<strong>Study Question:</strong> The question: is there any difference in pregnancy rate between embryo transfer day 5 and day 6 in IVF? What Is Known Already? Blastocyst transfer is increasingly popular i...<strong>Study Question:</strong> The question: is there any difference in pregnancy rate between embryo transfer day 5 and day 6 in IVF? What Is Known Already? Blastocyst transfer is increasingly popular in assisted reproductive technology (ART) centers today. Very few articles concentrate on comparing Day 5 and Day 6 embryo transfer with conflict results. <strong>Objective, Study Design:</strong> Systematic review and meta-analysis of published controlled studies. Searches conducted from 2001-2020 on PubMed. Medline, EMBASE, and ISI Web of Science Electronic database is used to collect data, using the following search terms: blastocyst, Day 5, Day 6, embryo transfer (E.T.) and pregnancy rate. <strong>Materials, Setting, Methods:</strong> A total of 6 full-text articles preselected from 211 references, based on title and abstract. Two independent reviewers performed data selection and extraction according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA). This systematic review was conducted according to (PICO) standard. Random-effect meta-analysis performed on all data (overall analysis). <strong>Results and the Role of Chance:</strong> Data from 6 relevant articles were extracted and integrated into the meta-analysis that reported clinical pregnancy rate (CPR) as an outcome in 5640 cycles, 2274 cycle had embryo transfer at day 6 and the control was 3366 cycle had embryo transfer day 5 showed a significantly higher clinical pregnancy rate following Day 5 embryo transfer compared with Day 6 embryo transfer with odd ratio and 95% confidence limit 0.73 (0.66 - 0.82)<em> p</em> value < 0.000. Sensitivity analysis led to similar results and conclusions.<strong> Limitations, Reasons for Caution: </strong>The validity of meta-analysis results depends mainly on the quality and the number of published studies available. Indeed, this meta-analysis included no randomized controlled trial (RCT). <strong>Wider Implications of the Findings: </strong>In regards to the results of this original meta-analysis, ART practitioners should preferably transfer D5 rather than D6 blastocysts. Further RCTs are needed to address the question of whether D6 embryos should be transported.展开更多
Intrauterine adhesion is a major cause of female reproductive disorders.Although we and others uncontrolled pilot studies showed that treatment with autologous bone marrow stem cells made a few patients with severe in...Intrauterine adhesion is a major cause of female reproductive disorders.Although we and others uncontrolled pilot studies showed that treatment with autologous bone marrow stem cells made a few patients with severe intrauterine adhesion obtain live birth,no large sample randomized controlled studies on this therapeutic strategy in such patients have been reported so far.To verify if the therapy of autologous bone marrow stem cells-scaffold is superior to traditional treatment in moderate to severe intrauterine adhesion patients in increasing their ongoing pregnancy rate,we conducted this randomized controlled clinical trial.Totally 195 participants with moderate to severe intrauterine adhesion were screened and 152 of them were randomly assigned in a 1:1 ratio to either group with autologous bone marrow stem cells-scaffold plus Foley balloon catheter or group with only Foley balloon catheter(control group)from February 2016 to January 2020.The per-protocol analysis included 140 participants:72 in bone marrow stem cells-scaffold group and 68 in control group.The ongoing pregnancy occurred in 45/72(62.5%)participants in the bone marrow stem cells-scaffold group which was significantly higher than that in the control group(28/68,41.2%)(RR=1.52,95%CI 1.08–2.12,P=0.012).The situation was similar in live birth rate(bone marrow stem cells-scaffold group 56.9%(41/72)vs.control group 38.2%(26/68),RR=1.49,95%CI 1.04–2.14,P=0.027).Compared with control group,participants in bone marrow stem cells-scaffold group showed more menstrual blood volume in the 3rd and 6th cycles and maximal endometrial thickness in the 6th cycle after hysteroscopic adhesiolysis.The incidence of mild placenta accrete was increased in bone marrow stem cells-scaffold group and no severe adverse effects were observed.In conclusion,transplantation of bone marrow stem cells-scaffold into uterine cavities of the participants with moderate to severe intrauterine adhesion increased their ongoing pregnancy and live birth rates,and this therapy was relatively safe.展开更多
Objective This study aimed to determine whether the day of blastocyst expansion affects pregnancy outcomes in frozen-thawed blastocyst transfer(FBT)cycles.Methods A retrospective match-cohort study was conducted.Patie...Objective This study aimed to determine whether the day of blastocyst expansion affects pregnancy outcomes in frozen-thawed blastocyst transfer(FBT)cycles.Methods A retrospective match-cohort study was conducted.Patients who underwent blastocyst transfer in frozen-thawed cycles at day 5 or 6 were matched for potential confounding factors.A total of 2207 matched pairs of FBT cycles were included from January 2016 to December 2019 in our Reproductive Medicine Center.Results The clinical pregnancy rate(CPR)and live birth rate(LBR)were significantly increased in day 5 blastocyst transfers when compared to day 6 blastocyst transfers,in terms of the same embryo quality.For FBT cycles with good-quality embryo,the CPR at day 5 and 6 was 61.30%and 57.56%,respectively(P=0.045),and the LBR was 44.79%and 36.16%,respectively(P<0.001).For FBT cycles with poor-quality embryo,the CPR at day 5 and 6 was 48.61%and 40.89%,respectively(P=0.006),and the LBR was 31.71%and 25.74%,respectively(P=0.019).The CPR for FBT cycles with good-quality embryo was statistically higher at day 6 than that at day 5 with poor-quality embryo transferred(57.56%vs.48.61%,P=0.001).Maternal age,anti-Müllerian hormone(AMH),endometrial thickness,embryo quality,and the day of blastocyst expansion were independently correlated with the CPR and LBR.The FBT cycles at day 5 had significantly higher CPR(adjusted odds ratio[OR]=1.246,95%confidence intervals[CI]:1.097–1.415,P=0.001)and LBR(adjusted OR=1.435,95%CI:1.258–1.637,P<0.001)than those at day 6.Conclusion The embryo quality is the primary indicator for FBT cycles.Day 5 blastocysts should be preferred when the quality of embryo at day 5 is the same as that at day 6.展开更多
With the clinical development and application of intracytoplasmic sperm injection(ICSI)technology in human assisted reproduction,the influence of oocyte quality on embryo development has been paid more and more attent...With the clinical development and application of intracytoplasmic sperm injection(ICSI)technology in human assisted reproduction,the influence of oocyte quality on embryo development has been paid more and more attention.So far,there have been many reports on oocyte morphology affecting embryo development.It has been found in some works that the appearance of smooth endoplasmic reticulum clusters(SERC)in oocytes may affect the fertilization and embryo development of oocytes.However,with the increasing reports of SERC-containing oocytes obtained by in vitro fertilization and healthy offspring in recent years,there is still some controversy on whether to continue to use SERC-containing oocytes for the following assisted reproductive therapy in clinical practice.Based on this,this review aims to review the research progress of SERC in oocytes in recent years.展开更多
