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.

Improvement of Live Birth Rate Following Frozen-Thawed Blastocyst Transfer by Combination of Prednisolone Administration and Stimulation of Endometrium Embryo Transfer

The endometrial condition is a significant factor for successful pregnancy. To regulate endometrial function in fertility treatment, prednisolone (PSL) is administered for suppression of increased natural killer cells and stimulation of endometrium embryo transfer (SEET) to enhance communication between embryo and maternal tissues. We attempted to improve the endometrial condition by PSL administration and SEET during frozen–thawed blastocyst transfer (FBT). Patients took PSL (5 mg) 3 times daily for 3 days after ovulation during the FBT cycle. To analyse effects of PSL combined with SEET, we determined rates of chemical pregnancy, clinical pregnancy, foetal heart movement (FHM) and live birth. Rates of chemical pregnancy, clinical pregnancy and FHM were significantly higher in the PSL(+)/SEET(+) (57.7%, 50.0% and 46.2%, respectively) and PSL(+)/SEET(-) (53.3%, 46.7% and 46.7%, respectively) groups than in the PSL(-)/SEET(+) (30.3%, 18.2% and 18.2%, respectively) and PSL(-)/SEET(-) (22.4%, 22.4% and 18.4%;P = 0.0043, 0.0081 and 0.0055, respectively) groups. The live birth rate was significantly higher in the PSL(+)/SEET(+) group than in the PSL(+)/SEET(-), PSL(-)/SEET(+) and PSL(-)/SEET(-) groups (42.3%, 26.7%, 18.2% and 12.2%, respectively;P = 0.0237). PSL combined with SEET may be a useful adjunct to assisted reproductive technology in women who repeatedly fail to conceive by infertility treatment.

Embryo Transfer Strategies for Women with Recurrent Implantation Failure During the Frozen-thawed Embryo Transfer Cycles:Sequential Embryo Transfer or Double-blastocyst Transfer?

Objective Both sequential embryo transfer(SeET)and double-blastocyst transfer(DBT)can serve as embryo transfer strategies for women with recurrent implantation failure(RIF).This study aims to compare the effects of SeET and DBT on pregnancy outcomes.Methods Totally,261 frozen-thawed embryo transfer cycles of 243 RIF women were included in this multicenter retrospective analysis.According to different embryo quality and transfer strategies,they were divided into four groups:group A,good-quality SeET(GQ-SeET,n=38 cycles);group B,poor-quality or mixed-quality SeET(PQ/MQ-SeET,n=31 cycles);group C,good-quality DBT(GQ-DBT,n=121 cycles);and group D,poor-quality or mixed-quality DBT(PQ/MQ-DBT,n=71 cycles).The main outcome,clinical pregnancy rate,was compared,and the generalized estimating equation(GEE)model was used to correct potential confounders that might impact pregnancy outcomes.Results GQ-DBT achieved a significantly higher clinical pregnancy rate(aOR 2.588,95%CI 1.267–5.284,P=0.009)and live birth rate(aOR 3.082,95%CI 1.482–6.412,P=0.003)than PQ/MQ-DBT.Similarly,the clinical pregnancy rate was significantly higher in GQ-SeET than in PQ/MQ-SeET(aOR 4.047,95%CI 1.218–13.450,P=0.023).The pregnancy outcomes of GQ-SeET were not significantly different from those of GQ-DBT,and the same results were found between PQ/MQ-SeET and PQ/MQ-DBT.Conclusion SeET relative to DBT did not seem to improve pregnancy outcomes for RIF patients if the embryo quality was comparable between the two groups.Better clinical pregnancy outcomes could be obtained by transferring good-quality embryos,no matter whether in SeET or DBT.Embryo quality plays a more important role in pregnancy outcomes for RIF patients.

