Embryo Transfer Strategies for Women with Recurrent Implantation Failure During the Frozen-thawed Embryo Transfer Cycles:Sequential Embryo Transfer or Double-blastocyst Transfer?

Objective Both sequential embryo transfer(SeET)and double-blastocyst transfer(DBT)can serve as embryo transfer strategies for women with recurrent implantation failure(RIF).This study aims to compare the effects of SeET and DBT on pregnancy outcomes.Methods Totally,261 frozen-thawed embryo transfer cycles of 243 RIF women were included in this multicenter retrospective analysis.According to different embryo quality and transfer strategies,they were divided into four groups:group A,good-quality SeET(GQ-SeET,n=38 cycles);group B,poor-quality or mixed-quality SeET(PQ/MQ-SeET,n=31 cycles);group C,good-quality DBT(GQ-DBT,n=121 cycles);and group D,poor-quality or mixed-quality DBT(PQ/MQ-DBT,n=71 cycles).The main outcome,clinical pregnancy rate,was compared,and the generalized estimating equation(GEE)model was used to correct potential confounders that might impact pregnancy outcomes.Results GQ-DBT achieved a significantly higher clinical pregnancy rate(aOR 2.588,95%CI 1.267–5.284,P=0.009)and live birth rate(aOR 3.082,95%CI 1.482–6.412,P=0.003)than PQ/MQ-DBT.Similarly,the clinical pregnancy rate was significantly higher in GQ-SeET than in PQ/MQ-SeET(aOR 4.047,95%CI 1.218–13.450,P=0.023).The pregnancy outcomes of GQ-SeET were not significantly different from those of GQ-DBT,and the same results were found between PQ/MQ-SeET and PQ/MQ-DBT.Conclusion SeET relative to DBT did not seem to improve pregnancy outcomes for RIF patients if the embryo quality was comparable between the two groups.Better clinical pregnancy outcomes could be obtained by transferring good-quality embryos,no matter whether in SeET or DBT.Embryo quality plays a more important role in pregnancy outcomes for RIF patients.

Pregnancy Outcomes for Day 5 Versus Day 6 Single Frozen-thawed Blastocyst Transfer with Different Qualities of Embryos: A Large Matched-cohort Study

Objective This study aimed to determine whether the day of blastocyst expansion affects pregnancy outcomes in frozen-thawed blastocyst transfer(FBT)cycles.Methods A retrospective match-cohort study was conducted.Patients who underwent blastocyst transfer in frozen-thawed cycles at day 5 or 6 were matched for potential confounding factors.A total of 2207 matched pairs of FBT cycles were included from January 2016 to December 2019 in our Reproductive Medicine Center.Results The clinical pregnancy rate(CPR)and live birth rate(LBR)were significantly increased in day 5 blastocyst transfers when compared to day 6 blastocyst transfers,in terms of the same embryo quality.For FBT cycles with good-quality embryo,the CPR at day 5 and 6 was 61.30%and 57.56%,respectively(P=0.045),and the LBR was 44.79%and 36.16%,respectively(P<0.001).For FBT cycles with poor-quality embryo,the CPR at day 5 and 6 was 48.61%and 40.89%,respectively(P=0.006),and the LBR was 31.71%and 25.74%,respectively(P=0.019).The CPR for FBT cycles with good-quality embryo was statistically higher at day 6 than that at day 5 with poor-quality embryo transferred(57.56%vs.48.61%,P=0.001).Maternal age,anti-Müllerian hormone(AMH),endometrial thickness,embryo quality,and the day of blastocyst expansion were independently correlated with the CPR and LBR.The FBT cycles at day 5 had significantly higher CPR(adjusted odds ratio[OR]=1.246,95%confidence intervals[CI]:1.097–1.415,P=0.001)and LBR(adjusted OR=1.435,95%CI:1.258–1.637,P<0.001)than those at day 6.Conclusion The embryo quality is the primary indicator for FBT cycles.Day 5 blastocysts should be preferred when the quality of embryo at day 5 is the same as that at day 6.

Artificial Cycle with or without a Depot Gonadotropin-releasing Hormone Agonist for Frozen-thawed Embryo Transfer： An Assessment of Infertility Type that Is Most Suitable

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.