In this study,we used a network meta-analysis(NMA)to compare the effectiveness of medicines and supplements for idiopathic male infertility and to identify the best treatment.Medline,Excerpta Medica Database(EMBASE),O...In this study,we used a network meta-analysis(NMA)to compare the effectiveness of medicines and supplements for idiopathic male infertility and to identify the best treatment.Medline,Excerpta Medica Database(EMBASE),Ovid,and China National Knowledge Infrastructure(CNKI),were searched for the period from January 1990 to June 2021 using the keywords"male infertility,""medical therapy,""supplement/nutrient therapy,"and related terms.Randomized controlled trials(RCTs)investigating medicines(mainly follicle-stimulating hormone(FSH),androgen,and clomiphene/tamoxifen)or supplements(mainly zinc,selenium,vitamin C or E,carnitine,coenzyme Q10(CoQ10),or combined treatment)for idiopathic infertile men were selected for meta-analysis.Preferred reporting items for systematic reviews and meta-analysis(PRISMA)was used for data extraction,and a risk-of-bias tool and grades of recommendation,assessment,development,and evaluation(GRADE)system adapted to the NMA were employed to assess the quality of the evidence.The primary outcomes were live birth and spontaneous pregnancy rate(SPR).The secondary outcomes were sperm parameters(including concentration,progressive motility,and morphology)and side effects.In total,65 RCTs involving 7541 men with sperm abnormalities but normal hormone levels were included.A total of 36 studies reported SPR but only three reported live birth rates.The quality of the included studies was found to be moderate to high.Compared with a placebo or being untreated,carnitine plus vitamins significantly improved SPR(relative risk(RR)=3.7,95%confidence interval(95%CI),1.6-8.5);fatty acids significantly increased sperm concentrations(mean difference(MD)=12.5×10^(6)mL-1,95%CI,3.1×10^(6)-22.0×10^(6));and selective estrogen receptor modulator(SERM)plus CoQ10 significantly improved sperm progressive motility(MD=11.0%,95%CI,0.1%-21.9%)and normal sperm morphology(MD=11.0%,95%CI,4.6%-17.4%).The most optimal intervention was carnitine plus vitamins and fatty acids for SPR and sperm concentrations,respectively,even after excluding trials at a high risk of bias.Compared with a placebo or being untreated,FSH(RR=4.9,95%CI,1.1-21.3)significantly increased SPR,whereas SERM plus kallikrein increased sperm concentration(MD=16.5×10^(6)mL^(-1),95%CI,1.6×10^(6)-31.4×10^(6)),and SERM plus CoQ10 significantly improved sperm progressive motility(MD=11.3%,95%CI,7.3%-15.4%)and normal morphology(MD=11.2%,95%CI,5.4%-16.9%)in men with oligoasthenozoospermia(OA).In terms of side effects,fatty acids and pentoxifylline were associated with foul breath and/or a bad taste(RR=8.1,95%CI,1.0-63.5)and vomiting(RR=8.0,95%CI,1.0-63.0),respectively.In conclusion,the optimal treatment for male infertility for live birth is still unknown.Carnitine plus vitamins and FSH are likely to be better than other therapies in achieving successful spontaneous pregnancy in couples overall and in cou ples with men with OA,respectively.The efficacy of other treatments on pregnancy outcomes warrants further verification.展开更多
Objective:To assess the effect of flaxseed supplementation on metabolic profile,endocrine concentrations,non-esterified fatty acids(NEFA),body composition variables,and reproductive performance of sows.Methods:All the...Objective:To assess the effect of flaxseed supplementation on metabolic profile,endocrine concentrations,non-esterified fatty acids(NEFA),body composition variables,and reproductive performance of sows.Methods:All the 21 crossbred Large White Yorkshire sows were considered in the study period starting at day 1 of current farrowing when the feeding of specific supplemental ration was started until the day of subsequent farrowing(days 150-155)and were equally allocated into three groups.Group 1 served as the control group and followed their normal feeding schedule.Group 2 and group 3,in addition to their normal feeding schedule,were supplemented with flaxseed at a rate of 0.5%and 1.0%of the dry matter,respectively.Blood samples were collected 15 days prior to farrowing,on the day of farrowing(day 0),at weekly intervals until day 28 of lactation and at monthly intervals during gestation to harvest the plasma.Plasma was used to assess the metabolic and endocrine status of sows.Body weight of each sow and individual birth weight of all piglets born were measured.Results:Flaxseed supplementation led to decrease in plasma cholesterol and triglyceride levels in the supplemented groups than in the control group(P<0.05).Plasma estradiol-17βlevel was higher in group 2 than that in group 1 and 3 on day 90 of the gestation period(P<0.05).The mean plasma level of insulin-like growth factor 1 was higher in group 3 than that in group 1 and 2 both in late lactation(day 28)as well as in early gestation(day 30)(P<0.05).Plasma NEFA and weight gain were greater in sows of group 2 and 3 compared to those fed with the normal control diets(P<0.05).The proportion of pregnant sows relative to sows bred was 100.0%in group 2 and 3 and 85.7%in the control group.Piglet mortality was lower in group 2 and 3 compared to group 1(P>0.05).Conclusions:Flaxseed improves endocrine profiles,NEFA concentrations and body weight,resulting in better pregnancy rate and litter size.展开更多
BACKGROUND Malignant ovarian germ cell tumors(MOGCT)are rare and frequently occur in women of young and reproductive age and the oncologic and reproductive outcomes after fertility-sparing surgery(FSS)for this disease...BACKGROUND Malignant ovarian germ cell tumors(MOGCT)are rare and frequently occur in women of young and reproductive age and the oncologic and reproductive outcomes after fertility-sparing surgery(FSS)for this disease are still limited.AIM To evaluate the oncology and reproductive outcomes of MOGCT patients who underwent FSS.METHODS All MOGCT patients who underwent FSS defined as the operation with a preserved uterus and at least one side of the ovary at our institute between January 2005 and December 2020 were retrospectively reviewed.RESULTS Sixty-two patients were recruited for this study.The median age was 22 years old and over 77%were nulliparous.The three most common histology findings were immature teratoma(32.2%),dysgerminoma(24.2%),and yolk sac tumor(24.2%).The distribution of stage was as follows;Stage I,74.8%;stage II,9.7%;stage III,11.3%;and stage IV,4.8%.Forty-three(67.7%)patients received adjuvant chemotherapy.With a median follow-up time of 96.3 mo,the 10-year progressionfree survival and overall survival were 82.4%and 91%,respectively.For reproductive outcomes,of 43 patients who received adjuvant chemotherapy,18(41.9%)had normal menstruation,and 17(39.5%)resumed menstruation with a median time of 4 mo.Of about 14 patients who desired to conceive,four were pregnant and delivered good outcomes.Only one case was aborted.Therefore,the successful pregnancy rate was 28.6%CONCLUSION The oncology and reproductive outcomes of MOGCT treated by FSS are excellent.Many patients show a long survival time with normal menstruation.However,the obstetric outcome is not quite satisfactory.展开更多
Objective: We evaluated the relationships between the incidence of the apoptotic cell of human granulose cell (GC) from the oocytes during intracytoplasmic sperm injection (ICSI) and the pregnancy rate. Methods: 275 o...Objective: We evaluated the relationships between the incidence of the apoptotic cell of human granulose cell (GC) from the oocytes during intracytoplasmic sperm injection (ICSI) and the pregnancy rate. Methods: 275 oocytes were retrieved from 29 patients with aging between 23 - 38 years, who underwent ICSI (21), percutanious sperm aspiration (PESA-ICSI)and testicular sperm extraction (TESE-ICSI) (7), only one case came from conventional IVF. The patients were divided into two groups based on pregnancy or not. The cumulus cells were collected to measure the number of apoptotic cell by using flow cytometer. The degree of cumulus GC apoptosis and clinic pregnancy rate were assessed, and compared with embryo morphology and number of blastomere. Results: The apoptosis value in pregnancy gruop (9 cases) were lower than the nonpregnancy group (19 cases) (P<0. 05). In pregnancy group, the apoptosis value in the GC obtained from replaced embryos (37) were significantly lower than that of the nonreplaced embryos (78) (P<0. 02). Conclusion: The results indicated that the embryos with lower apoptosis value would have the potency of increase pregnancy rate. It will be possible to elevate the clinic pregnancy rate by selecting the replaced embryos bases on the apoptosis value of GC from oocytes in addition to the morphological score.展开更多
Objectives: Study the effect of adding a delayed blastocyst to a transferred good quality one on ICSI cycle outcomes. Study design: Prospective cohort study. Participants/materials, setting, methods: 90 infertile pati...Objectives: Study the effect of adding a delayed blastocyst to a transferred good quality one on ICSI cycle outcomes. Study design: Prospective cohort study. Participants/materials, setting, methods: 90 infertile patients aged from 20<span><span><span> </span></span></span><span><span><span>- 35 years due to mild male factor, unexplained infertility or tubal factor. Patients with PCOS, endometriosis, RIF, poor responder and azoospermia were excluded. Setting: Duration 6 month</span></span></span><span><span><span>s</span></span></span><span><span><span> from October 2019 to April 2020 in a private IVF center in Egypt. 30 case</span></span></span><span><span><span>s</span></span></span><span><span><span> were subjected to elective single embryo transfer and the other 60 with two embryo transfer</span></span></span><span><span><span>s</span></span></span><span><span><span>, one good quality and </span></span></span><span><span><span>an</span></span></span><span><span><span>other poor quality blastocyst. Results: (clinical pregnancy rate) was comparable between the two groups, being 47.7% and 36.7% in SET and DET groups respectively (p = 0.361). Miscarriage and ectopic pregnancy rate were observed in 10% of the cases pregnant after SET (group I) and in only 6.7% of the cases pregnant after DET (group II) denoting no significant statistical difference between the two groups. The highest incidence was missed miscarriages in the two groups and ectopic pregnancy was observed only in one case in group II (DET). Twin pregnancy occurred in 22% of pregnant females in the second group. Late pregnancy complications in the form of preterm labour, premature rupture of membrane and preeclampsia occurred mainly in pregnant females in the second group 18%. Conclusion: Neither adding a delayed blastocyst negatively affect</span></span></span><span><span><span>ed</span></span></span><span><span><span> the good one nor affect</span></span></span><span><span><span>ed</span></span></span><span><span><span> the live birth rate but increased multiple pregnancy rate</span></span></span><span><span><span>s</span></span></span><span><span><span>.展开更多
