Cesarean scar pregnancy(CSP)is a rare form of ectopic pregnancy that is defined as a pregnancy sac located within the scar of a previous cesarean section.Recurrent cesarean scar pregnancy(RCSP)is even more uncommon,1 ...Cesarean scar pregnancy(CSP)is a rare form of ectopic pregnancy that is defined as a pregnancy sac located within the scar of a previous cesarean section.Recurrent cesarean scar pregnancy(RCSP)is even more uncommon,1 with Hasegawa et al reporting the first RCSP in 2005.2 RCSP is a high-risk pregnancy condition with potential complications that include heavy bleeding,uterine rupture,and maternal shock.The exact incidence rates for CSP and RCSP are unknown,although the incidence of CSP is 1/2656–1/1800 of the total number of cesarean sections,and the incidence of RCSP can reach 6.9%–34.3%.3,4,5 With the promulgation of the second and third child policies in China,an increasing number of patients now manifest fertility needs after cesarean section.With improvements in examination methods and awareness of CSP,we also suspect that the rates of CSP and RCSP may be even higher.Unfortunately,there is no standard treatment for CSP.We herein report a case in which the patient was treated by combined hysteroscopic and laparoscopic uterine repair without scar resection during the third RCSP,and the fourth RCSP occurred 6 months later;the patient then selected expectant management.The outcome was a successful cesarean section delivery of a live baby at 34 weeks of gestation,and the uterus was successfully preserved.Placental pathology was examined after delivery and revealed that the chorionic villi penetrated deeply into the myometrium.展开更多
Objective： The present study was designed to use an in vivo rabbit ear scar model to investigate the efficacy of systemic administration of endostatin in inhibiting scar formation. Methods： Eight male New Zealand wh...Objective： The present study was designed to use an in vivo rabbit ear scar model to investigate the efficacy of systemic administration of endostatin in inhibiting scar formation. Methods： Eight male New Zealand white rabbits were randomly assigned to two groups. Scar model was established by making six full skin defect wounds in each ear. For the intervention group, intraperitoneal injection of endostatin was performed each day after the wound healed （about 15 d post wounding）. For the control group, equal volume of saline was injected. Thickness of scars in each group was measured by sliding caliper and the scar microcirculatory perfusion was assessed by laser Doppler flowmetry on Days 15, 21, 28, and 35 post wounding. Rabbits were euthanatized and their scars were harvested for histological and proteomic analyses on Day 35 post wounding. Results： Macroscopically, scars of the control group were thicker than those of the intervention group. Significant differences between the two groups were observed on Days 21 and 35 （p〈0.05）. Scar thickness, measured by scar elevation index （SEI） at Day 35 post wounding, was significantly reduced in the intervention group （1.09±0.19） compared with the controls （1.36±0.28）. Microvessel density （MVD） observed in the intervention group （1.73±0.94） was significantly lower than that of the control group （5.63±1.78） on Day 35. The distribution of collagen fibers in scars treated with endostatin was relatively regular, while collagen fibers in untreated controls were thicker and showed disordered alignment. Western blot analysis showed that the expressions of type I collagen and Bcl-2 were depressed by injection of endostatin. Conclusions： Our results from the rabbit ear hypertrophic scar model indicate that systemic application of endostatin could inhibit local hypertrophic scar formation, possibly through reducing scar vascularization and angiogenesis. Our results indicated that endostatin may promote the apoptosis of endothelial cells and block their release of platelet-dedved growth factor （PDGF） and fibroblast growth factor （FGF）, thereby controlling collagen production by fibroblasts. Blood vessel-targeted treatment may be a promising strategy for scar therapy.展开更多
Male factor infertility affects 30%-50% of infertile couples worldwide, and there is an increasing interest in the optimal management of these patients. In studies comparing double and single intrauterine insemination...Male factor infertility affects 30%-50% of infertile couples worldwide, and there is an increasing interest in the optimal management of these patients. In studies comparing double and single intrauterine insemination （IUI）, a trend towards higher pregnancy rates in couples with male factor infertility was observed. Therefore, we set out to perform a meta-analysis to examine the superiority of double versus single IUI with the male partner＇s sperm in couples with male factor infertility. An odds ratio （OR） of 95% confidence intervals （CIs） was calculated for the pregnancy rate. Outcomes were analysed by using the ManteI-Haesel or DerSimonian-Laird model accordingto the heterogeneity of the results. Overall, five trials involving 1125 IUI cycles were included in the meta-analysis. There was a two-fold increase in pregnancies after a cycle with a double IUI compared with a cycle with a single IUI （OR. 2.0; 95% CI. 1.07-3.75; P〈O.03）. Nevertheless, this result was mainly attributed to the presence of a large trial that weighted as almost 50% in the overall analysis. Sensitivity analysis, excluding this large trial, revealed only a trend towards higher pregnancy rates among double IUI cycles （OR. 1.58; 95% CI. 0.59-4.21）, but without statistical significance （P=0.20）. Our systematic review highlights that the available evidence regarding the use of double IUI in couples with male factor infertility is fragmentary and weak. Although there may be a trend towards higher pregnancy rates when the number of IUIs per cycle is increased, further large and well-designed randomized trials are needed to provide solid evidence toide current clinical practice.展开更多
AMP-activated kinase （AMPK）, a protein that regulates energy balance and metabolism, has recently been identified in boar spermatozoa where regulates key functional sperm processes essential for fertilization. This ...AMP-activated kinase （AMPK）, a protein that regulates energy balance and metabolism, has recently been identified in boar spermatozoa where regulates key functional sperm processes essential for fertilization. This work＇s aims are AMPK identification, intracellular localization, and their role in human spermatozoa function. Semen was obtained from healthy human donors. Sperm AMPK and phospho-Thr172-AMPK were analyzed by Western blotting and indirect immunofluorescence. High- and low-quality sperm populations were separated by a 40%-80% density gradient. Human spermatozoa motility was evaluated by an Integrated Semen Analysis System （ISAS） in the presence or absence of the AMPK inhibitor compound C （CC）. AMPK is localized along the human spermatozoa, at the entire acrosome, midpiece and tail with variable intensity, whereas its active form, phospho-Thr172-AMPK, shows a prominent staining at the acrosome and sperm tail with a weaker staining in the midpiece and the postacrosomal region. Interestingly, spermatozoa bearing an excess residual cytoplasm show strong AMPK staining in this subcellular compartment. Both AMPK and phospho-Thr172-AMPK human spermatozoa contents exhibit important individual variations. Moreover, active AMPK is predominant in the high motility sperm population, where shows a stronger intensity compared with the low motility sperm population. Inhibition of AMPK activity in human spermatozoa by CC treatment leads to a significant reduction in any sperm motility parameter analyzed： percent of motile sperm, sperm velocities, progressivity, and other motility coefficients. This work identifies and points out AMPK as a new molecular mechanism involved in human spermatozoa motility. Further AMPK implications in the clinical efficiency of assisted reproduction and in other reproductive areas need to be studied.展开更多
