الملخص
Background: Effective ovulation induction is crucial in management of polycystic ovarian syndrome (PCOS) related infertility. Clomiphene citrate (CC) has long been the first line of treatment for inducing ovulation in women with PCOS. Letrozole, an aromatase inhibitor, has emerged as a promising alternative to CC for ovulation induction. The present study was aimed to compare efficacy and safety of letrozole versus CC for ovulation induction in women with PCOS.Methods: This study consists of 384 PCOS women, randomized into two groups: Letrozole (2.5 mg/day) and CC (50 mg/day), both administered from day 3 to day 7 of the menstrual cycle. The primary outcome was the ovulation rate, confirmed by serum progesterone levels >10 ng/ml. Secondary outcomes included clinical pregnancy rate, live birth rate, endometrial thickness, adverse effects, cost-effectiveness, and patient satisfaction. Participants were monitored through transvaginal ultrasound and serum progesterone measurements.Results: Ovulation was achieved in 76.0% of participants in the letrozole group compared to 55.2% in the CC group (p<0.001). Clinical pregnancy rates were significantly higher in the letrozole group (44.8%) compared to the CC group (28.1%) (p<0.001). Similarly, live birth rates were higher with letrozole (36.5% vs. 22.4%; p=0.002). Endometrial thickness was greater in the letrozole group (8.7 mm vs. 7.5 mm; p<0.001). Adverse effects, were significantly lower in the letrozole group.Conclusions: Letrozole is more effective than CC in inducing ovulation and achieving higher pregnancy and live birth rates in women with PCOS.
الملخص
Objective To observe the effects of Postmenstrual Proliferative Prescription(mainly composed of Codonopsis Radix,Atractylodis Macrocephalae Rhizoma,Poria,Rehmanniae Radix Praeparata,Paeoniae Radix Alba,Angelicae Sinensis Radix,Chuanxiong Rhizoma,Cervi Cornu Degelatinatum,Corni Fructus,Cuscutae Semen,and Eucommiae Cortex)through replenishing qi and blood on the ovulation rate and pregnancy rate in patients with ovulatory dysfunction infertility caused by polycystic ovarian syndrome(PCOS)during ovulation-induction treatment,and to explore the therapeutic effects and possible therapeutic mechanism.Methods Sixty patients with ovulatory dysfunction infertility due to PCOS were randomly divided into a treatment group and a control group,with 30 patients in each group.The control group was given Clomifene Citrate Capsules to promote ovulation,and the treatment group was given Postmenstrual Proliferative Prescription on the basis of the ovulation-induction program of the control group starting from the fifth day of menstruation or progesterone withdrawal bleeding.The two groups were treated for one menstrual cycle as a course of treatment.The changes in the serum sex hormones of estradiol(E2),follicle-stimulating hormone(FSH),luteinizing hormone(LH),and progesterone(P)on the 2nd to 5th day of menstruation,as well as the changes in serum growth differentiation factor 9(GDF9)and bone morphogenetic protein 15(BMP15)levels on the 2nd to 5th day of menstruation and on the day of human chorionic gonadotropin(HCG)injection were observed in the two groups.Moreover,the ovulation rate,pregnancy rate and clinical efficacy of the patients in the two groups were analyzed.Results(1)No statistically significant differences in serum levels of sex hormones E2,FSH,LH and P on the 2nd to 5th day of menstruation were shown between the two groups of patients(P＞0.05).(2)On the 2nd to 5th day of menstruation and on the day of HCG injection,there were no significant differences in the serum GDF9 and BMP15 levels between the two groups(P＞0.05).(3)The ovulation rate and pregnancy rate in the treatment group were 93.33%(28/30)and 26.67%(8/30)respectively,which were significantly higher than 70.00%(21/30)and 13.33%(4/30)in the control group.And the differences tested by chi-square test were statistically significant between the two groups(P＜0.05).(4)The total effective rate of the treatment group was 93.33%(28/30),and that of the control group was 70.00%(21/30).The intergroup comparison(tested by rank sum test)showed that the therapeutic efficacy of the treatment group was significantly superior to that of the control group,and the difference was statistically significant(P＜0.05).Conclusion Postmenstrual Proliferative Prescription through replenishing qi and blood can improve the ovulation rate and pregnancy rate during ovulation-induction treatment in the patients with ovulatory dysfunction infertility due to PCOS.It is indicated that Postmenstrual Proliferative Prescription can enhance the quality of the oocytes and the potential of embryo implantation during the ovulation-induction treatment.
