Long-term gonadotropin-releasing hormone agonist(Gn RHa) administration before in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI) in infertile women with endometriosis or adenomyosis significantly enha...Long-term gonadotropin-releasing hormone agonist(Gn RHa) administration before in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI) in infertile women with endometriosis or adenomyosis significantly enhanced the chances of pregnancy in both fresh and frozen embryo transfer cycles. We hypothesized that long-term Gn RHa treatment might also be beneficial for the idiopathic repeated implantation failure(RIF) patients. In the 21 patients receiving Gn RHa and hormone replacement therapy(G-HRT) protocols for frozen embryo transfer, their data were compared with those of the 56 of frozen/fresh cycles they had previously undergone(previous protocols). Comparison showed that the finial results were significantly better with G-HRT protocols than with their previous protocols, with pregnancy rate, clinical pregnancy rate, implantation rate and on-going pregnancy rate being 70%, 60%, 40% and 38% respectively with G-HRT protocols, against 17%, 11%, 6.3% and 5% with previous protocols. The results showed that hormonally controlled endometrial preparation with prior Gn RHa suppression could be used for patients who had experienced repeated failures of IVF treatment despite having morphologically optimal embryos, and the treatment may help increase the receptivity of the endometrium in these patients.展开更多
Objective:The objective of this study is to study whether preimplantation genetic testing for aneuploidy(PGT-A)improves the clinical outcomes of infertile patients with repeated implantation failure(RIF)undergoing fro...Objective:The objective of this study is to study whether preimplantation genetic testing for aneuploidy(PGT-A)improves the clinical outcomes of infertile patients with repeated implantation failure(RIF)undergoing frozen-thawed embryo transfer.Methods:This is a retrospective analysis of clinical pregnancy,live birth,miscarriage rates,and obstetric and perinatal outcomes of women with RIF with or without PGT-A.Statistical analyses of categorical data were performed using propensity score matching(PSM),χ^(2)test,and Student’s t test.Results:We enrolled 466 patients with RIF,of which,209 were in the RIF-PGT-A group.The rate of euploid blastocysts was significantly associated with age and day 5 or 6 blastocysts.There were significant differences between the RIF-PGT-A group and the RIF-non-PGT-A group across several parameters.After PSM,positive serum human chorionic gonadotropin(56.9%and 33.9%,P<0.01),clinical pregnancy(49.5%and 31.2%,P<0.01),live birth(43.1%and 25.7%,P<0.01),and fetal heart rates(50.0%and 29.8%,P<0.01)per transfer were significantly higher in the RIF-PGT-A group.Conclusion:Elective single-embryo transfer PGT-A can minimize the risk of obstetric and perinatal outcomes,especially fetal body weight,in women with RIF.Additionally,PGT-A can significantly improve pregnancy and live birth rates.展开更多
Objective Both sequential embryo transfer(SeET)and double-blastocyst transfer(DBT)can serve as embryo transfer strategies for women with recurrent implantation failure(RIF).This study aims to compare the effects of Se...Objective Both sequential embryo transfer(SeET)and double-blastocyst transfer(DBT)can serve as embryo transfer strategies for women with recurrent implantation failure(RIF).This study aims to compare the effects of SeET and DBT on pregnancy outcomes.Methods Totally,261 frozen-thawed embryo transfer cycles of 243 RIF women were included in this multicenter retrospective analysis.According to different embryo quality and transfer strategies,they were divided into four groups:group A,good-quality SeET(GQ-SeET,n=38 cycles);group B,poor-quality or mixed-quality SeET(PQ/MQ-SeET,n=31 cycles);group C,good-quality DBT(GQ-DBT,n=121 cycles);and group D,poor-quality or mixed-quality DBT(PQ/MQ-DBT,n=71 cycles).The main outcome,clinical pregnancy rate,was compared,and the generalized estimating equation(GEE)model was used to correct potential confounders that might impact pregnancy outcomes.Results GQ-DBT achieved a significantly higher clinical pregnancy rate(aOR 2.588,95%CI 1.267–5.284,P=0.009)and live birth rate(aOR 3.082,95%CI 1.482–6.412,P=0.003)than PQ/MQ-DBT.Similarly,the clinical pregnancy rate was significantly higher in GQ-SeET than in PQ/MQ-SeET(aOR 4.047,95%CI 1.218–13.450,P=0.023).The pregnancy outcomes of GQ-SeET were not significantly different from those of GQ-DBT,and the same results were found between PQ/MQ-SeET and PQ/MQ-DBT.Conclusion SeET relative to DBT did not seem to improve pregnancy outcomes for RIF patients if the embryo quality was comparable between the two groups.Better clinical pregnancy outcomes could be obtained by transferring good-quality embryos,no matter whether in SeET or DBT.Embryo quality plays a more important role in pregnancy outcomes for RIF patients.展开更多
