Luteal phase support for natural cycle frozen embryo transfer: a meta-analysis.

PURPOSE: We aimed to evaluate the effect of luteal phase support (LPS) on pregnancy outcome in natural cycle frozen embryo transfer (NC-FET). METHOD: We searched PubMed, Cochrane Library, Embase for related literature from start to February 2020. Relative risk ratio (RR) and 95% confidence intervals (95% CI) in random-effects, fixed-effects models were calculated using Review Manager 5.3. RESULTS: Totally 9 studies were included in the meta-analysis. The results showed no significant difference could be found regarding chemical pregnancy rate (RR 1.07, 95% CI 0.93-1.22; I2 = 54%) and miscarriage rate (RR 0.92, 95% CI 0.70-1.22; I2 = 0%) between the LPS groups and no LPS groups in NC-FET. LPS groups has increased the rate of clinical pregnancy rate (RR 1.23, 95% CI 1.12-1.34; I2 = 52%) compared with no LPS groups. Subgroup analysis according to trigger administration also showed a significant difference between the two groups. CONCLUSION: LPS might improve the clinical pregnancy rate in NC-FET. HCG trigger for ovulating may result in luteal phase deficiency. LPS subsequently improved clinical pregnancy rate and chemical pregnancy rate for patients undergoing HCG trigger and NC-FET. RETROSPECTIVELY REGISTERED: This meta-analysis was registered at PROSPERO, PROSPERO ID is CRD42020171758.

Single fresh blastocyst transfer or single cryopreserved-thawed blastocyst transfer: which is preferable for infertile patients in IVF/ICSI cycles? A meta-analysis.

PURPOSES: Nowadays, an increasing number of studies have proposed single embryo transfer (SET), especially single blastocyst transfer (SBT). To compare the clinical outcomes of single fresh blastocyst transfer (BT) and single cryopreserved-thawed BT in patients undergoing in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycles. METHODS: The PubMed, Embase, and Cochrane Library databases were searched from the start dates until February 2018. The primary outcomes were clinical pregnancy rate (CPR) and embryo implantation rate (IR). The secondary outcomes were multiple pregnancy rate (MPR), live birth rate (LBR), and miscarriage rate (MR). Using the Mantel-Haenszel random effects model to analyze summary risk ratio (RR) with 95% confidence intervals (CIs). Statistical heterogeneity scores were assessed with the standard Cochrane's Q test and I2 statistic. RESULTS: In total, eight studies (two prospective studies, six retrospective studies) were included in our analysis. There was no statistically significant difference regarding clinical pregnancy (RR = 1.18, 95% CI = 0.91-1.55) and embryo implantation (RR = 1.04, 95% CI = 0.77-1.41). Regarding secondary outcomes, there was no significant difference regarding miscarriage (RR = 0.79, 95% CI = 0.60-1.03) and multiple pregnancy (RR = 1.23, 95% CI = 0.75-2.04). However, single fresh BT is associated with an increased live birth (RR = 1.28, 95% CI = 1.05-1.57) compared with single cryopreserved-thawed BT. CONCLUSIONS: In summary, this meta-analysis supports the hypothesis that single cryopreserved BT might not be the best choice compared with single fresh BT in patients undergoing IVF/ICSI cycles.

Comparison of pregnancy outcomes after vitrification at the cleavage and blastocyst stage: a meta-analysis.

