Mesenteric vein thrombosis following impregnation via in vitro fertilization-embryo transfer

Pregnancy is an acquired hypercoagulable state. Most patients with thrombosis that develops during pregnancy present with deep vein leg thrombosis and/or pulmonary embolism, whereas the development of mesenteric vein thrombosis(MVT) in pregnant patients is rare. We report a case of MVT in a 34-year-old woman who had achieved pregnancy via in vitro fertilization-embryo transfer(IVFET). At 7 wk of gestation, the patient was referred to us due to abdominal pain accompanied by vomiting and hematochezia, and she was diagnosed with superior MVT. Following resection of the gangrenous portion of the small intestine, anticoagulation therapy with unfractionated heparin and thrombolysis therapy via a catheter placed in the superior mesenteric artery were performed, and the patient underwent an artificial abortion. Oral estrogen had been administered for hormone replacement as part of the IVF-ET procedure, and additional precipitating factors related to thrombosis were not found. Pregnancy itself, in addition to the administered estrogen, may have caused MVT in this case. We believe that MVT should be included in the differential diagnosis of a pregnant patient who presents with an acute abdomen.

Letter to the editor“regarding case report of chronic cornual ectopic pregnancy presenting as large cornual mass after in vitro fertilization-embryo transfer”

We read the Yang et al,published case report in Laparoscopic,Endoscopic and Robotic Surgery.2019.https://doi.org/10.1016/j.lers.2019.09.001,with great interest.Yang et al,in the introduction mentioned that the cornual ectopic pregnancy is defined as a pregnancy that is abnormally located in the proximal portion of the fallopian tube,lying within the muscular wall of the uterus.

Effect of different fertilization time after human chorionic gonadotropin injection on fertilization outcome of patients in vitro fertilizationembryo transfer

Objective:To explore the effect of different fertilization time after human chorionic gonadotropin(HCG)injection on the outcome of fertilization in vitro fertilization-embryo transfer(IVF-ET).Methods:One thousand one hundred and forty IVF-ET cycles from January 2016 to August 2018 were analyzed retrospectively.According to the different fertilization time after injection of HCG divided into four groups:Group A(38.0 h~39.0 h),Group B(39.1 h~40.0 h),Group C(40.1 h~41.0 h),and Group D(41.1 h~42.0 h).The normal fertilization rate,the normal cleavage rate,the embryo utilization rate,the high-quality embryo rate,the clinical pregnancy rate,the implantation rate,and the spontaneous abortion rate were analyzed among the groups.Then we investigated the effect of different promotion methods on the outcome of fertilization during the optimal fertilization time.Results:There was no significant difference in 2PN cleavage rate,available embryo rate,clinical pregnancy rate,implantation rate and abortion rate among the four groups(P>0.05).The high-quality embryo rate in Group D(44.6%)was the highest,and was significantly different among the four groups(P<0.05).The normal fertilization rate in Group D(71.6%)was the highest,and was significantly different among the four groups(P<0.05).The normal fertilization rate(78.1%)of antagonist group was significantly higher than other groups(P<0.05).Conclusion:The different fertilization time after HCG injection have effects on high-quality embryo rate and normal fertilization rate of patients in IVF-ET.The appropriate fertilization time of patients in IVF-ET was 41 h~42 h after HCG injection in our reproductive center,improved the clinical pregnancy rate and reduced the early abortion rate.The GnRH-ant protocol is superior to other protocol in IVF-ET.

185例复合妊娠的临床特征及妊娠结局分析

目的分析总结复合妊娠(heterotopic pregnancy,HP)的临床特征,提高对此病复杂性的认识。方法对2011年1月至2021年5月在上海市两家三级甲等妇产科医院就诊的所有390852名孕早期孕妇进行回顾性研究,筛选并纳入所有明确诊断为HP的患者,分析其停经时间、受孕方式、异位妊娠(ectopic pregnancy,EP)部位及临床表现等。结果共185例HP患者纳入研究,其中14例为EP破裂。84.9%的HP患者EP部位在输卵管,12.4%位于宫角。83.8%的HP患者通过体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)受孕,10.3%通过促排卵受孕,5.4%为自然受孕。38.4%的HP患者首发症状为阴道流血,21.1%表现为腹痛,12.4%同时有阴道流血和腹痛,但高达25.4%的患者无临床表现。HP患者EP部位破裂发生率为7.6%,71.4%的EP部位破裂患者有腹痛症状。EP部位破裂患者术后活产率为78.6%,术后流产率为14.3%。结论HP临床表现多样。对伴有阴道流血、腹痛、受孕方式为IVF-ET或促排卵的妊娠患者,应该对子宫及附件区域进行详细的超声扫查并动态评估。对伴有腹痛的患者需警惕异EP部位破裂并尽早干预。

