Clinical Effects of the Follicular Phase Long Regimen and Luteal Phase Long Regimen on Ovulation Induction in IVF-ET Treatment: A Meta-Analysis

Objective:To systematically evaluate the clinical effects of the follicular phase long regimen and the luteal phase long regimen on ovulation induction in IVF-ET treatment.Methods:Databases including PubMed,Embase,Cochrane Library,CNKI,Chinese Biomedical Literature(CBM),VIP,Wanfang,and others were searched up to January 2021.Clinical studies on ovulation induction using the follicular phase long regimen and luteal phase long regimen in IVF-ET treatment were identified.Literature screening,data extraction,and quality evaluation were conducted based on inclusion and exclusion criteria.Meta-analysis was performed using RevMan 5.3 software.Results:After screening,a total of 11 studies were included,comprising 21,544 patients:9,974 in the follicular phase long regimen group and 11,570 in the luteal phase long regimen group.The meta-analysis results were as follows:(1)The number of Gn days and the total amount of Gn in the follicular phase long regimen were higher than those in the luteal phase long regimen(P<0.05);(2)The number of eggs obtained in the follicular phase long regimen was higher than that in the luteal phase long regimen(P<0.05).There were no significant differences in the rate of embryo optimization and cycle cancellation between the two groups(P>0.05);(3)The embryo implantation rate and clinical pregnancy rate in the follicular phase long regimen were higher than those in the luteal phase long regimen(P<0.05),while the abortion rate in the follicular phase long regimen was lower than that in the luteal phase long regimen(P<0.05).Conclusion:Compared to the luteal phase long regimen,the follicular phase long regimen involves more Gn days and a higher total amount of Gn.The optimal embryo rate and cycle cancellation rate were similar between the regimens,but the follicular phase long regimen resulted in more eggs,significantly improved the implantation and clinical pregnancy rates,and reduced the abortion rate.However,these conclusions require further validation through more multicenter,large-sample RCT studies.

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

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

Normal epigenetic inheritance in mice conceived by in vitro fertilization and embryo transfer

An association between assisted reproductive technology （ART） and neurobehavioral imprinting disorders has been reported in many studies, and it seems that ART may interfere with imprint reprogramming. However, it has never been explored whether epigenetic erros or imprinting disease susceptibility induced by ART can be inherited transgenerationally. Hence, the aim of this study was to determine the effect of in vitro fertilization and embryo transfer （IVF-ET） on transgenerational inheritance in am inbred mouse model. Mice derived from IVF-ET were outcrossed to wild-type C57BL/6J to obtain their female and male line F2 and F3 generations. Their behavior, morphology, histology, and DNA methylation status at several important differentially methylated regions （DMRs） were analyzed by Morris water maze, hematoxylin and eosin （H＆E） staining, and bisulfite genomic sequencing. No significant differences in spatial learning or phenotypic abnormality were found in adults derived from IVF （F1） and female and male line F2 and F3 generations. A borderline trend of hypomethylation was found in H19 DMR CpG island 3 in the female line-derived F3 generation （0.40±0.118, P=0.086）. Methylation status in H19/Igf2 DMR island 1, Igf2 DMR, KvDMR, and Snrpn DMR displayed normal patterns. Methylation percentage did not differ significantly from that of adults conceived naturally, and the expression of the genes they regulated was not disturbed. Transgenerational integrity, such as behavior, morphology, histology, and DNA methylation status, was maintained in these generations, which indicates that exposure of female germ cells to hormonel stimulation and gamete manipulation might not affect the individuals and their descendents.

