A comparison of the rates of and indications for cesarean delivery between Syrian refugee women and Turkish women

SUMMARY OBJECTIVE: The aim of this study was to compare the rates of and indications for cesarean delivery among Syrian refugee women and local Turkish women. METHODS: The study included 74,864 pregnant women, of whom 52,145 were Turkish and 22,719 were Syrian refugee women and who gave birth at our hospital between January 2013 and December 2021. In this study, the pregnant women were divided into two groups: Syrian refugee women and Turkish women, and primary cesarean delivery rates were calculated separately for each group. Cesarean delivery rates for Syrian refugee women and Turkish women were compared separately for each year. Indications for cesarean delivery were determined separately for each group and compared between the groups. RESULTS: The overall cesarean delivery rate was 56% among Turkish women and 32% among Syrian women (p<0.05). The primary cesarean delivery rate was 18.4% for local Turkish women versus 10.7% among Syrian refugee women (p<0.05). The most common indication for cesarean delivery among both Syrian refugee women and local Turkish women was previous cesarean delivery, followed by acute fetal distress and cephalopelvic disproportion. CONCLUSION: Indications for cesarean delivery were similar for Syrian refugee women and local Turkish women, but both overall and primary cesarean delivery rates were higher among local Turkish women compared with Syrian refugee women.

Is the length of time between endometrial scratching and embryo transfer important for pregnancy success? An observational study

SUMMARY OBJECTIVE: This study sought to evaluate the influence of time (early <90 days and late >90 days) and endometrial injury on pregnancy success. METHODS: This is a retrospective study in which all infertile women who underwent at least one in vitro fertilization cycle at Clinica Gera between 2010 and 2015 were considered for inclusion. We included patients with a normal ovarian reserve and regular menses at intervals of up to 30 days. A total of 315 patient files were reviewed, and the study group was composed of patients who faced fertility issues and had male-caused infertility or idiopathic infertility. Also, women with male or unknown cause of infertility who have performed endometrial biopsy and have undergone embryo transfer up to 180 days after this procedure between 2010 and 2015 were included. The patients were divided into two groups according to the interval between biopsy and embryo transfer: group 1 (early—an interval of <90 days) and group 2 (late—an interval of >90 days and up to 180 days). RESULTS: The results were superior for the group with an interval of less than 90 days relative to the group with an interval of more than 90 days (p<0.04). The pregnancy rates for group 1 and group 2 were 58.5% and 43.4%, respectively. The odds ratio for pregnancy success was 1.63 (95% confidence interval: 1.04 to 2.55). CONCLUSION: The early transfer of embryos (<90 days) may produce better results with a high rate of pregnancy. Further studies are necessary to identify the mechanism involved in this phenomenon.

O impacto das intervenções de meditação breve e extremamente breve nas taxas de sucesso de Técnicas de Reprodução Assistida: um estudo controlado randomizado / The impact of brief and extremely brief meditation interventions on the success rates of Assisted Reproductive Techniques: a randomized controlled trial

Introdução: As taxas de sucesso da gravidez com as técnicas de reprodução assistida (ART) têm melhorado constantemente. O efeito das intervenções não farmacológicas, como a meditação, como terapias adjuvantes, nos resultados dos ciclos de ART tem sido pesquisado com resultados promissores. No entanto, até onde sabemos, há muitas dúvidas sobre os efeitos os efeitos de meditação breve e extremamente breve nas taxas de sucesso em ART. Portanto, uma meditação extremamente breve guiada por facilitador e uma meditação breve em formato de áudio e autogerenciada foram estudadas. Objetivo: Investigar o efeito das intervenções da meditação breve (IMB) e extremamente breve (IMEB) na taxa de gravidez em mulheres submetidas à Tecnologia de Reprodução Assistida (TRA). Método: Trata-se de um estudo prospectivo, randomizado, controlado com três braços. As intervenções foram realizadas no período de espera entre a transferência de embriões e o teste de gravidez ß-hCG. O tamanho da amostra foi calculado pelo qui-quadrado de Pearson com base no poder de 80%, tamanho do efeito de 0,4 e nível de confiança de 95%. As variáveis relacionadas ao sucesso da TRA foram incluídas na análise: idade em anos, número de embriões/blastocistos transferidos, número de embriões/blastocistos com qualidade excelente ou muito boa, número de ciclos de fertilização in vitro, faixa etária e se foi transferido embrião ou blastocisto. O teste qui-quadrado (χ2) e ANOVA compararam os valores das variáveis entre os grupos de intervenções e controle. A Análise de Regressão Logística Univariada avaliou se cada variável relacionada ao sucesso da TRA influenciou ou não a resposta da variável de desfecho "gravidez". Utilizou-se Análise de Regressão Logística Múltipla para avaliar a influência dessas variáveis em conjunto no desfecho da gravidez. Resultados: Foram incluídas 68 mulheres com idade de 37,5+4,3 anos (IMEB, n=24; IMB n=22 e GC, n=22). O teste qui-quadrado de Pearson e o teste t de Student para amostras independentes mostraram que não houve diferenças significativas (p<0,05) entre os grupos intervenção e grupo controle. Tanto a IMEB quanto a IMB não tiveram efeito significativo na taxa de gravidez em mulheres submetidas à ART. Conclusão: O uso da meditação breve ou extremamente breve não demonstrou diferenças significativas na taxa de gravidez entre os grupos intervenção e grupo controle, em mulheres sob tratamento com Técnicas de Reprodução Assistida. Os resultados dos efeitos da meditação na taxa de gravidez de mulheres em TRA são inconclusivos na literatura. Necessita-se de ensaios controlados randomizados com amostras maiores comparando ambas as intervenções de meditações breves e extremamente breves a um grupo controle para confirmar os achados deste estudo.