Effects of Electroacupuncture on Expression of PI3K/Akt/Foxo3a in Granulosa Cells from Women with Shen(Kidney) Deficiency Syndrome Undergoing in vitro Fertilization-Embryo Transfer

Objective: To observe the effects of electroacupuncture(EA) on reproductive outcomes in women with Shen(Kidndy) deficiency syndrome after in vitro fertilization-embryo transfer(IVF-ET),and explore the underlying molecular mechanism.Methods: Sixty-six infertile patients with Shen de?ciency syndrome undergoing IVF-ET were divided into EA or control groups according to a random table,33 cases in each group.Before undergoing IVF,patients in the EA and control groups received EA therapy and placebo needle puncture,respectively,for 3 menstrual cycles.Shen de?ciency syndrome scores were assessed.Other outcome measures included the number of retrieved oocytes and fertilization,high-quality embryo and clinical pregnancy rates.Follicular ?uid was collected on the day of oocyte retrieval,and granulosa cell expression of phosphatidylinositide3-kinases(PI3 K),serine-threonine kinase(Akt) and forkhead box O3(Foxo3 a) m RNA were measured by reverse transcribed and quantitative real-time polymerase chain reaction.Results: Syndrome scores for pre-versus post-treatments decreased significantly(16.53±1.75 to 8.67±1.61) in the EA group(P<0.05),but showed no signi?cant change in the control group(17.18±1.58 to 14.74±1.58).A signi?cant difference in score change was found between the EA and control groups(P<0.05).High-quality embryo and clinical pregnancy rates were both increased in the EA group compared with the control group [69.15%(195/282) vs.60.27%(176/292) and 66.67%(22/33) vs.42.42%(14/33),respectively,P<0.05].The fertilization rate was equivalent in EA and control groups.No difference was found in the number of retrieved oocytes between the two groups.Granulosa cell expression levels of PI3 K and Akt m RNA were signi?cantly increased in the EA group compared with the control group,while the expression of Foxo3 a was reduced(all P<0.05).Conclusions: For infertile patients with Shen de?ciency syndrome undergoing IVF,EA for tonifying Shen as an adjunct treatment may alleviate clinical symptoms and improve the high-quality embryo rate.The EA-induced mechanism may involve regulation of PI3 K/Akt/Foxo3 a expression in granulosa cells to improve the developmental microenvironment of oocytes and inhibit granulosa cell apoptosis,possibly contributing to the improved clinical pregnancy rate(Registration No.Chi CTR 1800016217).

Effects of Acupuncture on Endometrium and Pregnancy Outcomes in Patients with Polycystic Ovarian Syndrome Undergoing in vitro Fertilization-Embryo Transfer:A Randomized Clinical Trial

Objective:To observe the effect of acupuncture on endometrium and pregnancy outcomes in patients with polycystic ovary syndrome(PCOS)infertility undergoing in vitro fertilization-embryo transfer(IVF-ET).Methods:Eighty-three patients were randomly assigned to observation group(40 cases)and control group(43 cases)according to the random numbers generated by SPSS software.The patients of the two groups received GnRH agonist long protocol as a routine treatment.In the observation group,acupuncture was given at two acupoint groups for 30 min once every other day.Group 1 included Guanyuan(CV 4),Qihai(CV 6),Zhongji(CV 3),bilateral acupoints Zigong(EX-CA1).Group 2 included Mingmen(GV 4),Yaoyangguan(GV 3),bilateral Shenshu(BL 23)and Ciliao(BL 32).The two groups of acupoints were used alternately.The whole needling process was performed at the time of ovulation induction until the transplantation day and consisted of3 courses,while the control group did not receive acupuncture interventions.The Gn dosage and Gn stimulation time,endometrial thickness and type(A,B,and C),serum oestradiol(E2)and progesterone(P)levels on the day of injection of human chorionic gonadotropin(hCG),clinical pregnancy rate,as well as live birth rate were observed.Adverse reactions were also be recorded.All patients were followed up for the pregnant rate 14 days after IVF-ET and live birth rate after pregnancy.All adverse reactions(AEs)of acupuncture were recorded during the trial.Ressults:The Gn dosage and Gn stimulation time in the observation group were lower in the observation group than in the control group(P<0.01).The proportion of type A endometrium in the observation group were higher than that in the control group(P<0.05).The serum E2 and P levels on the day of hCG injection was lower and the clinical pregnancy rate was higher in the observation group compared to those in the control group(P<0.05).There was no serious AEs during this trial.Conclusion:Acupuncture can improve the proportion of type A endometrium,regulate the levelse of serum Eand P on the day of hCG injection,and improve the pregnancy rate in patients with PCOS infertility undergoing IVF-ET.