High-quality Cleavage Embryo versus Low-quality Blastocyst in Frozen-thawed Cycles:Comparison of Clinical Outcomes

This study compared the clinical outcomes of the frozen-thawed cycles of high-quality cleavage embryos with low-quality blastocysts to provide a reference for the choice of frozen-thawed embryo transfer schemes and to improve clinical pregnancy rates.A retrospective analysis was performed on the clinical data of patients undergoing frozen-thawed embryo transfer at the Reproductive Medicine Center of Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology from 2016 to 2017.In total,845 cases were divided into a high-quality cleavage embryo group(group A)and a low-quality blastocyst group(group B).Each group was further divided into subgroups based on the number of transplants.Group A was categorized into two subgroups comprising of 94 cases in subgroup Al(1 high-quality 8-cell group)and 201 cases in subgroup A2(2 high-quality 8-cell group).Group B was divided into four subgroups consisting of 73 cases in subgroup B I(D53BC group),65 cases in subgroup B2(D54BC group),110 cases in subgroup B3(D63BC group),and 282 cases in subgroup B4(D64BC group).The pregnancy outcomes and neonatal outcomes between the groups were compared.The clinical pregnancy rates(56.72%and 60.00%)and live birth rates(47.76%and 46.15%)in subgroups A2 and B2 showed no significant differences,but these rates were significantly higher in subgroups A2 and B2 than in the rest subgroups(P<0.05).The multiple birth rate(26.32%)in the subgroup A2 was significantly higher than that in the rest subgroups(P<0.05).There were no statistically significant differences in the abortion rates among all groups(P>0.05).In terms of neonatal outcomes,there were no statistically significant differences in the proportion of premature births,sex ratios,and birth defects among the low-weight and gigantic infants(P>0.05).Transplanting two high-quality cleavage embryos during the frozen-thawed embryo transfer cycles could significantly increase clinical pregnancy rates and live birth rates,but at the same time,it also increased the risks of multiple births and complications to mothers and infants.The D54BC subgroup had the most significant advantages among all groups(P<0.05).The rest low-quality blastocysts had clinical outcomes similar to the single high-quality cleavage embryo group.

Serum β-hCG level on day 7 of frozen-thawed embryo transfer: association with the clinical pregnancy outcomes in artificial cycles

Objective:The relationship between serum beta human chorionic gonadotropin(β-hCG)levels of patients(7 days after the transplantation of frozen-thawed embryos)and the pregnancy outcomes was investigated.Methods:This study was designed as a retrospective clinical trial of 366 women who underwent frozen-thawed embryo transfers(FETs)in artificial cycles.Patients were divided into three groups:clinical pregnancy group,biochemical pregnancy group,and non-pregnant group according to their pregnancy outcomes.Serumβ-hCG levels were tested on day 4,7,9,11 and 14 after FET.Results:In the clinical pregnancy group,the serumβ-hCG levels after 7-day post-transplantation were significantly elevated(16.20 IU/L vs.3.07 vs.0.1 IU/L;P<0.05)compared with the other two groups.Furthermore,it was found that Area Under Curve(AUC=0.96)was significant with cut-off value higher than 4.26 IU/L(sensitivity=92.3%,specificity=90.2%)to predict the clinical pregnancy outcomes in the receiver operating characteristic(ROC)analysis ofβ-hCG concentrations on day 7 of post-transplantation.Conclusion:Our results suggested that the elevated serumβ-hCG levels on day 7 of post-transplantation could predict the positive clinical pregnancy outcomes in artificial FET cycles.

Perinatal outcomes of frozen-thawed embryo transfer following blastocyst-stage embryo transfer compared to those of cleavage-stage embryo transfer:analysis of 9408 singleton newborns using propensity score analysis

Objective:Regarding frozen-thawed embryo transfer(FET),there is limited consensus on whether extending embryo culture from the cleavage stage to the blastocyst stage affects perinatal outcomes.This study aimed to compare perinatal outcomes of singletons between blastocyst-stage embryo transfer(BT)and cleavage-stage embryo transfer(CT)in FET.Methods:A total of 9408 FET cycles that met the inclusion criteria were included in this retrospective cohort study between 2019 and 2022.Blastocyst-stage embryo transfers were performed in the BT group,and cleavage-stage embryo transfers were performed in the CT group.Multivariate logistic regression analyses were performed,as well as propensity score matching(PSM)to adjust for confounders.Results:After PSM,a higher risk of pre-term birth(PTB;odds ratio[OR]:1.23,95%confidence interval[CI]:1.00-1.50,P=0.048)and being large for gestational age(LGA;OR:1.16,95%CI:1.00-1.35,P=0.050)was observed in the BT group compared to that in the CT group.After stratified PSM,in the subgroup under 35 years of age,only an increased risk of LGA was observed in the BT group compared to the CT group.Perinatal outcomes in the double-embryo transfer subgroup were similar to those in the unstratified group.However,in the subgroup beyond 35 years of age and the single embryo transfer subgroup,perinatal outcomes were not statistically different between the BT and CT groups(P>0.05).Conclusions:In FET,prolonged embryo culture to the blastocyst stage increased the risk of PTB and LGA in single fetuses.However,stratified analysis based on age and the number of transferred embryos yielded different results,necessitating further mechanistic studies.

