The Impact of Seasonal Variation on Clinical Pregnancy and Live Birth Rates in Assisted Reproductive Technology: A Retrospective Cohort Study in Hainan

Objective:To investigate the influence of season on live birth and clinical pregnancy rates,as well as assisted reproductive technology(ART)outcomes,in the Hainan region.Methods:Patients were categorized into four groups based on the dates of artificial insemination and transplantation:spring,summer,autumn,or winter.The main outcome measures were clinical pregnancy rates and live birth rates.Secondary outcomes included body mass index(BMI),oocyte number,two pronuclei(2PN)cleavage rate,total gonadotropin(Gn)dosage and days,age,2PN fertilization rate,sperm concentration,sperm PR rate,anti-Müllerian hormone(AMH),and endometrial thickness.Outpatient semen quality indicators included sperm PR rate,total sperm count,sperm concentration,and total sperm motility.Results:This retrospective cohort study analyzed 2,016 artificial insemination cycles and 1,783 ovarian retrieval cycles from January 2017 to October 2022,and assessed the semen quality of 6,651 outpatients from May 2017 to October 2022.In artificial insemination cycles,sperm PR rate and clinical pregnancy rate were highest in winter,with a statistically significant difference between groups(P<0.05).Clinical pregnancy rate was influenced by both age and sperm PR rate(P<0.05).In ovarian retrieval cycles,the winter group had significantly higher clinical pregnancy,2PN fertilization,and 2PN cleavage rates than the other groups.The autumn group had higher live birth rates,though not significantly different.Additionally,winter months showed higher total sperm concentration and total sperm number compared to other seasons.Conclusion:Seasonality affected clinical pregnancy and live birth rates in artificial insemination cycles but not in ovarian retrieval cycles in the Hainan region.These findings suggest that while there is no need to choose a specific season for ovarian retrieval cycles,artificial insemination in winter may be preferable for patients.

Analysis of Factors Influencing Pregnancy Rate in Frozenthawed Embryo Transfer

Objective To analyse factors influencing the outcome of frozen-thawed embryo transfer （FET）. Method A retrospective analysis was performed in our center on 129 thawing cycles from March 2001 to April 2003. The related parameters were compared between conceived and non-conceived cycles. Results There were totally 129 clinical pregnancies in these transfers （pregnancy rate： 27.1%）. Frozen-thawed embryos were transferred to natural cycles and CC cycling and hormone replacement treatment had equal success. Groups of IVF and ICSI did not differ significantly in pregnancy rates （P〉0.05）. The pregnancy rates for one, two, three and four pre-embryos transfer were 0, 20.0%,44.1% and 75.0%, respectively （P〈0.05）. There were statistical differences between pregnancy group or non- pregnancy group in the endometrial thickness, CES, CES/No. of embryo. A higher pregnancy rate was observed in embryo transfers which had at least one 4-cell grade I embryo （d 2）（P〈0.01）. Conclusions The most important factors influencing the implantation rate and pregnancy rate of frozen-thawed embryo transfer are age, endometrium thickness, and the number, morphology and growth rate of transferred frozen embryos of women participants.

Factors influencing success rate of IVF/ET:analysis of 770 treatment cycles

Objective:To evaluate the factors influencing success rate of in vitro fertilization/embryo transfer(IVF/ET).Methods:A retrospective study of 770 consecutive cycles undergone IVF/ET or in-tracytoplasmic sperm injection(ICSI)from March 1999 to June 2001.Estradiol and pro-gesterone concentrations on the day of hCG administration were measured.Factors effecting embryo transfer on the effects of clinical pregnancy rate were evaluated.Results:The overall clinical pregnancy rate in 770 cycles was 40.8%.Take home baby rate was 31%.No significantly differences rate were observed between groups with different estradiol levels.If the progesterone concentration on the day of hCG ad-ministration was>6.36 nmol/L,the implantation and clinical pregnancy rate was lower(P<0.003).The lowest clinical pregnancy rate was observed when the duration of in-fertility was≥10 years.The average number of embryos transferred was 2.23±0.83.Conclusion:This study demonstrated that the most important factor on clinical pregnancy rate was low progesterone concentration on the day of hCG administration.The other two important variables influencing success rate of IVF/ET were the duration of infertility,the number of high-grade embryos transferred.