Cryopreservation impairs sperm quality and functions,including motility and DNA integrity.Antioxidant additives in sperm freezing media have previously brought improvements in postthawed sperm quality.Green tea extrac...Cryopreservation impairs sperm quality and functions,including motility and DNA integrity.Antioxidant additives in sperm freezing media have previously brought improvements in postthawed sperm quality.Green tea extract(GTE)is widely considered as an excellent antioxidant,and its beneficial role has been proven in other human cells.This study aims to evaluate the GTE as a potential additive in cryopreservation media of human spermatozoa.In part one,the semen of 20 normozoospermic men was used to optimize the concentration of GTE that maintains sperm motility and DNA integrity against oxidative stress,induced by hydrogen peroxide(H_(2)O_(2)).Spermatozoa were treated with GTE at different concentrations before incubation with H_(2)O_(2).In part two,the semen of 45 patients was cryopreserved with or without 1.0 ng ml^(-1)GTE.After 2 weeks,the semen was thawed,and the effect on sperm motility and DNA fragmentation was observed.Our data showed that GTE significantly protected sperm motility and DNA integrity against oxidative stress induced by H_(2)O_(2)when added at a final concentration of 1.0 ng ml^(-1).We found that the addition of 1.0 ng ml^(-1)GTE to cryopreservation media significantly increased sperm motility and DNA integrity(both P<0.05).More interestingly,patients with high sperm DNA damage benefited similarly from the GTE supplementation.However,there was no significant change in the reactive oxygen species(ROS)level.In conclusion,supplementing sperm freezing media with GTE has a significant protective effect on human sperm motility and DNA integrity,which may be of clinical interest.展开更多
Uterine fibroids are the most common benign tumours in the reproductive system. They are proliferations of smooth muscle cells of the myometrium containing a large quantity of extracellular matrix and they are surroun...Uterine fibroids are the most common benign tumours in the reproductive system. They are proliferations of smooth muscle cells of the myometrium containing a large quantity of extracellular matrix and they are surrounded by a pseudo capsule of compressed areolar tissue and smooth muscle cells. They can cause various symptoms such as menorrhage, pain and infertility and therefore they can be a traumatic experience for several women. The treatment of choice is myomectomy. In the past, myomectomy was performed by relatively atraumatic techniques, which involved stretching the myoma from its pseudocapsule to extract the fibroid directly from the surrounding fibromuscular tissue, breaking up the fibrous bridge. Modern laparoscopic intracapsular myomectomy (LIM), however, leaves the fibrovascular network surrounding the myoma (namely the “fibroid neurovascular bundle”) intact which reduces the bleeding and/or uterine musculature trauma, and spares the neuropeptide fibers of the pseudocapsule. In this observational study, we compare the two techniques-laparoscopic intracapsular myomectomy (LIM) and conventional abdominal myomectomy (CAM) regarding the longterm uterine healing and a significantly faster healing process of the uterine incision was achieved by LIM compared to CAM.展开更多
Chronic cornual ectopic pregnancy is rare.A 37-year-old woman,G1P0,presented with cornual mass,mild vaginal bleeding,and low serum human chorionic gonadotropin.Cornuostomy and cornual repair were performed by laparosc...Chronic cornual ectopic pregnancy is rare.A 37-year-old woman,G1P0,presented with cornual mass,mild vaginal bleeding,and low serum human chorionic gonadotropin.Cornuostomy and cornual repair were performed by laparoscopy.With atypical symptoms,chronic cornual ectopic pregnancy is a challenge for the gynecologists to make accurate diagnosis and effective treatment.展开更多
Objective:The incidence of interstitial pregnancy(IP)has increased by using assisted reproductive technology,especially after ipsilateral salpingectomy.This review aimed to examine the current state of prevention,risk...Objective:The incidence of interstitial pregnancy(IP)has increased by using assisted reproductive technology,especially after ipsilateral salpingectomy.This review aimed to examine the current state of prevention,risk factors,diagnosis,and management of IP,based on the current literature.Data sources:We searched PubMed for English language articles published up to June 2018.The search terms included interstitial pregnancy,ectopic pregnancy or cornual pregnancy,angular pregnancy,and combinations of these terms.Study selection:Articles were obtained and reviewed to analyze risk factors,diagnosis,prevention,and management of IP.Results:Ipsilateral salpingectomy is the main high-risk factor of IP,especially after in vitro fertilization.Cornual suture at the time of salpingectomy helps to reduce the IP rate.Laparoscopic cornuostomy appears to be an effective treatment in intact cases,although it sometimes needs to be combined with methotrexate therapy in ruptured cases complicated by persistent disease.展开更多
Objective:This study aims to evaluate the surgical morbidity and obstetric outcomes following in-pregnancy or pre-pregnancy laparoscopic abdominal cerclage(LAC)for patients who were diagnosed with refractory cervical ...Objective:This study aims to evaluate the surgical morbidity and obstetric outcomes following in-pregnancy or pre-pregnancy laparoscopic abdominal cerclage(LAC)for patients who were diagnosed with refractory cervical insufficiency or had a short cervix.Methods:A retrospective study was conducted on patients undergoing LAC between May 2017 and May 2019 at the Department of Obstetrics and Gynecology,Sir Run Run Shaw Hospital.The patients were diagnosed with refractory cervical insufficiency based upon a previous failed transvaginal cervical cerclage(TVC),or had a short cervix who were considered unsuitable for a TVC after a previous cervical procedure.All patients were followed-up after surgery with transperineal ultrasonography until May 2020.Subsequently,surgical and obstetric data were collected and analyzed.Results:In total,44 patients underwent LAC,with 8 patients in-pregnancy and 36 pre-pregnancy.For