Is there a really need to validate oocyte vitrification technique in an ART laboratory before establishing it in daily practice? Validation of micromanipulationbased technique, in this case oocyte vitrification, is es...Is there a really need to validate oocyte vitrification technique in an ART laboratory before establishing it in daily practice? Validation of micromanipulationbased technique, in this case oocyte vitrification, is essential prior to enlarging its use to routine practice. Oocyte vitrification is a new worldwide used technique and legal recently inFrance. This micromanipulation needs to be performed by a skilled and experienced embryologist and requires an internal assessment in each ART unit before any wide use. We designed a prospective study, from September 2011 to July 2012, using sibling oocytes from women who recovered more than 12 Metaphase II oocytes. A part of freshly recovered oocytes underwent immediate ICSI while the remaining oocytes were vitrified. 87 couples undergoing ICSI were selected based on number of mature oocytes available on the recovery day after denudation. A part of fresh MII oocytes were microinjected and the others were vitrified using an open system (Cryotop?). The major criterion of interest was the number of embryo transferred/ number of Metaphase II ratio for after ICSI on fresh oocytes (42/211) versus vitrified/warmed oocytes (51/204) (p > 0.05). Secondary studied criteria were survival rate (80.5% ± 26.3%), fertilization rate (68.9 ± 33.5) and finally, cumulative pregnancy rate obtained in this study is 40.2%. One of the benefits of such practice is the limitation of embryo freezing. However, the study design delays oocytes warming cycles, due to pregnancies triggered by the transfer of fresh derived oocyte embryos and to the priority to transfer all the frozen embryos before starting oocytes warming. Moreover, no data is available about children’ health. Oocyte vitrification represents not only a change in our daily practice to improve cumulative pregnancy rate but also a promising tool to develop egg banking and donation. Clinical Trials Registration number: 209 R02.展开更多
Objective:To evaluate the pregnancy outcomes of the four endometrial preparation protocols for people undergoing frozen-thawed embryo transfer(FET),including natural cycle(NC),hormone replacement therapy cycle(HRT),go...Objective:To evaluate the pregnancy outcomes of the four endometrial preparation protocols for people undergoing frozen-thawed embryo transfer(FET),including natural cycle(NC),hormone replacement therapy cycle(HRT),gonadotropin-releasing hormone agonist artificial cycle(GAC),and ovarian stimulation cycle(OC).Methods:This retrospective cohort study enrolled 10,333 cycles of frozen embryo transfer performed at Xinan Gynecological Hospital in Sichuan,China,from January 2018 to December 2018.The patient's baseline characteristics and pregnancy outcomes were extracted from the medical record system.Pregnancy outcomes were compared among the four groups and multiple logistic regression models were used to adjust for the confounding factors.Results:After adjusting for covariates,multiple logistic regression analysis showed no statistical significance in pregnancy outcomes in the HRT group,GAC group,and OC group compared to the NC group in the entire population.The adjusted odds ratio of live birth was 0.976(95%)confidence interval[Cl](0.837-1.138)for the HRT group,0.959(95%confidence interval 0.797-1.152)for the GAC group,and 0.909(95%confidence interval 0.763-1.083)for the OC group.Conclusions:The natural protocol had comparable pregnancy outcomes compared to the other three endometrial preparation protocols in the overall FET population.More high-quality prospective randomized controlled trials are required to assess the efficacy of the four protocols and explore the optimal one.展开更多
The purpose of this retrospective study was to determine whether or not there was a significant relationship between women’s age as a cause of sterility and pregnancy after IUI. Furthermore, we evaluated the effect o...The purpose of this retrospective study was to determine whether or not there was a significant relationship between women’s age as a cause of sterility and pregnancy after IUI. Furthermore, we evaluated the effect of stimulation of antiestrogens and time of hCG administration on the success of IUI in relation to the age of women. During the period between 2008 and 2012, we performed a total number of 793 IUI. Patients were prepared for IUI in the natural cycle and stimulation with antiestrogens (clomiphene citrate-CC). Ovulation was induced by hCG (Ovitrelle) 40 hours before IUI or immediately after the procedure. Sperm was processed through density gradients. The average success rate of IUI was 10.2% of pregnant women per cycle. Significantly the highest number of pregnant women 16.3% was women with a diagnosis of anovulation. Significantly the lowest success rate of IUI was at the immunological cause of infertility and endometriosis. There was no evidence of age dependence for women on the success of IUI. Stimulation of CC did not significantly increase the chance of becoming pregnant. There was also no statistically significant difference in hCG before and after IUI pregnancy success. The most important group of women for whom IUI is a suitable form of assisted reproduction consists of patients of 35 years old with anovulation cause of sterility. Those patients with an immunological cause of infertility and endometriosis have significantly lower chances of conceiving after IUI and it is preferable for them to choose other techniques of assisted reproduction and embryo transfer.展开更多
Objective:To evaluate the efficacy and safety of Chinese medicine(CM)improving pregnancy outcomes after surgery for endometriosis-associated infertility.Methods:A multicenter,randomized,doubleblind placebo parallel co...Objective:To evaluate the efficacy and safety of Chinese medicine(CM)improving pregnancy outcomes after surgery for endometriosis-associated infertility.Methods:A multicenter,randomized,doubleblind placebo parallel controlled clinical trial was designed.A total of 202 patients who had laparoscopy for endometriosis-associated infertility with qi stagnation and blood stasis syndrome were included and randomly divided into the CM treatment group and placebo control group at a ratio of 1:1 using a central block randomization from May 2014 to September 2017,101 patients in each group.The two groups received continuous intervention at 1–5 days after surgery,for 6 menstrual cycles.Before ovulation,the CM group was treated Huoxue Xiaoyi Granule(活血消异颗粒);after ovulation,Bushen Zhuyun Granule(补肾助孕颗粒)was involved.The control group was treated with placebo.Transvaginal ultrasonography was performed every menstrual cycle during the treatment,and female hormone levels in the follicular and luteal phases were measured during the 1 st,3 rd and 6 th menstrual cycles.The analysis was continued until pregnancy.The primary outcomes were clinical pregnancy rate and pregnancy outcome,and the secondary outcomes were follicular development and endometrial receptivity.Safety evaluations were performed before and after treatment.Results:(1)Clinical pregnancy and live birth rates:the clinical pregnancy and live birth rates of the CM group were significantly higher than those of the placebo group[44.6%(45/101)vs.29.7%(30/101),34.7%(35/101)vs.20.8%(21/101),both P<0.05].(2)Follicle development:the incidence of dominant follicles,rate of cumulative cycle ovulation,and rate of cumulative cycle mature follicle ovulation were significantly higher in the CM group than those in the placebo group[93.8%(350/373)vs.89.5%(341/381),80.4%(275/342)vs.69.1%(253/366),65.8%(181/275)vs 56.1%(142/253),P<0.05 or P<0.01]).The incidence of cumulative cycle luteinized unruptured follicle syndrome was significantly lower in the CM group than in the placebo group[11.7%(40/342)vs.17.8%(65/366),P<0.05).(3)Endometrial receptivity:after treatment,both endometrial types and endometrial blood flow types in the CM group were mainly types A and B,while those in the placebo group were mainly types B and C,with a significant difference between the two groups(both P<0.05).(4)Adverse events:the incidence of adverse events between the two groups was not significantly different(P>0.05).Conclusion:Strategies for activating blood circulation-regulating Gan(Liver)-tonifying Shen(Kidney)sequential therapy can effectively improve the clinical pregnancy rate and live birth rate of endometriosis-associated infertility with qi stagnation and blood stasis after laparoscopy,improve follicular development,promote ovulation,improve endometrial receptivity,while being a safe treatment option.(Trial registration No.NCT02676713).展开更多