الملخص
Objective To systematically evaluate and sequentially analyze the clinical efficacy and safety of Baogong Zhixue Granules for the treatment of abnormal uterine bleeding due to ovulation disorder.Methods The randomized controlled trials(RCTs)of Baogong Zhixue Granules for the treatment of abnormal uterine bleeding due to ovulation disorder were retrieved from the databases of CNKI,Wanfang Data,VIP,China Biology Medicine,PubMed,Embase,and Cochrane Library from the establishment of the databases to January 5th,2023.Literature screening and data extraction were conducted according to Cochrane Handbook for Systematic Reviews of Interventions,and Meta-analysis was performed by RevMan 5.4.Results Totally 15 articles were included,involving 1 425 patients.Meta-analysis results showed that Baogong Zhixue Granules could effectively improve the clinical efficacy of abnormal uterine bleeding due to ovulatory disorder(RR=1.17,95%CI[1.13,1.23],P<0.000 01),shorten hemostasis time[bleeding control time(MD=-6.35,95%CI[-8.89,-3.81],P<0.000 01),complete hemostasis time(MD=-12.56,95%CI[-16.22,-8.89],P<0.000 01)],reduce endometrial thickness(MD=-1.26,95%CI[-1.71,-0.80],P<0.000 01),reduce hemoglobin loss(MD=13.35,95%CI[11.41,15.29],P<0.000 01),improve the score of uterine bleeding(MD=-2.22,95%CI[-2.43,-2.01],P<0.000 01),and reduce the recurrence of disease(RR=0.37,95%CI[0.19,0.72],P=0.004).There was no statistical significance between the test group and the control group in terms of adverse reactions(P=0.82).The trial sequential analysis of the total efficiency was carried out,and the cumulative included research passed the traditional threshold and trail sequential analysis threshold.Conclusion Baogong Zhixue Granules have a certain clinical efficacy in the treatment of abnormal uterine bleeding due to ovulation disorder,but there may be publication bias in the study,and higher quality clinical RCTs need to be carried out.
الملخص
Background: Infertility is a widespread concern, particularly among individuals with polycystic ovarian syndrome (PCOS). Clomiphene citrate (CC) has been a primary treatment for PCOS-related infertility, despite suboptimal pregnancy rates. Letrozole, an aromatase inhibitor, presents an alternative with potential advantages for improving pregnancy outcomes. This study aimed to rigorously compare letrozole and CC in the context of PCOS-related infertility, focusing on Bangladeshi women, adopting incremental dosing protocols, and examining endpoints to contribute valuable insights.Methods: A randomized controlled trial was conducted at a tertiary care center in Bangladesh from July 2021 to June 2023. Participants included women aged 18-35 with anovulatory infertility due to PCOS. They were randomized into two groups: letrozole and CC. Treatments were administered following incremental dosing protocols, and outcomes included endometrial thickness, ovulation rate, mono-follicular development, pregnancy rate, and time to pregnancy.Results: Out of 187 patients assessed for eligibility, 102 were enrolled, with 51 in each group. Demographics were comparable between groups. While endometrial thickness did not significantly differ between the groups, letrozole demonstrated a higher rate of mono-follicular development (72.55% versus 50.98%), a significantly higher pregnancy rate (47.06% versus 23.53%), and a shorter time to pregnancy (9.23 weeks versus 11.7 weeks) compared to CC.Conclusions: This study suggests that letrozole may be a preferred option for ovulation induction in PCOS patients due to its superior pregnancy rates and shorter time to pregnancy compared to CC. However, limitations such as a relatively small sample size and variations in dosages should be considered. Further research is needed to validate these findings and address the evolving needs of patients with PCOS-related infertility.
الملخص
There has been an increased prevalence of ectopic pregnancies in the present scenario attributing to 1.5-2% of all pregnancies. Caesarean scar pregnancies are rare, occurring in approximately 1 in 2000 pregnancies, although the incidence is increasing. The increasing rate of caesarean scar ectopic pregnancies mirrors the increasing rate of caesarean delivery. Disruption of the endometrium and myometrium after caesarean delivery predisposes to improper implantation at the site of the prior hysterotomy. Without normal surrounding myometrium, untreated caesarean scar ectopic pregnancies can result in uterine rupture with severe maternal hemorrhage and death. Although ultrasound remains the primary imaging modality for this diagnosis, MRI may be useful in the setting of equivocal cases and also may aid in the detection of possible placental implantation or bladder wall invasion. An MRI may provide additional confirmation of the ultrasound findings and characterize the myometrial interface if the pregnancy is difficult to distinguish from other pregnancy complications such as a cervical ectopic pregnancy or consideration for expectant management of pregnancy is considered.
