The ability of natural conception decreases with age,leading many advanced-age women with fertility desire begin to attempt in vitro fertilization and embryo transfer(IVF-ET)technique nowadays.Traditional Chinese medi...The ability of natural conception decreases with age,leading many advanced-age women with fertility desire begin to attempt in vitro fertilization and embryo transfer(IVF-ET)technique nowadays.Traditional Chinese medicine(TCM)believes that human body undergoes periodic changes corresponding to the natural rhythms.Women exhibit distinct physiological lunar rhythms of the thoroughfare vessel and the conception vessel,as well as pathological rhythms during the menstrual cycle and IVF-ET cycle.Based on the theory of TCM temporal rhythm,this paper discusses the pathogenesis characteristics of infertility in advanced-age women at different stages.It believes that acupuncture intervention should comply with the following ideas:determining main acupoints based on disease differentiation,with a preference for the acupoints on the thoroughfare vessel,the conception vessel,spleen meridian and kidney meridian,as well as the back-shu points of the liver,spleen and kidney;determining the supplementary acupoints based on syndrome differentiation and symptoms;determining the supplementary acupoints based on time differentiation of lunar rhythm of the thoroughfare vessel and the conception vessel,and integrating both reinforcing and reducing techniques.During the process of intervention,the physical and mental states were balanced simultaneously.展开更多
Objective:To explore the association between acupuncture during controlled ovarian hyperstimulation(COH)and the live birth rate(LBR)using different propensity score methods.Methods:In this retrospective cohort study,e...Objective:To explore the association between acupuncture during controlled ovarian hyperstimulation(COH)and the live birth rate(LBR)using different propensity score methods.Methods:In this retrospective cohort study,eligible women who underwent a COH were divided into acupuncture and non-acupuncture groups.The primary outcome was LBR,as determined by propensity score matching(PSM).LBR was defined as the delivery of one or more living infants that reached a gestational age over 28 weeks after embryo transfer.The propensity score model encompassed 16 confounding variables.To validate the results,sensitivity analyses were conducted using three additional propensity score methods:propensity score adjustment,inverse probability weighting(IPW),and IPW with a"doubly robust”estimator.Results:The primary cohort encompassed 9751 patients(1830[18.76%]in the acupuncture group and7921[81.23%]in the non-acupuncture group).Following 1:1 PSM,a higher LBR was found in the acupuncture cohort(41.4%[755/1824]vs 36.4%[664/1824],with an odds ratio of 1.23[95%confidence interval,1.08-1.41]).Three additional propensity score methods produced essentially similar results.The risk of serious adverse events did not significantly differ between the two groups.Conclusion:This retrospective study revealed an association between acupuncture and an increased LBR among patients undergoing COH,and that acupuncture is a safe and valuable treatment option.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 assess whether personalized embryo transfer guided by endometrial receptivity array(ERA)improves implantation and pregnancy rates in women with implantation failure.Methods:This retrospective case-control...Objective:To assess whether personalized embryo transfer guided by endometrial receptivity array(ERA)improves implantation and pregnancy rates in women with implantation failure.Methods:This retrospective case-control study was conducted on women with previous implantation failure.The women were divided into two groups,i.e,women who underwent ERA and those who underwent embryo transfer without ERA testing.ERA was performed using Igenomix.ERA results were interpreted as receptive or non-receptive.Women underwent frozen embryo transfer on the 6th day of progesterone(P+5).The primary outcomes were implantation rate,clinical pregnancy rate,abortion rate,and negative pregnancy rate.Results:This study included 229 women with previous implantation failure,with 154 in the ERA group and 75 in the no ERA group.The mean age of the women of the ERA group was(32.2±4.1)years,and that of the no ERA group was(31.5±4.8)years.Women in the ERA group had a higher implantation rate(60.4%)and clinical pregnancy rate(57.1%)compared to those in the no ERA group(48.0%and 46.7%,respectively).In addition,implantation rate of the nonreceptive ERA group was higher than the no ERA group(65%vs.48%),and clinical pregnancy rate was also higher in the non-receptive ERA group than the no ERA group(65%vs.47%).The abortion rate of the no ERA group was 9%and that of the non-receptive ERA group was 10%.52%no ERA group women and 35%non-receptive ERA group women had negative pregnancy results.Conclusions:Women who have undergone personalised embryo transfer guided by ERA have a higher clinical pregnancy rate than women who have not after previous implantation failure.展开更多
BACKGROUND Acupuncture,an ancient practice,is gaining recognition as a complementary and alternative medicine,especially in assisted reproductive technology.It plays a crucial role in enhancing embryo transfer success...BACKGROUND Acupuncture,an ancient practice,is gaining recognition as a complementary and alternative medicine,especially in assisted reproductive technology.It plays a crucial role in enhancing embryo transfer success rates.Research indicates that acupuncture can improve blood flow,increase endometrial receptivity regulate pressure,and affect neuroendocrine activities in the ovaries and uterus during embryo implantation,therefore improving pregnancy outcomes.AIM To highlight recent developments related to acupuncture's influence on embryo transfer and elucidating the precise mechanisms by which acupuncture influences embryo transfer.METHODS We searched database including PubMed,Cochrane Library up to September 2024 for relevant studies and patents to evaluate the effects of acupuncture on women undergoing in vitro fertilization(IVF).The experimental design included an intervention group using needling,and a control group consisting of no needling or sham needling.The main outcome is clinical pregnancy rate(CPR),while secondary includes live birth rate(LBR)and biochemical pregnancy rate(BPR).We examined the influence of adjunctive needling on pregnancy outcomes by analyzing variations in the main outcomes.RESULTS A total of 145 randomized controlled trials involving 27748 participants were analyzed.Data revealed that the overall CPR was significantly elevated in all acupuncture cohorts compared to the control group[relative risk(RR):1.21,95%CI:1.07-1.38,P=0.01].In contrast,the aggregated LBR did not exhibit a corresponding increase,and notable statistical heterogeneity was observed among the studies.Acupuncture-assisted frozen-thawed embryo transfer enhanced the BPR(RR:1.51,95%CI:1.21-1.89,P=0.03)and improved endometrial morphology(RR:1.41,95%CI:1.13-1.75,P=0.01).Furthermore,IVF outcomes were significantly superior in the acupuncture group when acupuncture was administered during controlled ovarian hyperstimulation(RR:1.71,95%CI:1.08-2.13,95%CI:1.08-4.21,P=0.03).CONCLUSION We find that acupuncture positively influences pregnancy rates in women receiving IVF treatment.Nonetheless,there are no established guidelines for optimal acupuncture protocols.Considering the methodological limitations identified in current research,there is a need for larger,methodologically rigorous studies.展开更多
Objective To observe the impacts of electroacupuncture （EA） on oocyte quality and pregnant outcome for the patients with polycystic ovary syndrome （PCOS） undergoing in vitro fertilization and embryo transfer （IVF...Objective To observe the impacts of electroacupuncture （EA） on oocyte quality and pregnant outcome for the patients with polycystic ovary syndrome （PCOS） undergoing in vitro fertilization and embryo transfer （IVF-ET） and explore its potential mechanism. Methods Sixty-six patients with PCOS and undergoing IVF-ET were divided into two groups randomly, including an observation group （34 cases） and a control group （32 cases）. Ethinylestradiol and cyproterone acetate tablets and gonadotropin-releasing hormone agonist were administered for long-program superovulation in either group. In the observation group, the intervention of EA was applied to Guānyuán （关元 CV 4）, Zhōngjí （中极 CV 3）, Sānyīnjiāo （三阴交 SP 6）, Zǐgōng （子宫 EX-CA 1） and Tàixī （太溪 KI 3） additionally for 30 min, once daily, 1 menstrual cycle before controlled ovarian hyperstimulation （COH） and during COH. The pregnant outcome, evaluation of kidney deficiency syndrome, blood hormone level on the day of human chorionic gonadotropin injection and the concentrations of stem cell factor （SCF） in the serum and follicular fluid on the day of oocyte collection were compared between the two groups. Results The score of kidney deficiency symptoms was reduced remarkably after treatment in either group and the improvement in the observation group was superior to that in the control group （P0.01）. The fertilization rate [（76.25？±？20.33）% vs （66.34？±？15.44）%], cleavage rate [（98.66？±？3.70）% vs （94.47？±？9.45）%] and the rate of high-quality embryos [（60.20？±？22.20）% vs （50.55？±？16.15）%] in the observation group were all superior to those in the control group separately （all P0.05）. Clinical pregnancy rate （46.67%, 14/30） in the observation group was higher than that （37.93%, 11/29） in the control group, but without statistical difference （P0.05）. SCF concentrations in the serum and follicular fluid on the day of oocyte collection in the observation group were higher obviously than those in the control group （both P0.05）. Conclusion Electroacupuncture plays an active role in the pregnant outcomes of PCOS patients undergoing IVF-ET and it can relieve the symptoms of kidney deficiency in terms of TCM and improve clinical pregnant rate. The mechanism is relevant to the overall adjustment of organic endocrinal system and the local micro-environment of ovary and the improvement of oocyte quality through the up-regulation of SCF concentration.展开更多
