Clinical Efficacy of TCM Multi-channel Intervention Plus Antagonist Regimen on Ovarian Function，TCM Syndromes and Natural Conception in Poor Ovarian Responders Undergoing IVF-ET / 中国实验方剂学杂志

ObjectiveTo objectively analyze the effects of traditional Chinese Medicine （TCM） multi-channel intervention on the ovarian function，TCM syndromes and natural conception of poor ovarian responders（kidney-Yin deficiency，liver depression and blood stasis pattern） who planned to receive another in vitro fertilization embryo transfer（IVF-ET）antagonist regimen. MethodThe 128 low-prognosis patients （kidney Yin deficiency，liver depression and blood stasis pattern） who attended the West China Second University Hospital， Sichuan University and the Hospital of Chengdu University of Traditional Chinese Medicine from August 2020 to February 2023 and met the inclusion criteria were selected，and then divided into the treatment group and the control group according to the random number table，with 64 patients in each group. The control group was treated with oral dehydroepiandrosterone（DHEA），while the treatment group was treated with multi-channel TCM（oral TCM decoction + auricular point sticking + Bushen Huoxue prescription through retention enema）. After 3 menstrual cycles，the relevant indicators for ovarian function evaluation，TCM syndrome scores and natural conception were collected from both groups. ResultCompared with the situation before treatment，the basal follicle stimulating hormone（bFSH），bFSH/basal luteinizing hormone（bLH），basal estradiol（bE2），antral follicle count（AFC），the number of oocytes obtained，the number of normal fertilization，the number of superior embryos and TCM syndrome scores in the treatment group were improved after treatment（P<0.05，P<0.01）. For the control group， the bFSH/bLH and TCM syndrome scores were increased after treatment（P<0.05）， while the bFSH，bFSH/bLH，bE2，AFC，the number of oocytes obtained，the number of normal fertilization，and the number of superior embryos showed no significant difference after treatment. Compared with the control group after treatment，bFSH，bFSH/bLH，bE2，AFC，the number of normal fertilization，the number of superior embryos and TCM syndrome scores in the treatment group were better （P<0.05，P<0.01），while there was no significant difference in the number of oocytes obtained. After treatment，there were 3 cases of natural conception in the treatment group，while there were no natural conception in the control group. ConclusionFor patients with poor ovarian response and kidney Yin deficiency，liver depression and blood stasis pattern，multi-channel intervention of TCM plus the antagonist regimen can reduce bFSH，bFSH/bLH values，improve the levels of bE2，increase AFC，the number of oocytes obtained，the number of normal fertilization and the number of superior embryos，improve ovarian function，menstruation and TCM syndromes，improve their quality of life，and even enable some patients to get pregnant naturally before re-progression and improve their pregnancy outcome.

Combined Therapies of Traditional Chinese Medicine Treat Low-prognosis Patients Undergoing IVF-ET Again / 中国实验方剂学杂志

ObjectiveTo objectively evaluate the clinical efficacy of multiple therapies of traditional Chinese medicine （TCM） in low-prognosis patients who received antagonist protocol for in vitro fertilization and embryo transfer （IVF-ET） again. MethodA total of 128 patients with kidney Yin deficiency， liver depression， and blood stasis who planned to receive antagonist protocol for IVF-ET in the West China Second Hospital of Sichuan University were enrolled and assigned into two groups by random number table method. The observation group （64 casces） was treated by oral administration of Chinese medicine decoction + enema of kidney-tonifying and blood-activating method + auricular point sticking + oral administration of dehydroepiandrosterone （DHEA）， while the control group （64 casces） was treated by only oral administration of DHEA. After treatment for three menstrual cycles， both groups received the antagonist protocol for IVF-ET. The TCM syndrome scores， basic sex hormone levels， antral follicle count （AFC）， the usage of gonadotropin （Gn）， endometrial receptivity indicators， embryo quality indicators， and pregnancy outcomes were compared between the two groups. ResultAfter treatment， the observation group showed decreased follicle-stimulating hormone （FSH）/luteinizing hormone （LH） ratio， lowered level of estradiol （E2）， increased AFC， decreased amount and days of Gn usage， improved endometrial receptivity indicators （endometrial thickness on trigger and ET days， proportion of endometrial type A in endometrial types and the level of E2 on trigger day） and embryo quality indicators （the rates of mature follicles， fertilization， normal fertilization， and premium embryos）， and decreased TCM syndrome scores （P<0.05， P<0.01）. Moreover， the observation group had lower FSH/LH ratio， E2 level， and amount of Gn usage， higher AFC， poorer endometrial receptivity and embryo quality indicators， and lower TCM syndrome scores than the control group after treatment （P<0.05， P<0.01）. In addition， except for 3 cases of natural pregnancy， the observation group outperformed the control group in terms of improving the clinical pregnancy rates during initiation cycle and transplantation cycle and clinical pregnancy rate and decreasing biochemical pregnancy rate and early abortion rate （P<0.05）. ConclusionCombined therapies of TCM can alleviate the clinical symptoms， reduce TCM syndrome scores， reduce the Gn usage amount， improve the number and quality of embryos and endometrial receptivity， and coordinate the synchronous development of endometrium and embryo. In this way， they can increase the clinical pregnancy rate and reduce biochemical pregnancy rate and early abortion rate in the low prognosis patients with kidney yin deficiency， liver depression， and blood stasis who are undergoing IVF-ET again.