الملخص
Background: Clomiphene citrate was considered as first line of treatment for ovulation and induction in patients with unexplained infertility, but there are differences in results which can be explained by anti-estrogenic effect of CC resulting in estrogen receptor depletion. Letrozole is potent non-steroidal aromatase inhibitor which increases gonadotrophin secretion with ovarian follicle stimulation. Research question was that which drug is more efficacious for ovulation and induction in patients with unexplained infertility.Methods: This comparative study was conducted at OBGYN OPD of RMCH and RC, Kanpur. Patients were 50 females with unexplained infertility randomly divided into 2 groups. Group A received letrozole 2.5 mg from D3-D7 of menstruation. Group B received CC 50 mg from D3-D7 plus 2 mg estradiol valerate BD on D8-D14 of menstruation. Female aged 18-35 years with complete fertility workup i.e. D3 FSH, LH, prolactin, serum TSH, HSG, USG-pelvis, mid luteal phase progesterone, semen analysis within normal limits are included in study. Patients with male infertility, hyperprolactinemia, thyroid disorders and BMI>30 kg/m2 were excluded.Results: There was statistically significant difference in endometrial thickness (ET) between two groups, (p value <0.03) as mean ET was 9.3�7 in group A (L) and 8.3�5 in group B (CC+E). The number of follicles after stimulation were better with CC+E 2.9�1 and L 2.1�2 showing statistically significant difference with p value <0.01 but clinical pregnancy rate was higher with letrozole as compared to CC-E without statistically significant difference.Conclusions: Letrozole has better effect on endometrial thickness with statistically significant difference. CC+E had advantage towards multifollicular development with statistically significant difference, but there was no significant difference in case of clinical pregnancy rate, abortion, ectopic, multiple gestation.
الملخص
Objective:To investigate the effect of follicular size on the clinical outcomes of frozen-thawed embryo transfer induced by human chorionic gonadotropin (hCG) of natural cycles on ovulation.Methods:Clinical data of 427 cycles of frozen-thawed single blastocyst transfer in Nanjing Drum Tower Hospital from January 2016 to December 2019 were retrospectively analyzed. The patients were divided into 15-16 mm group (15≤diameter≤16 mm, n=66), 16-17 mm group (16<diameter≤17 mm, n=101), 17-18 mm group (17<diameter≤18 mm, n=125), 18-20 mm group (18<diameter≤20 mm, n=109),>20 mm group (diameter>20 mm, n=26), according to the maximum follicle diameter on the induction day of hCG ovulation induction. The estradiol and luteinizing hormone (LH) levels, and clinical pregnancy rate, abortion rate and live birth rate were compared in five groups. Results:There were statistically significant differences in estradiol and LH levels among the five groups on the day of hCG induction (all P<0.05). Estradiol levels in 15-16 mm group to >20 mm group gradually increased on the day of hCG induction, and estradiol level in 15-16 mm group was significantly lower than those in 17-18 mm group, 18-20 mm group and >20 mm group (median: 1 002.3 vs 1 103.3 vs 1 171.2 vs 1 539.0 pmol/L), with statistical significances ( P=0.034, P<0.001, P=0.002). On the day of hCG induction, LH levels in 15-16 mm group to >20 mm group showed a decreasing trend, and LH level in 15-16 mm group was significantly higher than those in 17-18 mm group and >20 mm group (median: 37.73 vs 28.24 vs 24.11 U/L), with statistically significant differences ( P=0.007, P=0.006). There were no significant differences in clinical pregnancy rate, abortion rate and live birth rate in 15-16 mm group to >20 mm group (all P>0.05). Conclusion:In the natural cycle protocol of hCG induced ovulation, the small follicle group could achieve similar clinical outcomes compared with normal sized follicles in the single blastocyst transfer of frozen-thawed embryos.
الملخص
Abstract Physical and emotional burdens during the journey of infertile people through assisted reproductive technologies are sufficient to justify the efforts in developing patient-friendly treatment strategies. Thus, shorter duration of ovarian stimulation protocols and the need for less injections may improve adherence, prevent mistakes, and reduce financial costs. Therefore, the sustained follicle-stimulating action of corifollitropin alfa may be the most differentiating pharmacokinetic characteristic among available gonadotropins. In this paper, we gather the evidence on its use, aiming to provide the information needed for considering it as a first choice when a patient-friendly strategy is desired.
Resumo O desgaste físico e emocional durante a jornada de pessoas inférteis pelas tecnologias de reprodução assistida é suficiente para justificar esforços no desenvolvimento de estratégias de tratamento compassivas. Desta forma, a menor duração dos protocolos de estimulação ovariana e a necessidade de menos injeções podem melhorar a adesão, prevenir erros e reduzir custos financeiros. Portanto, a estimulação folicular sustentada da alfacorifolitropina parece ser a característica farmacocinética que melhor a diferencia das gonadotrofinas atualmente disponíveis no mercado. No presente artigo, reunimos evidências sobre seu uso, com o objetivo de fornecer as informações necessárias para considerá-la como primeira escolha quando se deseja uma estratégia amigável ao paciente.
