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 ...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.展开更多
Background Some studies suggested that human papillomavirus （HPV） infection could reduce the clinical pregnancy rate and double the spontaneous abortion rate compared with non-infected women after in-vitro fertiliza...Background Some studies suggested that human papillomavirus （HPV） infection could reduce the clinical pregnancy rate and double the spontaneous abortion rate compared with non-infected women after in-vitro fertilization and embryo transfer （IVF-ET）. But some other studies showed there was no difference between HPV infected and non-infected groups of ART outcomes. The role of HPV infection in infertile women undergoing IVF treatments has been a controversial issue which this article attempts to investigate. Methods This is a retrospective analysis of 3880 infertile women undergoing IVF treatment at Peking University Third hospital reproductive medical center in 2008. Patients with abnormal thin-layer preparation cytologic test （TCT） results who underwent fresh cycle embryo transfer were divided into an HPV positive group （n=56） and an HPV negative group （n=56）. The clinical parameters were compared （using Student＇s t-test and chi-squared test）. Univariate and multivariate analyses were taken to see if HPV infection affects the clinical pregnancy rate. Results Of the 3880 cases 157 had TCT abnormality （4.0%）. Of the 149 patients who had HPV test results, 112 women （81.2%） received a fresh cycle embryo transfer. Each group had 56 cases. The patients were of similar age and BMI, basic hormone levels, and infertile factors were similar. The gonadotropin use, oocyte retrieval number, clinical pregnancy rate, abortion rate and newborn condition were all similar between groups. Analyses showed neither HPV infection nor HPV hybrid capture （HC） II results affected clinical pregnancy rate after IVF treatments, but the FSH level did. Conclusion HPV positivity did not appear to impact assisted reproductive technology （ART） success. ＂Extensive treatment＂ for HPV before IVF was not recommended because treatment time will increase age and reduce ovarian function, which will lead to inferior IVF outcomes.展开更多
Rationale:The current literature has a surprising controversy regarding the use of low-dose human chorionic gonadotropin(hCG)for luteal support as an explanation for the development of ovarian hyperstimulation syndrom...Rationale:The current literature has a surprising controversy regarding the use of low-dose human chorionic gonadotropin(hCG)for luteal support as an explanation for the development of ovarian hyperstimulation syndrome,and this is because of the gap in the listing of the predisposing factors that put women at an increased risk of ovarian hyperstimulation syndrome.Patient concerns:A case of 25-year-old woman presented with abdominal pain,distention,dyspnea,and nausea with a 6.5 kg increase in weight from baseline.Ultrasonographic examination showed bilaterally enlarged multicystic ovaries after gonadotropin-releasing hormone(GnRH)agonist triggering and cycle segmentation with no hCG rescue administration.Diagnosis:Moderate/severe ovarian hyperstimulation syndrome.Interventions:The woman was admitted to the hospital for medical management of moderate/severe ovarian hyperstimulation syndrome,and pain management was advanced to patient-controlled anesthesia with the start of low molecular weight heparin.On day 2,albumin therapy followed by a furosemide chase was started due to an increase in abdominal girth.On day 1,Cabergoline was maintained,and on day 2 the GnRH antagonist Cetrorelix was started.Outcomes:The woman’s clinical condition improved,and a clinical pregnancy was eventually achieved during the first cryo-warmed blastocyst cycle.Lessons:Ovarian hyperstimulation syndrome can still happen even after the use of GnRH agonist and avoidance of hCG support.Segmentation of in vitro fertilization with complete avoidance of hCG for luteal support remains the best approach.展开更多
文摘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.
文摘Background Some studies suggested that human papillomavirus （HPV） infection could reduce the clinical pregnancy rate and double the spontaneous abortion rate compared with non-infected women after in-vitro fertilization and embryo transfer （IVF-ET）. But some other studies showed there was no difference between HPV infected and non-infected groups of ART outcomes. The role of HPV infection in infertile women undergoing IVF treatments has been a controversial issue which this article attempts to investigate. Methods This is a retrospective analysis of 3880 infertile women undergoing IVF treatment at Peking University Third hospital reproductive medical center in 2008. Patients with abnormal thin-layer preparation cytologic test （TCT） results who underwent fresh cycle embryo transfer were divided into an HPV positive group （n=56） and an HPV negative group （n=56）. The clinical parameters were compared （using Student＇s t-test and chi-squared test）. Univariate and multivariate analyses were taken to see if HPV infection affects the clinical pregnancy rate. Results Of the 3880 cases 157 had TCT abnormality （4.0%）. Of the 149 patients who had HPV test results, 112 women （81.2%） received a fresh cycle embryo transfer. Each group had 56 cases. The patients were of similar age and BMI, basic hormone levels, and infertile factors were similar. The gonadotropin use, oocyte retrieval number, clinical pregnancy rate, abortion rate and newborn condition were all similar between groups. Analyses showed neither HPV infection nor HPV hybrid capture （HC） II results affected clinical pregnancy rate after IVF treatments, but the FSH level did. Conclusion HPV positivity did not appear to impact assisted reproductive technology （ART） success. ＂Extensive treatment＂ for HPV before IVF was not recommended because treatment time will increase age and reduce ovarian function, which will lead to inferior IVF outcomes.
文摘Rationale:The current literature has a surprising controversy regarding the use of low-dose human chorionic gonadotropin(hCG)for luteal support as an explanation for the development of ovarian hyperstimulation syndrome,and this is because of the gap in the listing of the predisposing factors that put women at an increased risk of ovarian hyperstimulation syndrome.Patient concerns:A case of 25-year-old woman presented with abdominal pain,distention,dyspnea,and nausea with a 6.5 kg increase in weight from baseline.Ultrasonographic examination showed bilaterally enlarged multicystic ovaries after gonadotropin-releasing hormone(GnRH)agonist triggering and cycle segmentation with no hCG rescue administration.Diagnosis:Moderate/severe ovarian hyperstimulation syndrome.Interventions:The woman was admitted to the hospital for medical management of moderate/severe ovarian hyperstimulation syndrome,and pain management was advanced to patient-controlled anesthesia with the start of low molecular weight heparin.On day 2,albumin therapy followed by a furosemide chase was started due to an increase in abdominal girth.On day 1,Cabergoline was maintained,and on day 2 the GnRH antagonist Cetrorelix was started.Outcomes:The woman’s clinical condition improved,and a clinical pregnancy was eventually achieved during the first cryo-warmed blastocyst cycle.Lessons:Ovarian hyperstimulation syndrome can still happen even after the use of GnRH agonist and avoidance of hCG support.Segmentation of in vitro fertilization with complete avoidance of hCG for luteal support remains the best approach.
