Comparative analysis of the vaginal microbiome of healthy and polycystic ovary syndrome women: a large cross-sectional study.

RESEARCH QUESTION: What are the different features of the vaginal microbiome (VMB) between patients with polycystic ovary syndrome (PCOS) and healthy women? DESIGN: A cross-sectional study was conducted at a single academic university-affiliated centre. A total of 1446 participants were recruited (PCOS group, n =713, control group, n = 733). Vaginal swabs were analysed using 16S rRNA gene sequencing. The diversity and composition of the microbiome were compared between the PCOS group and the control group. Microbial interaction networks and functional prediction were investigated. RESULTS: The PCOS group had a higher alpha diversity than the control group (Shannon P = 0.03, Simpson P = 0.02), and higher intra-group variability was observed in PCOS group (P < 2.2E-16). At the genus level, the proportion of Lactobacillus decreased (85.1% versus 89.3%, false discovery rate [FDR] = 0.02), whereas the proportion of Gardnerella vaginalis and Ureaplasma increased in the PCOS group (5.1% versus 3.3%, FDR = 0.006; 1.2% versus 0.6%, FDR = 0.002, respectively). Lactobacillus acidophilus, Prevotella buccalis and G. vaginalis were identified as the main differential species. L. acidophilus was positively correlated with serum levels of anti-Müllerian hormone (AMH), and triglyceride (P = 2.01E-05, P = 0.004, respectively). P. buccalis was negatively correlated with serum levels of AMH and testosterone (P = 0.002, P = 0.003, respectively). G. vaginalis was positively correlated with serum levels of AMH, oestradiol and progesterone (P = 0.004, P = 0.005, P = 0.03, respectively). The VMB interaction network indicated that Lactobacillus crispus, Prevotella timonensis, and P. buccalis could be key drivers in the PCOS group. Overall, 55 predicted genes were found to be differentially abundant between PCOS and the control (FDRs < 0.25). CONCLUSIONS: The PCOS group had a higher diversity of vaginal microbiome and showed an enhanced level of heterogeneity. The proportion of Lactobacillus in the PCOS group decreased, whereas the proportions of Gardnerella and Ureaplasma increased. These results warrant further research that can validate the correlation between PCOS and VMB.

Congenital interruption between the ampulla and fimbria of the fallopian tube: case report.

We reported 5 patients with unilateral or bilateral tubal discontinuity between the ampulla and fimbria, occasionally detected through laparoscopy combined with hysteroscopy at the Reproductive Hospital Affiliated with Shandong University from 2017 to 2023. Three cases were observed to have this malformation on the left fallopian tube, 1 case on the right side, and 1 case bilaterally. None of these cases were combined with urological malformations. After surgery, there was 1 instance of postoperative delivery, 1 ongoing pregnancy, and 3 not yet conceived. The congenital ampulla and fimbria interruption of the fallopian tube may be independent of other significant deformities of reproductive or renal tracts. However, it can lead to hydrosalpinx and primary or secondary infertility. Surgical management options, such as salpingostomy, salpingectomy, and tubal ligation, have shown the potential to improve pregnancy outcomes.

Association Between Pregnancy Outcomes and the Time of Progesterone Exposure of D6 Single-Blastocyst Transfer in Frozen-Thawed Cycles: A Retrospective Cohort Study.

Purpose: The objective of this study was to assess reproductive outcomes of D6 blastocysts transferred on day 6 in comparison to those transferred on day 7 of progesterone exposure in frozen-thawed embryo transfer cycles. Patients and Methods: This retrospective cohort study included 2029 D6 single blastocysts from the first frozen-thawed embryo transfer cycles of patients at the Hospital for Reproductive Medicine Affiliated to Shandong University from February 2017 to January 2020. Participants were divided into Group A (blastocyst transferred on the 6th day of progesterone exposure, n=1634) and Group B (blastocyst transferred on the 7th day of progesterone exposure, n=395). Results: The live birth rate was comparable between Group A and Group B (38.7% versus 38.7%, P=0.999). Subgroup analysis revealed a significantly higher preterm birth rate in D6 single blastocysts transferred on the 7th day than in those transferred on the 6th day of progesterone exposure for natural cycle frozen-thawed embryo transfer (5.2% versus 11.3%, P=0.020). After adjustment for potential confounders, the differences in the preterm birth rate in natural cycles persisted (adjusted odds ratio 2.347, 95% confidence interval 1.129-4.877, P=0.022). Conclusion: In frozen-thawed embryo transfer cycles, transferring on the 6th or 7th day of progesterone exposure of D6 blastocysts did not affect the live birth rate; however, when a natural cycle protocol is adopted, the possible preterm risk of transferring D6 blastocysts on the 7th day of progesterone exposure should be noted.