الموضوعات
Humans , Female , Ovulation Induction , Reproductive Techniques, Assistedالملخص
ABSTRACT This work analyzes the electrical impedance (EI) measurement of cervical mucus (CM) using a device to determine the fertile window. In this prospective and longitudinal study, fourteen healthy women aged 18 to 44 were enrolled to evaluate three menstrual cycles. EI was measured through a medical device inserted into the vagina for two minutes daily. Patients were monitored by urine luteinizing hormone (LH) strip, blood collection, and vaginal ultrasound to visualize the dominant follicle. Finally, the predictive EI capacity was validated by the receiver operating characteristic (ROC) of anovulatory vs. ovulatory impedances. The peak of LH was 35.7 (±4.5) mUI/ml and the dominant follicle size was 15.45 mm (±0.559). There were statistical differences in EI measurements between the follicular and luteal phases vs. the ovulation phase (p<0.0361 and p<0.0160). After data normalization, an area under the ROC curve (AUC) of 0.713 (P value= 0.0253), a Youden J index of 0.4545Ω, a sensitivity of 63.6%, and a specificity of 81.8% were found. Low EI in the ovulatory period belongs to the LH ovulatory peak and follicular release. EI can be used for ovulation monitoring, birth control, or promoting pregnancy as a safe and innocuous method.
RESUMEN Este trabajo analiza la medición de la impedancia eléctrica (IE) del moco cervical (MC) mediante un dispositivo para determinar la ventana fértil. En este estudio prospectivo y longitudinal, se incluyeron 14 mujeres sanas de 18 a 44 años para evaluar tres ciclos menstruales. La IE se midió a través de un dispositivo médico colocado en la vagina durante dos minutos diarios. Las pacientes fueron monitoreadas con una tira de hormona luteinizante (LH) en orina, recolección de sangre y ultrasonido vaginal para visualizar el folículo dominante. Finalmente, la capacidad predictiva de IE fue validada por la curva ROC (receiver operating characteristic) de impedancias anovulatorias vs. ovulatorias. El pico de LH fue de 35.7(±4.5) mUI/ml; el folículo de tamaño dominante fue de 15.45 mm (±0.559). Se encontraron diferencias estadísticas para la medición de la IE de las fases folicular y lútea versus la fase de ovulación (p<0.0361 y p<0.0160). Después de la normalización de los datos, se encontró un área bajo la curva ROC (AUC) de 0.713 (valor de P = 0.0253), un índice de Youden J de 0.4545 Ω, sensibilidad del 63.6 % y especificidad del 81.8 %. La IE baja en el período ovulatorio que pertenece al pico ovulatorio de LH y liberación folicular. La IE se puede utilizar para el control de la ovulación, el control de la natalidad o la promoción del embarazo como método seguro e inocuo.
الملخص
From early adolescence to menopause, the menstrual cycle affects a woman’s physiological and psychological health for about 35 to 40 years in a normal population. Properly functioning hypothalamo pituitary ovarian axis, receptive endometrium with healthy ovum and sperm are considered to be the essential factors for conception. Acharyas have quoted Rutu, Kshetra, Ambhu and Beeja as Garbha sambhava samagri which is essential for conception where in Beeja can be taken as ovum. Shatapusha is mentioned in Kashyapa samhitha as Artavajanaka, hence an effort to evaluate its effect on estrous phase of female Wistar albino rats is the aim of this study. The selected animal was grouped into four groups with 6 animals each. The animal experiment showed significant increase in estrus phase of the oestrous cycle in rats which is the active phase of mating where the female receives the male.
الملخص
Background- Polycystic ovary syndrome (PCOS) is major endocrine and metabolic disease in reproductive women. As per latest procedures, letrozole should be taken as the first-line pharmacological treatment for infertile women with PCOS. This study was planned to study the role of clinical profile in ovulation induction after letrozole therapy among infertile women with polycystic ovarian syndrome. This was a prospective analytical observational st Methods- udy carried out at the IVF centre, SMS Medical College, Jaipur. The present study enrolled 100 patients attending the IVF centre for fertility treatment who were diagnosed with PCOS as per Rotterdam criteria. Anthropometric measurements like Body mass index (BMI calculated as weight in kilograms divided by square of height in meters) and waist circumference (the smallest circumference at the level of umbilicus) was taken. A comprehensive physical examination of all patients was done to note signs of clinical hyperandrogenism like acne, alopecia, and hirsutism. Treatment response was defined as ovulation in response to letrozole in doses from 2.5 mg to 7.5 mg. In this study, women from 20 to 25 years of age w Results- ith shorter duration of infertility, lower BMI, lower waist circumference, absence of hirsutism, or mild hirsutism on clinical examination showed better response to Letrozole. ConclusionLetrozole can be considered a suitable ovulation induction agent in infertile PCOS patients with lower BMI, lower waist circumference, and absence of hirsutism. A predictive ovulation score can be developed from basic clinical parameters. Identification of various factors affecting response to letrozole may help the clinician to individualize ovulation induction protocols in PCOS women.