Natural killer(NK)cells are thought to play a key role in the successful establishment of a pregnancy by facilitating immunological adaptation of the semi-allogeneic developing embryo.The aim of this study was to expl...Natural killer(NK)cells are thought to play a key role in the successful establishment of a pregnancy by facilitating immunological adaptation of the semi-allogeneic developing embryo.The aim of this study was to explore the cell number,immunophenotypic characteristics,and activities of peripheral blood NK cells in women with repeated implantation failure(RIF).Peripheral blood was obtained from 27 women with RIF and 11 healthy,fertile controls during the middle luteal phase of the menstrual cycle.CD3^-CD56^+NK cells were quantified and analyzed by flow cytometry for the expression of cytolytic molecules(granzyme B,granulysin,and perforin)as well as cell surface receptors responsible for NK cell activation or inhibition(NKG2D,NKp30,NKp46,CD158a,CD158b).NK cytotoxicity was measured at three effector-to-target cell ratios.Women with RIF and fertile controls did not differ significantly in the percentage of circulating CD3CD56t NK cells,or in the proportions of these cells that expressed granzyme B,granulysin,or perforin.The two groups also did not differ significantly in the proportions of NK cells expressing the receptors NKG2D,NKp30,NKp46,CD158a or CD158b.General linear model analysis showed that NK cytotoxicity increased with effector-to-target cell ratio.However,NK cytotoxicity did not differ significantly between patients with RIF and fertile controls.These results suggest that RIF is not associated with significant alterations in the number or function of peripheral blood NK cells.展开更多
Objectives:To investigate the clinical effect of sequential therapeutic intervention Yupei Qisun[compensating for weakness by invigorating Kidney(Shen) and Spleen(Pi) in advance]in Chinese medicine(CM)and hysteroscopi...Objectives:To investigate the clinical effect of sequential therapeutic intervention Yupei Qisun[compensating for weakness by invigorating Kidney(Shen) and Spleen(Pi) in advance]in Chinese medicine(CM)and hysteroscopic endometrial mechanical stimulation on the treatment of infertile patients with repeated implantation failure(RIF);and to study the differences in patients' endometrial thickness and type on the day of embryo transfer,serum hormone levels on embryo transfer day and clinical pregnancy outcomes.Methods:In the clinical study,168 frozen-thawed embryo transfer(FET) cycles for couples with RIF conforming to the research protocol were randomly divided into three groups:a CM group with 56 cycles(CM combined with FET),a hysteroscopy group with 55 cycles(hysteroscopic endometrial mechanical stimulation),and a control group with 57 cycles(conventional FET).Differences in endometrial thickness on the embryo transfer day,levels of serum estradiol(E_2) and progesterone(P) on the embryo transfer day,the E_2/P ratio on the embryo transfer day,biochemical and clinical pregnancy rates,implantation rate,abnormal pregnancy rate and other indices were compared among the three groups.Results:Endometrial thickness,E_2 and P levels,and the E_2/P ratio on embryo transfer day and other factors had no significant differences among groups.The biochemical pregnancy,clinical pregnancy,and implantation rates of the CM and hysteroscopy groups were significantly higher than the control group(P<0.05),and there were no significant differences between these two groups.The abnormal pregnancy rate had no significant difference among the three groups.Conclusions:Sequential therapy of Yupei Qisun could significantly improve the clinical outcomes of RIF-FET cycles,being equivalent to hysteroscopic endometrial mechanical stimulation,and provided a reliable method to treat such infertile couples.展开更多
Objective To investigate the outcome of revised super-long down-regulation protocol(RSDP) for in vitro fertilization / intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET) in the special infertile patients wi...Objective To investigate the outcome of revised super-long down-regulation protocol(RSDP) for in vitro fertilization / intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET) in the special infertile patients with repeated implantation failure(RIF).Methods Patients with RIF were divided into RSDP group and routine long downregulation protocol(RLDP) group. In RSDP group, gonadotropin releasing hormone agonist(GnRHa) was injected intramuscularly by 2.5 mg in mid-luteal phase for the first time and 1.25 mg after 28 d; gonadotropin(Gn) was started 14 d later after the second GnRHa dose. IVF/ICSI-ET was performed according to the routine procedure. The clinical outcomes of RSDP group were compared with those of RLDP group.Results In RSDP group, the number of retrieved oocytes and valid embryos was significantly lower(P<0.05); there were no significant differences about fertilization rate(P>0.05); both good-quality embryo rate and implantation rate were significantly increased(P<0.005); clinical pregnancy rate was obviously improved(P<0.05), as compared with RLDP group.Conclusion RSDP can improve the IVF outcomes significantly in RIF patients.展开更多
Implantation of the embryo into the endometrium is the first step in the establishment of pregnancy. This process is complex, and depends on many factors. Recurrent implantation failure is a source of distress to pati...Implantation of the embryo into the endometrium is the first step in the establishment of pregnancy. This process is complex, and depends on many factors. Recurrent implantation failure is a source of distress to patients and specialists. It is defined as failure to achieve a viable pregnancy, following “>3 embryo transfers with high quality embryos or the transfer of ≥ 10 embryos in multiple transfers”. Thrombophilic conditions that contribute to recurrent implantation failure are the main concern in this review. The mechanism of implantation failure is believed to be due to decreased blood flow to the endometrium and placenta which