Maximising access to and the success of fertility treatments should be a priority for global reproductive health,as should overall patient well-being.The demand for in vitro fertilization(IVF)and other assisted fertil...Maximising access to and the success of fertility treatments should be a priority for global reproductive health,as should overall patient well-being.The demand for in vitro fertilization(IVF)and other assisted fertility treatments has increased over the past decade and is likely to further increase in years to come.Nevertheless,there is still considerable unmet demand for infertility support worldwide.Moreover,the high emotional,physical and financial burden experienced by individuals undergoing IVF cycles can be a risk for their mental and physical health,which in turn can influence treatment continuation and the likelihood of IVF success.Studies from various parts of the world show that most individuals undergoing IVF also use adjunct alternative medicines and procedures,the most common being traditional Chinese medicine(TCM).The complementary and synergistic role of TCM for individuals undergoing IVF is an area that merits further attention and research,both for its potential positive effects on IVF success rates and for its broader physical and mental health benefits.However,much of the existing evidence is not sufficiently robust or consistent for findings to be adopted with confidence.This commentary argues that much work must be done to understand the efficacy and clinical best practices for these integrated approaches.This can be achieved in part by developing more robust and clinically relevant randomized controlled trial protocols,collecting and triangulating evidence through a variety of study designs and methods,and strengthening the collection and pooling of clinic-level data.展开更多
Objective:Some patients fail to obtain an embryo for transplantation during previousin vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI)cycles,and require multiple reproductive treatments.This study ai...Objective:Some patients fail to obtain an embryo for transplantation during previousin vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI)cycles,and require multiple reproductive treatments.This study aimed to evaluate whether changing the control ovarian stimulation(COS)protocol during the subsequent stimulation cycle could improve laboratory and clinical outcomes in these patients.Methods:Patients without a transplantable embryo(TE)in the previous IVF/ICSI cycles were recruited during their second cycles.They were classified into two groups according to their first cycle protocol:Group A,patients treated with a gonadotropinreleasing hormone agonist(GnRH-a),and Group B,patients treated with a gonadotropin-releasing hormone antagonist(GnRH-ant).The study group included patients whose stimulation protocols were changed,whereas the control group consisted of patients who used the same stimulation protocol in the second cycle.We then compared the numbers of oocytes collected(OC)and TE,the incidence of non-TE,the pregnancy rate(PR),and the live birth rate(LBR).Results:In Group A,the numbers of OC and TE were significantly lower(6.0±4.7vs.9.4±6.4,2.3±2.2vs.4.5±3.8,P<0.05)in the study group compared with those in the control group.In Group B,the numbers of OC and TE were higher(7.0±5.5vs.4.0±4.3,3.5±3.4vs.1.8±2.1,P<0.05)in the study group.There was a significant increase in the incidence of non-TE(adjusted odds ratio(AOR)=2.12,95%CI:1.04–4.69)of the study group in Group A but not in Group B.No significant differences in the PR or LBR were found between the study and control groups in either Group A or B.Conclusion:Changing the COS protocol from GnRH-ant to GnRH-a or continuing the GnRH-a protocol can improve laboratory outcomes in patients with no TE in the previous IVF/ICSI cycle.展开更多
Objectives:To identify,examine and summarize the available evidence on the effectiveness and safety of acupuncture for in vitro fertilisation(IVF)outcomes.Methods:Eight electronic databases,including Pub Med,EMBASE,Co...Objectives:To identify,examine and summarize the available evidence on the effectiveness and safety of acupuncture for in vitro fertilisation(IVF)outcomes.Methods:Eight electronic databases,including Pub Med,EMBASE,Cochrane Database of Systematic Review,Cochrane Central Register of Controlled Trials,China National Knowledge Infrastructure,Wanfang Database,Chinese Biomedical Database and VIP Database,were searched,supplemented by manual searches.Two researchers independently conducted the literature screening,data extraction,and methodological quality assessments.A narrative description was provided to show the general information and specific characteristics of the included studies.A bubble plot was used to visually display the overall effects of acupuncture on IVF outcomes.Results:Eighty-two studies were identified,including 64 primary studies and 18 systematic reviews.Transcutaneous electrical acupoint stimulation,electric acupuncture and manual acupuncture were applied in most studies and compared with no acupuncture,sham acupuncture and placebo acupuncture control groups.Sixty-three(98.4%)primary studies reported clinical pregnancy rate,and positive effects of acupuncture were found in 34 studies(54.0%).Live birth rate was reported in only 18(28.1%)primary studies,of which 10(55.6%)showed positive results.In addition,only 8 and 2 systematic reviews showed that acupuncture could increase clinical pregnancy events and live birth events,respectively.However,none of these reviews was of high methodological quality.Conclusions:Available evidence suggests that acupuncture therapy could improve clinical pregnancy rates.However,whether acupuncture could increase live birth events was difficult to determine based on the few studies that have reported this outcome indicator.Furthermore,the methodological quality of most systematic reviews was assessed as critically low or low.Studies with a rigorous design and standardized implementation should be performed to refine the available evidence.展开更多
文摘<strong>Study Question:</strong> The question: is there any difference in pregnancy rate between embryo transfer day 5 and day 6 in IVF? What Is Known Already? Blastocyst transfer is increasingly popular in assisted reproductive technology (ART) centers today. Very few articles concentrate on comparing Day 5 and Day 6 embryo transfer with conflict results. <strong>Objective, Study Design:</strong> Systematic review and meta-analysis of published controlled studies. Searches conducted from 2001-2020 on PubMed. Medline, EMBASE, and ISI Web of Science Electronic database is used to collect data, using the following search terms: blastocyst, Day 5, Day 6, embryo transfer (E.T.) and pregnancy rate. <strong>Materials, Setting, Methods:</strong> A total of 6 full-text articles preselected from 211 references, based on title and abstract. Two independent reviewers performed data selection and extraction according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA). This systematic review was conducted according to (PICO) standard. Random-effect meta-analysis performed on all data (overall analysis). <strong>Results and the Role of Chance:</strong> Data from 6 relevant articles were extracted and integrated into the meta-analysis that reported clinical pregnancy rate (CPR) as an outcome in 5640 cycles, 2274 cycle had embryo transfer at day 6 and the control was 3366 cycle had embryo transfer day 5 showed a significantly higher clinical pregnancy rate following Day 5 embryo transfer compared with Day 6 embryo transfer with odd ratio and 95% confidence limit 0.73 (0.66 - 0.82)<em> p</em> value < 0.000. Sensitivity analysis led to similar results and conclusions.<strong> Limitations, Reasons for Caution: </strong>The validity of meta-analysis results depends mainly on the quality and the number of published studies available. Indeed, this meta-analysis included no randomized controlled trial (RCT). <strong>Wider Implications of the Findings: </strong>In regards to the results of this original meta-analysis, ART practitioners should preferably transfer D5 rather than D6 blastocysts. Further RCTs are needed to address the question of whether D6 embryos should be transported.
