Post-salpingectomy interstitial heterotopic pregnancy after in vitro fertilization and embryo transfer:A case report

BACKGROUND Heterotopic pregnancy(HP)refers to the coexistence of ectopic pregnancy and intrauterine pregnancy.Salpingectomy is proposed as a pretreatment before in vitro fertilization and embryo transfer(IVF-ET)to reduce the risk of HP.HP after IVF-ET occurs in women who had already underwent bilateral salpingectomy,even though it is extremely rare.CASE SUMMARY A case of a 29-year-old woman with recurrent interstitial HP after IVF-ET following salpingectomy is presented.The main symptom was a sudden and worsening pelvic pain.Physical examinations revealed signs of peritoneal bleeding and irritation with stable vital signs.Transvaginal ultrasound showed a live intrauterine pregnancy and another live embryo with cardiac activity in the left cornu extending beyond the lateral edge of the uterus.Her hemoglobin concentration was 8.0 g/dL,and serum human chorionic gonadotropin value was 171116.9 mIU/mL.With the diagnosis of ruptured HP with internal bleeding,an emergency laparoscopic resection of left cornu was performed.The interstitial pregnancy was removed with caution to protect the intrauterine pregnancy.After the surgical treatment,the intrauterine pregnancy continued with no complications.A healthy baby was delivered by caesarean section at 39 wk.Outcomes of another three cases are further summarized.CONCLUSION Post-salpingectomy HP is a rare but challenging condition.Surgical treatment is preferred in the case with a viable intrauterine pregnancy.

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.

Relationship between lower number of oocytes retrieved and clinical outcomes of in vitro fertilization-embryo transfer

Objective:To explore the clinical outcomes of the infertile women with retrieved oocytes less than or equal to 5 undergoing in vitro fertilization-embryo transfer（IVF-ET） or intracytoplasmic sperm injection（1CSI）. Methods:The clinical data of 216 embryo transfer cycles with retrieved oocytes less than or equal to 5 during the procedure of IVF/ICSI in Reproductive Medicine Center of the 105th Hospital of PLA from Jul.2008 to Dec.2011 were analyze retrospectively.All the patients were divided into group A（< 35 years）,group B（35-39 years） and group C（≥40 years） according to the ages,and 409 IVF/ICSI cycles with patients’ age less than 35 years old and 6-15 retrieved oocytes in the same period were served as controlled group.Then the patients≥35 years were subdivided into gonadotropin-releasing hormone agonist（GnRH-a） long protocol group,GnRH-a short group and GnRH antagonist group according to the protocols of controlled ovarian hyperstimulation（COH）.The clinical date and the outcomes were analyzed and compared among all groups. Results:There were significantly differences in clinical pregnancy rate（38.3%vs.19.4%） and early abortion rate（16.1%vs.50.0%） between group A and group C（P<0.05）,and there were no significant differences in clinical pregnancy rate（38.3%vs.41.6%）and early abortion rate（16.1%vs.10.0%） between group A and control group（P>0.05）.There were no significant differences in clinical pregnancy rates（29.01%vs.26.1%vs.25.9%） and early abortion rates（33.3%vs.33.3%vs.40.0%） among GnRH-a long protocol group,GnRH-a short group and GnRH antagonist group（P>0.05）. Conclusions:Relatively satisfactory clinical outcomes of IVF/ICSI would still be got for the patients <35 years with retrieved oocytes less than or equal to 5,but whatever COH protocols such as GnRH-a long protocol,GnRH-a short and GnRH antagonist could not improve the outcomes of IVF/ICSI for the patients aged≥35 with retrieved oocytes less than or equal to 5.

The Effect of Insulin Resistance on In-Vitro Fertilization-Embryo Transfer in Women without Polycystic Ovary Syndrome