the patient with pre-pregancy LAC,the pregnancy rate was 80.6%(29/36),including 3 patients with first-trimester loss,1 patient with an ectopic pregnancy,and 25 patients with a delivery.For the remaining 7 patients,3 did not conceive,and another 4 had no pregnancy plans.All the patients with in-pregnancy LAC had a delivery.The“take-home baby”rate was 89.2%(33/37),with a live-birth rate of 100%and a neonatal survival rate of 100%for both patients with in-pregnancy and pre-pregnancy LAC.For patients with in-pregnancy LAC,75.0%(6/8)patients delivered at≥37 wk of gestation,12.5%(1/8)delivered between 34 and 36^(+6)wk,and 12.5%(1/8)delivered between 28 and 33^(+6)wk.For patients with pre-pregnancy LAC,80.0%(20/25)patients delivered at≥37 wk of gestation,16.0%(4/25)delivered between 34 and 36^(+6)wk,and 4.0%(1/25)delivered between 28 and 33^(+6)wk.No adverse-event intra-operative or post-operative sequelae were noted.Conclusions:LAC is an effective and safe procedure that results in remarkable obstetric outcomes for women with refractory cervical insufficiency,or with a short cervix who are considered unsuitable for a TVC.The success rate of in-pregnancy or pre-pregnancy LAC depends on a full evaluation of patients,a proper peri-operative management and close follow-up.展开更多
Objective To describe two clinical cases involving patients who were administered 800 IU of hCG to trigger oocyte maturation and who underwent a frozen-thawed embryo transfer （FET） cycle. Methods Two infertile patie...Objective To describe two clinical cases involving patients who were administered 800 IU of hCG to trigger oocyte maturation and who underwent a frozen-thawed embryo transfer （FET） cycle. Methods Two infertile patients with high ovarian response undergoing stimulation for IVF,, in which 800 IU of hCG was injected by mistake. IVF patients treated under a short protocol with 800 IU of hCG triggering ovulation. Live birth, clinical pregnancy outcomes and ovarian hyperstimulation syndrome （OHSS） were observed. Results Neither cycle of the two patients was canceled for oocyte retrieval failure and no OHSS was observed. Both patients gave birth to live twins after FET. Conclusion Triggering oocyte maturation in two hyper-responders by employing 800 IU of hCG could produce a good quantity of good-quality oocytes and an excellent clinical pregnancy and retain the opportunity for conception and live birth. Broader studies are needed.展开更多
Rudimentary horn of the uterus is a rare congenital malformation that is characterized by significant anatomic variability.We report two cases involving women who presented with a broadly attached rudimentary horn and...Rudimentary horn of the uterus is a rare congenital malformation that is characterized by significant anatomic variability.We report two cases involving women who presented with a broadly attached rudimentary horn and large ovarian endometriomas that were innovatively treated by laparoscopic coring-type dissection of the rudimentary horn of the uterus.This novel surgical approach ensured the integrity of the myometrium of the unicornuate uterus and avoided uterine rupture during pregnancy and ipsilateral ovarian function impairment.展开更多
There are few reports of the successful delivery of unicornuate uterus pregnancy after laparoscopic cervical cerclage.Here,we report a 32-year-old woman,gravida 2 para 1,who had been admitted for unicornuate uterus pr...There are few reports of the successful delivery of unicornuate uterus pregnancy after laparoscopic cervical cerclage.Here,we report a 32-year-old woman,gravida 2 para 1,who had been admitted for unicornuate uterus pregnancy by a thawed frozen blastocyst transplantation.She accepted laparoscopic cervical cerclage for cervical insufficiency and delivered successfully via caesarean section at 35^(+3) weeks.Cervical cerclage may be used as an effective method of preventing abortion in unicornuate uterus pregnancy,while surgery by laparoscopy would be a better choice for patients with poor cervical condition.Obstetricians should pay due attention to complications such as uterine rupture for these highrisk patients.展开更多
A more detailed blastocyst grading system provides a better selection of blastocysts with the highest implantation potential. Grading systems will help to decrease the number of blastocysts to be transferred without c...A more detailed blastocyst grading system provides a better selection of blastocysts with the highest implantation potential. Grading systems will help to decrease the number of blastocysts to be transferred without compromising high implantation and pregnancy rates.展开更多
Objective:To evaluate cervical function and pregnancy outcomes after hysteroscopic resection of the complete uterine septum,duplicate cervix and vaginal septum with Metzenbaum scissors.Methods:Between January 2010 and...Objective:To evaluate cervical function and pregnancy outcomes after hysteroscopic resection of the complete uterine septum,duplicate cervix and vaginal septum with Metzenbaum scissors.Methods:Between January 2010 and December 2016,13 patients admitted to the Department of Obstetrics and Gynecology of Sir Run Run Shaw Hospital with complete uterine septum,duplicate cervix and vaginal septum,were enrolled into this study.The cervical and corporal septum was cut by Metzenbaum scissors,and residual septum was cut by micro scissors under hysteroscopy.The vaginal septum was cut with the unipolar electric knife.Results:The operation time was about 10±1.31 min.All the 13 patients present normal uterine cavities without scar formation under hysteroscopy at 3 months after operation,there was mild adhesions between anterior and posterior intrauterine wall on 2 cases.After operation,there were 13 pregnancies naturally conceived in 11 patients,10 deliveries.The live birth rate was 76.92%,the early miscarriage rate was 23.08%.The cesarean section ratewas 30%,the vaginal delivery ratewas 70%,and all were term births.Conclusion:The operation was simple,convenient,and fast,without any complications and cervical insufficiency.It was easy to have vaginal deliveries.展开更多
Objective:To retrospectively estimate the impact of modified laparoscopic salpingectomy on the ovarian reserve in infertile women.Methods:There were 74 infertile women undergone modified laparoscopic salpingectomy fro...Objective:To retrospectively estimate the impact of modified laparoscopic salpingectomy on the ovarian reserve in infertile women.Methods:There were 74 infertile women undergone modified laparoscopic salpingectomy from June 2016 to January 2017,and their levels of serum antimüllerian hormone,basal follicle-stimulating hormone and estradiol were reviewed retrospectively.Results:No significant change was detected in serum antimüllerian hormone at 3 months after surgery compared to preoperative level(p=0.857).Similar changes were observed for the basal follicle-stimulating hormone(p=0.102)and estradiol(p=0.233)level.Conclusions:Our results revealed that modified laparoscopic salpingectomy might be a valuable treatment for hydrosalpinx before in vitro fertilization.展开更多
