Proximal tubal occlusion first or oocyte retrieval first for patients with hydrosalpinx?

PURPOSE: Our study aimed to investigate the best time to manage hydrosalpinx to improve pregnancy outcomes during in vitro fertilization-embryo transfer (IVF-ET). METHODS: Patients with hydrosalpinx who received IVF treatment were analyzed retrospectively. And two groups were included to compare the effects of different timing treatment of hydrosalpinx on IVF pregnancy outcomes, "Proximal Tubal Occlusion First Group" (Group Ligation-COH) and "Oocyte Retrieval First Group" (Group COH-Ligation). The main outcome measures included: ovarian response indexes, laboratory indexes and clinical pregnancy outcomes. Univariate and multivariate Logistic regression analysis was performed for outcome indicators, and the odds ratios (OR) and 95% confidence interval (CI) were used. RESULTS: A total of 1490 patients were included (n = 976 Ligation-COH and n = 514 COH-Ligation). The Gn starting dose and MII rate in group Ligation-COH were significantly higher than those in group COH-Ligation (203.33 ± 58.20 vs. 203.33 ± 58.20, 81.58% vs. 80.28%, P < 0.05). The number of oocytes obtained and the number of available D3 embryos in group COH-Ligation were higher than those in group Ligation-COH (15.10 ± 7.58 vs. 13.45 ± 6.42, 10.92 ± 5.81 vs. 9.94 ± 5.15, P < 0.05). Although the number of ET cycles per IVF cycle in group COH-Ligation was higher than that in group Ligation-COH (1.88 ± 1.00 vs. 1.48 ± 0.70, P < 0.05), the biochemical pregnancy rate, clinical pregnancy rate, multiple pregnancy rate, live birth rate and cumulative live birth rate in group Ligation-COH were significantly higher than those in group COH-Ligation (60.83% vs. 46.27% for biochemical pregnancy, 55.69% vs. 38.5% for clinical pregnancy, 26.18% vs. 17.74% for multiple pregnancy, 47.08% vs. 25.26% for live birth, 69.47% vs. 47.47% for cumulative live birth, P < 0.05), and the miscarriage rate in group Ligation-COH was lower than that in group COH-Ligation (10.47% vs. 17.20 for early abortion, 4.49% vs. 15.86% for late abortion, P < 0.05). In logistic regression analysis, after adjustment for age and multiple factors, the above results were still statistically significant differences (P < 0.001). For elderly patients, the clinical pregnancy rate, multiple birth rate and live birth rate in group Ligation-COH were also higher than those in group COH-Ligation (P < 0.001). No significant differences were detected for patients with diminished ovarian reserve. CONCLUSIONS: For the choice of ligation operation time, we recommend that patients choose tubal ligation first and then ovulation induction and oocyte retrieval treatment.

DHEA improves the antioxidant capacity of endometrial stromal cells and improves endometrium receptivity via androgen receptor.

OBJECTIVE: To investigate the effect of dehydroepiandrosterone (DHEA) on mouse decidual endometrial stromal cells (ESCs) and to explore mechanisms regulating endometrial receptivity. STUDY DESIGN: Mouse ESCs were incubated with increasing concentrations of DHEA during decidualization. Treatment with flutamide (FLU), a specific androgen receptor (AR) antagonist, was also performed. Flow cytometry was used to measure intracellular reactive oxygen species (ROS). Real time-PCR was used to determine mRNA expression of decidual PRL-related protein (dPRP), AR, and HomeoboxA10 (HOXA10). Protein levels of AR and HOXA10 were measured by western blot. RESULTS: DHEA significantly inhibited ESC proliferation at concentrations ≥1×10(-6)M. DHEA treatment reduced intracellular ROS in a dose-dependent manner. Expression of dPRP was minimally affected by DHEA at concentrations of 1 to 100nM. However, DHEA (100nM) significantly increased the expression of HOXA10 at both the mRNA and protein levels (P<0.01). Importantly, this DHEA-mediated increase in HOXA10 was attenuated by treatment with FLU. Finally, neither DHEA nor FLU influenced expression of AR mRNA or protein. CONCLUSION: Low concentration of DHEA improves the antioxidant capacity of decidual ESCs. DHEA treatment may also improve endometrium receptivity via AR.