Comparison of Pregnancy Outcomes of High-Quality D5- and D6-Blastocyst Transfer in Hormone-Replacement Frozen-Thawed Cycles

This study aimed to assess pregnancy outcomes after high-quality D5- and D6-blastocyst transfer in frozen cycles of in vitro fertilization and embryo transfer and to further evaluate whether there was a difference in blastocyst development potentials with different developmental speeds and in pregnancy outcomes. A retrospective analysis was conducted to analyze 247 frozen cycles in our center from September 2015 to July 2017, which were divided into two groups: a D5-FET group with 193 cycles of D5-blastocyst transfer, and a D6-FET group with 54 cycles of D6-blastocyst transfer. Hormone replacement method was utilized to prepare frozen-cycle endometria. Pregnancy outcomes were analyzed and compared between these two groups. The mean ages of the two groups were 31.45 ± 4.43 years and 31.98 ± 4.84 years, respectively, with no statistically significant differences (P > 0.05). The difference in the endometrial thickness during transfer was also not statistically significant. The implantation rate in the D5-FET group was 60.13%, significantly higher than that in the D6-FET group (31.58%, P P < 0.05). No statistically significant differences were found in the abortion rate and ectopic pregnancy rate between the two groups. The implantation, biochemical pregnancy, and clinical pregnancy rates of the blastocyst D5 were all superior to those of the blastocyst D6. In clinics, therefore, D5-blastocyst transfer could be prioritized for embryo transfer.

Artificial Cycle with or without a Depot Gonadotropin-releasing Hormone Agonist for Frozen-thawed Embryo Transfer： An Assessment of Infertility Type that Is Most Suitable

The clinical outcomes of five groups of infertility patients receiving frozen- thawed, cleavage-stage embryo transfers with exogenous hormone protocols with or without a depot gonadotropin-releasing hormone （GnRH） agonist were assessed. A retrospective cohort analysis was performed on 1003 cycles undergoing frozen-thawed, cleavage-stage embryo transfers from January 1, 2012 to June 31, 2015 in the Reproductive Medicine Center of Wuhan General Hospital of Guangzhou Military Region. Based on the infertility etiologies of the patients, the 1003 cycles were divided into five groups： tubal infertility, polycystic ovary syndrome （PCOS）, endometriosis, male infertility, and unexplained infertility. The main outcome was the live birth rate. Two groups were set up based on the intervention： group A was given a GnRH agonist with exogenous estrogen and progesterone, and group B （control group） was given exogenous estrogen and progesterone only. The results showed that the baseline serum hormone levels and basic characteristics of the patients were not significantly different between groups A and B. The live birth rates in groups A and B were 41.67% and 29.29%, respectively （P〈0.05）. The live birth rates in patients with PCOS in groups A and B were 56.25% and 30.61%, respectively （P〈0.05）. The clinical pregnancy, implantation and on-going pregnancy rates showed the same trends as the live birth rates between groups A and B. The ectopic pregnancy rate was significantly lower in group A than in group B. We concluded that the live birth rate was higher and other clinical outcomes were more satisfactory with GnRH agonist co- treatment than without GnRH agonist co-treatment for frozen-thawed embryo transfer. The GnRH agonist combined with exogenous estrogen and progesterone worked for all types of infertility tested, especially for women with PCOS.

High-quality Cleavage Embryo versus Low-quality Blastocyst in Frozen-thawed Cycles:Comparison of Clinical Outcomes

This study compared the clinical outcomes of the frozen-thawed cycles of high-quality cleavage embryos with low-quality blastocysts to provide a reference for the choice of frozen-thawed embryo transfer schemes and to improve clinical pregnancy rates.A retrospective analysis was performed on the clinical data of patients undergoing frozen-thawed embryo transfer at the Reproductive Medicine Center of Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology from 2016 to 2017.In total,845 cases were divided into a high-quality cleavage embryo group(group A)and a low-quality blastocyst group(group B).Each group was further divided into subgroups based on the number of transplants.Group A was categorized into two subgroups comprising of 94 cases in subgroup Al(1 high-quality 8-cell group)and 201 cases in subgroup A2(2 high-quality 8-cell group).Group B was divided into four subgroups consisting of 73 cases in subgroup B I(D53BC group),65 cases in subgroup B2(D54BC group),110 cases in subgroup B3(D63BC group),and 282 cases in subgroup B4(D64BC group).The pregnancy outcomes and neonatal outcomes between the groups were compared.The clinical pregnancy rates(56.72%and 60.00%)and live birth rates(47.76%and 46.15%)in subgroups A2 and B2 showed no significant differences,but these rates were significantly higher in subgroups A2 and B2 than in the rest subgroups(P<0.05).The multiple birth rate(26.32%)in the subgroup A2 was significantly higher than that in the rest subgroups(P<0.05).There were no statistically significant differences in the abortion rates among all groups(P>0.05).In terms of neonatal outcomes,there were no statistically significant differences in the proportion of premature births,sex ratios,and birth defects among the low-weight and gigantic infants(P>0.05).Transplanting two high-quality cleavage embryos during the frozen-thawed embryo transfer cycles could significantly increase clinical pregnancy rates and live birth rates,but at the same time,it also increased the risks of multiple births and complications to mothers and infants.The D54BC subgroup had the most significant advantages among all groups(P<0.05).The rest low-quality blastocysts had clinical outcomes similar to the single high-quality cleavage embryo group.

