A 43-year-old woman with an associated history of gynecological pathology and breast cancer with only one cryopreserved embryo wished to be a mother.Several factors that influenced the success of the pregnancy in this...A 43-year-old woman with an associated history of gynecological pathology and breast cancer with only one cryopreserved embryo wished to be a mother.Several factors that influenced the success of the pregnancy in this case were analyzed. Favorable factors included: triple positive breast cancer [positive hormone receptors and positive human epidermal growth factor receptor 2],which is more hormosensitive and chemosensitive; absence of metastasis; correct endometrium preparation; and the patient's optimistic attitude and strict health habits. In contrast, the factors against success were: breast cancer; adjuvant breast cancer therapy gonadotoxicity; the age of the patient(> 40-year-old);endometriosis; ovarian cyst; hydrosalpinx; submucosal fibroids and the respective associated surgery done for the above-mentioned pathology(all resolved prior to the embryo transfer); and a low quantity of ovules(low ovarian reserve) after ovarian stimulation. This is a very special clinical case of a patient with theoretically low pregnancy success probability due to the consecutive accumulation of gynecological and oncological pathologies, who nonetheless became pregnant and delivered a full-term infant and was able to provide adequate breastfeeding.展开更多
Background： The endometriosis fertility index （EFI） has a predictive value for pregnancy after surgery. In vitro fertilization and embryo transfer （IVF-ET） is a good treatment to infertility. This study aimed to ...Background： The endometriosis fertility index （EFI） has a predictive value for pregnancy after surgery. In vitro fertilization and embryo transfer （IVF-ET） is a good treatment to infertility. This study aimed to provide external validation of EFI, assess the factors affecting the ability of EFI to predict cumulative spontaneous pregnancy rates （PRs）, and propose reasonable advice for treatment by evaluating the effect of infertility management combining surgery and IVF-ET. Methods： This retrospective study enrolled 345 endometriosis-related infertile women after laparoscopic surgery from January 2012 to January 2016. Among them, 234 patients tried to conceive naturally and were divided into six groups according to their different EFI scores. Of the 345 patients, 307 with an EFI score 〉5 were divided into non-IVF-ET group （n = 209） and IVE-ET group （n = 98） to compare the cumulative PRs. Cumulative PRs＇ curves were calculated using the Kaplan-Meier product limit estimate and the differences were evaluated by log-rank test. Independent predictive factors for pregnancy were assessed using the Cox regression model. Results： Significant differences in spontaneous PRs among different EFI scores were identified （χ2 = 29.945, P 〈 0.05）. The least function score was proved to be the most important factor for EFI （χ2 = 6.931, P 〈 0.05） staging system. In patients with an EFI score ≥5 after 12 months from surgery, the cumulative PRs of those who received both surgery and IVF-ET were much higher than the spontaneous PRs of those who received surgery alone （χ2 =4.160, P = 0.041）. Conclusions： The EFI is a reliable staging system to predict the spontaneous PR of patients. The least function score was the most influential factor to predict the spontaneous PR. Patients with an EFI score ≥5 after 12 months from surgery are recommended to receive IVF-ET to achieve a higher PR.展开更多
OBJECTIVE:To investigate the effect of—Xiaoyi Yusi decoction(XYYSD,消异育嗣汤),a Traditional Chinese Medicine(TCM),on in vitro fertilization and embryo transfer(IVF-ET)in patients with endometriosis,and to study the ...OBJECTIVE:To investigate the effect of—Xiaoyi Yusi decoction(XYYSD,消异育嗣汤),a Traditional Chinese Medicine(TCM),on in vitro fertilization and embryo transfer(IVF-ET)in patients with endometriosis,and to study the mechanism underpinning the action.METHODS:Women who underwent IVF-ET were divided into three groups by simple randomization:the treatment(n=32;with TCM treatment),patient(n=28;with endometriosis alone),and control(n=33;with male factor alone)groups.The luteal phase short-acting gonadotropin-releasing hormone agonist prolonged protocol was used in all three groups.To compare the changes in TCM scores and reproductive outcomes before and after TCM