DHX36 plays a crucial role in regulating transcriptional and post-transcriptional processes through its interaction with G-quadruplexes(G4s).The mechanisms by which DHX36 regulates G4s vary across different cell types...DHX36 plays a crucial role in regulating transcriptional and post-transcriptional processes through its interaction with G-quadruplexes(G4s).The mechanisms by which DHX36 regulates G4s vary across different cell types and physiological conditions.Oocyte-specific conditional knockout(CKO)mice were utilized to study the impact of DHX36 deficiency on female fertility.The results show that the CKO mice exhibit severely impaired hormone response,ovulation,and complete infertility.The CKO germinal vesicle(GV)oocytes display large nucleoli,aberrant chromatin configuration,decreased chromatin accessibility,disturbed transcriptome,and inhibited meiosis progression.Following fertilization,the embryos derived from the CKO oocytes arrest at the zygote or 2-cell stage.Notably,we observed inadequate rRNA transcription in growing GV oocytes,as well as insufficient pre-rRNA processing and translation activity in fully-grown GV oocytes.Using a G4 probe and antibody,we found increased G4s formation at the chromatin and cytoplasm of CKO GV oocytes;these G4s mainly originate from the rDNA and pre-rRNA.Furthermore,the distribution of DHX36 was found to be spatiotemporally synchronized with that of pre-rRNA and G4s in early mouse embryos.In vitro experiments confirmed that DHX36 directly binds with pre-rRNA through the RHAU-specific motif(RSM).Overexpression of DHX36 could partially alleviate the pre-rRNA accumulation in fully-grown CKO oocytes.In conclusion,this study highlights the physiological significance of DHX36 in maintaining female fertility,underscoring its critical role in rRNA homeostasis and chromatin configuration through G4-unwinding mechanism in mouse oocytes.展开更多
Background:Ectopic pregnancy(EP)is a common complication in women undergoing assisted reproductive treatment,but the underlying causes for this remain unclear.This study aimed to explore factors affecting the incidenc...Background:Ectopic pregnancy(EP)is a common complication in women undergoing assisted reproductive treatment,but the underlying causes for this remain unclear.This study aimed to explore factors affecting the incidence of EP in in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI).Methods:This was a retrospective study on the incidence of EP in IVF/ICSI cycles between January 1,2013 and December 31,2017.Patient age,infertility diagnosis(tubal factor or not),primary or secondary infertility,type of cycle(frozen-thawed or fresh),type of embryo(s)transferred(cleavage embryo or blastocyst),number of embryos transferred(one,two,or three),previous history of EP,and endometrial combined thickness were analyzed to explore their relationships with the incidence of EP.Based on clinical typing results,the patients were divided into an EP group or a non-EP group.Categorical variables were analyzed using Chi-squared test or Fisher exact test.Logistic regression analysis was performed to explore their associations with the incidence of EP.Results:The percentage of patients with primary infertility in EP group was significantly lower than that in non-EP group(31.3%vs.46.7%,χ^2=26.032,P<0.001).The percentage of patients with tubal infertility in EP group was also significantly higher than that in non-EP group(89.2%vs.63.6%,χ^2=77.410,P<0.001).The percentages of patients with transfer of cleavage-stage embryo or blastocyst(91.4%vs.84.4%,χ^2=10.132,P=0.001)and different endometrial combined thickness(ECT)(χ^2=18.373,P<0.001)differed significantly between EP and non-EP groups.For patients who had a previous history of one to four EPs,the percentage of patients undergoing transfer of a cleavage-stage embryo was significantly higher in EP group than that in non-EP group(92.2%vs.77.6%,χ^2=13.737,P<0.001).In multivariate logistic regression analysis,tubal infertility was strongly associated with EP(adjusted odds ratio:3.995,95%confidence interval:2.706-5.897,P<0.001).Conclusions:In IVF/ICSI cycles,transfer of a blastocyst-stage embryo,especially for patients with a previous history of EP,reduced the rate of EP.Tubal infertility was strongly associated with EP.展开更多
Conservative treatment with high doses of progestin is an alternative to standard hysterectomy for young patients with early-stage endometrial adenocarcinoma who desire to preserve their fertility. Here we report a pa...Conservative treatment with high doses of progestin is an alternative to standard hysterectomy for young patients with early-stage endometrial adenocarcinoma who desire to preserve their fertility. Here we report a patient with well-differentiated early-stage endometrial adenocarcinoma and poor fertility potential who failed to become pregnant in two in vitro fertilization-embryo transfer cycles and suffered a relapse after conservative treatment. This case illustrates that assessment of fertility potential is critical at the time of initial evaluation and conservative treatment planning for patients with endometrial adenocarcinoma.展开更多
Objective Female sterilization is a common contraceptive method,but with changing family dynamics,an increasing number of women seek to restore fertility after tubal sterilization.Current clinical practice lacks effec...Objective Female sterilization is a common contraceptive method,but with changing family dynamics,an increasing number of women seek to restore fertility after tubal sterilization.Current clinical practice lacks effective tools for predicting pregnancy rates in this population after tubal anastomosis.This study aims to develop and internally validate a novel nomogram for predicting the pregnancy rate in women with tubal ligation after tubal anastomosis.Methods We developed a prediction model based on a training dataset of 208 patients with tubal ligation after undergoing tubal anastomosis between January 2012 and August 2020 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.The follow-up period for all patients was one year postsurgery,during which pregnancy outcomes were recorded.The LASSO regression model was used to optimize feature selection for the pregnancy rate risk model.The performance of the nomogram was assessed for its calibration,discrimination,and clinical usefulness.Internal validation was assessed.Results Predictors included in the prediction nomogram were age,type of anastomosis,sterilization duration,time of conception,and anti-Mullerian hormone(AMH)levels.The model displayed good discrimination,with a C-index of 0.924(95%CI:0.876–0.971),and good calibration.A high C-index value of 0.879 was still reached in the interval validation.Decision curve analysis revealed that the pregnancy rate nomogram was clinically useful when intervention was selected at the pregnancy rate possibility threshold of 1%.Conclusion This novel pregnancy rate nomogram incorporating age,type of anastomosis,sterilization duration,time of conception,and AMH could be conveniently used to predict the pregnancy rate in women with tubal ligation after tubal anastomosis.展开更多
基金supported by the“Pioneer”and“Leading Goose”R&D Program of Zhejiang(2023C03033,2024C03200).