Acupuncture for in vitro fertilization-embryo transfer: an overview of systematic reviews / 中国针灸

OBJECTIVES@#To evaluate the report quality, methodological quality and evidence quality of the systematic reviews and meta-analyses (SRs/MAs) of acupuncture for in vitro fertilization-embryo transfer (IVF-ET).@*METHODS@#The SRs/MAs of acupuncture for IVF-ET were searched electronically from databases of CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, Cochrane Library, from inception of each database to September 27th, 2022. Two reviewers independently screened the literature and extracted the data. Using PRISMA statement, the AMSTAR 2 scale and the GRADE system, the report quality, methodological quality and evidence quality of the included SRs/MAs were assessed.@*RESULTS@#A total of 28 SRs/MAs were included, with PRISMA scores ranging from 8.5 points to 27 points. The problems of report quality focused on protocol and registration, retrieval, risk of bias in studies, additional analysis, limitations and funding. The methodological quality of included studies was generally low, reflecting on items 2, 3, 7, 10, 12 and 16. A total of 85 outcome indexes were included in the GRADE system for evidence grade evaluation. Most of the evidences were low or very low in quality. The reasons for the downgrade were related to study limitations, inconsistency, imprecision and publication bias.@*CONCLUSIONS@#Acupuncture therapy improves the outcomes of IVF-ET, but the methodological quality and evidence quality of related SRs/MAs are low. It is recommended to conduct more high-quality studies in the future to provide more reliable evidences.

Effect of wheat-grain moxibustion at Yinbai (SP 1) on the menstrual period prolongation after IVF-ET down-regulation treatment / 中国针灸

OBJECTIVE@#To compare the clinical effect between wheat-grain moxibustion at Yinbai (SP 1) and oral administration of dydrogesterone tablet for menstrual period prolongation after down-regulation treatment of in vitro fertilization embryo transfer (IVF-ET).@*METHODS@#A total of 54 patients with prolonged menstrual period after down-regulation treatment of IVF-ET were randomly divided into an observation group and a control group, 27 cases in each one. In the observation group, when the menstrual period delayed more than 7 days, the wheat-grain moxibustion at Yinbai (SP 1) was performed, once a day, with an interval of 1 day between two 3-day treatments; when the menstrual blood was cleaned, the ovulation was continued and the eggs were taken. In the control group, when the menstrual period delayed more than 7 days, the oral administration of dydrogesterone tablet was provided, 10 mg each time, twice a day; when the menstrual blood was cleaned, the ovulation was continued and the eggs were taken. The number of days for menstrual blood to be cleaned, the area change of uterine cavity hemorrhage, the morphology of endometrium, the blood supply of endometrium, the number of oocytes obtained, the grade of frozen embryo and the clinical effect were observed between the two groups after treatment.@*RESULTS@#Compared with the control group, the number of days for menstrual blood to be cleaned was shorter in the observation group after treatment (0.05). The cured rate in the observation group was 100.0% (27/27), higher than 33.3% (9/27) in the control group (<0.05).@*CONCLUSION@#The wheat-grain moxibustion at Yinbai (SP 1) could more effectively treat prolonged menstrual period after IVF-ET down-regulation treatment, which is beneficial to the preparation of the endometrium, and has no effect on the oocyte collection and embryo culture.

Qilin pills prevent ovarian hyperstimulation syndrome of patients after IVF-ET by regulating plasma-related indicators / 中国临床药理学与治疗学