Effects of Zishen Yutai Pills on in vitro Fertilization-Embryo Transfer Outcomes in Patients with Diminished Ovarian Reserve:A Prospective,Open-Labeled,Randomized and Controlled Study

Objective:To explore the effects of Zishen Yutai Pills(ZYPs)on the quality of oocytes and embryos,as well as pregnancy outcomes in patients with diminished ovarian reserve(DOR)receiving in vitro fertilizationembryo transfer(IVF-ET).The possible mechanisms,involving the regulation of bone morphogenetic protein 15(BMP15)and growth differentiation factor 9(GDF9),were also investigated.Methods:A total of 120 patients with DOR who underwent their IVF-ET cycle were randomly allocated to 2 groups in a 1:1 ratio.The patients in the treatment group(60 cases)received ZYPs from the mid-luteal phase of the former menstrual cycle by using gonadotropin-releasing hormone(Gn RH)antagonist protocol.The patients in the control group(60 cases)received the same protocol but without ZYPs.The primary outcomes were the number of oocytes retrieved and high-quality embryos.Secondary outcomes included other oocyte or embryo indices as well as pregnancy outcomes.Adverse events were assessed by comparison of the incidence of ectopic pregnancy,pregnancy complications,pregnancy loss,and preterm birth.Contents of BMP15 and GDF9 in the follicle fluids(FF)were also quantified with enzymelinked immunosorbent assay.Results:Compared with the control group,the numbers of oocytes retrieved and high-quality embryos were significantly increased in the ZYPs group(both P<0.05).After treatment with ZYPs,a significant regulation of serum sex hormones was observed,including progesterone and estradiol.Both hormones were up-regulated compared with the control group(P=0.014 and 0.008),respectively.No significant differences were observed with regard to pregnancy outcomes including implantation rates,biochemical pregnancy rates,clinical pregnancy rates,live birth rates,and pregnancy loss rates(all P>0.05).The administration of ZYPs did not increase the incidence of adverse events.The expressions of BMP15 and GDF9 in the ZYPs group were significantly up-regulated compared with the control group(both P<0.05).Conclusions:ZYPs exhibited beneficial effects in DOR patients undergoing IVF-ET,resulting in increments of oocytes and embryos,and up-regulation of BMP15 and GDF9 expressions in the FF.However,the effects of ZYPs on pregnancy outcomes should be assessed in clinical trials with larger sample sizes(Trial reqistration No.Chi CTR2100048441).

Effect of Patient Age and Embryo Parameters on Pregnancy Outcomein In Vitro Fertilization-Embryo Transfer(IVF-ET)

