ObjectiveTo compare the clinical outcomes of different pituitary down regulation protocols with gonadotropin-releasing hormone agonist (GnRH-a) in patients undergoing in vitro fertilization and embryo transfer (IVF-ET) treatment. MethodsThe clinical data of 358 IVF cycles in women at 40 years old or younger from November 2012 to January 2013 in the West China Second University Hospital were analyzed retrospectively. All the 358 cycles were divided into two groups, according to whether the leading follicle diameter was <14 mm (group A, 158 cycles) or ≥14 mm (group B, 200 cycles) after discontinuing the GnRH-a. The clinical outcomes were compared between the two groups. ResultsCompared with group B, the amount of gonadotropins used was significantly more, and the time of gonadotropin use was also significantly longer in group A (P<0.05). However, the serum level of estradiol (E2), progesterone (P) and Luteinizing hormone (LH), incidence of premature P rise, retrieved ovum number, the rates of implantation, clinical pregnancy, miscarriage and live birth did not significantly differ between the two groups (P>0.05). ConclusionDiscontinuing the use of GnRH-a in early stage of controlled ovarian stimulation can keep effective pituitary down regulation and it has the same optimal clinical outcomes in patients undergoing IVF-ET.
【摘要】 目的 探讨不同年龄段和不同内膜准备方法对冻融胚胎移植（FET）妊娠率的影响。 方法 回顾性分析2007年3月-2009年8月107例患者131个FET周期，比较不同年龄段、不同内膜准备方法的妊娠情况。 结果 ①lt;29岁、30～34岁、≥35岁患者的周期临床妊娠率分别为45.28%、37.88%、33.33%，比较无统计学意义（Pgt;0.05）。②自然周期和激素替代周期内膜准备，两种方法患者平均年龄、平均移植胚胎数、胚胎评分及胚胎细胞数比较无统计学意义（Pgt;0.05），但自然周期的胚胎种植率及周期临床妊娠率均明显低于激素替代周期（16.78%比29.21%；29.51%比50.00%），比较有统计学意义（Plt;0.05）。 结论 患者年龄不影响FET周期临床妊娠率，激素替代周期内膜准备的FET胚胎种植率及周期临床妊娠率明显高于自然周期。【Abstract】 Objective To analyze the effect of age and method of preparing endometrium on the pregnancy rate of frozen-thawed embryo transfer (FET) among infertile women. Methods Retrospective analysis was made on 131 FET cycles in 107 patients from March 2007 to August 2009. The relationship between pregnancy rate of FET and following factors were analyzed: age, the method of preparing uterus endometrium. Results ①There was no significant difference in pregnancy rate of FET among ＜29, 30 - 34, and ≥35 years old patients (45.28%, 37.88%, and 33.33%, respectively) (Pgt;0.05). ②There was no significant difference in patients’ age, the average embryo amount, embryo score, the cell amount in every embryo between the FET with hormone replacement therapy (HRT) and the FET with natural cycle (NC). The embryo implantation rate and pregnancy rate of FET with NC were lower significantly than those of FET with HRT (16.78% vs 29.21%; 29.51% vs 50.00%) (P＜0.05). Conclusion Age might not influence pregnancy rate of FET. FET with HRT has higher implantation rate and pregnancy rate than FET with NC.