AIM: To study the preventive effect of Qilin pill on ovarian hyperstimulation syndrome (OHSS) after in vitro fertilization and embryo transfer (IVF-ET) and its effects on vascular endothelial growth factor (VEGF), tissue factor (TF) and tissue factor pathway inhibitor (TFPI) in plasma. METHODS: Sixty-four patients undergoing IVF-ET treated in our hospital from January 2016 to January 2019 were selected. On the day of ovulation induction injection of human chorionic gonadotropin (HCG), 32 patients with high risk factors of OHSS were randomly divided into two groups. The control group received western medicine therapy, while the observation group received extra Qilin pill. The incidence of mild to moderate OHSS, fresh cycle transplant cancellation rate, plasma VEGF, TF, TFPI levels, and clinical outcomes of patients undergoing IVF-ET (HCG positive rate, biochemical pregnancy rate, clinical pregnancy rate) were compared between the two groups.RESULTS:There was no severe OHSS occurred in the two groups, the incidence of OHSS in the observation group (12.50%) and the cancellation rate of fresh cycle transplantation (15.63%) were lower than those in the control group (50.00%, 43.75%)(χ2=6.063,P=0.014); The levels of VEGF and TF in the observation group on the day of egg retrieval and embryo transfer were [(368±103) pg/mL, (392±91) pg/mL],[(24±4)pg/ mL,(29±4) pg/mL], which were lower than the control group [(436±117) pg/mL, (448±108) pg/mL],[(26±4) pg/mL, (31±4) pg/mL] (t=2.450,2.237,4.093,5.204,P=0.017,0.029,<0.001,<0.001); The plasma TFPI levels in the observation group on the day of egg retrieval and embryo transfer were [(73±18) ng/mL,(66±12) ng/mL], higher than the control group [(62±16)ng/mL, (58±10) ng/mL](t=2.550,3.032,P=0.014,0.004); The biochemical pregnancy rate in the observation group (8.70%) was lower than that in the control group (42.86%) (χ2=4.147, P=0.042),the clinical pregnancy rate (91.30%) was higher than that of the control group (57.14%) (χ2=4.147,P=0.042).CONCLUSION:Qilin pill can prevent the occurrence of severe OHSS after IVF-ET, reduce the occurrence of mild to moderate OHSS, decrease the cancellation rate of fresh cycle transplantation and improve the pregnancy outcome after IVF-ET; Its mechanism may be related to the regulation of the expression of VEGF, TF and TFPI.

Gonadotropin-releasing hormone-antagonist up-regulate the proportion of uterine natural killer cells and enhance their toxicity during the implantation window period of mice / 上海交通大学学报（医学版）

Objective: To investigate the effects of gonadotropin-releasing hor-mone-antagonist (GnRH-ant) on the proportion and toxicity of mice uterine nature killer (uNK) cells during implantation window. Methods: Sixteen C57BL/6 mice were randomly divided into GnRH-ant group and control group, with 8 mice in each group. From the 3rd day of the estrous cycle, GnRH-ant (1.5 μg/100 g) was injected intraperitoneally into the mice of the GnRH-ant group for 7 days continuously, and the control group was injected with the same volume of normal saline at the same time point. On the 7th day, the mice of the two groups were injected with human menopausal gonadotropin (40 U/100 g). The next day, they were injected with human chorionic gonadotropin (100 U/100 g) and sacrificed after 48 h. The uterus tissues were taken out for primary digestion to obtain single-cell suspension. Flow cytometry was used to analyze the proportion of uNK cells and the expression levels of toxicity molecules perforin (Pf) and granzyme B (Gz-B). Results: Compared with the control group, the proportion of uNK cells in GnRH-ant group increased (P=0.000), the proliferation level increased (P=0.000), the apoptosis level decreased (P=0.004), and the expression of toxicity molecules Pf (P=0.000) and Gz-B (P=0.034) were up-regulated. Conclusion: GnRH-ant may up-regulate the proportion of uNK cells and enhance their toxicity in the implantation window period of mice.

Consideration and analysis on "Effect of acupuncture vs sham acupuncture on live births among women undergoing in vitro fertilization: a randomized clinical trial" in / 中国针灸

The article "Effect of acupuncture vs sham acupuncture on live births among women undergoing in vitro fertilization: a randomized clinical trial", published in in May 2018, has concluded that acupuncture does not improve the rate of live births among women undergoing IVF. Through careful study of the article, the author analyzes its reliability from acupuncture therapeutic plan and specific acupuncture operation. As a result, although the research showed no significant difference between the acupuncture group and the sham acupuncture group, it could not prove no therapeutic effect in the sham acupuncture group, so the conclusion that the acupuncture did not improve the therapeutic effect could not be drawn; the compatibility of acupoints was inconsistent with the previous protocol, and its rationality was controversial; whether the frequency and duration of acupuncture treatment could highlight the live birth rate should be further discussed. In addition, the selection of acupuncturists may be another reason for the failure of the research aim.