Serum β-hCG level on day 7 of frozen-thawed embryo transfer: association with the clinical pregnancy outcomes in artificial cycles

Objective:The relationship between serum beta human chorionic gonadotropin(β-hCG)levels of patients(7 days after the transplantation of frozen-thawed embryos)and the pregnancy outcomes was investigated.Methods:This study was designed as a retrospective clinical trial of 366 women who underwent frozen-thawed embryo transfers(FETs)in artificial cycles.Patients were divided into three groups:clinical pregnancy group,biochemical pregnancy group,and non-pregnant group according to their pregnancy outcomes.Serumβ-hCG levels were tested on day 4,7,9,11 and 14 after FET.Results:In the clinical pregnancy group,the serumβ-hCG levels after 7-day post-transplantation were significantly elevated(16.20 IU/L vs.3.07 vs.0.1 IU/L;P<0.05)compared with the other two groups.Furthermore,it was found that Area Under Curve(AUC=0.96)was significant with cut-off value higher than 4.26 IU/L(sensitivity=92.3%,specificity=90.2%)to predict the clinical pregnancy outcomes in the receiver operating characteristic(ROC)analysis ofβ-hCG concentrations on day 7 of post-transplantation.Conclusion:Our results suggested that the elevated serumβ-hCG levels on day 7 of post-transplantation could predict the positive clinical pregnancy outcomes in artificial FET cycles.

Predictive Value of Initial Serum Human Chorionic Gonadotropin Levels for Pregnancies after Single Fresh and Frozen Blastocyst Transfer

As one of the earliest markers for predicting pregnancy outcomes, human chorionic gonadotropin(h CG) values have been inconclusive on reliability of the prediction after frozen and fresh embryo transfer(ET). In this retrospective study, patients with positive h CG(day 12 after transfer) were included to examine the h CG levels and their predictive value for pregnancy outcomes following 214 fresh and 1513 vitrified-warmed single-blastocyst transfer cycles. For patients who got clinical pregnancy, the mean initial h CG value was significantly higher after frozen cycles than fresh cycles, and the similar result was demonstrated for patients with live births(LB). The difference in h CG value existed even after adjusting for the potential covariates. The area under curves(AUC) and threshold values calculated by receiver operator characteristic curves were 0.944 and 213.05 m IU/m L for clinical pregnancy after fresh ET, 0.894 and 399.50 m IU/m L for clinical pregnancy after frozen ET, 0.812 and 222.86 m IU/m L for LB after fresh ET, and 0.808 and 410.80 m IU/mL for LB after frozen ET with acceptable sensitivity and specificity, respectively. In conclusion, single frozen blastocyst transfer leads to higher initial h CG values than single fresh blastocyst transfer, and the initial h CG level is a reliable predictive factor for predicting IVF outcomes.