Introduction: Pregnancy success rates with assisted reproductive technology (ART) have steadily improved. The effect of non-pharmacological interventions such as meditation as adjunctive therapies on the outcomes of ART cycles has been researched with promising results. However, to the best of our knowledge, there is much doubt about the effects of brief and extremely brief meditation on ART success rates. Therefore, an extremely brief facilitatorguided meditation and an audio-guided, self-paced short meditation were studied. Objectives: To investigate the effect of extremely brief meditation (EBMI) or brief mindfulness interventions (Brief MI) on pregnancy rate in women undergoing Assisted Reproductive Technology (ART). Method: This is a prospective three arms randomized, controlled study. Interventions were performed in the waiting period between embryo transfer and the ß-hCG pregnancy test. The sample size was calculated using Pearson's chi-square based on a power of 80%, effect size of 0.4 and a confidence level of 95%. Variables related to the success of ART included in the analysis consisted of age in years, number of embryos/blastocysts transferred, number of embryos/blastocysts with excellent or very good quality, number of in vitro fertilization cycles, age range, and whether the embryo was transferred or blastocyst. Chi-square test (χ2) and ANOVA compared variable values between intervention and control groups. Univariate Logistic Regression Analysis evaluated whether each variable related to ART success influenced or not the response of the outcome variable "pregnancy". Multiple Logistic Regression Analysis assessed if these variables could influence jointly the outcome of pregnancy. Results: A total of 68 women aged 37.5+4.3y were included (EBMI, n=24; Brief MI, n=22 and CG, n=22) were. Pearson's Chi-square test and Student's t test for independent samples showed that there were no significant differences (p<0.05) between the intervention groups and control group. Both EBMI and BMI had no significant effect on pregnancy rate in women undergoing ART. Conclusion: The use of brief or extremely brief meditation did not demonstrate significant differences in the pregnancy rate between the intervention and control groups in women undergoing treatment with Assisted Reproductive Techniques. The results of the effects of meditation on the pregnancy rate of women on ART are inconclusive in the literature. Larger sample randomized controlled trials comparing both brief and extremely brief meditation interventions to a control group are needed to confirm the findings of this study.

Effects of paternal age on pregnancy outcomes in frozen-thaw embryo transfer cycles / 现代泌尿外科杂志

【Objective】 To observe the effects of paternal age on the pregnancy outcomes in frozen embryo transfer (FET) cycles. 【Methods】 The clinical data of two groups after propensity score matching (PSM) were retrospectively analyzed, including 738 cycles in the 0.05). The clinical pregnancy rate (52.2%vs. 67.2%) and live birth rate (41.1% vs. 57.2%) decreased in the 40-60 year group compared with those in the 0.05). 【Conclusion】 Advanced paternal age decreases clinical pregnancy rate and live birth rate.

Effect of Insemination Methods on Pregnancy Outcomes of Day 6 Blastocyst Transfer in Frozen Cycles / 中山大学学报(医学科学版)

ObjectiveTo compare the effects of two different insemination methods， conventional in vitro fertilization （IVF） and intracytoplasmic sperm injection （ICSI）， on pregnancy outcomes in patients with frozen-thawed D6（day 6） blastocyst transfer. MethodsA retrospective cohort study was conducted to analyze the clinical data of patients with thawed D6 blastocyst transfer between January 2018 and April 2020 at the Fertility Center of the Third Hospital of Sun Yat-sen University， divided into conventional IVF group （446 cycles ） and ICSI fertilization group （200 cycles） according to the fertilization method. Patients were divided into those with a history of D5（day 5） blastocyst transfer and those without. The patients’ general characteristics， blastocyst quality， and pregnancy outcomes of the two groups were compared. ResultsBMI， years of infertility， and basal FSH were not statistically significant in the IVF and ICSI groups （P > 0.05）. Regardless of the history of D5 transfer， patients in the ICSI group were younger than those in the IVF group （P < 0.001）， the proportion of primary infertility was significantly higher in the ICSI group （P < 0.001）， and the number of oocytes obtained and the number of normally fertilized oocytes in the ICSI group were higher than those in the conventional IVF fertilization group （P < 0.001）. The proportion of stage V and Ⅵ blastocysts was significantly higher in the conventional IVF group than in the ICSI group （21.6 % vs. 3.14 %， P < 0.001）. High-quality blastocysts with an ICM score of A were significantly higher in the ICSI group than in the IVF group （23.8 % vs. 14.3 %， P = 0.01）. The HCG-positive and clinical pregnancy rates were significantly higher in the ICSI group than in the IVF group （65.5 % vs. 48.4 %， P < 0.001； 56 % vs. 41.3 %， P = 0.001）， and embryo implantation and live birth rates were also higher in the ICSI group than in the conventional IVF group （43.8 % vs. 30.9 %， P < 0.001； 43.0 % vs. 31.8 %， P = 0.006）. After correcting for age and number of oocytes obtained between the two groups， the clinical pregnancy rate was still significantly higher in the ICSI group than in the conventional IVF group （OR： 1.590， 95 % CI： 1.030， 2.455， P = 0.036）. Infant birth weight was lower in the ICSI group than in the IVF group （P = 0.016）， and the differences in preterm birth rate， sex ratio， and mode of delivery were not statistically significant between the two groups. ConclusionsClinical pregnancy and live birth rates after thawing and transfer of D6 blastocysts fertilized by ICSI are higher than those of D6 blastocysts fertilized by conventional IVF， which may be related to the different factors contributing to the slow development of blastocysts in patients who received different fertilization methods. The relatively good pregnancy outcome after the transfer of thawed D6 blastocysts fertilized by ICSI may compensate to some extent for the difference in pregnancy outcome due to the relatively slow blastocyst development and a relatively higher proportion of D6 blastocysts after ICSI fertilization in male infertility patients.