Impact of Blood Clot in Oocyte-Corona-Cumulus Complex during in vitro Fertilization and Embryo Transfer

Objective To study the impact of blood clots in the oocyte-corona-cumulus complexes （OCCC） during in vitro fertilization and embryo transfer （IVF-ET）.Methods The OCCCs were harvested from the patients undergoing long protocol ovarian hyperstimulation. The OCCCs with blood clots removed or not, were randomly grouped into A or B. The OCCCs without blood clots were group C （the control）.Results The patient＇s age, infertility duration, the average GN consumption, the average days of superovulation and an average number of harvested oocytes showed no significant difference in the 3 groups. The fertilization rate and 2PN rate in group A were the highest, which were 85.4% and 71.1%, respectively, followed by group C, which were 77.5% and 64.9%, respectively. The lowest fertilization rate and 2PN rate were in group B, 75.8% and 62.2%, respectively. Those in group A were significantly higher than those in groups B and C （P〈0.01）, while there was no significant difference between group B and group C. The implantation rates and pregnancy rates showed no significant difference in the 3 groups after transplantation, even if group A got the highest rate among the 3 groups. Conclusion Removing the blood clots in OCCC can improve the outcome of IVF-ET without increasing the cost and complexity of the operation.

Is there A Link between Serum Thyroid Stimulating Hormone Level and the Results of in vitro Fertilization and Embryo Transfer?

Objective To analyze the clinical features and outcomes in infertile patients with different levels of thyroid stimulating hormone （TSH） undergoing IVF/ICSL and to investigate whether inappropriate level of TSH has the adverse effect on the results of the IVF-ET.Methods A total of 389 patients undergoing IVF/ICSI from January 2009 to December 2011 were divided into 3 groups according to the basal TSH level： group A （TSH〈 2.0 mlU/L）, group B （TSH 2.0-4.5 mlU/L） and group C （TSH〉4.5 mlU/L）. Oocyte retrieved, fertilization rate, cleavage rate, available embryo rate, pregnancy rate and miscarriage rate were analyzed to explore whether serum TSH level was correlated with the results of lVF/ICSI.Results There were no differences in number of oocyte retrieved, fertilization rate, cleavage rate and available embryo rate among 3 groups （P〉0.05）. Clinical pregnancy rate in group B （43.0%） was significantly higher than that in group A （30.2%） and group B （23.5%）, respectively （P〈0.05）. There were no significant differences in miscarriage rate among 3 groups.Conclusion TSH level has no effect on fertility rate or miscarriage rate in patients undergoing IVF/ICSL Inadequacy TSH level would decrease the IVF/ICSI pregnancy rate.

介入栓塞术治疗输卵管积水的疗效分析

目的:探讨输卵管积水的影像学表现及介入栓塞术治疗输卵管积水的效果。方法:选择2009年11月—2013年6月行输卵管介入栓塞术的396例输卵管积水患者,其中单侧输卵管积水250例,双侧输卵管积水146例,共计542条积水输卵管。根据积水输卵管形态分为轻型组(n=496)和重型组(n=46)。应用微导管将铂金微弹簧圈送至输卵管间质部及峡部,对积水的输卵管进行栓塞,比较2组的栓塞效果。结果:轻型组总有效率为100%,重型组总有效率为97.8%。结论:输卵管介入栓塞术作为体外受精-胚胎移植前输卵管积水预处理的较好方法,总成功率高、患者痛苦小、无麻醉风险;手术难度与输卵管形态有关,在术者的手术操作能力较强的情况下值得推广。