الملخص
OBJETIVO: Describir las tasas de recién nacidos vivos (RNV) y embarazo de la terapia de reproducción médicamente asistida de baja complejidad del Centro de Reproducción Humana de la Universidad de Valparaíso, Chile. MÉTODO: Estudio retrospectivo de todos los ciclos de estimulación ovárica controlada con inseminación intrauterina (IIU) completados, entre los años 2011 y 2019. Se evaluaron las características clínicas basales y los resultados en IIU homólogas y heterólogas según el ciclo inseminado, la causa de infertilidad, el rango etario y el índice de masa corporal (IMC). El desenlace principal fue la tasa de RNV por ciclo inseminado. RESULTADOS: Se estudiaron 1415 ciclos en 700 parejas. La tasa acumulativa de RNV fue del 19,6%, un 18,3% en IIU homóloga y un 39,0% en IIU heteróloga. La tasa de RNV fue del 10,0% al primer ciclo, del 5,8% al segundo ciclo y del 3,7% al tercer o más ciclos. Al separar por IIU heteróloga, esta aumenta al 24,4% al primer ciclo y al 14,6% al segundo ciclo. La tasa de RNV es significativamente mejor en pacientes menores de 35 años (23,7%) y con IMC < 29 (20,8%). CONCLUSIONES: El tratamiento de baja complejidad en pacientes infértiles es una opción terapéutica vigente con una aceptable tasa de RNV por ciclo inseminado. Los resultados están influenciados por la edad y por el IMC.
OBJECTIVE: To describe the rates of live newborns (LNB) and pregnancy of the low complexity therapy of the Centre for Human Reproduction of Universidad de Valparaíso, Chile. METHOD: Retrospective study of all cycles of controlled ovarian stimulation with intrauterine insemination (IUI) completed between 2011-2019. The baseline clinical characteristics and results in homologous and heterologous IUI were evaluated according to inseminated cycle, cause of infertility, age range and body mass index (BMI). The main outcome was rate of LNB per inseminated cycle. RESULTS: 1415 cycles were studied in 700 couples. The cumulative rate of LNB was 19.6%, 18.3% in homologous IUI and 39.0% in heterologous IUI. The LNB rate was 10.0% at the first cycle, 5.8% at the second cycle, 3.7% at the third or more cycles. When separating by heterologous IUI, it increases to 24.4% in the first cycle and 14.6% in the second cycle. The LNB rate is significantly better in patients under 35 years of age (23.7%) and with a BMI less than 29 (20.8%). CONCLUSIONS: Treatment of low complexity in selected infertile patients is a current therapeutic option with an acceptable rate of LNB per inseminated cycle. The results are influenced by age and BMI.
الموضوعات
Humans , Male , Female , Adult , Birth Rate , Reproductive Techniques, Assisted , Infertility/therapy , Ovulation Induction , Insemination, Artificial , Body Mass Index , Retrospective Studies , Age Factors , Pregnancy Rate , Live Birthالملخص
Abstract Objective The aim of the present retrospective study was to investigate the effectiveness of single-dose gonadotropin releasing hormone (GnRH) antagonist administration, the day after human chorionic gonadotropin (hCG) triggering for final oocyte maturation, on the prevention of premature luteinization in patients with diminished ovarian reserve in in-vitro fertilization (IVF) cycles. The secondary objective of the study was to search the effect of this protocol on pregnancy outcomes. Methods This is a retrospective study including 267 infertile patients who have single antral follicle seen with ultrasonography on the 2nd or 3rd day of the menstrual cycle before starting IVF treatment. We randomized patients into two groups. The case group comprised patients who had single-dose GnRH antagonist injection the day after hCG triggering formed, and the patients who had the standard treatment regime formed the control group. In both groups, the oocytes were collected 36 hours after hCG injection. Results The premature ovulation rate was significantly low in the case group compared with the control group (6.86 versus 20.6% per scheduled cycle) (p=0.022). Also, the oocyte retrieval rate (93.14 versus 67.87% per scheduled cycle) (p=0.013), the oocyte maturity rate (79.42 versus 47.87%) (p=0.041), the fertilization rate (65.68 versus 34.54%) (p=0.018), and the embryo transfer rate per scheduled cycle (44.11 versus 18.78%) (p=0.003) were higher in the GnRH antagonist group than in the control group. Conclusion The administration of GnRH antagonist the day after hCG trigger in IVF treatments of patients with diminished ovarian reserve enabled a significant decrease in the rate of premature ovulation but had no effect on live birth rate.
Resumo Objetivo O objetivo do presente estudo retrospectivo foi investigar a eficácia da administração do antagonista do hormônio liberador da gonadotrofina (GnRH) em dose única no dia seguinte ao desencadeamento da gonadotrofina coriônica humana (hCG) para a maturação final do oócito, na prevenção da luteinização prematura em pacientes com diminuição do ovário reserva em ciclos de fertilização in vitro (FIV). O objetivo secundário do estudo foi pesquisar o efeito deste protocolo nos resultados da gravidez. Métodos Trata-se de um estudo retrospectivo incluindo 267 pacientes inférteis que apresentam um único folículo antral visto por ultrassonografia no 2° ou 3° dia do ciclo menstrual antes de iniciar o tratamento de FIV. Nós randomizamos os pacientes em dois grupos. Os pacientes que receberam injeção de antagonista de GnRH em dose única no dia seguinte ao desencadeamento do hCG formaram o grupo caso, e os pacientes que receberam o regime de tratamento padrão formaram o grupo controle. Em ambos os grupos, os oócitos foram coletados 36 horas após a injeção de hCG. Resultados A taxa de ovulação prematura foi significativamente baixa no grupo caso em comparação com o grupo controle (6,86 versus 20,6% por ciclo programado) (p=0,022). Além disso, a taxa de recuperação de oócitos (93,14 versus 67,87% por ciclo programado) (p=0,013), a taxa de maturidade do oócito (79,42 versus 47,87%) (p=0,041), a taxa de fertilização (65,68 versus 34,54%) (p=0,018) e a taxa de transferência de embriões por ciclo programado (44,11 versus 18,78%) (p=0,003) foram maiores no grupo antagonista de GnRH do que no grupo controle. Conclusão A administração de antagonista de GnRH, no dia seguinte ao desencadeamento de hCG em tratamentos de FIV de pacientes com reserva ovariana diminuída permitiu uma redução significativa na taxa de ovulação precoce,mas não teve efeito na taxa de nascidos vivos.