Pregnancy Rate after Embryo Transfer on Day 5 and Day 6 in IVF. A Systematic Review and Meta-Analysis

Study Question: The question: is there any difference in pregnancy rate between embryo transfer day 5 and day 6 in IVF? What Is Known Already? Blastocyst transfer is increasingly popular in assisted reproductive technology (ART) centers today. Very few articles concentrate on comparing Day 5 and Day 6 embryo transfer with conflict results. Objective, Study Design: Systematic review and meta-analysis of published controlled studies. Searches conducted from 2001-2020 on PubMed. Medline, EMBASE, and ISI Web of Science Electronic database is used to collect data, using the following search terms: blastocyst, Day 5, Day 6, embryo transfer (E.T.) and pregnancy rate. Materials, Setting, Methods: A total of 6 full-text articles preselected from 211 references, based on title and abstract. Two independent reviewers performed data selection and extraction according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA). This systematic review was conducted according to (PICO) standard. Random-effect meta-analysis performed on all data (overall analysis). Results and the Role of Chance: Data from 6 relevant articles were extracted and integrated into the meta-analysis that reported clinical pregnancy rate (CPR) as an outcome in 5640 cycles, 2274 cycle had embryo transfer at day 6 and the control was 3366 cycle had embryo transfer day 5 showed a significantly higher clinical pregnancy rate following Day 5 embryo transfer compared with Day 6 embryo transfer with odd ratio and 95% confidence limit 0.73 (0.66 - 0.82) p value < 0.000. Sensitivity analysis led to similar results and conclusions. Limitations, Reasons for Caution: The validity of meta-analysis results depends mainly on the quality and the number of published studies available. Indeed, this meta-analysis included no randomized controlled trial (RCT). Wider Implications of the Findings: In regards to the results of this original meta-analysis, ART practitioners should preferably transfer D5 rather than D6 blastocysts. Further RCTs are needed to address the question of whether D6 embryos should be transported.

Effect of autologous bone marrow stem cells-scaffold transplantation on the ongoing pregnancy rate in intrauterine adhesion women:a randomized,controlled trial

Intrauterine adhesion is a major cause of female reproductive disorders.Although we and others uncontrolled pilot studies showed that treatment with autologous bone marrow stem cells made a few patients with severe intrauterine adhesion obtain live birth,no large sample randomized controlled studies on this therapeutic strategy in such patients have been reported so far.To verify if the therapy of autologous bone marrow stem cells-scaffold is superior to traditional treatment in moderate to severe intrauterine adhesion patients in increasing their ongoing pregnancy rate,we conducted this randomized controlled clinical trial.Totally 195 participants with moderate to severe intrauterine adhesion were screened and 152 of them were randomly assigned in a 1:1 ratio to either group with autologous bone marrow stem cells-scaffold plus Foley balloon catheter or group with only Foley balloon catheter(control group)from February 2016 to January 2020.The per-protocol analysis included 140 participants:72 in bone marrow stem cells-scaffold group and 68 in control group.The ongoing pregnancy occurred in 45/72(62.5%)participants in the bone marrow stem cells-scaffold group which was significantly higher than that in the control group(28/68,41.2%)(RR=1.52,95%CI 1.08–2.12,P=0.012).The situation was similar in live birth rate(bone marrow stem cells-scaffold group 56.9%(41/72)vs.control group 38.2%(26/68),RR=1.49,95%CI 1.04–2.14,P=0.027).Compared with control group,participants in bone marrow stem cells-scaffold group showed more menstrual blood volume in the 3rd and 6th cycles and maximal endometrial thickness in the 6th cycle after hysteroscopic adhesiolysis.The incidence of mild placenta accrete was increased in bone marrow stem cells-scaffold group and no severe adverse effects were observed.In conclusion,transplantation of bone marrow stem cells-scaffold into uterine cavities of the participants with moderate to severe intrauterine adhesion increased their ongoing pregnancy and live birth rates,and this therapy was relatively safe.

