Cumulative Live Birth Rate after Three Ovarian Stimulation IVF Cycles for Poor Ovarian Responders According to the Bologna Criteria

Summary： This study explored the cumulative live birth rate after three ovarian stimulation in vitro fer- tilization （IVF） cycles for poor ovarian responders according to the Bologna criteria. In this retrospec- tive cohort study, 479 poor ovarian responders according to the Bologna criteria in the first ovarian stimulation IVF cycle between July 2006 and January 2012 in our IVF centre were included. The cu- mulative live birth rate was calculated by optimistic and pessimistic methods. The cumulative live birth rate after three ovarian stimulation IVF cycles for poor ovarian responders according to the Bologna criteria was 12.7%-20.5%. The three-cycle cumulative live birth rate was 18.5%--24.5%, 13.2%-27.4% and 8.6%-14.9% for poor responders aged ≤35 years, 36-39 years and 〉40 years, re- spectively. In conclusion, poor responders according to the Bologna criteria can receive an acceptable cumulative live birth, rate after three ovarian stimulation IVF cycles, especially poor responders aged 〈40 years.

Does Lower Dose of Long-acting Triptorelin Maintain Pituitary Suppression and Produce Good Live Birth Rate in Long Down-regulation Protocol for In-vitro Fertilization?

The effects of pituitary suppression with one-third depot of long-acting gonadotropin-releasing hormone（Gn RH） agonist in Gn RH agonist long protocol for in vitro fertilization（IVF）/intracytoplasmic sperm injection（ICSI） were investigated. A retrospective cohort study was performed on 3186 cycles undergoing IVF/ICSI with Gn RH agonist long protocol in a university-affiliated infertility center. The pituitary was suppressed with depot triptorelin of 1.25 mg or 1.875 mg. There was no significant difference in live birth rate between 1.25 mg triptorelin group and 1.875 mg triptorelin group（41.2% vs. 43.7%）. The mean luteinizing hormone（LH） level on follicle-stimulating hormone（FSH） starting day was significantly higher in 1.25 mg triptorelin group. The mean LH level on the day of human chorionic gonadotrophin（h CG） administration was slightly but statistically higher in 1.25 mg triptorelin group. There was no significant difference in the total FSH dose between the two groups. The number of retrieved oocytes was slightly but statistically less in 1.25 mg triptorelin group than in 1.875 mg triptorelin group（12.90±5.82 vs. 13.52±6.97）. There was no significant difference in clinical pregnancy rate between the two groups（50.5% vs. 54.5%）. It was suggested that one-third depot triptorelin can achieve satisfactory pituitary suppression and produce good live birth rates in a long protocol for IVF/ICSI.

Cumulative live birth rates of in vitro fertilization/intracytoplasmic sperm injection after multiple complete cycles in China

There were few studies of cumulative live birth rates(CLBRs) based on multicenter reproductive clinical data from the general Chinese population.Here we report a retrospective cohort study,including 14 311 women with17 315 cycles,in three reproductive centers to evaluate two estimated parameters of CLBRs with multiple transfer cycles of in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI) in a Chinese population.We found that CLBRs were related to female age and endometrial thickness.By the fourth transfer cycle,the conservative and optimal estimates of CLBRs were 52.95% and 77.30% in women under 30 years of age,and 18.17% and26.51% in those 37 years of age or older,respectively.The two estimates were 44.70% and 63.15% in women with endometrial thickness more than 7 mm,and 32.05% and 46.18% in those with less than 7 mm,respectively.In addition,body mass index(BMI),duration of infertility,and infertility diagnoses may also be related to CLBRs on certain conditions.The findings from this study on CLBRs after multiple transfer cycles of IVF/ICSI treatment on different conditions in the Chinese population should be beneficial to both infertile couples and clinicians.