Analysis of pregnancy outcomes and influencing factors of single embryo transfer and double embryo transfer by in vitro fertilization and embryo transfer / 上海交通大学学报（医学版）

Objective • To compare the pregnancy outcomes between the patients undergoing single embryo transfer and double embryo transfer by in vitro fertilization and embryo transfer, and analyze the influencing factors. Methods • From Jan. 2011 to Jun. 2016, women who underwent single embryo transfer or double embryo transfer with in vitro fertilization and embryo transfer and successfully conceived in Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine were followed up to the pregnancy outcomes. According to the number of embryo transfer, the patients were divided into single embryo transfer group and double embryo transfer group. Univariate analysis (t test, Chi-square test) and multivariate Logistic regression analysis were used to compare the pregnancy outcomes between two groups, and analyze the influencing factors of adverse outcomes. Results • A total of 19 030 patients (98.69%) were followed up to the pregnancy outcomes. Stratified analysis showed that there were significant differences in the composition of pregnancy outcomes (P=0.000) and the number of live births (P=0.000) between two groups. For the neonatal birth quality, the infants born by the patients with single embryo transfer had higher birth weights than those born by the patients with double embryo transfer (P=0.000), and the proportions of newborns with low birth weights and full-term newborns with low birth weights were higher among the patients with double embryo transfer compared to those with single embryo transfer (P=0.000). In addition, there was no statistically significant difference in he incidence of birth defects between the infants born by the patients with single embryo transfer and double embryo transfer. Multivariate Logistic regression analysis showed that the risk of abortion or labor induction among the patients with double embryo transfer was higher than those with single embryo transfer with age, infertility causes and embryo type adjusted (OR=0.88, P=0.025). Conclusion • The risk of adverse pregnancy outcomes is higher among the patients with double embryo transfer than those with single embryo transfer.

A comparative study on the effects of intermittent drug withdrawal and small follicle aspiration on clinical outcomes in COH high-responders / 中国实用妇科与产科杂志

OBJECTIVE: To explore the treatment strategy for patients with hyperresponsiveness in the early and middle stages of superovulation induction(COH)by GnRH agonist down-regulation protocol in in vitro fertilization-embryo transfer(IVF-ET).METHODS: An analysis was made in 127 cases of IVF-ET performed in Reproductive Center of Shantou Central Hospital from June 2017 to June 2018.The patients were divided into 3 groups according to the different treatment:intermittent drug withdrawal group(group A),small follicle aspiration group(group B),and control group(group C).The embryo quality,pregnancy outcome,incidence of ovarian hyperstimulation syndrome(OHSS)and the number of cancelled fresh transplantation cycles were compared among the three groups.The embryo quality and pregnancy outcome was further compared between discontinuous withdrawal once(A1 group)and 2-3 times(A2 group),and between 1 day(A3 group)and 2-3 days(A4 group).RESULTS: The E2 level on HCG day,the rate of moderate and severe OHSS,cancellation rate and miscarriage rate in group A and group B were significantly lower than those in group C(P0.05).There was no significant difference in embryo quality or clinical outcomes between group A1 and A2,and between group A3 and A4(P>0.05).CONCLUSION: The intermittent withdrawal regimen is non-invasive,safe and simple,and can improve the quality of embryos.It is a suitable regimen for high-response patients to improve the chance of fresh transplantation.

Adjuvant therapy of acupoint catgut embedding for threatened abortion after in vitro fertilization-embryo transfer: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effects of acupoint catgut embedding on miscarriage prevention and pregnancy outcome in patients with threatened abortion after in vitro fertilization-embryo transfer (IVF-ET).@*METHODS@#Sixty cases of patients with threatened abortion after IVF-ET were randomly divided into an observation group and a control group, 30 cases in each group. The patients in the control group were treated with intramuscular injection of progesterone (40 mg) once every day, while the patients in the observation group, on the basis of the treatment of control group, were treated with catgut embedding at Geshu (BL 17), Ganshu (BL 18), Shenshu (BL 23), Pishu (BL 20), Weishu (BL 21), Xuehai (SP 10), Diji (SP 8) and Fuliu (KI 7), once every two weeks, six times as a course of treatment. The treatment was given until 12 weeks into pregnancy. The level of serum human chorionic gonadotropin (HCG), estradiol (E) and progesterone (P) before and after treatment was recorded; the TCM syndrome score before and after treatment was compared; the successful pregnancy rate and spontaneous abortion rate after treatment were observed in the two groups.@*RESULTS@#Compared before treatment, the scores of TCM syndrome in both groups were reduced after treatment (both <0.01), and score in the observation group was superior to that in the control group (<0.05). After treatment, the clinical efficacy in the observation group was superior to that in the control group (<0.05). After treatment, the hormone levels (β-HCG, E, P) in both groups were increased steadily; the hormone levels in 6-week pregnancy, 8-week pregnancy and 10-week pregnancy were significantly higher than those in 4-week pregnancy (all <0.05); except the levels of P and β-HCG in 10-week pregnancy, the hormone levels in the observation group were superior to those in the control group (all <0.05). After treatment, the early abortion rate was 16.7% (5/30) in the observation group, which was lower than 33.3% (10/30) in the control group (<0.01); the pregnancy rate was 96.0% (24/25) in the observation group, which was higher than 80.0% (16/20) in the control group (<0.01).@*CONCLUSION@#Acupoint catgut embedding is effective for preventing threatened abortion, which could significantly reduce the spontaneous abortion rate, improve the pregnancy success rate, regulate hormone levels in patients after IVF-ET.

