Impact of endometriosis on embryo quality and endometrial receptivity in women undergoing assisted reproductive technology.

ART is an important treatment method for infertile patients with endometriosis. However, the effects of endometriosis on embryo quality and endometrial receptivity remain unclear. Thus, we aimed to simultaneously investigate the impact of endometriosis and its stage on embryo quality and endometrial receptivity in women undergoing ART. We retrospectively analyzed the data from patients with and without endometriosis who underwent oocyte retrieval and/or high-quality embryos transfer between July 2015 and December 2020, including 1312 IVF cycles and 608 IVF or frozen-thawed embryo transfer (FET) cycles, respectively. The endometriosis group had a lower percentage of good cleavage-stage embryos and fertilization rates than those in the control group (p = 0.038 and 0.008, respectively). The number of retrieved oocytes, MII oocytes, cleavage, blastocysts, and blastulation rates was comparable between two groups. We found no significant difference in clinical pregnancy, implantation, live birth, miscarriage, or multiple pregnancy rates between the two groups among patients who transferred high-quality embryos. Stratification analysis showed that patients with stage III-IV endometriosis had fewer retrieved oocytes than those with stage I-II endometriosis (p = 0.012) and marginally fewer retrieved oocytes than the control group (p = 0.051). The stage I-II group had the lowest percentage of good cleavage-stage embryos, which was significantly lower than that of the control group (p = 0.043). In FET cycles, patients with stage III-IV endometriosis had a higher miscarriage rate than those in the control group (p = 0.023). Our results suggest that endometriosis does not alter endometrial receptivity but affects embryo quality, oocyte fertilization ability, and ovarian response.

Silver salt enabled H/D exchange at the ß-position of thiophene rings: synthesis of fully deuterated thiophene derivatives.

We disclose a silver catalyzed H/D exchange reaction, which can introduce the deuterium atom at the ß position of thiophene rings without the assistance of any coordinating groups. The advantages of this reaction include operation in open air, usage of D2O as the deuterium source, good tolerance to a range of functional groups and obtaining high atom% deuterium incorporation. In addition, this H/D exchange reaction is employed for direct deuteration of a thiophene based monomer, which is usually prepared by multistep synthesis from expensive deuterated starting materials.

Pregnancy Outcomes of In Vitro Fertilization with or without Ovarian Hyperstimulation Syndrome: A Retrospective Cohort Study in Chinese Patients.

BACKGROUND: The effect of ovarian hyperstimulation syndrome (OHSS) on pregnancy outcomes of in vitro fertilization (IVF) patients is still ambiguous. This study aimed to analyze pregnancy outcomes of IVF with or without OHSS in Chinese patients. METHODS: A retrospective cohort study was undertaken to compare pregnancy outcomes between 190 women with OHSS and 197 women without OHSS. We examined the rates of clinical pregnancy, multiple pregnancies, miscarriage, live birth, preterm delivery, preterm birth before 34 weeks' gestation, cesarean delivery, low birth weight (LBW), and small-for-gestational age (SGA) between the two groups. Odds ratios (OR s) and 95% confidence intervals (CI s) of measure of clinical pregnancy were also analyzed. RESULTS: The clinical pregnancy rate of OHSS patients was significantly higher than that of non-OHSS patients (91.8% vs. 43.5%, P < 0.001). After controlling for drug protocol and causes of infertility, the adjusted OR s of moderate OHSS and severe/critical OHSS for clinical pregnancy were 4.65 (95% CI, 1.86-11.61) and 5.83 (95% CI, 3.45-9.86), respectively. There were no significant differences in rates of multiple pregnancy (4.0% vs. 3.7%) and miscarriage (16.1% vs. 17.5%) between the two groups. With regard to ongoing clinical pregnancy, we also found no significant differences in the rates of live birth (82.1% vs. 78.8%), preterm delivery (20.9% vs. 17.5%), preterm birth before 34 weeks' gestation (8.6% vs. 7.9%), cesarean delivery (84.9% vs. 66.3%), LBW (30.2% vs. 23.5%), and SGA (21.9% vs. 17.6%) between the two groups. CONCLUSION: OHSS, which occurs in the luteal phase or early pregnancy in IVF patients and represents abnormal transient hemodynamics, does not exert any obviously adverse effect on the subsequent pregnancy.

Factors Associated with Effectiveness of Treatment and Reproductive Outcomes in Patients with Thin Endometrium Undergoing Estrogen Treatment.