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.

Research progress on the effect of oocyte smooth endoplasmic reticulum clusters on early embryo development and pregnancy outcome

With the clinical development and application of intracytoplasmic sperm injection(ICSI)technology in human assisted reproduction,the influence of oocyte quality on embryo development has been paid more and more attention.So far,there have been many reports on oocyte morphology affecting embryo development.It has been found in some works that the appearance of smooth endoplasmic reticulum clusters(SERC)in oocytes may affect the fertilization and embryo development of oocytes.However,with the increasing reports of SERC-containing oocytes obtained by in vitro fertilization and healthy offspring in recent years,there is still some controversy on whether to continue to use SERC-containing oocytes for the following assisted reproductive therapy in clinical practice.Based on this,this review aims to review the research progress of SERC in oocytes in recent years.

Factors Influencing the Superovulation and Artificial Insemination of Sheep

[Objective] This study aimed to find out a method for low-cost and highly efficient sheep superovulation treatment and artificial insemination. [Method] The factors those probably influencing the results of conventional superovulation and insemination, such as combination of FSH hormone and sponge suppository, estrus interval, number of insemination, and ram individuals were analyzed. [Result] The combination of sponge suppository and FSH produced in Beijing exhibited the poorest effect to superovulation, significantly worse than that of other combinations （P0.01）. The FSH produced in Ningbo, combined with sponge suppository or CIDR produced better effect to superovulation. The superovulation effect was better when the interval from the last FSH injection to estrus was 12 h, significantly better than that when the interval was 36 h （P0.01）; and there was no difference in the superovulation results when the interval was 0, 12 and 24 h. The pregnancy rate of two artificial inseminations was significantly higher than that of only one insemination （P0.01）. Rams themselves had significant influence on fertilization results. [Conclusion] The combination of domestic FSH and domestic sponge suppository cost much less and dose not reduce the superovulation results. Better fertilization result can be obtained if the ewes are inseminated twice with the sperm those gave high pregnancy rate.

Oncology and reproductive outcomes over 16 years of malignant ovarian germ cell tumors treated by fertility sparing surgery

BACKGROUND Malignant ovarian germ cell tumors(MOGCT)are rare and frequently occur in women of young and reproductive age and the oncologic and reproductive outcomes after fertility-sparing surgery(FSS)for this disease are still limited.AIM To evaluate the oncology and reproductive outcomes of MOGCT patients who underwent FSS.METHODS All MOGCT patients who underwent FSS defined as the operation with a preserved uterus and at least one side of the ovary at our institute between January 2005 and December 2020 were retrospectively reviewed.RESULTS Sixty-two patients were recruited for this study.The median age was 22 years old and over 77%were nulliparous.The three most common histology findings were immature teratoma(32.2%),dysgerminoma(24.2%),and yolk sac tumor(24.2%).The distribution of stage was as follows;Stage I,74.8%;stage II,9.7%;stage III,11.3%;and stage IV,4.8%.Forty-three(67.7%)patients received adjuvant chemotherapy.With a median follow-up time of 96.3 mo,the 10-year progressionfree survival and overall survival were 82.4%and 91%,respectively.For reproductive outcomes,of 43 patients who received adjuvant chemotherapy,18(41.9%)had normal menstruation,and 17(39.5%)resumed menstruation with a median time of 4 mo.Of about 14 patients who desired to conceive,four were pregnant and delivered good outcomes.Only one case was aborted.Therefore,the successful pregnancy rate was 28.6%CONCLUSION The oncology and reproductive outcomes of MOGCT treated by FSS are excellent.Many patients show a long survival time with normal menstruation.However,the obstetric outcome is not quite satisfactory.