Objective Prior pulmonary tuberculosis(PTB) on chest X-ray(CXR) was commonly found in infertile patients receiving examinations before in vitro fertilization and embryo transfer(IVF-ET). It was unclear whether untreat...Objective Prior pulmonary tuberculosis(PTB) on chest X-ray(CXR) was commonly found in infertile patients receiving examinations before in vitro fertilization and embryo transfer(IVF-ET). It was unclear whether untreated PTB would affect pregnancy outcomes after IVF-ET.Method We conducted a retrospective cohort study of 14,254 infertile patients who had received IVFET at Peking University Third Hospital in 2017. Prior PTB was defined as the presence of signs suggestive of old or inactive PTB on CXR, with or without a clinical TB history. Patients who had prior PTB on CXR but had not received a clinical diagnosis and anti-TB therapy were included for analysis. Live birth,clinical pregnancy, and miscarriage rates were compared between the untreated PTB and non-PTB groups.Results The untreated PTB group had significantly lower clinical pregnancy(31.7% vs. 38.1%) and live birth(23.8% vs. 30.6%) rates than the non-PTB group(both P < 0.001). Multivariate analysis revealed that untreated PTB was a risk factor for decreased live birth rate [odds ratio(OR), 0.80;95% confidence interval(CI), 0.66–0.98;P = 0.028] in all patients and for increased miscarriage(OR, 4.19;95% CI,1.69–10.39;P = 0.002) and decreased live birth(OR, 0.45;95% CI, 0.24–0.83;P = 0.011) rates in patients with unexplained infertility.Conclusions Untreated PTB was associated with adverse pregnancy outcomes after IVF-ET, especially in patients with unexplained infertility, highlighting the clinical significance of PTB in this specific patient population.展开更多
BACKGROUND Intramural pregnancy is a rare type of ectopic pregnancy,which is diagnosed by transvaginal ultrasound and magnetic resonance imaging.Management strategies vary depending on the site of the pregnancy,the ge...BACKGROUND Intramural pregnancy is a rare type of ectopic pregnancy,which is diagnosed by transvaginal ultrasound and magnetic resonance imaging.Management strategies vary depending on the site of the pregnancy,the gestational age and the desire to maintain fertility.The incidence of intramural pregnancy in assisted reproductive technology is higher than that in natural pregnancy.CASE SUMMARY We present a case of intramural pregnancy after in vitro fertilization and elective single embryo transfer following salpingectomy.The patient was completely asymptomatic and her serumβ-human chorionic gonadotropin level increased from 290 m IU/m L to 1759 m IU/m L.Three-dimensional transvaginal ultrasound indicated a heterogeneous echogenic mass arising from the uterine fundus which was surrounded by myometrium and a slender and extremely hypoechoic area stretching to the uterine cavity which was thought to be a fistulous tract.Therefore,we considered a diagnosis of intramural pregnancy and laparoscopic surgery was conducted at 7 wk gestation.CONCLUSION Early diagnosis and treatment of intramural pregnancy is significant for maintaining fertility.展开更多
OBJECTIVE： To assess the effects of using Chinese herbs in assisted reproductive technology. METHODS： Four hundred and thirty-three subjects aged less than 42 years with infertility due to Fallo- pian tube or male-r...OBJECTIVE： To assess the effects of using Chinese herbs in assisted reproductive technology. METHODS： Four hundred and thirty-three subjects aged less than 42 years with infertility due to Fallo- pian tube or male-related factors who were willing to undertake in vitro fertilization and embryo trans- plantation were randomly allocated to a Chinese herb intervention group （n=216） or a conventional treatment control group （n=217）. All subjects re- ceived one of four routine ultra-ovulation-promot- ing therapies at the Reproductive Center in the Third Hospital Affiliated to Beijing University ac- cording to their physician＇s assessments. The sub- jects in the intervention group received various Chi- nese herbs depending on their conventional treat- ment. Endometrial thickness, number of acquired eggs, and rates of normal fertility, high-quality em- bryos, biochemical and clinical pregnancy of sub- jects were assessed in both groups.RESULTS： The high-quality embryo rate of 51.9%, biochemical pregnancy rate of 51.0%, clinical preg- nancy rate of 44.2% and endometrial thickness of （10.84± 1.75） mm in the intervention group were all significantly higher than those in the control group [48.7%, 38.9%, 34.8%, and （10.52±1.50） mm, respec- tively; P〈O.05]. The normal fertility rate of 58.5% in the Chinese herb group was also significantly supe- rior to the 54.7% achieved in the control group （P〈 0.01）. There were no statistically significant differ- ences （P〉0.05） in the average number of acquired eggs within a single cycle, incidence of excessive stimulation of ovary, rates of embryo transplanta- tion or early abortion and birth of living babies be- tween the two groups. CONCLUSION： Our findings indicate that Chinese herbs increase endometrial thickness, improve the quality of fertility and embryo, and promote embry- onic nidation, thus enhancing the success rate of in vitro fertilization/intracytoplasmic sperm injec- tion-embryo transplantation cycle. Using Chinese herbs improves the outcomes and safety of assist- ed reproductive technologies.展开更多
Objective To investigate the reproduction-assisting effects of laparoscopic ＂corepulling＂ salpingectomy for patients with hydrosalpinx on ovarian reserve,responsiveness to stimuli and outcomes of in vitro fertilizat...Objective To investigate the reproduction-assisting effects of laparoscopic ＂corepulling＂ salpingectomy for patients with hydrosalpinx on ovarian reserve,responsiveness to stimuli and outcomes of in vitro fertilization and embryo transfer（IVF-ET）.Methods Infertile females receiving treatment in Reproductive Medicine Center of Yantai Yuhuangding Hospital due to fallopian tube disorders（n=214） were enrolled from July 2006 to December 2007 and further divided into three groups.＂Core-pulling＂ procedure group（group A） consisted of patients receiving pretreatment with ＂corepulling＂ salpingectomy due to hydrosalpinx in our center（n=31）,wherein 16 patients received IVF-ET.Conventional procedure group（group B） consisted of patients receiving conventional salpingectomy for hydrosalpinx or ectopic pregnancy in our center or other institutes prior to IVF-ET（n=59）.Control group（group C） consisted of patients receiving IVF-ET without the history of previous hydrosalpinx or salpingectomy（n=124）.Results At baseline,the antral follicle count of group B was significantly less than that of groups A and C（8.6±2.5 vs 8.3±2.0 vs 9.8±2.4）.The mature oocytes retrieved numbered less than the other two groups,in a statistically significant manner compared with group C（13.1±5.7 vs 10.6±5.0 vs 12.0±6.2）.Patients of groups A and B received more gonadotropin while the dosage of group B differed significantly from group C（31.0±17.7 vs 37.6±8.3 vs 30.0±4.6）.E2 level on hCG injection day was slightly lower in group B than in the other two groups,statistically significant compared with that of group C,but not compared with that of group A.After receiving IVF-ET,patients of group A showed significantly higher conception rate than groups B and C（62.5% vs 43.6% vs 39.2%）.Conclusion Compared with the conventional procedure,laparoscopic ＂core-pulling＂ salpingectomy should be recommended for patients with hydrosalpinx intending to receive IVF-ET,which did not interfere with the ovarian reserve or responsiveness but improve the conception rate in clinical practice.展开更多
BACKGROUND Treatment of thin endometrium with granular leukocyte-colony stimulating factor(G-CSF)remains controversial.AIM To investigate the effect of G-CSF on the outcome of frozen embryo transfer in patients with t...BACKGROUND Treatment of thin endometrium with granular leukocyte-colony stimulating factor(G-CSF)remains controversial.AIM To investigate the effect of G-CSF on the outcome of frozen embryo transfer in patients with thin endometrium.METHODS A retrospective propensity score matching(PSM)study was performed to assess patients administered frozen embryo transfer at the Reproductive Medicine Center of the Affiliated Drum Tower Hospital of Nanjing University Medical School,in 2012-2018.The patients were divided into G-CSF intrauterine perfusion(G-CSF)and non-G-CSF groups,and clinical pregnancy,implantation,ectopic pregnancy,and early abortion rates between the two groups were compared.RESULTS Before PSM,372 cycles were enrolled,including 242 and 130 cycles in the G-CSF and non-G-CSF groups,respectively.Age(34.23±5.76 vs 32.99±5.59 years;P=0.047)and the blastula/cleavage stage embryo ratio(0.68 vs 0.37;P=0.011)were significantly elevated in the G-CSF group compared with the non-G-CSF group;however,clinical pregnancy(46.28%vs 51.54%;P=0.371)and embryo implantation(35.21%vs 35.65%;P=0.910)rates were similar in both groups.After PSM by age and blastula/cleavage stage embryo ratio,244 cycles were included(122 cases each in the G-CSF and non-G-CSF groups).The clinical pregnancy(50.82%vs 48.36%;P=0.701)and embryo implantation(37.38%vs 34.11%;P=0.480)remained similar in both groups.CONCLUSION Intrauterine infusion of G-CSF does not improve the clinical outcome of frozen embryo transfer in patients with thin endometrium.展开更多