Purpose: Insulin resistance (IR) plays an important role in the pathogenesis of polycystic ovary syndrome (PCOS);therefore, insulin-sensitizing agents are widely used to improve IR in women with PCOS. However, whether IR in patients without PCOS should be treated remains uncertain. This study aims to clarify whether IR in patients without PCOS affects the outcomes of in-vitro fertilization-embryo transfer (IVF-ET) and pregnancy. Methods: Between January 2011 and December 2013, we retrospectively reviewed the medical records of 116 non-PCOS patients who underwent the first IVF–ET cycle. IR was calculated using the homeostasis model assessment (HOMA) index [HOMA-IR = (insulin × glucose)/405]. A HOMA index of >2.5 was used to indicate IR. Based on the HOMA index calculation, 28 patients were IR(+) and 88 patients had normal insulin sensitivity. We retrospectively compared the response with controlled ovarian hyperstimulation, retrieved oocytes number, fertilization rates, pregnancy rate, live birth rates, and gestational diabetes mellitus (GDM) incidence. Results: There were no significant differences in human menopausal gonadotropin administration, peak estradiol, retrieved oocyte number, fertilized embryo number, good quality embryo number, implantation rate, clinical pregnancy rate, miscarriage rate, delivery rate, or ovarian hyperstimulation syndrome and GDM incidences between the groups. Conclusion: IR in non-PCOS patients has no effect on IVF-ET outcomes or perinatal prognosis.

Untreated Prior Pulmonary Tuberculosis Adversely Affects Pregnancy Outcomes in Infertile Women Undergoing in vitro Fertilization and Embryo Transfer: A Large Retrospective Cohort Study

Objective Prior pulmonary tuberculosis(PTB) on chest X-ray(CXR) was commonly found in infertile patients receiving examinations before in vitro fertilization and embryo transfer(IVF-ET). It was unclear whether untreated PTB would affect pregnancy outcomes after IVF-ET.Method We conducted a retrospective cohort study of 14,254 infertile patients who had received IVFET at Peking University Third Hospital in 2017. Prior PTB was defined as the presence of signs suggestive of old or inactive PTB on CXR, with or without a clinical TB history. Patients who had prior PTB on CXR but had not received a clinical diagnosis and anti-TB therapy were included for analysis. Live birth,clinical pregnancy, and miscarriage rates were compared between the untreated PTB and non-PTB groups.Results The untreated PTB group had significantly lower clinical pregnancy(31.7% vs. 38.1%) and live birth(23.8% vs. 30.6%) rates than the non-PTB group(both P < 0.001). Multivariate analysis revealed that untreated PTB was a risk factor for decreased live birth rate [odds ratio(OR), 0.80;95% confidence interval(CI), 0.66–0.98;P = 0.028] in all patients and for increased miscarriage(OR, 4.19;95% CI,1.69–10.39;P = 0.002) and decreased live birth(OR, 0.45;95% CI, 0.24–0.83;P = 0.011) rates in patients with unexplained infertility.Conclusions Untreated PTB was associated with adverse pregnancy outcomes after IVF-ET, especially in patients with unexplained infertility, highlighting the clinical significance of PTB in this specific patient population.

Intramural pregnancy after in vitro fertilization and embryo transfer:A case report

BACKGROUND Intramural pregnancy is a rare type of ectopic pregnancy,which is diagnosed by transvaginal ultrasound and magnetic resonance imaging.Management strategies vary depending on the site of the pregnancy,the gestational age and the desire to maintain fertility.The incidence of intramural pregnancy in assisted reproductive technology is higher than that in natural pregnancy.CASE SUMMARY We present a case of intramural pregnancy after in vitro fertilization and elective single embryo transfer following salpingectomy.The patient was completely asymptomatic and her serumβ-human chorionic gonadotropin level increased from 290 m IU/m L to 1759 m IU/m L.Three-dimensional transvaginal ultrasound indicated a heterogeneous echogenic mass arising from the uterine fundus which was surrounded by myometrium and a slender and extremely hypoechoic area stretching to the uterine cavity which was thought to be a fistulous tract.Therefore,we considered a diagnosis of intramural pregnancy and laparoscopic surgery was conducted at 7 wk gestation.CONCLUSION Early diagnosis and treatment of intramural pregnancy is significant for maintaining fertility.

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.

Laparoscopic management of an ectopic pregnancy after in vitro fertilization and embryo transfer at CHRACERH:A case report

1.Introduction Initially,in vitro fertilization and embryo transfer(IVF-ET)was designed to solve tubal factors infertility(TFI)by placing the embryo(s)within the uterine cavity.However,in some cases,an ectopic implantation occurs as the embryo can enter the tube.Ectopic pregnancy(EP)is the location of the pregnancy outside the intrauterine cavity.The prevalence of EP following assisted reproductive technology(ART)ranges between 2.1%and 8.6%of all pregnancies and it can reach up to 11%inwomen with tubal factors infertility history.