Effects of Medicines and Supplements on Spontaneous Pregnancy and Semen Parameters in Male Infertility:A Systematic Review Update and Network Meta-Analysis

In this study,we used a network meta-analysis(NMA)to compare the effectiveness of medicines and supplements for idiopathic male infertility and to identify the best treatment.Medline,Excerpta Medica Database(EMBASE),Ovid,and China National Knowledge Infrastructure(CNKI),were searched for the period from January 1990 to June 2021 using the keywords"male infertility,""medical therapy,""supplement/nutrient therapy,"and related terms.Randomized controlled trials(RCTs)investigating medicines(mainly follicle-stimulating hormone(FSH),androgen,and clomiphene/tamoxifen)or supplements(mainly zinc,selenium,vitamin C or E,carnitine,coenzyme Q10(CoQ10),or combined treatment)for idiopathic infertile men were selected for meta-analysis.Preferred reporting items for systematic reviews and meta-analysis(PRISMA)was used for data extraction,and a risk-of-bias tool and grades of recommendation,assessment,development,and evaluation(GRADE)system adapted to the NMA were employed to assess the quality of the evidence.The primary outcomes were live birth and spontaneous pregnancy rate(SPR).The secondary outcomes were sperm parameters(including concentration,progressive motility,and morphology)and side effects.In total,65 RCTs involving 7541 men with sperm abnormalities but normal hormone levels were included.A total of 36 studies reported SPR but only three reported live birth rates.The quality of the included studies was found to be moderate to high.Compared with a placebo or being untreated,carnitine plus vitamins significantly improved SPR(relative risk(RR)=3.7,95%confidence interval(95%CI),1.6-8.5);fatty acids significantly increased sperm concentrations(mean difference(MD)=12.5×10^(6)mL-1,95%CI,3.1×10^(6)-22.0×10^(6));and selective estrogen receptor modulator(SERM)plus CoQ10 significantly improved sperm progressive motility(MD=11.0%,95%CI,0.1%-21.9%)and normal sperm morphology(MD=11.0%,95%CI,4.6%-17.4%).The most optimal intervention was carnitine plus vitamins and fatty acids for SPR and sperm concentrations,respectively,even after excluding trials at a high risk of bias.Compared with a placebo or being untreated,FSH(RR=4.9,95%CI,1.1-21.3)significantly increased SPR,whereas SERM plus kallikrein increased sperm concentration(MD=16.5×10^(6)mL^(-1),95%CI,1.6×10^(6)-31.4×10^(6)),and SERM plus CoQ10 significantly improved sperm progressive motility(MD=11.3%,95%CI,7.3%-15.4%)and normal morphology(MD=11.2%,95%CI,5.4%-16.9%)in men with oligoasthenozoospermia(OA).In terms of side effects,fatty acids and pentoxifylline were associated with foul breath and/or a bad taste(RR=8.1,95%CI,1.0-63.5)and vomiting(RR=8.0,95%CI,1.0-63.0),respectively.In conclusion,the optimal treatment for male infertility for live birth is still unknown.Carnitine plus vitamins and FSH are likely to be better than other therapies in achieving successful spontaneous pregnancy in couples overall and in cou ples with men with OA,respectively.The efficacy of other treatments on pregnancy outcomes warrants further verification.

Effect of flaxseed supplementation on metabolic state,endocrine profiles,body composition and reproductive performance of sows