Comparison of the Effects of Single Sperm Cryopreservation and Conventional Cryopreservation on Embryo Culture and Pregnancy in Patients Undergoing Micro-TESE / 中山大学学报(医学科学版)

ObjectiveTo compare the effects of single sperm cryopreservation and conventional cryopreservation on embryo culture and pregnancy in patients undergoing microdissection testicular sperm extraction （micro-TESE）. MethodsA retrospective analysis was done on the patients who underwent micro-TESE at the Reproductive Medicine Center in the Sixth Affiliated Hospital of Sun Yat-Sen University between January 2018 and December 2021. The single sperm cryopreservation group included 39 patients undergoing single sperm cryopreservation and 307 MII oocytes. The conventional cryopreservation group included 39 patients undergoing conventional cryopreservation and 410 MII oocytes. Propensity score matching （PSM） was performed to balance the selection bias. The fertility rate， embryo culture and pregnancy of these two groups were compared. ResultsThere was no statistical difference in age， body mass index （BMI）， years of infertility， basal FSH， basal LH， basal E2， AMH， AFC， number of oocytes retrieved and number of transferred embryos between the two groups （P>0.05）. No significant difference was found in fertilization rate （65.8% vs. 60.49%）， available embryo rate （67.82% vs. 58.87%） and high-quality embryo rate （70.80% vs. 75.34%）. The single sperm cryopreservation group had significantly lower clinical pregnancy rate than conventional cryopreservation group （45.45% vs. 70.0%， P=0.049）. ConclusionIf the patients undergoing micro-TESE have very few sperms， single sperm cryopreservation could be an effective choice to increase the utilization of each sperm and ensure the subsequent sperm retrieval after thawing， but the clinical pregnancy rate is decreased. Due to the limited number of cases， we need a large additional number of cases to observe and analyze.

ICSI-A RAY OF HOPE IN DIFFERENT CAUSES OF INFERTILITY

Background- Different success rate of Intracytoplasmic Sperm injection (ICSI) are seen in different causes of infertility. In present study, we evaluated ICSI outcome in different causes of infertility. Materials and Methods- This is a retrospective study of ICSI cycles performed on 120 subjects at ART unit of Omega hospital Pvt Ltd, Nagpur between Jan 2020 and December 2021 to see ICSI outcomes in different causes of infertility. In present Results- study, out of 120 subjects, majority 52(43%) subjects were in the age group of 31-35 years followed by 49(41%) subjects in 25-30 years age group.Majority 55(46%) subjects were having infertility of 5-10 years, 52(43%) subjects were having infertility of <5 years. Majority 83(69%) subjects were having primary infertility. 45(37%) subjects had male infertility, 41(34%) subjects had ovulatory factor, 15(13%) subjects had unexplained infertility. 77(64%) subjects had biochemical pregnancies. 64(53%) subjects had clinical pregnancy by Ultrasound. 59(49%) subjects had live birth. 17(14%) subjects had abortion, 13 (11%) subjects had preterm labour. 3(2%) babies had to be admitted in NICU. Most important 74% mothers & 96% babies reported no complications. We found that ICSI is an effective option in couples with different causes of infertility. Therefore, Conclusion- physicians should have adequate training and required information regarding ICSI to improve the pregnancy outcomes reducing burden of infertility in the community.

One Plus One is Better than Two: An Approach Towards a Single Blastocyst Transfer Policy for All IVF Patients / Um mais um é melhor que dois: Uma abordagem pela prática da transferência de embrião único para todos os pacientes de FIV

Abstract Objective It is known that the single embryo transfer (SET) is the best choice to reduce multiples and associated risks. The practice of cryopreserving all embryos for posterior transfer has been increasingly performed for in vitro fertilization (IVF) patients at the risk of ovarian hyperstimulation syndrome or preimplantation genetic testing for aneuploidy. However, its widespread practice is still controverse. The aim of this study was to evaluate how effective is the transfer of two sequential SET procedures compared with a double embryo transfer (DET) in freeze-only cycles. Methods This retrospective study reviewed 5,156 IVF cycles performed between 2011 and 2019, and 506 cycles using own oocytes and freeze-only policy with subsequent elective frozen-thawed embryo transfers (eFET) were selected for this study. Cycles having elective SET (eSET, n = 209) comprised our study group and as control group we included cycles performed with elective DET (eDET, n = 291). In the eSET group, 57 couples who had failed in the 1st eSET had a 2nd eFET, and the estimated cumulative ongoing pregnancy rate was calculated and compared with eDET. Results After the 1st eFET, the ongoing pregnancy rates were similar between groups (eSET: 35.4% versus eDET: 38.5%; p =0.497), but the estimated cumulative ongoing pregnancy rate after a 2nd eFET in the eSET group (eSET + SET) was significantly higher (48.8%) than in the eDET group (p < 0.001). Additionally, the eSET +SET group had a 2.7% rate of multiple gestations, which is significantly lower than the eDET group, with a 30.4% rate (p < 0.001). Conclusion Our study showed the association of freeze-only strategy with until up to two consecutive frozen-thawed eSETs resulted in higher success rates than a frozenthawed DET, while drastically reducing the rate of multiple pregnancies.

Resumo Objetivo Sabe-se que a transferência de embrião único (SET) é a melhor escolha para reduzir as gestações múltiplas e riscos associados. A prática da criopreservação de todos os embriões para transferência posterior tem sido cada vez mais utilizada para fertilização in vitro (FIV), em especial quando há risco de síndrome de hiperestimulação ovariana ou realização de teste genético pré-implantacional. Entretanto, sua utilização disseminada ainda é controversa. O objetivo deste estudo foi avaliar a eficácia de duas SET sequenciais em comparação com uma transferência de embrião dupla (DET) em ciclos de FIV onde todos os embriões foram criopreservados. Métodos Neste estudo retrospectivo foram revisados 5.156 ciclos de FIV realizados entre 2011 e 2019, e 506 ciclos usando oócitos próprios e criopreservação de todos os embriões com transferências eletivas subsequentes de embriões descongelados, foram selecionados para este estudo. Ciclos com transferência eletiva de embrião único (eSET, n = 209) compuseram nosso grupo de estudo e como grupo de controle incluímos os ciclos com transferência eletiva de dois embriões (eDET, n = 291). No grupo eSET, 57 casais que falharam na 1ª tentativa de eSET tiveram uma 2ª eFET e a taxa de gravidez em curso cumulativa foi estimada para o grupo eSET e comparada com o grupo eDET. Resultados Após a 1ª eFET, as taxas de gravidez em curso foram semelhantes entre os grupos (eSET: 35,4% versus eDET: 38,5%; p = 0,497), mas a taxa de gravidez em curso cumulativa estimada após a 2ª eFET no grupo eSET (eSET + SET) foi significativamente maior (48,8%) do que no grupo eDET (p <0,001). Além disso, as taxas de gestação múltipla foram expressivamente inferiores no grupo eSET + SET (2,7%) quando comparado ao grupo eDET (30,4%; p < 0,001). Conclusão Nosso estudo mostrou que a associação das estratégias de congelamento de todos os embriões com até duas eSETs sequenciais resultou em maiores taxas de sucesso do que uma DET com embriões descongelados, além de reduzir drasticamente a ocorrência de gestações múltiplas.