基金This work was supported by the Strategic Priority Research Program of the Chinese Academy of Sciences(XDA16040302,XDA01030505)the National Natural Science Foundation of China(81971336)+1 种基金Jiangsu Provincial Key Medical Center(YXZXB2016004)Jiangsu Provincial Obstetrics and Gynecology Innovation Center(CXZX202229)。
文摘Intrauterine adhesion is a major cause of female reproductive disorders.Although we and others uncontrolled pilot studies showed that treatment with autologous bone marrow stem cells made a few patients with severe intrauterine adhesion obtain live birth,no large sample randomized controlled studies on this therapeutic strategy in such patients have been reported so far.To verify if the therapy of autologous bone marrow stem cells-scaffold is superior to traditional treatment in moderate to severe intrauterine adhesion patients in increasing their ongoing pregnancy rate,we conducted this randomized controlled clinical trial.Totally 195 participants with moderate to severe intrauterine adhesion were screened and 152 of them were randomly assigned in a 1:1 ratio to either group with autologous bone marrow stem cells-scaffold plus Foley balloon catheter or group with only Foley balloon catheter(control group)from February 2016 to January 2020.The per-protocol analysis included 140 participants:72 in bone marrow stem cells-scaffold group and 68 in control group.The ongoing pregnancy occurred in 45/72(62.5%)participants in the bone marrow stem cells-scaffold group which was significantly higher than that in the control group(28/68,41.2%)(RR=1.52,95%CI 1.08–2.12,P=0.012).The situation was similar in live birth rate(bone marrow stem cells-scaffold group 56.9%(41/72)vs.control group 38.2%(26/68),RR=1.49,95%CI 1.04–2.14,P=0.027).Compared with control group,participants in bone marrow stem cells-scaffold group showed more menstrual blood volume in the 3rd and 6th cycles and maximal endometrial thickness in the 6th cycle after hysteroscopic adhesiolysis.The incidence of mild placenta accrete was increased in bone marrow stem cells-scaffold group and no severe adverse effects were observed.In conclusion,transplantation of bone marrow stem cells-scaffold into uterine cavities of the participants with moderate to severe intrauterine adhesion increased their ongoing pregnancy and live birth rates,and this therapy was relatively safe.
基金supported by the National Natural Science Foundation of China(No.81701509).
文摘Objective This study aimed to determine whether the day of blastocyst expansion affects pregnancy outcomes in frozen-thawed blastocyst transfer(FBT)cycles.Methods A retrospective match-cohort study was conducted.Patients who underwent blastocyst transfer in frozen-thawed cycles at day 5 or 6 were matched for potential confounding factors.A total of 2207 matched pairs of FBT cycles were included from January 2016 to December 2019 in our Reproductive Medicine Center.Results The clinical pregnancy rate(CPR)and live birth rate(LBR)were significantly increased in day 5 blastocyst transfers when compared to day 6 blastocyst transfers,in terms of the same embryo quality.For FBT cycles with good-quality embryo,the CPR at day 5 and 6 was 61.30%and 57.56%,respectively(P=0.045),and the LBR was 44.79%and 36.16%,respectively(P<0.001).For FBT cycles with poor-quality embryo,the CPR at day 5 and 6 was 48.61%and 40.89%,respectively(P=0.006),and the LBR was 31.71%and 25.74%,respectively(P=0.019).The CPR for FBT cycles with good-quality embryo was statistically higher at day 6 than that at day 5 with poor-quality embryo transferred(57.56%vs.48.61%,P=0.001).Maternal age,anti-Müllerian hormone(AMH),endometrial thickness,embryo quality,and the day of blastocyst expansion were independently correlated with the CPR and LBR.The FBT cycles at day 5 had significantly higher CPR(adjusted odds ratio[OR]=1.246,95%confidence intervals[CI]:1.097–1.415,P=0.001)and LBR(adjusted OR=1.435,95%CI:1.258–1.637,P<0.001)than those at day 6.Conclusion The embryo quality is the primary indicator for FBT cycles.Day 5 blastocysts should be preferred when the quality of embryo at day 5 is the same as that at day 6.
基金National Natural Science Foundation of China (No.82072880,81960283)Science and Technology Project of Hainan Province (No.LCYX202102)Key Science and Technology Project of Hainan Province (No.ZDKJ2017007)。
文摘With the clinical development and application of intracytoplasmic sperm injection(ICSI)technology in human assisted reproduction,the influence of oocyte quality on embryo development has been paid more and more attention.So far,there have been many reports on oocyte morphology affecting embryo development.It has been found in some works that the appearance of smooth endoplasmic reticulum clusters(SERC)in oocytes may affect the fertilization and embryo development of oocytes.However,with the increasing reports of SERC-containing oocytes obtained by in vitro fertilization and healthy offspring in recent years,there is still some controversy on whether to continue to use SERC-containing oocytes for the following assisted reproductive therapy in clinical practice.Based on this,this review aims to review the research progress of SERC in oocytes in recent years.