The Cystic Anechoic Zone of Uterine Cavity Newly Observed during Controlled Ovarian Hyperstimulation Affects Pregnancy Outcomes of Fresh Embryo Transfer.

During controlled ovarian hyperstimulation (COH), cystic anechoic zones in the uterine cavity are occasionally visible. This retrospective matched cohort study collected information on patients who underwent in vitro fertilization/intracytoplasmic injection (IVF/ICSI) from January 2014 to December 2020 at our center. The propensity score algorithm matched 179 cases that had uterine cystic anechoic zones, with 358 which did not have uterine cystic anechoic zones cases. After matching, the live birth rate (38.0% vs. 48.6%, p = 0.025) of patients with uterine cystic anechoic zones was lower than that in the no uterine cystic anechoic zone group, while for clinical pregnancy miscarriage rate (22.2% vs. 12.4%, p = 0.031), the rate was higher. The results showed no correlation in the association between live birth rate (r = −0.027, p = 0.718), clinical pregnancy rate (r = −0.037, p = 0.620) or biochemical pregnancy rate (r = −0.015, p = 0.840) and the diameters of the cystic anechoic zones in the uterine cavity. There was a significant difference in the type of endometrium between the two groups (p < 0.001). The result of this study can provide guidance to patients on whether to undergo fresh embryo transfer in the current cycle.

Effects of bicornuate uterus on pregnancy and obstetric outcomes of in vitro fertilization / intracytoplasmic sperm injection.

OBJECTIVE: A bicornuate uterus results from failure of the Müllerian ducts to completely fuse. If patients with bicornuate uterus are diagnosed with infertility, they can conceive with help from in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). With few studies on the reproductive performances of bicornuate uterus following IVF/ICSI treatment, the aim of present study is to investigate whether a bicornuate uterus would affect pregnancy rates and obstetric outcomes of infertile women. STUDY DESIGN: A retrospective cohort study contained 232 women (58 with bicornuate uterus and 174 with normal uterus) was conducted. Patient data for IVF/ICSI treatment and follow-up were collected and analyzed. Cumulative pregnancy rate and cumulative live birth rate after one complete assisted reproductive technology (ART) cycle were the primary outcomes. RESULTS: Baseline characteristics were comparable between the bicornuate uterus group and the control group. Ovarian response to stimulation and embryological results were similar between the two groups. In fresh embryo transfer cycles, embryo implantation rate (32.7 % vs. 42.9 %, P = 0.176), biochemical pregnancy rate (54.1 % vs. 64.9 %, P = 0.236), and clinical pregnancy rate (45.9 % vs. 58.8 %, P = 0.172) did not differ significantly between the bicornuate uterus group and the control group. Live birth rate (40.5 % vs. 43.9 %, P = 0.723), term delivery rate (93.3 % vs. 90.0 %, P = 0.696), cesarean section rate (73.3 % vs. 76.0 %, P = 0.833), and newborn birth weight (3.35 ± 0.56 vs. 3.32 ± 0.51, P = 0.524) also did not differ significantly between the two groups. In frozen-thawed embryo transfer cycles, there were no significant differences in outcomes between the two groups. Upon completion of one IVF/ICSI cycle, cumulative pregnancy rate (59.6 % vs. 71.0 %, P = 0.112) and cumulative live birth rate (58.2 % vs. 64.8 %, P = 0.375) were similar between the two groups. CONCLUSION: There were no significant differences in ovarian responses, pregnancy outcomes, and obstetric outcomes after IVF/ICSI treatment between women with bicornuate uterus and women with normal uterus. Bicornuate uterus had no significant negative effects on cumulative IVF/ICSI outcomes of infertile patients.