can hinder normal endometrial receptivity leading to miscarriage. Defects in early placentation resulting in pregnancy failure, have focused attention on the therapeutic potential of low molecular weight heparin in the implantation process. Heparin has a role at all stages of implantation to improve pregnancy outcomes. There are controversies in literature regarding the association between thrombophilia and recurrent implantation failure and available literature regarding this issue is very heterogeneous. Various investigators, have shown that women with RIF are more likely to have a thrombophilia disorder, yet a clear cause cannot be acknowledged from these studies. Heparin treatment has been evaluated in several studies, showing conflicting evidence. However, several studies have pointed out that it may play a role in a subset of patients who presents a thrombophilia mutation, thus the group of patients that might benefit is needed to be identified. This review is dedicated to evaluate the published literature about the role of low molecular weight heparin in case of recurrent implantation failure with or without the presence of thrombophilia.展开更多
The paper attempts to represent a case of repeated failures on a high cut slope due to multi-excavation. The characteristics of each failure induced by excavation are analyzed through geological investigation, and the...The paper attempts to represent a case of repeated failures on a high cut slope due to multi-excavation. The characteristics of each failure induced by excavation are analyzed through geological investigation, and then a geological model at different failure stages is proposed. The geological analysis shows that the excavation-induced repeated failures are related to the exposure of the weak bedding plane and the toe unloading of the cut slope. Numerical modeling is conducted based on a sequential method, taking into account the main failure stages of cut slope. The simulation results fairly coincide with the practical phenomena observed in field. It is shown that the decrease in normal stress of displaced mass on cut slope will induce the increase in shear stress in bedding planes and that at the toe of the cut slope. The released stress leads to repeated gravitational instabilities of cut slope due to the decrease in normal stress and the increase in shear stress along the bedding planes of mudstone.展开更多
To observe the effect of acupuncture on CXCL8 receptors(CXCR1 and CXCR2)in rat endometrium experiencing embryo implantation failure,72 pregnant rats were randomly divided into four groups:normal group(N),embryo implan...To observe the effect of acupuncture on CXCL8 receptors(CXCR1 and CXCR2)in rat endometrium experiencing embryo implantation failure,72 pregnant rats were randomly divided into four groups:normal group(N),embryo implantation failure group(M),acupuncture treatment group(A),and progestin treatment group(W).Then the rats in each group were equally randomized into a day-6(D6)group,a day-8(D8)group,and a day-10(D10)group.The rats in group M,group A,and group W were treated with mifepristone-sesame oil solution on day 1,while the rats in group N were injected with the same amount of sesame oil.Meanwhile,"Housanli"and"Sanyinjiao"were selected for acupuncture.From day 1 to the time of death,the rats in group A were fastened up and then acupuncture was administered while the rats in group N and group M were only fixed,and the rats in group W were given progestin.The number of implanted embryos was calculated.The expression of CXCR1 and CXCR2 in rat endometrium was detected by immunohistochemistry,Western blotting and real-time PCR.Compared to group N,the average number of implanted embryos,the protein and mRNA expression of CXCR1(D6,D8 and D10),and the protein and mRNA expression of CXCR2(D8 and D10)in rat endometrium were significantly decreased in group M.Compared to group M,there was significant elevation in the average number of implanted embryos,the protein expression(D6,D8 and D10)and mRNA expression(D8)of CXCR1 in rat endometrium of group A,and the protein expression(D8 and D10)and mRNA expression(D8)of CXCR2 in rat endometrium of group W.These findings indicated that acupuncture can increase the number of implanted embryos in rats of embryo implantation failure,which may be relevant with up-regulation the expression of CXCR1and CXCR2 at maternal-fetal interface of rats with embryo implantation failure.展开更多
Objectives: To calculate the incidence of ectopic pregnancy in cases with recurrent early pregnancy loss and cases of recurrent implantation failure. Methods and materials: This is a retrospective cohort study. 200 wo...Objectives: To calculate the incidence of ectopic pregnancy in cases with recurrent early pregnancy loss and cases of recurrent implantation failure. Methods and materials: This is a retrospective cohort study. 200 women were recruited from the infertility clinic at shat by maternity university hospital seeking fertility. 100 of them were with history of recurrent implantation failure (RIF) and 100 with history of recurrent pregnancy loss (RPL). Revisiting their hospital files for the history of ectopic pregnancy was done. Results: 8% of cases of RPL had history of ectopic pregnancy while only 6% of cases of RIF had the history. There was no significant difference between the two groups (p = 0.579). There was significantly higher incidence of ectopic pregnancy in both groups if compared with the general population (p = 0.0001 and 0.043) in RPL and RIF consecutively. Conclusions: RPL and RIF may be considered as a risk factor for ectopic pregnancy.展开更多