الموضوعات
Humans , Female , Pregnancy , Oocytes , Receptors, LHRH , Pregnancy Rateالملخص
This study aimed to determine the effect of antral follicle count (AFC), and pubertal status on the fertility of beef heifers. In this study, 230 Nelore heifers, 20±2 months of age, were subjected to an estradiol progesterone-based timed artificial insemination (TAI) program. On Day 0 of the TAI protocol, the heifers were examined by transrectal ultrasound to record videos of the ovaries. Later, in the darkroom of the laboratory of images, the videos were analyzed for AFC (≥ 3 mm) of each ovary. Females who failed the first TAI were resynchronized with the same hormonal protocol. The pregnancy status was evaluated by ultrasonography 30 days after each FTAI. The general mean of the AFC was 22.0 follicles. Thus, the heifers were divided into 2 groups according to AFC: Low AFC (Ë 22 follicles, n = 114), and High AFC (≥ 22 follicles, n = 116). No differences (P > 0.05) in the pregnancy per AI (P/AI) were observed between the Low and High AFC groups, and between pubertal and prepubertal categories. The P/AI was not different between heifers that displayed or did not estrus (P = 0.2). However, considering the estrus response of each AFC group, High AFC heifers that displayed estrus had greater P/AI (P = 0.01) than High AFC heifers that did not display estrus. In summary, AFC and pubertal status did not affect the fertility of Nelore heifers. In contrast, the P/AI of heifers that did not display estrus was lower than heifers observed in estrus only in the High AFC group.(AU)
Esse estudo teve como objetivo determinar o efeito da contagem de folículos antrais (CFA) e da maturidade sexual na fertilidade de novilhas de corte. Neste estudo, 230 novilhas Nelore, com 20 ± 2 meses de idade, foram submetidas a um protocolo de inseminação em tempo-fixo (IATF) a base de estradiol e progesterona. No Dia 0 do protocolo de IATF as novilhas foram examinadas por ultrassonografia transretal e vídeos dos ovários foram gravados para posterior CFA (≥ 3 mm) realizada na sala escura do laboratório de imagens. Trinta dias após a ultrassonografia, as fêmeas que falharam na primeira IATF foram ressincronizadas com o mesmo protocolo hormonal. A prenhez foi avaliada por ultrassonografia 30 dias após cada IATF. A média geral da CFA foi de 22 folículos; assim, as novilhas foram divididas em 2 grupos de acordo com a CFA: CFA baixa (Ë 22 folículos, n=114) e CFA alta (≥ 22 folículos, n=116). A prenhez por IA (P/IA) foi semelhante (P > 0,05) entre os grupos CFA baixa e alta e entre novilhas púberes e pré-púberes. A P/IA não foi diferente entre as novilhas que apresentaram ou não cio (P = 0,2). No entanto, novilhas com CFA alta que apresentaram cio tiveram maior P/IA (P = 0,01) do que novilhas com CFA alta que não apresentaram cio. Em conclusão, a CFA e a maturidade sexual não afetaram a fertilidade de novilhas. Por outro lado, a P/IA das novilhas que apresentaram cio foi maior do que das novilhas não observadas em cio apenas no grupo CFA alta.(AU)
الموضوعات
Animals , Female , Pregnancy , Cattle/embryology , Insemination, Artificial/methods , Fertility/physiology , Ovarian Follicle/physiology , Pregnancy, Animal/physiologyالملخص
Objective:To investigate the effects of letrozole combined with human menopausal gonadotropin (HMG) on pregnancy rate and prognosis in patients with refractory polycystic ovary syndrome (PCOS).Methods:A total of 102 patients with refractory PCOS who received treatment in Jinhua Hongyue Women's and Children's Hospital between May 2019 and May 2020 were included in this study. They were randomly assigned to observation and control groups ( n = 51/group). All patients received the same treatment in the early period. During later ovulation induction period, patients in the control group were administered HMG and those in the observation group were given letrozole combined with HMG. Before treatment and 3 months after treatment, sex hormones [follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E 2), testosterone (T)], arterial hemodynamic indicators around the follicle [end diastolic velocity (EDV), peak systolic velocity (PSV), pulsation