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.

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.

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.

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.

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.

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.

FET中卵裂期胚胎移植与囊胚移植妊娠结局的比较

目的:探讨胚胎和囊胚在冻融胚胎移植(FET)中妊娠结局的差异。方法:通过比较本中心111例冻融胚胎移植周期中卵裂期胚胎和囊胚两组患者基本资料和妊娠结局的不同,探讨其基本资料与妊娠结局的不同。结果:两组患者的年龄、不孕年限、不孕原因、不孕类型、体重指数、基础FSH、基础E2、受精方式均没有统计学差异(P>0.05),囊胚组的平均复苏胚胎数、移植胚胎数均低于卵裂期胚胎组,有极显著差异(P<0.01),而完全存活率、种植率、临床妊娠率显著高于卵裂期胚胎组。结论:冻融胚胎移植中囊胚的妊娠率显著高于卵裂期胚胎妊娠率。

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.

宫腔粘连术后影响FET成功率的临床因素探讨

目的探讨宫腔粘连术后影响辅助生殖患者冻融胚胎移植(FET)临床妊娠率的临床因素。方法回顾性分析2011年3月至2015年6月于南京医科大学附属南京妇幼保健院生殖中心因宫腔粘连行宫腔镜下粘连电切或分离术,择期行冻融胚胎移植130个周期辅助生殖患者的病历资料,根据结局分为妊娠组(G1=46例)及非妊娠组(G2=84例),比较两组的一般情况、术后移植间隔时间、移植胚胎数、优质胚胎数及转化日子宫内膜厚度进一步比较妊娠组(Gl=42例)及非妊娠组(G2=80例)口服雌激素剂量及用药天数的差异此外分析不同用药类型(补佳乐组N1=80例,芬吗通组N2=42例)、不同优胚数目移植组临床妊娠率的差异,以期进一步指导临床治疗。结果 G1组与G2组的一般情况、术后移植间隔时间、移植胚胎数差异均未见统计学意义(均P>0.05)。GI组移植优质胚胎数(1.83±0.570枚)多于G2组(1.30±0.847枚)(t=4.231,P<0.05);移植2枚优质胚胎组临床妊娠率分别高于0枚、1枚优质胚胎组(X^2=11.289,P=0.001;X^2=6.605,P=0.013)。G1组转化日子宫内膜厚度(7.76±1.214mm)高于G2组(6.75±1.131 mm),差异有统计学意义(t=4.725,P<0.05)。G2组口服雌激素剂量高于G1组(t=-2.675,P<0.05),用药天数相近(P>0.05),N1组不孕年限长于N2组(t=2.516,P<0.05),余项差异均无统计学意义(均P>0.05)。结论对于宫腔粘连术后行冻融胚胎移植的患者,转化日子宫内膜厚度及移植优质胚胎数是影响其妊娠结局的重要因素,移植2枚优质胚胎能获得相对更高的临床妊娠率。

自然周期FET肌注HCG后不同移植时间与妊娠结局的关系

[目的]探讨自然周期冻融胚胎移植(FET)中肌注人绒毛膜促性腺激素(HCG)后不同移植时间与妊娠结局的关系,以期寻找最佳的移植时机。[方法]回顾性分析2013年1月至2017年8月就诊于郑州大学第三附属医院生殖中心行HCG诱导排卵的自然周期FET助孕患者的临床资料,共609周期,根据肌注HCG后不同黄体支持时间分为2组(肌注HCG日为第0天)。A组:第1天给予黄体支持,第4天行FET移植术;B组:第2天给予黄体支持,第5天行FET移植术。根据最终卵泡是否排出分为2组。1组:卵泡排出;2组:形成LUF囊肿。比较A1、A2、B1、B2四组的临床资料及妊娠结局。[结果]B2组的临床妊娠率和分娩率明显低于其余三组,差异均有统计学意义(P<0.05);妊娠结局不良率高于其余三组,但差异无统计学意义(P>0.05)。其余三组之间的妊娠结局比较均无统计学差异(P>0.05)。[结论]自然周期FET时,卵泡排卵对妊娠结局有利,也可寻找合适的时机使用HCG诱发排卵,肌注HCG后第4天行冻胚移植术。

两种不同黄体支持方案对人工周期FET妊娠结局的影响

目的探讨两种不同黄体支持方案对人工周期冻融胚胎移植(FET)妊娠结局的影响。方法回顾性分析2014年5月至2018年1月我院生殖医学科366个人工周期FET患者的临床资料,根据黄体支持方案不同分为A组(地屈孕酮+黄体酮注射液组,246个周期)和B组(地屈孕酮+黄体酮阴道缓释凝胶组,120个周期)。比较两组患者的实验室及临床妊娠指标。结果两组间患者的年龄、不孕年限、体重指数(BMI)、基础FSH、基础LH、基础E2、移植日内膜厚度、移植优质胚胎数等比较均无显著性差异(P>0.05);B组的种植率(33.33%)、生化妊娠率(60.00%)、临床妊娠率(56.67%)均显著高于A组(分别为25.93%、46.34%和41.46%)(P<0.05);A、B两组间的自然流产率(13.73%vs.14.71%)、双胎妊娠率(15.45%vs.15.00%)比较则无显著性差异(P>0.05)。结论黄体酮阴道缓释凝胶联合地屈孕酮用于人工周期FET黄体支持能够提高临床妊娠率,但是尚需以后扩大样本量、完善实验设计进行深入探讨。

