Association between TSH Level and Pregnancy Outcomes in Euthyroid Women Undergoing IVF/ICSI:A Retrospective Study and Meta analysis

The aim of this study was to determine the association between thyroid-stimulating hormone (TSH) level and pregnancy outcomes in euthyroid women undergoing in vitro fertilization (IVF)/intra-cytoplasmic sperm injection (ICSI).A total of 1185 women were enrolled in the retrospective study,and 12 studies with a total of 6624 women were included in the meta-analysis (including the data of the present retrospective study).Participants in the retrospective study were divided into two groups in terms of their serum TSH levels:TSH <2.5 mIU/L group (w=830) and TSH >2.5 mIU/L group (h=355).They were monitored for the status of clinical pregnancy or miscarriage.In the TSH <2.5 mIU/L group,441 (53.1%) women achieved clinical pregnancy,while 48 (5.8%) had early pregnancy loss and 12 (1.4%) had ectopic pregnancy.In the TSH >2.5 mIU/ L group,175 (49.3%) women achieved clinical pregnancy,while 21 (5.9%) had early pregnancy loss and 3 (0.8%) had ectopic pregnancy.No significant differences were observed between the two groups in pregnancy outcomes (P=0.126,P=0.512,P=0.297).The meta-analysis also revealed no significant difference in the clinical pregnancy rate and the miscarriage rate between women with serum TSH <2.5 mIU/L and those with serum TSH >2.5 mIU/L.In conclusion,high TSH levels (TSH level >2.5 mIU/L) did not affect clinical pregnancy rate or increase miscarriage rate in euthyroid women undergoing IVF/ICSI.

Developmental Potential and Clinical Value of Embryos with Abnormal Cleavage Rate

To investigate the developmental potential and clinical value of embryos with abnormal cleavage rate,a retrospective analysis was performed on 66 635 2-prokaryotic(2PN)and 1-pronuclear(1PN)embryos.The embryos were given conventionally in vitro fertilization(IVF)treatment and continuously cultured on the day 3(D3)at the Reproductive Medicine Center,Tongji Medical College,Huazhong University of Science and Technology from January 2016 to December 2017.The embryos were separated into the day-2(D2)undivided group with 106 cases,the arrested development group with 3482 cases,the blastomere reduction group with 541 cases,and the control group with 62 506 cases,respectively.The blastocyst utilization rates of these three abnormal groups were 2.83%,10.86%and 6.84%,respectively,which were significantly different from that in control group(39.46%).Furthermore,2 cases of anabiosis and 1 case of live birth were found in D2 undivided group.In arrested development group,there were 55 cases of anabiosis,11 cases of clinical pregnancy in single-embryo transplantation(including 6 cases of live birth),and 25 cases of clinical pregnancy in combination with one normal embryo transplantation(including 23 cases of live births and 15 cases of dizygotic twins under B-ultrasound).There were 13 case of anabiosis in blastomere reduction group:there was 1 case of single embryo transplantation and clinical pregnancy was obtained;there were also 6 cases of clinical pregnancy in combination with one single normal embryo transplantation(including 5 cases of live births and 2 cases of di2ygotic twins under B-ultrasound).In conclusion,embryos with abnormal cleavage rate still have the potential to continue to develop,and have certain blastocyst utilization rate and live birth.

Immunofluorescent Study of Human MⅡ Oocytes Failed to Fertilize after IVF and ICSI

Objective To discuss the reason why human M Ⅱ oocytes failed to fertilize after IVF and ICSI. Methods The unfertilized human MⅡ oocytes were collected 24-48 h after IVF and ICSI and stained for immunoflurescence and PI counterstain. The types of fertilization failure were identified under the fluorescence microscopy. Results About 55.8% oocytes in IVF were found no sperm in them, which were more than that in ICSI （9.7%） （P〈0.01）. About 14.9% oocytes in IVF and 58.1% in ICSI displayed oocyte activation failure. The difference was significant （P〈0.01）. Defects in pronuclear formation and or migration was found in a similar proportion of oocytes both after IVF （25.3%） and ICSI （32.3%）（P〉0.05）. There were 3.9% oocytes with other abnormalities were observed in IVF but none in ICSI. Conclusion The main reason of fertilization failure after IVF was no sperm penetration. However fertilization failure after ICSI was mainly associated with incomplete oocyte activation.