来曲唑联合克罗米芬治疗卵巢储备功能下降对患者体外受精―胚胎移植结局的影响

目的探究来曲唑联合克罗米芬治疗卵巢储备功能下降(DOR)对患者体外受精―胚胎移植(IVF-ET)结局的影响。方法选取郑州市精神病防治医院2019年4月至2020年7月间接受IVF-ET且合并DOR的110例患者为研究对象,按照数字随机表法分为对照组和观察组,各55例。对照组患者采用克罗米芬联合小剂量促性腺激素微刺激的方案进行干预,观察组55例患者在对照组基础上联合应用来曲唑,对比两组患者的促排卵参数(HCG日子宫内膜厚度、获卵数、可利用胚胎数、优质胚胎数)及临床结局。结果观察组患者的HCG日子宫内膜厚度、获卵数、可利用胚胎数、优质胚胎数均显著高于对照组,差异有统计学意义(P<0.05);观察组患者的种植率、临床妊娠率均显著高于对照组,差异有统计学意义(P<0.05);两组多胎率、流产率比较,差异无统计学意义(P>0.05)。结论来曲唑联合克罗米芬治疗DOR患者的疗效确切,可提高胚胎种植率和妊娠率,且不会增加流产率,值得临床应用。

Double Pulmonary Embolism and Left Common Iliac Vein Thrombosis after in vitro fertilization and embryo transfer： a Case Report

This article discusses the mechanism, diagnosis, and treatment of a case of double pulmonary embolism and left common iliac vein thrombosis following in vitro fertilization （IVF） and embryo transfer （ET） to arouse vigilance for unexpected thrombosis after ovarian hyperstimulation and to serve as a clinical reference of this condition. This paper reports the case of a woman with double pulmonary embolism and left common iliac vein thrombosis after IVF-ET and the successful management of this condition. The woman had primary infertility, and underwent IVF-ET with 14 ooeytes recovered and two embryos transferred. The patient suffered breathing difficulty 17 days after the ET, and was hospitalized 6 days later as her condition had exacerbated. Computed tomographic （CT） angiography of pulmonary arteries showed double pulmonary embolism, left common iliae vein thrombosis, abnormal density shadow in uterine appendages, and ascites. A healthy baby boy and girl were safely delivered by Caesarean section after successful treatment. Thrombosis after IVF-ET is an uncommon but life-threatening complication and concurrent pulmonary embolism is even rarer. It is suggested that careful thrombosis risk assessment be taken before therapy and particular attention be paid to patients with special body constitutions to develop thrombosis. Whenever patients experience breathing difficulty after IVF-ET, it is strongly advised to examine the possibility of pulmonary embolism. The main treatments for thrombosis are anticoagulant therapy by low-molecular-weight heparin and thrombolysis by urokinase.

Effect of electroacupuncture on oocyte quality and pregnancy of patients with PCOS undergoing in vitro fertilization and embryo transfer

Objective To observe the impacts of electroacupuncture （EA） on oocyte quality and pregnant outcome for the patients with polycystic ovary syndrome （PCOS） undergoing in vitro fertilization and embryo transfer （IVF-ET） and explore its potential mechanism. Methods Sixty-six patients with PCOS and undergoing IVF-ET were divided into two groups randomly, including an observation group （34 cases） and a control group （32 cases）. Ethinylestradiol and cyproterone acetate tablets and gonadotropin-releasing hormone agonist were administered for long-program superovulation in either group. In the observation group, the intervention of EA was applied to Guānyuán （关元 CV 4）, Zhōngjí （中极 CV 3）, Sānyīnjiāo （三阴交 SP 6）, Zǐgōng （子宫 EX-CA 1） and Tàixī （太溪 KI 3） additionally for 30 min, once daily, 1 menstrual cycle before controlled ovarian hyperstimulation （COH） and during COH. The pregnant outcome, evaluation of kidney deficiency syndrome, blood hormone level on the day of human chorionic gonadotropin injection and the concentrations of stem cell factor （SCF） in the serum and follicular fluid on the day of oocyte collection were compared between the two groups. Results The score of kidney deficiency symptoms was reduced remarkably after treatment in either group and the improvement in the observation group was superior to that in the control group （P0.01）. The fertilization rate [（76.25？±？20.33）% vs （66.34？±？15.44）%], cleavage rate [（98.66？±？3.70）% vs （94.47？±？9.45）%] and the rate of high-quality embryos [（60.20？±？22.20）% vs （50.55？±？16.15）%] in the observation group were all superior to those in the control group separately （all P0.05）. Clinical pregnancy rate （46.67%, 14/30） in the observation group was higher than that （37.93%, 11/29） in the control group, but without statistical difference （P0.05）. SCF concentrations in the serum and follicular fluid on the day of oocyte collection in the observation group were higher obviously than those in the control group （both P0.05）. Conclusion Electroacupuncture plays an active role in the pregnant outcomes of PCOS patients undergoing IVF-ET and it can relieve the symptoms of kidney deficiency in terms of TCM and improve clinical pregnant rate. The mechanism is relevant to the overall adjustment of organic endocrinal system and the local micro-environment of ovary and the improvement of oocyte quality through the up-regulation of SCF concentration.

