Analysis of the proportion and clinical characteristics of obstructive sleep apnea in women with polycystic ovary syndrome.

PURPOSE: To investigate the proportion and clinical characteristics of obstructive sleep apnea (OSA) in Chinese patients with polycystic ovarian syndrome (PCOS) through home sleep apnea test (HSAT) and to evaluate the reproductive endocrine and metabolic characteristics in these patients. METHODS: The study was a cross-sectional analysis of infertile PCOS patients who underwent sleep respiratory monitoring between January and December 2019 at Peking University Third Hospital Reproductive Medical Center and respiratory and critical care medicine department. The prevalence of OSA, body mass index (BMI), menstruation, reproductive endocrine, and metabolic characteristics were collected in patients with PCOS. Logistic regression was performed to identify significant relationships among these factors and OSA. RESULTS: Amont 328 patients with PCOS, the prevalence of OSA was 40% (131/328), and six cases (5%) were severe. Univariate analysis showed that BMI and blood pressure were significantly higher in patients with OSA than in those without OSA (P < 0.05), whereas the anti-Mullerian hormone was lower than that in patients without OSA. In terms of glucose and lipid metabolism, the glycosylated hemoglobin (HbA1c), fasting plasma glucose, and fasting insulin levels were significantly higher in patients with PCOS and comorbid OSA than in those without OSA (all P < 0.05). Patients with OSA also had higher triglyceride, low-density lipoprotein cholesterol, and high-sensitivity C-reactive protein levels and lower high-density lipoprotein cholesterol levels (P < 0.05). Logistic regression analysis revealed that higher BMI, elevated serum testosterone, and decreased high-density lipoprotein cholesterol (HDL-C) are correlated with occurrence of OSA (P < 0.05). CONCLUSION: OSA in patients with PCOS was associated with multiple alterations in indexes of reproductive endocrine and metabolic disorders.

Lower cumulative live birth rates in cured endometrial tuberculosis patients after one ART cycle including all subsequent frozen-thaw cycles: A matched-pair study.

OBJECTIVE: To investigate the outcomes of the first ART cycle including all subsequent frozen-thaw cycles from the same oocyte retrieval till first live birth in women with cured endometrial tuberculosis. STUDY DESIGN: This is a 1:4 matched-pair study, 113 cured endometrial tuberculosis patients (TB group) and 452 patients of non-tuberculosis (Non-TB group) matched for age, basal E2, basal FSH and ovulation protocol who underwent first complete ART cycles in our institution during December 2010 and December 2015 were included in the study. The baseline characteristic, clinic data, and IVF treatment outcomes were compared and analyzed between the two groups. RESULTS: Compared with the Non-TB group, the cumulative clinical pregnancy rates was similar (64.6% vs 65.1%, p = 0.89) but the cumulative live birth rates (40.7% vs 52.7%, p < 0.00) were significantly lower and the spontaneous abortion rates (37.0% vs 13.2%, P＜0.05 was significantly higher in TB group. There was no significant difference in the clinical pregnancy rates, live birth rates and spontaneous abortion rates between the fresh cycles and frozen-thaw cycles in the TB group. CONCLUSION: Women may have increased risk of miscarriage and decreased CLBRs after cured endometrial TB infection when undergoing IVF.

Ovulation induction and intrauterine insemination in infertile women with polycystic ovary syndrome: A comparison of drugs.