OBJECTIVE: This systematic review sought to evaluate the clinical outcomes of vitrification at the cleavage stage and blastocyst stage for embryo transfer in patients undergoing assisted reproductive technology (ART) treatment. METHODS: We searched for related comparative studies published in the PubMed, EMBASE, and Cochrane Library databases up to July 2017. The primary outcomes were clinical pregnancy rate (CPR) and embryo implantation rate (IR). Secondary outcomes were multiple pregnancy rate (MPR), miscarriage rate (MR), live birth rate (LBR), and ongoing pregnancy rate (OPR). The Mantel-Haenszel fixed effects model and random effects model were used to analyze the summary risks ratios (RRs) with 95% confidence intervals (CIs). RESULTS: Eight studies with more than 6590 cycles were included in our meta-analysis. Seven studies were observational retrospective comparative studies. One was a prospective study. Overall, the current study summarizes information from 6590 vitrification warming cycles (cleavage stage n = 4594; blastocysts n = 1996). There was no difference in the primary outcome clinical pregnancy rate (RR = 0.97, 95% CI = 0.90-1.04; fixed effects model; I 2  = 21%), whereas vitrified blastocyst transfer was significantly superior to vitrified cleavage-stage embryo transfer regarding the implantation rate (RR = 0.85, 95% CI = 0.74-0.97; random effects model; I 2  = 43). Regarding the secondary outcomes, no differences were found in the multiple pregnancy rate (RR = 1.20, 95% CI = 0.79-1.82; fixed effects model; I 2  = 22), live birth rate (RR = 1.07, 95% CI = 0.98-1.16; fixed effects model; I 2  = 0), and ongoing pregnancy rate (RR = 1.01, 95% CI = 0.92-1.120; fixed effects model; I 2  = 0), whereas a higher miscarriage rate was observed with vitrified blastocyst transfer (RR = 0.65, 95% CI = 0.45-0.93; random effects model; I 2  = 23). CONCLUSION: In summary, this meta-analysis shows that vitrification at any stage has no detrimental effect on clinical outcome. Blastocyst transfer will still remain a favorable and promising option in ART. Due to the small sample evaluated in the pool of included studies, large-scale, prospective, and randomized controlled trials are required to determine if these small effects are clinically relevant.

The effect of laser-assisted hatching on pregnancy outcomes of cryopreserved-thawed embryo transfer: a meta-analysis of randomized controlled trials.

It is well known that laser-assisted hatching (LAH) is the most popular and ideal embryo hatching technology, but the relevance to pregnancy outcomes of cryopreserved-thawed embryo transfer (ET) is controversial. The purpose of this meta-analysis was to evaluate the effects of LAH on pregnancy outcomes of cryopreserved-thawed ET. We searched for relevant studies published in the PubMed, EMBASE, and Cochrane Central databases up to March 2017. This meta-analysis was primarily used to evaluate the effect of laser-assisted hatching on assisted reproductive outcomes: clinical pregnancy, embryo implantation, multiple pregnancy, miscarriage, and live birth. Using the Mantel-Haenszel fixed effects model and random effects model, we determined the summary odds ratios (OR) with 95% confidence intervals (CIs). There were 12 randomized controlled trials (more than 2574 participants) included in our analysis. The rates of clinical pregnancy (OR = 1.65, 95% CI = 1.24-2.19, I 2 = 49), implantation (OR = 1.59, 95% CI = 1.06-2.38, I 2 = 82%), multiple pregnancy (OR = 2.30, 95% CI = 1.30-4.07, I 2 = 33%), miscarriage (OR = 0.86, 95% CI = 0.50-1.48, I 2 = 0%), and live birth (OR = 1.09, 95% CI = 0.77-1.54, I 2 = 0%) revealed comparable results for both groups. In summary, this meta-analysis demonstrates that LAH is related to a higher clinical pregnancy rate, embryo implantation rate, and multiple pregnancy rate in women with cryopreserved-thawed embryos. However, LAH is unlikely to increase live birth rates and miscarriage rates. Due to the small sample evaluated in the pool of included studies, large-scale, prospective, randomized, controlled trials are required to determine if these small effects are clinically relevant.

Shilling Black-Box Recommender Systems by Learning to Generate Fake User Profiles.

Due to the pivotal role of recommender systems (RS) in guiding customers toward the purchase, there is a natural motivation for unscrupulous parties to spoof RS for profits. In this article, we study shilling attacks where an adversarial party injects a number of fake user profiles for improper purposes. Conventional Shilling Attack approaches lack attack transferability (i.e., attacks are not effective on some victim RS models) and/or attack invisibility (i.e., injected profiles can be easily detected). To overcome these issues, we present learning to generate fake user profiles (Leg-UP), a novel attack model based on the generative adversarial network. Leg-UP learns user behavior patterns from real users in the sampled "templates" and constructs fake user profiles. To simulate real users, the generator in Leg-UP directly outputs discrete ratings. To enhance attack transferability, the parameters of the generator are optimized by maximizing the attack performance on a surrogate RS model. To improve attack invisibility, Leg-UP adopts a discriminator to guide the generator to generate undetectable fake user profiles. Experiments on benchmarks have shown that Leg-UP exceeds state-of-the-art shilling attack methods on a wide range of victim RS models. The source code of our work is available at: https://github.com/XMUDM/ShillingAttack.