index (PI)], endometrial thickness and classification were compared between the two groups. The ovulation rate and pregnancy rate as well as pregnancy outcomes at 6 months of follow-up were recorded in each group. Results:After 3 months of treatment, FSH, LH, E 2 and T levels in each group were significantly decreased compared with those before treatment (all P < 0.05). FSH, LH, E 2 and T levels in the observation group were (1.85 ± 0.45) U/L, (9.86 ± 1.47) U/L, (81.25 ± 10.47) pmol/L, (1.75 ± 0.26) nmol/L, respectively, which were significantly lower than those in the control group [(3.12 ± 1.47) U/L, (12.58 ± 2.14) U/L, (109.25 ± 27.14) pmol/L, (3.58 ± 0.76) nmol/L, t = 5.90, 7.48, 6.87, 16.27, all P < 0.05). EDV in each group was significantly decreased after 3 months of treatment compared with that before treatment (both P < 0.05). After treatment, EDV in the observation group was significantly lower than that in the control group [(3.12 ± 1.42) cm/s vs. (5.14 ± 1.89) cm/s, t = 21.14, P < 0.001]. PSV in each group was significantly increased after treatment compared with that before treatment (both P < 0.05). After treatment, PSV in the observation group was significantly higher than that in the control group [(13.36 ± 2.01) cm/s vs. (10.24 ± 2.47) cm/s, t = 4.21, P < 0.001]. In each group, PI measured after treatment was not significantly different from that measured before treatment (both P > 0.05). After treatment, endometrial thickness in the observation group was significantly higher than that in the control group [(9.09 ± 1.58) mm vs. (8.41 ± 1.42) mm, t = 2.28, P < 0.05]. Ovulation rate in the observation group was significantly higher than that in the control group [88.24% (45/51) vs. 70.59% (36/51), χ2 = 4.85, P < 0.05]. There were no significant differences in endometrial type, biochemical pregnancy, clinical pregnancy rate, abortion rate, and premature delivery rate between the two groups (all P > 0.05). Conclusion:Letrozole combined with HMG has an ideal effect on refractory PCOS. It can improve the levels of sex hormones, restore the hemodynamic status in ovarian stroma and increase ovulation rate.
الملخص
Objective:To explore the related factors of poor ovarian response (POR) in patients receiving controlled ovarian stimulation (COS) and to establish the nomogram for predicting POR in patients who received in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI).Methods:In this retrospective research, clinical data of 17 164 cycles of patients who received IVF/ICSI treatment at Henan Provincial People′s Hospital from September 1st, 2016 to September 1st, 2020 were analyzed. Independent correlative factors affecting the occurrence of POR were screened by logistic regression, which were the model enrollment variables in the prediction model. Totally 13 266 cycles with well-record of enrollment variables were screened, and these data were randomly divided into model group (9 896 patients) and validation group (3 370 patients) according to 3∶1. The nomogram was established according to the regression coefficient of the relevant variables. The prediction accuracy of the nomogram was evaluated by calculating area under the receiver operating characteristic curve (AUC).Results:Multivariate logistic regression analysis showed age, infertility type, body mass index, anti-Müllerian hormone, basal follicle stimulating hormone, basal estrogen, antral follicle number, previous times of POR, history of ovarian surgery, ovulation stimulation protocol and average amount of gonadotropin were independent correlative factors affecting the occurrence of POR (all P<0.05). In the model group, according to the above factors, the prediction model and nomogram of POR risk were constructed and the validation group verified the model. The AUC of the model group was 0.893 (95% CI: 0.885-0.900), and the AUC of the validation group was 0.890 (95% CI: 0.878-0.903). Conclusion:The influencing factors of POR after COS in patients treated by IVF/ICSI are screened, and the nomogram for predicting POR established in this study is proved to be effective, simple, intuitive and clear in predicting the occurrence of POR.