Successful live birth following hysteroscopic adhesiolysis under laparoscopic observation for Asherman’s syndrome: A case report

BACKGROUND Asherman’s syndrome is characterized by reduced menstrual volume and adhesions within the uterine cavity and cervix,resulting in inability to carry a pregnancy to term,placental malformation,or infertility.We present the case of a 40-year-old woman diagnosed with Asherman’s syndrome who successfully gave birth to a live full-term neonate after hysteroscopic adhesiolysis under laparoscopic observation,intrauterine device insertion,and Kaufmann therapy.CASE SUMMARY A 40-year-old woman(Gravida 3,Para 0)arrived at our hospital for specialist care to carry her pregnancy to term.She had previously undergone six sessions of dilation and curettage owing to a hydatidiform mole and persistent trophoblastic disease,followed by chemotherapy.She subsequently became pregnant twice,but both pregnancies resulted in spontaneous miscarriages during the first trimester.Her menstrual periods were very light and of short duration.Hysteroscopic adhesiolysis with concurrent laparoscopy was performed,and Asherman’s syndrome was diagnosed.The uterine adhesions covered the area from the internal cervical os to the uterine fundus.Postoperative Kaufmann therapy was administered,and endometrial regeneration was confirmed using hysteroscopy.She became pregnant 9 mo postoperatively and delivered through elective cesarean section at 37 wk of gestation.The postpartum course was uneventful,and she was discharged on postoperative day 7.CONCLUSION Hysteroscopic adhesiolysis with concurrent laparoscopy enables identification and resection of the affected area and safe and accurate surgery,without complications.

Live births from in vitro fertilization-embryo transfer following the administration of gonadotropin-releasing hormone agonist without gonadotropins:Two case reports

BACKGROUND The prevalence of female infertility between the ages of 25 and 44 is 3.5%to 16.7%in developed countries and 6.9%to 9.3%in developing countries.This means that infertility affects one in six couples and is recognized by the World Health Organization as the fifth most serious global disability.The International Committee for Monitoring Assisted Reproductive Technology reported that the global total of babies born as a result of assisted reproductive technology procedures and other advanced fertility treatments is more than 8 million.Advancements in controlled ovarian hyperstimulation procedures led to crucial accomplishments in human fertility treatments.The European Society for Human Reproduction and Embryology guideline on ovarian stimulation gave us valuable evidence-based recommendations to optimize ovarian stimulation in assisted reproductive technology.Conventional ovarian stimulation protocols for in vitro fertilization(IVF)–embryo transfer are based upon the administration of gonadotropins combined with gonadotropin-releasing hormone(GnRH)analogues,either GnRH agonists(GnRHa)or antagonists.The development of ovarian cysts requires the combination of GnRHa and gonadotropins for controlled ovarian hyperstimulation.However,in rare cases patients may develop an ovarian hyper response after administration of GnRHa alone.CASE SUMMARY Here,two case studies were conducted.In the first case,a 33-year-old female diagnosed with polycystic ovary syndrome presented for her first IVF cycle at our reproductive center.Fourteen days after triptorelin acetate was administrated(day 18 of her menstrual cycle),bilateral ovaries presented polycystic manifestations.The patient was given 5000 IU of human chorionic gonadotropin.Twenty-two oocytes were obtained,and eight embryos formed.Two blastospheres were transferred in the frozen-thawed embryo transfer cycle,and the patient was impregnated.In the second case,a 37-year-old woman presented to the reproductive center for her first donor IVF cycle.Fourteen days after GnRHa administration,the transvaginal ultrasound revealed six follicles measuring 17-26 mm in the bilateral ovaries.The patient was given 10000 IU of human chorionic gonadotropin.Three oocytes were obtained,and three embryos formed.Two high-grade embryos were transferred in the frozen-thawed embryo transfer cycle,and the patient was impregnated.CONCLUSION These two special cases provide valuable knowledge through our experience.We hypothesize that oocyte retrieval can be an alternative to cycle cancellation in these conditions.Considering the high progesterone level in most cases of this situation,we advocate freezing embryos after oocyte retrieval rather than fresh embryo transfer.

Predicting a live birth by artificial intelligence incorporating both the blastocyst image and conventional embryo evaluation parameters