BACKGROUND: Thin endometrium is associated with poor reproductive outcomes; estrogen treatment can increase endometrial thickness (EMT). The aim of this retrospective cohort study was to investigate the factors influencing the effectiveness of estrogen treatment and reproductive outcomes after the treatment in patients with thin endometrium. METHODS: Relevant clinical data of 101 patients with thin endometrium who had undergone estrogen treatment were collected. Possible factors influencing the effectiveness of treatment were analyzed retrospectively by logistic regression analysis. Eighty-seven infertile women without thin endometrium who had undergone assisted reproduction served as controls. The cases and controls were matched for age, assisted reproduction method, and number of embryos transferred. Reproductive outcomes of study and control groups were compared using Student's t-test and the Chi-square test. RESULTS: At the end of estrogen treatment, EMT was ≥8 mm in 93/101 patients (92.1%). Effectiveness of treatment was significantly associated with maximal pretreatment EMT (P = 0.017) and treatment duration (P = 0.004). The outcomes of assisted reproduction were similar in patients whose treatment was successful in increasing EMT to ≥8 mm and the control group. The rate of clinical pregnancy in patients was associated with the number of good-quality embryos transferred in both fresh (P = 0.005) and frozen-thawed (P = 0.000) embryo transfer cycles. CONCLUSIONS: Thinner EMT before estrogen treatment requires longer treatment duration and predicts poorer treatment outcomes. The effectiveness of treatment depends on the duration of estrogen administration. Assisted reproductive outcomes of patients whose treatment is successful (i.e., achieves an EMT ≥8 mm) are similar to those of controls. The quality of embryos transferred is an important predictor of assisted reproductive outcomes in patients treated successfully with exogenous estrogen.

[Pregnant rate and pregnancy-relating factors of patients with early endometrial carcinoma and severe atypical hyperplasia of endometrium after fertility-preserving treatment by progestin].

OBJECTIVE: To summarize the pregnant rate of patients with early endometrial carcinoma and severe atypical hyperplasia after fertility-preserving treatment and analyze their pregnancy-relating factors. METHODS: Endometrial curettage was used to evaluate the therapy response of endometrium after every 3 months of administration of high-dose progestin as fertility-sparing treatment for 51 patients with stage I endometrial carcinoma or severe endometrial atypical hyperplasia from Jun. 1996 to Jan. 2010. Individualized maintained treatment was given to patients after achieving complete remission of the endometrium. Pregnant results and pregnancy-relating factors were analyzed retrospectively. RESULTS: The median age of all the 51 patients was 29 years old. Forty-five (88%, 45/51) achieved complete response. Of the 34 cases who desired to conceive after complete response, 16 of them had 22 pregnancies, the pregnant rate was 47% (16/34); and 12 women obtained healthy live birth baby, the fertility rate was 35% (12/34). The pregnant rate of patients at age >35 or ≤ 35 was 0/2 and 50% (16/32) respectively (P > 0.05). The pregnant rate of patients with or without infertility was 40% (8/20) and 8/14, with endometrial cancer or severe atypical hyperplasia was 40% (10/25) and 6/9, respectively (all P > 0.05). The pregnant rate of patients who received in vitro fertilization-embryo transfer, ovulation promotion, or no treatment was 7/7, 6/16 and 3/11 respectively (P < 0.01). CONCLUSIONS: Fertility-preserving treatment for early endometrial cancer and severe atypical hyperplasia with high-dose progestin could achieve higher response rate. Assisted reproductive technologies could significantly increase the chance of conception.

[Relationship between endometriosis fertility index and pregnancies after laparoscopic surgery in endometriosis-associated infertility].

OBJECTIVE: To evaluate the relationship between endometriosis fertility index (EFI) and pregnancies after laparoscopic surgery in endometriosis-associated infertility. METHODS: From Jan. 2005 to Jan. 2010, medical documents of 350 infertile patients due to endometriosis undergoing laparoscopic surgery were studied retrospectively. Pregnancy outcomes were followed up by telephone. EFI was calculated by history factors, least function score and some aspects of the revised American Fertility Society (r-AFS) endometriosis stage. The cumulative pregnancy rate was calculated and compared by Kaplan-Meier survival analysis. RESULTS: Within 3 years after surgery, the cumulative pregnancy rates among patients with EFI score 8, 9, 10 were 62.5%, 69.8% and 81.1%, respectively. There was no significant difference in pregnancy rates among those three groups of patients (P = 0.24). The cumulative pregnancy rates among patients with EFI score 5, 6, 7 were 49.8%, 43.9% and 41.6%, respectively, which did not reach statistical difference (P = 0.83). The cumulative pregnancy rates of EFI score 8 - 10 was significantly higher than that of EFI score 5 - 7 (71.8% vs. 44.4%, P = 0.000). The patients with EFI score 0 - 4 was quite small with only 33 cases, among which 15 cases were pregnant. CONCLUSIONS: There is relationship between EFI and pregnancy in patients with endometriosis-associated infertility. EFI is meaningful to guide post-surgical treatment.

