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.

Support from Healthcare Professionals for Couples/Partners Undergoing Assisted Reproductive Technology in Japan: A Literature Review

Background and Purpose: A growing number of couples/partners have been undergoing assisted reproductive technology (ART) in Japan. The purpose of this study was to clarify the support from healthcare professionals based on the support vectors in the Family Care/Caring Theory proposed by Hohashi (2015) through a literature review. Methods: Using Ichushi-Web, we searched for original articles using the keywords “assisted reproductive technology”, “infertility”, “family”, “couple”, “nursing”, “care”, and “support”. Thirteen articles suitable for the purpose of this study were subjected to content analysis. Family support was encoded and grouped into subcategories and categories, and classified according to support vectors. Results: A total of 21 categories of support from healthcare professionals was extracted. Intervention for family internal environment included seven categories, such as “Nursing professionals stay close to females”. Intervention for family system unit included five categories, such as “Nursing professionals adjust couple/partner relationships”. Intervention for micro system only included “Nursing professionals provide opportunities for peer support to the couples/partners” and intervention for macro system only included “Nursing professionals encourage medical doctors to relate to females”. Intervention for family chrono environment included seven categories, such as “Healthcare professionals resolve female’s anxieties”. Conclusion: The support from healthcare professionals could be organized by the support vectors of Family Care/Caring Theory, but intervention for supra system (culture, religion, etc.) was lacking. Moreover, because most support was directed toward females or couples/partners, male-focused direct and/or indirect support are also needed. .

Embryo quality and chromosomal abnormality in embryos from couples undergoing assisted reproductive technology using preimplantation genetic screening

Objective:To detect common chromosomal aneuploidy variations in embryos from couples undergoing assisted reproductive technology and preimplantation genetic screening and their possible associations with embryo quality.Methods:In this study,359 embryos from 62 couples were screened for chromosomes 13,21,18,X,and Y by fluorescence insitu hybridization.For biopsy of blastomere,a laser was used to remove a significantly smaller portion of the zona pellucida.One blastomere was gently biopsied by an aspiration pipette through the hole.After biopsy,the embryo was immediately returned to the embryo scope until transfer.Embryo integrity and blastocyst formation were assessed on day 5.Results:Totally,282 embryos from 62 couples were evaluated.The chromosomes were normal in 199(70.57%)embryos and abnormal in 83(29.43%)embryos.There was no significant association between the quality of embryos and numerical chromosomal abnormality(P=0.67).Conclusions:Embryo quality is not significantly correlated with its genetic status.Hence,the quality of embryos determined by morphological parameters is not an appropriate method for choosing embryos without these abnormalities.

时差成像技术和人工智能在ART治疗中的应用

准确评估胚胎发育对于辅助生殖技术(ART)成功至关重要。传统方法多基于主观的胚胎形态学评估,缺乏客观性和实时性。时差成像技术(TLT)提供更稳定的培养环境,实现胚胎发育的动态监测,分析和建模不同发育时期的动态学参数,用于预测胚胎的植入潜力。然而,动态学参数通常需要人工标注,引入主观干扰,数据模型分析能力差异较大,与实际情况相差甚远,尤其在染色体整倍性分析方面表现较弱。随着人工智能(AI)的不断发展,TLT与AI的结合提供了减少TLT人工标注时间、提高胚胎植入率和染色体整倍性预测等方面的可能性。旨在探讨TLT结合AI在形态学和动态学参数方面对胚胎植入潜力和染色体整倍性的应用。

Assisted Reproductive Technology for HIV-1 Serodiscordant Couples: A Review of Current Controversies

Since 1992, assisted reproductive technology （ART） has been reported as a viable means of helping HIV-1 serodiscordant couples achieve pregnancy while theoretically reducing the risk for viral transmission. While the sum of the evidence suggests that ART is effective and safe, numerous controversies still exist, The follow- ing review addresses several of the important issues involved in the use of ART for HIV-serodiscordant couples, including patient selection, semen processing techniques, post-process HIV testing, the use of lUI vs IVF-ICSI.

Benign ovarian cysts in reproductive-age women undergoing assisted reproductive technology treatment

The scope of this review is to focus on the management of benign ovarian cyst in the reproductive-age group of women undergoing ART. Ovarian cysts are a common occurrence in this patient population. The differential diagnosis includes functional cysts, dermoid cysts, endometrioma. The appropriate evaluation includes medical history and physical examination, laboratory tests and imaging. The treatment options include conservative follow-up, medical treatment and surgery. This review will explore the differential diagnosis, appropriate work-up and treatment options to the various cyst types encountered.