Oxidative stress in granulosa cells contributes to poor oocyte quality and IVF-ET outcomes in women with polycystic ovary syndrome / 医学前沿

The increased levels of intracellular reactive oxygen species (ROS) in granulosa cells (GCs) may affect the pregnancy results in women with polycystic ovary syndrome (PCOS). In this study, we compared the in vitro fertilization and embryo transfer (IVF-ET) results of 22 patients with PCOS and 25 patients with tubal factor infertility and detected the ROS levels in the GCs of these two groups. Results showed that the PCOS group had significantly larger follicles on the administration day for human chorionic gonadotropin than the tubal factor group (P 0.05). PCOS group had slightly lower fertilization, cleavage, grade I/II embryo, clinical pregnancy, and implantation rates and higher miscarriage rate than the tubal factor group (P > 0.05). We further found a significantly higher ROS level of GCs in the PCOS group than in the tubal factor group (P < 0.05). The increased ROS levels in GCs caused GC apoptosis, whereas NADPH oxidase 2 (NOX2) specific inhibitors (diphenyleneiodonium and apocynin) significantly reduced the ROS production in the PCOS group. In conclusion, the increased ROS expression levels in PCOS GCs greatly induced cell apoptosis, which further affected the oocyte quality and reduced the positive IVF-ET pregnancy results of women with PCOS. NADPH oxidase pathway may be involved in the mechanism of ROS production in GCs of women with PCOS.

Effect of Stage-based Acupuncture-moxibustion on Endometrial Thickness After Repeated Implantation Failure in IVF-ET / 上海针灸杂志

Objective To observe the effect of stage-based acupuncture-moxibustion therapy on the endometrial thickness in patients suffering from repeated implantation failure in IVF-ET (in vitro fertilization and embryo transfer). Method Seventy-two patients suffering from repeated implantation failure in IVF-ET were randomized into two groups. Thirty-six cases in the treatment group were intervened by stage-based acupuncture-moxibustion therapy plus oral administration of Estradiol valerate tablets; the other 36 cases in the control group were prescribed with oral administration of Estradiol valerate tablets alone. The implantation result of IVF-ET was analyzed 3 cycles later. The endometrial thickness was compared before and after the intervention. Result The endometrial thickness of the non-pregnant women increased after the treatment in both groups (P<0.05), and the increase in the treatment group was more significant than that in the control group (P<0.05). The clinical pregnancy rate in the treatment group was significantly higher than that in the control group (P<0.05). Conclusion Stage-based acupuncture-moxibustion therapy can improve the endometrial thickness, promote the growth of endometrium, benefit the implantation of embryo, and enhance the clinical pregnancy rate.

Application time-point and effect observation of fire needling therapy in IVF-ET / 中国针灸

<p><b>OBJECTIVE</b>To observe the effects of the intervention with fire needling therapy on the uterine microenvironment at the specific time points of menstrual cycle and evaluate the effects on the assisted reproduction.</p><p><b>METHODS</b>Sixty-eight patients of in vitro fertilization and embryo transplantation (IVF-ET) were randomized into an observation group (35 cases) and a control group (33 cases). The patients in the two groups all received post-IVF-ET corpus luteum support of the microstimulation scheme in the Clinical Reproduction Center of Jiangsu People's Hospital. In the control group, the regular sequential therapy of acupuncture was used. In the observation group, on the basis of the treatment as the control group, the intervention of fire needling therapy was applied after ovulation (the 1st time point, on the 1st day after ovulation) and at the end of premenstrual stage (the 2nd time point, 3 days before the menstruation). At the 1st time point, Shenshu (BL 23), Mingmen (GV 4) and Yaoyangguan (GV 3) were selected and at the 2nd time point, Shenshu (BL 23) and Ciliao (BL 32) were selected. The acupoints were stimulated from up to down and from the left to the right. The changes in TCM syndrome during the preparation, the endometrial thickness and types on the day of transplantation, the biochemical pregnant rate after transplantation and clinical pregnant rate were observed and compared in the patients of the two groups.</p><p><b>RESULTS</b>After treatment, TCM syndrome scores were all reduced in the two groups (both<0.05). In the observation group, the biochemical pregnant rate and clinical pregnant rate were slightly higher than those in the control group, without significant difference in comparison (both>0.05). In the observation group, the endo-metrial thickness on the day of transplantation was higher than that in the control group (<0.05). After treatment, the differences in TCM syndrome score and endometrial type were not significant statistically between the two groups (all>0.05).</p><p><b>CONCLUSIONS</b>The intervention of fire needling therapy at the specific time points of menstrual cycle relieves menstrual symptoms and increases endometrial thickness so as to assist embryo implantation in the patients of infertility.</p>

