Impact of Progesterone on Inhibins during Controlled Ovarian Stimulation

Background:To explore the impact of progesterone on inhibins during controlled ovarian stimulation in women with normal ovarian reserve and to compare cycle characteristics and pregnancy outcomes in subsequently frozen-thawed embryo transfer(FET)cycles.Methods:A total of 93 patients were randomly divided into two groups,study group(human menopausal gonadotropin[hMG]+medroxyprogesterone acetate[MPA])and control group(short protocol).Serum hormones were detected on day 3 before ovarian and day 10-12,the trigger day,and the day after trigger(approximately 10 h after trigger).Viable embryos were cryopreserved for later transfer in both protocols.Results:In the study group,inhibins signifcantly increased during ovarian stimulation,and the average inhibins level on the trigger day was signifcantly higher than the basal levels.Inhibin A level increased significantly to 2046.7±1280.5 ng/L after trigger 10 h.Serum inhibin B level slightly decreased at the time of trigger 10 h later compared with the trigger time but did not reach a significant difference.The number of oocytes retrieved in study group was similar to that in control(10.5±4.5 vs.9.0±5.2,P<0.05).No statistically significant differences were found in the clinical pregnancy rate(47.4%vs.52.2%,P<0.05),implantation rate(36.5%vs.36%),and live birth rate(43.4%vs.39.1%,P<0.05)between the two groups.Conclusions:The high level of progesterone did not affect the secretion in granulosa cells during the controlled ovarian stimulation.Therefore,sufficient oocytes/embryos can be obtained by hMG and MPA co-treatment in women undergoing in vitro fertilization/intracytoplasmic sperm injection treatments,with optimal pregnancy outcomes in FET cycles.

Anti-Müllerian hormone and antral follicle count predict ovarian response in women less than 45 years following GnRH antagonist multiple-dose protocol

Objective:To speculate which of the following parameters:antral follicle count(AFC),anti-Müllerian hormone(AMH),follicle-stimulating hormone(FSH)and age can be used as a predictor of ovarian response to gonadotropin-releasing hormone(GnRH)antagonist stimulation multiple-dose protocol in women under 45 years,and to determine the cutoff value of these parameters and their correlations for predicting low and high ovarian response.Methods:This prospective study included 462 women with the mean age of(29.3±6.5)years.All women were subjected to the GnRH antagonist stimulation multiple-dose protocol.On the second day of the menstrual cycle,ultrasonography was conducted to determine AFC in both ovaries.Peripheral blood samples were collected to evaluate the level of estradiol,FSH,luteinizing hormone,prolactin,thyroid-stimulating hormone,and AMH.The women were divided into three groups:low response(AHH<1 ng/mL,n=173),normal response(AMH=1.0-3.5 ng/mL,n=175),and high response(AMH>3.5 ng/mL,n=114).Results:A significant decrease was found in the age and FSH level in the high response group compared to other groups(P<0.001).Conversely,a significant increase was shown in AMH,estradiol on human chorionic gonadotropin(hCG)day,AFC,mature oocytes,fertilized oocytes,and embryos transferred in the high response group compared to the other two groups(P<0.001).The receiver operating characteristic(ROC)curves demonstrated that AFC and AMH had the highest accuracy,followed by basal FSH level and age in the prediction of low ovarian reserves(P<0.001)with cutoff values of≤4.50 and≤0.95 for AFC and AMH,respectively.Moreover,the ROC analysis showed that AFC had the highest accuracy,followed by AMH level and age in the prediction of high ovarian reserves with a cutoff value of≥14.50,≥3.63,and≤27.50 years,respectively(P<0.01).A significant decrease was observed in women's age,estradiol level,and oocyte fertilization rate in pregnant women compared to non-pregnant women(P<0.001).Additionally,significant negative correlations were found between the AFC,the number of mature oocytes,fertilized oocytes,embryos transferred,and the age of pregnant women(P<0.001).Conclusions:AFC and AMH predict low and high ovarian response to GnRH antagonist stimulation multiple-dose protocol in women under 45 years.

Effects of Bu-Shen-An-Tai Recipe and Its Two Components on Endometrial Morphology during Peri-implantation in Superovulated Mice

The aim of this study was to investigate the effect of Bu-Shen-An-Tai recipe （BSATR） and its two components （Bushen recipe, and Huoxue recipe） on endometrial morphology during peri-implantation in superovulated mice. Mice were randomly divided into five groups, including the normal （N）, model （M）, Bushen （BS）, Huoxue （HX） and Bu-Shen-An-Tai （BH） groups. The uteri were collected on day 4 of pregnancy, and the endometrium thickness, microvessel density （MVD） and number of pinopodes observed. Compared with the M group, the endometrial thickness in the BS, HX and BH groups was significantly increased and there was a significant difference in endometrial thickness between the BS and the BH groups. The mean MVD was significantly lower in the M group than in the N group, and there was a significant increase in MVD in the BS, HX and BH groups as compared with the M group. Compared with the M group, the pinopode scores in the en- dometrium were significantly increased in the HX and BH groups; and the BS group had significantly higher pinipode scores than the HX and BH groups. In conclusion, the results of the present study demonstrated that the recipes （Bushen, Huoxue and BSATR） could improve the endometrial envi- ronment by regulating the endometrial thickness, MVD and the number of pinopodes at the window of implantation. Moreover, the Huoxue recipe and the BSATR were more efficient than the Bushen recipe, with the BSATR tending to have the most beneficial effects.

The effect of serum luteinizing hormone on trigger day with a GnRH antagonist protocol in IVF/ICSI treatment

Objective:To investigate the effect of serum luteinizing hormone(LH)on trigger day with a Gonadotrophinreleasing hormone(GnRH)antagonist protocol in patients receiving in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)treatment for pregnancy outcomes.Methods:We retrospectively reviewed the medical documents of patients receiving IVF/ICSI with fresh embryo transfers from the Reproductive Medicine Center of Peking University People's Hospital between January 2016 and December 2018.730 patients were included and divided into three groups by their serum LH level determined on trigger day.All patients were categorized into Group A,Group B,and Group C based on LH concentrations<1.0 IU/L,1.0–5.0 IU/L,and from 5.0 to 10.0 IU/L on trigger day during the cycle,respectively.Comparisons were made between the three groups.Results:There was a significant difference in implantation rates between Group A and Group C(24.8%versus 40.1%,respectively,P<0.05).The clinical pregnancy rates(39.3%versus 54.3%,respectively,P=0.078)and live birth rate(LBR)(32.1%versus 46.5%,respectively,P=0.116),though the differences were not significant.Multivariate logistic regression analysis showed that the OR of Group C for clinical pregnancy(OR=1.849,P=0.040)and for LBR(OR=1.915,P=0.034)were significant using Group A as the base level.Conclusions:Our study has demonstrated that patients with higher serum LH levels(5.0–10.0 IU/L)on trigger day in the GnRH antagonist protocol may confer better clinical outcomes than those with lower LH levels(<1.0 IU/L).