Intracytoplasmic sperm injection in cases with a history of in vitro fertilization failure

<abstract>Aim: To evaluate the effect of intracytoplasmic sperm injection (ICSI) in the management of cases with a history of conventional in vitro fertilization (IVF) failure. Methods: Two groups of patients, 19 with normal semen parameters and a history of IVF failure (metaphase Ⅱ oocytes: 0~30 %) and 28 with severe male factor infertility received ICSI technology during the same period. Ovarian stimulation was achieved by conventional procedure. Transvaginal ultrasound-guided oocyte collection was done 35~37 h after human chorionic gonadotrophin (hCG) injection. Only metaphase Ⅱ oocytes were selected for microinjection. Results: Fertilization was achieved with ICSI in all the patients. The fertilization rate (75.6 %±21.1 % vs. 73.9 %±19.2 %), cleavage rate (85.1 %±19.3 % vs. 82.7 %±22.1 %), clinical pregnancy rate per embryo transfer cycle (31.6 % vs. 28.6 %) and implantation rate per embryo (15.3 % vs. 14.4 %) did not differ significantly between the two groups. Conclusion: ICSI is a valuable method for couples with a history of IVF failure. These patients may have a similar ICSI result as in severe male infertility.

Fertilization of in vitro matured human oocytes by intracytoplasmic sperm injection (ICSI) using ejaculated and testicular spermatozoa

Aim: To evaluate the fertilization competence of spermatozoa from ejaculates and testicle when the oocytes were matured in vitro following intracytoplasmic sperm injection (ICSI). Methods: Fifty-six completed cycles in 46 women with polycystic ovarian syndrome were grouped according to the semen parameters of their male partners. Group 1 was 47 cycles that presented motile and normal morphology spermatozoa in ejaculates and Group 2 was the other nine cycles where male partners were diagnosed as obstructive azoospermia and spermatozoa could only be found in testicular tissue fragment. All female patients received minimal stimulation with gonadotropin. Immature oocytes were matured in vitro and inseminated by ICSI. The spermatozoa from testes were retrieved by testicular fine needle aspiration. Results: A total of 449 and 78 immature oocytes were collected and cultured for 48 hours, 75.5 % (339/449) and 84.6 % (66/78) oocytes were matured in Groups 1 and 2, respectively. The percentage of oocytes achieving normal fertilization was significantly higher in Group 1 than that in Group 2 (72.9 % vs. 54.5 %, P < 0.05). There were no significant differences in the rates of oocytes cleavage and clinical pregnancies in these two groups [87.4 % (216/247) vs. 88.9 % (32/36); 21.3 % (10/47) vs. 44.4 % (4/9)]. A total of 15 babies in the two groups were healthy delivered at term. Conclusion: It appears that IVM combined with ICSI using testicular spermatozoa can produce healthy infants, while the normal fertilization rate of in vitro matured oocytes after ICSI using testicular spermatozoa was significantly lower than using the ejaculated spermatozoa.

A nomogram predicting clinical pregnancy in the first fresh embryo transfer for women undergoing in vitro fertilization and intracytoplasmic sperm injection(IVF/ICSI) treatments

The extent to which factors affect the probability of clinical pregnancy in the first fresh embryo transfer after assisted conception is unknown.In order to examine the predictors of clinical pregnancy,a retrospective cohort study was launched between January 1,2013 and December 31,2016 in four infertility clinics including 19837 in vitro fertilization and intracytoplasmic sperm injection(IVF/ICSI)fresh cycles with known outcomes and relevant records.A multivariable logistic regression was used to select the most significant predictors in the final nomogram for predicting clinical pregnancy.Furthermore,the model was validated by an independent validation set and the performance of the model was evaluated by the receiver operating characteristic(ROC)curves along with the area under the ROC curve(AUC)and calibration plots.In a training set including 17854 participants,we identified that female age,tubal factor,number of embryos transferred,endometrial thickness and number of good-quality embryos were independent predictors for clinical pregnancy.We developed a nomogram using these five factors and the predictive ability was 0.66 for AUC(95%CI=0.64−0.68),which was independently validated in the validation set(AUC=0.66,95%CI=0.65−0.68).Our results show that some specific factors can be used to provide infertile couples with an accurate assessment of clinical pregnancy following assisted conception and facilitate to guide couples and clinicians.