Effects of electro-acupuncture on embryo implanted potential of patients with infertility of different syndromes

Objective To explore the impacts of electro-acupuncture on embryo implanted potential and its molecular mechanism in patients with infertility of different syndromes. Methods Among infertile patients treated with in vitro fertilization and embryo transplantation （IVF-ET） combined with electro-acupuncture, 82 cases of kidney deficiency syndrome （group A）, 74 cases of liver qi stagnation syndrome （group B） and 54 cases of phlegm dampness syndrome （group C） were selected. Patients in three groups all received a long program of ovarian hyperstimulation. Additionally, electro-acupuncture was applied before controlled ovarian hyperstimulation （COH） and in the process of ovarian hyperstimulation. Contents of human leukocyte antigen G （HLA-G） in the serum were determined in three groups respectively on the 2nd day of menstruation （M2） and the day of human Chorionic Gonadotropin （hCG） injection. Content of HLA-G in the culture solution of three groups was examined separately on the day of embryo transplantation. The fertilization rate, implantation rate and clinical pregnancy rate were observed for patients in three groups. Results Contents of HLA-G in the serum on the day of hCG injection and in the culture solution on the day of embryo transplantation in group A and B were significantly higher than those in group C （all P0.05）. However, there was no significant difference with contents of HLA-G in serum on M2 day among three groups. The high quality embryo rate in either group A （73.6%, 352/478） or group B （70.6%, 379/537） was significantly higher than that in group C （54.2%, 208/384） with significantly statistical difference （all P0.01）. But there were no significant differences in clinical pregnancy rate, fertilization rate and cleavage rate among three groups. Conclusion Electro-acupuncture combined could increase contents of HLA-G in the body and the level of HLA-G secreted from embryos of patients in the process of IVF-ET. Eventually, the pregnancy outcome and the pregnancy rate are improved. It showed better clinical effects of electro-acupuncture for patients with kidney deficiency and liver qi stagnation syndromes than those of phlegm dampness syndome.

Effects of body mass index on the outcomes of in vitro fertilization in Chinese patients with polycystic ovary syndrome: a retrospective cohort study

Objective: To investigate the effects of body mass index(BMI) on the outcomes of in vitro fertilization(IVF) in Chinese patients with polycystic ovary syndrome(PCOS). Methods: In the retrospective cohort study, a total of 1074 patients with PCOS undergoing IVF between April 2010 and May 2017 in two reproductive medicine centers, respectively in eastern China(Women's Hospital, School of Medicine, Zhejiang University, Zhejiang Province) and in southern China(Maternal and Child Health Care Hospital of Liuzhou, Guangxi Province), were included. The patients were divided into four groups according to the recommended Chinese BMI cut-off points: underweight(BMI<18.5kg/m^2), normal weight(18.5kg/m^2≤BMI<24.0kg/m^2), overweight(24.0kg/m^2≤BMI<28.0kg/m^2), and obese(BMI≥28.0kg/m2). The basic characteristics of the PCOS patients, the details of IVF treatment, and the pregnancy outcomes were collected. Main results: There were no significant differences among the normal weight, overweight, and obese PCOS patients undergoing IVF on the biochemical pregnancy rate, clinical pregnancy rate, miscarriage rate, live birth rate, or term delivery rate(P>0.05), although the overweight and obese PCOS patients required more gonadotropin(Gn)(P<0.001) as well as longer stimulation period(P<0.001), and got less retrieved oocytes(P<0.05) and fertilized oocytes(P<0.05). The underweight PCOS patients required less Gn(P<0.05) and achieved higher live birth rate and term delivery rate(P<0.05), compared with the normal weight PCOS patients. Conclusions: High BMI had no negative effects on the outcomes of IVF in Chinese patients with PCOS; however, the conclusion may seem a little limited due to the retrospective design and the potential bias.