Impact of gonadotropin-releasing hormone agonist and hormone replacement therapy on pregnancy outcomes in single euploid frozen-thawed embryo transfer for patients with endometrial polyps

Objective:Although consensus on the optimal endometrial preparation protocol for frozen-thawed embryo transfer(FET)is lacking,this is particularly true for patients with infertility and a history of endometrial polyps(EPs).In this study,we aimed to investigate whether a gonadotropin-releasing hormone agonist combined with hormone replacement therapy(GnRHa-HRT)could improve pregnancy outcomes in single euploid FET for patients with a history of EPs.Methods:In this retrospective cohort study,395 women who underwent their first single euploid FET cycle were divided into groups according to endometrial preparation protocols as follows:natural cycle(NC)(n=220),hormone replacement therapy(HRT)(n=122),and GnRHa-HRT groups(n=53).Subsequently,the FET cycles in the three groups were subdivided according to maternal age.All patients underwent hysteroscopic polypectomy before FET,and their EPs were confirmed by pathology.Results:No statistically significant differences were observed in live birth rates among the three groups(58.64%vs.58.20%vs.56.60%,P=0.964).Furthermore,the rates of miscarriage,ectopic pregnancy,premature live birth,and pregnancy complications were comparable among the three groups(P>0.05).After adjusting for potential confounding factors,no significant differences in pregnancy outcomes were reported between the groups(adjusted odds ratios[OR]and 95%credible intervals[CI]for live birth rate,HRTvs.NC:1.119,0.660–1.896,P=0.677;GnRHa-HRTvs.NC:1.165,0.610–2.226,P=0.643).Additionally,the pregnancy outcomes of the FET cycle were not influenced by the endometrial preparation protocols in the subgroups when stratified by maternal age(P>0.05).Conclusion:GnRHa-HRT did not improve the pregnancy outcomes of the single euploid FET in patients with a history of EPs.

A frozen-thawed embryo transfer program improves the embryo utilization rate

Background Frozen-thawed embryo transfer （FET） is the most common way to prevent serious late ovarian hyperstimulation syndrome and increase the cumulative pregnancy rate. We evaluated the effectiveness of an FET program for improving the embryo implantation and clinical pregnancy rates, and ultimate embryo utilization rate in infertility treatment. Methods Patients undergoing in vitro fertilisation （IVF） cycles from January 2006 to June 2008 were enrolled, including 179 patients who had undergone the first FET cycle after controlled ovarian hyperstimulation （COH） in which all embryos were frozen （group C1） and 1306 patients who had COH with fresh embryo transfer （ET） （group T1）. Logistic regression was used to model the embryo implantation and clinical pregnancy rates based on the mother＇s age, numbers of oocytes retrieved, embryos transferred and high-quality embryos transferred. The embryo implantation and clinical pregnancy rates were also compared between two groups after adjusting for age, the numbers of oocytes retrieved and the numbers of embryos transferred. Results Logistic regression analysis confirmed that embryo implantation and clinical pregnancy rates in group C1 were both significantly higher than those in group T1 after adjusting for confounding factors （43.6% vs 29.0%, 63.1% vs 47.0%, respectively; P 〈0.01）. The embryo implantation and clinical pregnancy rates were consistently higher in group C1 by comparing the age groups ≥35 or 〈35 years. The clinical pregnancy rates for the numbers of oocytes retrieved per cycle being ≥15 or 〈15 were higher in group C1, as was the embryo implantation rate. These differences were statistically significant for oocyte numbers 〉15 （P 〈0.05）. The embryo implantation and clinical pregnancy rates in group C1 were both significantly higher than in group T1 when two or three embryos were transferred （P 〈0.05）. Conclusion A program of freezing all embryos and performing FET improved the rates of embryo implantation and clinical pregnancy, and ultimately enhanced the embryo utilization rate.