目的:探讨IVF-ET周期中,对常规IVF完全受精失败的卵子补行卵胞浆内单精子注射精子(Rescue ICSI)的临床应用价值。方法:在常规IVF后18～22 h,对体外受精完全失败的12个周期、85个未受精MⅡ期卵行补行ICSI。以同时期进行ICSI的34个周期、226个MⅡ期卵为对照,比较ICSI结局。结果:补救ICSI组与对照组比较,基础内分泌指标,HCG 日平均血清雌二醇和孕激素水平、子宫内膜厚度,获MⅡ期卵个数以及平均移植胚胎个数,无显著性差异。补救ICSI组受精率和卵裂率分别为78.82％、91.04％,与对照组(受精率为80.09%,卵裂率为95.58%)比较,差异无统计学意义。取卵后第3天,补救ICSI组卵裂球数≥5的优质胚胎比例占13.11％,低于对照ICSI组(73.99％),差异有显著性 (Plt;0.05)。对照ICSI组妊娠率为38.24％,补救ICSI组无一例妊娠。结论:补行ICSI虽然可使常规IVF中未受精卵受精并获得胚胎,但是所得胚胎的发育潜能差,妊娠率极低,临床应用价值有限。
Objective To systematically review the endometrial receptivity evaluated by transvaginal ultrasound and predict the clinical pregnancy outcome of in vitro fertilization-embryo transfer (IVF-ET). Methods PubMed, The Cochrane Library, EMbase, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect studies on transvaginal ultrasound evaluation of endometrial receptivity to predict the clinical pregnancy outcome of IVF-ET from inception to December 1st, 2021. Two researchers independently screened literature, extracted data and evaluated the risk of bias of the included studies. RevMan 5.4 software and Stata 16.0 software were used to perform meta-analysis. Results A total of 24 cohort studies and 1 case-control study were included. The total sample size was 6 632 cases, including 3 340 in non-pregnancy group and 3 292 in pregnancy group. The results of meta-analysis showed that there was no difference in endometrial volume (MD=−0.11, 95%CI −0.33 to 0.11, P=0.34) or uterine artery S/D (MD= −0.04, 95%CI −0.17 to 0.09, P=0.55) between the two groups. The endometrial thickness measured on human chorionic gonadotrophin (HCG) day in the non-pregnant group (MD=−0.48, 95%CI −0.77 to −0.18, P=0.001) was thinner than that in the pregnant group. On embryo transfer (ET) day, uterine artery pulsatility index (PI) (MD=0.08, 95%CI 0.02 to 0.15, P=0.01) and resistance index (RI) (MD=0.01, 95%CI 0.01 to 0.01, P<0.000 01) were higher than those in the pregnancy group. Conclusion Endometrial volume and uterine artery S/D measured during IVF-ET were not correlated with clinical pregnancy outcome, while endometrial thickness measured on HCG day and uterine artery PI and RI measured on ET day were correlated with clinical pregnancy outcome. Transvaginal ultrasound evaluation of endometrial receptivity has a certain predictive value for clinical pregnancy outcome of IVF-ET. Due to the limited quality and quantity of included studies, more high-quality studies are needed to verify the above conclusion.
【摘要】 目的 观察提前去除卵丘细胞对胚胎质量的影响，进一步探讨其临床应用价值。 方法 将2009年7-9月行体外受精-胚胎移植治疗的患者随机分为两组，试验组共137个周期，于授精后5 h去除卵丘细胞；对照组共146个周期，于授精后16～18 h去除卵丘细胞。两组均于授精后16～18 h观察受精情况，72 h对胚胎进行评分，选择1～3枚优质胚胎进行胚胎移植。分别比较两组的年龄、不育年限、获卵数、受精率、卵裂率、优质胚胎率、胚胎种植率和临床妊娠率。 结果 两组的优质胚胎率差异有统计学意义（Plt;0.01）；但年龄、不育年限、获卵数、受精率、卵裂率、胚胎种植率和临床妊娠率比较，差异均无统计学意义（Pgt;0.05）。 结论 体外受精中提前去除卵丘细胞优质胚胎增加，有助于提高临床累积妊娠率。【Abstract】 Objective To evaluate the effect of denuding the oocyte granulose cells soon after fertilization in vitro (IVF). Methods A total of 283 IVF cycles in patients from July to September 2009 were divided into a trial group and a control group randomly. The trial group contained 137 cycles, being denuded the oocyte granulose cells only 5 hours after IVF. The controlled group contained 146 cycles, being denuded the oocyte granulose cell and observed the pronuclear 18 hours after IVF. The outcomes of female age, infertile duration, the number of oocyte, fertilization rate,abnormal fertilization rate, good quality embryo rate, and clinical pregnancy rate were measured. Results There was no difference in any of the outcomes between the two groups except for the high quality embryo rate (Plt;0.01). The clinical pregnancy rate was higher in the trial group without significant differences (Pgt;0.05). Conclusions Denuding the oocyte granulose cells soon after IVF helps to improve the embryo quality and the clinical accumulated pregnancy rate.