Cumulative live birth rates of in vitro fertilization/intracytoplasmic sperm injection after multiple complete cycles in China

There were few studies of cumulative live birth rates(CLBRs) based on multicenter reproductive clinical data from the general Chinese population.Here we report a retrospective cohort study,including 14 311 women with17 315 cycles,in three reproductive centers to evaluate two estimated parameters of CLBRs with multiple transfer cycles of in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI) in a Chinese population.We found that CLBRs were related to female age and endometrial thickness.By the fourth transfer cycle,the conservative and optimal estimates of CLBRs were 52.95% and 77.30% in women under 30 years of age,and 18.17% and26.51% in those 37 years of age or older,respectively.The two estimates were 44.70% and 63.15% in women with endometrial thickness more than 7 mm,and 32.05% and 46.18% in those with less than 7 mm,respectively.In addition,body mass index(BMI),duration of infertility,and infertility diagnoses may also be related to CLBRs on certain conditions.The findings from this study on CLBRs after multiple transfer cycles of IVF/ICSI treatment on different conditions in the Chinese population should be beneficial to both infertile couples and clinicians.

In vitro maturation of human oocytes maintaining good development potential for rescue intracytoplasmic sperm injection with fresh sperm

BACKGROUND The outcomes of the use of commercial in vitro maturation(IVM)medium to culture immature oocytes obtained from conventional ovulation induction,followed by rescue intracytoplasmic sperm injection(RICSI),are not ideal.It is thus difficult to widely adopt this approach in clinical practice.Therefore,it is necessary to explore methods for improving the clinical outcome of IVM.AIM To study the effect of sperm on the developmental potential of in vitro-matured oocytes in conventional culture.METHODS This was a retrospective study of patients whose immature oocytes were harvested from conventional oocyte stimulation cycles and underwent ICSI at our hospital between June 2018 and August 2020.RICSI was performed using sperm collected on the day of oocyte harvest(old)and sperm collected on the day of RICSI(fresh)and oocytes matured in vitro after 24 h of culture in conventional medium.The rates of in vitro oocyte maturation,normal fertilization,normal cleavage,day-3 top-quality embryos,and useful blastocyst formation were compared between the two groups.RESULTS In total,102 germinal vesicle(GV)-stage immature oocytes were cultured in the old sperm group.In the fresh sperm group,122 GV-stage immature oocytes were collected and cultured in vitro for 24 h.There were no significant differences in the general conditions of males and females between the two groups(P>0.05).The oocyte maturation,normal fertilization,and normal cleavage rates of the old and fresh groups were 51.0%vs 55.7%,61.5%vs 64.7%,and 93.8%vs 93.2%,respectively.None of the rates differed significantly(P>0.05)between the two groups.However,the day-3 top-quality embryo and useful blastocyst rates of the old and fresh sperm groups were 16.6%vs 63.4%;6.67%vs 34.6%,respectively.The day-3 top-quality embryos and useful blastocyst rates of the old sperm group were significantly lower than those of the fresh group(P<0.05).CONCLUSION In vitro maturation with conventional culture medium combined with the use of fresh sperm collected on the day of RICSI is an easy-to-implement strategy for patients whose oocytes are completely or mostly immature.