Repeated superovulation induction after failure in previous IVF-ET cycles with the ultra-long protocol: Analysis of outcomes of clinical pregnancy / 中华男科学杂志

Objective@#To analyze the clinical outcomes of repeated superovulation induction in patients with adenomyosis or moderate to severe pelvic endometriosis after failure in previous IVF-ET cycles with the ultra-long protocol.@*METHODS@#We retrospectively analyzed the clinical data about 37 patients with adenomyosis or moderate to severe pelvic endometriosis in our center from 2009 to 2013, who underwent repeated IVF-ET after failure in the previous cycles with the ultra-long protocol, namely by injection of 2－6 ampoules of 3.75 mg gonadotropin-releasing hormone agonist (GnRH-a). All the patients met the following requirements: hCG-negative at 14 days after transfer, within 3－7 days after menstruation, and properly down-regulated serum follicle stimulating hormone (FSH) (<10 mIU/ml), luteinizing hormone (LH) (<10 mIU/ml), estradiol (E2) (<30 pg/ml), follicle diameter (<10 mm) and endometrial thickness, and received GnRH (Gonal-F, Serono) for ovulation induction. We compared the clinical and laboratory data and pregnancy outcomes between the first and repeated cycles before and after ovulation induction.@*RESULTS@#The repeated cycles, as compared with previous ones, showed significant increases in the antral follicle count (AFC) on the first day of stimulation (7.55 ± 1.86 vs 6.45 ± 2.5, P<0.05), number of follicles =≥14 mm in diameter on the hCG trigger day (7.81 ± 3.6 vs 5.56 ± 3.68, P<0.05), level of E2 (［2 362.15 ± 1 210.49］ vs ［1 749.22 ± 1 139.44］ pg/ml, P<0.05), and numbers of oocytes retrieved (7.51 ± 3.23 vs 4.78 ± 3.41, P<0.05) and embryos transferred (2.00 ± 0.33 vs 1.50 ± 0.67, P<0.05), exhibited a remarkably reduction in the dose of GnRH (［1 791.65 ± 1 889.41］ vs ［3 439.56 ± 1 836.53］ IU, P<0.05), and achieved a clinical pregnancy rate of 62.16%.@*CONCLUSIONS@#With proper reduction of the FSH, LH and E2 levels and follicle diameter, repeated superovulation induction for IVF-ET can improve the ovarian response and pregnancy outcomes of the patients with adenomyosis or moderate to severe pelvic endometriosis after failure in the previous IVF-ET cycles with the ultra-long protocol.

Clinical Effects of Different Doses of Long-acting Gonadotropin Releasing Hormone Agonist (GnRH-a) Versus Daily Injections of Short-acting GnRH-a in IVF Cycles / 医学研究杂志

Objective Clinical efficacy was compared among single injections of different doses of long acting gonadotropin releasing hormone agonist (GnRH-a),and daily injections of short-acting GnRH-a in order to evaluate different methods of ovarian stimulation for in vitro fertilization (IVF) cycles.Methods A retrospective study of 214 patients who underwent IVF assisted fertility treatments was conducted.Patients were allocated into four study groups:the short protocol (group A),in which daily injections of 0.1 mg GnRH-a was administered in the mid-luteal phase until the day of human chorionic gonadotropin (hCG) administration (see below);or the long protocol (group B,C & D),in which single injections of 3.75mg,2.0mg,or 0.9mg of long-acting GnRH-a was given in the mid-luteal phase,respectively.Stimulation with gonadotropins (Gn) started when pituitary down-regulation was established.When vaginal ultrasonographic scans showed that at least two follicles had reached 16-20mm in diameter,Gn stimulation was withdrawn,and serum estradiol (E2),progesterone (P),and luteinizing hormone (LH) were determined.Additionally,human chorionic gonadotropin (hCG) was administered that evening.Egg collection was performed 38 hours after hCG injection and the standard IVF procedure was performed.Results There were no statistically significant differences amongst the four groups when measuring serum LH levels,number of oocytes,number of fertilized eggs,number of good quality embryos,and clinical pregnancy rate.The total amount of Gn administered was almost identical when comparing group A and group D,as well as when comparing group B and group C.However,Group A and D required less Gn stimulation to exhibit follicles of 16-20mm in diameter,compared to group B and C (P ＜0.005).Moreover,there was a significant difference in the time required for ovulation induction between group A and group C,where group A had a shorter time to ovulation.The fertilization rate was statistically different between group B and other groups (P ＜ 0.005).Conclusion Through our data analysis,we conclude based on outcome,cost,side-effects,and simplification of treatments,that the 0.9mg long-acting GnRH-a treatment is eminent for ovarian stimulation for IVF.