基金supported by the National Public Welfare Projects for Chinese Medicine(201507001)to Xiao Ke WuTheme-based Research Scheme(T13-602/21-N)from Research Grant Councilthe Health and Medical Research Fund(06170246)from Food and Health Bureau to Chi Chiu Wang。
文摘In this study,we used a network meta-analysis(NMA)to compare the effectiveness of medicines and supplements for idiopathic male infertility and to identify the best treatment.Medline,Excerpta Medica Database(EMBASE),Ovid,and China National Knowledge Infrastructure(CNKI),were searched for the period from January 1990 to June 2021 using the keywords"male infertility,""medical therapy,""supplement/nutrient therapy,"and related terms.Randomized controlled trials(RCTs)investigating medicines(mainly follicle-stimulating hormone(FSH),androgen,and clomiphene/tamoxifen)or supplements(mainly zinc,selenium,vitamin C or E,carnitine,coenzyme Q10(CoQ10),or combined treatment)for idiopathic infertile men were selected for meta-analysis.Preferred reporting items for systematic reviews and meta-analysis(PRISMA)was used for data extraction,and a risk-of-bias tool and grades of recommendation,assessment,development,and evaluation(GRADE)system adapted to the NMA were employed to assess the quality of the evidence.The primary outcomes were live birth and spontaneous pregnancy rate(SPR).The secondary outcomes were sperm parameters(including concentration,progressive motility,and morphology)and side effects.In total,65 RCTs involving 7541 men with sperm abnormalities but normal hormone levels were included.A total of 36 studies reported SPR but only three reported live birth rates.The quality of the included studies was found to be moderate to high.Compared with a placebo or being untreated,carnitine plus vitamins significantly improved SPR(relative risk(RR)=3.7,95%confidence interval(95%CI),1.6-8.5);fatty acids significantly increased sperm concentrations(mean difference(MD)=12.5×10^(6)mL-1,95%CI,3.1×10^(6)-22.0×10^(6));and selective estrogen receptor modulator(SERM)plus CoQ10 significantly improved sperm progressive motility(MD=11.0%,95%CI,0.1%-21.9%)and normal sperm morphology(MD=11.0%,95%CI,4.6%-17.4%).The most optimal intervention was carnitine plus vitamins and fatty acids for SPR and sperm concentrations,respectively,even after excluding trials at a high risk of bias.Compared with a placebo or being untreated,FSH(RR=4.9,95%CI,1.1-21.3)significantly increased SPR,whereas SERM plus kallikrein increased sperm concentration(MD=16.5×10^(6)mL^(-1),95%CI,1.6×10^(6)-31.4×10^(6)),and SERM plus CoQ10 significantly improved sperm progressive motility(MD=11.3%,95%CI,7.3%-15.4%)and normal morphology(MD=11.2%,95%CI,5.4%-16.9%)in men with oligoasthenozoospermia(OA).In terms of side effects,fatty acids and pentoxifylline were associated with foul breath and/or a bad taste(RR=8.1,95%CI,1.0-63.5)and vomiting(RR=8.0,95%CI,1.0-63.0),respectively.In conclusion,the optimal treatment for male infertility for live birth is still unknown.Carnitine plus vitamins and FSH are likely to be better than other therapies in achieving successful spontaneous pregnancy in couples overall and in cou ples with men with OA,respectively.The efficacy of other treatments on pregnancy outcomes warrants further verification.
基金The project was granted by the Indian Council of Agricultural Research,New Delhi on 28.12.2016 vide sanction order No.:[170NRC(P)/2006-2007/1061(1)]with date of commencement of the Project on 1 April 2017.
文摘Objective:To assess the effect of flaxseed supplementation on metabolic profile,endocrine concentrations,non-esterified fatty acids(NEFA),body composition variables,and reproductive performance of sows.Methods:All the 21 crossbred Large White Yorkshire sows were considered in the study period starting at day 1 of current farrowing when the feeding of specific supplemental ration was started until the day of subsequent farrowing(days 150-155)and were equally allocated into three groups.Group 1 served as the control group and followed their normal feeding schedule.Group 2 and group 3,in addition to their normal feeding schedule,were supplemented with flaxseed at a rate of 0.5%and 1.0%of the dry matter,respectively.Blood samples were collected 15 days prior to farrowing,on the day of farrowing(day 0),at weekly intervals until day 28 of lactation and at monthly intervals during gestation to harvest the plasma.Plasma was used to assess the metabolic and endocrine status of sows.Body weight of each sow and individual birth weight of all piglets born were measured.Results:Flaxseed supplementation led to decrease in plasma cholesterol and triglyceride levels in the supplemented groups than in the control group(P<0.05).Plasma estradiol-17βlevel was higher in group 2 than that in group 1 and 3 on day 90 of the gestation period(P<0.05).The mean plasma level of insulin-like growth factor 1 was higher in group 3 than that in group 1 and 2 both in late lactation(day 28)as well as in early gestation(day 30)(P<0.05).Plasma NEFA and weight gain were greater in sows of group 2 and 3 compared to those fed with the normal control diets(P<0.05).The proportion of pregnant sows relative to sows bred was 100.0%in group 2 and 3 and 85.7%in the control group.Piglet mortality was lower in group 2 and 3 compared to group 1(P>0.05).Conclusions:Flaxseed improves endocrine profiles,NEFA concentrations and body weight,resulting in better pregnancy rate and litter size.
文摘BACKGROUND Malignant ovarian germ cell tumors(MOGCT)are rare and frequently occur in women of young and reproductive age and the oncologic and reproductive outcomes after fertility-sparing surgery(FSS)for this disease are still limited.AIM To evaluate the oncology and reproductive outcomes of MOGCT patients who underwent FSS.METHODS All MOGCT patients who underwent FSS defined as the operation with a preserved uterus and at least one side of the ovary at our institute between January 2005 and December 2020 were retrospectively reviewed.RESULTS Sixty-two patients were recruited for this study.The median age was 22 years old and over 77%were nulliparous.The three most common histology findings were immature teratoma(32.2%),dysgerminoma(24.2%),and yolk sac tumor(24.2%).The distribution of stage was as follows;Stage I,74.8%;stage II,9.7%;stage III,11.3%;and stage IV,4.8%.Forty-three(67.7%)patients received adjuvant chemotherapy.With a median follow-up time of 96.3 mo,the 10-year progressionfree survival and overall survival were 82.4%and 91%,respectively.For reproductive outcomes,of 43 patients who received adjuvant chemotherapy,18(41.9%)had normal menstruation,and 17(39.5%)resumed menstruation with a median time of 4 mo.Of about 14 patients who desired to conceive,four were pregnant and delivered good outcomes.Only one case was aborted.Therefore,the successful pregnancy rate was 28.6%CONCLUSION The oncology and reproductive outcomes of MOGCT treated by FSS are excellent.Many patients show a long survival time with normal menstruation.However,the obstetric outcome is not quite satisfactory.
文摘Objective: We evaluated the relationships between the incidence of the apoptotic cell of human granulose cell (GC) from the oocytes during intracytoplasmic sperm injection (ICSI) and the pregnancy rate. Methods: 275 oocytes were retrieved from 29 patients with aging between 23 - 38 years, who underwent ICSI (21), percutanious sperm aspiration (PESA-ICSI)and testicular sperm extraction (TESE-ICSI) (7), only one case came from conventional IVF. The patients were divided into two groups based on pregnancy or not. The cumulus cells were collected to measure the number of apoptotic cell by using flow cytometer. The degree of cumulus GC apoptosis and clinic pregnancy rate were assessed, and compared with embryo morphology and number of blastomere. Results: The apoptosis value in pregnancy gruop (9 cases) were lower than the nonpregnancy group (19 cases) (P<0. 05). In pregnancy group, the apoptosis value in the GC obtained from replaced embryos (37) were significantly lower than that of the nonreplaced embryos (78) (P<0. 02). Conclusion: The results indicated that the embryos with lower apoptosis value would have the potency of increase pregnancy rate. It will be possible to elevate the clinic pregnancy rate by selecting the replaced embryos bases on the apoptosis value of GC from oocytes in addition to the morphological score.