Effect of Fasting of Ramadan on Infertile Women Undergoing In-Vitro Fertilization/Intracytoplasmic Sperm Injection Cycles: A Prospective Cohort Study

Objective: To determine the effects of fasting of Ramadan in patients undergoing in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles. Design: A prospective cohort study conducted during Ramadan. Setting: Ain Shams University IVF centre. Population: Three hundred fasting, infertile women undergoing their first trial of IVF/ICSI and 300 non-fasting matched controls undergoing the same procedure during Ramadan. Methods: Anxiety and depression were measured by the Hospital Anxiety and Depression Scale, at the start of the induction protocol. All the successful pregnant women were followed up until delivery. Main Outcome Measures: The primary outcome measure was the live birth rate. Results: The live birth rate was higher in the fasting group than in the non-fasting group;this was not significant (43% vs. 40%, P = 0.46). The fasting group needed higher doses and durations of induction. Embryo quality did not differ between both groups. The pregnancy complication rate among successful cases was higher in the fasting group (52.9% vs. 40.4%, P = 0.03);however, the frequencies of anxiety and depression were significantly lower than those in the non-fasting group (18% vs. 38%, P P < 0.00001, respectively). Conclusion: Fasting during Ramadan does not seem to significantly affect the IVF/ICSI outcome;however, it significantly decreased the anxiety and depression usually associated with these procedures.

Success rates of in vitro fertilization versus intracytoplasmic sperm injection in men with serum anti-sperm antibodies:a consecutive cohort study

Antisperm antibodies(ASAs)are assumed to be a possible causative factor for male infertility,with ASAs detected in 5%-15%of infertile men but in only l%-2%of fertile ones.It remains unclear whether ASAs have an adverse effect on the outcome of in v/tro fertilization(IVF)or intracytoplasmic sperm injection(ICSI).This study investigated differences in the rates of fertilization,pregnancy,and live births associated with serum ASA-positive and ASA-negative men following IVF or ICSI.Five hundred and fifty-four consecutive infertile couples undergoing IVF(n=399)or ICSI(n=155)were included.The two-sample two-sided t-test and Chi-square or Fisher's exact test was used for statistical analysis.Lower rates of fertilization(41.7%vs 54.8%,P=0.03),good embryos(18.9%vs 35.2%,P=0.00),pregnancy(38.5%vs 59.4%,P=0.00),and live births(25.8%vs 42.5%,P=0.00)were observed in men of the IVF group with a positive serum ASA than in those with a negative ASA.ASA positivity/negativity correlated with pregnancy rates(P=0.021,odds ratio[OR]:0.630,95%confidence interval[Cl]:0.425-0.932)and live birth rates(P=0.010,OR:1.409,95%Cl:1.084-1.831)after controlling for the female serum follicle-stimulating hormone level and the couple's ages at IVF.Women coupled with ASA-positive men had lower live birth rates with IVF than with ICSI(25.8%and 47.4%,respectively;P=0.07).Women coupled with ASA-positive men had lower rates of pregnancy and live births following IVF than those coupled with ASA-negative men but had a similar outcome with ICSI.

Influence of sperm morphology on pregnancy outcome and offspring in in vitro fertilization and intracytoplasmic sperm injection:a matched case-control study

Sperm morphology was once believed as one of the most predictive indicators of pregnancy outcome in assisted reproductive technology(ART).However,the impact of teratozoospermia on in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI)outcomes and its offspring remains inconclusive.In order to evaluate the influence of teratozoospermia on pregnancy outcome and newborn status after IVF and ICSI,a retrospective study was conducted.This was a matched case-control study that included 2202 IVF cycles and 2574 ICSI cycles and was conducted at the Reproductive and Genetic Hospital of CITIC-Xiangya in Changsha,China,from June 2013 to June 2018.Patients were divided into two groups based on sperm morphology:teratozoospermia and normal sperm group.The pregnancy outcome and newborn outcome were analyzed.The results indicated that couples with teratozoospermia had a significantly lower optimal embryo rate compared to those with normal sperm morphology in IVF(P=0.007),while there were no statistically significant differences between the two groups in terms of the fertilization rate,cleavage rate,implantation rate,and pregnancy rate(all P>0.05).Additionally,teratozoospermia was associated with lower infant birth weight in multiple births after IVF.With regard to ICSI,there was no significant difference in both pregnancy outcome and newborn outcome between the teratozoospermia and normal groups(both P>0.05).Furthermore,no increase in the risk of birth defects occurred in the teratozoospermia group after IVF/ICSI.Consequently,we believe that teratozoospermia has limited predictive value for pregnancy outcomes in IVF/ICSI,and has little impact on the resulting offspring if multiple pregnancy is avoided.