Objective To study the effect of patient age, the number and quality of embryos transferred on pregnancy outcome in in vitro fertilization-embryo transfer procedures （IVF-ETs）. Methods A retrospective study was conducted with infertile women who underwent a total of 1 800 cycles of lVF-ET and intracytoplasmic sperm injection （ICSI） at the Reproductive Medicine Center of the Third Affiliated Hospital of Guangzhou Medical College from Jan. 2006 to Dec. 2007. The patients were divided into three groups based on age （year）. 〈30, 30-34 and 235. The rates of clinical pregnancy and multiple pregnancies were compared in each group when 1-3 embryos and 0-3 goodquality embryos were transferred respectively. Results 1） In the group of patients aged 〈30 years, there was no significant difference in pregnancy outcomes with 1-3 embryos transferred. However, pregnancy rates were similar when 2 3 good-quality embryos were transferred, which was significantly higher compared with 0-1 good-quality embryos transferred; the incidence of multiple pregnancies was not an issue when only 1 embryo was transferred. 2） The pregnancy rate of the patients aged 30 34 was not significant not only when only 2-3 embryos were transferred but also when 2-3 good-quality embryos were transferred, which was significant compared with when 1 embryo or 0 1 good-quality embryo was transferred. The subgroup of 3 good-quality embryos transferred, at the same time, was expected to significantly increase multiple pregnancy rate. 3） For the patients aged 235, there were similar pregnancy rates in the subgroup involving 1-3 embryos transferred. Compared with 0-2 good-quality embryos transferred, the pregnancy rate was significantly higher in the patients with 3 good-quality embryos transferred. An increased trend toward multiple pregnancies was observed among not only the subgroups with 1-3 embryos transferred, but also when 1-3 good-quality embryos were transferred, although it was significantly higher in patients with 3 good-quality embryo transferred. Conclusion In an effort to achieve the ideal pregnancy rate without the risk of multiple pregnancies, it is desirable to employ a single good-quality embryo transfer for patients aged 〈30 years and 2 good-quality embryos for patients aged 330. As older women （aged 335 years）, this is important, need to abstain from poor-quality embryo transferred by increasing the number of embryos transferred in an effort to improve the rate of clinical pregnancy, if the patients have had enough 2 high-quality embryos.

Analysis of Factors Influencing the Cumulative Pregnancy Outcome of In Vitro Fertilization-Embryo Transfer in Women Aged 35 Years and Older with Normal Ovarian Reserve

Background:To investigate the factors associating with the cumulative clinical pregnancy outcome of in vitro fertilization-embryo transfer(IVF-ET)in women aged 35 years and older with normal ovarian reserve.Methods:A total of 358 patients undergoing IVF-ET at the Department of Reproductive Medicine,the First Affiliated Hospital of Xinjiang Medical University between January 2014 and June 2016 were analyzed by the Kaplan-Meier method and Cox proportional hazards model.Results:The probability of pregnancy in women 35-37 years of age and 38-40 years of age was 75.9%(95%confidence interval[CI]:75.1%-76.7%)and 66.9%(95%CI:65.6%-68.2%),respectively,and it was 37.8%(95%CI:34.7%-41.1%)in women aged 40 years and older.Univariate analysis(hazard ratio[HR]:2.50,95%CI:1.647-3.774)and multivariate analysis(HR:2.17,95%CI:1.427-3.268)showed a correlation between the number of retrieved oocytes and successful pregnancy.Conclusions:The number of retrieved oocytes plays a key role in the pregnancy outcome of women aged 35 years and older with normal ovarian reserve.We recommend the number of retrieved oocytes be increased for women aged 35 years and older with normal ovarian reserve.

精子形态对体外受精－胚胎移植治疗结局的影响

目的：探讨正常形态精子百分率对体外受精-胚胎移植（IVF-ET）治疗结局的影响。方法回顾分析于生殖医学中心接受治疗的323个IVF-ET周期，采用WHO第5版精液质量分析标准严格进行精子形态学分析，研究分3组：A组：1%≤正常形态精子百分率﹤2.5%，中度畸形组；B组：2.5%≤正常形态精子百分率﹤4%，轻度畸形组；C组：正常形态精子百分率≥4%，正常形态组。比较各组间受精率、卵裂率、可移植胚胎率、优质胚胎率、着床率、临床妊娠率。结果各组间女方年龄、不孕年限、男方年龄差异均无统计学意义（P﹥0.05）。三组患者间多精受精率、双原核卵裂率、可移植胚胎率、优质胚胎率、着床率、临床妊娠率等差异均无统计学意义（P﹥0.05），但随着正常形态精子比率升高，受精率随之升高，三组之间差异有统计学意义（P﹤0.05）。结论在常规IVF-ET中，精子形态可在一定程度上影响卵子的受精率，但与胚胎质量、妊娠结局无明显相关性。