文摘Objectives: Study the effect of adding a delayed blastocyst to a transferred good quality one on ICSI cycle outcomes. Study design: Prospective cohort study. Participants/materials, setting, methods: 90 infertile patients aged from 20<span><span><span> </span></span></span><span><span><span>- 35 years due to mild male factor, unexplained infertility or tubal factor. Patients with PCOS, endometriosis, RIF, poor responder and azoospermia were excluded. Setting: Duration 6 month</span></span></span><span><span><span>s</span></span></span><span><span><span> from October 2019 to April 2020 in a private IVF center in Egypt. 30 case</span></span></span><span><span><span>s</span></span></span><span><span><span> were subjected to elective single embryo transfer and the other 60 with two embryo transfer</span></span></span><span><span><span>s</span></span></span><span><span><span>, one good quality and </span></span></span><span><span><span>an</span></span></span><span><span><span>other poor quality blastocyst. Results: (clinical pregnancy rate) was comparable between the two groups, being 47.7% and 36.7% in SET and DET groups respectively (p = 0.361). Miscarriage and ectopic pregnancy rate were observed in 10% of the cases pregnant after SET (group I) and in only 6.7% of the cases pregnant after DET (group II) denoting no significant statistical difference between the two groups. The highest incidence was missed miscarriages in the two groups and ectopic pregnancy was observed only in one case in group II (DET). Twin pregnancy occurred in 22% of pregnant females in the second group. Late pregnancy complications in the form of preterm labour, premature rupture of membrane and preeclampsia occurred mainly in pregnant females in the second group 18%. Conclusion: Neither adding a delayed blastocyst negatively affect</span></span></span><span><span><span>ed</span></span></span><span><span><span> the good one nor affect</span></span></span><span><span><span>ed</span></span></span><span><span><span> the live birth rate but increased multiple pregnancy rate</span></span></span><span><span><span>s</span></span></span><span><span><span>.
文摘Is there a really need to validate oocyte vitrification technique in an ART laboratory before establishing it in daily practice? Validation of micromanipulationbased technique, in this case oocyte vitrification, is essential prior to enlarging its use to routine practice. Oocyte vitrification is a new worldwide used technique and legal recently inFrance. This micromanipulation needs to be performed by a skilled and experienced embryologist and requires an internal assessment in each ART unit before any wide use. We designed a prospective study, from September 2011 to July 2012, using sibling oocytes from women who recovered more than 12 Metaphase II oocytes. A part of freshly recovered oocytes underwent immediate ICSI while the remaining oocytes were vitrified. 87 couples undergoing ICSI were selected based on number of mature oocytes available on the recovery day after denudation. A part of fresh MII oocytes were microinjected and the others were vitrified using an open system (Cryotop?). The major criterion of interest was the number of embryo transferred/ number of Metaphase II ratio for after ICSI on fresh oocytes (42/211) versus vitrified/warmed oocytes (51/204) (p > 0.05). Secondary studied criteria were survival rate (80.5% ± 26.3%), fertilization rate (68.9 ± 33.5) and finally, cumulative pregnancy rate obtained in this study is 40.2%. One of the benefits of such practice is the limitation of embryo freezing. However, the study design delays oocytes warming cycles, due to pregnancies triggered by the transfer of fresh derived oocyte embryos and to the priority to transfer all the frozen embryos before starting oocytes warming. Moreover, no data is available about children’ health. Oocyte vitrification represents not only a change in our daily practice to improve cumulative pregnancy rate but also a promising tool to develop egg banking and donation. Clinical Trials Registration number: 209 R02.
基金supported by the grants from Natural Science Foundation of Chongqing(Nos:cstc2019jcyj-msxmX0749,cstc2019jxjl130030,cstc2018jxjl130065)Intelligent Medicine Research Project of Chongqing Medical University(YJSZHYX202010)Sichuan Provincial Science and Technology Plan Project(2019YFSY0047)and Applied Basic Research Project in Sichuan Province(2018JY0357).
文摘Objective:To evaluate the pregnancy outcomes of the four endometrial preparation protocols for people undergoing frozen-thawed embryo transfer(FET),including natural cycle(NC),hormone replacement therapy cycle(HRT),gonadotropin-releasing hormone agonist artificial cycle(GAC),and ovarian stimulation cycle(OC).Methods:This retrospective cohort study enrolled 10,333 cycles of frozen embryo transfer performed at Xinan Gynecological Hospital in Sichuan,China,from January 2018 to December 2018.The patient's baseline characteristics and pregnancy outcomes were extracted from the medical record system.Pregnancy outcomes were compared among the four groups and multiple logistic regression models were used to adjust for the confounding factors.Results:After adjusting for covariates,multiple logistic regression analysis showed no statistical significance in pregnancy outcomes in the HRT group,GAC group,and OC group compared to the NC group in the entire population.The adjusted odds ratio of live birth was 0.976(95%)confidence interval[Cl](0.837-1.138)for the HRT group,0.959(95%confidence interval 0.797-1.152)for the GAC group,and 0.909(95%confidence interval 0.763-1.083)for the OC group.Conclusions:The natural protocol had comparable pregnancy outcomes compared to the other three endometrial preparation protocols in the overall FET population.More high-quality prospective randomized controlled trials are required to assess the efficacy of the four protocols and explore the optimal one.
文摘The purpose of this retrospective study was to determine whether or not there was a significant relationship between women’s age as a cause of sterility and pregnancy after IUI. Furthermore, we evaluated the effect of stimulation of antiestrogens and time of hCG administration on the success of IUI in relation to the age of women. During the period between 2008 and 2012, we performed a total number of 793 IUI. Patients were prepared for IUI in the natural cycle and stimulation with antiestrogens (clomiphene citrate-CC). Ovulation was induced by hCG (Ovitrelle) 40 hours before IUI or immediately after the procedure. Sperm was processed through density gradients. The average success rate of IUI was 10.2% of pregnant women per cycle. Significantly the highest number of pregnant women 16.3% was women with a diagnosis of anovulation. Significantly the lowest success rate of IUI was at the immunological cause of infertility and endometriosis. There was no evidence of age dependence for women on the success of IUI. Stimulation of CC did not significantly increase the chance of becoming pregnant. There was also no statistically significant difference in hCG before and after IUI pregnancy success. The most important group of women for whom IUI is a suitable form of assisted reproduction consists of patients of 35 years old with anovulation cause of sterility. Those patients with an immunological cause of infertility and endometriosis have significantly lower chances of conceiving after IUI and it is preferable for them to choose other techniques of assisted reproduction and embryo transfer.