Comparison of the Clinical Outcomes of Fresh Embryo Transfer with GnRH Agonist Long Protocol Versus GnRH Antagonist Protocol in Different Age Groups and Different Responders / 中山大学学报(医学科学版)

[Objective]To compare the clinical outcomes of fresh embryo transfer of the in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)in different age groups as well as in different responders using gonadotropin-re-leasing hormone agonist(GnRH-a)long protocol or GnRH antagonist(GnRH-ant)protocol.[Methods]A retrospective analysis was performed on 737 IVF/ICSI cycles,including 386 cycles of GnRH-a long protocol(group A)and 351 cycles of GnRH-ant protocol (group B),from August 28,2015 to December 31,2016. Then all the cycles were divided into sub-groups by ages and retrieved oo-cyte numbers:group a1(15). The basic information of patients and clinical outcomes were compared.[Results](1)Comparable results were obtained from group A and group B in these following variables such as fertilization rate,normal fertilization rate,biochemical pregnancy rate and miscarriage rage. But the stimulation period,the total gonadotropin(Gn)dosage,estradiol(E2)level and endometrial thickness on the day of human chorionic gonadotropin(hCG)administration,number of oocytes retrieved and mature oocytes,ovarian hyperstimulation syn-drome(OHSS)rate,implantation rate and clinical pregnancy rate were significantly higher in group A than group B(P<0.05),and significantly higher cancellation rate of fresh embryo transfer was observed in group B(P<0.001).(2)When divided by ages,no mat-ter in sub-group a1 or sub-group a2,the implantation rate was slightly lower in GnRH-ant protocol than in GnRH-a long protocol, although they failed to reach significant difference(sub-group a1:32.6%vs 39.8%,P=0.067;sub-group a2:9.7%vs 17.9%,P=0.066). The clinical pregnancy rate was comparable using these two protocols in sub-group a1(54.8%vs 50.4%,P=0.429),but it was significantly lower by using GnRH-ant protocol than GnRH-a long protocol in sub-group a2(19.6%vs 39.1%,P=0.021).(3) When divided by numbers of oocytes retrieved,the implantation rate was significantly lower when using GnRH-ant protocol in sub-group b1(13.1%vs 26.0%,P=0.026),but we failed to observe significant differences in other two sub-groups. The clinical preg-nancy rates were comparable in all sub-groups ,whereas differed considerably in sub-group b1 (36.6% vs 19.3%,P = 0.056).[Conclusion]Overall,the implantation rate and clinical pregnancy rate were higher in GnRH-a long protocol than those in GnRH-ant protocol. Nevertheless,GnRH-ant protocol could reduce the dosage of Gn,shorten the treatment duration,and effectively reduce the occurrence of OHSS. There were similar pregnancy outcomes in two protocols for normal responders and high responders ,while for advanced patients or other poor responders,the implantation rate and clinical pregnancy rate were higher in GnRH-a protocol.

Introduction of Experience of Professor ZHANG Liang-ying's TCM Adjunctive Therapy for IVF-ET / 中国中医药信息杂志

Professor ZHANG Liang-ying in Yunnan University of Traditional Chinese Medicine conducted TCM adjuvant therapy for in vitro fertilization - embryo transfer (IVF-ET) of infertility patients, which has obtained satisfactory results. The use of kidney-based, disease differentiation combined with the treatment, emphasizing preoperative conditioning, psychological adjustment, and appropriate choice, can help improve the IVF-ET pregnancy rate and complications of many problems.

Effects of sperm morphology, sperm DNA fragment index and seminal plasma zinc on pregnancy outcome of IVF-ET / 中国生化药物杂志

Objective To investigate the influence of sperm morphology, sperm DNA fragmentation index and seminal plasma zinc on pregnancy outcome of in vitro fertilization and embryo transfer (IVF-ET).MethodsA total of 341 infertile couples underwent IVF-ET were selected from January 2016 to June 2016 in our hospital.Sperm morphology, sperm DNA fragmentation index and seminal plasma zinc level were compared according to pregnancy.ResultsIn 341 cases, 204 cases pregnancy and 137 cases of no pregnancy, with the pregnancy rate of 59.8%(204/341).Compared with the pregnancy group, the percentage of normal sperm percentage was low, the abnormal sperm index was higher in the non-pregnant group (P<0.05), the sperm DNA index was higher (P<0.05).The percentage of normal sperm, sperm DNA fragmentation index and seminal plasma zinc and pregnancy rate in sperm morphology were linear (P<0.05), And there was a negative correlation between abnormal sperm index and sperm DNA fragment index (P<0.05), and other indicators were positively correlated (P<0.05).ConclusionSperm morphology, sperm DNA fragmentation index and seminal plasma zinc levels may influence the outcome of IVF-ET.The above parameters can be used to predict pregnancy outcome of IVF-ET.

