Effects of time of recombinant luteinized hormone supplementation on pregnancy outcomes of women with advanced reproductive age during follicular-phase long protocol / 中华妇产科杂志

Objective:To investigate the effects of supplementation of recombinant luteinized hormone (rLH) and its timing on pregnancy outcomes of patients at 35 years or older with follicular-phase long protocol.Methods:Clinical data of women undergoing in vitro fertilization or intracytoplasmic sperm injection with follicular-phase long protocol was collected and retrospectively analyzed in the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2019. There were 558 patients at 35 years or older included in this study, and they were divided into three groups: group A was patients with only recombinant follicle stimulating hormone (rFSH) stimulation (127 cycles), group B was patients with rFSH plus rLH supplementation in the mid-follicular phase (141 cycles), and patients in group C received combined rFSH and rLH from the first day of ovarian stimulation (290 cycles). The basic characteristics of patients of each group were observed and the effects of ovarian simulation and pregnancy outcomes were compared among the three groups. Logistic regression model was performed to explore the association between different groups and pregnancy outcomes.Results:The basic characteristics such as age, duration of infertility, body mass index (BMI) and serum basic follicle stimulating hormone (FSH) were comparable among the three groups (all P>0.05). Anti-Müllerian hormone (AMH), antral follicles count (AFC) and basic luteinized hormone (LH) were significantly lower in group C compared to group A and group B (all P<0.05). There were statistically significant differences in initiation dosage, total dosage and duration of gonadotropin (Gn) among the three groups (all P<0.01), the initiation dosage, total dosage and duration of Gn were higher in group C than the other two groups. The number of oocytes retrieved and available embryos were significantly lower in group B and group C than group A (all P<0.001). In fresh embryo transfer cycles, significantly higher implantation rate (45.3%, 117/258) and clinical pregnancy rate (52.6%, 111/211) were found for group C when compared with group A and group B ( P=0.036, P=0.006). The live birth rate in fresh embryo transfer cycles was comparable among the three groups ( P=0.098). The implantation rate, clinical pregnancy rate and live birth rate in the subsequent frozen-thawed embryo transfer cycles did not differ significantly among the three groups (all P>0.05). There were no significantly differences in the cumulative pregnancy rate and the cumulative live birth rate among the three groups (all P>0.05). After adjusted for age, BMI, AMH, AFC, basic FSH and LH, total Gn dosage, endometrial thickness at transfer, number of oocytes retrieved, number of embryos transferred and stage of embryo transferred, in fresh embryo transfer cycles, the clinical pregnancy rate (adjusted OR=2.793, 95% CI: 1.512-5.162, P<0.001) and live birth rate (adjusted OR=2.324, 95% CI: 1.241-4.351, P=0.008) were higher in group C, while clinical pregnancy rate and live birth rate were similar between group B and group A in fresh embryo transfer cycles (all P>0.05); there was no significant difference in cumulative live birth rate among the three groups ( P>0.05). Conclusions:The supplementation of rLH from the first day of ovarian stimulation improves the pregnancy outcomes of patients at 35 years or older in fresh embryo transfer cycles during follicular-phase long protocol. However, the supplementation of rLH has no benefit on cumulative live birth rate.

Influence of female age on the fresh cycle live birth rate of different controlled ovarian hyperstimulation protocols in poor ovarian response patients / 中华妇产科杂志