The clinical outcomes of five groups of infertility patients receiving frozen- thawed, cleavage-stage embryo transfers with exogenous hormone protocols with or without a depot gonadotropin-releasing hormone （GnRH） a...The clinical outcomes of five groups of infertility patients receiving frozen- thawed, cleavage-stage embryo transfers with exogenous hormone protocols with or without a depot gonadotropin-releasing hormone （GnRH） agonist were assessed. A retrospective cohort analysis was performed on 1003 cycles undergoing frozen-thawed, cleavage-stage embryo transfers from January 1, 2012 to June 31, 2015 in the Reproductive Medicine Center of Wuhan General Hospital of Guangzhou Military Region. Based on the infertility etiologies of the patients, the 1003 cycles were divided into five groups： tubal infertility, polycystic ovary syndrome （PCOS）, endometriosis, male infertility, and unexplained infertility. The main outcome was the live birth rate. Two groups were set up based on the intervention： group A was given a GnRH agonist with exogenous estrogen and progesterone, and group B （control group） was given exogenous estrogen and progesterone only. The results showed that the baseline serum hormone levels and basic characteristics of the patients were not significantly different between groups A and B. The live birth rates in groups A and B were 41.67% and 29.29%, respectively （P〈0.05）. The live birth rates in patients with PCOS in groups A and B were 56.25% and 30.61%, respectively （P〈0.05）. The clinical pregnancy, implantation and on-going pregnancy rates showed the same trends as the live birth rates between groups A and B. The ectopic pregnancy rate was significantly lower in group A than in group B. We concluded that the live birth rate was higher and other clinical outcomes were more satisfactory with GnRH agonist co- treatment than without GnRH agonist co-treatment for frozen-thawed embryo transfer. The GnRH agonist combined with exogenous estrogen and progesterone worked for all types of infertility tested, especially for women with PCOS.展开更多
Objective To explore the different endometrial preparation for frozen-thawed embryo transfer （FET） in women with advanced endometriosis （EMS）. Methods The pregnancy outcomes of patients with advanced EMS （542 cyc...Objective To explore the different endometrial preparation for frozen-thawed embryo transfer （FET） in women with advanced endometriosis （EMS）. Methods The pregnancy outcomes of patients with advanced EMS （542 cycles）, who were prepared for FET, were retrospectively assessed. Included patients underwent a total of 233 FET cycles （180 patients） using natural cycle （NC）, a total of 142 FET cycles （115 patients） using letrozole （LE） ovulation induction, and a total of 167 FET cycles （137 patients） using hormonal replacement treatment （HRT） for endometrial preparation.Results There were no significant diffenences in the clinical pregnancy rate （LE： 49.30%, NC： 50.21%, and HRT： 43.11~/o, P=0.343）, the implantation rate （LE： 29.26%, NC： 36.03%, and HRT： 29.55%, P=0.084）, and the live birth rate （LE： 38.02%, NC： 39.11%, and HR T.＂ 35.33 %, P=O. 648） among the three groups. No statistically signifi- cant differences were observed in the ongoing pregnancy rate, the miscarriage rate, and the pregnancy complication rate. The single birth weight in patients using NC- FET was lower than that in patients using HRT-FET （P=0.044） and a higher twin birth weight in patients using LE-FET were observed compared with other groups （P=O. 022）. The rate of birth weight 〈2 500 g was also higher in the NC-FET group than in other groups. No congenital birth defects were found in the three groups. Conclusion Different endometrial preparation protocols without ultra-long GnRH-a down-regulation for FET yield similar pregnancy outcomes in patients with EMS. A tailored endometrial preparation protocol should be recommended according to different patients＇ situation.展开更多
BACKGROUND Heterotopic pregnancy(HP)refers to the coexistence of ectopic pregnancy and intrauterine pregnancy.Salpingectomy is proposed as a pretreatment before in vitro fertilization and embryo transfer(IVF-ET)to red...BACKGROUND Heterotopic pregnancy(HP)refers to the coexistence of ectopic pregnancy and intrauterine pregnancy.Salpingectomy is proposed as a pretreatment before in vitro fertilization and embryo transfer(IVF-ET)to reduce the risk of HP.HP after IVF-ET occurs in women who had already underwent bilateral salpingectomy,even though it is extremely rare.CASE SUMMARY A case of a 29-year-old woman with recurrent interstitial HP after IVF-ET following salpingectomy is presented.The main symptom was a sudden and worsening pelvic pain.Physical examinations revealed signs of peritoneal bleeding and irritation with stable vital signs.Transvaginal ultrasound showed a live intrauterine pregnancy and another live embryo with cardiac activity in the left cornu extending beyond the lateral edge of the uterus.Her hemoglobin concentration was 8.0 g/dL,and serum human chorionic gonadotropin value was 171116.9 mIU/mL.With the diagnosis of ruptured HP with internal bleeding,an emergency laparoscopic resection of left cornu was performed.The interstitial pregnancy was removed with caution to protect the intrauterine pregnancy.After the surgical treatment,the intrauterine pregnancy continued with no complications.A healthy baby was delivered by caesarean section at 39 wk.Outcomes of another three cases are further summarized.CONCLUSION Post-salpingectomy HP is a rare but challenging condition.Surgical treatment is preferred in the case with a viable intrauterine pregnancy.展开更多
Background:In vitro embryo production(IVP)and embryo transfer(ET)are two very common assisted reproductive technologies(ART)in human and cattle.However,in pig,the combination of either procedures,or even their use sep...Background:In vitro embryo production(IVP)and embryo transfer(ET)are two very common assisted reproductive technologies(ART)in human and cattle.However,in pig,the combination of either procedures,or even their use separately,is still considered suboptimal due to the low efficiency of IVP plus the difficulty of performing ET in the long and contorted uterus of the sow.In addition,the potential impact of these two ART on the health of the offspring is unknown.We investigated here if the use of a modified IVP system,with natural reproductive fluids(RF)as supplements to the culture media,combined with a minimally invasive surgery to perform ET,affects the output of the own IVP system as well as the reproductive performance of the mother and placental molecular traits.Results:The blastocyst rates obtained by both in vitro systems,conventional(C-IVP)and modified(RF-IVP),were similar.Pregnancy and farrowing rates were also similar.However,when compared to in vivo control(artificial insemination,AI),litter sizes of both IVP groups were lower,while placental efficiency was higher in AI than in RF-IVP.Gene expression studies revealed aberrant expression levels for PEG3 and LUM in placental tissue for C-IVP group when compared to AI,but not for RF-IVP group.Conclusions:The use of reproductive fluids as additives for the culture media in pig IVP does not improve reproductive performance of recipient mothers but could mitigate the impact of artificial procedures in the offspring.展开更多
OBJECTIVE: To evaluate the curative effect of Traditional Chinese Medicine(TCM) multi-channel interventional therapy on women with Assisted Reproductive Technology(ART) failure, to compare the curative effect of the d...OBJECTIVE: To evaluate the curative effect of Traditional Chinese Medicine(TCM) multi-channel interventional therapy on women with Assisted Reproductive Technology(ART) failure, to compare the curative effect of the dual therapy and triple therapy on women with ART Failure, and to choose the best TCM interventional therapeutic plan.METHODS: The 95 cases with ART Failure from West China second University Hospital of Sichuan University meeting the inclusion criteria were randomly divided into three groups:dual therapy group(31 cases), triple therapy group(33 cases)and control group(31 cases). According to the intervene treatment of in vitro Fertilization and Embryo Transfer(IVF-ET) long cycle scheme, the control group wait naturally for 3 months before IVFET. The dual therapy group take TCM prescriptionⅡ of cultivating emotion and assisting reproduction and auricular acupoint therapy for 3 months before IVF-ET, then Western Medicine treatment progestin supporting as well as auricular application and Antai Recipe after IVF-ET transplantation.The triple therapy group take TCM prescription Ⅱof cultivated emotion and assisted reproduction,auricular acupoint therapy and retention enema of TCM, and combination treatment the same as dual therapy group after transplantation. The natural pregnancy number, the period condition of secondary IVF-ET and the improvement of the kidney deficiency, liver depression and blood stasis syndrome among those three groups were compared.RESULTS: It was showed from analysis in 95 cases with ART failure that the number of natural preg-nancy was as followings: 3 patients from the dual therapy group, 10 patients from the triple therapy group, and no patient from the control group. The comparison among three groups have statistical significance(P < 0.05). The treatment group is superior to the control group, while the triple therapy is superior to the dual therapy. The comparison of the condition of the fertility rate, clinical pregnancy rate, biochemical pregnancy rate and early abortion rate during the period of secondary IVF-ET between pre-therapy and post-treatment of both the dual therapy group and the triple therapy group have statistical significance(P < 0.05). The comparison of the improvement of the kidney deficiency,liver depression and blood stasis syndrome between pre-therapy and post-treatment of both the dual therapy group and the triple therapy group have statistical significance(P < 0.05). The comparison between three groups after treatment have statistical significance(P < 0.05).CONCLUSION: TCM multi-channel interventional therapy can increase the natural pregnancy rate of patients with ART Failure(the triple therapy is superior to the dual therapy); it can increase the fertility rate, clinical pregnancy rate, and decrease the early abortion rate during the period of secondary IVF-ET; it can improve syndromes of kidney deficiency, liver depression and blood stasis.展开更多