NIPT对ART和自然妊娠胎儿染色体疾病产前筛查的检测效能比较研究

目的通过比较无创产前筛查(NIPT)对辅助生殖技术(ART)和自然妊娠胎儿染色体疾病的检测效能来探究NIPT在ART胎儿中的产前筛查价值。方法收集2020年8月—2022年12月于兰州大学第一医院分子检测实验室行NIPT的3011例孕妇病例资料。比较NIPT对自然妊娠组和ART组的检测效能,并分析检测差异及检测失败的原因。结果共筛查出47例高风险孕妇,检测阳性率为1.57%,其中有36例孕妇接受了介入性产前诊断。21-三体综合征、18-三体综合征在ART组和自然妊娠组的阳性预测值分别为50.00%、0和100.00%、33.33%,差异均无统计学意义;13-三体综合征在ART组的阳性预测值为50.00%,自然妊娠组未检出13-三体综合征高风险患者。性染色体异常及拷贝数变异在ART组和自然妊娠组的阳性预测值分别为0、33.33%和33.33%、33.33%,差异均无统计学意义。未发现假阴性病例,所有检测的非整倍体疾病的灵敏性均为100%,特异性均高于99.60%。结论NIPT检测ART胎儿的21-三体综合征、18-三体综合征和13-三体综合征有一定的可行性,其检测效能符合国家质量控制要求,但仍需要更大样本量的研究验证。

Live birth rates of assisted reproductive technology treatment and spontaneous conception among subfertile couples in Singapore: A follow-up study

Objective: To explore the potential predictors of a live birth (LB) outcome among subfertile couples of Asian ethnicity undergoing the first fertility treatment cycle;to assess the cumulative live birth rates after successive cycles;and to determine the incidence rate of spontaneous conception (SC).Methods:Subfertile couples were grouped according to treatment modalities at the first fertility treatment cycle: intrauterine insemination (IUI),in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and no treatment, and were followed-up for duration up to seven years. Multivariable logistic regression analysis was used for statistical analyses. Results: Age of female subjects [35-38 years, odds ratio (OR): 0.39;≥39 years, OR: 0.14], uterine factor subfertility (OR: 5.24), and treatment modalities (ORs: IUI 0.25, IVF 2.33 and ICSI 1.91) significantly predicted a LB outcome (P<0.05). The cumulative live birth rates were 11.7% IUI, 41.5% IVF, 27.5% ICSI and 22.6% from frozen embryo transfer cycles. The cumulative SC rate was 24.6% in the non-treated group and 10.7% in the treated group. All LBs from IVF cycles were delivered by the second cycle and within four years, compared to SC delivery of within five years in the non-treated group and six years in the treated group. Conclusions:Age of female subject, uterine factor and modalities of treatment are significant predictors for LB outcome at the first cycle. Higher delivery rates could be achieved following fewer successive IVF cycles and within a shorter duration compared to SC.

Awareness and perception of assisted reproductive technology practice amongst women with infertility in Northern Nigeria

Background: Involuntary infertility is a tragedy in most African setting. This is due to premium placed on fertility as a result of roles children fulfill in the family and the society. Aetiologic factors of infertility in sub-Saharan Africa are mostly infection related and they are mainly associated with poor treatment outcome to conventional non assisted conception technique. Objective: To evaluate the level of awareness and perception of assisted conception treatment among women attending fertility clinic. Methods: A descriptive cross-sectional study. Results: One hundred and ninety six women attending fertility clinic were interviewed. Mean age was 34.8year and mean duration of infertility of 4.1 years. Of the 196 infertile women interviewed, 150 (76.5%) have heard of Assisted Reproductive Technology treatment. Sources of information were mainly family relation (46%) and friends (28.7%). Knowledge on some of Assisted Reproductive Technology practices showed that 50.7% were aware that the treatment could fail, 36.8% knew it could be applied for male infertility treatment, 9.3% and 18.7% respectively are aware that donor oocyte and sperm could be used for treatment. Perception on babies conceived from assisted conception treatment revealed that 52% of patients interviewed could not comment if they are normal and natural babies. Majority of patients could not affirm if they will agree to the use of donor gamete or zygote for their treatment. Conclusion: Awareness of assisted conception treatment was high, however knowledge on specifics of treatment was low and perception on some of the practices was unfavorable. Sensitization of the public will help overcome some beliefs that may be at tangent to some practices of assisted conception.