Is There Any Effect of the Physician Performing Embryo Transfer in IVF-ICSI Treatment: A Prospective Cohort Study / Existe algum efeito domédico que realiza a transferência de embriões no tratamento de FIV-ICSI: Um estudo de coorte prospectivo

Abstract Objective To evaluate whether there is an effect of the physician who transfers the embryos on pregnancy rates in in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) treatment. Methods A total of 757 participants were analyzed between 2012 and 2017. Participants were classified according to 3 physicians who transferred the embryos: ([group 1=164 patients]; [group 2=233 patients]; [group 3=360 patients]). Baseline parameters and IVF-ICSI outcomes were compared between the groups. Results No differences were determined between the groups regarding the baseline parameters (age, age subgroups [20-29, 30-39, and ≥ 40 years old)], body mass index (BMI), smoking status, infertility period, cause of infertility, baseline follicle stimulating hormone, luteinizing hormone, estradiol (E2), thyroid stimulating hormone, prolactin levels, antral follicle count, duration of stimulation, stimulation protocol, gonadotropin dose required, maximum E2 levels, progesterone levels, endometrial thickness on human chorionic gonadotropin (hCG) administration and transfer days (p>0.05). The numbers of oocytes retrieved,metaphase II (MII), 2 pronucleus (2PN), transferred embryo, fertilization rate, day ofembryo transfer, the catheter effect and embryo transfer technique, and clinical pregnancy rates (CPRs) were also comparable between the groups (p>0.05). Conclusion Our data suggests that the physician who transfers the embryos has no impact on CPRs in patients who have undergone IVF-ICSI, but further studies with more participants are required to elucidate this situation.

Resumo Objetivo Avaliar se há ou não efeito do médico que realiza a transferência de embriões nas taxas de gravidez no tratamento com fertilização in vitro-injeção intracitoplasmática de espermatozoide (FIV-ICSI, na sigla em inglês). Métodos Um total de 757 participantes foram analisados entre 2012 e 2017. Os participantes foram classificados de acordo com 3 médicos que transferiram os embriões: ([grupo 1=164 pacientes]; [grupo 2=233 pacientes]; [grupo 3=360 pacientes]). Parâmetros basais e resultados de FIV-ICSI foram comparados entre os grupos. Resultados Nenhuma diferença foi determinada entre os grupos nos parâmetros basais (idade, subgrupos de idade [20-29, 30-39 e ≥ 40 anos)], índice de massa corporal (IMC), tabagismo, período de infertilidade, causa da infertilidade, hormônio folículo estimulante basal , hormônio luteinizante, estradiol (E2), hormônio estimulador da tireoide, níveis de prolactina, contagem de folículos antrais, duração da estimulação, protocolo de estimulação, dose de gonadotrofina necessária, níveis máximos de E2, níveis de progesterona e espessura endometrial na administração de hCG e nos dias de transferência (p>0,05). O número de oócitos recuperados, MII e 2PN, embrião transferido, taxa de fertilização, dia da transferência do embrião, o efeito do cateter e a técnica de transferência de embrião e taxas clínicas de gravidez (RCPs) também foram comparáveis entre os grupos (p>0,05). Conclusão Nossos dados sugerem que o médico que transfere os embriões não tem impacto sobre as RCPs em pacientes que se submeteram a FIV-ICSI, mas mais estudos com mais participantes são necessários para elucidar esta situação.

Effect of Acupuncture on Outcomes of in vitro Fertilisation: A Scoping Review / 中国结合医学杂志

OBJECTIVES@#To identify, examine and summarize the available evidence on the effectiveness and safety of acupuncture for in vitro fertilisation (IVF) outcomes.@*METHODS@#Eight electronic databases, including PubMed, EMBASE, Cochrane Database of Systematic Review, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Database and VIP Database, were searched, supplemented by manual searches. Two researchers independently conducted the literature screening, data extraction, and methodological quality assessments. A narrative description was provided to show the general information and specific characteristics of the included studies. A bubble plot was used to visually display the overall effects of acupuncture on IVF outcomes.@*RESULTS@#Eighty-two studies were identified, including 64 primary studies and 18 systematic reviews. Transcutaneous electrical acupoint stimulation, electric acupuncture and manual acupuncture were applied in most studies and compared with no acupuncture, sham acupuncture and placebo acupuncture control groups. Sixty-three (98.4%) primary studies reported clinical pregnancy rate, and positive effects of acupuncture were found in 34 studies (54.0%). Live birth rate was reported in only 18 (28.1%) primary studies, of which 10 (55.6%) showed positive results. In addition, only 8 and 2 systematic reviews showed that acupuncture could increase clinical pregnancy events and live birth events, respectively. However, none of these reviews was of high methodological quality.@*CONCLUSIONS@#Available evidence suggests that acupuncture therapy could improve clinical pregnancy rates. However, whether acupuncture could increase live birth events was difficult to determine based on the few studies that have reported this outcome indicator. Furthermore, the methodological quality of most systematic reviews was assessed as critically low or low. Studies with a rigorous design and standardized implementation should be performed to refine the available evidence.