OBJECTIVE:To investigate the effect of Soothing liver therapy on infertile women undergoing in vitro fertilization and embryo transfer(IVF-ET)and to explore its mechanism.METHODS:Fifty-eight women with tubal infertili...OBJECTIVE:To investigate the effect of Soothing liver therapy on infertile women undergoing in vitro fertilization and embryo transfer(IVF-ET)and to explore its mechanism.METHODS:Fifty-eight women with tubal infertility were randomized into two groups:30 in an experimental group treated with Xiaoyao powder(Shugan)plus gonadotropin-releasing hormone analog(GnRHa)/follicle-stimulating hormone(FSH)/human chorionic gonadotropin(hCG)and 28 in the control group who were treated with GnRHa/FSH/hCG only.The total gonadotropin(Gn)doses required,endometrial thickness,oocyte numbers,high quality embryo production rate and pregnancy rate of the two groups were compared.The concentration of growth differentiation factor-9(GDF-9)in follicular fluid was detected by western blotting and the expression of GDF-9 mRNA in granulosa cells was measured using reverse tran-scription-polymerase chain reaction amplification.RESULTS:In the experimental group,the Gn dose was significantly lower than that in the control group;the endometrial thickness,high quality embryo production and pregnancy rates were significantly higher and the expression of GDF-9 mRNA was also significantly higher than in the control group(all P<0.05).CONCLUSION:Shugan treatment can improve the pregnancy rate of women with tubal infertility;its mechanism is possibly related to the increased expression of GDF-9 in granulosa cells.展开更多
Damage to sperm DNA was proposed to play an important role in embryonic development.Previous studies focused on outcomes after fresh embryo transfer,whereas this study investigated the influence of sperm DNA fragmenta...Damage to sperm DNA was proposed to play an important role in embryonic development.Previous studies focused on outcomes after fresh embryo transfer,whereas this study investigated the influence of sperm DNA fragmentation index(DFI)on laboratory and clinical outcomes after frozen embryo transfer(FET).This retrospective study examined 381 couples using cleavage-stage FET.Sperm used for intracytoplasmic sperm injection(ICSI)or in vitro fertilization(IVF)underwent density gradient centrifugation and swim up processing.Sperm DFI had a negative correlation with sperm motility(r=−0.640,P<0.01),sperm concentration(r=−0.289,P<0.01),and fertilization rate of IVF cycles(r=−0.247,P<0.01).Sperm DFI examined before and after density gradient centrifugation/swim up processing was markedly decreased after processing(17.1%vs 2.4%,P<0.01;65 randomly picked couples).Sperm progressive motility was significantly reduced in high DFI group compared with low DFI group for both IVF and ICSI(IVF:46.9%±12.4%vs 38.5%±12.6%,respectively;ICSI:37.6%±14.1%vs 22.3%±17.8%,respectively;both P<0.01).The fertilization rate was significantly lower in high(≥25%)DFI group compared with low(<25%)DFI group using IVF(73.3%±23.9%vs 53.2%±33.6%,respectively;P<0.01)but was equivalent in high and low DFI groups using ICSI.Embryonic development and clinical outcomes after FET were equivalent for low and high DFI groups using ICSI or IVF.In this study,sperm DFI did not provide sufficient information regarding embryo development or clinical outcomes for infertile couples using FET.展开更多
Objective To compare the results of a novel regimen of human menopausal gonadotrophin （hMG） in combination with clomiphene citrate （CC） in mid-to-late follicular phase with those of a short protocol of GnRH agoni...Objective To compare the results of a novel regimen of human menopausal gonadotrophin （hMG） in combination with clomiphene citrate （CC） in mid-to-late follicular phase with those of a short protocol of GnRH agonist （GnRHa） and hMG used for IVF. Methods In the retrospective study, 842 patients undergoing IVF were collected and classified into two groups： hMG in combination with CC in mid-to-late follicular phase （group A, n=319） and short protocol of GnRHa-hMG （group B, n=523）. The main outcome measures were ovarian responses in stimulation cycles and pregnancy outcomes in subsequent frozen-thawed embryo transfer （FET） cycles. Results In group A, the serum LH concentration on day 8 -10 was similar with that on the day of hCG administration （2.43 ± 1.92 IU vs 2.51 ±2.05 IU）. The number of mature follicles and oocytes retrieved was significantly lower in group A than in group B while the fertilization rate and the cleavage rate were comparable. The clinical pregnancy rate （47. 79% vs 48.04%）, the implantation rate （32.49% vs 33.11%） and the cumulative pregnancy rate （58.09% vs 60.22%） were respectively similar in group A and group B. Conclusion hMG in combination with CC in mid-to-late follicular phase results in the same pregnancy outcome as short protocol. The novel protocol may take the advantage of eliminating the occurrehce of a premature endogenous LH Surge.展开更多
OBJECTIVE:To investigate the effect of—Xiaoyi Yusi decoction(XYYSD,消异育嗣汤),a Traditional Chinese Medicine(TCM),on in vitro fertilization and embryo transfer(IVF-ET)in patients with endometriosis,and to study the ...OBJECTIVE:To investigate the effect of—Xiaoyi Yusi decoction(XYYSD,消异育嗣汤),a Traditional Chinese Medicine(TCM),on in vitro fertilization and embryo transfer(IVF-ET)in patients with endometriosis,and to study the mechanism underpinning the action.METHODS:Women who underwent IVF-ET were divided into three groups by simple randomization:the treatment(n=32;with TCM treatment),patient(n=28;with endometriosis alone),and control(n=33;with male factor alone)groups.The luteal phase short-acting gonadotropin-releasing hormone agonist prolonged protocol was used in all three groups.To compare the changes in TCM scores and reproductive outcomes before and after TCM intervention in patients with endometriosis,partial least-squares discriminant analysis was used to analyze the follicular fluid samples of each group and screen and compare metabolites using the MetaboA nalyst software.RESULTS:The clinical data indicated that following TCM intervention,kidney deficiency and blood stasis symptom patterns improved dramatically in patients with endometriosis and that their clinical pregnancy rate increased significantly(71.9%vs 57.1%,P<0.05).Metabolomics showed that the two groups of samples were separated before and after TCM intervention.After TCM intervention,the intervention group was close to the control group,indicating that the TCM had a certain effect.Pathway analysis revealed that after TCM intervention,the metabolism of glycerin phospholipid,pyruvate,and citric acid was regulated.CONCLUSIONS:Through the pyruvate and glycerophospholipid metabolism pathways and tricarboxylic acid cycle,the TCM XYYSD successfully improved kidney deficiency and blood stasis symptom pattern,as well as the clinical reproductive outcomes of patients with endometriosis-related infertility.展开更多
基金Supported by Beijing University of Chinese Medicine First Class Discipline Construction:90010961020079。
文摘The ability of natural conception decreases with age,leading many advanced-age women with fertility desire begin to attempt in vitro fertilization and embryo transfer(IVF-ET)technique nowadays.Traditional Chinese medicine(TCM)believes that human body undergoes periodic changes corresponding to the natural rhythms.Women exhibit distinct physiological lunar rhythms of the thoroughfare vessel and the conception vessel,as well as pathological rhythms during the menstrual cycle and IVF-ET cycle.Based on the theory of TCM temporal rhythm,this paper discusses the pathogenesis characteristics of infertility in advanced-age women at different stages.It believes that acupuncture intervention should comply with the following ideas:determining main acupoints based on disease differentiation,with a preference for the acupoints on the thoroughfare vessel,the conception vessel,spleen meridian and kidney meridian,as well as the back-shu points of the liver,spleen and kidney;determining the supplementary acupoints based on syndrome differentiation and symptoms;determining the supplementary acupoints based on time differentiation of lunar rhythm of the thoroughfare vessel and the conception vessel,and integrating both reinforcing and reducing techniques.During the process of intervention,the physical and mental states were balanced simultaneously.