Modified strict sperm morphology threshold aids in the clinical selection of conventional in vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI)

For infertility treatment,the selection of in vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI)is decided by multiplying indicators(including fallopian tube factors,semen count,and semen motility),except for sperm morphology.In this study,we conducted a retrospective analysis,from implantation to birth,over a period of 5 years.A total of 1873 couples with primary or secondary fallopian tube factors and an increased defective sperm morphology rate(DSMR)were divided into different groups to receive IVF or ICSI cycles.By comparing the outcomes,we found that the F1 group(DSMR<96%,IVF group 1)had higher cleavage rate,biochemical pregnancy rate,clinical pregnancy rate,and live birth rate than the F3 group(DSMR>98%,IVF group 3;P<0.05).In contrast,there was no significant difference in the ICSI subgroups.Furthermore,a comparison of the outcomes between IVF and ICSI showed that the S3 group(DSMR>98%,ICSI group 3)had higher cleavage rate(P<0.001),biochemical pregnancy rate(P<0.05),clinical pregnancy rate(P<0.05)and live birth rate(P<0.05)than the F3 group.However,the ICSI subgroup had a lower two pronuclei fertilization rate than the IVF subgroup(P<0.05).Our data suggest that the sperm morphology should also be considered when selecting IVF or ICSI combined with other semen parameters before the first assisted reproductive technologies(ART)cycle,especially for males with severe sperm defects.

Analysis of related factors affecting cumulative live birth rates of the first ovarian hyperstimulation in vitro fertilization or intracytoplasmic sperm injection cycle: a population-based study from 17,978 women in China

Background:More and more scholars have called for the cumulative live birth rate(CLBR)of a complete ovarian stimulation cycle as a key indicator for assisted reproductive technology.This research aims to study the CLBR of the first ovarian hyperstimulation cycles and analyze the related prognosis factors that might affect the CLBR.Methods:Our retrospective study included first in vitro fertilization or intracytoplasmic sperm injection(IVF/ICSI)cycles performed between January 2013 to December 2014.A total of 17,978 couples of first ovarian hyperstimulation IVF/ICSI cycles were included.The study was followed up for 4 years to observe the CLBR.The multivariable logistic regression model was used to analyze the prognosis factor,P value of<0.05 was considered statistically significant.Results:The cumulative pregnancy rate was 58.14%(10,452/17,978),and the CLBR was 49.66%(8928/17,978).The female age was younger in the live birth group when compared with the non-live birth group(30.81±4.05 vs.33.09±5.13,P<0.001).The average duration of infertility was shorter than the non-live birth cohort(4.22±3.11 vs.5.06±4.08,P<0.001).The preliminary gonadotropin used and the total number of gonadotropin used were lower in the live birth group when compared with the non-live birth group(both P<0.001).Meanwhile,the number of oocytes retrieved and transferrable embryos were both significantly higher in the live birth group(15.35±7.98 vs.11.35±7.60,P<0.001;6.66±5.19 vs.3.62±3.51,P<0.001,respectively).Conclusions:The women's age,body mass index,duration of infertility years,infertility factors,controlled ovarian hyperstimulation protocol,the number of acquired oocytes,and number of transferrable embryos are the prognosis factors that significantly affected the CLBR.

Clomiphene Citrate or Medroxyprogesterone Acetate with Human Menopausal Gonadotropin in Poor Responders during In vitro Fertilization/Intracytoplasmic Sperm Injection Treatments Combined with Embryo Cryopreservation?