Impact factors and dynamic simulation of tillage-layer temperature in frozen-thawed soil under different cover conditions

Based on a winter field experiment between 2016 and 2017,four treatments(bare land(BL),natural snowfall coverage(NS),5-cm-deep straw+natural snowfall coverage(SC5),and 10-cm-deep straw+natural snowfall coverage(SC10))were established to determine the effects of the different treatments on soil temperature at the soil surface and at depths of 10 cm,20 cm,and 30 cm.The environmental factors of ambient temperature,ambient humidity,water vapor pressure,10-min wind speed,total radiation,net radiation,and long wave radiation were obtained from the weather station in the study area.Through correlation,multiple regression,and stepwise regression analysis,models for dynamic simulation of the tillage-layer soil temperature were constructed for analyzing the relation between tillage-layer soil temperature and environmental factors.The results showed that the environmental factors were all significantly correlated with tillage-layer temperature at the 0.01 level;when the impacts of other environmental factors were excluded,the correlations decreased significantly.The dynamic simulation models for tillage-layer soil temperature under different coverage conditions were different,and the larger the coverage amount,the fewer the environmental factors that could affect the tillage-layer temperature.The coefficients of determination of the prediction results of the dynamic models for the tillage-layer soil temperature under the four treatments(BL,NS,SC5,and SC10)were 0.8385,0.7110,0.7283,and 0.6216,respectively.The prediction had a high accuracy and can accurately depict the dynamic changes of the tillage-layer soil temperature.The results provided a theoretical basis for the efficient utilization of farmland soil water and heat resources.

Different endometrial preparation protocols yield similar pregnancy outcomes for frozen-thawed embryo transfer in patients with advanced endometriosis

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.

Clomiphene Citrate as An Adjuvant to hMG Stimulation of the Ovaries in Mid-to-late Follicular Phase and Subsequently Pregnancy Outcome of Frozen-thawed Embryo Transfers

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.

Effect of Traditional Chinese Herbs Combined with Low Dose Human Menopausal Gonadotropin Applied in Frozen-thawed Embryo Transfer

Objective： To assess embryo implantation rate （IR） and pregnancy rate （PR） in women who received Bushen Wengong Decoction （补肾温宫汤, BSWGD）, a Chinese herbal formula, combined with low dose of human menopausal gonadotropin （hMG） prior to frozen-thawed embryo transfer （FET）. Methods： A total of 262 subjects （674 transferred embryos） who received FET were analyzed retrospectively. In them, 122 women were under 30 years old, 106 between 30-35 years and 32 over 35 years. The 85 subjects with normal ovulation were assigned to Group A, the natural menstruation cycling group, on whom no pre-transfer treatment was applied. The other 177 subjects with abnormal ovulation were assigned to Group B, and subdivided, according to the pre-transfer treatment they received, into three groups, Group B1 （50 cases） received BSWGD, Group B2 （58 cases） received hMG and Group B3 （69 cases） received both BSWGD and low dose hMG. The IR and PR of FET in the four groups were compared time on PR of FET were compared also. Besides, the influencing factors and the effect of the embryo cryoto FET were analyzed. Results： IR and PR were significantly higher in all age sects of Group B3 than those in Group A, showing significant difference （ P〈0.05）. IR and PR in subjects in age sects of 〈30 years and 〉 35 years in group B3 were significantly higher than those in Group B1 （ P〈0.05）, but no significant difference was shown in the two parameters between Group B 2 and Group B3 （P〉0.05）. PR in the subjects who received embryos with cryo-time of 〉 200 days was significantly lower than that in those with cryo-time of ~ 100 days （P〈0.05）. Embryo cryo-time, endometrial thickness, use of BSWGD and use of hMG were of significance in FET （ P〈 0.05）. Conclusion： A programmed cycle of BSWGD combined with low dose of hMG could improve the embryo IR and PR of FET. Embryo cryo-time, endometrial thickness, and the use of BSWGD and hMG are of significance for FET.

Reducing the Trigger Dose of Human Chorionic Gonadotrophin Does Not Affect Final Oocyte Maturation and Subsequently Pregnancy Outcome of Frozen-thawed Embryo Transfer