Objective To evaluate the effectiveness of GnRH antagonist in vitro fertilization-embryo transfer (IVF-ET) in polycystic ovary syndrome (PCOS) patients.Methods Such databases as PubMed (1997 to 2010), PML (1997 to 2010), FMJS (2000 to 2010), CBMdisc (1979 to 2010), CNKI (1994 to 2010), VIP (1989 to 2010), WanFang (1994 to 2010), and duxiu scholar searcher (www.duxiu.com), and nine relevant Chinese journals were searched for retrieving the randomized controlled trails (RCTs) on the effectiveness of GnRH antagonist versus GnRH agonist for IVF-ET in PCOS Patients. The studies were screened according to the inclusive and exclusive criteria by two reviewers independently, the data was abstracted and the quality was evaluated. The RevMan 4.2.7 software was used for Meta-analyses. Results Six grade-B studies involving 699 participants were included. The results of Meta-analyses showed that, compared with the GnRH agonist, there was no significant difference in the GnRH antagonist group about the stimulation duration (WMD= –1.23, 95%CI –2.76 to –0.31), dose of gonadotrophins (Gns) (WMD= –4.87, 95%CI –14.20 to 4.46), serum E2 value on the day of HCG administration (WMD= 31.37, 95%CI –263.40 to 326), number of oocytes retrieved (WMD= 1.34, 95%CI –1.02 to 4.70), clinical pregnancy rate (OR= 1.27, 95%CI 0.77 to2.10), and miscarraige rate (Peto OR= 0.67, 95%CI 0.38 to1.18). But the OHSS rate in the GnRH antagonist group was lower with a significant difference (Peto OR= 0.35, 95%CI 0.24 to 0.50). Conclusions Compared with the GnRH agonist protocol, the GnRH antagonist protocol can obviously reduce the incidence of OHSS, but has the same effect in Gn dose, retrieving oocytes and clinical pregnancy rate. Because the GnRH antagonist can decrease the treatment duration and cost, and has better safety, so it may be an ideal choice for PCOS patients to have IVF-ET therapy. For the quality and quantity limitation, and the methodology difference of the included studies, it is suggested that the conclusion from this study should be only served as a reference of clinical analyses, and should be revaluated and updated unceasingly.
Objective To systematically review the effectiveness of letrozole combined with GnRH antagonist for in vitro fertilization-embryo transfer (IVF-ET) in poor responders. Methods Such databases as VIP, CNKI, PubMed, EMbase and FMJS were electronically searched for randomized controlled trials (RCTs) or quasi-RCTs on the effectiveness of letrozole combined with GnRH antagonist for IVF-ET. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.0 software. Results Six studies involving 977 patients were finally included. The results of meta-analysis showed that, for IVF-ET poor responders, compared with the control group, the letrozole combined with GnRH antagonist group had less dosage of Gn (MD=–8.05, 95%CI –13.67 to –2.43, P=0.005), and lower serum E2 value on the day of HCG administration (MD= –1 026.41, 95%CI –1 949.61 to –103.20, P=0.03). However, no significant difference was found in the number of ocytes obtained (MD= –0.61, 95%CI –2.41 to –1.19, P=0.51) and clinical pregnancy rates (OR=1.03, 95%CI 0.53 to 2.02, P=0.92) between the two groups. Conclusion As for the effectiveness of impelling-ovulation treatment for IVF-ET in poor responders, letrozole combined with GnRH antagonist is similar to the control scheme in clinical outcomes, but it reduces the dosage of Gn and treatment costs of IVF-ET, which provides another clinical option for poor responders. Due to the limited quantity and quality of the included studies as well as the difference in methodology, we suggest this above conclusion could be taken as a reference for clinical analysis which needs to be further evaluated in its effects.