intervention in patients with endometriosis,partial least-squares discriminant analysis was used to analyze the follicular fluid samples of each group and screen and compare metabolites using the MetaboA nalyst software.RESULTS:The clinical data indicated that following TCM intervention,kidney deficiency and blood stasis symptom patterns improved dramatically in patients with endometriosis and that their clinical pregnancy rate increased significantly(71.9%vs 57.1%,P<0.05).Metabolomics showed that the two groups of samples were separated before and after TCM intervention.After TCM intervention,the intervention group was close to the control group,indicating that the TCM had a certain effect.Pathway analysis revealed that after TCM intervention,the metabolism of glycerin phospholipid,pyruvate,and citric acid was regulated.CONCLUSIONS:Through the pyruvate and glycerophospholipid metabolism pathways and tricarboxylic acid cycle,the TCM XYYSD successfully improved kidney deficiency and blood stasis symptom pattern,as well as the clinical reproductive outcomes of patients with endometriosis-related infertility.展开更多
Background Endometriosis affects natural fertility through various approaches, and in vitro fertilization （IVF） is a good treatment. But the IVF result of endometriosis patients is still under debate. We investigate...Background Endometriosis affects natural fertility through various approaches, and in vitro fertilization （IVF） is a good treatment. But the IVF result of endometriosis patients is still under debate. We investigated the effect of endometriosis on IVF by analyzing the data from a single reproductive center. Methods A retrospective, database-searched cohort study was performed. Relevant information was collected from the electronic records of women who underwent IVF/intracytoplasmic sperm injection between January 2006 and December 2010 in the Assisted Reproductive Unit of Sir Run Run Shaw Hospital. Patients with endometriosis were enrolled the study group. The rest of the women formed the control group. The main outcome was the clinical pregnancy rate. Secondary outcomes were oocytes retrieved number, fertilization rate, high-quality embryo rate, number of high-quality embryo for embryo transplantation, and implantation embryo/high-quality embryo ratio （IE/HQE ratio）. Comparisons were performed by the z2-test and independent t-test. Results The endometriosis group （n=177） had a markedly lower oocytes retrieved number, fertilization rate, implantation rate, and clinical pregnancy rate （7.6_＋5.1, 63.6%, 27.7%, and 45.2%, respectively） compared with the non-endometriosis group （n=4267; 11.8＋7.3, 68.4%, 36.2%, and 55.2%, respectively）. Stratified analysis showed that this difference was found in the subgroup younger than 35-years old, while only fertilization rate and implantation rate were different in the elder subgroup. The ratio of high-quality embryos transferred is lower in endometriosis group （53.7% vs. 71.8%, P 〈0.05）, but there is no difference in IE/HQE ratio between two groups. There is no significant difference in fertilization rate, implantation rate, and clinical pregnancy rate between mild and severe endometriosis patients. Conclusions Endometriosis patients suffer a decreasing IVF pregnancy rates mainly caused by reducing oocytes number and fertilization rate, regardless of the severity of the disease. Appropriate intracytoplasmic sperm injection manipulation might improve the outcomes of IVF.展开更多
Background:Endometriosis is a chronic inflammatory condition involving endometrial-like tissue outside of the uterus.There are no medical management options available to improve fertility in patients with known endome...Background:Endometriosis is a chronic inflammatory condition involving endometrial-like tissue outside of the uterus.There are no medical management options available to improve fertility in patients with known endometriosis prior to conception.Specifically,the fertility sparing surgical techniques used to manage endometriomas and colorectal endometriosis are controversial prior to natural conception and implementing assisted reproductive technology.Methods:A literature search,including PubMed and the Cochrane Library,was performed from November 2020 to February 2021 and articles in English that addressed endometriosis associated infertility and surgical treatments were included.Our review provides a comprehensive evidence-based evaluation of