安宫黄体酮降调节在40岁以上高龄妇女体外受精中的应用价值

目的:探讨安宫黄体酮（MPA）降调在40岁以上高龄妇女体外受精中的应用价值。方法:回顾分析2014年6月2015年12月在解放军第105医院生殖中心实施体外受精/卵胞质内单精子显微授精（IVF/ICSI）治疗的40岁以上女性患者的临床资料,其中69例采用MPA垂体降调节（A组）,126例采用GnRH-a短方案者（B组）,并对A组中36例（A1组）前一周期采用其他促排方案因无可移植胚胎或胚胎移植后未孕者（A2组）进行自身对照观察,比较两组及A组自身对照的促排卵及IVF结局。结果:A组与B组的Gn用量和天数、HCG日≥14mm卵泡数、HCG日E2及LH水平、获卵数、成熟卵率、受精率、卵裂率、优质胚胎率、可利用胚胎数、取卵周期取消率、无可利用胚胎周期取消率均无统计学差异（P>0.05）;A组出现早发LH峰比例为4.35%,显著低于B组（15.87%）（P<0.05）。A1组的成熟卵率及优质胚胎率（84.17%vs 68.82%）均显著高于A2组（71.03 vs 44.78%）（P<0.05）,早发LH峰率则显著低于A2组（0 vs 33.33%）（P<0.05）。结论:MPA降调节能有效降低40岁以上女性超促排卵过程中早发LH峰发生率,获得更多的成熟卵数及优质胚胎,为高龄患者提供了一个简便、经济、高效,患者依从性好的垂体降调方案。

Relationship between Pronuclear Scoring and Embryo Quality and Implantation Potential in IVF-ET

To assess the relationship between pronuclear scoring and day-3 embryo quality and pregnancy outcome and to determine the Clinical value of pronuclear stage scoring system in human in vitro fertilization-embryo transfer （IVF-ET） program, a pronuclear scoring system was used to score zygotes 16-20 h after insemination during conventional IVF or intracytoplasmic sperm injection （ICSI）. The embryos were classified into groups Z1, Z2, Z3 and Z4, Comparisons were made of the rates of arrested embryos and excellent embryos on day 3. Comparisons of pregnancy outcome were made only in those patients in whom cohorts of similarly Z-scored embryos were transferred, The results showed that there were less arrested embryos and more excellent embryos on day 3 in groups Z1 and Z2 than those in group Z3 and Z4, More embryos arrested and less excellent embryos developed in group Z4 than group Z3. The clinical pregnancy rates resulting from the transfer of single pronuclear score homologous embryo types were similar among groups Z1, Z2 and Z3. Implantation rates of group Z1 were higher （P〈0.05） than that of group Z3, These findings suggests that pronuclear scoring can predict developmental ability on day 3 and implantation potential. A evaluation that combines the Z-score and day 3 embryo morphology is useful in the determination of the most viable embryos and the number of embryos for transfer.

Resistin levels of serum and follicular fluid in non-obese patients with polycystic ovary syndrome during IVF cycles

Objectives: To measure serum and follicular resistin, steroids hormone levels in women with PCOS (polycystic ovary syndrome) (BMI (body mass index)<25 kg/m2), to assess possible correlations of resistin to hormonal and metabolic parameters and to analyze the clinical outcomes of in vitro fertilization-embryo transfer (IVF-ET) in women with PCOS and tubal infertility. Study design: We analyzed the clinical outcomes of IVF-ET in women with PCOS (BMI<25 kg/m2) and tubal infertility during the years 2002 to 2004 and compared the serum and follicular fluid resistin levels, estradiol (E2), progesterone (P), testosterone (T) levels in 20 PCOS and 20 healthy, age-matched women without PCOS during IVF-stimulated cycles. The correlations between the resistin levels and the outcomes of IVF-ET were evaluated. Results: No significant differences in resistin levels of either serum or follicular fluid between PCOS and control group were found. However, resistin levels in serum were higher than that in follicular fluid in both groups. Multiple regression analysis showed that resistin levels in serum did not correlate with BMI, estradiol, LH (luteinizing hormone) and insulin level in fasting blood. No significant correlations were found between follicular fluid reisistin levels and fertilization rate, implantation rate, clinical pregnancy rate or early miscarriage rate in both PCOS and control groups. Conclusion: Our results show that resistin does not have correlation with the hormonal and metabolic parameters as well as the outcomes of IVF. These data suggest that resistin is unlikely to be a local determinant factor in steroidogenesis and growth and maturation of oocytes during IVF-ET in lean women with PCOS.