BACKGROUND: Sub-endometrial junction zone (JZ) plays an important role in most of reproductive functions. OBJECTIVE: To find out the effect of the sub-endometrial JZ thickness assessment by 3-D trans-vaginal ultrasoun...BACKGROUND: Sub-endometrial junction zone (JZ) plays an important role in most of reproductive functions. OBJECTIVE: To find out the effect of the sub-endometrial JZ thickness assessment by 3-D trans-vaginal ultrasound (TVUS) on intracytoplasmic sperm injection (ICSI) outcomes in patients with unexplained recurrent implantation failure (RIF). SETTING: ART Unit of Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Qena, Egypt. DURATION: From April 2016 to October 2018. STUDY DESIGN: A prospective observational study. METHDS: Fifty couples with history of unexplained RIF in previous ICSI cycles and prepared for another ICSI cycle (group I) and fifty couples with unexplained infertility prepared for ICSI for the first time (group II) had been included in this study. At time of ovum pick up, 3-DTVUS was done for all cases in both groups for assessment of sub endometrial junction zone thickness and correlated with ICSI outcome. RESULTS: There were statistically significant differences between group I and group II in JZ thickness in the 3 uterine regions (fundus, anterior and posterior walls) with p 0.001, but there were mildly statistically significant differences between both groups in chemical and clinical pregnancy rates with p < 0.01. CONCLUSIONS: The thickness of JZ in patients with history of unexplained RIF was higher than those with unexplained infertility scheduled for ICSI. The JZ thickness was inversely correlated with increased embryo implantation rates in ICSI procedures, the thinner the JZ thickness was associated with higher pregnancy rates (both chemical and clinical pregnancy rates).展开更多
Using self-made impact fatigue test instruments and related analytic devices, the mechanical components with laser cladding layer have been attempted. It is found that, on repeated impact force, several failure modes ...Using self-made impact fatigue test instruments and related analytic devices, the mechanical components with laser cladding layer have been attempted. It is found that, on repeated impact force, several failure modes of the components include the surface cracks, surface plastic deformation, corrosive pitting and coat collapse, etc. The paper reported the test method and initial analysis conclusions about the unique failure characteristics of the mechanical components on repeated impact load.展开更多
Objective:To elucidate the possible role of unfractionated heparin in patients with failed repeated in in vitro fertilization and embryo transfer(IVF-ET)and thrombophilia.Methods:This case control study evaluated the ...Objective:To elucidate the possible role of unfractionated heparin in patients with failed repeated in in vitro fertilization and embryo transfer(IVF-ET)and thrombophilia.Methods:This case control study evaluated the efficacy of the unfractionated heparin in increasing the pregnancy and implantation ratio in women with recurrent IVF-ET failures.Eighty-six women received in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)with a record of three or more previous IVF-ET failures.Participants were randomly distributed into two groups.Group A(n=43)received unfractionated heparin 5000 IU twice daily,and group B(n=43)did not take any antithrombotic drugs.Coagulation abnormalities such as factor桋Leiden(FVL)mutation,methylene tetra hydro folate reductase(MTHFR)mutation and prothrombin mutation(F栻)were evaluated.Age,body mass index,basal follicular stimulating hormone,basal estradiol,duration of infertility,and number of IVF-ET failures were compared between two groups.Results:45.0%and 17.4%of women were pregnant with and without MTHFR and prothrombin mutation,respectively,when they received unfractionated heparin treatment.The implantation rate was more in group A(12.5%)than group B(4.3%)and differences in the fertilization rate of the two groups were observed(27.7%vs.35.9%).The clinical pregnancy rate per cycle was remarkably more in group A(30.2%)than group B(14.0%).Conclusions:Heparin is a safe and valuable treatment for patients with repeated IVF-ET failures.The clinical pregnancy and implantation rates are higher in the heparin-treated group in contrast with the control group.展开更多
Objective An increasing number of patients requiring ventricular assist devices (VAD) have had previous valvular corrections,including valve repair,and valve replacement with mechanical or bioprosthetic valves. The op...Objective An increasing number of patients requiring ventricular assist devices (VAD) have had previous valvular corrections,including valve repair,and valve replacement with mechanical or bioprosthetic valves. The operative and peri-operative management of these patients are various. Methods A retrospective study of VADs between Jan 1994 and June 2008 revealed 10 patients展开更多
目的评估宫腔灌注富血小板血浆(PRP)对反复种植失败(RIF)妇女妊娠结局的影响。方法使用PubMed、Embase、Scopus、Web of Science、CochraneLibrary、中国知识基础设施工程、维普数据库、万方数据库,检索PRP宫腔灌注治疗RIF患者的临床研...目的评估宫腔灌注富血小板血浆(PRP)对反复种植失败(RIF)妇女妊娠结局的影响。方法使用PubMed、Embase、Scopus、Web of Science、CochraneLibrary、中国知识基础设施工程、维普数据库、万方数据库,检索PRP宫腔灌注治疗RIF患者的临床研究。提取数据后使用固定效应模型或随机效应模型进行Meta分析。结果共纳入7项研究。接受PRP宫腔灌注女性的生化妊娠率[OR=2.18,95%CI:[1.34,3.52],P<0.05]、临床妊娠率(OR=2.47,95%CI:[1.66,3.68],P<0.05)、活产率(OR=5.00,95%CI:[1.09,22.99],P<0.05)和胚胎种植率(OR=1.99,95%CI:[1.36,2.93],P<0.05)高于对照组,流产率低于对照组(OR=0.28,95%CI:[0.10,0.77],P<0.05)。亚组分析显示宫腔灌注0.5 mL PRP组的临床妊娠率高于宫腔灌注1.0 mL PRP组(P<0.05),流产率低于宫腔灌注1.0 mL PRP组(P<0.05)。结论宫腔灌注PRP可提高RIF患者的胚胎种植率、活产率、生化妊娠率和临床妊娠率,且显著降低流产的风险,宫腔灌注0.5 mL PRP具有更好的临床效果。展开更多
