Effect of different fertilization time after human chorionic gonadotropin injection on fertilization outcome of patients in vitro fertilizationembryo transfer

Objective:To explore the effect of different fertilization time after human chorionic gonadotropin(HCG)injection on the outcome of fertilization in vitro fertilization-embryo transfer(IVF-ET).Methods:One thousand one hundred and forty IVF-ET cycles from January 2016 to August 2018 were analyzed retrospectively.According to the different fertilization time after injection of HCG divided into four groups:Group A(38.0 h~39.0 h),Group B(39.1 h~40.0 h),Group C(40.1 h~41.0 h),and Group D(41.1 h~42.0 h).The normal fertilization rate,the normal cleavage rate,the embryo utilization rate,the high-quality embryo rate,the clinical pregnancy rate,the implantation rate,and the spontaneous abortion rate were analyzed among the groups.Then we investigated the effect of different promotion methods on the outcome of fertilization during the optimal fertilization time.Results:There was no significant difference in 2PN cleavage rate,available embryo rate,clinical pregnancy rate,implantation rate and abortion rate among the four groups(P>0.05).The high-quality embryo rate in Group D(44.6%)was the highest,and was significantly different among the four groups(P<0.05).The normal fertilization rate in Group D(71.6%)was the highest,and was significantly different among the four groups(P<0.05).The normal fertilization rate(78.1%)of antagonist group was significantly higher than other groups(P<0.05).Conclusion:The different fertilization time after HCG injection have effects on high-quality embryo rate and normal fertilization rate of patients in IVF-ET.The appropriate fertilization time of patients in IVF-ET was 41 h~42 h after HCG injection in our reproductive center,improved the clinical pregnancy rate and reduced the early abortion rate.The GnRH-ant protocol is superior to other protocol in IVF-ET.

Effect of Patient Age and Embryo Parameters on Pregnancy Outcomein In Vitro Fertilization-Embryo Transfer(IVF-ET)

Objective To study the effect of patient age, the number and quality of embryos transferred on pregnancy outcome in in vitro fertilization-embryo transfer procedures （IVF-ETs）. Methods A retrospective study was conducted with infertile women who underwent a total of 1 800 cycles of lVF-ET and intracytoplasmic sperm injection （ICSI） at the Reproductive Medicine Center of the Third Affiliated Hospital of Guangzhou Medical College from Jan. 2006 to Dec. 2007. The patients were divided into three groups based on age （year）. 〈30, 30-34 and 235. The rates of clinical pregnancy and multiple pregnancies were compared in each group when 1-3 embryos and 0-3 goodquality embryos were transferred respectively. Results 1） In the group of patients aged 〈30 years, there was no significant difference in pregnancy outcomes with 1-3 embryos transferred. However, pregnancy rates were similar when 2 3 good-quality embryos were transferred, which was significantly higher compared with 0-1 good-quality embryos transferred; the incidence of multiple pregnancies was not an issue when only 1 embryo was transferred. 2） The pregnancy rate of the patients aged 30 34 was not significant not only when only 2-3 embryos were transferred but also when 2-3 good-quality embryos were transferred, which was significant compared with when 1 embryo or 0 1 good-quality embryo was transferred. The subgroup of 3 good-quality embryos transferred, at the same time, was expected to significantly increase multiple pregnancy rate. 3） For the patients aged 235, there were similar pregnancy rates in the subgroup involving 1-3 embryos transferred. Compared with 0-2 good-quality embryos transferred, the pregnancy rate was significantly higher in the patients with 3 good-quality embryos transferred. An increased trend toward multiple pregnancies was observed among not only the subgroups with 1-3 embryos transferred, but also when 1-3 good-quality embryos were transferred, although it was significantly higher in patients with 3 good-quality embryo transferred. Conclusion In an effort to achieve the ideal pregnancy rate without the risk of multiple pregnancies, it is desirable to employ a single good-quality embryo transfer for patients aged 〈30 years and 2 good-quality embryos for patients aged 330. As older women （aged 335 years）, this is important, need to abstain from poor-quality embryo transferred by increasing the number of embryos transferred in an effort to improve the rate of clinical pregnancy, if the patients have had enough 2 high-quality embryos.