腹部定位卡和宣教卡对体外受精-胚胎移植患者皮下注射低分子肝素的效果分析

目的探讨腹部定位卡和宣教卡对体外受精-胚胎移植(IVF-ET)患者皮下注射低分子肝素的效果。方法选择2017年10月至2018年5月在广东省妇幼保健院生殖健康与不孕症科行IVF-ET需皮下注射低分子肝素的162例女性患者为研究对象,利用Excel随机数进行随机等分成对照组和干预组各81例。对照组给予常规护理措施,干预组额外发放腹部定位卡和宣教卡。在注射后第5天比较患者对低分子肝素皮下注射知识的知晓率、患者的基本情况、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分,第10天比较两组患者皮下出血发生率、硬结发生率,孕12周时比较临床妊娠率、早期流产率。结果干预组患者的皮下出血发生率为11.1%,明显低于对照组的25.9%,差异有统计学意义(P<0.05);干预组患者的硬结发生率为3.7%,与对照组的6.2%比较,差异无统计学意义(P>0.05);干预组患者对皮下注射低分子肝素的使用原因、重要性和注意事项的知晓率分别为98.8%、98.8%、92.6%,均明显高于对照组的77.8%、71.6%、49.4%,差异均有统计学意义(P<0.05);干预组患者的SAS和SDS得分分别为(40.26±4.05)分和(43.57±6.12)分,均明显低于对照组的(47.52±5.02)分和(48.52±6.24)分,差异均有统计学意义(P<0.05);干预组患者的临床妊娠率为58.0%,略高于对照组的49.4%,流产率为8.6%,略低于对照组的18.5%,但差异均无统计学意义(P>0.05)。结论腹部定位卡和宣教卡能明显降低皮下出血的发生率,提升患者对低分子肝素皮下注射护理的知晓率,进而有效降低IVF-ET患者的焦虑、抑郁状态,缓解患者的心理压力,从而可能获得更好的临床治疗结局,使患者获益。

Selective Short-term Fertilization Combined with Early Rescue ICSI: An Optimal Strategy for Patients at High Risk for Fertilization Failure

Objective To investigate clinical outcomes in patients who were at more precise criteria risks for fertilization failure and were treated with selective, short-term fertilization （oocytes and sperm co-incubated for 4 h） and early rescue intracytoplasmic sperm injection （ICSI）. Methods A retrospective analysis was performed on 2023 women undergoing assisted reproductive technology （ART）. They were assigned to 4 groups： short-term in vitro fertilization （short-term IVF,, group A, n=217）, regular IVF （oocytes and sperm coincubated overnight, group B, n=1475）, short-term IVF and early rescue ICSI （shortterm ICSI, group C, n=94）, and regular ICSI （group D, n=237）. Results In group A, 69.8% （217/311） achieved normal fertilization rates, and the complete fertilization failure rate （fertilization rate was 0%） was 12.9% （40/311）. But all of the fertilization failure oocytes got rescue ICSI. In group B, the complete fertilization failure rate was 1.1% （19/1 692）. The fertilization rate, 2 PN （pronucleus） rate, and i PN rate were significantly lower in group A than those in group B （70.9% vs 80.8%, 57.8% vs 66.3%, and 3.5% vs 6.2%, respectively）. No significant differences were observed in clinical pregnancy rates and birth defect rates between groups A and B. The fertilization rates in groups C and D did not significantly differ （77.9% vs 76.2%）, which was also true for birth defect rates. The clinical pregnancy rate of group C was higher than that of group D （51.2% vs 42.3%）, but this difference was not significant （P〉0. 05）.Conclusion These results suggested that selective, short-term fertilization can result in effective outcomes for patients who were at high risk for fertilization failure.

Case of acupuncture combined with Chinese herbal medication in assistance of pregnancy after 11 failures of IVF-ET at advanced age

This paper reports one case of successful pregnancy in the assistance of acupuncture therapy for regulating menstruation and promoting pregnancy and the periodic intervention with Chinese herbal medicine in a 41-year-old patient with infertility.The patient suffered from 11 failures in the assisted reproductive technique during 3 years.This case suggests that the combined treatment with acupuncture for regulating menstruation and promoting pregnancy and the periodic intervention with Chinese herbal medicine increase the levels of follicle-stimulating hormone(FSH)and estradiol(E2),improve the oocyte quality and the uterine environment.This therapeutic method plays a positive auxiliary role in the whole process of in vitro fertilization and embryo transfer(IVF-ET)and it can be adopted as an intervention for patients with multiple assisted reproductive failures.