目的系统评价使用双膦酸盐药物(bisphosphonates,BPs)患者种植体早期失败率及种植术后药物相关性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)发生率,为临床评估相关风险提供依据。方法计算机检索Cochrane Library、Wi...目的系统评价使用双膦酸盐药物(bisphosphonates,BPs)患者种植体早期失败率及种植术后药物相关性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)发生率,为临床评估相关风险提供依据。方法计算机检索Cochrane Library、Wiley Online Library、PubMed、中国知网、万方数据知识服务平台,收集纳入各数据库建库至2022年5月发表的关于使用BPs患者种植体早期失败或种植术后发生MRONJ的临床研究。采用Stata 15.0软件对种植体早期失败率进行单组率Meta分析。结果共纳入13篇文献,其中口服BPs患者植入1182颗种植体,静脉注射BPs患者植入79颗,共计1261颗种植体。口服BPs患者合并种植体早期失败率为1.7%(95%CI:0.3%~3.9%),MRONJ发生率为0。静脉注射BPs患者种植体早期失败率为0,MRONJ发生率为5.6%。结论口服BPs患者种植体早期失败率及术后MRONJ发生率低,与健康人群基本相当。静脉使用BPs患者种植术后发生MRONJ风险较高,临床适应证选择应慎重。展开更多
基金supported by grants from the National Natural Science Foundation of China(No.81100401 and No.81470063)Guangdong Natural Science Foundation of China(No.2014A030313129)the Doctoral Fund of the Ministry of Education of China(No.20110171120096)
文摘Long-term gonadotropin-releasing hormone agonist(Gn RHa) administration before in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI) in infertile women with endometriosis or adenomyosis significantly enhanced the chances of pregnancy in both fresh and frozen embryo transfer cycles. We hypothesized that long-term Gn RHa treatment might also be beneficial for the idiopathic repeated implantation failure(RIF) patients. In the 21 patients receiving Gn RHa and hormone replacement therapy(G-HRT) protocols for frozen embryo transfer, their data were compared with those of the 56 of frozen/fresh cycles they had previously undergone(previous protocols). Comparison showed that the finial results were significantly better with G-HRT protocols than with their previous protocols, with pregnancy rate, clinical pregnancy rate, implantation rate and on-going pregnancy rate being 70%, 60%, 40% and 38% respectively with G-HRT protocols, against 17%, 11%, 6.3% and 5% with previous protocols. The results showed that hormonally controlled endometrial preparation with prior Gn RHa suppression could be used for patients who had experienced repeated failures of IVF treatment despite having morphologically optimal embryos, and the treatment may help increase the receptivity of the endometrium in these patients.
基金National Natural Science Foundation of China(No.81901558)
文摘Objective:The objective of this study is to study whether preimplantation genetic testing for aneuploidy(PGT-A)improves the clinical outcomes of infertile patients with repeated implantation failure(RIF)undergoing frozen-thawed embryo transfer.Methods:This is a retrospective analysis of clinical pregnancy,live birth,miscarriage rates,and obstetric and perinatal outcomes of women with RIF with or without PGT-A.Statistical analyses of categorical data were performed using propensity score matching(PSM),χ^(2)test,and Student’s t test.Results:We enrolled 466 patients with RIF,of which,209 were in the RIF-PGT-A group.The rate of euploid blastocysts was significantly associated with age and day 5 or 6 blastocysts.There were significant differences between the RIF-PGT-A group and the RIF-non-PGT-A group across several parameters.After PSM,positive serum human chorionic gonadotropin(56.9%and 33.9%,P<0.01),clinical pregnancy(49.5%and 31.2%,P<0.01),live birth(43.1%and 25.7%,P<0.01),and fetal heart rates(50.0%and 29.8%,P<0.01)per transfer were significantly higher in the RIF-PGT-A group.Conclusion:Elective single-embryo transfer PGT-A can minimize the risk of obstetric and perinatal outcomes,especially fetal body weight,in women with RIF.Additionally,PGT-A can significantly improve pregnancy and live birth rates.
文摘Objective Both sequential embryo transfer(SeET)and double-blastocyst transfer(DBT)can serve as embryo transfer strategies for women with recurrent implantation failure(RIF).This study aims to compare the effects of SeET and DBT on pregnancy outcomes.Methods Totally,261 frozen-thawed embryo transfer cycles of 243 RIF women were included in this multicenter retrospective analysis.According to different embryo quality and transfer strategies,they were divided into four groups:group A,good-quality SeET(GQ-SeET,n=38 cycles);group B,poor-quality or mixed-quality SeET(PQ/MQ-SeET,n=31 cycles);group C,good-quality DBT(GQ-DBT,n=121 cycles);and group D,poor-quality or mixed-quality DBT(PQ/MQ-DBT,n=71 cycles).The main outcome,clinical pregnancy rate,was compared,and the generalized estimating equation(GEE)model was used to correct potential confounders that might impact pregnancy outcomes.Results GQ-DBT achieved a significantly higher clinical pregnancy rate(aOR 2.588,95%CI 1.267–5.284,P=0.009)and live birth rate(aOR 3.082,95%CI 1.482–6.412,P=0.003)than PQ/MQ-DBT.Similarly,the clinical pregnancy rate was significantly higher in GQ-SeET than in PQ/MQ-SeET(aOR 4.047,95%CI 1.218–13.450,P=0.023).The pregnancy outcomes of GQ-SeET were not significantly different from those of GQ-DBT,and the same results were found between PQ/MQ-SeET and PQ/MQ-DBT.Conclusion SeET relative to DBT did not seem to improve pregnancy outcomes for RIF patients if the embryo quality was comparable between the two groups.Better clinical pregnancy outcomes could be obtained by transferring good-quality embryos,no matter whether in SeET or DBT.Embryo quality plays a more important role in pregnancy outcomes for RIF patients.