基金funded by the National Natural Science Foundation of China(No.81973966)。
文摘Objective:To explore the association between acupuncture during controlled ovarian hyperstimulation(COH)and the live birth rate(LBR)using different propensity score methods.Methods:In this retrospective cohort study,eligible women who underwent a COH were divided into acupuncture and non-acupuncture groups.The primary outcome was LBR,as determined by propensity score matching(PSM).LBR was defined as the delivery of one or more living infants that reached a gestational age over 28 weeks after embryo transfer.The propensity score model encompassed 16 confounding variables.To validate the results,sensitivity analyses were conducted using three additional propensity score methods:propensity score adjustment,inverse probability weighting(IPW),and IPW with a"doubly robust”estimator.Results:The primary cohort encompassed 9751 patients(1830[18.76%]in the acupuncture group and7921[81.23%]in the non-acupuncture group).Following 1:1 PSM,a higher LBR was found in the acupuncture cohort(41.4%[755/1824]vs 36.4%[664/1824],with an odds ratio of 1.23[95%confidence interval,1.08-1.41]).Three additional propensity score methods produced essentially similar results.The risk of serious adverse events did not significantly differ between the two groups.Conclusion:This retrospective study revealed an association between acupuncture and an increased LBR among patients undergoing COH,and that acupuncture is a safe and valuable treatment option.
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 assess whether personalized embryo transfer guided by endometrial receptivity array(ERA)improves implantation and pregnancy rates in women with implantation failure.Methods:This retrospective case-control study was conducted on women with previous implantation failure.The women were divided into two groups,i.e,women who underwent ERA and those who underwent embryo transfer without ERA testing.ERA was performed using Igenomix.ERA results were interpreted as receptive or non-receptive.Women underwent frozen embryo transfer on the 6th day of progesterone(P+5).The primary outcomes were implantation rate,clinical pregnancy rate,abortion rate,and negative pregnancy rate.Results:This study included 229 women with previous implantation failure,with 154 in the ERA group and 75 in the no ERA group.The mean age of the women of the ERA group was(32.2±4.1)years,and that of the no ERA group was(31.5±4.8)years.Women in the ERA group had a higher implantation rate(60.4%)and clinical pregnancy rate(57.1%)compared to those in the no ERA group(48.0%and 46.7%,respectively).In addition,implantation rate of the nonreceptive ERA group was higher than the no ERA group(65%vs.48%),and clinical pregnancy rate was also higher in the non-receptive ERA group than the no ERA group(65%vs.47%).The abortion rate of the no ERA group was 9%and that of the non-receptive ERA group was 10%.52%no ERA group women and 35%non-receptive ERA group women had negative pregnancy results.Conclusions:Women who have undergone personalised embryo transfer guided by ERA have a higher clinical pregnancy rate than women who have not after previous implantation failure.
基金Supported by Funding from the Jiangsu Provincial Science and Technology Plan Special Foundation,No.BE2022712The Special Research Project on The Development Plan of Traditional Chinese Medicine Technology in Jiangsu Province,No.ZT202120.
文摘BACKGROUND Acupuncture,an ancient practice,is gaining recognition as a complementary and alternative medicine,especially in assisted reproductive technology.It plays a crucial role in enhancing embryo transfer success rates.Research indicates that acupuncture can improve blood flow,increase endometrial receptivity regulate pressure,and affect neuroendocrine activities in the ovaries and uterus during embryo implantation,therefore improving pregnancy outcomes.AIM To highlight recent developments related to acupuncture's influence on embryo transfer and elucidating the precise mechanisms by which acupuncture influences embryo transfer.METHODS We searched database including PubMed,Cochrane Library up to September 2024 for relevant studies and patents to evaluate the effects of acupuncture on women undergoing in vitro fertilization(IVF).The experimental design included an intervention group using needling,and a control group consisting of no needling or sham needling.The main outcome is clinical pregnancy rate(CPR),while secondary includes live birth rate(LBR)and biochemical pregnancy rate(BPR).We examined the influence of adjunctive needling on pregnancy outcomes by analyzing variations in the main outcomes.RESULTS A total of 145 randomized controlled trials involving 27748 participants were analyzed.Data revealed that the overall CPR was significantly elevated in all acupuncture cohorts compared to the control group[relative risk(RR):1.21,95%CI:1.07-1.38,P=0.01].In contrast,the aggregated LBR did not exhibit a corresponding increase,and notable statistical heterogeneity was observed among the studies.Acupuncture-assisted frozen-thawed embryo transfer enhanced the BPR(RR:1.51,95%CI:1.21-1.89,P=0.03)and improved endometrial morphology(RR:1.41,95%CI:1.13-1.75,P=0.01).Furthermore,IVF outcomes were significantly superior in the acupuncture group when acupuncture was administered during controlled ovarian hyperstimulation(RR:1.71,95%CI:1.08-2.13,95%CI:1.08-4.21,P=0.03).CONCLUSION We find that acupuncture positively influences pregnancy rates in women receiving IVF treatment.Nonetheless,there are no established guidelines for optimal acupuncture protocols.Considering the methodological limitations identified in current research,there is a need for larger,methodologically rigorous studies.
基金Supported by Natural Science Fund Project of Shandong Province: Y 2007 C 131
文摘Objective To observe the impacts of electroacupuncture （EA） on oocyte quality and pregnant outcome for the patients with polycystic ovary syndrome （PCOS） undergoing in vitro fertilization and embryo transfer （IVF-ET） and explore its potential mechanism. Methods Sixty-six patients with PCOS and undergoing IVF-ET were divided into two groups randomly, including an observation group （34 cases） and a control group （32 cases）. Ethinylestradiol and cyproterone acetate tablets and gonadotropin-releasing hormone agonist were administered for long-program superovulation in either group. In the observation group, the intervention of EA was applied to Guānyuán （关元 CV 4）, Zhōngjí （中极 CV 3）, Sānyīnjiāo （三阴交 SP 6）, Zǐgōng （子宫 EX-CA 1） and Tàixī （太溪 KI 3） additionally for 30 min, once daily, 1 menstrual cycle before controlled ovarian hyperstimulation （COH） and during COH. The pregnant outcome, evaluation of kidney deficiency syndrome, blood hormone level on the day of human chorionic gonadotropin injection and the concentrations of stem cell factor （SCF） in the serum and follicular fluid on the day of oocyte collection were compared between the two groups. Results The score of kidney deficiency symptoms was reduced remarkably after treatment in either group and the improvement in the observation group was superior to that in the control group （P0.01）. The fertilization rate [（76.25？±？20.33）% vs （66.34？±？15.44）%], cleavage rate [（98.66？±？3.70）% vs （94.47？±？9.45）%] and the rate of high-quality embryos [（60.20？±？22.20）% vs （50.55？±？16.15）%] in the observation group were all superior to those in the control group separately （all P0.05）. Clinical pregnancy rate （46.67%, 14/30） in the observation group was higher than that （37.93%, 11/29） in the control group, but without statistical difference （P0.05）. SCF concentrations in the serum and follicular fluid on the day of oocyte collection in the observation group were higher obviously than those in the control group （both P0.05）. Conclusion Electroacupuncture plays an active role in the pregnant outcomes of PCOS patients undergoing IVF-ET and it can relieve the symptoms of kidney deficiency in terms of TCM and improve clinical pregnant rate. The mechanism is relevant to the overall adjustment of organic endocrinal system and the local micro-environment of ovary and the improvement of oocyte quality through the up-regulation of SCF concentration.