Analysis of pregnancy outcomes of single top-quality blastocyst transfer developed from cleavage embryos with different grading / 中华妇产科杂志

Objective:To explore the clinical outcomes of top-quality blastocysts transfer developed from cleavage embryos with different grading and determine whether the cleavage stage embryo morphology grading should be taken into consideration when transferring the embryo at the blastocyst stage.Methods:A number of 3 059 cycles were included with single top-quality blastocyst transfer dating from January 2017 to May 2021 in Henan Provincial People′s Hospital. According to the number of cleavage sphere and degree of fragmentation, all cleavage stage embryos were divided into three groups: top D3 embryo (8 cells, ≤5% fragments)-TB group, suboptimal D3 embryo (8 cells, 5%<fragments≤10%; 7 cells or 9 cells, ≤10%)-TB group, and normal D3 embryo-TB group. Univariate analysis, multivariate logistic regression analysis and threshold effect analysis were performed on the data.Results:The clinical pregnancy rates of top D3 embryo-TB group(1 326 cycles), suboptimal D3 embryo-TB group (830 cycles) and normal D3 embryo-TB group (903 cycles) were 69.53%, 70.12% and 66.67%, respectively ( P>0.05); and the early abortion rate were 10.74%, 12.54% and 12.62%, respectively ( P>0.05). After adjusting for confounders, logistic regression showed that no significant associations were found between cleavage stage embryo morphology grading and clinical pregnancy rate (suboptimal D3 embryo-TB group: OR=1.02, 95% CI: 0.76-1.38, P=0.879; normal D3 embryo-TB group: OR=0.84, 95% CI: 0.61-1.14, P=0.262) and early abortion rate (suboptimal D3 embryo-TB group: OR=1.18, 95% CI: 0.77-1.82, P=0.445; normal D3 embryo-TB group: OR=1.26, 95% CI: 0.81-1.98, P=0.309). The results of threshold effect analysis showed that when a single top-quality blastocysts was transferred, the effect of age on the clinical pregnancy rate showed a curve relationship, when the age was≥33 years old, the clinical pregnancy rate decreased significantly with age increased ( OR=0.89, 95% CI: 0.83-0.95, P=0.007); and there was no significant change in early abortion rate ( OR=1.01, 95% CI: 0.97-1.06, P=0.628). Conclusions:Cleavage stage embryo grading is not found to correlate with clinical outcomes in single top-quality blastcyst tranfer. Therefore, when considering blastocyst transfer, its morphology at blastocyst stage is more relevant. The effect of age on pregnancy outcomes of single blastocyst transfer should be considered.

Clinical study of hysteroscopical electroresection of FIGO type 3 myoma / 中华妇产科杂志

Objective:To analyze the clinical application and to evaluate the efficiency of hysteroscopical electroresection of International Federation of Gynecology and Obstetrics (FIGO) type 3 myoma.Methods:The clinical data of patients who underwent hysteroscopical electroresection single FIGO type 3 myoma in Obstetrics and Gynecology Hospital of Fudan University from January 2019 to October 2021 were collected retrospectively. The clinical symptoms, myoma size, location, operation time, intraoperative bleeding, surgical complications and postoperative follow-up were recorded, and the subsequent pregnancy outcomes were followed-up.Results:Totally 35 patients with FIGO type 3 myoma were included in this study. The average age was (36.6±4.7) years old, the diameter of myoma was (4.0±1.2) cm (range: 2.0-5.8 cm). The rate of complete resection of myoma in one operation was 86% (30/35), the average operation time was (41±15) minutes (range: 20-65 minutes), and the average intraoperative bleeding was (24±18) ml (range: 5-150 ml). No complications such as uterine perforation, massive hemorrhage, hyperhyderation syndrome and infection occurred in all patients perioperation. There were 20 cases with significant increase of menstruation before operation, the cure rate and effective rate of hysteroscopical electroresection of FIGO type 3 myoma were 75% (15/20) and 95% (19/20). There were 24 patients with fertility requirements, their average follow-up time was (14.5±6.8) months, the pregnancy rate within 1 year after operation was 79% (19/24), and the average postoperative pregnancy time was (5.8±3.4) months. There were 15 cases who had completed delivery after operation, including 10 cases of vaginal delivery and 5 cases of cesarean section, and none of them had uterine rupture.Conclusions:Hysteroscopy could effectively resect FIGO type 3 myoma. Hysteroscopical electroresection of FIGO type 3 myoma is minimally invasive with rapid postoperative recovery and could achieve pregnancy in a short time, which is not only helpful to reduce the amount of menstruation, but also beneficial for the prognosis of fertility. It should be carried out by the experienced hysteroscopists.

Effectiveness, safety and cost of urinary follicle stimulating hormone in controlled ovarian stimulation in China: multi-center retrospective cohort study of 102 061 in vitro fertilization cycles / 中华妇产科杂志

