Effects of changing the control ovarian stimulation protocol in patients without a transplantable embryo in the previous in vitro fertilization/intracytoplasmic sperm injection cycle

Objective:Some patients fail to obtain an embryo for transplantation during previousin vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI)cycles,and require multiple reproductive treatments.This study aimed to evaluate whether changing the control ovarian stimulation(COS)protocol during the subsequent stimulation cycle could improve laboratory and clinical outcomes in these patients.Methods:Patients without a transplantable embryo(TE)in the previous IVF/ICSI cycles were recruited during their second cycles.They were classified into two groups according to their first cycle protocol:Group A,patients treated with a gonadotropinreleasing hormone agonist(GnRH-a),and Group B,patients treated with a gonadotropin-releasing hormone antagonist(GnRH-ant).The study group included patients whose stimulation protocols were changed,whereas the control group consisted of patients who used the same stimulation protocol in the second cycle.We then compared the numbers of oocytes collected(OC)and TE,the incidence of non-TE,the pregnancy rate(PR),and the live birth rate(LBR).Results:In Group A,the numbers of OC and TE were significantly lower(6.0±4.7vs.9.4±6.4,2.3±2.2vs.4.5±3.8,P<0.05)in the study group compared with those in the control group.In Group B,the numbers of OC and TE were higher(7.0±5.5vs.4.0±4.3,3.5±3.4vs.1.8±2.1,P<0.05)in the study group.There was a significant increase in the incidence of non-TE(adjusted odds ratio(AOR)=2.12,95%CI:1.04–4.69)of the study group in Group A but not in Group B.No significant differences in the PR or LBR were found between the study and control groups in either Group A or B.Conclusion:Changing the COS protocol from GnRH-ant to GnRH-a or continuing the GnRH-a protocol can improve laboratory outcomes in patients with no TE in the previous IVF/ICSI cycle.

Proportion of Uterine Malignant Tumors in Patients with Laparoscopic Myomectomy： A National Multicenter Study in China

Background： The Food and Drug Administration recently announced that the use of morcellation may cause fibroids or pelvic dissemination and metastasis of uterine sarcoma; therefore, the use of morcellation is limited in the USA. A large sample study is necessary to assess the proportion of uterine malignant tumors found in patients with laparoscopic myomectomy. Methods： A national multicenter study was performed in China. From 2002 to 2014, 33,723 cases were retrospectively selected. We calculated the prevalence and recorded the clinical characteristics of the patients with malignancy after morcellation application. A total of 62 cases were finally pathologically confirmed as malignant postoperatively. Additionally, the medical records of the 62 patients were analyzed in details. Results： The proportion of postoperative malignancy after morcellation application was 0.18% （62/33,723） for patients who underwent laparoscopic myomectomy. Nearly 62.9% （39/62） of patients had demonstrated blood flow signals in the uterine fibroids before surgery. And, 23 （37.1%） patients showed rapid growth at the final preoperative ultrasound. With respect to the pathological types, 38 （61.3%） patients had detectable endometrial stromal sarcoma, 13 （21.0%） had detectable uterine leiomyosarcoma, only 3 （3.2%） had detectable carcinosarcoma, and 5 （8.1%） patients with leiomyoma had an undetermined malignant potential. Conclusions： The proportion of malignancy is low after using moreellation in patients who undergo laparoscopie myomectomy. Patients with fast-growing uterine fibroids and abnormal ultrasonic tumor blood flow should be considered for malignant potential, and morcellation should be avoided.