基金supported by the National Natural Science Foundation No. 81400041 and No. 81871212the National Natural Science Foundation of China Youth Fund Project No. 81400038cohort study project of the Peking University Third Hospital Y70545-04。
文摘Objective Prior pulmonary tuberculosis(PTB) on chest X-ray(CXR) was commonly found in infertile patients receiving examinations before in vitro fertilization and embryo transfer(IVF-ET). It was unclear whether untreated PTB would affect pregnancy outcomes after IVF-ET.Method We conducted a retrospective cohort study of 14,254 infertile patients who had received IVFET at Peking University Third Hospital in 2017. Prior PTB was defined as the presence of signs suggestive of old or inactive PTB on CXR, with or without a clinical TB history. Patients who had prior PTB on CXR but had not received a clinical diagnosis and anti-TB therapy were included for analysis. Live birth,clinical pregnancy, and miscarriage rates were compared between the untreated PTB and non-PTB groups.Results The untreated PTB group had significantly lower clinical pregnancy(31.7% vs. 38.1%) and live birth(23.8% vs. 30.6%) rates than the non-PTB group(both P < 0.001). Multivariate analysis revealed that untreated PTB was a risk factor for decreased live birth rate [odds ratio(OR), 0.80;95% confidence interval(CI), 0.66–0.98;P = 0.028] in all patients and for increased miscarriage(OR, 4.19;95% CI,1.69–10.39;P = 0.002) and decreased live birth(OR, 0.45;95% CI, 0.24–0.83;P = 0.011) rates in patients with unexplained infertility.Conclusions Untreated PTB was associated with adverse pregnancy outcomes after IVF-ET, especially in patients with unexplained infertility, highlighting the clinical significance of PTB in this specific patient population.
基金Supported by National Natural Science Foundation of China,No. 81971386 and No. 81871210
文摘BACKGROUND Intramural pregnancy is a rare type of ectopic pregnancy,which is diagnosed by transvaginal ultrasound and magnetic resonance imaging.Management strategies vary depending on the site of the pregnancy,the gestational age and the desire to maintain fertility.The incidence of intramural pregnancy in assisted reproductive technology is higher than that in natural pregnancy.CASE SUMMARY We present a case of intramural pregnancy after in vitro fertilization and elective single embryo transfer following salpingectomy.The patient was completely asymptomatic and her serumβ-human chorionic gonadotropin level increased from 290 m IU/m L to 1759 m IU/m L.Three-dimensional transvaginal ultrasound indicated a heterogeneous echogenic mass arising from the uterine fundus which was surrounded by myometrium and a slender and extremely hypoechoic area stretching to the uterine cavity which was thought to be a fistulous tract.Therefore,we considered a diagnosis of intramural pregnancy and laparoscopic surgery was conducted at 7 wk gestation.CONCLUSION Early diagnosis and treatment of intramural pregnancy is significant for maintaining fertility.
基金Supported by the Capital Fund for Development of Medical Scienceand Technology(No.SF-2009-III-33)
文摘OBJECTIVE： To assess the effects of using Chinese herbs in assisted reproductive technology. METHODS： Four hundred and thirty-three subjects aged less than 42 years with infertility due to Fallo- pian tube or male-related factors who were willing to undertake in vitro fertilization and embryo trans- plantation were randomly allocated to a Chinese herb intervention group （n=216） or a conventional treatment control group （n=217）. All subjects re- ceived one of four routine ultra-ovulation-promot- ing therapies at the Reproductive Center in the Third Hospital Affiliated to Beijing University ac- cording to their physician＇s assessments. The sub- jects in the intervention group received various Chi- nese herbs depending on their conventional treat- ment. Endometrial thickness, number of acquired eggs, and rates of normal fertility, high-quality em- bryos, biochemical and clinical pregnancy of sub- jects were assessed in both groups.RESULTS： The high-quality embryo rate of 51.9%, biochemical pregnancy rate of 51.0%, clinical preg- nancy rate of 44.2% and endometrial thickness of （10.84± 1.75） mm in the intervention group were all significantly higher than those in the control group [48.7%, 38.9%, 34.8%, and （10.52±1.50） mm, respec- tively; P〈O.05]. The normal fertility rate of 58.5% in the Chinese herb group was also significantly supe- rior to the 54.7% achieved in the control group （P〈 0.01）. There were no statistically significant differ- ences （P〉0.05） in the average number of acquired eggs within a single cycle, incidence of excessive stimulation of ovary, rates of embryo transplanta- tion or early abortion and birth of living babies be- tween the two groups. CONCLUSION： Our findings indicate that Chinese herbs increase endometrial thickness, improve the quality of fertility and embryo, and promote embry- onic nidation, thus enhancing the success rate of in vitro fertilization/intracytoplasmic sperm injec- tion-embryo transplantation cycle. Using Chinese herbs improves the outcomes and safety of assist- ed reproductive technologies.
文摘Objective To investigate the reproduction-assisting effects of laparoscopic ＂corepulling＂ salpingectomy for patients with hydrosalpinx on ovarian reserve,responsiveness to stimuli and outcomes of in vitro fertilization and embryo transfer（IVF-ET）.Methods Infertile females receiving treatment in Reproductive Medicine Center of Yantai Yuhuangding Hospital due to fallopian tube disorders（n=214） were enrolled from July 2006 to December 2007 and further divided into three groups.＂Core-pulling＂ procedure group（group A） consisted of patients receiving pretreatment with ＂corepulling＂ salpingectomy due to hydrosalpinx in our center（n=31）,wherein 16 patients received IVF-ET.Conventional procedure group（group B） consisted of patients receiving conventional salpingectomy for hydrosalpinx or ectopic pregnancy in our center or other institutes prior to IVF-ET（n=59）.Control group（group C） consisted of patients receiving IVF-ET without the history of previous hydrosalpinx or salpingectomy（n=124）.Results At baseline,the antral follicle count of group B was significantly less than that of groups A and C（8.6±2.5 vs 8.3±2.0 vs 9.8±2.4）.The mature oocytes retrieved numbered less than the other two groups,in a statistically significant manner compared with group C（13.1±5.7 vs 10.6±5.0 vs 12.0±6.2）.Patients of groups A and B received more gonadotropin while the dosage of group B differed significantly from group C（31.0±17.7 vs 37.6±8.3 vs 30.0±4.6）.E2 level on hCG injection day was slightly lower in group B than in the other two groups,statistically significant compared with that of group C,but not compared with that of group A.After receiving IVF-ET,patients of group A showed significantly higher conception rate than groups B and C（62.5% vs 43.6% vs 39.2%）.Conclusion Compared with the conventional procedure,laparoscopic ＂core-pulling＂ salpingectomy should be recommended for patients with hydrosalpinx intending to receive IVF-ET,which did not interfere with the ovarian reserve or responsiveness but improve the conception rate in clinical practice.
基金Supported by Chinese Medical Association,No.17020450714Medical Science and Technology Development Foundation,Nanjing Department of Health,No.YKK18090.