基金This work was supported by the Shenzhen Healthcare Research Project,China(SZXJ2018004)Clinical Research Program of Chinese Medical Association,China(17020340703)the Sanming Project of Medicine in Shenzhen,China(SZSM201502035).
文摘Natural killer(NK)cells are thought to play a key role in the successful establishment of a pregnancy by facilitating immunological adaptation of the semi-allogeneic developing embryo.The aim of this study was to explore the cell number,immunophenotypic characteristics,and activities of peripheral blood NK cells in women with repeated implantation failure(RIF).Peripheral blood was obtained from 27 women with RIF and 11 healthy,fertile controls during the middle luteal phase of the menstrual cycle.CD3^-CD56^+NK cells were quantified and analyzed by flow cytometry for the expression of cytolytic molecules(granzyme B,granulysin,and perforin)as well as cell surface receptors responsible for NK cell activation or inhibition(NKG2D,NKp30,NKp46,CD158a,CD158b).NK cytotoxicity was measured at three effector-to-target cell ratios.Women with RIF and fertile controls did not differ significantly in the percentage of circulating CD3CD56t NK cells,or in the proportions of these cells that expressed granzyme B,granulysin,or perforin.The two groups also did not differ significantly in the proportions of NK cells expressing the receptors NKG2D,NKp30,NKp46,CD158a or CD158b.General linear model analysis showed that NK cytotoxicity increased with effector-to-target cell ratio.However,NK cytotoxicity did not differ significantly between patients with RIF and fertile controls.These results suggest that RIF is not associated with significant alterations in the number or function of peripheral blood NK cells.
基金Supported by Shanghai Municipal Health Bureau Foundation of Chinese Traditional Medicine(No.2010L026A)
文摘Objectives:To investigate the clinical effect of sequential therapeutic intervention Yupei Qisun[compensating for weakness by invigorating Kidney(Shen) and Spleen(Pi) in advance]in Chinese medicine(CM)and hysteroscopic endometrial mechanical stimulation on the treatment of infertile patients with repeated implantation failure(RIF);and to study the differences in patients' endometrial thickness and type on the day of embryo transfer,serum hormone levels on embryo transfer day and clinical pregnancy outcomes.Methods:In the clinical study,168 frozen-thawed embryo transfer(FET) cycles for couples with RIF conforming to the research protocol were randomly divided into three groups:a CM group with 56 cycles(CM combined with FET),a hysteroscopy group with 55 cycles(hysteroscopic endometrial mechanical stimulation),and a control group with 57 cycles(conventional FET).Differences in endometrial thickness on the embryo transfer day,levels of serum estradiol(E_2) and progesterone(P) on the embryo transfer day,the E_2/P ratio on the embryo transfer day,biochemical and clinical pregnancy rates,implantation rate,abnormal pregnancy rate and other indices were compared among the three groups.Results:Endometrial thickness,E_2 and P levels,and the E_2/P ratio on embryo transfer day and other factors had no significant differences among groups.The biochemical pregnancy,clinical pregnancy,and implantation rates of the CM and hysteroscopy groups were significantly higher than the control group(P<0.05),and there were no significant differences between these two groups.The abnormal pregnancy rate had no significant difference among the three groups.Conclusions:Sequential therapy of Yupei Qisun could significantly improve the clinical outcomes of RIF-FET cycles,being equivalent to hysteroscopic endometrial mechanical stimulation,and provided a reliable method to treat such infertile couples.
文摘Objective To investigate the outcome of revised super-long down-regulation protocol(RSDP) for in vitro fertilization / intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET) in the special infertile patients with repeated implantation failure(RIF).Methods Patients with RIF were divided into RSDP group and routine long downregulation protocol(RLDP) group. In RSDP group, gonadotropin releasing hormone agonist(GnRHa) was injected intramuscularly by 2.5 mg in mid-luteal phase for the first time and 1.25 mg after 28 d; gonadotropin(Gn) was started 14 d later after the second GnRHa dose. IVF/ICSI-ET was performed according to the routine procedure. The clinical outcomes of RSDP group were compared with those of RLDP group.Results In RSDP group, the number of retrieved oocytes and valid embryos was significantly lower(P<0.05); there were no significant differences about fertilization rate(P>0.05); both good-quality embryo rate and implantation rate were significantly increased(P<0.005); clinical pregnancy rate was obviously improved(P<0.05), as compared with RLDP group.Conclusion RSDP can improve the IVF outcomes significantly in RIF patients.