Effect of Mitochondrial Function of Ovarian Granulosa Cells on In Vitro Fertilization and Embryo Transfer Outcomes in Obese Polycystic Ovary Syndrome Patients

Objective:To investigate the effect of abnormal ovarian granulosa cell metabolism on in vitro fertilization and embryo transfer(IVF-ET)outcomes in obese polycystic ovary syndrome(PCOS)patients.Methods:Patients with PCOS who met the study criteria were screened according to the inclusion criteria.A total of 32 patients with obese PCOS were recruited into the study group,and 39 patients with non-obese PCOS were recruited into the control group.The general data(age,body mass index,and years of infertility),insulin resistance index(HOMA-IR),follicle-stimulating hormone(FSH),luteinizing hormone(LH),granulosa cell mitochondrial function,and IVF-ET outcome of patients in the study group and control group were retrospectively analyzed.Results:The differences in age and years of infertility between the study group and the control group were insignificant(P>0.05),and the body mass index(BMI)of the study group and control group was 30.5±1.24 kg/m2 and 22.3±1.12 kg/m2,respectively,in which the difference was statistically significant(P<0.05);the HOMA-IR of the study group was significantly higher than that of the control group(P<0.05);the reactive oxygen species(ROS)in the study group was significantly higher than that in the control group(P<0.05),and the ATP content in the study group was significantly lower than that in the control group(P<0.05);comparing the FSH and LH levels between the two groups,the difference was not statistically significant(P>0.05);the rate of IVF-ET failure was significantly higher in the study group than in the control group.Conclusion:PCOS is a complex endocrine disorder,and obesity is one of the independent risk factors for the development of PCOS.

Effect of Progestin-primed Ovarian Stimulation Protocol on Outcomes of Aged Infertile Women Who Failed to Get Pregnant in the First IVF/ ICSI Cycle： A Self-controlled Study

This study aimed to explore the outcomes of progestin-primed ovarian stimulation protocol （PPOS） in aged infertile women who failed to get pregnant in the first IVF/ICSI-ET cycles with GnRH-a long protocol. A self-controlled study was conducted to retrospectively investigate the clinical outcomes of 104 aged infertile patients who didn＇t get pregnant in the first IVF/ICSI-ET treatment by stimulating with GnRH-a long protocol （non-PPOS group）, and underwent PPOS protocol （PPOS group） in the second cycle between January 2016 and December 2016 in the Center for Reproductive Medicine, Renmin Hospital of Wuhan University. The primary outcomes included clinical pregnancy rate of frozen-thawed embryos transfer （FET） in PPOS group, and good-quality embryo rate in both groups. The secondary outcomes were fertilization rate, egg utilization rate and cycle cancellation rate. The results showed that there were no significant differences in basal follicle stimulating hormone （bFSH）, antral follicle count （AFC）, duration and total dosage of gonadotropin （Gn）, number of oocytes retrieved, intracytoplasmic sperm injection （ICSI） rate, fertilization rate, and cycle cancellation rate between the two groups （P〉0.05）. However, the oocyte utilization rate and good-quality embryo rate in PPOS group were significantly higher than those in non-PPOS group （P〈0.05）. By the end of April 2017, 62 FET cycles were conducted in PPOS group. The clinical pregnancy rate and embryo implantation rate were 22.58% and 12.70%, respectively. In conclusion, PPOS protocol may provide better clinical outcomes by improving the oocyte utilization rate and good-quality embryo rate for aged infertile patients who failed to get pregnant in the first IVF/ ICSI-ET cycles.

Reproductive Outcomes in Women with Prior Cesarean Section Undergoing In Vitro Fertilization:A Retrospective Case-control Study