fertility sparing endometriosis surgery.Results:The pathogenesis of endometriosis and its role in infertility is poorly understood and complex.The management of patients with painful endometriomas continues to be excision,whereas small asymptomatic endometriomas require an individualized approach.Colorectal endometriosis excision improves pregnancy rates in retrospective and prospective cohort studies.However,randomized control trials are still needed to confirm these findings and their functional risks must be carefully discussed with the patient.Conclusions:Surgical excision of endometriosis improves fertility in patients with symptomatic disease.Further research with randomized controlled trials is needed to determine if surgery is mandatory prior to implementing assisted reproductive technologies in those patients with asymptomatic endometriosis and infertility.展开更多
Background For patients with severe endometriosis, the spontaneous pregnancy rates have been reported to be near 0 due to extreme distortion of normal pelvic anatomy.Surgery is one of the treatment options; however, i...Background For patients with severe endometriosis, the spontaneous pregnancy rates have been reported to be near 0 due to extreme distortion of normal pelvic anatomy.Surgery is one of the treatment options; however, if patients failed to conceive after surgery, in vitro fertilization （IVF） is effective.The objective of this retrospective study was to determine the clinical characteristics of IVF/intracytoplasmic sperm injection （ICSI） in patients with stage Ⅲ/Ⅳ endometriosis, and to determine the impact of the interval from surgery to IVF/ICSI on outcome.Methods One hundred and sixty patients who were diagnosed with stage Ⅲ/Ⅳ endometriosis underwent IVF/ICSI cycles between February 2004 and June 2009 were enrolled.The mean interval from surgery to IVF, number of oocytes retrieved, fertilization rate, implantation rate, embryos transferred, and good embryos transferred were compared between two age groups （≤35 years and 〉 35 years）.Results The mean interval from surgery to IVF was （37.9±28.9） months for the group ≤ 35 years of age and （57.6±39.7）months for the group 〉35 years of age.Twenty-five IVF/ICSI cycles （12.8%） were performed during the first year after surgery, and 34.9% IVF/ICSI cycles were performed 2 years after surgery.No significant differences existed between the two groups with respect to the fertilization rate, implantation rate, number of embryos transferred, number of good embryos,clinical pregnancy rates, live birth rates, and cumulative clinical pregnancy rates （P 〉0.05）.The probability of cumulative clinical pregnancies was 75%, 50%, and 25% （（29.0±4.8）, （61.0±7.6）, and （120.0±16.9） months after surgery, respectively）.Conclusions For infertile patients with stage Ⅲ/Ⅳ endometriosis, the optimal time to conceive by IVF/ICSI is 〈2 years after surgery; nevertheless, most of the patients took a longer time to conceive.展开更多
基金Supported by grants from the Instituto Carlos Ⅲ,Nos.PI11/01377 and ISCⅢ-RETICRD12/0036/0029Government of Catalonia,No.2017SGR-1014
文摘A 43-year-old woman with an associated history of gynecological pathology and breast cancer with only one cryopreserved embryo wished to be a mother.Several factors that influenced the success of the pregnancy in this case were analyzed. Favorable factors included: triple positive breast cancer [positive hormone receptors and positive human epidermal growth factor receptor 2],which is more hormosensitive and chemosensitive; absence of metastasis; correct endometrium preparation; and the patient's optimistic attitude and strict health habits. In contrast, the factors against success were: breast cancer; adjuvant breast cancer therapy gonadotoxicity; the age of the patient(> 40-year-old);endometriosis; ovarian cyst; hydrosalpinx; submucosal fibroids and the respective associated surgery done for the above-mentioned pathology(all resolved prior to the embryo transfer); and a low quantity of ovules(low ovarian reserve) after ovarian stimulation. This is a very special clinical case of a patient with theoretically low pregnancy success probability due to the consecutive accumulation of gynecological and oncological pathologies, who nonetheless became pregnant and delivered a full-term infant and was able to provide adequate breastfeeding.
基金This work was supported by a grant from the National Natural Science Foundation of China （No. 81671427）.