Objective:This study aimed to compare the efficacy of clomiphene citrate(CC)with human menopausal gonadotropin(hMG)and that of medroxyprogesterone acetate(MPA)with hMG in poor responders defined according to the Bologna criteria.Methods:The data of patients with poor ovarian response(POR)according to the Bologna criteria from September 2016 to November 2017 were retrospectively reviewed.All participants received either CC+hMG or the progesterone-primed ovarian stimulation protocol(PPOS)protocol.Results:A total of 340 patients and 563 in vitro fertilization cycles were analyzed in this study.The incidence of spontaneous luteinizing hormone(LH)surge and the mean LH level on trigger day were significantly lower in the PPOS group than in the CC+HMG group(0.04%vs.3.49%and 4.26±3.59 vs.9.38±6.92 mIU/mL,respectively,P<0.05);however,the incidence of premature ovulation was similar between the two groups.The number of viable embryos harvested was not statistically different between the two groups(1.7±1.1 vs.1.5±0.8,P=0.06).The mean dose and duration of hMG were significantly higher in the PPOS group than in the CC+hMG group(908.7±556.6 vs.177.9±214.5 IU and 6.0±3.4 vs.1.2±1.5 days,respectively,P<0.05).However,the number of oocytes retrieved,number of metaphase II oocytes,and fertilization rate were comparable between the two groups.Conclusions:The CC with low-dose gonadotropin strategy was superior to the MPA with hMG protocol for POR.

Real value oftheoocyteswith smooth endoplasmic reticulum aggregates in in vitro fertilization/intracytoplasmic sperm injection cycle: a retrospective cohort study

objective:The management of oocytes affected by smooth endoplasmic reticulum aggregates(SERa)remains debatable.To understand how to manage SERa+oocytes and cycles,we performed a retrospective cohort study and analyzed the impact of SERa+cycles and oocytes on clinical and neonatal outcomes.Methods:We included 4856 cycles(149 SERa+and 4707 SERa-)from 4201 women(age:21-42 years)who received in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSl)treatments at the Center of Reproductive Medicine,First Affliated Hospital of Army Military University,from 2016 to 2019.SERa+cycles had at least one SERa oocyte in the oocyte cohort.All 1722 oocytes in the SERa+cycle were divided into SERa+(405)and SERa-(1317)oocytes.Results:The rates of two pronuclei(2PN)and high-quality embryos were lower in SERa+cycles than in SERa-cycles,regardless of IVF or ICSI(P<0.05).As the proportion of SERa+oocytes increased in the SERa+cycles,the rate of high-quality embryos declined gradually(P<0.05).Furthermore,the rate of 2PN in SERa+oocytes was significantly lower than that in SERa-oocytes(P<0.05).Regardless of whether IVF or ICSl insemination was performed,no significant differences in terms of clinical pregnancy rate and spontaneous abortion rate were observed between SERa+and SERa-cycles or between SERa+and SERa-oocytes(P>0.05).conclusion:Normal fertilization with SERa+cycles and oocytes was substantially reduced,regardless of the insemination method.Embryos originating from SERa+oocytes can be transferred when there are no other options,but fully informed consent and strict follow-up of fetal development are mandatory.

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.

A Modified Ultra-Long Downregulation Protocol Improves Pregnancy Outcomes in High Body Mass Index Patients Undergoing In vitro Fertilization/Intracytoplasmic Sperm Injection Treatment