Effects of Chinese herbs combined with in vitro fertilization and embryo transplantation on infertility:a clinical randomized controlled trial

OBJECTIVE： To assess the effects of using Chinese herbs in assisted reproductive technology. METHODS： Four hundred and thirty-three subjects aged less than 42 years with infertility due to Fallo- pian tube or male-related factors who were willing to undertake in vitro fertilization and embryo trans- plantation were randomly allocated to a Chinese herb intervention group （n=216） or a conventional treatment control group （n=217）. All subjects re- ceived one of four routine ultra-ovulation-promot- ing therapies at the Reproductive Center in the Third Hospital Affiliated to Beijing University ac- cording to their physician＇s assessments. The sub- jects in the intervention group received various Chi- nese herbs depending on their conventional treat- ment. Endometrial thickness, number of acquired eggs, and rates of normal fertility, high-quality em- bryos, biochemical and clinical pregnancy of sub- jects were assessed in both groups.RESULTS： The high-quality embryo rate of 51.9%, biochemical pregnancy rate of 51.0%, clinical preg- nancy rate of 44.2% and endometrial thickness of （10.84± 1.75） mm in the intervention group were all significantly higher than those in the control group [48.7%, 38.9%, 34.8%, and （10.52±1.50） mm, respec- tively; P〈O.05]. The normal fertility rate of 58.5% in the Chinese herb group was also significantly supe- rior to the 54.7% achieved in the control group （P〈 0.01）. There were no statistically significant differ- ences （P〉0.05） in the average number of acquired eggs within a single cycle, incidence of excessive stimulation of ovary, rates of embryo transplanta- tion or early abortion and birth of living babies be- tween the two groups. CONCLUSION： Our findings indicate that Chinese herbs increase endometrial thickness, improve the quality of fertility and embryo, and promote embry- onic nidation, thus enhancing the success rate of in vitro fertilization/intracytoplasmic sperm injec- tion-embryo transplantation cycle. Using Chinese herbs improves the outcomes and safety of assist- ed reproductive technologies.

Effect of traditional Chinese comprehensive therapy on gestation in patients with previously failed in vitro fertilization and embryo transfer

OBJECTIVE: To explore the effect of traditional Chinese comprehensive therapy(TCCT) on promoting gestation in patients with previously failed in vitro fertilization and embryo transfer(IVF-ET) because of kidney deficiency, liver stagnation, and blood stasis(KLB).METHODS: Sixty-seven patients were enrolled in this study and divided into two groups: a trial group with 35 patients and a control group with 32 patients. The trial group was given TCCT for 3months, then administered IVF-ET or awaited natural pregnancy. The control group was administered IVF-ET without TCCT 3 months after the previous IVF-ET or natural pregnancy attempt. The patterns of KLB were observed both before and after treatment. The natural pregnancy rate of the two groups was calculated after treatment. Differences between the two groups were compared after using IVF-ET treatment again in fertilized egg number and fertilization rate were evaluated.RESULTS: After treatment with TCM comprehensive therapy, seven patients in the treatment group became pregnant, while there were no successful conceptions in the control group. The difference in clinical pregnancy rate in the initial cycle and transfer cycle of IVF were significantly different(P <0.05). The trial group had a significantly higher conception rate than that of the control group(P <0.05).CONCLUSION: TCCT can promote the natural pregnancy rate in patients with previously failed IVF-ET.TCCT could increase patients' fertilized egg number, fertilization rate, pregnancy rate, and clinical pregnancy rate after another IVF-ET treatment.TCCT can also relieve the symptoms of KLB.