Objective:To explore the effectiveness, safety and cost between urinary follicle stimulating hormone (uFSH) and recombinant follicle stimulating hormone (rFSH) in controlled ovarian stimulation (COS) in China.Methods:Data were collected from 16 reproductive centers in China covering oocytes collection time from May 1, 2015 to June 30, 2018. Eligible patients were over 18 years old, adopting COS with uFSH (uFSH group) or rFSH (rFSH group) as start gonadotropins (Gn), and using in vitro fertilization (IVF) and (or) intracytoplasmic sperm injection for fertilisation, excluding frozen embryo recovery cycle. Generalised estimating equation was used to address the violation of independency assumption between cycles due to multiple IVF cycles for one person and clustering nature of cycles carried out within one center. Controlling variables included age, body mass index, anti-Müllerian hormone level, cause of infertility, ovulation protocol, type of fertilisation, number of embryos transferred, number of days of Gn use.Results:Totally 102 061 cycles met eligibility criteria and were included in the analyses. In terms of effectiveness, after controlling relevant unbalanced baseline characteristics, compared with rFSH group, the high oocyte retrieval (>15 oocytes was considered high retrieval) rate of uFSH group significantly decreased in gonadotropin-releasing hormone agonist protocol ( OR=0.642, P<0.01) and in gonadotropin-releasing hormone antagonist protocol ( OR=0.556, P=0.001), but the clinical pregnancy rate per transfer cycle and the live birth rate per transfer cycle significantly increased ( OR=1.179, OR=1.169, both P<0.01) in both agonist and antagonist protocols. For safety, multiple analysis result demonstrated that in the agonist protocol, compared with rFSH group, the incidence of moderate to severe ovarian hyperstimulation syndrome of uFSH group significantly decreased ( OR=0.644, P=0.002). The differences in ectopic pregnancy rate and multiple pregnancy rate between the uFSH and rFSH groups were not significant ( P=0.890, P=0.470) in all patients. In terms of cost, compared with rFSH group, the uFSH group had lower total Gn costs for each patient ( P<0.01). Conclusion:For patients who underwent COS, uFSH has better safety, and economic profiles over rFSH in China.

Effect of Wenshen Yangxue Prescription on Outcome of In Vitro Fertilization- embryo Transfer in Patients with Poor Ovarian Response / 中国实验方剂学杂志

ObjectiveTo evaluate the effect of Wenshen Yangxue prescription （WSYX） on the outcome of in vitro fertilization-embryo transfer （IVF-ET） in poor ovarian responders and the safety. MethodA total of 116 eligible patients who were admitted to Beijing Obstetrics and Gynecology Hospital in June 2016-June 2019 were randomized into the experimental group and the control group with random number table method （58 in either group）. Conventional controlled ovarian hyperstimulation （COH） was directly implemented in the control group， while the experimental group was intervened with WSYX for 3 menstrual cycles before the COH. The pregnant patients were observed till childbirth and the non-pregnant patients for 12 months. Gonadotropins （Gn） dosage and the days of use were recorded. Serum levels of follicle-stimulating hormone （FSH）， basal FSH （bFSH）， basal luteinizing hormone （bLH）， and basal estrogen （bE2）， endometrial thickness， and antral follicle count （AFC） before and after treatment were measured. The serum levels of estrogen （E2）， progesterone （P）， and luteinizing hormone （LH） on the day of human chorionic gonadotropin （HCG） injection， and levels of FSH， LH， E2， testosterone （T）， and P in follicular fluid 36 h after HCG injection were determined. Number of fertilization， rate of fertilization， number of high-quality embryos， cycle cancellation rate， clinical pregnancy rate， and live birth rate were evaluated. The traditional Chinese medicine （TCM） syndrome scores before and after treatment were recorded. Liver and kidney functions were detected before and after treatment， and adverse reactions during treatment were recorded. ResultCompared with the control group， the experimental group showed the decrease in the days of Gn use and dosage of Gn （P<0.05）， endometrium thickening （P<0.05）， and increase in oocytes obtained， levels of E2 and LH on the day of HCG injection， and ovarian reserve function. Moreover， in follicular fluid 36 h after HCG injection， the reduction in level of FSH （P<0.05）， rise of levels of LH and E2 （P<0.05）， and insignificant changes in levels of T and P in the experimental group were observed as compared with those in the control group. In addition， larger number of fertilization， more available embryos， and higher rate of high-quality embryos were observed in the experimental group than in the control group （P<0.05）. The experimental group demonstrated improvement in quality of oocytes， decrease in cycle cancellation rate ， and increase in clinical pregnancy rate and live birth rate compared with the control group. The TCM syndrome score in experimental group was decreased after treatment compared with that before treatment （P<0.05）. No serious adverse reactions occurred in two groups during treatment and the safety indexes before and after treatment were all within the normal ranges. ConclusionWSYX can reduce the use duration and dosage of Gn in infertile patients receiving IVF-ET， improve the quality of oocytes， increase the rate of high-quality embryos， and improve the pregnancy outcome of IVF-ET patients.

Relación entre la ubicación de la burbuja de aire en la transferencia embrionaria y las tasas de implantación y gestación evolutiva / Relationship between air bubble location at embryo transfer and implantation and ongoing pregnancy rates

Resumen OBJETIVO: Evaluar la relación entre la ubicación de la burbuja de aire que contiene los embriones y las tasas de implantación y de gestación clínica. El secundario: estudiar la relación entre la posición de la punta de la cánula, el grosor endometrial y el desplazamiento de la burbuja con esos desenlaces reproductivos. MATERIALES Y MÉTODOS: Estudio retrospectivo, observacional y de análisis de imágenes ecográficas de transferencias de embrión único en estadio de blastocisto practicadas por un mismo especialista en la Fundación IVI, Valencia, España, entre septiembre de 2013 y febrero de 2021. Criterios de selección: grosor endometrial ≥ 6 mm en el último control ecográfico, ausencia de miomas, IMC menor de 30 kg/m2, transferencias atraumáticas efectuadas por el mismo especialista. En función de la ubicación de la burbuja de aire se establecieron tres grupos de estudio (alta: mayor de 0.98 cm, media: 0.98 a 1.44 cm y baja: mayor de 1.44 cm) y para evaluar la asociación entre las categorías se aplicó el cálculo de razón de momios (OR) e IC95%. RESULTADOS: Se estudiaron 342 transferencias de embrión único. La edad media de las pacientes fue 39.70 ± 4.5 años. La relación entre la distancia de la burbuja de aire al fondo uterino y la tasa de implantación fue de 61 ± 9% en el grupo de ubicación alta, 64 ± 9% en el grupo de ubicación media, y de 56 ± 1% en el grupo de ubicación baja (p = 0.437). No se observaron diferencias en la tasa de gestación evolutiva analizada mediante probabilidad de ocurrencia entre grupos, con frecuencias de 0.60 en comparación con 0.64 (OR: 1.42; IC95%: 0.83 a 2.44; p: 0.199) y en la ubicación alta con media, y frecuencias de 0.60 en comparación con 0.56 (OR: 1.22; IC95%: 0.72-2.08; p: 0.462) entre alta y baja. CONCLUSIONES: No se encontró asociación entre la ubicación de la burbuja y las tasas de implantación y de gestación evolutiva. El mayor desplazamiento de la burbuja se asoció con mayores tasas de gestación evolutiva.