文摘Implantation of the embryo into the endometrium is the first step in the establishment of pregnancy. This process is complex, and depends on many factors. Recurrent implantation failure is a source of distress to patients and specialists. It is defined as failure to achieve a viable pregnancy, following “>3 embryo transfers with high quality embryos or the transfer of ≥ 10 embryos in multiple transfers”. Thrombophilic conditions that contribute to recurrent implantation failure are the main concern in this review. The mechanism of implantation failure is believed to be due to decreased blood flow to the endometrium and placenta which can hinder normal endometrial receptivity leading to miscarriage. Defects in early placentation resulting in pregnancy failure, have focused attention on the therapeutic potential of low molecular weight heparin in the implantation process. Heparin has a role at all stages of implantation to improve pregnancy outcomes. There are controversies in literature regarding the association between thrombophilia and recurrent implantation failure and available literature regarding this issue is very heterogeneous. Various investigators, have shown that women with RIF are more likely to have a thrombophilia disorder, yet a clear cause cannot be acknowledged from these studies. Heparin treatment has been evaluated in several studies, showing conflicting evidence. However, several studies have pointed out that it may play a role in a subset of patients who presents a thrombophilia mutation, thus the group of patients that might benefit is needed to be identified. This review is dedicated to evaluate the published literature about the role of low molecular weight heparin in case of recurrent implantation failure with or without the presence of thrombophilia.
基金Supported by the National Natural Science Foundation of China(41072213 and 40801212)the Opening Fund of Key Laboratory of Mechanics on Disaster and Environment in Western China, Lanzhou University(201207)
文摘The paper attempts to represent a case of repeated failures on a high cut slope due to multi-excavation. The characteristics of each failure induced by excavation are analyzed through geological investigation, and then a geological model at different failure stages is proposed. The geological analysis shows that the excavation-induced repeated failures are related to the exposure of the weak bedding plane and the toe unloading of the cut slope. Numerical modeling is conducted based on a sequential method, taking into account the main failure stages of cut slope. The simulation results fairly coincide with the practical phenomena observed in field. It is shown that the decrease in normal stress of displaced mass on cut slope will induce the increase in shear stress in bedding planes and that at the toe of the cut slope. The released stress leads to repeated gravitational instabilities of cut slope due to the decrease in normal stress and the increase in shear stress along the bedding planes of mudstone.
基金supported by the National Natural Science Foundation of China(No.30973833)
文摘To observe the effect of acupuncture on CXCL8 receptors(CXCR1 and CXCR2)in rat endometrium experiencing embryo implantation failure,72 pregnant rats were randomly divided into four groups:normal group(N),embryo implantation failure group(M),acupuncture treatment group(A),and progestin treatment group(W).Then the rats in each group were equally randomized into a day-6(D6)group,a day-8(D8)group,and a day-10(D10)group.The rats in group M,group A,and group W were treated with mifepristone-sesame oil solution on day 1,while the rats in group N were injected with the same amount of sesame oil.Meanwhile,"Housanli"and"Sanyinjiao"were selected for acupuncture.From day 1 to the time of death,the rats in group A were fastened up and then acupuncture was administered while the rats in group N and group M were only fixed,and the rats in group W were given progestin.The number of implanted embryos was calculated.The expression of CXCR1 and CXCR2 in rat endometrium was detected by immunohistochemistry,Western blotting and real-time PCR.Compared to group N,the average number of implanted embryos,the protein and mRNA expression of CXCR1(D6,D8 and D10),and the protein and mRNA expression of CXCR2(D8 and D10)in rat endometrium were significantly decreased in group M.Compared to group M,there was significant elevation in the average number of implanted embryos,the protein expression(D6,D8 and D10)and mRNA expression(D8)of CXCR1 in rat endometrium of group A,and the protein expression(D8 and D10)and mRNA expression(D8)of CXCR2 in rat endometrium of group W.These findings indicated that acupuncture can increase the number of implanted embryos in rats of embryo implantation failure,which may be relevant with up-regulation the expression of CXCR1and CXCR2 at maternal-fetal interface of rats with embryo implantation failure.
文摘Objectives: To calculate the incidence of ectopic pregnancy in cases with recurrent early pregnancy loss and cases of recurrent implantation failure. Methods and materials: This is a retrospective cohort study. 200 women were recruited from the infertility clinic at shat by maternity university hospital seeking fertility. 100 of them were with history of recurrent implantation failure (RIF) and 100 with history of recurrent pregnancy loss (RPL). Revisiting their hospital files for the history of ectopic pregnancy was done. Results: 8% of cases of RPL had history of ectopic pregnancy while only 6% of cases of RIF had the history. There was no significant difference between the two groups (p = 0.579). There was significantly higher incidence of ectopic pregnancy in both groups if compared with the general population (p = 0.0001 and 0.043) in RPL and RIF consecutively. Conclusions: RPL and RIF may be considered as a risk factor for ectopic pregnancy.