BACKGROUND The achievement of live birth is the goal of assisted reproductive technology in reproductive medicine.When the selected blastocyst is transferred to the uterus,the degree of implantation of the blastocyst is evaluated by microscopic inspection,and the result is only about 30%-40%,and the method of predicting live birth from the blastocyst image is unknown.Live births correlate with several clinical conventional embryo evaluation parameters(CEE),such as maternal age.Therefore,it is necessary to develop artificial intelligence(AI)that combines blastocyst images and CEE to predict live births.AIM To develop an AI classifier for blastocyst images and CEE to predict the probability of achieving a live birth.METHODS A total of 5691 images of blastocysts on the fifth day after oocyte retrieval obtained from consecutive patients from January 2009 to April 2017 with fully deidentified data were retrospectively enrolled with explanations to patients and a website containing additional information with an opt-out option.We have developed a system in which the original architecture of the deep learning neural network is used to predict the probability of live birth from a blastocyst image and CEE.RESULTS The live birth rate was 0.387(=1587/4104 cases).The number of independent clinical information for predicting live birth is 10,which significantly avoids multicollinearity.A single AI classifier is composed of ten layers of convolutional neural networks,and each elementwise layer of ten factors is developed and obtained with 42792 as the number of training data points and 0.001 as the L2 regularization value.The accuracy,sensitivity,specificity,negative predictive value,positive predictive value,Youden J index,and area under the curve values for predicting live birth are 0.743,0.638,0.789,0.831,0.573,0.427,and 0.740,respectively.The optimal cut-off point of the receiver operator characteristic curve is 0.207.CONCLUSION AI classifiers have the potential of predicting live births that humans cannot predict.Artificial intelligence may make progress in assisted reproductive technology.

Improvement of Live Birth Rate Following Frozen-Thawed Blastocyst Transfer by Combination of Prednisolone Administration and Stimulation of Endometrium Embryo Transfer

The endometrial condition is a significant factor for successful pregnancy. To regulate endometrial function in fertility treatment, prednisolone (PSL) is administered for suppression of increased natural killer cells and stimulation of endometrium embryo transfer (SEET) to enhance communication between embryo and maternal tissues. We attempted to improve the endometrial condition by PSL administration and SEET during frozen–thawed blastocyst transfer (FBT). Patients took PSL (5 mg) 3 times daily for 3 days after ovulation during the FBT cycle. To analyse effects of PSL combined with SEET, we determined rates of chemical pregnancy, clinical pregnancy, foetal heart movement (FHM) and live birth. Rates of chemical pregnancy, clinical pregnancy and FHM were significantly higher in the PSL(+)/SEET(+) (57.7%, 50.0% and 46.2%, respectively) and PSL(+)/SEET(-) (53.3%, 46.7% and 46.7%, respectively) groups than in the PSL(-)/SEET(+) (30.3%, 18.2% and 18.2%, respectively) and PSL(-)/SEET(-) (22.4%, 22.4% and 18.4%;P = 0.0043, 0.0081 and 0.0055, respectively) groups. The live birth rate was significantly higher in the PSL(+)/SEET(+) group than in the PSL(+)/SEET(-), PSL(-)/SEET(+) and PSL(-)/SEET(-) groups (42.3%, 26.7%, 18.2% and 12.2%, respectively;P = 0.0237). PSL combined with SEET may be a useful adjunct to assisted reproductive technology in women who repeatedly fail to conceive by infertility treatment.

Effect of Dual Trigger In Vitro Fertilization and Intracytoplasmic Sperm Injection During the Gonadotropin-releasing Hormone-Antagonist Cycle on Final Oocyte Maturation and Cumulative Live Birth Rate in Women with Diminished Ovarian Reserve

Objective It is well known that a dual trigger treatment can improve clinical outcomes of in vitro fertilization(IVF)in high or normal ovarian responders.However,it is not clear whether dual triggering also benefits patients with diminished ovarian reserve(DOR).The aim of this study was to investigate whether a dual trigger treatment of gonadotropin-releasing hormone(GnRH)agonist combined with human chorionic gonadotropin(hCG)for final follicular maturation improves the cumulative live birth rate(CLBR)during the GnRH-antagonist cycle in patients with DOR.Methods This retrospective study included patients with DOR who received a GnRH-antagonist protocol during IVF and intracytoplasmic sperm injection(IVF-ICSI)cycles at Peking University People’s Hospital from January 1,2017 through December 31,2017.Oocyte maturation was triggered by GnRH combined with hCG(n=110)or hCG alone(n=71).Embryos were transferred on the third day after oocyte retrieval or during a subsequent freeze-thaw cycle.Patients were followed up for 3 years.Results The dual trigger treatment did not affect CLBR,which is an overall determinant of the success rate of assisted reproductive technology(ART).Women in the dual trigger group had significantly higher rates of fertilization than those in the hCG group(90.1%vs.83.9%,P=0.040).Conclusion Dual trigger with GnRH agonist and hCG did not improve CLBR in patients with DOR,but did slightly improve fertilization rate,oocyte count,and embryo quality.