The impact of prior cesarean section（CS） on the pregnancy and neonatal outcomes of in vitro fertilization and embryo transfer（IVF-ET） was investigated. A retrospective analysis was performed on 144 patients with prior CS between January 2013 and December 2015. The pregnancy, delivery, and neonatal outcomes of patients who had previous CS delivery and received IVF-ET were analyzed. The control group comprised 166 patients who had only previous vaginal delivery（VD） and received IVF-ET during the same period. The results showed that the basal follicle stimulating hormone level, estradiol level on human chorionic gonadotropin（h CG） day, gonadotrophin dosage, duration of stimulation, retrieved oocytes, fertilization rate, high-quality embryo rate, multiple birth rate, abortion rate and ectopic pregnancy rate had no significant difference between the two groups（P〉0.05）. The pregnancy rate（40.28% vs. 54.22%） and implantation rate（24.01% vs. 34.67%） were significantly lower（P〈0.05）, and the ratio of embryo difficulty transfer（9/144 vs. 0/166） was significantly higher in CS group than in VD group. The risk of pernicious placenta previa and postpartum hemorrhage in twin deliveries was significantly increased in CS group as compared with that in VD group（P〈0.05）, and gestational age and neonatal birth weight were significantly reduced in twin deliveries as compared with singleton deliveries in both groups（P〈0.05）. It was suggested that the existence of CS scar may impact embryo implantation and clinical pregnancy outcome, and increase the difficulty of ET. We should limit the number of transfer embryos to avoid multiple pregnancies and strengthen gestational supervision in patients with cesarean scar.

基于活产建立体外受精-胚胎移植精子DNA碎片指数的参考阈值及子代短期安全性

背景:精子DNA碎片指数与受精、胚胎发育潜能、胚胎植入、流产及子代安全性等存在显著的相关性。然而,其临床参考值受多种因素的影响,导致临床意义极其有限,该研究以活产为结局,通过倾向评分匹配校正其他混杂因素后,构建精子DNA碎片指数与活产的最佳临床截断值,并对其进行内外部验证,具有较好的预测价值及临床应用效能。目的:探讨基于活产建立体外受精-胚胎移植精子DNA碎片指数的参考阈值及子代短期安全性。方法:选取2019年5月至2021年5月于常州市妇幼保健院接受体外受精-胚胎移植患者1921例,以倾向匹配容差0.02为标准,1∶1进行倾向评分匹配,结果活产组与非活产组各成功匹配540例,以此建立模型组;通过选取同时期广西壮族自治区南溪山医院接受体外受精-胚胎移植患者135例作为外部验证组;采用受试者工作曲线探求精子DNA碎片指数对活产的临床最佳截断值,分别采用限制性立方样条曲线、标准曲线、临床决策曲线、临床影响曲线及内外部验证等方法,对该截断值的准确性及临床应用效能进行评估。结果与结论:(1)非活产组精子DNA碎片指数显著高于活产组且与活产存在显著的负相关性(r=-0.444,P<0.001);(2)受试者工作曲线结果显示,DNA碎片指数对活产的最佳截断值为24.33%,曲线下面积为0.775(0.746,0.804),特异度为72.60%,敏感度为78.90%,准确度为75.70%;(3)限制性立方样条曲线拟合Logistic回归结果显示,当精子DNA碎片指数大于24.57%时,临床非活产的风险呈趋势性增涨;(4)Logistic回归概率分析结果显示,精子DNA碎片指数为活产的危险因素[OR(95%CI)=0.916(0.904,0.928),P<0.001],且当精子DNA碎片指数大于27.78%时,临床活产发生的概率将小于50%,随着精子DNA碎片指数每增高1个单位,活产的概率下降8.4%;(5)内外部对该临床截断值的验证均显示,该截点具有一定的临床预测价值及准确性;(6)临床决策曲线与临床影响曲线显示,以该临床截断值建立的预测模型在阈概率为0.22-0.73时具有临床最大净获益值,且在该阈概率范围内损失与获益的比值始终小于1,证实该预测模型具有较好的临床应用效能;(7)精子DNA碎片指数与子代短期安全性分析结果显示,精子DNA碎片指数与出生儿早产、体质量、畸形、性别差异无显著性;(8)结果表明,精子DNA碎片指数对体外受精-胚胎移植活产的最佳临床截断值为24.33%,以此建立的临床预测模型具有较好的区分度、准确度与临床应用效能,精子DNA碎片指数对子代短期安全性影响并不显著,但仍需大样本及长期的追踪评估。

In vitro fertilization: Facts in medical sciences

In vitro fertilization (IVF) is one of the assisted reproductive technologies in the field of medical sciences. Fusion of collected egg from female and sperm from male done in a culture media under aseptic condition in laboratory is called as IVF. This technique is one of the gifts of science towards the human society and mainly those who are facing problem in reproduction due to having either male or female defective reproductive systems. In this present study, factors to consider during IVF, steps followed in this technology, need of IVF are discussed. Risk of multiple birth and phenotypic changes to the newborn due to IVF are also well reviewed. And different types of instruments used during this process are focused. Few ethical and legal issues arising during this IVF process are shown as well. We also emphasize that part of IVF.