精子形态对体外受精－胚胎移植治疗结局的影响

目的：探讨正常形态精子百分率对体外受精-胚胎移植（IVF-ET）治疗结局的影响。方法回顾分析于生殖医学中心接受治疗的323个IVF-ET周期，采用WHO第5版精液质量分析标准严格进行精子形态学分析，研究分3组：A组：1%≤正常形态精子百分率﹤2.5%，中度畸形组；B组：2.5%≤正常形态精子百分率﹤4%，轻度畸形组；C组：正常形态精子百分率≥4%，正常形态组。比较各组间受精率、卵裂率、可移植胚胎率、优质胚胎率、着床率、临床妊娠率。结果各组间女方年龄、不孕年限、男方年龄差异均无统计学意义（P﹥0.05）。三组患者间多精受精率、双原核卵裂率、可移植胚胎率、优质胚胎率、着床率、临床妊娠率等差异均无统计学意义（P﹥0.05），但随着正常形态精子比率升高，受精率随之升高，三组之间差异有统计学意义（P﹤0.05）。结论在常规IVF-ET中，精子形态可在一定程度上影响卵子的受精率，但与胚胎质量、妊娠结局无明显相关性。

Clinical Analysis on IVF-ET Treatment of 9 Cases of Post-cesarean Section Uterine Diverticulum

Objective To evaluate the influence of uterine diverticulum patients who have a history of cesarean section on IVF-ET process and pregnancy outcome. Methods Nine patients with uterine diverticulum after cesarean were retrospectively analyzed, who have received IVF-ET treatment. Clinical pregnancy rate and embryo implantation rate were measured. Results There were 9 infertility patients in all, 7 cases with tubal factor, 2 with unexplained factor; 3 cases were associated with prolonged menstruation period, including 1 patient was misdiagnosed as dysfunctioned uterine bleeding. There were a total of 16 transplantation cycles, including14 fresh cycles and 2 thawing cycles. Each cycle had at least one high-quality embryo available for transfer. Five cases were difficult to transfer. Two were clinical pregnancie, the implantation rate was 5.13% （2/39）. Conclusion In this study, 14 fresh cycles all had high-quality embryo transfer, uterine diverticulum had no effect on the development of ovums and the formation of high- quality embryos. But forming uterine diverticulum after cesarean section may lead to secondary infertility or patients with prolonged menstruation period, it also may lead it difficult to transfer during the treatment of IVF-ET and affect embryo implantation. So the patients with a history of cesarean section shall receive ultrasonic examination or hysteroscopy routinely before IVF treatment. If necessary surgical treatment is required.

Related Factors of in vitro Fertilization and Embryo Transfer Patients with Complete Fertilization Failure

Objective To find the possible factors predicting fertilization failure of in vitro fertilization-embryo transfer （1VF-ET）. Methods The IVF-ET patients with complete fertilization failure （experimental group, n =32） were analyzed retrospectively. The patients whose oocytes retrieved at the same day and cultured on the same incubators with ≥ 50% fertilization rates were matched as the control （n=56）. Results The infertility duration, superovulation days, the rates of primary case, progesterone （P） level 〉3.12 nmol/L rate and rate of severe abnormal sperm （abnormal sperm rate 〉95%） in experimental group were significantly higher than those in the control （6.4 ±3.1 years, 12.6 ±2.2 d, 56%, 43%, 43% vs 4.6±2.9years, 11.6 ±% 1.3 d, 33%, 23%, 23%, respectively, P〈0.05）. Conclusion We should pay attention to these patients with primary infertility, longer infertility duration and superovulation days （〉6.4 years and 〉12.6 d） and having increased level of P on hCG injection day （〉3.12 nmol/L）, abnormal sperm rate 〉95% at the same time. They should be included in such patients at high risk of fertilization failure.