Sperm DNA fragmentation does not affect the clinical outcomes in the cumulative transfers of an ICSI cycle along with blastocyst transfers in couples with normozoospermic male patients

Objective:To know whether sperm DNA fragmentation(SDF)affects the clinical outcomes in the cumulative transfers of an intracytoplasmic sperm injection(ICSI)cycle along with blastocyst transfers in couples with normozoospermic males.Methods:The study included 252 couples who underwent their first ICSI cycles along with blastocyst transfer and whose male partner semen samples were normozoospermic according to the World Health Organization 2010 criteria.All the couples were classified into two groups based on the SDF:the low SDF group(SDF≤30%,n=162)and the high SDF group(SDF>30%,n=90).Clinical as well as laboratory outcomes were correlated between the two groups.Sperm DNA fragmentation was assessed on the post-wash semen samples by acridine orange test.The main outcome measures were the live birth rate and miscarriage rate.Results:A significant decrease in the live birth rates was observed in the high SDF group compared to the low SDF group in fresh embryo transfer cycles(P<0.05).However,no significant difference was observed in the clinical outcomes either in the frozen embryo transfer cycles or in the overall cumulative transfer cycles(P>0.05).No significant difference was observed in the laboratory outcomes between the two SDF groups.A remarkable decrease in sperm motility was observed in the high SDF group compared to the low SDF group(P<0.05).Conclusions:Sperm DNA fragmentation does not affect the clinical outcomes in the cumulative transfers of an ICSI cycle along with blastocyst transfers in couples with normozoospermic males.

Blastocyst elective single embryo transfer improves perinatal outcomes among women undergoing assisted reproductive technology in Indonesia

Objective:To compare the effectiveness of blastocyst elective single embryo transfer(eSET)and double embryo transfer(DET)in reducing low birth weight,preterm birth,and perinatal mortality in in vitro fertilization(IVF)cycles of Indonesian women.Methods:A retrospective observational study was conducted at Morula IVF Clinic,Jakarta,Indonesia.A total of 179 women who underwent either eSET or DET and had met the eligibility criteria were included.Seventy-six women underwent eSET while 103 underwent DET in their IVF cycles.Low birth-weight rate,preterm birth rate,and perinatal mortality rate of both groups were measured as the primary study outcomes.Neonatal intensive care unit(NICU)admission rate,Apgar score,multiple pregnancy,and maternal complications during pregnancy were also evaluated.Results:The risk of low birth weight[odds ratio(OR)=0.21,95%confidential interval(CI):0.10-0.45,P<0.001]and preterm birth(OR=0.25,95%CI:0.13-0.49,P<0.001)was significantly lower in the eSET group compared with the DET group.Furthermore,eSET efficiently reduced the incidence of NICU admission and multiple pregnancy(P=0.01 and P<0.001,respectively).No significant difference was observed in terms of perinatal mortality rate,Apgar score,and maternal complications including gestational diabetes,preeclampsia as well as pregnancy-induced hypertension(P≥0.05).However,a lower incidence of antepartum hemorrhage was noticed in the eSET group than in the DET group(P=0.03).Conclusions:Compared with DET,infants conceived through IVF cycles with eSET have a significantly lower risk of low birth weight,preterm birth,and NICU admissions.Moreover,eSET is shown to reduce multiple pregnancy rate,yet no significant differences are observed in the perinatal mortality rates,Apgar score and maternal complications(except for the incidence of antepartum hemorrhage)between both groups.

Frozen Blastocyst Transfer during <i>in Vitro</i>Fertilization/Intracytoplasmic Sperm Injection Cycle Lowers the Rate of Ectopic Pregnancy

This study aimed to determine whether frozen blastocyst transfer can lower the incidence rate of ectopic pregnancy. A total of 1577 in vitro fertilization/ intra-cytoplasmic cycles were analyzed, including 757 fresh D3-ET cycles, 429 frozen D3-ET cycles, and 391 frozen D5-ET cycles. The differences of ages, the proportion of IVF cycles, the proportion of primary infertility, and the proportion of tubal factor between three groups were not significant. The clinical pregnancy rate in Frozen D5-ET Group was 62.15%, which was significantly higher than other two groups (46.10%;38.93%;P < 0.05). The miscarriage rates of three groups were similar. The ectopic pregnancy rate in Frozen D5-ET Group was 0.41%, which was significantly lower than that in Frozen D3-ET Group (2.99%, P < 0.05) and slightly lower than that in Fresh D3-ET Group (2.29%, P = 0.089). Results from this study show that the transfer of frozen D5 blastocysts can significantly decrease the incidence rate of ectopic pregnancy.