Embryo Glue在IVF-ET临床应用的前瞻性研究

目的：研究EmbrycGlue是否有利于IVF-ET妊娠率的提高。方法：将2003年2月～2004年2月在本中心接受常规体外受精-胚胎移植（IVF-ET）或单精子卵母细胞浆内注射（ICSI）治疗周期的180例不孕患者随机分成两组进行双盲试验，实验组共100例，使用EmbryoGlue作为胚胎移植液，对照组80例，使用IVF-20胚胎培养液作为移植液。结果：实验组平均移植胚胎数为2．5个，对照组为2．4个（P〉0．05），实验组临床妊娠率及胚胎种植率分别为46．0％、32．7％，对照组为38．7％、26．4％，实验组临床妊娠率及胚胎种植率与对照组相比有上升趋势。结论：使用Embryo Glue作为胚胎移植液有助于提高妊娠率。

体外受精-胚胎移植屈螺酮炔雌醇预处理对多囊卵巢综合征妊娠结局的影响

目的探讨体外受精-胚胎移植(IVF-ET)屈螺酮炔雌醇预处理对多囊卵巢综合征(PCOS)患者妊娠结局的影响。方法回顾性分析2022年3月至2023年4月周口市中心医院收治的70例PCOS患者的临床资料,按照治疗方法不同分组,其中36例在IVF-ET治疗前未使用屈螺酮炔雌醇处理者纳入对照组,34例在IVF-ET治疗前使用屈螺酮炔雌醇处理者纳入观察组。治疗3个周期后,比较两组患者的妊娠结局,以及治疗前后的性激素水平、子宫内膜厚度、窦卵细胞数目、卵巢体积、胰岛素指数、胰岛素抵抗指数,同时比较两组患者的不良反应发生情况。结果治疗后,观察组患者的临床妊娠率为67.65%,高于对照组的52.78%,流产率和异位妊娠率分别为2.94%、2.94%,低于对照组的8.33%、5.56%,但差异均无统计学意义(P>0.05)。治疗前,两组患者的促性腺激素血清促卵泡刺激素(FSH)、促黄体生成素(LH)、睾酮(T)、雌二醇(E2)、抗苗勒氏管激素(AMH)水平比较差异均无统计学意义(P>0.05);治疗3个周期后,对照组患者的FSH、T、AMH高于治疗前,LH、E2低于治疗前,但差异无统计学意义(P>0.05);治疗3个周期后,观察组患者的FSH、AMH水平均高于治疗前且明显高于对照组,LH、T、E2水平低于治疗前且明显低于对照组,差异均有统计学意义(P<0.05)。治疗3个周期后,两组患者的子宫内膜厚度均大于治疗前,且观察组明显大于对照组,窦卵细胞数目和卵巢体积均小于治疗前,且观察组明显小于对照组,差异均有统计学意义(P<0.05)。治疗3个周期后,两组患者的胰岛素指数、胰岛素抵抗指数均低于治疗前,且观察组明显低于对照组,差异均有统计学意义(P<0.05)。治疗期间,观察组患者的不良反应总发生率为5.88%,略低于对照组的11.11%,但差异无统计学意义(P>0.05)。结论PCOS患者IVF-ET治疗前使用屈螺酮炔雌醇处理可显著改善患者的性激素水平,增加其子宫内膜厚度和卵巢体积,从而改善妊娠结局。