To compare the efficacy of human chorionic gonadotrophin （hCG） at reduced doses of 2 000 IU and 3 000 IU for moderate or high responders with the dose of 5 000 IU in term of inducing final oocyte maturation for IVF/ICSI and the subsequent pregnancy outcome in frozen-thawed embryo transfer （FET）. Methods In the retrospective cohort study, 2 166patients undergoing IVF/ICSI with moderate or high response were recruited and classified into three groups according to the trigger dose of hCG： 2 000 IU （group A, n=722）, 3 000 IU （group B, n=722） and 5 000 IU （group C, n= 722）. The main outcome was the proportion of mature oocytes retrieved, fertilization rates, clinical pregnancy rates, cumulative pregnancy rates and incidence of ovarian hyperstimulation syndrome （OHSS）. Results No evidence of statistically difference was found in the proportion of mature oocytes retrieved （89.92%, 91.40%, 90.20%, respectively） and fertilization rate （79.8%, 80.07%, 80.51%, respectively） among groups A, B and C. Serum E2 level on the day of hCG injection, the number of mature oocytes retrieved and good-quality embryos in group A were significantly higher than those in group B and group C. Clinical pregnancy rates per transfer cycle （45.95%, 43.97% and 44.25%）, ongoing pregnancy rates （43.17%, 40.91% and 42,53%）, implantation rates （30, 74%, 2Z 78% and 29.86%） and cumulative pregnancy rates per patient （58.31%, 53.6% and 54.85%）A reduced hCG dose of 2 000 IUfor moderate or high responders leads

THE FIRST SUCCESSFUL CLINICAL PREGNANCY AFTER FROZEN-THAWED EMBRYOS TRANSFER IN China's Mainland

In the afternoon of July 8,1994,at the In Vitro Fertilization Center of the Third Hospital of Beijing Medical University,

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.

草鱼贮藏过程中导电特性变化规律的研究

运用物理特性-伏安法测定了不同频率下冰鲜和解冻草鱼的阻抗,分析在不同贮藏时间下阻抗的相对变化值(Q值)的变化特点。结果显示:从1 kHz增大到10 kHz,冰鲜和解冻草鱼的阻抗均随着频率的增大而减小,冰鲜草鱼的阻抗相对变化值(Q值)明显大于解冻草鱼。冰鲜草鱼在第1、2、4、7、10天的阻抗相对变化Q值分别为:28.89%、25.10%、17.01%、11.65%、10.37%,而冷冻7、14、30 d后解冻草鱼的最大Q值分别为4.34%、4.18%、4.63%。结果表明:以Q值10%为界限,快速鉴定冰鲜草鱼和解冻草鱼是基本可行的。

Assisted Hatching in Couples with Advanced Maternal Age： A Systematic Review and Meta-analysis

This systematic review aimed to evaluate the efficacy and safety of assisted hatching （AH） performed in couples with advanced maternal age. We searched for randomized controlled trials （RCTs） in electronic databases, including MEDLINE, EMBASE and CENTRAL （from inception to January 2018）; in addition, we hand-searched the reference lists of included studies and similar reviews. We included RCTs comparing AH versus no treatment （control）. The meta-analysis was performed by RevMan 5.3 software. The search retrieved 943 records and 8 RCTs were included, comprising 870 cycles （n=440 for AH, and n=430 for control）. There was no significant difference in the rates of live birth （RR 0.88, 95% CI 0.65 to 1.18, 3 RCTs, n-427,I^2=0%）, clinical pregnancy （RR 1.00, 95% CI 0.83 to 1.19, 8 RCTs, n=870, I^2=22%）, implantation （RR 1.07, 95% CI 0.83 to 1.39, 4 RCTs, n=1359, I^2=0%）, miscarriage （RR 1.13, 95% CI 0.66 to 1.94, 2 RCTs, n=116, I^2=0%） and multiple pregnancy （RR 0.89, 95% CI 0.31 to 2.52, 1 RCT, n=97,I^2=not applicable） between the treatment group and control group. No reasonable conclusions could be drawn regarding reproductive outcomes after AH in patients with advanced maternal age due to the small sample pooled in meta-analyses. Studies of high methodological quality and with adequate power are necessary to further investigate the value of AH in assisted conception of those patients.

Synchronous and Asynchronous Blastomere Cleavage at Cryopreservation: Effect on Subsequent Embryo Survival, Pregnancy and Live Birth Rates