Effects of Triggering Oocytes Maturation by rhCG 250 μg vs uhCG 10 000 IU on the Outcomes of IVF-ET Treatment in Chinese Population:A Cohort Study

Objective To compare the effects of recombinant hCG （rhCG） 250 μg and urinary hCG （uhCG） 10 000 1U on triggering oocyte maturation during COH/1VF-ET in Chinese women. Methods A retrospective cohort study which included COH/1VF-ET cases at reproductive medical center of Peking University Third Hospital from March to May 2010 was performed. Analysis of covariance （ANCOVA） was taken for data analysis. Results There were 318 cycles （group A） using rhCG 250μg and 810 cycles （group B） using uhCG 10 000 1U for triggering. In 1VF procedure, there were no significant differences in the number of oocyte retrieval, 2PN fertilization rate, good-quality embryo rate, embryo implantation rate and clinical pregnancy rate between the two groups. The delivery weeks, mean neonatal birth weight and live birth rates were also similar between the two groups. There was no local allergic reaction after injection or neonatal birth defect in group A. Conclusion The rhCG 250 μg and uhCG 10 000 IU have equal effects on triggering oocyte maturation for patients with normal ovarian function in Chinese population. rhCG may have even lower local discomfort occurrence.

Different Pretreatments before Application of GnRH Antagonist Protocol in Controlled Ovarian Hyperstimulation

Objective To analyze the clinical features and outcome of patients who used different pretreatments before application of gonadotropin-releasing hormone antagonist protocol during in vitro fertilization - embryo transfer （IVF-ET） cycles, and to explore how effective to use the antagonist protocol. Methods A retrospective analysis was performed. All the ET cycles were divided into three groups, group A （n=125） used short acting GnRH agonist before GnRH antagonist treatment, group B （n=113） used short-acting oral contraceptives before GnRH antagonist treatment, group C （n=81） was untreated before GnRH antagonist treatment. All the patients had no tubal fluid, endometrial polyps and no anatomical abnormalities of the uterus, from April 2010 to December 2010. The patient＇s age, dose and duration of gonadotropin （Gn） treatment, the serum LH and E2 levels on the day of hCG injection, the number of oocytes retrieved, the rates of good-quality embryos, the clinical pregnancy rates were compared. At the same time, 261 GnRH agonist long protocol cycles （group D） were selected at the same period as further comparison. Results The patients in group C （32.9 ~ 4.8 years） were significantly older than those in groups A and B （31.6 ___＋3.7 years, 31.2 ___%4.1 years）（P 〈0.05）. The dose and the duration of Gn in group C were significantly lower than those in groups A and B. The serum LH level on the day of hCG injection in group A and group B was significantly lower than that in group C （P 〈0.05）, especially in group A. The endometrium was the thinnest in group B. There were no significant differences in the fertilization rates and the good-quality embryosrates among them. The clinical pregnancy rate of group B decreased significantly compared with groups A and C （P〈0. 05）. The clinical pregnancy rate of group C was the highest among them. There was no significant difference of clinical pregnancy rates between group C and group D （37% vs 40.2%,P〉0.05）. However, the dose （19.8 ±6.6 ampoule vs 26.4 ±8.1 ampoule） and the duration （9.0± 1.6 d vs 11.6±2.5 d） of Gn treatment in group C were decreased significantly than those in group D, P〈0.05. Conclusion The short acting GnRH agonist used before GnRH antagonist treatment during IVF-ET cycles failed to improve the pregnancy rates, the use of short-acting oral contraceptives before GnRH antagonist treatment makes the pregnancy rates decrease significantly, but untreated before GnRH antagonist protocol can get a better clinical outcome compared with agonist long protocol Untreated GnRH anagonist protocol is the best GnRH anagonist protocol.