文摘Background： The endometriosis fertility index （EFI） has a predictive value for pregnancy after surgery. In vitro fertilization and embryo transfer （IVF-ET） is a good treatment to infertility. This study aimed to provide external validation of EFI, assess the factors affecting the ability of EFI to predict cumulative spontaneous pregnancy rates （PRs）, and propose reasonable advice for treatment by evaluating the effect of infertility management combining surgery and IVF-ET. Methods： This retrospective study enrolled 345 endometriosis-related infertile women after laparoscopic surgery from January 2012 to January 2016. Among them, 234 patients tried to conceive naturally and were divided into six groups according to their different EFI scores. Of the 345 patients, 307 with an EFI score 〉5 were divided into non-IVF-ET group （n = 209） and IVE-ET group （n = 98） to compare the cumulative PRs. Cumulative PRs＇ curves were calculated using the Kaplan-Meier product limit estimate and the differences were evaluated by log-rank test. Independent predictive factors for pregnancy were assessed using the Cox regression model. Results： Significant differences in spontaneous PRs among different EFI scores were identified （χ2 = 29.945, P 〈 0.05）. The least function score was proved to be the most important factor for EFI （χ2 = 6.931, P 〈 0.05） staging system. In patients with an EFI score ≥5 after 12 months from surgery, the cumulative PRs of those who received both surgery and IVF-ET were much higher than the spontaneous PRs of those who received surgery alone （χ2 =4.160, P = 0.041）. Conclusions： The EFI is a reliable staging system to predict the spontaneous PR of patients. The least function score was the most influential factor to predict the spontaneous PR. Patients with an EFI score ≥5 after 12 months from surgery are recommended to receive IVF-ET to achieve a higher PR.
基金the National Natural Science Fund Project:A Theoretical Study of Renal Reproduction Based on in vitro Fertilization Follicular Fluid Differential Protein-metabolite Global Regulatory Network(No.81874484)。
文摘OBJECTIVE:To investigate the effect of—Xiaoyi Yusi decoction(XYYSD,消异育嗣汤),a Traditional Chinese Medicine(TCM),on in vitro fertilization and embryo transfer(IVF-ET)in patients with endometriosis,and to study the mechanism underpinning the action.METHODS:Women who underwent IVF-ET were divided into three groups by simple randomization:the treatment(n=32;with TCM treatment),patient(n=28;with endometriosis alone),and control(n=33;with male factor alone)groups.The luteal phase short-acting gonadotropin-releasing hormone agonist prolonged protocol was used in all three groups.To compare the changes in TCM scores and reproductive outcomes before and after TCM intervention in patients with endometriosis,partial least-squares discriminant analysis was used to analyze the follicular fluid samples of each group and screen and compare metabolites using the MetaboA nalyst software.RESULTS:The clinical data indicated that following TCM intervention,kidney deficiency and blood stasis symptom patterns improved dramatically in patients with endometriosis and that their clinical pregnancy rate increased significantly(71.9%vs 57.1%,P<0.05).Metabolomics showed that the two groups of samples were separated before and after TCM intervention.After TCM intervention,the intervention group was close to the control group,indicating that the TCM had a certain effect.Pathway analysis revealed that after TCM intervention,the metabolism of glycerin phospholipid,pyruvate,and citric acid was regulated.CONCLUSIONS:Through the pyruvate and glycerophospholipid metabolism pathways and tricarboxylic acid cycle,the TCM XYYSD successfully improved kidney deficiency and blood stasis symptom pattern,as well as the clinical reproductive outcomes of patients with endometriosis-related infertility.
基金＂I＇IllS study was supported by a grant from the Natural Science Foundation of Zhejiang （No. Y2080505）.