Objective:To investigate the influence of age on the fresh cycle live birth rate in patients with poor ovarian response in different controlled ovarian hyperstimulation groups.Methods:The clinical data of 3 342 patients in The First Affiliated Hospital of Zhengzhou University from February 2014 to November 2018 were retrospectively collected, including early-follicular phase long-acting gonadotropin-releasing hormone (GnRH) agonist long protocol group (1 375 cases), mid-luteal phase short-acting GnRH agonist long protocol group (1 161 cases) and GnRH antagonist protocol group (806 cases); each group was divided into 4 subgroups according to age: ≤30 years, 31－35 years, 36－40 years and >40 years, the pregnancy outcomes in each age subgroup were analyzed under different controlled ovarian hyperstimulation protocols.Results:In early-follicular phase long-acting GnRH agonist long protocol group, the final live birth rates of each age subgroup were 39.4% (228/579), 36.1% (135/374), 16.6% (48/290) and 3.0% (4/132); in mid-luteal phase short-acting GnRH agonist long protocol group, live birth rates of each age subgroup were 32.1% (99/308), 20.8% (55/264), 13.0% (45/346) and 7.0% (17/243); in GnRH antagonist protocol group, live birth rates of each age subgroup were 22.8% (26/114), 16.3% (25/153), 11.2% (31/278), and 3.8% (10/261); the live birth rate of each group decreased significantly with the increase of age (all P<0.01). When the age≤35 years old, the fresh cycle live birth rate of the early-follicular phase long-acting GnRH agonist long protocol group was significantly better than those of the other two groups (all P<0.01). The multivariate logistic regression analysis of age and live birth rate of the three controlled ovarian hyperstimulation groups showed age was the independent influence factor ( OR=0.898, 95% CI: 0.873-0.916, P<0.01; OR=0.926, 95% CI: 0.890-0.996, P<0.01; OR=0.901, 95% CI: 0.863-0.960, P<0.01). Conclusions:Age is an independent influencing factor for the prediction of fresh cycle live birth rate in low ovarian response patients. No matter which controlled ovarian hyperstimulation protocol is adopted, the final live birth rate decreases significantly with the increase of women′s age. In addition, the early-follicular phase long-acting GnRH agonist long protocol has the highest fresh cycle live birth rate among all controlled ovarian hyperstimulation groups.

Clinical analysis of 77 cases with ovarian hyperstimulation syndrome / 上海交通大学学报（医学版）

Objective·To discusses the high risk factors and therapy strategies for ovarian hyperstimulation syndrome (OHSS). Methods·Seventy-seven cases with moderate and severe OHSS were collected to be retrospectively analyzed in Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January 2010 to December 2016. Results·Compared with non-pregnant patients, pregnant patients were more likely to have severe OHSS (P<0.05). Embryo transfer patients who underwent ovulation induction and oocyte retrieval became severe OHSS much more easily and had a much longer hospital stay than oocyte retrieval patients (P<0.05). Pumping ascites and pleural effusion or not has no effect on the length of hospital stay and the usage of low molecular dextran for patients with severe OHSS. Conclusion·The risk of OHSS should be evaluated to determine whether or not to carry out a fresh embryo transfer in patients who underwent ovulation induction and oocyte retrieval. For OHSS patients who have undergone embryo transfer or pregnancy, more attention should be paid to the progress of the disease, and individualized treatment is required.

A randomized, single-blind, parallel-controlled and multicentre study：compare the efficacy and safety of domestic and imported human recombinant FSH in WHO group Ⅱ anovulatory infertility / 中华妇产科杂志

Objective To evaluate the efficacy and safety of domestic human recombinant FSH (rhFSH) in women with anovulation of WHO groupⅡ. Methods A randomized, blind, parallel-controlled, non-inferiority and multicenter study was performed. A total of 534 admitted to 13 hospitals from May 2008 to August 2009. There were 531 women with ovulatory disorder was included in the statistical analysis, were randomly divided into test group (domestic rhFSH, n=352) and control group (imported rhFSH, n=179). Percentage of cycle with mature follicle, ovulation rate, clinical pregnancy rate, multiple pregnancy rate, ovarian hyperstimulation syndrome (OHSS) and adverse events were observed. Results No statistical significant differences (P>0.05) were observed between the two groups in terms of the efficiency on mature follicle [91.8%(323/352) versus 88.8%(159/179)], ovulation rate [91.3%(295/323) verus 90.6%(144/159)], clinical pregnancy rate [19.2%(62/323) verus 18.2%(29/159)], the number of the follicles0.05), and no other adverse events were observed in test group during treatment. Conclusion Ovarian stimulation with domestic rhFSH is effective, safe and economical in women with anovulation of WHO groupⅡ.