Acupuncture improves the live birth of patients with repeated implantation failure: a retrospective cohort study

OBJECTIVE:To explore the therapeutic efficacy of acupuncture treatment on repeated implantation failure(RIF)patients with cryo-thawed embryo transfer(CET).METHODS:In a retrospective cohort study,all eligible women undergoing RIF were recruited in our center from January 1,2018 to December 31,2021.The patients were grouped by whether an acceptance of acupuncture treatment before CET,including the acupuncture group(Acu-group,55 cycles)and control group(Con-group,244 cycles).Data were analyzed by using binary logistic regression to explore the relationship of acupuncture treatment with pregnancy outcomes.RESULTS:The Acu-group had higher live-birth rate(LBR)[54.5%vs 41.0%,respectively;odds ratio(OR)=1.105,95%confidence interval(CI)(1.029,1.187),P=0.006]and ongoing pregnancy rate(OPR)[56.4%vs 43.0%,respectively;OR=1.100,95%CI(1.025,1.181),P=0.008]than the Con-group.There were no significant between-group differences in the rates of implantation[OR=1.070,95%CI(0.996,1.149),P=0.064],clinical pregnancy[OR=1.065,95%CI(0.997,1.138),P=0.061],biochemical pregnancy[OR=1.002,95%CI(0.903,1.112),P=0.967],or miscarriage[OR=0.778,95%CI(0.551,1.099),P=0.155].Perinatal outcomes did not differ significantly between the two groups.CONCLUSIONS:Acupuncture treatment could improve the LBR and OPR in RIF patients with CET cycles,suggesting a potential adjuvant therapy of acupuncture to improve the pregnancy outcomes in RIF patients.

Analysis of related factors affecting cumulative live birth rates of the first ovarian hyperstimulation in vitro fertilization or intracytoplasmic sperm injection cycle: a population-based study from 17,978 women in China

Background:More and more scholars have called for the cumulative live birth rate(CLBR)of a complete ovarian stimulation cycle as a key indicator for assisted reproductive technology.This research aims to study the CLBR of the first ovarian hyperstimulation cycles and analyze the related prognosis factors that might affect the CLBR.Methods:Our retrospective study included first in vitro fertilization or intracytoplasmic sperm injection(IVF/ICSI)cycles performed between January 2013 to December 2014.A total of 17,978 couples of first ovarian hyperstimulation IVF/ICSI cycles were included.The study was followed up for 4 years to observe the CLBR.The multivariable logistic regression model was used to analyze the prognosis factor,P value of<0.05 was considered statistically significant.Results:The cumulative pregnancy rate was 58.14%(10,452/17,978),and the CLBR was 49.66%(8928/17,978).The female age was younger in the live birth group when compared with the non-live birth group(30.81±4.05 vs.33.09±5.13,P<0.001).The average duration of infertility was shorter than the non-live birth cohort(4.22±3.11 vs.5.06±4.08,P<0.001).The preliminary gonadotropin used and the total number of gonadotropin used were lower in the live birth group when compared with the non-live birth group(both P<0.001).Meanwhile,the number of oocytes retrieved and transferrable embryos were both significantly higher in the live birth group(15.35±7.98 vs.11.35±7.60,P<0.001;6.66±5.19 vs.3.62±3.51,P<0.001,respectively).Conclusions:The women's age,body mass index,duration of infertility years,infertility factors,controlled ovarian hyperstimulation protocol,the number of acquired oocytes,and number of transferrable embryos are the prognosis factors that significantly affected the CLBR.