Abstract OBJECTIVE: To evaluate the relationship between the location of the air bubble containing the embryos and the implantation and clinical gestation rates. Secondary: to study the relationship between the position of the cannula tip, the endometrial thickness and the displacement of the bubble with these reproductive outcomes. MATERIALS AND METHODS: Retrospective, observational, ultrasound image analysis study of single embryo transfers at blastocyst stage performed by the same specialist at the IVI Foundation, Valencia, Spain, between September 2013 and February 2021. Selection criteria: endometrial thickness ≥ 6 mm at the last ultrasound control, absence of fibroids, BMI less than 30 kg/m2, atraumatic transfers, performed by the same specialist. Based on the location of the air bubble, three study groups were established (high: greater than 0.98 cm, medium: 0.98 to 1.44 cm and low: greater than 1.44 cm) and the odds ratio (OR) and 95%CI were used to evaluate the association between the categories. RESULTS: A total of 342 single embryo transfers were studied. The mean age of the patients was 39.70 ± 4.5 years. The relationship between the distance of the air bubble to the uterine fundus and the implantation rate was 61 ± 9% in the high placement group, 64 ± 9% in the medium placement group, and 56 ± 1% in the low placement group (p = 0.437). No differences were observed in the evolutionary gestation rate analyzed by probability of occurrence between groups, with frequencies of 0.60 compared to 0.64 (OR: 1.42; 95%CI: 0.83 to 2.44; p: 0.199) and high to medium location, and frequencies of 0.60 compared to 0.56 (OR: 1.22; 95%CI: 0.72-2.08; p: 0.462) between high and low. CONCLUSIONS: No association was found between the air bubble localization and implantation or ongoing pregnancy rates. However, a greater displacement of the bubble was associated with higher ongoing pregnancy rates.

Influence of blood metabolites and body condition score at parturition on fertility and milk yield in Holstein cows / Influencia de metabolitos sanguíneos y condición corporal al parto sobre la fertilidad y producción de leche de vacas Holstein / Influência dos metabólitos sanguíneos e da condição corporal ao nascimento na fertilidade e produção de leite de vacas Holstein

Abstract Background: Variables associated with body tissue mobilization place dairy cows at greater risk of reproductive failure. Objective: To investigate the association between blood metabolites and body condition score (BCS) at the beginning of lactation and the reproductive efficiency and milk yield of Holstein cows in a hot environment. Methods: In total, 165 Holstein cows were selected for the study from which blood samples were taken to determine the concentration of various blood metabolites and their association with the reproductive efficiency and milk yield. Results: Cows with serum β-hydroxybutyrate (BHBA) ≤0.8 mmol/L one week postpartum were 3.3 times more likely to become pregnant at first service, and 2.2 times more likely to become pregnant before 80 d postpartum than cows with higher serum BHBA levels. The odds (OR 2.7; 95% CI 1.3-5.4; p<0.01) of a cow getting pregnant at first service were higher in cows with serum creatinine levels higher than 2.0 mg/dL one week postpartum than cows with lower blood levels of this metabolite. The BCS at 30 and 60 d postpartum that predicted pregnancy at first service and pregnancy to all services was 3.0. Blood urea nitrogen >15 mg/dL, creatinine <1.8 mg/dL, total protein ≤5.0 mg/dL one week postpartum, and >0.40 units of BCS loss during the first 30 d postpartum were critical threshold that predicted the likelihood of 305-d milk yield higher than 10,500 kg. Conclusions: Serum BHBA and creatinine one wk after calving as well as BCS 30 and 60 d post-calving provided reasonably accurate cut-off screening values to discriminate cows with better reproductive performance and higher 305-d milk yield.

Resumen Antecedentes: Las variables asociadas a mayor movilización de tejido corporal en vacas lecheras conducen a un mayor riesgo de falla reproductiva. Objetivo: Investigar la asociación entre los metabolitos sanguíneos y condición corporal (BCS) al comienzo de la lactancia y la eficiencia reproductiva y producción de leche de vacas Holstein en un ambiente caluroso. Métodos: En total, se seleccionaron 165 vacas Holstein de las cual se tomaron muestras de sangre para determinar la concentración de varios matabolitos sanguíneos, los cuales se asociaron con el desempeño reproductivo y producción de leche. Resultados: Las vacas con β-hidroxibutirato (BHBA) en suero ≤0,8 mmol/L una semana postparto tuvieron 3,3 veces más probabilidades de quedar preñadas en los primeros servicios, y 2,2 veces más probabilidades de quedar gestantes antes de los 80 días postparto que las vacas con mayores niveles séricos de BHBA. Las probabilidades (OR 2,7; IC 95% 1,3-5,4; p<0,01) de que una vaca se preñara en el primer servicio fueron mayores en vacas con niveles de creatinina en suero sanguíneo superiores a 2,0 mg/dL una semana postparto que las vacas con niveles más bajos de este metabolito en sangre. Una BCS de 3 a los 30 y 60 días postparto fue un buen predictor de la preñez al primer servicio y la gestación considerando todos los servicios. El nitrógeno ureico en sangre >15 mg/dL, la creatinina <1,8 mg/dL, la proteína total ≤5,0 mg/dL una semana después del parto y >0,40 unidades de pérdida de BCS durante los primeros 30 días postparto fueron los valores críticos para predecir una producción de leche a 305 días superior a 10.500 kg. Conclusiones: El BHBA y la creatinina en suero sanguíneo una semana postparto, así como la BCS 30 y 60 d después del parto, proporcionan valores razonablemente precisos para identificar las vacas que tendrán mejor desempeño reproductivo y mayor producción de leche a 305 días.