Implementation and Evaluation of Infertility Reflection in Early Pregnancy after the Use of Assisted Reproductive Technology: A Feasibility Study

Background: This study aims to evaluate the infertility reflection in early pregnancy after assistive reproductive therapy (ART), including 1) process evaluation (the use and evaluation of infertility reflection) and 2) outcome evaluation (satisfaction of care needs, anticipatory anxiety towards the loss of a pregnancy or fetus, cognition of infertility experience, and depression and anxiety). Methods: This program evaluation study used a one-group pre-post-test design. The participants were 50 primiparas who had undergone ART at two fertility treatment facilities in a metropolitan area in Japan. For the infertility reflection, they conducted an online reflection. Data were collected three times: at the 5th week of pregnancy (Time 1), the 8th week of pregnancy as the final consultation at the clinic (Time 2), and the 16th week of pregnancy as the final point of early pregnancy (Time 3). Results: The data from 40 participants were analyzed. More than 80% of the users of the online reflection positively evaluated the appropriateness and usefulness of the methods and contents. Organized thoughts and feelings by reflection were shown as the reasons for the usefulness. The evaluation of the online reflection showed a relatively strong correlation with the Care Need Satisfaction Scale (CNSS) for both Time 2 and Time 3, but the online reflection did not show a significant correlation with the other outcome variables. There were no significant differences in outcome variables between users and non-users of online reflection between Time 2 and Time 3. Conclusions: Attempts at the reflection in early pregnancy require modified methods that do not have a negative impact and lead to the fulfillment of needs.

Clinical study of different fertilization methods of assisted reproductive technology on neonatal birth defects

Objective:To investigate the incidence of neonatal birth defects in assisted reproductive technology(ART)by in vitro fertilization(IVF)and intracytoplasmic sperm injection(ICSI).Methods:The clinical data of 4229 cases of singleton deliver by infertile patients under 35 years old who received IVF/ICSI-ET in our center were analyzed.According to different fertilization methods,they were divided into IVF group(2967 cases)and ICSI group(1262 cases).The general situation of birth,birth defects and the location of defects were compared between the two groups.Results:a total of 38 cases of neonatal birth defects were found,the incidence of birth defects was 0.89%,including 30 cases(1.01%)in IVF group and 8 cases(0.64%)in ICSI group.There was no significant difference in the incidence of birth defects between the two groups(P>0.05).There was also no significant difference in birth weight,gestational age and gender ratio between the two groups(P>0.05).Conclusion:Different fertilization methods in assisted reproductive technology do not increase the incidence of neonatal birth defects.

Pregnancies Outcome after Assisted Reproductive Technology: A Multicenter Case Control Study in a Low Income Setting Douala, Cameroon

The objective was to assess the outcome of pregnancies after assisted reproductive technology (ART). It was a case-control study carried out in four health facilities in Douala-Cameroon, over a period of five years. The cases were pregnant women who conceived through ART and the controls were those who conceived naturally. Cases and controls were matched for maternal age and parity (one case for two controls). A logistic regression analysis was used to compute Odds ratios. Statistical significance was set at 0.05. A total of 174 women who conceived through ART and 348 who conceived naturally were enrolled. Some independent factors associated with ART were: age over 45 years [aOR: 7.55; 95% CI (1.55 - 36.76);p: 0.01], twin pregnancies [aOR: 16.55; 95% CI (7.91 - 34.60);p < 0.01], Cervical cerclage [aOR: 3.04; 95% CI (1.23 - 7.50);p: 0.01], miscarriages [aOR: 11.73; 95% CI (5.07 - 27.10);p: 0.01], elective cesarean section [aOR: 4.63; 95% CI (2.27 - 9.45);p: 0.01] and low birth weight [aOR: 3.32; 95% CI (1.90 - 5.82);p < 0.01]. Women who conceived by ART were older with higher rates of multiple pregnancy and complications. We recommend transfer of a single embryo.

The relationship between maternal body fat and pre-implantation embryonic weight: Implications for survival and long-term development in an assisted reproductive environment

There can be little argument that embryo quality is one of the most critical factors in the success of assisted reproductive techniques. Yet the current methods of grading embryos are subjective at best. While a number of different groups have described more qualitative means of assessing embryo quality, the current standard remains morphology. Morphology has proven a good standard, but it does not allow for the detection of chromosomal abnormalities nor can it assess the biochemical status of the embryo prior to transfer. This laboratory recently described a method to estimate embryo weight and suggested weight might be a good indicator of biochemical status. The objective of the present study was to determine the relationship between maternal body composition and embryo weight and determine the influence maternal chemistry had on embryo development. The data continue to suggest that maternal body composition, especially body fat, influences the chemical nature of the embryo and may play a critical role in long-term survival.