Related Factors of in vitro Fertilization and Embryo Transfer Patients with Complete Fertilization Failure

Objective To find the possible factors predicting fertilization failure of in vitro fertilization-embryo transfer （1VF-ET）. Methods The IVF-ET patients with complete fertilization failure （experimental group, n =32） were analyzed retrospectively. The patients whose oocytes retrieved at the same day and cultured on the same incubators with ≥ 50% fertilization rates were matched as the control （n=56）. Results The infertility duration, superovulation days, the rates of primary case, progesterone （P） level 〉3.12 nmol/L rate and rate of severe abnormal sperm （abnormal sperm rate 〉95%） in experimental group were significantly higher than those in the control （6.4 ±3.1 years, 12.6 ±2.2 d, 56%, 43%, 43% vs 4.6±2.9years, 11.6 ±% 1.3 d, 33%, 23%, 23%, respectively, P〈0.05）. Conclusion We should pay attention to these patients with primary infertility, longer infertility duration and superovulation days （〉6.4 years and 〉12.6 d） and having increased level of P on hCG injection day （〉3.12 nmol/L）, abnormal sperm rate 〉95% at the same time. They should be included in such patients at high risk of fertilization failure.

Assessment of Uterine Receptivity by Endometrial and Subendometrial Blood Flows Measured by Vaginal Color Doppler Ultrasound in Women Undergoing IVF Treatment

Objective To evaluate endometrial and subendometrial blood flows measured by vaginal color Doppler ultrasound as a predicator of endometrial receptivity in women undergoing IVF treatment. Methods A total of 119 infertile patients undergoing the first IVF/ICSI-ET cycle were recruited. Three groups were divided according to a color Doppler ultrasound examination performed on the day of hCG injection. Group A, endometrial and subendometrial blood flows were 2 branches and below; group B, endometrial and subendometrial blood flows were between 3 and 4 branches; group C, endometrial and subendometrial blood flows were 5 branches and above. Patients were transferred 1-3 embryos each. Demographic data, ovarian responses, endometrial thickness, PI, RI, development of embryo and IVF result among groups were compared. Results Demographic data, ovarian responses, endometrial thickness, PI, RI and development of embryo among groups have no significant difference. The pregnancy rate of group A was significantly lower than that of group B （P〈0.05） and group C （P〈0.01）. The implantation rate of group A was significantly lower than than of group C （P〈0.01）. There was no significant difference of the rate of pregnancy and implantation between group B and group C （P〉0.05）. Conclusion Endometrial and subendometrial blood flows measured by vaginal color Doppler ultrasound is a good predicator of pregnancy during IVF treatment. A good endometrial and subendometrial blood flows is benefit for the result of IVF.

Impact of Body Mass Index on In Vitro Fertilization–Embryo Transfer Outcomes in Xinjiang,China

Background:To investigate the effect of body mass index(BMI)on the outcomes of in vitro fertilization–embryo transfer(IVF-ET)treatment,and to provide evidence for future clinical studies of infertile women with different body mass indices.Methods:The relationship between pregnancy outcome and BMI in 717 infertile women who underwent IVF-ET was analyzed.Results:A total of 531 out of 717 patients were classified as having a standard body weight,and 20 patients were classified as obese.We found a significant difference in the basal follicle-stimulating hormone(FSH)level among the groups;the basal FSH level was lower in the obese group(6.80±2.20 IU/L)than in the standard weight group(7.56±2.25 IU/L).However,there were no significant differences in the age of females,the age of males,basal estradiol(E2)and luteinizing hormone(LH)levels,length of infertility,and history of dysmenorrhea.Although the pregnancy rate was highest(54.6%)in the standard weight group and lowest(45.0%)in the obese group,there was no significant difference among these groups by Chi-square test analysis.Furthermore,there were no significant differences in gonadotropin-releasing hormone agonist days,number of 2PN,and the LH level on the day of human chorionic gonadotropin treatment among the groups.Conclusions:Obese women can improve a successful pregnancy rate after undergoing IVF–ET treatment by controlling weight.