Association between estradiol levels and clinical outcomes of IVF cycles with single blastocyst embryo transfer

Objective:To determine the correlation of different serum estradiol levels on the trigger day with the clinical and laboratory outcomes of in-vitro fertilization(IVF)cycles comprising a single fresh top-quality blastocyst transfer.Methods:This was a retrospective observational study performed in Morula IVF Clinic Jakarta.Five hundred forty-two women were recruited and grouped according to their serum estradiol levels on the trigger day of follicular maturation as follows:<2000 pg/mL,2000-2999 pg/mL,3000-3999 pg/mL,and≥4000 pg/mL.Clinical pregnancy and miscarriage rates were evaluated as the primary outcomes and embryology laboratory results as the secondary outcomes which consisted of the number of retrieved,mature,and fertilized oocytes,the total sum of derived embryos,and top-quality embryos at cleavage and blastocyst stage.Results:Clinical pregnancy and miscarriage rates did not differ among the groups(P>0.05).Nonetheless,the study demonstrated a positive correlation of the serum estradiol levels with the overall laboratory outcomes including the number of retrieved,mature,and fertilized oocytes,the total sum of derived embryos,and top-quality embryos at cleavage and blastocyst stage(P<0.001).The subject group with estradiol level of≥4000 pg/mL was superior to the other groups in its respective median number of retrieved,mature,fertilized oocytes,total derived embryos,and top-quality cleavage-and blastocyst-stage embryos.Conclusions:Although an apparent positive correlation is observed between estradiol levels and laboratory outcomes,serum estradiol level on hCG trigger day is not associated with the clinical outcomes of IVF.

Effect of double cleavage stage versus sequential cleavage and blastocyst stage embryo transfer on clinical pregnancy rates

Objective:To compare clinical pregnancy rates following sequential day-3 and day-5 embryo transfer with double or sequential cleavage-stage transfers.Methods:This study enrolled 242 patients undergoing gonadotropin-releasing hormone antagonist protocol and fresh embryo transfer.Basal follicle stimulating hormone,luteinizing hormone,serum estradiol and anti-Müllerian hormone levels and controlled ovarian stimulation outcomes were noted.Of 242 women,135 underwent double embryo transfer on day 2 or day 3(the double group),54 women underwent sequential embryo transfer on day 2 and day 3(the D2/D3 group),and 53 underwent sequential embryo transfer on day 3 and day 5(the D3/D5 group).Clinical pregnancy rates were compared among the groups.Results:Female age,body mass index,basal follicle stimulating hormone,luteinizing hormone and estradiol levels were similar among the groups(P>0.05).The D3/D5 group had a significantly higher number of metaphaseⅡoocytes,fertilized oocytes and good quality embryos on day 3 compared with the double group and the D2/D3 group(P<0.001).Clinical pregnancy rates in the double,D2/D3 and D3/D5 groups were 26.6%(36/135),16.6%(9/54)and 37.7%(20/53),respectively.There was no significant difference in clinical pregnancy rates between the double group and the D2/D3 group(P=0.204)or the D3/D5 group(P=0.188).The D3/D5 group had significantly higher clinical pregnancy rates compared with the D2/D3 group(P=0.025).Conclusions:Sequential cleavage-stage transfer(D2/D3)or cleavage stage and blastocyst transfer(D3/D5)does not improve clinical pregnancy rates compared with double cleavage-stage embryo transfer.Although sequential transfer seems to be an effective option in certain patient populations,routine application of this technique might not be a suitable approach in an unselected population to improve assisted reproductive technology outcomes.

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.

Live births from in vitro fertilization-embryo transfer following the administration of gonadotropin-releasing hormone agonist without gonadotropins:Two case reports