Resumo Antecedentes: A maior mobilização do tecido corporal das vacas leiteiras leva a um aumento do risco de falhas reprodutivas. Objetivo: Para investigar a relação entre os metabolitos sanguíneos e condição do corpo (BCS) para o início da lactação e eficiência reprodutiva e produção de leite de vacas Holstein num ambiente quente. Métodos: No total, foram selecionadas 165 vacas da raça Holandesa, das quais foram coletadas amostras de sangue para determinar a concentração de vários metabólitos sanguíneos, associados ao desempenho reprodutivo e à produção de leite das vacas. Resultados: As vacas com β-hidroxibutirato (BHBA) soro ≤0,8 mmol/L de uma semana após o nascimento foram 3,3 vezes mais probabilidade de engravidar nos primeiros serviços, e 2,2 vezes mais provável que seja grávida antes de 80 dias após o parto do que vacas com níveis séricos de BHBA mais elevados. As probabilidades (OR 2,7, IC de 95% 1,3-5,4, p<0,01) que uma vaca preñara primeiros serviços vacas foram maiores com níveis mais elevados de creatinina no soro do sangue >2,0 mg/dL, uma semana pós-parto do que vacas com níveis sanguíneos mais baixos deste metabolito. Um CC de 3 aos 30 e 60 dias pós-parto foi um bom predictor de gravidez no primeiro serviço e gestação, considerando todos os serviços. O azoto de ureia no sangue >15 mg/dL, creatinina <1,8 mg/dL e proteína total, ≤5,0 mg/dL uma semana após o parto e >0,40 unidades perda CC durante os primeiros 30 dias após o nascimento estavam valores críticos que previram produção de leite em 305 dias >10.500 kg. Conclusões: BHBA e creatinina sérica, uma semana após o parto, bem como CC 30 e 60 d após o parto, forneceram valores razoavelmente precisos para discriminar vacas com melhor desempenho reprodutivo e maior produção de leite em 305 dias.

Incidence of unintended pregnancy within 2 years after delivery and its influencing factors in China / 中华妇产科杂志

Objective:To investigate the present situation of unintended pregnancy within two years postpartum and its influencing factors in China.Methods:Participants who delivered a live birth at 60 hospitals in 15 provinces in the eastern, central and western regions of China during July 2015 to June 2016 were interviewed by using structured questionnaire. Information on occurrence of unintended pregnancy within 2 years after delivery, postpartum contraceptive use, sexual resumption, breastfeeding, and women′s socio-demographic characteristics, and so on, were collected. Life-table analysis, cluster log-rank tests and a 2-level Cox regression model were used for data analysis.Results:A total of 18 045 postpartum women were investigated. The cumulative 1- and 2-year unintended pregnancy rates after delivery were 5.3% (95% CI: 4.5%－6.1%) and 13.1% (95% CI: 11.3%－14.8%), respectively. Cox regression model analysis showed that the risk of unintended pregnancy within 2 years postpartum were increased in younger women, ethnic minorities, women with abortion history, and those who had a vaginal delivery with short lactation time and late postpartum contraceptive initiation (all P<0.01). The risk of postpartum unintended pregnancy was not associated with geographic regions and hospitals where women gave a birth (all P>0.05). Conclusions:In China, the risk of unintended pregnancy within 2 years after delivery is relatively high. Service institutions and service providers should improve the quality of postpartum family planning services, promote the use of high effect contraceptive methods, and educate women to use a method at the time of their sexual resumption or even before.

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.

Transcutaneous electrical acupoint stimulation improves pregnancy outcomes of in vitro fertilization- embryo transfer : A meta-analysis of randomized controlled trials / 中华男科学杂志

Objective@#To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on the pregnancy outcomes of in vitro fertilization-embryo transfer (IVF-ET) based on the available clinical evidence.@*METHODS@#We searched PubMed, MEDLINE, EMBASE, Cochrane Library, CNKI, VIP, CBM and Wanfang Database up to February 2021 for published randomized controlled trials (RCT) relevant to TEAS for the improvement of the pregnancy outcomes of IVF-ET. We performed literature screening, data extraction and quality evaluation according to the inclusion and exclusion criteria, followed by a meta-analysis with the RevMan 5.3 software.@*RESULTS@#A total of 2 206 cases of IVF-ET from 9 RCTs were included, 1 018 in the TEAS group and 1 188 in the control. The clinical pregnancy rate was significantly higher in the TEAS than in the mock TEAS and non-TEAS control groups (RR = 1.85, 95% CI: 1.42－2.42, P < 0.001; RR = 1.23, 95% CI: 1.10－1.39, P = 0.0004), and so was it before and after oocyte retrieval (RR = 1.50, 95% CI: 1.03－2.17, P = 0.03; RR = 1.47, 95% CI: 1.12－1.92, P = 0.005). The TEAS group also showed dramatically improved embryo implantation rate (RR = 1.49, 95% CI: 1.24－1.79, P < 0.0001) and live birth rate (RR = 1.44, 95% CI: 1.04－1.98, P = 0.03) compared with the control.@*CONCLUSIONS@#As a safe and non-invasive treatment, TEAS can significantly improve the pregnancy outcomes of IVF-ET, with definite effectiveness. /.

Effect of staging treatment of / 中国针灸

OBJECTIVE@#To compare the effect of @*METHODS@#A total of 74 patients with RIF of thin endometrium type undergoing freeze-thaw embryo transfer were randomly divided into an observation group (37 cases) and a control group (37 cases). The patients in the control group were treated with freeze-thaw embryo transfer in hormone replacement cycle, and the estradiol valerate tablets were taken orally from the fifth day of menstruation, 2 mg per day. On the basis of the control group, the observation group was additionally treated with @*RESULTS@#The clinical pregnancy rate was 37.8% (14/37) in the observation group, which was higher than 16.2% (6/37) in the control group (@*CONCLUSION@#On the basis of conventional medication,