基金Supported by the Key Projects of the National Science and Technology Pillar Program during the 12th Five-Year Plan Period(No.2014BAI10B08)
文摘Objective:To evaluate the efficacy and safety of Chinese medicine(CM)improving pregnancy outcomes after surgery for endometriosis-associated infertility.Methods:A multicenter,randomized,doubleblind placebo parallel controlled clinical trial was designed.A total of 202 patients who had laparoscopy for endometriosis-associated infertility with qi stagnation and blood stasis syndrome were included and randomly divided into the CM treatment group and placebo control group at a ratio of 1:1 using a central block randomization from May 2014 to September 2017,101 patients in each group.The two groups received continuous intervention at 1–5 days after surgery,for 6 menstrual cycles.Before ovulation,the CM group was treated Huoxue Xiaoyi Granule(活血消异颗粒);after ovulation,Bushen Zhuyun Granule(补肾助孕颗粒)was involved.The control group was treated with placebo.Transvaginal ultrasonography was performed every menstrual cycle during the treatment,and female hormone levels in the follicular and luteal phases were measured during the 1 st,3 rd and 6 th menstrual cycles.The analysis was continued until pregnancy.The primary outcomes were clinical pregnancy rate and pregnancy outcome,and the secondary outcomes were follicular development and endometrial receptivity.Safety evaluations were performed before and after treatment.Results:(1)Clinical pregnancy and live birth rates:the clinical pregnancy and live birth rates of the CM group were significantly higher than those of the placebo group[44.6%(45/101)vs.29.7%(30/101),34.7%(35/101)vs.20.8%(21/101),both P<0.05].(2)Follicle development:the incidence of dominant follicles,rate of cumulative cycle ovulation,and rate of cumulative cycle mature follicle ovulation were significantly higher in the CM group than those in the placebo group[93.8%(350/373)vs.89.5%(341/381),80.4%(275/342)vs.69.1%(253/366),65.8%(181/275)vs 56.1%(142/253),P<0.05 or P<0.01]).The incidence of cumulative cycle luteinized unruptured follicle syndrome was significantly lower in the CM group than in the placebo group[11.7%(40/342)vs.17.8%(65/366),P<0.05).(3)Endometrial receptivity:after treatment,both endometrial types and endometrial blood flow types in the CM group were mainly types A and B,while those in the placebo group were mainly types B and C,with a significant difference between the two groups(both P<0.05).(4)Adverse events:the incidence of adverse events between the two groups was not significantly different(P>0.05).Conclusion:Strategies for activating blood circulation-regulating Gan(Liver)-tonifying Shen(Kidney)sequential therapy can effectively improve the clinical pregnancy rate and live birth rate of endometriosis-associated infertility with qi stagnation and blood stasis after laparoscopy,improve follicular development,promote ovulation,improve endometrial receptivity,while being a safe treatment option.(Trial registration No.NCT02676713).
文摘Maximising access to and the success of fertility treatments should be a priority for global reproductive health,as should overall patient well-being.The demand for in vitro fertilization(IVF)and other assisted fertility treatments has increased over the past decade and is likely to further increase in years to come.Nevertheless,there is still considerable unmet demand for infertility support worldwide.Moreover,the high emotional,physical and financial burden experienced by individuals undergoing IVF cycles can be a risk for their mental and physical health,which in turn can influence treatment continuation and the likelihood of IVF success.Studies from various parts of the world show that most individuals undergoing IVF also use adjunct alternative medicines and procedures,the most common being traditional Chinese medicine(TCM).The complementary and synergistic role of TCM for individuals undergoing IVF is an area that merits further attention and research,both for its potential positive effects on IVF success rates and for its broader physical and mental health benefits.However,much of the existing evidence is not sufficiently robust or consistent for findings to be adopted with confidence.This commentary argues that much work must be done to understand the efficacy and clinical best practices for these integrated approaches.This can be achieved in part by developing more robust and clinically relevant randomized controlled trial protocols,collecting and triangulating evidence through a variety of study designs and methods,and strengthening the collection and pooling of clinic-level data.
基金grants to W.H.M.from the National Natural Science Foundation of China(81860160)M.J.L.from Guangxi Key Research and Development Program(No.AB20238002)+2 种基金Y.H.Y.from the National Natural Science Foundation of China(81871172)the Natural Science Foundation of Guangxi Zhuang Autonomous Region(2019GXNSFFA245013,2018GXNSFDA050017)the Guangxi Medical University Training Program for Distinguished Young Scholars and the Special Fund of the Female Fertility Preservation Innovation Team of the First Affiliated Hospital of Guangxi Medical University。
文摘Objective:Some patients fail to obtain an embryo for transplantation during previousin vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI)cycles,and require multiple reproductive treatments.This study aimed to evaluate whether changing the control ovarian stimulation(COS)protocol during the subsequent stimulation cycle could improve laboratory and clinical outcomes in these patients.Methods:Patients without a transplantable embryo(TE)in the previous IVF/ICSI cycles were recruited during their second cycles.They were classified into two groups according to their first cycle protocol:Group A,patients treated with a gonadotropinreleasing hormone agonist(GnRH-a),and Group B,patients treated with a gonadotropin-releasing hormone antagonist(GnRH-ant).The study group included patients whose stimulation protocols were changed,whereas the control group consisted of patients who used the same stimulation protocol in the second cycle.We then compared the numbers of oocytes collected(OC)and TE,the incidence of non-TE,the pregnancy rate(PR),and the live birth rate(LBR).Results:In Group A,the numbers of OC and TE were significantly lower(6.0±4.7vs.9.4±6.4,2.3±2.2vs.4.5±3.8,P<0.05)in the study group compared with those in the control group.In Group B,the numbers of OC and TE were higher(7.0±5.5vs.4.0±4.3,3.5±3.4vs.1.8±2.1,P<0.05)in the study group.There was a significant increase in the incidence of non-TE(adjusted odds ratio(AOR)=2.12,95%CI:1.04–4.69)of the study group in Group A but not in Group B.No significant differences in the PR or LBR were found between the study and control groups in either Group A or B.Conclusion:Changing the COS protocol from GnRH-ant to GnRH-a or continuing the GnRH-a protocol can improve laboratory outcomes in patients with no TE in the previous IVF/ICSI cycle.
基金Supported by Innovation Fund of China Academy of Chinese Medical Sciences(No.CI2021A03503)"The Belt and Road"TCM Cooperation Project of China Academy of Chinese Medical Sciences(No.GH201901)the Fundamental Research Funds for the Central Public Welfare Research Institutes(No.ZZ13-024-9)。
文摘Objectives:To identify,examine and summarize the available evidence on the effectiveness and safety of acupuncture for in vitro fertilisation(IVF)outcomes.Methods:Eight electronic databases,including Pub Med,EMBASE,Cochrane Database of Systematic Review,Cochrane Central Register of Controlled Trials,China National Knowledge Infrastructure,Wanfang Database,Chinese Biomedical Database and VIP Database,were searched,supplemented by manual searches.Two researchers independently conducted the literature screening,data extraction,and methodological quality assessments.A narrative description was provided to show the general information and specific characteristics of the included studies.A bubble plot was used to visually display the overall effects of acupuncture on IVF outcomes.Results:Eighty-two studies were identified,including 64 primary studies and 18 systematic reviews.Transcutaneous electrical acupoint stimulation,electric acupuncture and manual acupuncture were applied in most studies and compared with no acupuncture,sham acupuncture and placebo acupuncture control groups.Sixty-three(98.4%)primary studies reported clinical pregnancy rate,and positive effects of acupuncture were found in 34 studies(54.0%).Live birth rate was reported in only 18(28.1%)primary studies,of which 10(55.6%)showed positive results.In addition,only 8 and 2 systematic reviews showed that acupuncture could increase clinical pregnancy events and live birth events,respectively.However,none of these reviews was of high methodological quality.Conclusions:Available evidence suggests that acupuncture therapy could improve clinical pregnancy rates.However,whether acupuncture could increase live birth events was difficult to determine based on the few studies that have reported this outcome indicator.Furthermore,the methodological quality of most systematic reviews was assessed as critically low or low.Studies with a rigorous design and standardized implementation should be performed to refine the available evidence.