Objective:Overweight and obesity are increasingly epidemic and negatively related to reproductive outcome.The aim of this study was to investigate the advantages of a modified ultra-long downregulation protocol on pregnancy outcomes of patients with high body mass index(BMI)undergoingin vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI),compared to the long protocol(LP).Methods:We retrospectively analyzed the clinical data of 3,920 infertile patients at the Reproductive and Genetic Hospital of Citic-Xiangya from January 2012 to December 2017 by propensity score matching(PSM).Patients were divided into two groups:modified ultra-LP(MULP)(n=1,960)and LP(n=1,960).Results:In the MULP group,live birth rate(52.65%vs.46.79%,P<0.001,odds ratio[OR]:1.784,95%confidence interval[CI]:1.563-2.036),clinical pregnancy rate(62.50%vs.57.91%,P=0.003,OR:1.211,95%CI:1.066-1.377),and implantation rate(53.24%vs.49.65%,P=0.004,OR:1.155,95%CI:1.048-1.272)were statistically significantly higher than those of the LP group.Moreover,the cycle cancellation rates(12.70%vs.15.15%,P=0.027,OR:0.815,95%CI:0.68-0.977),abortion rates(12%vs.14.8%,P=0.046,OR:0.785,95%CI:0.619-0.996),and ectopic pregnancy rates(1.06%vs.2.11%,P=0.04,OR:0.497,95%CI:0.252-0.98)were lower than those in the LP group.Conclusion:The modified ultra-long downregulation protocol improved the pregnancy outcomes in patients with high BMI undergoing IVF/ICSI treatment,providing a potential option for physicians when deciding an optimized ovary stimulation protocol for high BMI patients.

Effect of sperm DNA fragmentation on assisted reproductive technology treatment category

Objectives:To investigate the effect of sperm DNA fragmentation on outcomes of in vitro fertilization(IVF) and intracytoplasmic sperm injection(ICSI). Methods:A total of 242 cycles(154 IVF and 88 ICSI) from 235 couples were included.Sperm DNA fragmentation(SDF) and routine semen analysis were performed on the retrieval day.The rates of fertilization, embryo cleavage,good quality embryos,implantation and clinical pregnancy were measured. Results:Sperm DNA fragmentation index(DFI) in ICSI group was significantly higher than that in IVF group (P<0.01).The rates of fertilization,implantation and clinical pregnancy in ICSI were significantly higher than those in IVF with DFI≥24%(P<0.05).When DFI exceeded 24%,the OR for clinical pregnancy was 3.85(95% CI 1.40-10.59) comparing ICSI with IVF,and the OR for clinical pregnancy increased to 4.61(95%CI 1.09- 19.57) after inclusion of sperm concentration,progressively motile sperm percentage and female age as covariates. Conclusions:High DNA fragmentation might affect the outcome of ICSI and IVF.When DFI exceeds 24%, ICSI should be chosen instead of IVF.

IVF/ICSI-ET中胚胎实时监测系统与常规形态学评估选择性单胚胎移植累积活产率分析

目的:分析胚胎实时监测(TLM)系统和常规形态学评估(CMA)在体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)中选择性单胚胎移植的临床应用价值,并初步探讨拉曼光谱分析胚胎培养液对临床妊娠率的预测价值。方法:本研究为前瞻性随机对照临床研究,选择2019年4月至2020年7月在苏州市立医院生殖与遗传中心行IVF/ICSI-ET助孕的139例患者,随机分为TLM组和CMA组,分别选择最优胚胎行单胚胎移植(新鲜周期和复苏周期),患者第1次胚胎移植未获临床妊娠,则进行第2次,比较两组患者移植后的累积活产率和其他妊娠结局差异。同时收集IVF/ISCI受精后第3天胚胎培养液15μl,进行拉曼光谱分析。结果:TLM组与CMA组的累积活产率、累积临床妊娠率、累积早产率、累积早期自然流产率、累积异位妊娠率、累积早产率、小于胎龄儿或大于胎龄儿差异均无统计学意义(P>0.05)。TLM组新生儿性别比低于CMA组,但差异无统计学意义(P>0.05)。胚胎培养液拉曼光谱分析预测临床妊娠率的准确度为67.21%。结论:在卵巢储备功能良好的年轻女性中,进行选择性单胚胎移植时TLM评估胚胎优势不明显,需警惕基于动力学参数的胚胎选择可能影响性别比。拉曼光谱分析胚胎培养液尚不能很好地预测胚胎的种植能力。