[A multicenter prospective randomized open comparative study on the treatment of ovulatory menorrhagia with tranexamic acid and norethisterone in China].

OBJECTIVE: To compare the efficacy and safety of tranexamic acid (TA) and norethisterone (NET) for the treatment of patients with ovulatory menorrhagia in China. METHODS: One hundred and thirty one patients with proven ovulatory menorrhagia from gynecologic clinics of 5 teaching hospitals located in 4 different cities in China were enrolled during Jul 2004 to Dec 2006. Among them 128 completed the study. Patients were randomly divided into two therapeutic regimen groups: TA 1 g thrice daily during menstrual cycle days (D) 1-5, 69 cases; or NET 5 mg twice daily on D19-26, 59 cases. The drugs were administered for 2 consecutive cycles, then withdrawn and patients were followed-up for 1 more cycle. Data on menstrual blood loss [estimated by pictorial blood assessment chart (PBAC)], length of menstrual periods, quality of life (QOL) evaluated by a 6 item health-related questionnaire were collected before, during each cycle and were compared. RESULTS: Both treatments led to significant decreases of mean PBAC scores and shorter duration of menstrual periods, and improved the QOL ranking during the two treatment cycles. The mean percentages of PBAC decrements in the TA first and second cycles were significantly greater than those in the NET corresponding cycles(35% vs 17% , P = 0.004; 44% vs 34%, P = 0.04 respectively). The success rate of TA second cycle was higher than that of the NET second cycle (41% vs 24%, P = 0.04). Improvement of QOL ranking in the TA first cycle was also significantly better than those in the NET first cycle (P = 0.03). The percentage of patients with at least 1 adverse event in TA group (19%) was significantly lower than that in NET group (35%, P = 0.04). Patients' willingness to continue the treatment in the TA second and follow-up cycles (94%, 79% respectively) were significantly higher than those in the corresponding cycles of NET groups (79%, 59% respectively; P = 0.01, P = 0.02). CONCLUSION: The regimen of TA 3 g daily during menstrual days 1-5 is a more effective and tolerable treatment than luteal phase norethisterone for patients with ovulatory menorrhagia.

[Value of serum inhibin B measurement in predicting ovarian response in controlled ovarian hyperstimulation for in vitro fertilization cycle].

OBJECTIVE: To explore the value of serum inhibin measurement in predicting ovarian response in infertile patients undergoing controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF) cycle. METHODS: A total of 37 patients undergoing their first cycles of IVF treatment were studied and serum estradiol (E(2)), progesterone (P), inhibin (INH) B, INHA levels were detected on days 2 - 4 and 21 of the previous cycle, on day 5 of gonadotropin therapy (day 5), hCG injection day, oocyte retrieval day and at middle luteal phase of the IVF cycle. According to number of oocytes, peak E(2) concentration and presence or absence of ovarian hyperstimulation syndrome (OHSS), the 37 patients were allocated into two groups: poor ovarian response group (group A), normal and high response group (group B). Characteristics of the treatment cycle and INH, E(2), P levels were analyzed. A multiple logistic regression model and receiver operating characteristic (ROC) analysis were then used for all possible prognostic variables to evaluate the value of different hormone in predicting ovarian response. The sensitivity and specificity were calculated at the discriminating cut-off point. RESULTS: (1) In group A, basal serum INHB level, INHB and INHA levels on day 5 of recombinant FSH (rFSH) stimulation were significantly lower than group B (P < 0.05), and basal serum INHB levels were (37 +/- 35), (91 +/- 90) ng/L respectively, INHB levels on day 5 of rFSH stimulation were (194 +/- 157), (2254 +/- 4765) ng/L respectively, INHA levels on day 5 of rFSH stimulation were (36 +/- 35), (91 +/- 90) ng/L respectively in groups A and B. (2) There was positive correlation between oocytes number and basal inhibin B and dynamic serum inhibin B levels, inhibin A and E(2) levels of rFSH therapy (INHB: r = 0.39 - 0.67, P < 0.05; INHA: r = 0.43 - 0.59, P < 0.01; E(2): r = 0.50 - 0.60, P < 0.01). (3) ROC analysis: day 5 inhibin B had the largest area under curve (AUC) 0.948 (95% CI: 0.871 - 1.025), indicating that a threshold of 400 ng/L gave 82.8% sensitivity, and 99.1% specificity. CONCLUSIONS: The basal INHB levels and INHB measured on day 5 of rFSH stimulation may offer accurate and early prediction of ovarian response. Day 5 INHB levels are the best predictor of ovarian response.