Clinical observation and treatment of ovulation dysfunction / 重庆医学

Objective Through observing and treating the ovulation dysfunction patients with birth demand ,to study the clinic characteristics and therapy strategy .Methods 630 clinical cases including natural cycles and controlled ovarian stimulated cycles . monitored by transvaginal B-ultrasonography from April 2008 to April 2012 ,The common reasons ,clinical manifestation ,and out-come undergoing different treatment strategies were analyzed .Results In the natural cycles ,41 .61% patients suffered ovulation dysfunction ,PCOS patients occupied the most .Through the therapy of controlled ovarian stimulating on these patients ,60 .84% of ovulation dysfunction patients recovered normal ovulation .The therapeutic regimen of clomiphene citrate (CC) 50 mg and of CC combined with human menopausal gonadotropin(HMG) showed a higher ovulation rate ,66 .49% and 67 .57% respectively(P<0 .05) .Anovulia was the most commonly type of the ovulation dysfunction ,followed small follicle ovulation and luteinizing unrup-tured follicle .Conclusion Ovulation dysfunction is frequent in infertility patients .Understanding the clinical characteristic and the disease cause ,working out the favourable and effective therapeutic regimen can increase their conception possibility .

Inseminação intrauterina: uma alternativarealista em reprodução assistida / Intrauterine insemination: a realistic alternative in assisted reproduction

Objetivo: o propósito deste estudo é determinar se a probabilidade de gravidez aumenta com a utilização da inseminação intrauterina associada à hiperestimulação ovariana controlada. Material e Métodos: este estudo prospectivo incluiu 51 mulheres submetidas a 64 ciclos de inseminação intraovariana. Três protocolos de estimulação ovariana foram utilizados: citrato de clomifeno mais gonadotrofina menopausal humana, gonadotrofina menopausal humana ou hormônio recombinante folículo estimulante isolados. As pacientes foram monitoradas por meio de ultrassonografia transvaginal e determinações séricas dos níveis de hormônio luteinizante e hormônio folículo estimulante. Foram, ainda, separadas por idade em dois grupos: Grupo 1 (≤35 anos) e Grupo 2 (>35 anos). Resultados: observou-se uma taxa de 18,7% de gravidez por ciclo e de 23,5% de gravidez por paciente. As taxas de gravidez foram três vezes maiores no Grupo 1 em comparação ao Grupo 2 (24,3 e 8,7%, respectivamente). Não foram observadas diferenças em relação aos parâmetros de hormônio folículo estimulante, espessura do endométrio, número de folículos >16 mm, concentração espermática, total de espermatozoides móveis e taxa de gravidez nos diferentes protocolos de estimulação ovariana. Conclusões: os achados do presente estudo dão suporte à utilização da inseminação intrauterina no tratamento para casais inférteis.

Objective: the purpose of this study was to determine whether pregnancy outcomes are improved by intrauterine insemination combined with controlled ovarian hyperstimulation. Material and methods: this prospective study included 51 women who underwent 64 cycles of intrauterine insemination. Three ovarian stimulation protocols were applied: clomiphene citrate plus human menopausal gonadotropin, human menopausal gonadotropin or recombinant follicle stimulating hormone. Patients were monitored by transvaginal ultrasonography and serum luteinising hormone and follicle stimulating hormone levels. The patients were divided by age into two groups: Group 1 (≤35 years) and Group 2 (>35 years). Results: we observed 18.7% of pregnancy per cycle and 23.5% of pregnancy per woman. Pregnancy rates were three times higher in Group 1 in comparison to Grupo 2 (24.3 and 8.7%, respectively). No differences were observed among the protocols in terms of follicle stimulating hormone parameters, endometrial size, number of ovarian follicles >16mm, sperm concentration, number of motile spermatozoa and pregnancy rates. Conclusions: The findings of this study support the use of intrauterine insemination as treatment for infertile couples.

Heterotopic pregnancy following tuboplasty and ovulation induction by clomiphene citrate and timed intrauterine insemination: Case report.

A Thai woman 36 year old with post tubal sterilization. She was performed for Tuboplasty to restore fertility on new marriage. Both fallopian tubes functioned post correction. She tried natural conception, but was not successful. The doctor treated her by the way of ovarian induction with Clomiphene Citrate and intrauterine insemination. She conceived in the 4th cycle, but she had an heterotopic pregnancy. Gestational sac, fetal echo and positive fetal heart beat were detected at both the intrauterine cavity and the right adnexa, and she had no abnormal symptoms. The Diagnostic Laparoscopy was performed. Following the operation an unruptured right tubal pregnancy was found. Right salpingectomy was done and the pathological report confirmed tubal pregnancy. Post operative time, she had no signs of abortion, and normal intrauterine growth was detected.