Perinatal outcomes after vitrified-warmed day 5 blastocyst transfers compared to vitrified-warmed day 6 blastocyst transfers: A meta analysis.

AIMS: The aim of this meta-analysis was to compare the perinatal outcomes between the vitrified-warmed day 5 blastocyst transfer (BT) and the vitrified-warmed day 6 blastocyst transfer (BT). METHODS: PubMed, EMBASE and the Cochrane Library were searched for the perinatal outcomes after in vitro fertilisation / intracytoplasmic sperm injection (IVF/ICSI) from inception to October 2018.The perinatal outcomes included birth weight, gestational age, number of males, premature delivery, birth defects, and neonatal deaths. We used a random effect model to analyse the summary risk ratios (RRs) and mean difference (WMD) with 95 % confidence intervals (CIs). RESULTS: Eight retrospective studies that met the inclusion criteria were included. Compared with vitrified-warmed day 5 BT, vitrified-warmed day 6 BT was associated with increased birth weight (WMD = -80.39; 95 % CI = -151.8 to -8.97; I2 = 41 %, P = 0.03);There was no significant difference in gestational age (WMD = 0.10; 95 % CI =-0.07-0.27; I2 = 0%, P = 0.24), number of males (RR 0.93, 95 % CI 0.78-1.10; I2 = 43 %), premature delivery (RR 0.84, 95 % CI 0.13-5.27; I2 = 72 %), birth defects (RR 1.48, 95 % CI 0.71-3.11; I2 = 0%) and neonatal deaths (RR 1.2, 95 % CI 0.25-5.71; I2 = 0%) between the two groups. CONCLUSIONS: Vitrified-warmed day 6 BT is associated with increased birth weight rather than day 5 BT. There was no difference in gestational age, number of males, premature deliveries, birth defects, and neonatal death, between the two groups. These results concluded that vitrified-warmed day 6 BT has no difference compared with vitrified-warmed day 5 BT in regard to adverse impact on perinatal outcomes.

Association of antinuclear antibody with clinical outcome of patients undergoing in vitro fertilization/intracytoplasmic sperm injection treatment: A meta-analysis.

PROBLEM: Several recent studies have investigated the relationship between antinuclear antibodies (ANAs) and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes. This meta-analysis evaluated the effect of ANA on clinical outcome for patients undergoing IVF/ICSI treatment. METHOD OF STUDY: A systemic survey of the literature was performed using PubMed, EMBASE and the Cochrane Library databases, through January 2019. Evaluated outcomes included clinical pregnancy rate (CPR), miscarriage rate (MR) and implantation rate (IR). Relative risk ratio (RR) and 95% confidence intervals (95% CI) were used for dichotomous data. Meta-analyses were performed with Review Manager 5.3 software. RESULTS: Eleven eligible studies were found. For IVF/ICSI cycles, compared with an ANA(-) group, infertile patients with ANA(+) had significantly reduced incidence of CPR (RR 0.66, 95% CI 0.56-0.79; I2  = 60%) and IR (RR 0.61, 95% CI 0.49-0.76; I2  = 75%), and had a higher MR (RR 1.81, 95% CI 1.40-2.36; I2  = 48%). CONCLUSION: This study suggested that ANA might cause poor pregnancy outcomes for infertile women undergoing IVF/ICSI treatment.

Evaluation of lipid profile and its relationship with blood pressure in patients with Cushing's disease.