[Effect of chemotherapy to ovary function in ovarian malignancy patients undergoing conservative surgery].

OBJECTIVE: To determine the effect of chemotherapy on ovarian endocrine function and menstruation. METHODS: Menstruation and serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E2) levels were observed when the patients with ovarian cancer undergoing one side ovarectomy were followed by chemotherapy. RESULTS: Abnormal menstruation occurred in 86.7% cases, including 80% amenorrhea and 6.7% oligomenstruate. Menstruation resumed around 2 months after chemotherapy. Serum LH, FSH levels rose and E2 level declined during amenorrhea. No significant change was observed in progesterone or testosterone levels. CONCLUSIONS: Ovary function impairment may occur in ovarian cancer patient treated by one side ovarectomy followed by chemotherapy. Serum LH, FSH, and E2 levels change and abnormal menstruation are two common manifestations. However, chemotherapy-related amenorrhea is reversible.

[Prevention effects of sodium hyaluronate on nerve root adhesion after lumbar intervertebral disc protrusion].

OBJECTIVE: To observe the effects of sodium hyaluronate on nerve root adhesion after operation of lumbar disc protrusion (LDP). METHODS: From April 1996 to June 2001, 152 cases with LDP were performed the removal of nucleus pulposus under endoscope. After operation, 2 ml of sodium hyaluronate were injected. The clinical results were evaluated by clinical symptom, straight leg raising test, patient's satisfaction degree and back pain. RESULTS: All the patients were followed for 1 month to 3 years. The average angle of straight leg raising test increased from 26 degree preoperatively to 62 degree postoperatively. The patient's pain were markedly relieved. Patient's satisfactory degree were 86.8%. CONCLUSION: The injection of sodium hyaluronate after operation of LDP has effect on preventing postoperative nerve root adhesion.

[Experiment of histocompatibility and degradation in vivo of artificial material calcium polyphosphate fiber].

OBJECTIVE: To study the histocompatibility and degradation in vivo of a new artificial material, calcium polyphosphate fiber (CPPF), and to provide some experimental basis for further study in tendon tissue engineering. METHODS: CPPF and carbon fiber (CF) as control material were implanted in symmetry part in subcutaneous layer, muscle and Achilles tendon of 20 SD rats. The day of operation, the 4th, 8th, 12th, 16th, and 20th weeks after operation, X-ray examination was performed to detect the density change of materials. Local tissue and materials were observed grossly, and pathological examination was made with HE staining 4, 8, 12, 16 weeks after operation. RESULTS: CPPF degraded completely within 16 weeks in muscle, and in 20 weeks after implantation in Achilles tendon and subcutaneous layer according to X-ray and pathological examination. No calcium phosphate crystal deposit was observed in local tissue. No obviously degradation of CF was found within 20 weeks. Local infiltration of lymphocytes and macrophagocytes around CPPF were much fewer than that of CF. CPPF combined compactly with surrounding hyperplastic tissue. CONCLUSION: CPPF degrade thoroughly from 16 to 20 weeks without sediment of crystal of calcium phosphate in vivo. CPPF has good histocompatibility and can be used as a scaffold material of tissue engineering.

[Feasibility of calcium polyphosphate fiber as scaffold materials for tendon tissue engineering in vitro].

OBJECTIVE: To study the feasibility of calcium polyphosphate fiber (CPPF) as the scaffold material of tendon tissue engineering. METHODS: CPPF (15 microns in diameter) were woven to form pigtail of 3 mm x 2 mm transverse area; and the tensile strength, porous ratio and permeability ratio were evaluated in vitro. Tendon cells (5 x 10(4)/ml) derived from phalangeal flexor tendon of SD rats were co-culture with CPPF scaffold or CPPF scaffold resurfaced with collagen type-I within 1 week. The co-cultured specimens were examined under optical and electric scanning microscope. RESULTS: The tensile strength of CPPF scaffolds was (122.80 +/- 17.34) N; permeability ratio was 61.56% +/- 14.57%; and porous ratio was 50.29% +/- 8.16%. CPPF had no obvious adhesive interaction with tendon cells, while CPPF of surface modified with collagen type-I showed good adhesive interaction with tendon cells. CONCLUSION: The above results show that CPPF has some good physical characteristics as scaffold of tendon tissue engineering, but its surface should be modified with organic substance or even bioactive factors.