中心性肥胖对不孕女性体外受精-胚胎移植妊娠结局的影响

目的探讨中心性肥胖对不孕女性接受体外受精-胚胎移植后的妊娠结局的影响。方法回顾性选取2017年10月至2019年9月在温州医科大学附属第一医院生殖医学中心首次接受体外受精-胚胎移植的2801例不孕女性为研究对象。根据进入治疗周期时的BMI和腰臀比(WHR)分为正常BMI非中心性肥胖组1659例、正常BMI中心性肥胖组654例、肥胖非中心性肥胖组146例和肥胖中心性肥胖组342例,比较4组治疗过程中促性腺激素使用剂量、促排时间、获卵数、可用胚胎数及新鲜胚胎移植妊娠结局。采用多元线性回归分析中心性肥胖对促排周期获得可用胚胎数的影响,多因素logistic回归分析影响患者新鲜胚胎移植能否获得活产的相关因素。应用Kaplan-Meier生存曲线绘制各组单个取卵周期累积活产率。结果与正常BMI非中心性肥胖组相比,肥胖中心性肥胖组促性腺激素使用剂量增加,获卵数和可用胚胎数减少,新鲜胚胎移植后活产率下降,妊娠丢失率增加,单个取卵周期累积活产率下降,差异均有统计学意义(均P<0.05)。多元线性回归分析提示WHR≥0.85显著降低患者促排周期获得的可用胚胎数。不论BMI是否提示肥胖,WHR≥0.85的中心性肥胖女性,其单个取卵周期累积活产率较正常BMI非中心性肥胖组女性下降(均P<0.05)。多因素logistic回归分析发现腰围的增加会使新鲜胚胎移植后活产率降低(OR=0.978,95%CI:0.963~0.992,P=0.003)。Kaplan-Meier生存曲线显示随着胚胎移植周期数增多,4组患者单个取卵周期累积活产率比较差异有统计学意义(P<0.05)。结论中心性肥胖对女性体外受精-胚胎移植的妊娠结局造成不良影响。

决策树和Logistic回归模型对体外受精-胚胎移植患者妊娠结局的预测价值比较

目的:比较决策树和Logistic回归模型对体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)患者妊娠结局的预测价值。方法:纳入2021年1月至2022年10月在长治医学院附属和平医院接受IVF-ET的患者350例为研究对象,根据妊娠结局分为妊娠成功组(215例)和妊娠失败组(135例)。收集患者临床资料,建立IVF-ET患者妊娠结局Logistic回归和决策树预测模型,并在是否基于Logistic回归结果条件下建立决策树分析模型(决策树1和决策树2),采用受试者工作特征(receiver operating characteristic,ROC)曲线对模型预测效果进行评价。结果:350例患者中,妊娠成功患者占61.43%,妊娠失败者占38.57%。妊娠失败组年龄≥35岁、不孕年限≥5年、周期次数≥1次、有心理精神障碍的患者比例及HCG日血清孕酮水平均高于妊娠成功组,获卵数≥10枚、受精率≥75%的患者比例及HCG日子宫内膜厚度、优质胚胎数小于妊娠成功组(P<0.05)。多因素Logistic回归分析结果显示,年龄、HCG日血清孕酮水平、优质胚胎数及心理精神障碍均是IVF-ET患者妊娠结局的影响因素(P<0.05)。决策树模型显示,年龄、HCG日血清孕酮水平、优质胚胎数为IVF-ET患者妊娠结局的影响因素。Logistic回归模型曲线下面积(area under curve,AUC)为0.832,预测敏感度、特异度和准确度分别为87.3%、71.4%、83.5%;决策树1的AUC为0.859,预测敏感度、特异度和准确度分别为85.1%、76.8%、85.6%;决策树2的AUC为0.820,预测敏感度、特异度和准确度分别为83.7%、73.2%、82.4%。决策树1的AUC大于决策树2(P<0.05),但与Logistic回归模型的AUC比较差异无统计学意义(P>0.05)。结论:Logistic回归模型和决策树模型对于IVF-ET患者妊娠结局均有一定的预测价值。

接受体外受精-胚胎移植治疗夫妻中男性患者自我效能与生活质量的关系:基于婚姻调适的中介效应

目的探讨接受体外受精-胚胎移植(IVF-ET)治疗夫妻中男性患者婚姻调适在自我效能与生活质量间的中介效应。方法采用时间连续抽样法,选取2022年1月至4月在北京市某三甲医院生殖医学中心接受IVF-ET治疗的293例男性患者作为研究对象。采用一般资料调查表、自我效能感量表、Locke-Wallace婚姻调适量表和生育生活质量量表进行调查,采用结构方程模型进行中介效应检验。结果接受IVF-ET治疗的男性患者生活质量总分为(68.46±10.85)分。婚姻调适与自我效能、生活质量总分均呈正相关(r=0.408、0.391,P<0.01),婚姻调适是自我效能和生活质量的中介变量(β=0.104,P<0.001),中介效应占总效应的26.74%。结论接受IVF-ET治疗的男性患者生活质量处于中等水平,婚姻调适在自我效能和生活质量间起部分中介作用。建议在改善接受IVF-ET治疗男性患者生活质量的干预工作中,应重视婚姻调适的影响,注重激发患者自我效能,开展夫妻共同健康教育,提高婚姻调适水平以进一步提高生活质量。