Magnetic-activated cell sorting of nonapoptotic spermatozoa with a high DNA fragmentation index improves the live birth rate and decreases transfer cycles of IVF/ICSI

The present study aimed to evaluate the clinical outcomes of magnetic-activated cell sorting(MACS)in sperm preparation for male subjects with a sperm DNA fragmentation index(DFI)≥30%.A total of 86 patients who had undergone their first long-term long protocol were selected.The protocol involved in vitro fertilization(IVF)and intracytoplasmic sperm injection(ICSI)cycles,and the patients were divided into the MACS or control groups.The MACS group included sperm samples analyzed with MACS that were combined with density gradient centrifugation(DGC)and the swim-up(SU)technique(n=39),and the control group included sperm samples prepared using standard techniques(DGC and SU;n=41).No differences were noted with regard to basic clinical characteristics,number of oocytes retrieved,normal fertilization rate,cleavage rate,or transplantable embryo rate between the two groups in IVF/ICSI.In addition,the clinical pregnancy and implantation rates of the first embryo transfer cycles indicated no significant differences between the two groups.However,there was a tendency to improve the live birth rate(LBR)of the first embryo transfer cycle(63.2%vs 53.9%)and the cumulative LBR(79.5%vs 70.7%)in the MACS group compared with the control group.Moreover,the number of transferred embryos(mean±standard deviation[s.d.]:1.7±0.7 vs 2.3±1.6)and the transfer number of each retrieved cycle(mean±s.d.:1.2±0.5 vs 1.6±0.8)were significantly lower in the MACS group than those in the control group.Thus,the selection of nonapoptotic spermatozoa by MACS for higher sperm DFI could improve assisted reproductive clinical outcomes.

Prediction of Cumulative Live Birth Rate in Women Aged 40 Years and Over Undergoing In vitro Fertilization/Intracytoplasmic Sperm Injection

Objective:To investigate cumulative live birth rate (cLBR) per oocyte retrieval in infertile patients aged 40 years and over undergoing their first in vitro fertilization/intracytoplasmic sperm injection cycles and to identify the possible predictors.Methods:A total of 1,613 patients at a university hospital in China from January 2013 to May 2017 were enrolled in this retrospective study.All data for fresh and subsequent frozen-thawed cycles were analyzed.Multivariate logistic regression analysis with stepwise selection of possible predictors for cLBR was performed,and Loess curve was constructed to determine the association between cLBR and the number of oocytes retrieved.Results:cLBR significantly increased with the number of oocytes retrieved and reached up to 75% when > 20 oocytes were retrieved (P<0.001).Variables of antral follicle count (AFC) and the number of oocytes retrieved were selected using multiple logistic regression analysis with stepwise selection to predict the significance of cLBR.cLBR demonstrated an obvious upward trend as the number of oocytes retrieval increased in the Loess curve.Conclusions:For patients aged 40 years and over,AFC and the number of oocytes retrieved were two key predictors for cLBR and maximization of ovarian reserve exploitation was pivotal to increase the chance of live birth.

Use of a male antioxidant nutraceutical is associated with superior live birth rates during IVF treatment

Oxidative stress is prevalent among infertile men and is a significant cause of sperm DNA damage.Since sperm DNA damage may reduce embryo quality and increase miscarriage rates,it is possible that untreated sperm oxidative stress may impair in vitro fertilization(IVF)live birth rates.Given that the antioxidant Menevit is reported to reduce sperm DNA damage,it was hypothesized that men’s consumption of this supplement may alter IVF outcomes.Therefore,a retrospective cohort study was conducted analyzing outcomes for couples undergoing their first fresh embryo transfer.Men were classified as controls if they were taking no supplements,health conscious controls if taking“general health”supplements,or Menevit users.Men with karyotype abnormalities,or cycles using donated,frozen and surgically extracted sperm were excluded.Among the final study cohort of 657 men,live birth rates were significantly higher in Menevit users than controls(multivariate adjusted odds ratio[OR]:1.57,95%confidence interval[Cl]:1.01-2.45,P=0.046),but not between controls taking no supplements and those using general health supplements,thereby suggesting that potential health conscious behavior in supplement users is unlikely responsible for the superior outcomes in Menevit users.Interestingly,in a post hoc sensitivity analysis,live birth rates among Menevit users were statistically superior to controls for lean men(OR:2.73,95%Cl:1.18-6.28;P=0.019),not their overweight/obese counterparts(OR:1.29,95%Cl:0.75-2.22,P=0.37).The results of this large cohort study therefore support a positive association between men’s use of the Menevit antioxidant during IVF treatment and live birth rates,especially in lean individuals.