Objective:To assess the effect of flaxseed supplementation on metabolic profile,endocrine concentrations,non-esterified fatty acids(NEFA),body composition variables,and reproductive performance of sows.Methods:All the 21 crossbred Large White Yorkshire sows were considered in the study period starting at day 1 of current farrowing when the feeding of specific supplemental ration was started until the day of subsequent farrowing(days 150-155)and were equally allocated into three groups.Group 1 served as the control group and followed their normal feeding schedule.Group 2 and group 3,in addition to their normal feeding schedule,were supplemented with flaxseed at a rate of 0.5%and 1.0%of the dry matter,respectively.Blood samples were collected 15 days prior to farrowing,on the day of farrowing(day 0),at weekly intervals until day 28 of lactation and at monthly intervals during gestation to harvest the plasma.Plasma was used to assess the metabolic and endocrine status of sows.Body weight of each sow and individual birth weight of all piglets born were measured.Results:Flaxseed supplementation led to decrease in plasma cholesterol and triglyceride levels in the supplemented groups than in the control group(P<0.05).Plasma estradiol-17βlevel was higher in group 2 than that in group 1 and 3 on day 90 of the gestation period(P<0.05).The mean plasma level of insulin-like growth factor 1 was higher in group 3 than that in group 1 and 2 both in late lactation(day 28)as well as in early gestation(day 30)(P<0.05).Plasma NEFA and weight gain were greater in sows of group 2 and 3 compared to those fed with the normal control diets(P<0.05).The proportion of pregnant sows relative to sows bred was 100.0%in group 2 and 3 and 85.7%in the control group.Piglet mortality was lower in group 2 and 3 compared to group 1(P>0.05).Conclusions:Flaxseed improves endocrine profiles,NEFA concentrations and body weight,resulting in better pregnancy rate and litter size.

Factors influencing the outcome of embryo freezing and thawing program

Objective: To investigate the factors that might influence the success of an embryo freezing and thawing program. Method: The relationship between the pregnancy rate in 73 cycles of embryo freezing and thawing program and the following factors was analyzed: maternal age, E 2 level at the time of HCG trigger, embryo storage time, number of thawed embryos transferred, presence of sponsoring embryos and intact embryos. And the survival rate of thawed embryos with different morphology, cell stage and storage time was evaluated. Result: Transfer with three or more than three thawed embryos resulted in pregnancy rates of 38.5% and 35.7%, respectively, compared with 5.3% for transfer of fewer than three embryos. The presence of sponsoring embryos and intact embryos significantly increases pregnancy rate in embryo freezing and thawing program. No other factor examined had any effect on pregnancy outcome. The survival rate of good morphology embryos was higher than poor ones, but was not influenced by cell stage and storage time. Conclusion: Embryo morphology before freezing, number of thawed embryos transferred and the presence of intact embryos are important to the outcome of embryo freezing and thawing program.

Can apoptosis analysis of cumulus granulosal cell evaluatethe potential vitality of replaced embryo?

Objective: We evaluated the relationships between the incidence of the apoptotic cell of human granulose cell (GC) from the oocytes during intracytoplasmic sperm injection (ICSI) and the pregnancy rate. Methods: 275 oocytes were retrieved from 29 patients with aging between 23 - 38 years, who underwent ICSI (21), percutanious sperm aspiration (PESA-ICSI)and testicular sperm extraction (TESE-ICSI) (7), only one case came from conventional IVF. The patients were divided into two groups based on pregnancy or not. The cumulus cells were collected to measure the number of apoptotic cell by using flow cytometer. The degree of cumulus GC apoptosis and clinic pregnancy rate were assessed, and compared with embryo morphology and number of blastomere. Results: The apoptosis value in pregnancy gruop (9 cases) were lower than the nonpregnancy group (19 cases) (P<0. 05). In pregnancy group, the apoptosis value in the GC obtained from replaced embryos (37) were significantly lower than that of the nonreplaced embryos (78) (P<0. 02). Conclusion: The results indicated that the embryos with lower apoptosis value would have the potency of increase pregnancy rate. It will be possible to elevate the clinic pregnancy rate by selecting the replaced embryos bases on the apoptosis value of GC from oocytes in addition to the morphological score.