卵裂期胚胎发育速度对体外受精-胚胎移植临床结局的影响

目的 探讨不同发育速度的卵裂期胚胎对后续囊胚培养及移植后结局的影响。方法 回顾性分析2020年1月至2023年7月于该院生殖中心行体外受精-胚胎移植/卵胞浆内单精子注射助孕的患者资料,根据第3天胚胎卵裂球数目分为6~10个细胞组及11~16个细胞组。其中6~10个细胞组又分为6个细胞组、7个细胞组、8个细胞组、9个细胞组和10个细胞组;11~16个细胞组又分为11~12个细胞组、13~14个细胞组和15~16个细胞组。比较各组的囊胚培养情况和移植后的临床结局。结果 11~16个细胞组的非二倍卵裂率和卵裂球碎裂率明显高于6~10个细胞组,差异有统计学意义(P<0.05)。6~10个细胞组的囊胚形成率和优质囊胚率均明显低于11~16个细胞组,差异均有统计学意义(P<0.05);2组临床妊娠率、胚胎种植率、流产率、活产率和抱婴回家率比较,差异均无统计学意义(P>0.05)。在6~10个细胞各亚组中,6个细胞组的囊胚形成率明显低于其他各组,差异有统计学意义(P<0.05);7个细胞组的囊胚形成率明显低于8个细胞组、9个细胞组、10个细胞组,差异有统计学意义(P<0.05);6个细胞组和7个细胞组的优质囊胚率明显低于8个细胞组、9个细胞组、10个细胞组,差异有统计学意义(P<0.05);各组间的临床妊娠率、胚胎种植率、早期流产率、活产率和抱婴回家率比较,差异无统计学意义(P>0.05)。在11~16个细胞各亚组中,3组的囊胚形成率、优质囊胚率、临床妊娠率、胚胎种植率、流产率、活产率和抱婴回家率比较,差异均无统计学意义(P>0.05)。结论 发育速度较快的11~16个细胞胚胎可形成高质量囊胚,移植后可获得较好的临床结局。

血清PGC-1α水平与PCOS患者体外受精-胚胎移植妊娠结局的关系

目的探析血清过氧化物酶体增殖物激活受体γ共激活因子1α(PGC-1α)水平与多囊卵巢综合征(PCOS)患者体外受精-胚胎移植(IVF-ET)妊娠结局的关系。方法选取2021年1月至2022年12月于广西壮族自治区妇幼保健院接受IVF-ET治疗的99例PCOS患者作为研究对象,依据患者妊娠结局分为妊娠组(n=49)和未妊娠组(n=50)。收集并比较所有患者基线资料以及性激素、血清PGC-1α水平等。采用Logistic回归分析影响PCOS患者IVF-ET妊娠结局的危险因素;采用受试者工作特征(ROC)曲线评估血清PGC-1α水平对PCOS患者IVF-ET妊娠结局的预测价值。结果99例PCOS患者中有49例妊娠成功,妊娠成功率为49.49%。未妊娠组血清甘油三酯(TG)、睾酮(T)水平均高于妊娠组,且血清PGC-1α水平低于妊娠组,差异具有统计学意义(P<0.05)。Logistic回归分析显示,血清T、TG水平高是PCOS患者IVF-ET治疗后妊娠结局的危险因素(OR>1,P<0.05),PGC-1α水平高是PCOS患者IVF-ET治疗后妊娠结局的保护因素(OR<1,P<0.05)。绘制ROC曲线显示,血清PGC-1α水平预测PCOS患者IVF-ET妊娠结局的曲线下面积(AUC)为0.752(95%CI:0.654~0.850,P<0.05),具有一定的预测价值。当血清PGC-1α的Cut-off值为0.485 ng/mL时,预测PCOS患者IVF-ET妊娠结局的灵敏度和特异度分别为76%、67%。结论血清PGC-1α水平与PCOS患者IVF-ET妊娠结局有关,且当其水平达0.485 ng/mL时,妊娠失败风险明显增加,具有一定的预测价值,未来或可将其作为预测IVF-ET妊娠结局的辅助指标。