BACKGROUND The prevalence of female infertility between the ages of 25 and 44 is 3.5%to 16.7%in developed countries and 6.9%to 9.3%in developing countries.This means that infertility affects one in six couples and is recognized by the World Health Organization as the fifth most serious global disability.The International Committee for Monitoring Assisted Reproductive Technology reported that the global total of babies born as a result of assisted reproductive technology procedures and other advanced fertility treatments is more than 8 million.Advancements in controlled ovarian hyperstimulation procedures led to crucial accomplishments in human fertility treatments.The European Society for Human Reproduction and Embryology guideline on ovarian stimulation gave us valuable evidence-based recommendations to optimize ovarian stimulation in assisted reproductive technology.Conventional ovarian stimulation protocols for in vitro fertilization(IVF)–embryo transfer are based upon the administration of gonadotropins combined with gonadotropin-releasing hormone(GnRH)analogues,either GnRH agonists(GnRHa)or antagonists.The development of ovarian cysts requires the combination of GnRHa and gonadotropins for controlled ovarian hyperstimulation.However,in rare cases patients may develop an ovarian hyper response after administration of GnRHa alone.CASE SUMMARY Here,two case studies were conducted.In the first case,a 33-year-old female diagnosed with polycystic ovary syndrome presented for her first IVF cycle at our reproductive center.Fourteen days after triptorelin acetate was administrated(day 18 of her menstrual cycle),bilateral ovaries presented polycystic manifestations.The patient was given 5000 IU of human chorionic gonadotropin.Twenty-two oocytes were obtained,and eight embryos formed.Two blastospheres were transferred in the frozen-thawed embryo transfer cycle,and the patient was impregnated.In the second case,a 37-year-old woman presented to the reproductive center for her first donor IVF cycle.Fourteen days after GnRHa administration,the transvaginal ultrasound revealed six follicles measuring 17-26 mm in the bilateral ovaries.The patient was given 10000 IU of human chorionic gonadotropin.Three oocytes were obtained,and three embryos formed.Two high-grade embryos were transferred in the frozen-thawed embryo transfer cycle,and the patient was impregnated.CONCLUSION These two special cases provide valuable knowledge through our experience.We hypothesize that oocyte retrieval can be an alternative to cycle cancellation in these conditions.Considering the high progesterone level in most cases of this situation,we advocate freezing embryos after oocyte retrieval rather than fresh embryo transfer.

多囊卵巢综合征患者冻融胚胎移植周期妊娠结局的影响因素分析

目的探讨多囊卵巢综合征(PCOS)患者冻融胚胎移植(FET)周期妊娠结局的影响因素。方法回顾性分析882个FET周期PCOS患者的资料,根据患者的妊娠结局分为未着床组(A组)、流产组(B1组)和活产组(B2组)。比较这三组患者的临床资料和实验室指标,并使用有序Logistic回归分析冻融胚胎移植后妊娠结局的影响因素。再按照获取优质囊胚数的百分位数(0~3、4~6、7~10、≥11个)将患者分为C1、C2、C3、C4组,比较不同优质囊胚数组患者的临床资料及实验室相关指标。结果882个PCOS患者移植周期的临床妊娠率71.09%(627/882),活产率61.68%(544/882),流产率13.24%(83/627)。单因素分析显示,在A、B1和B2这三组的比较中,体质量指数(BMI)、不孕类型、注射人绒毛膜促性腺激素(hCG)日雌二醇(E_(2))水平、获卵数和优质囊胚数之间存在显著差异(P<0.05)。对五项差异指标进行进一步多元Logistic回归分析显示,BMI(OR=1.046,95%CI:1.001~1.093,P=0.044)和有既往妊娠史(OR=1.417,95%CI:1.030~1.950,P=0.032)是PCOS患者成功妊娠的独立危险因素。A组与B2组比较:OR=0.920,95%CI:0.880~0.962,P=0.000;B1组与B2组比较:OR=0.923,95%CI:0.862~0.988,P=0.022;而优质囊胚数增多则是妊娠成功的独立保护因素。在优质囊胚数C1-C4这四组之间比较中,与其他三组相比,C4组的促性腺激素(Gn)总量最低,获卵数最多(P<0.05)。C4组的BMI、促卵泡生成素(FSH)和极低密度脂蛋白(vLDL)水平较C1组低,黄体生成素与促卵泡生成素(LH/FSH)比值比C1组高(P<0.05)。C4组与C3组相比,空腹胰岛素(FINS)和胰岛素抵抗指数(HOMA-IR)值较低,与C2和C3组相比,高密度脂蛋白胆固醇(HDL-C)和载脂蛋白A1(ApoA1)水平较高(P<0.05)。结论BMI、既往妊娠史和优质囊胚数是预测PCOS患者FET周期妊娠结局的独立因素。优质囊胚数更多的患者在FET周期中具有更高的临床妊娠率。