文摘Cesarean scar pregnancy(CSP)is a rare form of ectopic pregnancy that is defined as a pregnancy sac located within the scar of a previous cesarean section.Recurrent cesarean scar pregnancy(RCSP)is even more uncommon,1 with Hasegawa et al reporting the first RCSP in 2005.2 RCSP is a high-risk pregnancy condition with potential complications that include heavy bleeding,uterine rupture,and maternal shock.The exact incidence rates for CSP and RCSP are unknown,although the incidence of CSP is 1/2656–1/1800 of the total number of cesarean sections,and the incidence of RCSP can reach 6.9%–34.3%.3,4,5 With the promulgation of the second and third child policies in China,an increasing number of patients now manifest fertility needs after cesarean section.With improvements in examination methods and awareness of CSP,we also suspect that the rates of CSP and RCSP may be even higher.Unfortunately,there is no standard treatment for CSP.We herein report a case in which the patient was treated by combined hysteroscopic and laparoscopic uterine repair without scar resection during the third RCSP,and the fourth RCSP occurred 6 months later;the patient then selected expectant management.The outcome was a successful cesarean section delivery of a live baby at 34 weeks of gestation,and the uterus was successfully preserved.Placental pathology was examined after delivery and revealed that the chorionic villi penetrated deeply into the myometrium.
基金supported by the National Natural Science Foundation of China (No.81272120)the Health Department of the Zhejiang Province (No.2007B086),China
文摘Objective： The present study was designed to use an in vivo rabbit ear scar model to investigate the efficacy of systemic administration of endostatin in inhibiting scar formation. Methods： Eight male New Zealand white rabbits were randomly assigned to two groups. Scar model was established by making six full skin defect wounds in each ear. For the intervention group, intraperitoneal injection of endostatin was performed each day after the wound healed （about 15 d post wounding）. For the control group, equal volume of saline was injected. Thickness of scars in each group was measured by sliding caliper and the scar microcirculatory perfusion was assessed by laser Doppler flowmetry on Days 15, 21, 28, and 35 post wounding. Rabbits were euthanatized and their scars were harvested for histological and proteomic analyses on Day 35 post wounding. Results： Macroscopically, scars of the control group were thicker than those of the intervention group. Significant differences between the two groups were observed on Days 21 and 35 （p〈0.05）. Scar thickness, measured by scar elevation index （SEI） at Day 35 post wounding, was significantly reduced in the intervention group （1.09±0.19） compared with the controls （1.36±0.28）. Microvessel density （MVD） observed in the intervention group （1.73±0.94） was significantly lower than that of the control group （5.63±1.78） on Day 35. The distribution of collagen fibers in scars treated with endostatin was relatively regular, while collagen fibers in untreated controls were thicker and showed disordered alignment. Western blot analysis showed that the expressions of type I collagen and Bcl-2 were depressed by injection of endostatin. Conclusions： Our results from the rabbit ear hypertrophic scar model indicate that systemic application of endostatin could inhibit local hypertrophic scar formation, possibly through reducing scar vascularization and angiogenesis. Our results indicated that endostatin may promote the apoptosis of endothelial cells and block their release of platelet-dedved growth factor （PDGF） and fibroblast growth factor （FGF）, thereby controlling collagen production by fibroblasts. Blood vessel-targeted treatment may be a promising strategy for scar therapy.
文摘Male factor infertility affects 30%-50% of infertile couples worldwide, and there is an increasing interest in the optimal management of these patients. In studies comparing double and single intrauterine insemination （IUI）, a trend towards higher pregnancy rates in couples with male factor infertility was observed. Therefore, we set out to perform a meta-analysis to examine the superiority of double versus single IUI with the male partner＇s sperm in couples with male factor infertility. An odds ratio （OR） of 95% confidence intervals （CIs） was calculated for the pregnancy rate. Outcomes were analysed by using the ManteI-Haesel or DerSimonian-Laird model accordingto the heterogeneity of the results. Overall, five trials involving 1125 IUI cycles were included in the meta-analysis. There was a two-fold increase in pregnancies after a cycle with a double IUI compared with a cycle with a single IUI （OR. 2.0; 95% CI. 1.07-3.75; P〈O.03）. Nevertheless, this result was mainly attributed to the presence of a large trial that weighted as almost 50% in the overall analysis. Sensitivity analysis, excluding this large trial, revealed only a trend towards higher pregnancy rates among double IUI cycles （OR. 1.58; 95% CI. 0.59-4.21）, but without statistical significance （P=0.20）. Our systematic review highlights that the available evidence regarding the use of double IUI in couples with male factor infertility is fragmentary and weak. Although there may be a trend towards higher pregnancy rates when the number of IUIs per cycle is increased, further large and well-designed randomized trials are needed to provide solid evidence toide current clinical practice.