文摘BACKGROUND Treatment of thin endometrium with granular leukocyte-colony stimulating factor(G-CSF)remains controversial.AIM To investigate the effect of G-CSF on the outcome of frozen embryo transfer in patients with thin endometrium.METHODS A retrospective propensity score matching(PSM)study was performed to assess patients administered frozen embryo transfer at the Reproductive Medicine Center of the Affiliated Drum Tower Hospital of Nanjing University Medical School,in 2012-2018.The patients were divided into G-CSF intrauterine perfusion(G-CSF)and non-G-CSF groups,and clinical pregnancy,implantation,ectopic pregnancy,and early abortion rates between the two groups were compared.RESULTS Before PSM,372 cycles were enrolled,including 242 and 130 cycles in the G-CSF and non-G-CSF groups,respectively.Age(34.23±5.76 vs 32.99±5.59 years;P=0.047)and the blastula/cleavage stage embryo ratio(0.68 vs 0.37;P=0.011)were significantly elevated in the G-CSF group compared with the non-G-CSF group;however,clinical pregnancy(46.28%vs 51.54%;P=0.371)and embryo implantation(35.21%vs 35.65%;P=0.910)rates were similar in both groups.After PSM by age and blastula/cleavage stage embryo ratio,244 cycles were included(122 cases each in the G-CSF and non-G-CSF groups).The clinical pregnancy(50.82%vs 48.36%;P=0.701)and embryo implantation(37.38%vs 34.11%;P=0.480)remained similar in both groups.CONCLUSION Intrauterine infusion of G-CSF does not improve the clinical outcome of frozen embryo transfer in patients with thin endometrium.
文摘The clinical outcomes of five groups of infertility patients receiving frozen- thawed, cleavage-stage embryo transfers with exogenous hormone protocols with or without a depot gonadotropin-releasing hormone （GnRH） agonist were assessed. A retrospective cohort analysis was performed on 1003 cycles undergoing frozen-thawed, cleavage-stage embryo transfers from January 1, 2012 to June 31, 2015 in the Reproductive Medicine Center of Wuhan General Hospital of Guangzhou Military Region. Based on the infertility etiologies of the patients, the 1003 cycles were divided into five groups： tubal infertility, polycystic ovary syndrome （PCOS）, endometriosis, male infertility, and unexplained infertility. The main outcome was the live birth rate. Two groups were set up based on the intervention： group A was given a GnRH agonist with exogenous estrogen and progesterone, and group B （control group） was given exogenous estrogen and progesterone only. The results showed that the baseline serum hormone levels and basic characteristics of the patients were not significantly different between groups A and B. The live birth rates in groups A and B were 41.67% and 29.29%, respectively （P〈0.05）. The live birth rates in patients with PCOS in groups A and B were 56.25% and 30.61%, respectively （P〈0.05）. The clinical pregnancy, implantation and on-going pregnancy rates showed the same trends as the live birth rates between groups A and B. The ectopic pregnancy rate was significantly lower in group A than in group B. We concluded that the live birth rate was higher and other clinical outcomes were more satisfactory with GnRH agonist co- treatment than without GnRH agonist co-treatment for frozen-thawed embryo transfer. The GnRH agonist combined with exogenous estrogen and progesterone worked for all types of infertility tested, especially for women with PCOS.
基金supported in part by grants from the National Natural Science Foundation of China(No.81270749 and No.81470064)the Natural Science Foundation of Shanghai,China(No.15411953000,No.15411964500 and No.14ZR1423900)
文摘Objective To explore the different endometrial preparation for frozen-thawed embryo transfer （FET） in women with advanced endometriosis （EMS）. Methods The pregnancy outcomes of patients with advanced EMS （542 cycles）, who were prepared for FET, were retrospectively assessed. Included patients underwent a total of 233 FET cycles （180 patients） using natural cycle （NC）, a total of 142 FET cycles （115 patients） using letrozole （LE） ovulation induction, and a total of 167 FET cycles （137 patients） using hormonal replacement treatment （HRT） for endometrial preparation.Results There were no significant diffenences in the clinical pregnancy rate （LE： 49.30%, NC： 50.21%, and HRT： 43.11~/o, P=0.343）, the implantation rate （LE： 29.26%, NC： 36.03%, and HRT： 29.55%, P=0.084）, and the live birth rate （LE： 38.02%, NC： 39.11%, and HR T.＂ 35.33 %, P=O. 648） among the three groups. No statistically signifi- cant differences were observed in the ongoing pregnancy rate, the miscarriage rate, and the pregnancy complication rate. The single birth weight in patients using NC- FET was lower than that in patients using HRT-FET （P=0.044） and a higher twin birth weight in patients using LE-FET were observed compared with other groups （P=O. 022）. The rate of birth weight 〈2 500 g was also higher in the NC-FET group than in other groups. No congenital birth defects were found in the three groups. Conclusion Different endometrial preparation protocols without ultra-long GnRH-a down-regulation for FET yield similar pregnancy outcomes in patients with EMS. A tailored endometrial preparation protocol should be recommended according to different patients＇ situation.
文摘BACKGROUND Heterotopic pregnancy(HP)refers to the coexistence of ectopic pregnancy and intrauterine pregnancy.Salpingectomy is proposed as a pretreatment before in vitro fertilization and embryo transfer(IVF-ET)to reduce the risk of HP.HP after IVF-ET occurs in women who had already underwent bilateral salpingectomy,even though it is extremely rare.CASE SUMMARY A case of a 29-year-old woman with recurrent interstitial HP after IVF-ET following salpingectomy is presented.The main symptom was a sudden and worsening pelvic pain.Physical examinations revealed signs of peritoneal bleeding and irritation with stable vital signs.Transvaginal ultrasound showed a live intrauterine pregnancy and another live embryo with cardiac activity in the left cornu extending beyond the lateral edge of the uterus.Her hemoglobin concentration was 8.0 g/dL,and serum human chorionic gonadotropin value was 171116.9 mIU/mL.With the diagnosis of ruptured HP with internal bleeding,an emergency laparoscopic resection of left cornu was performed.The interstitial pregnancy was removed with caution to protect the intrauterine pregnancy.After the surgical treatment,the intrauterine pregnancy continued with no complications.A healthy baby was delivered by caesarean section at 39 wk.Outcomes of another three cases are further summarized.CONCLUSION Post-salpingectomy HP is a rare but challenging condition.Surgical treatment is preferred in the case with a viable intrauterine pregnancy.
基金This study was funded by Spanish Ministry of Economy and Competitiveness(MINECO)and European Regional Development Fund(FEDER)grant AGL2015–66341-R and Fundación Seneca,Agencia de Ciencia y Tecnología de la Region de Murcia grant 20040/GERM/16.EPO received funding from“Ayudas para estancias en el extranjero de jóvenes investigadores y estudiantes de doctorado en las líneas de actuación de Campus Mare Nostrum”,R-47/2018,to a doctoral stay at the Babraham Institute(Cambridge,U.K.).
文摘Background:In vitro embryo production(IVP)and embryo transfer(ET)are two very common assisted reproductive technologies(ART)in human and cattle.However,in pig,the combination of either procedures,or even their use separately,is still considered suboptimal due to the low efficiency of IVP plus the difficulty of performing ET in the long and contorted uterus of the sow.In addition,the potential impact of these two ART on the health of the offspring is unknown.We investigated here if the use of a modified IVP system,with natural reproductive fluids(RF)as supplements to the culture media,combined with a minimally invasive surgery to perform ET,affects the output of the own IVP system as well as the reproductive performance of the mother and placental molecular traits.Results:The blastocyst rates obtained by both in vitro systems,conventional(C-IVP)and modified(RF-IVP),were similar.Pregnancy and farrowing rates were also similar.However,when compared to in vivo control(artificial insemination,AI),litter sizes of both IVP groups were lower,while placental efficiency was higher in AI than in RF-IVP.Gene expression studies revealed aberrant expression levels for PEG3 and LUM in placental tissue for C-IVP group when compared to AI,but not for RF-IVP group.Conclusions:The use of reproductive fluids as additives for the culture media in pig IVP does not improve reproductive performance of recipient mothers but could mitigate the impact of artificial procedures in the offspring.