INTRODUCTION: The purpose of the study was to describe lipid profile and explore pathogenetic role of LDL-c on hypertension in patients with Cushing's disease (CD). Hypertension is a common feature in patients with CD. Previous study found low-density lipoprotein cholesterol (LDL-c) uptake in vascular cells might be involved in vascular remodeling in patients with CD. Therefore, we evaluated the relationship between lipid profile and the blood pressure in patients with CD. METHODS: This retrospective study included 84 patients referred to Huashan Hospital for the evaluation and diagnosis of CD from January 2012 to December 2013. All subjects had detailed clinical evaluation by the same group of endocrinology specialists to avoid subjective influences. RESULTS: We found that high LDL-c patients had significant higher body mass index (BMI), systolic blood pressure (SBP), cholesterol (CHO), triglyceride (TG), and apolipoproteinB (apoB) (P < 0.05). An association was detected between SBP values and lipids profile including CHO, TG, LDL-c, apolipoproteinA (apoA), apoB and lipoprotein(a) (LP(a)). After adjustment for all covariates, the LDL-c remained positively associated with SBP. In patients with or without taking statins, patients with LDL-c ≥3.37 mmol/L had higher SBP than patients with LDL-c <3.37 mmol/L. Then, LDL-c was coded using restricted cubic splines (RCS) function with three knots located at the 5th, 50th and 95th percentiles of the distribution of LDL-c. Compared to individuals with 3.215 mmol/L of LDL-c, individuals with 4.0, 4.5 and 5.0 mmol/L of LDL-c had differences of 3.86, 8.53 and 14.11 mmHg in SBP, respectively. CONCLUSIONS: An independent association between LDL-c and SBP was found in patients with CD. We speculate that LDL-c may be a pathogenic factor for hypertension in those patients.

Gender-Specific Differences in Clinical Profile and Biochemical Parameters in Patients with Cushing's Disease: A Single Center Experience.

Cushing's disease (CD) is remarkably prevalent among females; however, more severe clinical presentation and adverse outcomes have been found in males. The purpose of this study was to investigate the overall clinical profile and biochemical parameters in patients with CD to identify the gender differences. Here we describe our series of CD patients referred to our medical center during 2012-2013. Among 73 cases, females presented a marked preponderance compared to males. Males had significantly higher ACTH, BMI, HbA1c, systolic blood pressure, and hemoglobin than females. For the first time, the incidence of fatty liver and hepatic function was also shown to be elevated in males. Multiple linear regression analysis was performed to further investigate the correlation of risk factors with hypokalemia, HbA1c, and systolic blood pressure. Gender and serum cortisol were associated with hypokalemia. Age, gender, and serum cortisol were significantly associated with HbA1c. Additionally, only gender was significantly associated with systolic blood pressure. Regarding clinical presentation, purple striae seemed to occur more frequently in males than in females. Thus, more severe clinical presentation, biochemical parameters, and complications were found in males than in females. Clinical professionals should pay more attention to the diagnosis and management of males with CD.

Differences in the metabolic status of healthy adults with and without active brown adipose tissue.

BACKGROUND: Previous studies have proven the existence of active brown adipose tissue (BAT) in adults; however, its effect on systematic metabolism remains unclear. AIM: The current study was designed to investigate the differences in the metabolic profiles of healthy adults with and without active BAT using positron emission tomography-computed tomography (PET-CT) scans in the un-stimulated state. METHODS: A cross-sectional analysis was performed to assess the health of adults using PET-CT whole-body scans at Huashan Hospital Medical Centre between November 2009 and May 2010. A total of 62 healthy adults with active BAT were enrolled in the BAT-positive group. For each positive subject, a same-gender individual who underwent PET-CT the same day and who had no detectable BAT was chosen as the negative control. Body composition was measured, and blood samples were collected for assays of metabolic profiles and other biomarkers. RESULTS: In both the male and female groups, BAT-positive individuals were younger and had lower body mass indexes, fasting insulin, insulin resistance, and leptin, but a greater level of high-density lipoprotein cholesterol compared with the negative controls. In the male group, body fat content and levels of tumor necrosis factor-α were significantly lower in the BAT-positive than in the negative control group. CONCLUSIONS: The healthy adults with active BAT in an un-stimulated state had favorable metabolic profiles suggesting that active BAT may be a potential target for preventing and treating obesity and other metabolic disorders.