文摘AMP-activated kinase （AMPK）, a protein that regulates energy balance and metabolism, has recently been identified in boar spermatozoa where regulates key functional sperm processes essential for fertilization. This work＇s aims are AMPK identification, intracellular localization, and their role in human spermatozoa function. Semen was obtained from healthy human donors. Sperm AMPK and phospho-Thr172-AMPK were analyzed by Western blotting and indirect immunofluorescence. High- and low-quality sperm populations were separated by a 40%-80% density gradient. Human spermatozoa motility was evaluated by an Integrated Semen Analysis System （ISAS） in the presence or absence of the AMPK inhibitor compound C （CC）. AMPK is localized along the human spermatozoa, at the entire acrosome, midpiece and tail with variable intensity, whereas its active form, phospho-Thr172-AMPK, shows a prominent staining at the acrosome and sperm tail with a weaker staining in the midpiece and the postacrosomal region. Interestingly, spermatozoa bearing an excess residual cytoplasm show strong AMPK staining in this subcellular compartment. Both AMPK and phospho-Thr172-AMPK human spermatozoa contents exhibit important individual variations. Moreover, active AMPK is predominant in the high motility sperm population, where shows a stronger intensity compared with the low motility sperm population. Inhibition of AMPK activity in human spermatozoa by CC treatment leads to a significant reduction in any sperm motility parameter analyzed： percent of motile sperm, sperm velocities, progressivity, and other motility coefficients. This work identifies and points out AMPK as a new molecular mechanism involved in human spermatozoa motility. Further AMPK implications in the clinical efficiency of assisted reproduction and in other reproductive areas need to be studied.
基金The Chinese University of Hong Kong Direct Grant for their partial support for this research(grant No.4054351).
文摘Cryopreservation impairs sperm quality and functions,including motility and DNA integrity.Antioxidant additives in sperm freezing media have previously brought improvements in postthawed sperm quality.Green tea extract(GTE)is widely considered as an excellent antioxidant,and its beneficial role has been proven in other human cells.This study aims to evaluate the GTE as a potential additive in cryopreservation media of human spermatozoa.In part one,the semen of 20 normozoospermic men was used to optimize the concentration of GTE that maintains sperm motility and DNA integrity against oxidative stress,induced by hydrogen peroxide(H_(2)O_(2)).Spermatozoa were treated with GTE at different concentrations before incubation with H_(2)O_(2).In part two,the semen of 45 patients was cryopreserved with or without 1.0 ng ml^(-1)GTE.After 2 weeks,the semen was thawed,and the effect on sperm motility and DNA fragmentation was observed.Our data showed that GTE significantly protected sperm motility and DNA integrity against oxidative stress induced by H_(2)O_(2)when added at a final concentration of 1.0 ng ml^(-1).We found that the addition of 1.0 ng ml^(-1)GTE to cryopreservation media significantly increased sperm motility and DNA integrity(both P<0.05).More interestingly,patients with high sperm DNA damage benefited similarly from the GTE supplementation.However,there was no significant change in the reactive oxygen species(ROS)level.In conclusion,supplementing sperm freezing media with GTE has a significant protective effect on human sperm motility and DNA integrity,which may be of clinical interest.
文摘Uterine fibroids are the most common benign tumours in the reproductive system. They are proliferations of smooth muscle cells of the myometrium containing a large quantity of extracellular matrix and they are surrounded by a pseudo capsule of compressed areolar tissue and smooth muscle cells. They can cause various symptoms such as menorrhage, pain and infertility and therefore they can be a traumatic experience for several women. The treatment of choice is myomectomy. In the past, myomectomy was performed by relatively atraumatic techniques, which involved stretching the myoma from its pseudocapsule to extract the fibroid directly from the surrounding fibromuscular tissue, breaking up the fibrous bridge. Modern laparoscopic intracapsular myomectomy (LIM), however, leaves the fibrovascular network surrounding the myoma (namely the “fibroid neurovascular bundle”) intact which reduces the bleeding and/or uterine musculature trauma, and spares the neuropeptide fibers of the pseudocapsule. In this observational study, we compare the two techniques-laparoscopic intracapsular myomectomy (LIM) and conventional abdominal myomectomy (CAM) regarding the longterm uterine healing and a significantly faster healing process of the uterine incision was achieved by LIM compared to CAM.
基金This case report was supported by the Key Research and Development Program of Zhejiang Province(2017C03022).
文摘Chronic cornual ectopic pregnancy is rare.A 37-year-old woman,G1P0,presented with cornual mass,mild vaginal bleeding,and low serum human chorionic gonadotropin.Cornuostomy and cornual repair were performed by laparoscopy.With atypical symptoms,chronic cornual ectopic pregnancy is a challenge for the gynecologists to make accurate diagnosis and effective treatment.
基金This study was supported by the programs of Medical Science and Technology of Zhejiang Province,China(2018244125)Department of Education of Zhejiang Province,China(Y201534677).
文摘Objective:The incidence of interstitial pregnancy(IP)has increased by using assisted reproductive technology,especially after ipsilateral salpingectomy.This review aimed to examine the current state of prevention,risk factors,diagnosis,and management of IP,based on the current literature.Data sources:We searched PubMed for English language articles published up to June 2018.The search terms included interstitial pregnancy,ectopic pregnancy or cornual pregnancy,angular pregnancy,and combinations of these terms.Study selection:Articles were obtained and reviewed to analyze risk factors,diagnosis,prevention,and management of IP.Results:Ipsilateral salpingectomy is the main high-risk factor of IP,especially after in vitro fertilization.Cornual suture at the time of salpingectomy helps to reduce the IP rate.Laparoscopic cornuostomy appears to be an effective treatment in intact cases,although it sometimes needs to be combined with methotrexate therapy in ruptured cases complicated by persistent disease.
基金supported by the Natural Science Foundation of Zhejiang Province(LGF20H180013).
