower miscarriage rate.RESULTS The study identified a substantial psychological burden,with anxiety prevalence at 55.0%(mean Self-Rating Anxiety Scale score,50.89±9.34)and depression at 61.2%(mean Self-Rating Depression Scale score,55.55±9.48).Multivariate analysis identified annual household income>100000 yuan as protective factors against both anxiety and depression,whereas advanced maternal age(>35 years)and multiple implantation failures(≥3)served as risk factors.Additionally,anxiety-specific risk factors included prolonged infertility treatment(>5 years)and the spouse’s status as an only child.As to depression-specific risks,chronic infertility(>3 years)and higher educational attainment(college/bachelor’s degree or higher)were key determinants,whereas urban residence was a protective factor.Age>35 years was a risk factor for clinical pregnancy in patients experiencing RIF,whereas blastocyst-stage ET,a higher number of embryos transferred,and thicker endometrium were protective factors.CONCLUSION Patients experiencing RIF are particularly susceptible to anxiety and depression,and advanced maternal age and multiple implantation failures represent salient risk factors.Clinicians should implement proactive and evidencebased interventions to mitigate these psychological burdens.For patients experiencing RIF,ERT-guided ET demonstrates significant potential to improve assisted reproductive outcomes.
文摘Objective: to explore and analyze the effect of laparoscopic and open surgery in the treatment of ectopic pregnancy patients, and analyze its clinical application value. Methods: 120 cases of ectopic pregnancy patients admitted by our hospital from September 2017 to September 2019 were randomly selected as the research object. They were divided into control group and experimental group by computer sequencing method, with 60 patients in each group. The control group was treated with traditional open surgery, while the experimental group was treated with laparoscopic surgery. The difference of operation and prognosis between the two groups was observed. The follow-up period of half a year was conducted to compare the intrauterine pregnancy rate between the two groups. Results: the operative and prognostic indexes of the experimental group were lower than those of the control group (P < 0.05), and the intrauterine pregnancy rate of the experimental group was significantly higher than that of the control group (P < 0.05) after 6 months follow-up. Conclusion: laparoscopic ectopic pregnancy surgery has the characteristics of high efficiency, minimally invasive, high safety and less impact on patients' long-term reproductive outcomes, so it should be applied in clinical practice.
基金National Key R&D Program of China(2018YFC1003200)Natural Science Foundation of China(81873819)+2 种基金National Natural Science Foundation of China(82101759)Zhejiang Provincial Natural Science Foundation of China(LQ22H040006)Zhejiang Provincial Science and Technology Project of China(2021C03100)。
文摘Objective:Optimal luteinizing hormone(LH)levels forin vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)patients following the gonadotropin-releasing hormone(GnRH)antagonist protocol remain controversial.This study aimed to estimate the association between serum LH levels on the triggering day(LHLOT)and clinical pregnancy outcomes in IVF/ICSI patients following the GnRH antagonist protocol.Methods:We enrolled 4743 IVF/ICSI cycles using flexible or fixed GnRH antagonist protocols between January 2017 and June 2021.The patients were stratified into four groups according to the LHLOT quartiles(Q1–Q4).Each group was further divided into two subgroups according to the median basal LH/LHLOT.The main outcomes were clinical pregnancy,birth,and miscarriage rates.Secondary outcomes were oocyte yield,number of MII,fertilized oocytes(2PN),and high-quality embryos.Results:Serum LHLOT levels were negatively correlated with oocyte yield and the numbers of MII,2PN,and high-quality embryos.Reproductive outcomes were compared among the different quartiles and subgroups.The absolute difference in the clinical pregnancy rates between the Q4 and Q1 groups was 6.4%(47.2%vs.40.8%,P<0.05).Clinical pregnancy rates between the subgroups with basal LH/LHLOT>3.04 and≤3.04 were 32.7%and 48.6%(P<0.01),respectively,in Q1.Within Q3,the clinical pregnancy rates between the subgroups with basal LH/LHLOT>2.14 and≤2.14 were 50.2%and 41.9%,respectively(P<0.05).The greater the decrease in LH levels,the lower the oocyte maturation rate across all quartiles.Conclusions:According to the LHLOT quartiles,the Q1 of serum LHLOT<1.43 IU/L may result in a higher number of oocytes but reduced oocyte maturation and lower clinical pregnancy rates.A decrease in LH levels by approximately 2.14 to 3.04 times compared to basal LH levels may lead to higher clinical pregnancy rates in IVF/ICSI patients following the GnRH antagonist protocol.
文摘Objective:Recurrent ectopic pregnancy(REP)is rare,but can have severe consequences for patients.The aim of this study was to report outcomes of laparoscopic management of REP in our center.Methods:Retrospective cohort study including REP treated surgically at a single,tertiary-care academic medical center between 2009 and 2018.All patients undergoing laparoscopic salpingostomy or salpingectomy were included.Patients were then followed up to monitor outcomes of future reproductive events.Results:Of 41 eligible patients,14 suffered from ipsilateral recurrence including 5 cases of tubal stump pregnancy.In the other 27 cases,the REP occurred in the contralateral tube that was previously unaffected.All patients with ipsilateral recurrence underwent salpingectomy.In patients with contralateral recurrence,salpingectomy was carried out in 21 patients(77.8%)and salpingostomy in 6 patients(22.2%).32 patients(78%)subsequently sought to conceive either spontaneously or by in vitro fertilization.The subsequent live birth rates were 51.8%(14/27)in the salpingectomy group and 60.0%(3/5)in the salpingostomy group.Conclusion:Where trained laparoscopists and adequate facilities are available,it is possible to achieve acceptable reproductive outcomes after REP irrespective of the surgical approach.