Capsule: Although embryos with synchronous blastomere cleavage showed higher post-thaw survival rates, pregnancy rates did not differ. Thus, embryos with all cleavage patterns may be safely cryopreserved. Objective: To compare post-thaw embryo survival, pregnancy and live birth rates of embryos with synchronous vs asynchronous blastomere cleavage in frozen embryo transfer (FET) cycles. Design: Retrospective study. Setting: University-affiliated IVF unit. Patients: One thousand and sixty FET cycles performed from 2004-2006. Interventions: Cycles were divided into 3 groups: 1: cycles in which only embryos with synchronous blastomere cleavage were frozen;2: cycles in which only embryos with asynchronous blastomere cleavage were frozen;3: cycles in which both embryos with synchronous and asynchronous blastomere cleavage were frozen. Clinical and laboratory data were recorded and analyzed. Main Outcome Measures: Post-thaw embryo survival, morphologic grading, pregnancy and live birth rates. Results: A total of 1863 embryos were analyzed. Synchronous embryos had higher blastomere survival rates and morphological grading at thawing. Pregnancy and birth rates did not differ among groups. In a multivariant logistic regression analysis, a number of transferred embryos and embryo morphological grading at thawing were the only parameters that affected pregnancy and live birth rates. Conclusions: Embryos with both synchronous and asynchronous blastomere cleavage can be selected by classical embryo grading and safely cryopreserved.

针灸辅助改善冻融胚胎移植疗效的网状meta分析

Objective:To evaluate the clinical effect of acupuncture-moxibustion as the adjuvant therapy on frozenthawed embryo transfer(FET)using network meta-analysis.Methods:In PubMed,Embase,Cochrane Library,Chinese National Knowledge Infrastructure(CNKI),Wanfang database(WanFang),VIP database and Chinese Biomedical Literature Database(SinoMed),the randomized controlled trials(RCTs)of the adjuvant therapy of acupuncture-moxibustion for FET were retrieved,from database inception to April 1,2021.Cochrane risk of bias assessment tool was used to screen and evaluate the quality of the included studies,and RevMan 5.3,GeMTC0.14.3 and Stata16.0 software were adopted to complete the network meta-analysis.Results:Twenty-nine RCTs comprising 2880 patients were finally included,involving 17 interventions and 4 outcome measures.The results of network meta-analysis showed that the top three therapies under each outcome based on the magnitude of SUCRA values were:(1)Clinical pregnancy rate(CPR,%):"transcutaneous electrical acupoint stimulation+herbal medicine"(76.4),"moxibustion+herbal medicine"(74.7),"acupuncture+moxibustion"(73.3);(2)Biochemical pregnancy rate(BPR):"moxibustion+herbal medicine"(89.3),"acupuncture+moxibustion"(82.1),"acupuncture+herbal medicine"(78.7);(3)Endometrial thickness:"acupoint injection+Western medicine"(87.2),auricular therapy(76.8),"acupuncture+herbal medicine"(73.5);(4)Type A endometrial morphology rate:"acupoint injection+Western medicine"(78.3),"moxibustion+herbal medicine"(58.0)and"acupuncture+moxibustion"(52.6).Conclusion:The combined treatment of acupuncture-moxibustion was superior to single therapy for FET patients.The combined therapy of transcutaneous electrical acupoint stimulation and herbal medicine had the best effect for improving CPR,"moxibustion+herbal medicine"obtained the best average comprehensive effect,and"acupoint injection+Western medicine"was conductive to ameliorate the endome trial thickness and morphology.Due to the limitations of existing studies,more high-quality RCTs are needed in the future to further verify these conclusions.

Pregnancy outcomes of four different cycle protocols for frozen embryo transfer: a large retrospective cohort study

Objective:To evaluate the pregnancy outcomes of the four endometrial preparation protocols for people undergoing frozen-thawed embryo transfer(FET),including natural cycle(NC),hormone replacement therapy cycle(HRT),gonadotropin-releasing hormone agonist artificial cycle(GAC),and ovarian stimulation cycle(OC).Methods:This retrospective cohort study enrolled 10,333 cycles of frozen embryo transfer performed at Xinan Gynecological Hospital in Sichuan,China,from January 2018 to December 2018.The patient's baseline characteristics and pregnancy outcomes were extracted from the medical record system.Pregnancy outcomes were compared among the four groups and multiple logistic regression models were used to adjust for the confounding factors.Results:After adjusting for covariates,multiple logistic regression analysis showed no statistical significance in pregnancy outcomes in the HRT group,GAC group,and OC group compared to the NC group in the entire population.The adjusted odds ratio of live birth was 0.976(95%)confidence interval[Cl](0.837-1.138)for the HRT group,0.959(95%confidence interval 0.797-1.152)for the GAC group,and 0.909(95%confidence interval 0.763-1.083)for the OC group.Conclusions:The natural protocol had comparable pregnancy outcomes compared to the other three endometrial preparation protocols in the overall FET population.More high-quality prospective randomized controlled trials are required to assess the efficacy of the four protocols and explore the optimal one.