文摘BACKGROUND: Sub-endometrial junction zone (JZ) plays an important role in most of reproductive functions. OBJECTIVE: To find out the effect of the sub-endometrial JZ thickness assessment by 3-D trans-vaginal ultrasound (TVUS) on intracytoplasmic sperm injection (ICSI) outcomes in patients with unexplained recurrent implantation failure (RIF). SETTING: ART Unit of Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Qena, Egypt. DURATION: From April 2016 to October 2018. STUDY DESIGN: A prospective observational study. METHDS: Fifty couples with history of unexplained RIF in previous ICSI cycles and prepared for another ICSI cycle (group I) and fifty couples with unexplained infertility prepared for ICSI for the first time (group II) had been included in this study. At time of ovum pick up, 3-DTVUS was done for all cases in both groups for assessment of sub endometrial junction zone thickness and correlated with ICSI outcome. RESULTS: There were statistically significant differences between group I and group II in JZ thickness in the 3 uterine regions (fundus, anterior and posterior walls) with p 0.001, but there were mildly statistically significant differences between both groups in chemical and clinical pregnancy rates with p < 0.01. CONCLUSIONS: The thickness of JZ in patients with history of unexplained RIF was higher than those with unexplained infertility scheduled for ICSI. The JZ thickness was inversely correlated with increased embryo implantation rates in ICSI procedures, the thinner the JZ thickness was associated with higher pregnancy rates (both chemical and clinical pregnancy rates).
文摘Using self-made impact fatigue test instruments and related analytic devices, the mechanical components with laser cladding layer have been attempted. It is found that, on repeated impact force, several failure modes of the components include the surface cracks, surface plastic deformation, corrosive pitting and coat collapse, etc. The paper reported the test method and initial analysis conclusions about the unique failure characteristics of the mechanical components on repeated impact load.
文摘Objective:To elucidate the possible role of unfractionated heparin in patients with failed repeated in in vitro fertilization and embryo transfer(IVF-ET)and thrombophilia.Methods:This case control study evaluated the efficacy of the unfractionated heparin in increasing the pregnancy and implantation ratio in women with recurrent IVF-ET failures.Eighty-six women received in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)with a record of three or more previous IVF-ET failures.Participants were randomly distributed into two groups.Group A(n=43)received unfractionated heparin 5000 IU twice daily,and group B(n=43)did not take any antithrombotic drugs.Coagulation abnormalities such as factor桋Leiden(FVL)mutation,methylene tetra hydro folate reductase(MTHFR)mutation and prothrombin mutation(F栻)were evaluated.Age,body mass index,basal follicular stimulating hormone,basal estradiol,duration of infertility,and number of IVF-ET failures were compared between two groups.Results:45.0%and 17.4%of women were pregnant with and without MTHFR and prothrombin mutation,respectively,when they received unfractionated heparin treatment.The implantation rate was more in group A(12.5%)than group B(4.3%)and differences in the fertilization rate of the two groups were observed(27.7%vs.35.9%).The clinical pregnancy rate per cycle was remarkably more in group A(30.2%)than group B(14.0%).Conclusions:Heparin is a safe and valuable treatment for patients with repeated IVF-ET failures.The clinical pregnancy and implantation rates are higher in the heparin-treated group in contrast with the control group.
文摘Objective An increasing number of patients requiring ventricular assist devices (VAD) have had previous valvular corrections,including valve repair,and valve replacement with mechanical or bioprosthetic valves. The operative and peri-operative management of these patients are various. Methods A retrospective study of VADs between Jan 1994 and June 2008 revealed 10 patients
文摘目的评估宫腔灌注富血小板血浆(PRP)对反复种植失败(RIF)妇女妊娠结局的影响。方法使用PubMed、Embase、Scopus、Web of Science、CochraneLibrary、中国知识基础设施工程、维普数据库、万方数据库,检索PRP宫腔灌注治疗RIF患者的临床研究。提取数据后使用固定效应模型或随机效应模型进行Meta分析。结果共纳入7项研究。接受PRP宫腔灌注女性的生化妊娠率[OR=2.18,95%CI:[1.34,3.52],P<0.05]、临床妊娠率(OR=2.47,95%CI:[1.66,3.68],P<0.05)、活产率(OR=5.00,95%CI:[1.09,22.99],P<0.05)和胚胎种植率(OR=1.99,95%CI:[1.36,2.93],P<0.05)高于对照组,流产率低于对照组(OR=0.28,95%CI:[0.10,0.77],P<0.05)。亚组分析显示宫腔灌注0.5 mL PRP组的临床妊娠率高于宫腔灌注1.0 mL PRP组(P<0.05),流产率低于宫腔灌注1.0 mL PRP组(P<0.05)。结论宫腔灌注PRP可提高RIF患者的胚胎种植率、活产率、生化妊娠率和临床妊娠率,且显著降低流产的风险,宫腔灌注0.5 mL PRP具有更好的临床效果。
文摘目的系统评价使用双膦酸盐药物(bisphosphonates,BPs)患者种植体早期失败率及种植术后药物相关性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)发生率,为临床评估相关风险提供依据。方法计算机检索Cochrane Library、Wiley Online Library、PubMed、中国知网、万方数据知识服务平台,收集纳入各数据库建库至2022年5月发表的关于使用BPs患者种植体早期失败或种植术后发生MRONJ的临床研究。采用Stata 15.0软件对种植体早期失败率进行单组率Meta分析。结果共纳入13篇文献,其中口服BPs患者植入1182颗种植体,静脉注射BPs患者植入79颗,共计1261颗种植体。口服BPs患者合并种植体早期失败率为1.7%(95%CI:0.3%~3.9%),MRONJ发生率为0。静脉注射BPs患者种植体早期失败率为0,MRONJ发生率为5.6%。结论口服BPs患者种植体早期失败率及术后MRONJ发生率低,与健康人群基本相当。静脉使用BPs患者种植术后发生MRONJ风险较高,临床适应证选择应慎重。