囊胚培养与移植在不孕症患者中的应用

目的 探讨囊胚培养与移植在辅助生殖技术治疗过程中的应用价值,为改善不孕症患者妊娠结局提供一定的理论基础。方法 对2021年11月至2023年4月在本院生殖中心接受体外受精/卵胞浆内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection embryo transfer, IVF/ICSI-ET)治疗的631例新鲜周期患者的一般资料、促排卵效果、获卵数、受精卵数、胚胎发育情况及移植胚胎类型与临床妊娠结局比较进行分析,同时,收集本时间段内接受冻融周期即第3天(day 3,D3)卵裂期或第5/6天(day 5/day 6,D5/D6)囊胚期移植患者的妊娠结局进行分析比较。结果 IVF/ICSI-ET治疗患者中,D3卵裂期胚胎未养囊组、养囊成功组和养囊失败组的女方年龄[(34.85±0.37)vs (30.53±0.33)vs (32.43±0.47)]、促性腺激素(Gonadotropin, Gn)天数[(9.45±0.14)vs (9.82±0.10)vs (10.11±0.17)]、Gn总量[(2323.79±51.03)vs (2073.48±47.02)vs (2288.42±69.94)]、人绒毛膜促性腺激素(human chorionic gonadotropin, HCG)日促黄体素(luteinizing hormone, LH)[(4.34±0.23)vs (3.32±0.17) vs (3.95±0.31)]和雌二醇(estradiol, E2)[(1586.21±86.84) vs (4642.65±226.48) vs (2756.45±147.13)]水平及获卵(获卵数:[(5.52±0.26)vs (16.51±0.56)vs (10.80±0.54)]和早期胚胎发育情况(优质胚胎数:[(2.34±0.10) vs (7.51±0.31)vs (3.73±0.27)]均存在统计学差异,养囊成功组囊胚形成率41.68%。囊胚移植与D3卵裂期移植患者相比,HCG日激素水平、获卵数[(13.86±1.14)vs (8.37±0.28)]、成熟卵数[(12.29±1.06) vs (7.16±0.24)]及优质胚胎数[6.33±1.10)vs (3.68±0.14)]明显升高,但妊娠结局无统计学差异。冻融周期中囊胚移植、卵裂期移植及混合移植三组间胚胎种植率(45.59%vs 25.25%vs 34.85%)和临床妊娠率(55.93vs 39.01%vs 57.58%)均存在统计学差异,但流产率、多胎妊娠率和异位妊娠率无显著差异。结论 囊胚培养显著提高胚胎利用率,增加不孕症患者移植机率;囊胚移植有助于提高ART助孕患者的胚胎种植率和临床妊娠率。

大于38岁女性冻融移植周期单囊胚与双囊胚移植妊娠结局比较

目的探讨大于38岁女性在冻融囊胚移植周期中移植不同囊胚数目和质量时的妊娠结局。方法纳入2017年1月至2021年12月在广东省生殖医院生殖中心接受冻融囊胚移植且移植年龄大于38岁的249例女性为研究对象,对其249个移植周期的临床资料进行回顾性分析。根据不同的囊胚移植数目和质量分为5组:移植单个优质囊胚组(A组,94个周期),移植单个非优质囊胚组(B组,103个周期),移植双优质囊胚组(C组,10个周期),移植单个优质囊胚+单个非优质囊胚组(D组,18个周期)和移植双非优质囊胚组(E组,24个周期)。比较分析不同囊胚移植数目和质量组间的一般资料、胚胎实验室指标及妊娠结局。结果各组患者的一般情况比较发现,D组的取卵年龄显著大于A组(P<0.05),C组的基础FSH(bFSH)显著低于A组,E组的bFSH显著低于B组(P均<0.05);各组间移植年龄、窦卵泡数、体质量指数(BMI)、促性腺激素(Gn)用量、移植日内膜厚度、人工周期方案比例均无显著性差异(P>0.05)。E组的获卵数显著大于B组[(12.67±4.98)vs.(10.69±4.08),P<0.05];各组间D3可用胚胎数、优胚数、囊胚培养数、囊胚形成数、囊胚冷冻数比较均无显著性差异(P>0.05)。A组与C组比较,多胎率显著降低(6.00%vs.33.30%,P<0.05),组间着床率、临床妊娠率、流产率、活产率及早产率比较均无显著性差异(P>0.05);A组与D组比较,着床率显著增高(53.20%vs.27.80%,P<0.05),活产率相似(35.10%vs.33.30%,P>0.05);A组与E组比较,多胎率显著降低(6.00%vs.33.30%,P<0.05),组间着床率、临床妊娠率、流产率、早产率、活产率比较均无显著性差异(P>0.05);B组与E组比较,临床妊娠率、多胎率显著降低(P<0.05),组间着床率、流产率、活产率及早产率比较均无显著性差异(P>0.05)。结论大于38岁高龄女性在冻融囊胚移植周期中若有优质囊胚,建议优先移植单个优质囊胚;若没有优质囊胚,也应考虑移植单个囊胚。