Objective To analyze the efficacy and safety of different acupuncture methods on outcome of in vitro fertilization-embryo transfer (IVF-ET). Methods The PubMed, EMbase, Cochrane Library, CNKI, VIP, WanFang Data and CBM databases were searched to collect randomized controlled trials (RCTs) related to the objectives of the study from the inception to April 16, 2023. After two investigators independently screened the literature, extracted the data and evaluated the risk of bias of the included studies, a network meta-analysis was performed using Stata 16.0 software. Results There were 62 trials total with 9844 patients, involving 7 interventions. Network meta-findings analysis revealed the following: ① Clinical pregnancy rate (CPR): needle warming > auricular acupressure > transcutaneous electrical acupoint stimulation (TEAS) > electroacupuncture > acupuncture > sham acupuncture > no adjunctive treatment; ② Live birth rate (LBR): electroacupuncture > auricular acupressure > TEAS > acupuncture > sham acupuncture > no adjunctive treatment. Conclusion Needle warming assisted IVF-ET is superior to other acupuncture therapies in improving CPR, especially during the promotion period of excretion, and the selection of Zusanli, Guanyuan and uterine acupoints for 3-month cycles may have the best effect. And for the LBR, the effect of electroacupuncture is better than that of other therapies. Besides, auricular acupressure may have good therapeutic potential. Due to the limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusions.
目的 探讨3种不同助孕方案在≥40岁妇女体外受精-胚胎移植（IVF-ET）周期中的临床效果。 方法 回顾性分析2010年8月－2012年2月期间，于四川大学华西第二医院生殖中心行IVF-ET助孕、年龄≥40岁妇女共245个周期的临床资料，排除一侧卵巢缺如患者3例，余242个周期根据助孕方案不同分为3组：拮抗剂组（GnRH-A方案组）44个周期、长方案组109个周期及短方案组89个周期，比较3种方式助孕的临床效果。 结果 3组均无早发黄体生成素峰；长方案组应用促性腺激素（Gn）的时间最长，应用Gn数量最多，获得最高的获卵数及获胚数（P＜0.05）；3组的受精率、优胚率、冷冻胚胎数、周期取消率、卵巢过度刺激综合征发生率、早期流产率均无统计学意义（P＞0.05），短方案组的种植率及临床妊娠率最低（P＜0.05）。 结论 GnRH-a长方案在≥40岁妇女的IVF-ET周期中具有较好的临床结局，在≥40岁妇女IVF-ET周期中具有与长方案相似的结局，并且可以减少Gn使用量，提高卵泡及胚胎质量，短方案组对≥40岁妇女临床效果较差。
Objective To assess the necessity and effectiveness of salpingectomy before IVF-ET for hydrosalpinx among Chinese infertile patients. Methods The relevant papers published from 2000 to December of 2010 in China were electronically searched in CBM, VIP and CNKI to collect randomized controlled trials (RCTs) involving Chinese hydrosalpinx women with or without salpingectomy before IVF-ET. The quality of the included trials was independently assessed by two reviewers, and the data were extracted and analyzed by RevMan 5.0 software. Results Nine RCTs involving 687 patients and 730 IVF-ET cycles were identified. The results of meta-analyses showed that: a) There were significant differences between the two groups in Gn dosage (WMD=1.23, 95%CI 0.17 to 2.30, P=0.02), fertilization rate (RR=1.07, 95%CI 1.02 to 1.13, P=0.006), cleavage rate (RR=1.05, 95%CI 1.00 to 1.09, P=0.03), clinical pregnancy rate (RR=1.92, 95%CI 1.41 to 2.61, Plt;0.000 1), and abortion rate (RR=0.34, 95%CI 0.13 to 0.86, P=0.002); and b) There were no significant differences between the two groups in days of Gn (WMD= –0.27, 95%CI –0.59 to 0.06, P=0.11), E2 in HCG day (WMD=59.15, 95%CI –9.61 to 127.91, P=0.09), number of eggs (WMD= –0.27, 95%CI –0.44 to 0.99, P=0.46), quality embryonic rate (RR=1.02, 95%CI 0.91 to 1.14, P=0.79), and ectopic pregnancy rate (RR=0.22, 95%CI 0.03 to 1.82, P=0.16). Conclusion The current evidence shows that salpingectomy before IVF-ET for hydrosalpinx Chinese hydrosalpinx patients is necessary and effective. For the low quality of methodology of the included studies, more reasonably-designed and double-blind RCTs with large sample are required to provide more high-quality proof.