Effects of acupuncture on ovarian blood supply and pregnancy outcomes in patients receiving assisted reproduction

To observe the effects of acupuncture at the follicular phase on ovarian blood supply and pregnancy outcomes in patients who received in vitro fertilization/intracytoplasmic sperm injection-embry transfer （IVF/ICSI-ET） of assisted reproductive technology （ART）. Methods： A total of 169 IVF/ICSI-ET female recipients from the Reproductive Center of Xiehe Hospital, Tongji Medical College, Huazhong University of Science ＆ Technology were randomized into an observation group （57 cases）, a placebo group （54 cases） and a control group （58 cases）. The observation group received acupuncture during the follicular phase, meanwhile the placebo group received placebo-acupuncture, and the control group did not receive acupuncture. The hemodynamic index, biochemical pregnancy rate and clinical pregnancy rate of each group were observed, respectively. Results： As to the ovarian arterial hemodynamic index, the pulsatility index （PI）, resistance index （RI）, and the systolic-to-diastolic peak velocity ratio （S/D） of the observation group were （0.819＋0.131）, （0.552＋0.055） and （2.306＋0.512）, respectively, obviously lower than those in the placebo group and the control group, and the differences were statistically significant （all P〈0.05）, but there were no statistically significant differences between the placebo group and the control group （all P〉0.05）. As to the biochemical pregnancy rate and clinical pregnancy rate, the biochemical pregnancy rate in the observation group was 64.9% and the clinical pregnancy rate was 52.6%, which were significantly higher than those in the placebo group and the control group, and the differences were statistically significant （all P〈0.05）, while there were no significant differences between the placebo group and the control group （both P〉0.05）. Conclusion： Acupuncture treatment during the follicular phase can improve ovarian blood supply and pregnancy rate in those receiving IVF/ICSI-ET.

Effect of soothing liver therapy on oocyte quality and growth differentiation factor-9 in patients undergoing in vitro fertilization and embryo transfer

OBJECTIVE:To investigate the effect of Soothing liver therapy on infertile women undergoing in vitro fertilization and embryo transfer(IVF-ET)and to explore its mechanism.METHODS:Fifty-eight women with tubal infertility were randomized into two groups:30 in an experimental group treated with Xiaoyao powder(Shugan)plus gonadotropin-releasing hormone analog(GnRHa)/follicle-stimulating hormone(FSH)/human chorionic gonadotropin(hCG)and 28 in the control group who were treated with GnRHa/FSH/hCG only.The total gonadotropin(Gn)doses required,endometrial thickness,oocyte numbers,high quality embryo production rate and pregnancy rate of the two groups were compared.The concentration of growth differentiation factor-9(GDF-9)in follicular fluid was detected by western blotting and the expression of GDF-9 mRNA in granulosa cells was measured using reverse tran-scription-polymerase chain reaction amplification.RESULTS:In the experimental group,the Gn dose was significantly lower than that in the control group;the endometrial thickness,high quality embryo production and pregnancy rates were significantly higher and the expression of GDF-9 mRNA was also significantly higher than in the control group(all P<0.05).CONCLUSION:Shugan treatment can improve the pregnancy rate of women with tubal infertility;its mechanism is possibly related to the increased expression of GDF-9 in granulosa cells.

Ear Acupuncture Anesthesia for In Vitro Fertilization and Embryo Transfer Egg Retrieval

Objective：To observe the anesthesia effect of ear acupuncture for in vitro fertilization-embryo transfer （IVF-ET） egg retrieval.Method：All of 160 IVF-ET cases were allocated into a treatment group （120 cases） and a control group （40 cases）.Ear acupuncture and Pethidine Hydrochloride （Dolantin） were employed respectively to alleviate pain.After that,the anesthesia effects in two groups were compared.Results：There were no significant differences in anesthesia effect and retrieved eggs between the treatment group and the control group （P〉0.05）.Conclusion：Ear acupuncture can obtain similar effects as Pethidine Hydrochloride;however,it is safer and more effective.