الملخص
Objective:To investigate the relationship between the level of anti Mullerian hormone (AMH) and antral follicle count (AFC) and oocytes number in patients with in vitro fertilization (IVF). Methods:372 patients with primary infertility who received IVF and embryo transfer (IVF-ET) treatment in the Affiliated Hospital of Guizhou Medical University from January 2020 to December 2020 were prospectively selected as the study subjects. According to the oocytes obtained, the patients were divided into low ovarian response group (LOR group, the number of oocytes obtained ≤5, n=37), normal group (NOR group, the number of oocytes obtained was 6-15, n=292) and high ovarian response group (HOR group, the number of oocytes obtained >15, n=43). The levels of AMH and AFC in the three groups were observed. The relationship between AMH, AFC with LOR and HOR was observed by multivariate logistic analysis. The sensitivity, specificity, optimal cut-off value and area under the curve (AUC) of AMH and AFC for predicting LOR and HOR were calculated by receiver operating characteristic (ROC) curve. Results:There were significant difference in AMH, AFC and oocyte number among the three groups (all P<0.05). The AMH, AFC and oocyte number in NOR group were higher than those in LOR group, and AMH, AFC and oocyte number in HOR group were higher than those in LOR and NOR group (all P<0.05). The results of binary multivariate analysis showed that AFC and AMH were protective factors of LOR (all P<0.05), while AFC and AMH were risk factors of HOR ( P<0.05). The sensitivity and specificity of AMH and AFC in predicting LOR were 83.8% and 75.7%, 65.7% and 84.2%, respectively. The sensitivity of AMH or AFC positive as the standard for predicting LOR was 94.6%, and the specificity of AMH and AFC was 91.6%. The sensitivity and specificity of positive AMH and AFC in predicting HOR were 69.8% and 74.4%, 69.6% and 83.6%, respectively. The sensitivity of AMH or AFC positive as the standard for predicting HOR was 93.0%, and the specificity of AMH and AFC positive as the standard for predicting HOR was 93.0%. Conclusions:AMH and AFC are significantly correlated with oocyte number in patients with primary infertility. Flexible application of AMH and AFC is beneficial to better predict the number of oocytes obtained, which provides a reference for clinical development of individualized ovarian stimulation program.
الملخص
Objective:The aim of this study was to investigate the efficacy and safety of rtansabdominal wall press to adjust ovarian position in patients with difficulty in oocyte retrieval.Methods:A retrospective case-control study was conducted to collect 177 patients with difficulty in oocyte retrieval from January 2020 to December 2021 in the Reproductive Medical Center of Peking University Shenzhen Hospital. Among the 177 patients with difficulty in oocyte retrieval, 76 patients used transabdominal wall press to adjust the position of the ovary (pushing group), and the other 101 patients were treated with routine oocyte retrieval (control group). The oocyte retrieval rate, the number of oocyte and mature oocyte, the number of transferable embryos and high-quality embryos were compared between the two groups, and the incidence of complications was recorded.Results:There was no significant difference between the two groups in the ovarian stimulation program, the dosage of ovulation promoting drugs and the number of follicles ≥14 mm on human chorionic gonadotropin (HCG) day (all P>0.05). The days of promoting ovulation in the pushing group were longer than those in the control group, and the level of estradiol on HCG day was significantly higher than that in the control group (all P<0.05). The rate of oocyte retrieval, the number of oocytes retrieved, the number of transferable embryos and high-quality embryos in the pushing group were significantly higher than those in the control group (all P<0.05). The incidence of complications during oocyte retrieval in the pushing group was significantly lower than that in the control group ( P=0.003). Conclusions:Transabdominal wall press to adjust ovarian position can improve oocyte retrieval rate and reduce the incidence of complications in patients with difficulty in oocyte retrieval.
الملخص
Polycystic ovary syndrome(PCOS)is the most common endocrine and metabolic disease in women of reproduc-tive age.PCOS is characterized by ovulatory disruption,which can lead to infertility.Patients with PCOS are also more likely to have poor pregnancy outcomes.For obese women,lifestyle interventions are recommended first,which have general health benefits.For women who have difficulty changing their lifestyle,drugs for the treatment of obesity or bariatric surgery could be considered.Clomiphene citrate is the first-line medication after weight loss that has been utilized in the past.Letrozole is supplanting clomiphene as the best option for ovulation induction for now,particularly in patients with PCOS.Metformin can improve ovulation and pregnancy rates;however,it has minimal effects in terms of raising live birth rates.Second-line therapies include gonadotropins and laparoscopic ovary drilling.In vitro fertilization can be utilized as a third-line treatment for patients with PCOS who have failed ovulation induction therapy or have other infertility factors.In summary,to achieve fer-tility,patients with PCOS require standardized individualized therapy.
الملخص
Abstract This was a forthcoming study of those patients, who undergo in-vitro fertilization (IVF) and freeze-all embryo, who acquiesce for the study. The number of participated patients (n=350) in this study, underwent for IVF. The blood sample was collected from patients to evaluate the level of serum progesterone in vacuum vials on the day of ovulation trigger. After 36 hrs of ovulation trigger, ovum picked up was done. Quantitative methods were used to estimate the level of serum progesterone through the electrochemiluminescence immunoassay and correlation of serum progesterone with embryo transfer (ET) outcomes. Main outcome of this current study was to evaluate the value of mean serum progesterone level i.e.0.868± 0.712 ng/ml and 0.88±0.723 ng/ml was found in case of pregnancy positive and negative respectively, at p=0.216 value. In antagonist (n=40) and agonist (n=310) cases, it was 8(20%) and 37(11.94%) PL occurrence was noted at p=0.143 respectively. An overall value of the premature lutenization (PL) occurrences was 13.63% and 15.25% observed in both positive and negative cases of pregnancy at p=0.216 respectively. This study concluded that 12.66% of PL occurrences were recorded in the case of IVF. Study results proved, there were no significant effect of PL on pregnancy outcomes.