Development and Validation of a Nomogram for Predicting the Probability of Live Birth in Infertile Women

Objective:To develop a nomogram to predict the probability of live birth on the basis of the association of patient characteristics in subfertile individuals or couples.Methods:A retrospective study was conducted from January 2014 to December 2015.A nomogram was built from a training cohort and tested on an independent validation cohort.A total of 2,257 patients who had undergone their first nondonor cycle of in vitro fertilization(IVF)(including intracytoplasmic sperm injection)were randomly split 2:1 into training(n=1,527)and validation(n=730)cohorts.Results:There were no statistically significant differences in the patients’baseline and cycle characteristics between the training and validation cohorts.On multiple logistic regression analysis,female age,antral follicle count,tubal factor,anovulation,ethnicity,unexplained fertility,and male factor were significantly associated with live birth.The nomogram had a C-index of 0.700(95%confidence interval[CI]:0.698-0.701)in the training cohort and 0.684(95%CI:0.681-0.687)in the validation cohort.Conclusions:Our nomogram can predict the probability of live birth for infertile women and can be used to guide clinicians and couples to decide on an IVF treatment option.

基于活产建立体外受精-胚胎移植精子DNA碎片指数的参考阈值及子代短期安全性

背景:精子DNA碎片指数与受精、胚胎发育潜能、胚胎植入、流产及子代安全性等存在显著的相关性。然而,其临床参考值受多种因素的影响,导致临床意义极其有限,该研究以活产为结局,通过倾向评分匹配校正其他混杂因素后,构建精子DNA碎片指数与活产的最佳临床截断值,并对其进行内外部验证,具有较好的预测价值及临床应用效能。目的:探讨基于活产建立体外受精-胚胎移植精子DNA碎片指数的参考阈值及子代短期安全性。方法:选取2019年5月至2021年5月于常州市妇幼保健院接受体外受精-胚胎移植患者1921例,以倾向匹配容差0.02为标准,1∶1进行倾向评分匹配,结果活产组与非活产组各成功匹配540例,以此建立模型组;通过选取同时期广西壮族自治区南溪山医院接受体外受精-胚胎移植患者135例作为外部验证组;采用受试者工作曲线探求精子DNA碎片指数对活产的临床最佳截断值,分别采用限制性立方样条曲线、标准曲线、临床决策曲线、临床影响曲线及内外部验证等方法,对该截断值的准确性及临床应用效能进行评估。结果与结论:(1)非活产组精子DNA碎片指数显著高于活产组且与活产存在显著的负相关性(r=-0.444,P<0.001);(2)受试者工作曲线结果显示,DNA碎片指数对活产的最佳截断值为24.33%,曲线下面积为0.775(0.746,0.804),特异度为72.60%,敏感度为78.90%,准确度为75.70%;(3)限制性立方样条曲线拟合Logistic回归结果显示,当精子DNA碎片指数大于24.57%时,临床非活产的风险呈趋势性增涨;(4)Logistic回归概率分析结果显示,精子DNA碎片指数为活产的危险因素[OR(95%CI)=0.916(0.904,0.928),P<0.001],且当精子DNA碎片指数大于27.78%时,临床活产发生的概率将小于50%,随着精子DNA碎片指数每增高1个单位,活产的概率下降8.4%;(5)内外部对该临床截断值的验证均显示,该截点具有一定的临床预测价值及准确性;(6)临床决策曲线与临床影响曲线显示,以该临床截断值建立的预测模型在阈概率为0.22-0.73时具有临床最大净获益值,且在该阈概率范围内损失与获益的比值始终小于1,证实该预测模型具有较好的临床应用效能;(7)精子DNA碎片指数与子代短期安全性分析结果显示,精子DNA碎片指数与出生儿早产、体质量、畸形、性别差异无显著性;(8)结果表明,精子DNA碎片指数对体外受精-胚胎移植活产的最佳临床截断值为24.33%,以此建立的临床预测模型具有较好的区分度、准确度与临床应用效能,精子DNA碎片指数对子代短期安全性影响并不显著,但仍需大样本及长期的追踪评估。

