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.

Clinical Outcomes of Transfer Vitrified-Thawed Day 4,8-Cell Embryos into Endometrium Prepared for Day 3 Embryos

Objective:To determine the clinical outcomes of transfer of day 3,8-cell embryos into endometrium prepared for day 3 embryos.Methods:This study performed a retrospective analysis of 1,190 retarded embryos.These embryos underwent extended culture in vitro to select and vitrify day 4,8-cell embryos,followed by 176 frozen embryo transfer cycles(study group),matching 660 transfer cycles with single frozen day 3,8-cell embryos as the control(control group).Results:The study group achieved successful implantation rates,clinical pregnancy rate,and live-birth rates(20.45%,15.91%,14.20%,respectively),although these were lower than that in the control group(30.45%,27.42%,and 20.91%;P=0.009,0.002,and 0.046,respectively).The miscarriage rate was similar to that in the control group(4.55%vs.3.33%,P>0.05),and the mean birth weight of the study group was higher than that in the control group(3,556±381 g vs.3,311±570 g,P=0.012).Conclusions:Transfer of frozen day 4,8-cell embryos into endometrial prepared for day 3 embryos can be a new and safe alternative for patients with delayed embryos.

Clinical outcomes of using three gonadatropins and medroxyprogestrone acetate(MPA) during ovarian stimulation in normal ovulatory women undergoing IVF/ICSI treatments

Objective To compare the clinical characteristics in a gonadotropin （Gn） and medroxyprogestrone acetate （MPA） protocol using three types of Gn in normal ovulatory women undergoing IVF/ICSI treatments. Methods A total of 258 normal ovulatory IVF/ICSI patients undergoing ovarian stimulation in a Gn and MPA protocol were analyzed in this retrospective study and allocated into three groups according to the Gn used： group A, hMG-A （brand name： Fengyuan, n=105）; group B, hMG-B （brand name： Lebaode, n=90）; group C： u-FSH （brand name： Lishenbao, n=63）. The hormone profile, embryological characteristics, and the pregnant results after frozen-thawed embryo transfer （FET） were compared among the three groups. Results There was no significant difference in the number of oocytes retrieved among the three groups （12.1± 6.9 vs 12.1±5.6 vs 13.1 ±8.8, P〉0.05）. Other indicators such as the number of mature oocyte, fertilization, cleavage and viable embryo were similar （P〉0.05）. No premature LH surges were detected, with a range of 0.04-7.38 IU/L. No differences were found in the clinical pregnancy rate per transfer （43.48% vs 37.93% vs 40. 74%, P〉0.05） and the implantation rate （34.88% vs 22.22% vs 26.42%, P〉O.05）. Conclusion MPA is an effective oral alternative for the prevention of premature LH surges. Progestin-primed ovarian stimulation （PPOS） is a novel regimen of ovarian stimulation in combination with embryo cryopreservation, in which the two types of hMG are as effective as u-FSH.

Correlations of Sperm Mitochondrial Membrane Potential with Semen Parameters and Male Obesity

Background:To investigate the correlations of sperm mitochondrial membrane potential(MMP)with semen parameters and body mass index(BMI)in males with obesity.Methods:Semen samples were obtained by masturbation after 3-7 days of sexual abstinence from males who visited semen collect room of Shanghai Ninth People’s Hospital.Conventional semen analyses were performed by computer-aided sperm analysis(CASA),and sperm morphology was analyzed by modified Papanicolaou staining.Spermatozoa were stained by JC-1 to evaluate MMP through flow cytometry.Results:Sperm MMP of asthenozoospermia group(41.24%±9.71%)was significantly lower than that in control group(56.68%±11.13%).MMP was negatively correlated with BMI(r=−0.25,P<0.01),but positively correlated with total sperm motility(r=0.63,P<0.01),motility of progressive sperm(r=0.64,P<0.01),and normal sperm morphology rate(r=0.37,P<0.01).In addition,MMP showed no significant correlations with age,volume of semen,sperm concentration,sperm count,and other indexes.Conclusions:Sperm MMP is an important index in the evaluation of sperm function,and detection of MMP may provide references for the diagnosis and treatment of male infertility.

The Clinical Outcomes of In Vitro Fertilization/Intracytoplasmic Sperm Injection Treatments in 43 Women with a History of Gestational Trophoblastic Disease

Background:To analyze the clinical outcomes of in vitro fertilization(IVF)/intracytoplasmic sperm injection treatments in women with a history of gestational trophoblastic disease(GTD).Methods:This retrospective study included 43 patients with a history of GTD as the study group and 43 matched patients as the control group.The patients in the study group were divided into two groups according to the therapy received.Patients in Subgroup A(n=32)underwent uterine curettage treatment only.Patients in Subgroup B(n=11)underwent uterine curettage combined with chemotherapy.The characteristics of ovarian stimulation and outcomes of embryos and pregnancy were compared.Results:In the first cycle,there was a higher number of retrieved oocytes and normal fertilized oocytes in the control group than those in the study group(9.2 vs.6.2 and 6.0 vs.4.0,respectively;P<0.05);however,a similar mature oocyte rate(83.5%vs.85.0%),normal fertilization rate(84.5%vs.80.1%),number of good-quality embryos(1 vs.2),and viable embryos(2 vs.2)were found between the two groups(P>0.05).There was no difference in the outcomes between Subgroup A and Subgroup B.There was a significant difference in thickness of the endometrium between the control group and study group(10.9 mm vs.9.2 mm,respectively;P<0.05).The biochemical pregnancy rate and ongoing pregnancy rate in the control group were significantly higher than those in the study group(51.4%vs.31.7%and 37.8%vs.18.3%,respectively;P<0.05).In the study group,28(93.3%)patients had intrauterine adhesion(IUA)and 23(76.7%)patients used an intrauterine device(IUD),which were both significantly higher than those in control group(P<0.05).In addition,the rate of IUA in second-look hysteroscopy was lower than that in the first surgery in the study group(P<0.05).Conclusions:Patients with a history of GTD can present with a similar normal fertilization rate and number of viable embryos.However,patients with a history of GTD may have a thinner endometrium and lower ongoing pregnancy rate.Hysteroscopy before frozen embryo transfer and usage of an IUD can improve the occurrence of IUA.

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