Expression of Cellular FLICE-like Inhibitory Protein in Granulosa Cells in In Vitro Fertilization Patients with Advanced Endometriosis

Background:This study evaluated the expression of cellular FLICE-like inhibitory protein(cFLIP)in granulosa cells(GCs)obtained from in vitro fertilization-embryo transfer patients with advanced endometriosis.Methods:A total of 267 patients with advanced endometriosis were enrolled in this study.They were divided into clinical pregnancy group(n=114)and nonpregnancy group(n=153).The expressions of cFLIP in mRNA and protein level were measured by real-time polymerase chain reaction(RT-PCR)and Western blotting.The related factors on the clinical pregnancy were analyzed using logistic regression analysis.Coefficients of correlation were calculated using the nonparametric rho-Spearman test.Results:The number of oocytes retrieved,fertilization rate,and cleavage rate were significantly and independently related with clinical pregnancy(P>0.05).RT-PCR and Western blotting analysis showed that the expressions of cFLP in mRNA and protein level were significantly higher in the clinical pregnancy group than in nonpregnancy group(P>0.05).cFLIP had a significantly positive correlation with the number of oocytes retrieved(P>0.05)and no correlation with fertilization rate and cleavage rate(P<0.05).Conclusion:Higher expression of cFLIP increased the pregnancy rate in women with advanced endometriosis.

电针对多囊卵巢综合征患者体外受精-胚胎移植中卵细胞质量及妊娠的影响

目的:观察多囊卵巢综合征(PCOS)患者体外受精-胚胎移植(IVF-ET)过程中给予电针干预对卵细胞质量及妊娠结局有无影响,并探讨其作用机制。方法:将接受IVF-ET的PCOS患者66例随机分为观察组(34例)、对照组(32例),两组均给予达英-35及促性腺激素释放激素激动剂长方案超促排卵,观察组加用电针干预,穴取关元、中极、三阴交、子宫、太溪。比较两组妊娠结局及取卵日血清、卵泡液干细胞因子(SCF)水平。结果:两组治疗后肾虚症状评分均明显降低,且观察组较对照组改善明显(P<0.01);观察组较对照组受精率[(76.25±20.33)%vs(66.34±15.44)%]、卵裂率[(98.66±3.70)%vs(94.47±9.45)%]、优质胚胎率[(60.20±22.20)%vs(50.55±16.15)%]均明显提高(均P<0.05);观察组临床妊娠率为46.67%(14/30)高于对照组的37.93%(11/29),但差异无统计学意义(P>0.05)。取卵日血清、卵泡液SCF水平明显高于对照组(均P<0.05)。结论:电针对接受IVF-ET的PCOS患者的妊娠结局具有积极作用,可改善中医肾虚症状,提高临床妊娠率。其机制为通过提高SCF水平从整体上调节机体内分泌和卵巢局部微环境,改善卵细胞的质量。

薄型子宫内膜的评价与改善措施

在人类辅助生殖技术周期中,超声测定子宫内膜厚度可以反映内膜功能状态,并且与妊娠率呈正相关。本文分别从药物给与、激素调节和手术方式虽均能改善薄型子宫内膜的厚度,但目前对于改善薄型子宫内膜的方法仍处在摸索中,需进一步研究。

子宫内膜不典型增生或早期高分化子宫内膜癌患者保留生育功能治疗后体外受精-胚胎移植助孕妊娠结局分析

目的 探讨子宫内膜不典型增生(AEH)或早期高分化子宫内膜样腺癌(EC)患者保留生育功能治疗后行体外受精-胚胎移植(IVF-ET)助孕的临床情况和妊娠结局。方法 回顾性分析2012年1月至2020年12月于中山大学孙逸仙纪念医院生殖中心行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)及冻胚移植(FET)的AEH或早期高分化EC患者共57例的临床资料。结果 41例AEH患者共进行90个取卵周期,拮抗剂方案最多有28个,其次为微刺激方案,平均每周期获卵6个。AEH患者进行了22个新鲜胚胎移植周期和37个FET周期,累积妊娠率为29.0%,累积活产率为17.7%。16例早期高分化EC患者共进行24个取卵周期,拮抗剂方案最多有9个,其次为长方案,平均每周期获卵数为7个。EC患者共进行7个新鲜胚胎移植周期和15个FET周期,累积妊娠率为36.4%,累积活产率为31.8%。57例AEH或早期高分化EC患者进行了29个新鲜胚胎移植周期及52个FET周期,新鲜胚胎移植临床妊娠率为37.9%,活产率为31.0%,FET临床妊娠率为28.8%,活产率为17.3%,新鲜胚胎移植和FET间临床妊娠率、活产率的差异无统计学意义(P>0.05)。结论 接受保留生育功能治疗的AEH或早期高分化EC患者行IVF-ET助孕,可获得较满意的临床妊娠率和活产率,IVF-ET是AEH或早期高分化EC患者保守治疗后的很好助孕选择。