抗苗勒管激素低水平人群行IVF/ICSI助孕效果分析

目的 分析抗苗勒管激素(AMH)低水平女性行IVF/ICSI-ET助孕的妊娠结局以及在不同年龄组内低AMH水平对妊娠结局的影响。方法 回顾性分析2018年1月至2022年12月期间于济宁市第一人民医院生殖医学科进行第一周期IVF/ICSI的396例患者的资料,按照AMH水平分为极低AMH组(AMH≤0.5 ng/ml, 149例)和低AMH组(0.5 ng/ml35岁,215例)两组,分析两组在极低AMH和低AMH条件下的妊娠结局和累计活产率。结果 (1)极低AMH和低AMH两组患者间不孕年限、基础雌二醇(E2)和基础孕酮(P)差异均无统计学意义(P>0.05);与低AMH组比较,极低AMH组患者年龄更长、基础FSH和基础LH水平更高(P<0.05),促排卵过程中促性腺激素(Gn)用量更低、Gn天数更短、获卵数更少(P<0.05),累计活产率显著降低(P<0.05)。(2)低龄组患者中低AMH组的获卵数显著高于极低AMH组(P<0.05),但妊娠结局差异均无统计学意义(P>0.05);高龄组患者中低AMH组的获卵数显著高于极低AMH组(P<0.05),且累计活产率也显著高于极低AMH组(P<0.05)。结论 在低AMH条件下(AMH<1.1 ng/ml)进行IVF/ICSI助孕时,随着AMH水平的降低,累计活产率越低,高龄患者受影响程度更甚。

短时授精和早补救卵胞浆内单精子显微注射对妊娠结局及新生儿结局的影响

目的 探讨短时授精及短时授精联合早补救胞浆内单精子注射(early rescue intracytoplasmic sperm injection,E-RICSI)对IVF患者临床结局及新生儿结局的影响。方法 回顾性分析2019年1月至2023年12月在生殖中心接受新鲜胚胎移植患者的临床资料,按授精方式分为:短时IVF组(n=204),常规IVF组(n=208),E-RICSI组(n=13)和常规ICSI组(n=92)。分别比较短时IVF组与常规IVF组、E-RICSI组与常规ICSI组的受精情况、胚胎发育情况、妊娠结局和新生儿结局。结果 与常规IVF组和常规ICSI组相比,短时IVF组和E-RICSI组在胚胎发育、临床妊娠、流产、异位妊娠、活产、新生儿性别及出生体质量等方面差异均无统计学意义(P> 0.05),但短时IVF组的受精率(79.11%vs. 84.39%,P <0.001)和2PN受精率(63.98%vs. 70.83%,P <0.001)显著低于常规IVF组;E-RICSI组的受精率(65.49%vs. 91.68%,P <0.001)和2PN受精率(57.75%vs. 88.35%, P <0.001)显著低于常规ICSI组。结论 虽然与常规IVF和ICSI相比,短时授精和E-RICSI的受精率有所降低,但对胚胎发育、妊娠结局及新生儿结局并没有影响。短时授精结合早补救ICSI是预防完全受精失败的有效且安全的技术。

子宫内膜异位症合并薄型内膜不孕患者的两种冻融胚胎移植方案比较

目的:比较2种冻融胚胎移植(frozen-thawed embryo transfer,FET)方案对子宫内膜异位症合并薄型内膜不孕患者妊娠结局的影响。方法:回顾性分析子宫内膜异位症合并薄型子宫内膜患者200个FET周期的临床资料,根据不同子宫内膜准备方案分为降调节-人工周期组(D-HRT组,n=99)和降调节-促排卵方案组(D-OI组,n=101)。比较2组患者的一般资料、内膜准备和胚胎移植相关指标、妊娠及围产结局相关指标。结果:2组患者的年龄、不孕年限、人工流产次数、体质量指数(body mass index,BMI)、基础性激素水平、抗米勒管激素(anti-Müllerian hormone,AMH)、糖类抗原125(carbohydrate antigen 125,CA125)、窦卵泡计数(antral follicle count,AFC)及既往人绒毛膜促性腺激素(hCG)日或移植日子宫内膜厚度比较,差异均无统计学意义(均P>0.05)。D-OI组扳机日雌二醇(estradiol,E2)水平低于D-HRT组,移植日子宫内膜厚度高于D-HRT组,差异均有统计学意义(均P<0.05)。2组扳机前治疗天数、扳机日孕酮水平、移植胚胎数、移植胚胎类型、优质胚胎率和种植率比较,差异均无统计学意义(均P>0.05)。D-OI组临床妊娠率、持续妊娠率及活产率高于D-HRT组,早期流产率、早产率低于D-HRT组,差异均有统计学意义(均P<0.05)。2组异位妊娠率、双胎妊娠率、剖宫产率、妊娠期糖尿病发生率、妊娠期高血压疾病发生率及新生儿畸形发生率比较,差异均无统计学意义(均P>0.05)。结论:在FET周期中,子宫内膜异位症合并薄型子宫内膜患者采用D-OI方案可获得比D-HRT方案更高的临床妊娠率、持续妊娠率及活产率,且早期流产率和早产率更低,值得进一步临床研究。