两类不孕女性行IVF/ICSI-ET术后妊娠结局的影响因素

目的探讨输卵管性不孕(TFI)与多囊卵巢综合征(PCOS)不孕症患者行体外受精(IVF)/卵胞浆内单精子注射(ICSI)-胚胎移植(ET)后妊娠结局的相关影响因素。方法选取行IVF/ICSI助孕的TFI和PCOS不孕症患者77例为研究对象,分为TFI组(n=45)和PCOS组(n=32),根据是否发生妊娠分为TFI组妊娠者(n=21)和未妊娠者(n=24)、PCOS组妊娠者(n=10)及未妊娠者(n=22),收集各组不孕症患者的一般临床资料[年龄、文化水平、体质量指数(BMI)、月经周期、既往阴道炎史、不孕类型、不孕年限及既往孕产史];采集各组不孕症患者月经第2~3天静脉血,检测血清中抗苗勒氏管激素(AMH)及基础性激素水平[促卵泡生成素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(P)、催乳素(PRL)及睾酮(T)],并计算FSH/LH;收集各组患者进入IVF/ICSI周期后的促排卵资料[控制性超促排卵(COH)方案、促性腺激素(Gn)总剂量、Gn总天数]及注射人绒毛膜促性腺激素(HCG)日血清FSH、LH、E2、P水平;各组不孕症患者卵泡成熟后取卵,收集实验室相关资料(总获卵数、成熟卵数、受精方式及优质卵数)及移植情况(移植胚胎数量、移植胚胎类型及移植日子宫内膜厚度),并计算成熟卵数占卵子总数比例;行IVF/ICSI助孕4~6周,收集各组ET后的妊娠结局,采用单因素和多因素logistic回归分析影响两类患者妊娠结局的因素。结果PCOS组不孕症患者年龄、Gn总剂量低于TFI组(P<0.05),月经稀发、原发性不孕、孕产史、异位妊娠史、总获卵数及成熟卵数高于TFI组(P<0.05);TFI组不孕症患者中未妊娠者基础P水平低于妊娠者(P<0.05),Gn总剂量、Gn总天数及卵裂期ET比例高于妊娠者(P<0.05);PCOS组不孕症患者中妊娠者的年龄、月经周期正常比例低于TFI妊娠者(P<0.05),基础FSH激素水平、总获卵数及成熟卵数高于TFI组妊娠者(P<0.05);PCOS组不孕症患者中未妊娠者月经周期正常、继发性不孕患者比例低于TFI组未妊娠者(P<0.05),基础LH激素水平、Gn总剂量、注射HCG日LH水平、总获卵数及成熟卵数高于TFI组未妊娠者(P<0.05);TFI组不孕症患者妊娠结局的logistic回归分析结果未筛选出有统计学意义的指标。结论一般临床资料、血清激素水平、促排卵及卵细胞实验室培养情况等指标未对行IVF/ICSI-ET的TFI及PCOS不孕症患者妊娠结局产生影响。

卵巢微环境内邻苯二甲酸酯暴露与炎性因子水平的关系

目的:评估卵巢微环境内邻苯二甲酸酯(phthalates,PAEs)暴露与炎性因子水平的关系。方法:纳入2020年4—12月接受体外受精/卵胞质内单精子注射-胚胎移植治疗的64例患者,测定其卵泡液内10种邻苯二甲酸酯代谢物(phthalate metabolites,mPAEs)及2种炎性因子的水平。通过多元线性回归模型评估卵巢微环境内mPAEs暴露与炎性因子水平的关系,并进一步按年龄分层分析。结果:卵泡液中邻苯二甲酸单丁酯(MBP)水平与肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平(β=0.446,P=0.003)及白细胞介素-6(interleukin-6,IL-6)水平(β=0.425,P=0.003)均呈正相关,邻苯二甲酸(2-乙基-5-氧己基)单酯(MEOHP)水平与TNF-α水平呈正相关(β=0.411,P=0.019)。在分层分析中,年龄≥30岁组卵泡液中MBP水平与TNF-α水平(β=0.667,P=0.000)及IL-6水平(β=0.407,P=0.028)均呈正相关,在年龄<30岁组内未观察到mPAEs与炎症因子之间存在关联。结论:PAEs暴露可影响卵泡液中炎性因子水平,提示PAEs暴露可能带来卵巢微环境炎症负荷的改变。