Effect of Delayed Insemination on Holstein Cows＇ Reproductive Performance

Holstein cows＇ fertility has decreased in the last decade, creating a need for new management methods to improve the reproductive performance which in this case was defined by pregnancy rates and number of artificial inseminations （AI） per pregnancy. Previous studies showed that deliberately delaying rebreeding until after peak lactation can improve reproductive performance compared with the traditional rebreeding in early lactation. The objective was to compare the reproductive performance of cows in consecutive lactations of different lengths. The reproductive performance （pregnancy rate and number of insemination to pregnancy） of 62 Holstein cows involved in a 16 months extended lactation trial was recorded and compared with the reproductive performance of the previous and following 10 months lactation of the same cows. It was hypothesized that a late rebreeding （at eight months, 16 months lactation） will improve the reproductive performance compared with an early rebreeding （at two months, 10 months lactation） in the previous lactation, and it will have no negative effect on the reproductive performance in the following lactation with an early rebreeding. The results showed that the pregnancy rates were similar for the 16 months lactation and the previous and following 10 months lactations, while the number of AI to pregnancy was increased in the 10 months lactation, following by the 16 months lactation. The use of the double AI technique did not improve pregnancy rates compared with a single AI per estrus, and induced confusion, as how to report the herd reproductive performance. To conclude, the reproductive performance was similar between the heifers, primiparous and multiparous cows, and between 10 months and 16 months lactations.

Effect of Adding a Delayed Blastocyst to a Good Quality One during Embryo Transfer on ICSI Cycle Outcomes

Objectives: Study the effect of adding a delayed blastocyst to a transferred good quality one on ICSI cycle outcomes. Study design: Prospective cohort study. Participants/materials, setting, methods: 90 infertile patients aged from 20 - 35 years due to mild male factor, unexplained infertility or tubal factor. Patients with PCOS, endometriosis, RIF, poor responder and azoospermia were excluded. Setting: Duration 6 months from October 2019 to April 2020 in a private IVF center in Egypt. 30 cases were subjected to elective single embryo transfer and the other 60 with two embryo transfers, one good quality and another poor quality blastocyst. Results: (clinical pregnancy rate) was comparable between the two groups, being 47.7% and 36.7% in SET and DET groups respectively (p = 0.361). Miscarriage and ectopic pregnancy rate were observed in 10% of the cases pregnant after SET (group I) and in only 6.7% of the cases pregnant after DET (group II) denoting no significant statistical difference between the two groups. The highest incidence was missed miscarriages in the two groups and ectopic pregnancy was observed only in one case in group II (DET). Twin pregnancy occurred in 22% of pregnant females in the second group. Late pregnancy complications in the form of preterm labour, premature rupture of membrane and preeclampsia occurred mainly in pregnant females in the second group 18%. Conclusion: Neither adding a delayed blastocyst negatively affected the good one nor affected the live birth rate but increased multiple pregnancy rates.

Oocyte vitrification:A local validation of the method

Is there a really need to validate oocyte vitrification technique in an ART laboratory before establishing it in daily practice? Validation of micromanipulationbased technique, in this case oocyte vitrification, is essential prior to enlarging its use to routine practice. Oocyte vitrification is a new worldwide used technique and legal recently inFrance. This micromanipulation needs to be performed by a skilled and experienced embryologist and requires an internal assessment in each ART unit before any wide use. We designed a prospective study, from September 2011 to July 2012, using sibling oocytes from women who recovered more than 12 Metaphase II oocytes. A part of freshly recovered oocytes underwent immediate ICSI while the remaining oocytes were vitrified. 87 couples undergoing ICSI were selected based on number of mature oocytes available on the recovery day after denudation. A part of fresh MII oocytes were microinjected and the others were vitrified using an open system (Cryotop?). The major criterion of interest was the number of embryo transferred/ number of Metaphase II ratio for after ICSI on fresh oocytes (42/211) versus vitrified/warmed oocytes (51/204) (p > 0.05). Secondary studied criteria were survival rate (80.5% ± 26.3%), fertilization rate (68.9 ± 33.5) and finally, cumulative pregnancy rate obtained in this study is 40.2%. One of the benefits of such practice is the limitation of embryo freezing. However, the study design delays oocytes warming cycles, due to pregnancies triggered by the transfer of fresh derived oocyte embryos and to the priority to transfer all the frozen embryos before starting oocytes warming. Moreover, no data is available about children’ health. Oocyte vitrification represents not only a change in our daily practice to improve cumulative pregnancy rate but also a promising tool to develop egg banking and donation. Clinical Trials Registration number: 209 R02.