不同治疗方案对卵巢储备功能正常年轻女性夫精人工授精妊娠结局的影响

目的探讨不同治疗方案对年龄<35岁卵巢储备功能正常女性夫精人工授精(AIH)妊娠结局的影响。方法回顾性分析2015年1月至2021年8月在本中心行AIH助孕的年龄<35岁卵巢储备功能正常女性的3024个周期的临床资料。根据治疗方案分为6组:自然周期组(NC组,n=380)、克罗米芬组(CC组,n=57)、CC联合促性腺激素(Gn)组(CC+Gn组,n=78)、Gn组(n=1712)、来曲唑组(LE组,n=430)以及LE联合Gn(LE+Gn组,n=367),比较各组患者的一般情况和妊娠结局,并采用多因素Logistic回归分析影响AIH临床妊娠率及活产率的相关因素。结果一般情况比较:6组间体质量指数(BMI)、窦卵泡数(AFC)、基础卵泡刺激素(FSH)水平、优势卵泡数、不孕因素整体比较有统计学差异(P<0.05),而女方年龄、不孕年限、不孕类型及精液处理方式比较均无统计学差异(P>0.05)。妊娠结局比较:6组患者间临床妊娠率和活产率整体比较有统计学差异(P<0.05),其中LE+Gn组的临床妊娠率和活产率显著高于NC组(分别为20.7%vs.9.5%;16.3%vs.7.4%)(P<0.05);6组间流产率、异位妊娠率及多胎率比较无统计学差异(P>0.05)。多因素Logistic回归分析结果显示,矫正混杂因素后,LE+Gn治疗方案和优势卵泡数均是临床妊娠和活产的保护因素(OR>1,P<0.05),而不孕年限是临床妊娠和活产的危险因素(OR<1,P<0.05)。结论LE联合Gn方案可显著提高AIH的临床妊娠率和活产率,可作为年龄<35岁卵巢储备功能正常女性AIH助孕的首选治疗方案。

重组人促卵泡激素(芳乐舒■)6.5年的三期随访研究

目的对重组人促卵泡激素(芳乐舒■)三期临床研究进行随访,评估患者的累积妊娠率、累积活产率和新生儿结局指标。方法对芳乐舒■中国三期临床研究(NCT03506243/CTR20150341,2015年5月15日至2016年6月27日)进行随访至2022年12月31日。本研究分为芳乐舒■组和果纳芬■组,按照年龄分为20~30岁、31~35岁和36~39岁三个亚组。对患者的累积妊娠率、累积活产率、移植胚胎数、每获胚活产数、每获卵活产数、鲜胚移植和冻胚移植的临床妊娠率、鲜胚移植和冻胚移植的活产率、新生儿表征(双胎妊娠率、体质量、性别、出生缺陷率)等指标进行评估和分析。结果共446例患者纳入分析,其中芳乐舒■组336例,果纳芬■组110例,随访时间为6.5年。芳乐舒■组和果纳芬■组的累积妊娠率、累积活产率差异均无统计学意义(均P>0.05)。各年龄亚组两组间累积妊娠率和累积活产率差异均无统计学意义(均P>0.05),36~39岁亚组中芳乐舒■组累积妊娠率[60.0%(12/20)]、累积活产率[55.0%(11/20)]相比于果纳芬■组[28.6%(2/7),14.3%(1/7)]有增高趋势,但差异均无统计学意义(均P>0.05)。芳乐舒■组和果纳芬■组的双胎妊娠率、每获胚活产数、每获卵活产数、新生儿性别、新生儿体质量、出生缺陷率差异均无统计学意义(均P>0.05)。结论芳乐舒■在控制性超促排卵中的安全性、有效性与果纳芬■相似。相比于果纳芬■,芳乐舒■在高龄人群中的累积妊娠率和累积活产率有增高趋势,但差异无统计学意义。