文摘Objective:This study aims to evaluate the surgical morbidity and obstetric outcomes following in-pregnancy or pre-pregnancy laparoscopic abdominal cerclage(LAC)for patients who were diagnosed with refractory cervical insufficiency or had a short cervix.Methods:A retrospective study was conducted on patients undergoing LAC between May 2017 and May 2019 at the Department of Obstetrics and Gynecology,Sir Run Run Shaw Hospital.The patients were diagnosed with refractory cervical insufficiency based upon a previous failed transvaginal cervical cerclage(TVC),or had a short cervix who were considered unsuitable for a TVC after a previous cervical procedure.All patients were followed-up after surgery with transperineal ultrasonography until May 2020.Subsequently,surgical and obstetric data were collected and analyzed.Results:In total,44 patients underwent LAC,with 8 patients in-pregnancy and 36 pre-pregnancy.For the patient with pre-pregancy LAC,the pregnancy rate was 80.6%(29/36),including 3 patients with first-trimester loss,1 patient with an ectopic pregnancy,and 25 patients with a delivery.For the remaining 7 patients,3 did not conceive,and another 4 had no pregnancy plans.All the patients with in-pregnancy LAC had a delivery.The“take-home baby”rate was 89.2%(33/37),with a live-birth rate of 100%and a neonatal survival rate of 100%for both patients with in-pregnancy and pre-pregnancy LAC.For patients with in-pregnancy LAC,75.0%(6/8)patients delivered at≥37 wk of gestation,12.5%(1/8)delivered between 34 and 36^(+6)wk,and 12.5%(1/8)delivered between 28 and 33^(+6)wk.For patients with pre-pregnancy LAC,80.0%(20/25)patients delivered at≥37 wk of gestation,16.0%(4/25)delivered between 34 and 36^(+6)wk,and 4.0%(1/25)delivered between 28 and 33^(+6)wk.No adverse-event intra-operative or post-operative sequelae were noted.Conclusions:LAC is an effective and safe procedure that results in remarkable obstetric outcomes for women with refractory cervical insufficiency,or with a short cervix who are considered unsuitable for a TVC.The success rate of in-pregnancy or pre-pregnancy LAC depends on a full evaluation of patients,a proper peri-operative management and close follow-up.
文摘Objective To describe two clinical cases involving patients who were administered 800 IU of hCG to trigger oocyte maturation and who underwent a frozen-thawed embryo transfer （FET） cycle. Methods Two infertile patients with high ovarian response undergoing stimulation for IVF,, in which 800 IU of hCG was injected by mistake. IVF patients treated under a short protocol with 800 IU of hCG triggering ovulation. Live birth, clinical pregnancy outcomes and ovarian hyperstimulation syndrome （OHSS） were observed. Results Neither cycle of the two patients was canceled for oocyte retrieval failure and no OHSS was observed. Both patients gave birth to live twins after FET. Conclusion Triggering oocyte maturation in two hyper-responders by employing 800 IU of hCG could produce a good quantity of good-quality oocytes and an excellent clinical pregnancy and retain the opportunity for conception and live birth. Broader studies are needed.
基金supported by the Medical Science and Technology Project Foundation of Zhejiang Province(2021KY741).
文摘Rudimentary horn of the uterus is a rare congenital malformation that is characterized by significant anatomic variability.We report two cases involving women who presented with a broadly attached rudimentary horn and large ovarian endometriomas that were innovatively treated by laparoscopic coring-type dissection of the rudimentary horn of the uterus.This novel surgical approach ensured the integrity of the myometrium of the unicornuate uterus and avoided uterine rupture during pregnancy and ipsilateral ovarian function impairment.
基金supported by the Key Research and Development Program of Zhejiang Province(LGF18H040005).
文摘There are few reports of the successful delivery of unicornuate uterus pregnancy after laparoscopic cervical cerclage.Here,we report a 32-year-old woman,gravida 2 para 1,who had been admitted for unicornuate uterus pregnancy by a thawed frozen blastocyst transplantation.She accepted laparoscopic cervical cerclage for cervical insufficiency and delivered successfully via caesarean section at 35^(+3) weeks.Cervical cerclage may be used as an effective method of preventing abortion in unicornuate uterus pregnancy,while surgery by laparoscopy would be a better choice for patients with poor cervical condition.Obstetricians should pay due attention to complications such as uterine rupture for these highrisk patients.
文摘A more detailed blastocyst grading system provides a better selection of blastocysts with the highest implantation potential. Grading systems will help to decrease the number of blastocysts to be transferred without compromising high implantation and pregnancy rates.
基金supported by the Department of Education of Zhejiang Province,China(Y201534677).
文摘Objective:To evaluate cervical function and pregnancy outcomes after hysteroscopic resection of the complete uterine septum,duplicate cervix and vaginal septum with Metzenbaum scissors.Methods:Between January 2010 and December 2016,13 patients admitted to the Department of Obstetrics and Gynecology of Sir Run Run Shaw Hospital with complete uterine septum,duplicate cervix and vaginal septum,were enrolled into this study.The cervical and corporal septum was cut by Metzenbaum scissors,and residual septum was cut by micro scissors under hysteroscopy.The vaginal septum was cut with the unipolar electric knife.Results:The operation time was about 10±1.31 min.All the 13 patients present normal uterine cavities without scar formation under hysteroscopy at 3 months after operation,there was mild adhesions between anterior and posterior intrauterine wall on 2 cases.After operation,there were 13 pregnancies naturally conceived in 11 patients,10 deliveries.The live birth rate was 76.92%,the early miscarriage rate was 23.08%.The cesarean section ratewas 30%,the vaginal delivery ratewas 70%,and all were term births.Conclusion:The operation was simple,convenient,and fast,without any complications and cervical insufficiency.It was easy to have vaginal deliveries.
基金This study was supported by the Department of Education of Zhejiang Province,China(Y201534677).
文摘Objective:To retrospectively estimate the impact of modified laparoscopic salpingectomy on the ovarian reserve in infertile women.Methods:There were 74 infertile women undergone modified laparoscopic salpingectomy from June 2016 to January 2017,and their levels of serum antimüllerian hormone,basal follicle-stimulating hormone and estradiol were reviewed retrospectively.Results:No significant change was detected in serum antimüllerian hormone at 3 months after surgery compared to preoperative level(p=0.857).Similar changes were observed for the basal follicle-stimulating hormone(p=0.102)and estradiol(p=0.233)level.Conclusions:Our results revealed that modified laparoscopic salpingectomy might be a valuable treatment for hydrosalpinx before in vitro fertilization.