Assessment of Risk of Carrier Waves in the Assisted Reproductive Laboratory

Assisted reproductive technology (ART) laboratories represent the marriage of the most basic of biological activities with the most cutting edge technologies. While this association has worked well, the mixture of biology and technology can create risks to normal embryo development. Recently a significant amount of literature has explored the risks of manmade, electrically induced magnetic fields and carrier waves on reproduction, which some studies have suggested will lower functional gamete numbers in the males and potentially induce genetic issues in embryos. However, little is known about these phenomena within the ART laboratory, a laboratory filled with electronic equipment. The object of the present study was to explore the potential exposure of gametes and early stage embryos to two of the most prevalent fields and waves utilized in manmade technologies seen in the general environment, electromagnetic fields (EMF) and radio frequency waves (RF), and determine the effect varying levels of these energetic forces had on gamete function and embryo development. Results indicated that while extremely high concentrations of EMF (approximately 50-100X of laboratory background) caused negative outcomes in both gametes and embryos, levels consistent will the majority of lab equipment did not appear to impact growth, or function. Further, even extremely high RF appeared to have no impact cellular function. Results suggest few issues with EMF or RF on gamete and embryo function at normal laboratory levels for the relatively short exposure times seen in the ART laboratory.

Research on the Application of CAI Computer Technology in the Teaching of Western Art History

The purpose of the computer aided instruction(CAI)is to improve the teachers'teaching efficiency and stimulate the students'interests in their learning.By using the modem means of the computer aided instruction(CAI),we can do a better job in our teaching.The application of the computer-aided instruction(CAI)in the art teaching should be guided by the new ideas and concepts in the best environment for the students to leam in the most efficient and intuitive way to promote the development of the educational modernization.The current situation of the CAI courseware assistant teaching is good as a whole,but there are still some shortcomings in three aspects:the teachers'CAI skill proficiency,the integration and sharing of the CAI teaching resources,and the frequency of the CAI courseware teaching.The teaching of the art history needs to be improved.

Effects of female body mass index on embryo development and ART outcomes

Objective:To investigate the effects of female body mass index on embryo development and assisted reproductive technology outcomes,aiming to provide better treatment for patients with different body mass index and provide reference for clinical treatment.Methods:The study retrospectively collected data of 3783 patients who received their first fresh embryo transfer and were ovulated by a long protocol at the Reproductive Medicine Center of the First Affiliated Hospital of Hainan Medical University from January 2015 to October 2021.Patients were divided into four groups based on body mass index(BMI):low weight group,normal weight group,overweight group and obese group.The normal weight group was used as a control to compare the basic information,assisted reproductive technology process,embryo development and assisted reproductive technology outcomes between different groups.Results:Analyzing patients'basic information,we found that the duration of infertility was significantly longer in obese women(P=0.007).Basal hormone levels in the overweight and obese groups were lower than those in the normal group(P<0.05).Basal Follicle-stimulating hormone(FSH),basal Luteinizing hormone(LH),basal Estradiol(E2),basal Progesterone(P),and anti-Mullerian hormone(AMH)in the obese group were lower than the normal weight group(P<0.05),and the number of antral follicle counting(AFC)was reduced in the obese group(P=0.011).The overweight group only showed a decrease in E2 and P levels(P<0.05).During the ART,there was a significant difference in Gonadotropin(Gn)dosage among the four groups,with the obese group was the most,followed by the overweight group,and the low weight group was the least(P<0.001).Gn days were increased in the obese group(P<0.001).LH,E2,and P on trigger day were all lower in the overweight and obese groups than in the normal weight group(P<0.05).Comparing the embryo development process,we found that the blastocysts of the obese group showed delayed development at the stages of pronuclei disappearance,four-cell and blastocyst formation(P<0.05).The ART outcomes were worse in the obese group,the clinical pregnancy rate(P=0.044)and live birth rate(P=0.036)were reduced in the obese group.After logistic regression,obesity was found to be a risk factor for clinical pregnancy(OR=0.683,95%CI:0.479-0.973,P=0.035)and live birth(OR=0.662,95%CI:0.459-0.954,P=0.027).Female age was a risk factor for biochemical pregnancy,clinical pregnancy and live birth(P<0.05).Conclusion:Female obesity prolongs the duration of infertility,causes endocrine disorders,increases Gn dosage and days,and leads to poorer assisted reproductive technology outcomes.Female obesity delays the blastocyst development process and presents as a risk factor for clinical pregnancy and live birth.