GnRha降调和非降调下HRT-FET中内源性LH水平与妊娠结局的关系分析

目的探讨GnRha降调和非降调下激素替代-冻融胚胎移植周期中不同内源性促黄体生成素(LH)增高水平对妊娠结局的影响。方法回顾性分析2015年1月至2018年10月在本院行GnRha降调和非降调下激素替代-冻融胚胎移植(HRT-FET)且年龄≤35周岁以及基础LH水平<10 IU/L的非子宫内膜异位症患者2313个周期的临床资料。根据有无GnRha降调分为降调下HRT-FET组(225个)和无降调HRT-FET组(2088个),再将无降调HRT-FET患者根据冻融胚胎移植中最高一次的LH水平分为3组:A组(LH<10 IU/L)、B组(LH 10~19.99 IU/L)和C组(LH≥20 IU/L)。比较无降调HRT-FET患者不同LH水平组间妊娠结局的差异和进一步比较无降调LH升高患者(≥20 IU/L)和降调下LH降低(LH<10 IU/L)患者妊娠率等结局的差异。结果A、B、C 3组患者的取卵年龄、移植胚胎数、妊娠率和种植率均无统计学差异(均P>0.05),GnRha降调组较非降调组患者的妊娠率和种植率明显降低(均P<0.05)。结论非子宫内膜异位症患者HRT-FET中出现LH增高对妊娠结局可能无不良影响,GnRha降调并不改善妊娠率。

IVF/ICSI-ET/FET后自然流产的胚胎染色体异常的相关因素分析

目的探讨体外受精(in vitro fertilization,IVF)、卵泡浆内单精子注射(intracytoplasmic sperm injection,ICSI)后新鲜胚胎移植(embryo-transfer,ET)及冷冻胚胎移植(frozen embryo transfer,FET)后自然流产的胚胎染色体异常的相关危险因素。方法选择2008年10月至2012年4月于南方医科大学南方医院生殖中心行IVF/ICSI-ET/FET后发生自然流产的夫妇115例,根据胚胎染色体结果分为异常组(74例)及正常组(41例),比较两组的一般资料及助孕相关指标间的差异并探讨胚胎染色体异常的相关危险因素。结果IVF/ICSI-ET/FET中自然流产绒毛染色体异常率为64.3%,以非整倍体率(91.9%)为主。胚胎染色体异常组的女性年龄显著高于正常组[(34.3±4.5)vs(32.2±4.5),P<0.05],促性腺激素(Gonadotrophin,Gn)总量显著高于后者[(2935.5±1418.5)vs(2398±1014.9),P<0.05],男性年龄亦高于后者[(37.1±4.9)vs(35.3±5.2),P>0.05],但差异无统计学意义。正常组的男女性别比为1∶2.4,女胎比例显著高于异常组(P<0.05)。IVF与ICSI的胚胎染色体异常类型差异无统计学意义(P>0.05)。Logistic回归分析提示仅女性年龄为胚胎染色体异常的独立危险因素(OR:1.008~1.204)。结论胚胎染色体异常是IVF/ICS-ET/FET后自然流产的主要原因,但细胞培养法可能会降低胚胎染色体异常的检出率。女性年龄是胚胎染色体异常的独立危险因素,而IVF/ICS-ET/FET治疗并不增加胚胎染色体异常的风险。

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

拮抗剂方案FET与新鲜周期移植结局的比较

目的比较拮抗剂方案全胚冷冻后第一次冻融胚胎移植(FET)与新鲜周期移植结局。方法回顾性分析2016年1至12月在西北妇女儿童医院生殖中心行体外受精-胚胎移植(IVF-ET)患者的拮抗剂新鲜周期移植及全胚冷冻后第一次FET的数据,共896个移植周期。按照是否全胚冷冻分为两组,A组为全胚冷冻后第一次FET,B组为拮抗剂新鲜移植组。分析两组间年龄、基础促卵泡素(bFSH)、基础窦卵泡数(AFC)、身体质量指数(BMI)、促性腺激素(Gn)刺激天数、Gn用量、获卵数、正常受精(2PN)率、优胚率、囊胚形成率、种植率、临床妊娠率等。结果 (1)两组患者的年龄、不孕年限、bFSH、AFC、BMI差异均无统计学意义(均P>0.05);(2)两组的促排卵后Gn用量、Gn天数及人绒毛膜促性腺激素(hCG)日雌二醇(E2)值、移植日内膜厚度、获卵数、移植胚胎数差异亦均无统计学意义(均P>0.05);(3)两组2PN率、囊胚形成率差异均无统计学意义(均P>0.05),但B组优胚率显著高于A组(χ2=11.356,P<0.05);(4)A组种植率、临床妊娠率均显著高于B组(χ2值分别为18.451、9.671,均P<0.05),两组早期流产率差异无统计学意义(P>0.05)。结论拮抗剂方案全胚冷冻后,FET较新鲜移植能够获得更好的结局。

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.

不同冷冻原因FET周期移植结局的分析

目的分析辅助生殖技术中不同冷冻原因的玻璃化冻融胚胎移植结局。方法对2009年3月至2011年5月1186个玻璃化冻融胚胎移植周期进行回顾性统计学分析,根据不同的冷冻原因分为预防卵巢过度刺激综合征(OHSS)全胚冷冻组(A组)、新鲜周期移植后剩余胚胎冷冻组(B组)、宫腔积液原因取消移植胚胎冷冻组(C组)和其他原因胚胎冷冻组(D组),分析各组的临床妊娠率。结果 A、B、C、D组的妊娠率分别为64.2%、45.5%、44.0%、51.5%,A组与B组、C组均有显著性差异(x^2值分别为35.080、4.119,均P<0.05)。但与D组无显著性差异(x^2=2.113,P>0.05),B组与C组、D组间均无显著性差异(x^2值分别为0.022、0.461,均P>0.05)。结论对于有过激风险和宫腔积液的患者,进行冻融胚胎移植是一种有效的助孕方法 。

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.