新鲜周期体外受精-胚胎移植后子代单胎活产儿中小于胎龄儿的发生率及危险因素分析

目的探究女性接受新鲜周期体外受精/卵母细胞内单精子注射(IVF/ICSI)-胚胎移植(ET)助孕后子代单胎活产儿中不同程度小于胎龄儿(SGA)的发生率及危险因素。方法回顾性收集2014年4月-2020年12月于四川大学华西第二医院接受新鲜周期IVF/ICSI-ET助孕并分娩单胎活产儿的2262例患者的临床资料,根据子代出生体重在同性别、同胎龄新生儿中的百分位数将患者分为正常组(第10~第90百分位)、轻中度SGA组(第3~第10百分位)和重度SGA组(小于第3百分位)。比较不同程度SGA组与正常组患者病史及IVF/ICSI-ET相关临床资料的差异,采用多因素logistic回归筛选不同程度SGA的危险因素。结果女性接受新鲜周期IVF/ICSI-ET助孕后分娩的单胎活产儿中SGA的发生率为9.9%,其中轻中度SGA的发生率为5.0%、重度SGA的发生率为4.9%。BMI<18.5 kg/m^(2)、有自然流产史为子代发生轻中度SGA的危险因素(校正OR=4.54和1.91,95%CI=1.78~11.55和1.18~3.10);有自然流产史、早产为子代发生重度SGA的危险因素(校正OR=2.80和2.22,95%CI=1.78~4.42和1.23~3.98)。有活产史为子代发生轻中度及重度SGA的保护因素。结论接受新鲜周期IVF/ICSI-ET助孕的患者中,BMI<18.5 kg/m^(2)、有自然流产史、早产者子代发生SGA的风险增加,临床工作中应予以关注。

不同促排卵方案对行IVF/ICSI-ET助孕治疗的PCOS患者妊娠结局及胚胎实验室参数的影响

目的分析不同促排卵方案对行体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)助孕治疗的多囊卵巢综合征(PCOS)患者妊娠结局及胚胎实验室参数的影响。方法2018年6月-2019年9月内蒙古医科大学附属医院收治的行IVF/ICSI-ET助孕治疗PCOS患者134例,取得患者知情同意后,依据治疗方案的不同分为A组(早卵泡期长方案,47例,研究期间脱落2例,最终n=45,49个周期)、B组(长效长方案,32例,研究期间脱落1例,最终n=31,42个周期)以及C组(拮抗剂方案,55例,研究期间脱落3例,最终n=52,146个周期)。比较3组临床相关资料、妊娠结局、胚胎实验室参数及促排卵情况。结果与B组、C组比较,A组的新鲜胚胎移植率、临床妊娠率更高(P<0.05);与A组、B组比,C组的启动日促黄体生成素(LH)、雌二醇(E2)、HCG日LH水平均更高,促性腺激素(Gn)天数则更短,Gn剂量则更少(P<0.05)。结论IVF/ICSI-ET助孕治疗PCOS患者的三种促排卵方案中,早卵泡期长方案较其他方案,更能够提高患者的新鲜胚胎移植率、临床妊娠率;而拮抗剂方案较其他方案,则具有注射用醋酸曲普瑞林用药时间短、用药量少的特点,但在调节患者异常内分泌环境方面较差,因此临床应结合PCOS患者的实际情况,选择适合患者的促排卵方案。