基金supported by the National Key Research and Development Program of China(2021YFC2700100)the National Natural Science Foundation of China(31930031 and 32300714)+2 种基金the Key Research and Development Program of Zhejiang Province,China(2021C03100 and 2021C03098)the Natural Science Foundation of Zhejiang Province,China(LD22C060001)the National Ten Thousand Talent Program,China.
文摘DHX36 plays a crucial role in regulating transcriptional and post-transcriptional processes through its interaction with G-quadruplexes(G4s).The mechanisms by which DHX36 regulates G4s vary across different cell types and physiological conditions.Oocyte-specific conditional knockout(CKO)mice were utilized to study the impact of DHX36 deficiency on female fertility.The results show that the CKO mice exhibit severely impaired hormone response,ovulation,and complete infertility.The CKO germinal vesicle(GV)oocytes display large nucleoli,aberrant chromatin configuration,decreased chromatin accessibility,disturbed transcriptome,and inhibited meiosis progression.Following fertilization,the embryos derived from the CKO oocytes arrest at the zygote or 2-cell stage.Notably,we observed inadequate rRNA transcription in growing GV oocytes,as well as insufficient pre-rRNA processing and translation activity in fully-grown GV oocytes.Using a G4 probe and antibody,we found increased G4s formation at the chromatin and cytoplasm of CKO GV oocytes;these G4s mainly originate from the rDNA and pre-rRNA.Furthermore,the distribution of DHX36 was found to be spatiotemporally synchronized with that of pre-rRNA and G4s in early mouse embryos.In vitro experiments confirmed that DHX36 directly binds with pre-rRNA through the RHAU-specific motif(RSM).Overexpression of DHX36 could partially alleviate the pre-rRNA accumulation in fully-grown CKO oocytes.In conclusion,this study highlights the physiological significance of DHX36 in maintaining female fertility,underscoring its critical role in rRNA homeostasis and chromatin configuration through G4-unwinding mechanism in mouse oocytes.
基金This study was supported by grants from the National Key Research and Development Program of China(No.2018YFC1004800)the National Natural Science Foundation of China(No.81701514)+1 种基金the Natural Science Program of Zhejiang(No.LY20C080002,No.LQ19H040014)the Medical&Health Program of Zhejiang(No.2019KY411)。
文摘Background:Ectopic pregnancy(EP)is a common complication in women undergoing assisted reproductive treatment,but the underlying causes for this remain unclear.This study aimed to explore factors affecting the incidence of EP in in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI).Methods:This was a retrospective study on the incidence of EP in IVF/ICSI cycles between January 1,2013 and December 31,2017.Patient age,infertility diagnosis(tubal factor or not),primary or secondary infertility,type of cycle(frozen-thawed or fresh),type of embryo(s)transferred(cleavage embryo or blastocyst),number of embryos transferred(one,two,or three),previous history of EP,and endometrial combined thickness were analyzed to explore their relationships with the incidence of EP.Based on clinical typing results,the patients were divided into an EP group or a non-EP group.Categorical variables were analyzed using Chi-squared test or Fisher exact test.Logistic regression analysis was performed to explore their associations with the incidence of EP.Results:The percentage of patients with primary infertility in EP group was significantly lower than that in non-EP group(31.3%vs.46.7%,χ^2=26.032,P<0.001).The percentage of patients with tubal infertility in EP group was also significantly higher than that in non-EP group(89.2%vs.63.6%,χ^2=77.410,P<0.001).The percentages of patients with transfer of cleavage-stage embryo or blastocyst(91.4%vs.84.4%,χ^2=10.132,P=0.001)and different endometrial combined thickness(ECT)(χ^2=18.373,P<0.001)differed significantly between EP and non-EP groups.For patients who had a previous history of one to four EPs,the percentage of patients undergoing transfer of a cleavage-stage embryo was significantly higher in EP group than that in non-EP group(92.2%vs.77.6%,χ^2=13.737,P<0.001).In multivariate logistic regression analysis,tubal infertility was strongly associated with EP(adjusted odds ratio:3.995,95%confidence interval:2.706-5.897,P<0.001).Conclusions:In IVF/ICSI cycles,transfer of a blastocyst-stage embryo,especially for patients with a previous history of EP,reduced the rate of EP.Tubal infertility was strongly associated with EP.
文摘Conservative treatment with high doses of progestin is an alternative to standard hysterectomy for young patients with early-stage endometrial adenocarcinoma who desire to preserve their fertility. Here we report a patient with well-differentiated early-stage endometrial adenocarcinoma and poor fertility potential who failed to become pregnant in two in vitro fertilization-embryo transfer cycles and suffered a relapse after conservative treatment. This case illustrates that assessment of fertility potential is critical at the time of initial evaluation and conservative treatment planning for patients with endometrial adenocarcinoma.
基金supported by the Zhejiang Provincial Health Science and Technology Project Fund (2024KY227).
文摘Objective Female sterilization is a common contraceptive method,but with changing family dynamics,an increasing number of women seek to restore fertility after tubal sterilization.Current clinical practice lacks effective tools for predicting pregnancy rates in this population after tubal anastomosis.This study aims to develop and internally validate a novel nomogram for predicting the pregnancy rate in women with tubal ligation after tubal anastomosis.Methods We developed a prediction model based on a training dataset of 208 patients with tubal ligation after undergoing tubal anastomosis between January 2012 and August 2020 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.The follow-up period for all patients was one year postsurgery,during which pregnancy outcomes were recorded.The LASSO regression model was used to optimize feature selection for the pregnancy rate risk model.The performance of the nomogram was assessed for its calibration,discrimination,and clinical usefulness.Internal validation was assessed.Results Predictors included in the prediction nomogram were age,type of anastomosis,sterilization duration,time of conception,and anti-Mullerian hormone(AMH)levels.The model displayed good discrimination,with a C-index of 0.924(95%CI:0.876–0.971),and good calibration.A high C-index value of 0.879 was still reached in the interval validation.Decision curve analysis revealed that the pregnancy rate nomogram was clinically useful when intervention was selected at the pregnancy rate possibility threshold of 1%.Conclusion This novel pregnancy rate nomogram incorporating age,type of anastomosis,sterilization duration,time of conception,and AMH could be conveniently used to predict the pregnancy rate in women with tubal ligation after tubal anastomosis.