冻胚移植发生复合妊娠的影响因素分析

目的 探讨影响冻胚移植(frozen embryo transfer, FET)发生复合妊娠(heterotopic pregnancy, HP)的相关性因素。方法 回顾性分析2016-01/2022-06月在作者医院生殖医学科行FET术后妊娠178例患者的临床资料,根据妊娠部位分为HP组(n=17)、异位妊娠组(n=76)、宫内妊娠组(n=85)。结果 3组患者因输卵管因素造成不孕的比例比较差异有统计学意义(P<0.05),异位妊娠组患者因输卵管因素造成不孕的比例高于宫内妊娠组(P<0.05)。HP组和异位妊娠组既往有输卵管手术史的患者占比明显高于宫内妊娠组(P<0.05)。3组FET患者移植胚胎个数差异有统计学意义(P<0.05),异位妊娠组中单胚胎移植率明显低于宫内妊娠组(P<0.05)。HP组和FET异位妊娠组患者卵裂期胚胎移植率明显高于宫内妊娠组,囊胚移植率明显低于宫内妊娠组(P均<0.05)。进一步Logistic回归分析发现,相对于FET宫内妊娠,输卵管手术史会增加FET发生HP的风险(OR=5.250,95%CI:1.467~18.788),移植胚胎个数的增多会增加FET发生HP的风险(OR=14.336,95%CI:1.381~148.849),而移植囊胚会降低FET发生HP的风险(OR=0.164,95%CI:0.027~0.996)。结论 输卵管手术史是FET发生HP的高危因素,而通过减少移植胚胎个数和囊胚移植可降低HP的发生率。

使用孕酮P4诱导雌鼠同步发情

目的 探索采用注射孕酮的方式诱导SD大鼠和BALB/c小鼠的雌鼠同步发情。方法 在实验第1天和第2天给8周龄SD大鼠和BALB/c小鼠的雌鼠注射孕酮激素和注射孕酮量分别为每只10 mg和2 mg,连续注射2 d,第4天合笼,分别在第5天、第6天和第7天进行检栓。利用见栓后的SD大鼠假孕鼠进行胚胎移植,选择发情雌鼠与结扎雄鼠交配得到的假孕鼠同步移植作为对照;利用见栓后的BALB/c小鼠雌鼠冲取囊胚用于胚胎干细胞(ESC)注射。结果 注射孕酮后的SD大鼠雌鼠单日最高见栓率可达到44%,整体见栓率能达到80%以上;注射孕酮后的BALB/c小鼠雌鼠单日最高见栓率可达到46%,整体见栓率能达到70%以上;注射孕酮单日见栓率是传统选择发情后合笼见栓的7~8倍,整体见栓率是传统方式的15倍以上,与传统方法相比,用于准备假孕的SD大鼠雌鼠和供体囊胚BALB/c小鼠雌鼠的基础雌鼠数量可降低10%~20%;SD大鼠假孕鼠的胚胎出生率较传统方法提高13%。结论 注射每只10 mg和每只2 mg孕酮可分别用于诱导8周龄SD大鼠雌鼠和BALB/c小鼠的雌鼠同步发情,可显著提高见栓率和SD大鼠雌鼠胚胎出生率。