基金Supported by the Key Project of Sichuan Department of Science and Technology:the Evaluation of the Curative Effect of Traditional Chinese Medicine Joint Treatment Intervene in In Vitro Fertilization(No.2012SZ0086)the Program Science and Technology Bureau in Chengdu:the Research of the Curative Effect of TCM intervene in In Vitro Fertilization(No.11DXYB286)
文摘OBJECTIVE: To evaluate the curative effect of Traditional Chinese Medicine(TCM) multi-channel interventional therapy on women with Assisted Reproductive Technology(ART) failure, to compare the curative effect of the dual therapy and triple therapy on women with ART Failure, and to choose the best TCM interventional therapeutic plan.METHODS: The 95 cases with ART Failure from West China second University Hospital of Sichuan University meeting the inclusion criteria were randomly divided into three groups:dual therapy group(31 cases), triple therapy group(33 cases)and control group(31 cases). According to the intervene treatment of in vitro Fertilization and Embryo Transfer(IVF-ET) long cycle scheme, the control group wait naturally for 3 months before IVFET. The dual therapy group take TCM prescriptionⅡ of cultivating emotion and assisting reproduction and auricular acupoint therapy for 3 months before IVF-ET, then Western Medicine treatment progestin supporting as well as auricular application and Antai Recipe after IVF-ET transplantation.The triple therapy group take TCM prescription Ⅱof cultivated emotion and assisted reproduction,auricular acupoint therapy and retention enema of TCM, and combination treatment the same as dual therapy group after transplantation. The natural pregnancy number, the period condition of secondary IVF-ET and the improvement of the kidney deficiency, liver depression and blood stasis syndrome among those three groups were compared.RESULTS: It was showed from analysis in 95 cases with ART failure that the number of natural preg-nancy was as followings: 3 patients from the dual therapy group, 10 patients from the triple therapy group, and no patient from the control group. The comparison among three groups have statistical significance(P < 0.05). The treatment group is superior to the control group, while the triple therapy is superior to the dual therapy. The comparison of the condition of the fertility rate, clinical pregnancy rate, biochemical pregnancy rate and early abortion rate during the period of secondary IVF-ET between pre-therapy and post-treatment of both the dual therapy group and the triple therapy group have statistical significance(P < 0.05). The comparison of the improvement of the kidney deficiency,liver depression and blood stasis syndrome between pre-therapy and post-treatment of both the dual therapy group and the triple therapy group have statistical significance(P < 0.05). The comparison between three groups after treatment have statistical significance(P < 0.05).CONCLUSION: TCM multi-channel interventional therapy can increase the natural pregnancy rate of patients with ART Failure(the triple therapy is superior to the dual therapy); it can increase the fertility rate, clinical pregnancy rate, and decrease the early abortion rate during the period of secondary IVF-ET; it can improve syndromes of kidney deficiency, liver depression and blood stasis.
基金Supported by the National Natural Science Foundation of China(No.81173294)
文摘OBJECTIVE:To investigate the effect of Soothing liver therapy on infertile women undergoing in vitro fertilization and embryo transfer(IVF-ET)and to explore its mechanism.METHODS:Fifty-eight women with tubal infertility were randomized into two groups:30 in an experimental group treated with Xiaoyao powder(Shugan)plus gonadotropin-releasing hormone analog(GnRHa)/follicle-stimulating hormone(FSH)/human chorionic gonadotropin(hCG)and 28 in the control group who were treated with GnRHa/FSH/hCG only.The total gonadotropin(Gn)doses required,endometrial thickness,oocyte numbers,high quality embryo production rate and pregnancy rate of the two groups were compared.The concentration of growth differentiation factor-9(GDF-9)in follicular fluid was detected by western blotting and the expression of GDF-9 mRNA in granulosa cells was measured using reverse tran-scription-polymerase chain reaction amplification.RESULTS:In the experimental group,the Gn dose was significantly lower than that in the control group;the endometrial thickness,high quality embryo production and pregnancy rates were significantly higher and the expression of GDF-9 mRNA was also significantly higher than in the control group(all P<0.05).CONCLUSION:Shugan treatment can improve the pregnancy rate of women with tubal infertility;its mechanism is possibly related to the increased expression of GDF-9 in granulosa cells.
基金This research was funded by the Basic Science Research Program of Nantong(JC2019017)to XW.
文摘Damage to sperm DNA was proposed to play an important role in embryonic development.Previous studies focused on outcomes after fresh embryo transfer,whereas this study investigated the influence of sperm DNA fragmentation index(DFI)on laboratory and clinical outcomes after frozen embryo transfer(FET).This retrospective study examined 381 couples using cleavage-stage FET.Sperm used for intracytoplasmic sperm injection(ICSI)or in vitro fertilization(IVF)underwent density gradient centrifugation and swim up processing.Sperm DFI had a negative correlation with sperm motility(r=−0.640,P<0.01),sperm concentration(r=−0.289,P<0.01),and fertilization rate of IVF cycles(r=−0.247,P<0.01).Sperm DFI examined before and after density gradient centrifugation/swim up processing was markedly decreased after processing(17.1%vs 2.4%,P<0.01;65 randomly picked couples).Sperm progressive motility was significantly reduced in high DFI group compared with low DFI group for both IVF and ICSI(IVF:46.9%±12.4%vs 38.5%±12.6%,respectively;ICSI:37.6%±14.1%vs 22.3%±17.8%,respectively;both P<0.01).The fertilization rate was significantly lower in high(≥25%)DFI group compared with low(<25%)DFI group using IVF(73.3%±23.9%vs 53.2%±33.6%,respectively;P<0.01)but was equivalent in high and low DFI groups using ICSI.Embryonic development and clinical outcomes after FET were equivalent for low and high DFI groups using ICSI or IVF.In this study,sperm DFI did not provide sufficient information regarding embryo development or clinical outcomes for infertile couples using FET.
基金supported by National Natural Science Foundation of China (No. 31071275, No. 81270749 and No. 31101070)
文摘Objective To compare the results of a novel regimen of human menopausal gonadotrophin （hMG） in combination with clomiphene citrate （CC） in mid-to-late follicular phase with those of a short protocol of GnRH agonist （GnRHa） and hMG used for IVF. Methods In the retrospective study, 842 patients undergoing IVF were collected and classified into two groups： hMG in combination with CC in mid-to-late follicular phase （group A, n=319） and short protocol of GnRHa-hMG （group B, n=523）. The main outcome measures were ovarian responses in stimulation cycles and pregnancy outcomes in subsequent frozen-thawed embryo transfer （FET） cycles. Results In group A, the serum LH concentration on day 8 -10 was similar with that on the day of hCG administration （2.43 ± 1.92 IU vs 2.51 ±2.05 IU）. The number of mature follicles and oocytes retrieved was significantly lower in group A than in group B while the fertilization rate and the cleavage rate were comparable. The clinical pregnancy rate （47. 79% vs 48.04%）, the implantation rate （32.49% vs 33.11%） and the cumulative pregnancy rate （58.09% vs 60.22%） were respectively similar in group A and group B. Conclusion hMG in combination with CC in mid-to-late follicular phase results in the same pregnancy outcome as short protocol. The novel protocol may take the advantage of eliminating the occurrehce of a premature endogenous LH Surge.
基金the National Natural Science Fund Project:A Theoretical Study of Renal Reproduction Based on in vitro Fertilization Follicular Fluid Differential Protein-metabolite Global Regulatory Network(No.81874484)。
文摘OBJECTIVE:To investigate the effect of—Xiaoyi Yusi decoction(XYYSD,消异育嗣汤),a Traditional Chinese Medicine(TCM),on in vitro fertilization and embryo transfer(IVF-ET)in patients with endometriosis,and to study the mechanism underpinning the action.METHODS:Women who underwent IVF-ET were divided into three groups by simple randomization:the treatment(n=32;with TCM treatment),patient(n=28;with endometriosis alone),and control(n=33;with male factor alone)groups.The luteal phase short-acting gonadotropin-releasing hormone agonist prolonged protocol was used in all three groups.To compare the changes in TCM scores and reproductive outcomes before and after TCM intervention in patients with endometriosis,partial least-squares discriminant analysis was used to analyze the follicular fluid samples of each group and screen and compare metabolites using the MetaboA nalyst software.RESULTS:The clinical data indicated that following TCM intervention,kidney deficiency and blood stasis symptom patterns improved dramatically in patients with endometriosis and that their clinical pregnancy rate increased significantly(71.9%vs 57.1%,P<0.05).Metabolomics showed that the two groups of samples were separated before and after TCM intervention.After TCM intervention,the intervention group was close to the control group,indicating that the TCM had a certain effect.Pathway analysis revealed that after TCM intervention,the metabolism of glycerin phospholipid,pyruvate,and citric acid was regulated.CONCLUSIONS:Through the pyruvate and glycerophospholipid metabolism pathways and tricarboxylic acid cycle,the TCM XYYSD successfully improved kidney deficiency and blood stasis symptom pattern,as well as the clinical reproductive outcomes of patients with endometriosis-related infertility.