Intrauterine Insemination—Our Results between the Years 2008-2012

The purpose of this retrospective study was to determine whether or not there was a significant relationship between women’s age as a cause of sterility and pregnancy after IUI. Furthermore, we evaluated the effect of stimulation of antiestrogens and time of hCG administration on the success of IUI in relation to the age of women. During the period between 2008 and 2012, we performed a total number of 793 IUI. Patients were prepared for IUI in the natural cycle and stimulation with antiestrogens (clomiphene citrate-CC). Ovulation was induced by hCG (Ovitrelle) 40 hours before IUI or immediately after the procedure. Sperm was processed through density gradients. The average success rate of IUI was 10.2% of pregnant women per cycle. Significantly the highest number of pregnant women 16.3% was women with a diagnosis of anovulation. Significantly the lowest success rate of IUI was at the immunological cause of infertility and endometriosis. There was no evidence of age dependence for women on the success of IUI. Stimulation of CC did not significantly increase the chance of becoming pregnant. There was also no statistically significant difference in hCG before and after IUI pregnancy success. The most important group of women for whom IUI is a suitable form of assisted reproduction consists of patients of 35 years old with anovulation cause of sterility. Those patients with an immunological cause of infertility and endometriosis have significantly lower chances of conceiving after IUI and it is preferable for them to choose other techniques of assisted reproduction and embryo transfer.

针灸辅助改善冻融胚胎移植疗效的网状meta分析

Objective:To evaluate the clinical effect of acupuncture-moxibustion as the adjuvant therapy on frozenthawed embryo transfer(FET)using network meta-analysis.Methods:In PubMed,Embase,Cochrane Library,Chinese National Knowledge Infrastructure(CNKI),Wanfang database(WanFang),VIP database and Chinese Biomedical Literature Database(SinoMed),the randomized controlled trials(RCTs)of the adjuvant therapy of acupuncture-moxibustion for FET were retrieved,from database inception to April 1,2021.Cochrane risk of bias assessment tool was used to screen and evaluate the quality of the included studies,and RevMan 5.3,GeMTC0.14.3 and Stata16.0 software were adopted to complete the network meta-analysis.Results:Twenty-nine RCTs comprising 2880 patients were finally included,involving 17 interventions and 4 outcome measures.The results of network meta-analysis showed that the top three therapies under each outcome based on the magnitude of SUCRA values were:(1)Clinical pregnancy rate(CPR,%):"transcutaneous electrical acupoint stimulation+herbal medicine"(76.4),"moxibustion+herbal medicine"(74.7),"acupuncture+moxibustion"(73.3);(2)Biochemical pregnancy rate(BPR):"moxibustion+herbal medicine"(89.3),"acupuncture+moxibustion"(82.1),"acupuncture+herbal medicine"(78.7);(3)Endometrial thickness:"acupoint injection+Western medicine"(87.2),auricular therapy(76.8),"acupuncture+herbal medicine"(73.5);(4)Type A endometrial morphology rate:"acupoint injection+Western medicine"(78.3),"moxibustion+herbal medicine"(58.0)and"acupuncture+moxibustion"(52.6).Conclusion:The combined treatment of acupuncture-moxibustion was superior to single therapy for FET patients.The combined therapy of transcutaneous electrical acupoint stimulation and herbal medicine had the best effect for improving CPR,"moxibustion+herbal medicine"obtained the best average comprehensive effect,and"acupoint injection+Western medicine"was conductive to ameliorate the endome trial thickness and morphology.Due to the limitations of existing studies,more high-quality RCTs are needed in the future to further verify these conclusions.

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.

Intrauterine Insemination Treatment Strategy for Women over 35 Years Old： Based on a Large Sample Multi-center Retrospective Analysis

As we all known, maternal age and ovarian reserve are two of the most important prognosis i-hctors for fertility, in 1980, the study of Menken et al. showed the female fertility declined after 32 years old, especially after 37 years old.