剖宫产子宫瘢痕缺损对采用辅助生殖技术孕妇妊娠结局的影响及对策

近二十年中国的剖宫产率持续上升,导致继发性不孕的剖宫产瘢痕缺损(CSD)患者增加,需要通过辅助生殖技术(ART)解决再生育问题。CSD可显著降低ART活产率、临床妊娠率和胚胎植入率,这与患者子宫内膜容受性下降、瘢痕局部发生腺肌病及子宫内膜异位症、宫腔微环境紊乱、ART操作难度及妊娠并发症增加有关。除了使用促性腺激素释放激素类似物可能改善妊娠结局,宫腔镜手术、腹腔镜手术和经阴道手术是治疗CSD的有效方法,可提高妊娠率。本文通过文献回顾,分析CSD对采用ART孕妇妊娠结局的影响及相应的治疗方法,以期为CSD患者管理及改善ART妊娠结局提供新思路。

遗传性疾病患者生育权与子代权益的伦理冲突——1例外胚层发育不良申请辅助生殖技术助孕案例的伦理分析

随着人类辅助生殖技术的进步,更多的遗传性疾病被发现并通过创新技术的使用拟降低遗传风险,不孕症夫妇的生育权得到更大程度的保护和满足。但对一些特殊遗传病例,子代权益需要被充分考虑。以1例“外胚层发育不良”申请实施人类辅助生殖技术进行助孕的个案为基础进行伦理剖析,揭示在对遗传性疾病患者实施辅助生殖技术治疗中,由于患者生育权与子代权益保护存在矛盾、人类辅助生殖技术实施与阻断遗传风险之间存在矛盾,处理该类病例会面临伦理困境。通过文献回顾提出:在遗传性病例的诊疗及伦理判断过程中,应充分履行知情同意,基于关怀伦理基础,采用叙事医学方法形成医患共同决策,避免家长主义;同时提供充分的信息支持及完善伦理监督机制,以有效应对伦理困境。

不同HPV感染亚型对不孕女性阴道微生态及辅助生殖助孕结局的影响

目的探讨不同人乳头瘤病毒(HPV)感染亚型对不孕女性阴道微生态及辅助生殖(ART)助孕结局的影响。方法选取2020年1月至2022年3月期间于宝鸡市中心医院进行ART助孕的HPV阳性不孕女性190例,对所有患者均进行了HPV分型检查,根据患者感染HPV的不同亚型将其分为高危组(151例)与低危组(39例),选取同期进行ART助孕的HPV阴性不孕女性纳入对照组(95例)。检查患者阴道微生态情况及阴道病原菌感染情况,记录患者ART助孕结局(获卵数、可移植胚胎数及优质胚胎数)和妊娠结局(临床妊娠率、活产分娩率及流产率),并对各组数据进行统计分析。结果高危组、低危组、对照组的H_(2)O_(2)阳性率比较差异无统计学意义(P>0.05);高危组、低危组、对照组的乳酸杆菌、唾液酸苷酶、白细胞酯酶的阳性率及阴道微生态失衡率比较差异均有统计学意义(χ^(2)值分别为7.604、9.086、6.825、8.502,P<0.05);高危组的乳酸杆菌、唾液酸苷酶、白细胞酯酶的阳性率及阴道微生态失衡率均明显高于对照组,经比较差异均有统计学意义(χ^(2)值分别为7.087、9.038、6.767、8.373,P<0.05)。高危组、低危组、对照组的外阴阴道假丝酵母菌病(VVC)、细菌性阴道病(BV)的感染率比较差异均无统计学意义(P>0.05),高危组、低危组、对照组的混合型阴道感染率比较差异有统计学意义(χ^(2)=15.258,P<0.05);高危组的混合型阴道感染率均明显高于低危组和对照组,经比较差异均有统计学意义(χ^(2)值分别为4.808、12.002,P<0.05)。高危组、低危组、对照组患者的获卵数、可移植胚胎数及优质胚胎数比较差异均无统计学意义(P>0.05)。高危组、低危组、对照组患者的临床妊娠率比较差异无统计学意义(P>0.05),三组的活产分娩率和流产率比较差异均有统计学意义(χ^(2)值分别为2.841、2.936,P<0.05);高危组的活产分娩率明显低于对照组,流产率明显高于对照组,经比较差异均有统计学意义(χ^(2)值分别为7.981、5.123,P<0.05)。结论不同HPV感染亚型对不孕患者阴道微生态情况、ART助孕结局、临床妊娠率及活产分娩率的影响较小,但高危HPV感染会增加不孕患者混合型阴道感染的风险。