文摘Background Endometriosis affects natural fertility through various approaches, and in vitro fertilization （IVF） is a good treatment. But the IVF result of endometriosis patients is still under debate. We investigated the effect of endometriosis on IVF by analyzing the data from a single reproductive center. Methods A retrospective, database-searched cohort study was performed. Relevant information was collected from the electronic records of women who underwent IVF/intracytoplasmic sperm injection between January 2006 and December 2010 in the Assisted Reproductive Unit of Sir Run Run Shaw Hospital. Patients with endometriosis were enrolled the study group. The rest of the women formed the control group. The main outcome was the clinical pregnancy rate. Secondary outcomes were oocytes retrieved number, fertilization rate, high-quality embryo rate, number of high-quality embryo for embryo transplantation, and implantation embryo/high-quality embryo ratio （IE/HQE ratio）. Comparisons were performed by the z2-test and independent t-test. Results The endometriosis group （n=177） had a markedly lower oocytes retrieved number, fertilization rate, implantation rate, and clinical pregnancy rate （7.6_＋5.1, 63.6%, 27.7%, and 45.2%, respectively） compared with the non-endometriosis group （n=4267; 11.8＋7.3, 68.4%, 36.2%, and 55.2%, respectively）. Stratified analysis showed that this difference was found in the subgroup younger than 35-years old, while only fertilization rate and implantation rate were different in the elder subgroup. The ratio of high-quality embryos transferred is lower in endometriosis group （53.7% vs. 71.8%, P 〈0.05）, but there is no difference in IE/HQE ratio between two groups. There is no significant difference in fertilization rate, implantation rate, and clinical pregnancy rate between mild and severe endometriosis patients. Conclusions Endometriosis patients suffer a decreasing IVF pregnancy rates mainly caused by reducing oocytes number and fertilization rate, regardless of the severity of the disease. Appropriate intracytoplasmic sperm injection manipulation might improve the outcomes of IVF.
文摘Background:Endometriosis is a chronic inflammatory condition involving endometrial-like tissue outside of the uterus.There are no medical management options available to improve fertility in patients with known endometriosis prior to conception.Specifically,the fertility sparing surgical techniques used to manage endometriomas and colorectal endometriosis are controversial prior to natural conception and implementing assisted reproductive technology.Methods:A literature search,including PubMed and the Cochrane Library,was performed from November 2020 to February 2021 and articles in English that addressed endometriosis associated infertility and surgical treatments were included.Our review provides a comprehensive evidence-based evaluation of fertility sparing endometriosis surgery.Results:The pathogenesis of endometriosis and its role in infertility is poorly understood and complex.The management of patients with painful endometriomas continues to be excision,whereas small asymptomatic endometriomas require an individualized approach.Colorectal endometriosis excision improves pregnancy rates in retrospective and prospective cohort studies.However,randomized control trials are still needed to confirm these findings and their functional risks must be carefully discussed with the patient.Conclusions:Surgical excision of endometriosis improves fertility in patients with symptomatic disease.Further research with randomized controlled trials is needed to determine if surgery is mandatory prior to implementing assisted reproductive technologies in those patients with asymptomatic endometriosis and infertility.
文摘Background For patients with severe endometriosis, the spontaneous pregnancy rates have been reported to be near 0 due to extreme distortion of normal pelvic anatomy.Surgery is one of the treatment options; however, if patients failed to conceive after surgery, in vitro fertilization （IVF） is effective.The objective of this retrospective study was to determine the clinical characteristics of IVF/intracytoplasmic sperm injection （ICSI） in patients with stage Ⅲ/Ⅳ endometriosis, and to determine the impact of the interval from surgery to IVF/ICSI on outcome.Methods One hundred and sixty patients who were diagnosed with stage Ⅲ/Ⅳ endometriosis underwent IVF/ICSI cycles between February 2004 and June 2009 were enrolled.The mean interval from surgery to IVF, number of oocytes retrieved, fertilization rate, implantation rate, embryos transferred, and good embryos transferred were compared between two age groups （≤35 years and 〉 35 years）.Results The mean interval from surgery to IVF was （37.9±28.9） months for the group ≤ 35 years of age and （57.6±39.7）months for the group 〉35 years of age.Twenty-five IVF/ICSI cycles （12.8%） were performed during the first year after surgery, and 34.9% IVF/ICSI cycles were performed 2 years after surgery.No significant differences existed between the two groups with respect to the fertilization rate, implantation rate, number of embryos transferred, number of good embryos,clinical pregnancy rates, live birth rates, and cumulative clinical pregnancy rates （P 〉0.05）.The probability of cumulative clinical pregnancies was 75%, 50%, and 25% （（29.0±4.8）, （61.0±7.6）, and （120.0±16.9） months after surgery, respectively）.Conclusions For infertile patients with stage Ⅲ/Ⅳ endometriosis, the optimal time to conceive by IVF/ICSI is 〈2 years after surgery; nevertheless, most of the patients took a longer time to conceive.