Predictive Value of Early Serum Beta-Human Chorionic Gonadotropin Measurements After Cleavage or Blastocyst Embryo Transfers / 中山大学学报(医学科学版)

[Objective]To compare early serum beta-human chorionic gonadotropin (β-hCG) levels after cleavage or blastocyst embryo transfers (ET) in predicting pregnancy outcome.[Methods]A total of 2421 IVF-ET cycles in our center performed from June 2010 to May 2015 and resulted in clinical intrauterine pregnancies were analyzed retrospectively. The predictive value was compared betweenβ-hCG on day 14 after cleavage ET andβ-hCG on day 12 after blastocyst ET.[Results]Serumβ-hCG levels of patients re?sulted in clinical intrauterine pregnancies were significantly higher with blastocyst ET compared with cleavage ET. This significant dif?ference was also existed in patients resulted in miscarriage, ongoing pregnancy (OP) or live birth (LB). However, this significant differ?ence was only existed in frozen embryo transfers. For a frozen cleavage ET, the cut-off value was 475 U/L (sensitivity 79%, specificity 61.3%) in predicting LB. For a frozen blastocyst ET, the cut-off value was 575 U/L (sensitivity 74.9%, specificity 59.2%) in predicting LB.[Conclusion]In frozen embryo transfers, early serumβ-hCG level after blastocyst ET is higher than cleavage ET. The cut-off val?ue in predicting pregnancy outcome is different according to the stage embryo transferred. Early serum β-hCG can effectively predict live birth after blastocyst or cleavage ET.

Doble transferencia embrionaria consecutiva D3/D5-6: una alternativa para mejorar las tasas de embarazo en pacientes sometidas a fertilización in vitro/transferencia embrionaria (FIV/TE)

Objetivo: Evaluar la doble transferencia embrionaria consecutiva D3/D5-6 (DTEC D3/D5-6) como alternativa para mejorar las tasas de embarazo en pacientes sometidas a un programa de fertilización in vitro/transferencia embrionaria (FIV/TE) que obtengan más de dos embriones de día 3 (D3), independientemente del número de intentos previos, de la edad y de los criterios de inclusión al programa. Métodos: Estudio observacional prospectivo realizado en un centro de fertilidad privado. Se aplicó la técnica de la DTEC D3/D5-6 de acuerdo al protocolo del Centro Valenciano de Fertilidad y Esterilidad (CEVALFES) a 58 pacientes durante el período septiembre 2012-2014 y que obtuvieron dos o más embriones de buena calidad. Resultados: La tasa de éxito general fue de un 39,65 %. Estos resultados se compararon con las tasas de éxito de la aplicación de la TE de D3 y de D5-6 de un solo embrión y de dos y tres embriones llevadas a cabo en un solo momento. La tasa de éxito general fue superior a las obtenidas con las TE D3 dobles y triples (29,23 % y 31,01 % respectivamente) y a las TE de blastocistos desvitrificados únicas y dobles (15,38 % y 15,15 % respectivamente). Conclusiones: La doble transferencia embrionaria consecutiva D3/D5-6 se perfila como una técnica eficaz para tomar la decisión de cuántos embriones transferir y el momento de hacerlo cuando la pareja cuenta con dos o más embriones de D3. Ello se traduce en una alternativa que puede mejorar los resultados de las técnicas de reproducción asistida en la actualidad.

Objective: The aim of this study was to evaluate a double consecutive embryo transfer day 3/ day 5-6 as an alternative to improve pregnancy rates among patients undergoing an IVF/ET program who obtain more than two day-3 embryos, without taking into account the number of previous attempts, age or IVF/ET program inclusion criteria. Method: Prospective observational study at a private fertility center. The double consecutive embryo transfer day 3/ day 5-6 approach was performed, according to the protocol outlined at CEVALFES, on 58 patients of our fertility center who obtained two or more good quality embryos between September 2012 and September 2014. Results: The overall pregnancy rate was 39,65%. These results were compared with single embryo transfers day 3 and day 5-6 and double and triple embryo transfers performed either on day 3 or on day 5-6. This overall pregnancy rate was higher than the rates obtained for double and triple day-3 ET (29,23% and 31,01% respectively) and for single and double thawed blastocyst ET (15,38% and 15,15% respectively). Conclusions: The double consecutive embryo transfer day 3 and day 5-6 approach presents itself as an effective alternative to inform decision making when two or more day-3 embryos are available: how many day-3 embryos are to be transferred and if ET can be performed consecutively on day 3 and day-5-6. This, in turn, becomes a choice that can improve current pregnancy rates.