OBJECTIVE: To study the effectiveness of different ovulation induction protocols in infertile women with polycystic ovary syndrome (PCOS) undergoing intrauterine insemination (IUI). DESIGN: Retrospective cohort study. PATIENTS: Infertile women with PCOS undergoing IUI had ovulation induced with clomiphene citrate (CC), letrozole, or gonadotropins. MAIN OUTCOME MEASURE: Live birth and multiple pregnancy rates. RESULTS: We performed 1068 IUI cycles in 765 couples. Live birth rates were comparable in CC-stimulated cycles (13.9%), letrozole-stimulated cycles (13.5%, OR 0.96 [95% CI, 0.63, 1.47]), and gonadotropins-stimulated cycles (13.2%, OR 0.94[95% CI, 0.62, 1.43]). Multiple pregnancy rates were 8.3%, 4.1% (OR 0.47 [95% CI, 0.09, 2.42]), and 3.3% (OR 0.34 [95% CI, 0.07, 1.95]) in CC, letrozole and gonadotropins stimulated cycles, respectively. Compared to CC, letrozole generated more often mono-follicular growth (75.9% versus 67.0%; OR 1.55 [95% CI, 1.11, 2.15]) but not more often after gonadotropins (72.9%, OR 1.17 [95% CI, 0.82, 1.66]. Cycles with multi-follicular growth did not result in statistically higher live birth rates than cycles with mono-follicular growth (15.8% vs. 12.7%, OR 1.29 [95% CI 0.89, 1.89]), but more often in multiple pregnancies (15.5% versus 0.8%, OR 22.4 [95% CI, 2.8, 181.6]). CONCLUSION: In women with PCOS undergoing stimulated IUI, CC, letrozole and gonadotropins were equally effective and safe. Since multi-follicular growth increased the multiple pregnancy rates without increasing the overall live birth rate, ovulation induction would strictly aim for mono-follicular growth. Since letrozole had the highest mono-follicular growth rate, we recommend this drug as the treatment of first choice in infertile women undergoing ovulation induction and IUI.

Effects of Chinese herbs combined with in vitro fertilization and embryo transplantation on infertility: a clinical randomized controlled trial.

OBJECTIVE: To assess the effects of using Chinese herbs in assisted reproductive technology. METHODS: Four hundred and thirty-three subjects aged less than 42 years with infertility due to Fallopian tube or male-related factors who were willing to undertake in vitro fertilization and embryo transplantation were randomly allocated to a Chinese herb intervention group (n = 216) or a conventional treatment control group (n = 217). All subjects received one of four routine ultra-ovulation-promoting therapies at the Reproductive Center in the Third Hospital Affiliated to Beijing University according to their physician's assessments. The subjects in the intervention group received various Chinese herbs depending on their conventional treatment. Endometrial thickness, number of acquired eggs, and rates of normal fertility, high-quality embryos, biochemical and clnical pregnancy of subjects were assessed in both groups. RESULTS: The high-quality embryo rate of 51.9%, biochemical pregnancy rate of 51.0%, clinical pregnancy rate of 44.2% and endometrial thickness of (10.84 +/- 1.75) mm in the intervention group were all significantly higher than those in the control group [48.7%, 38.9%, 34.8%, and (10.52 +/- 1.50) mm, respectively; P < 0.05]. The normal fertility rate of 58.5% in the Chinese herb group was also significantly superior to the 54.7% achieved in the control group (P < 0.01). There were no statistically significant differences (P > 0.05) in the average number of acquired eggs within a single cycle, incidence of excessive stimulation of ovary, rates of embryo transplantation or early abortion and birth of living babies between the two groups. CONCLUSION: Our findings indicate that Chinese herbs increase endometrial thickness, improve the quality of fertility and embryo, and promote embryonic nidation, thus enhancing the success rate of in vitro fertilization/intracytoplasmic sperm injection-embryo transplantation cycle. Using Chinese herbs improves the outcomes and safety of assisted reproductive technologies.

The hysteroscopy and histological diagnosis and treatment value of chronic endometritis in recurrent implantation failure patients.

PURPOSE: To study the consistency of hysteroscopy findings and histological chronic endometritis (CE) in recurrent implantation failure (RIF) cases, and to compare their values in indicating antibiotic treatment. METHODS: Sixty RIF cases (January 2009-January 2010) and 202 consecutive RIF cases (May 2010-April 2012) in Peking University Third Hospital reproductive medical center were studied. 60 RIF patients' endometrial samples redid section and CD38/CD138 immunohistochemical stain for CE screening. In 202 RIF cases, the presence of hyperemia, mucosal edema, and micropolyps under hysteroscopy were considered CE diagnostic parameters. Antibiotic was offered to part of the patients. The patients' clinical outcomes were analyzed by statistical methods. RESULTS: In 202 RIF cases, the hysteroscopy CE rate was 66.3 %, while histological CE rate was 43.6 %. The sensitivity and specificity of hysteroscopy were 35.2 and 67.5 %. In histological CE patients, 68 cases underwent regular antibiotic treatment and 20 did not. Two groups had similar clinical pregnancy rates (35.3 vs. 30.0 %), embryo implantation rates (18.9 vs. 20.4 %) and ongoing pregnancy rates (29.4 vs. 25.0 %). In hysteroscopy CE patients, the implantation rate (18.6 vs. 4.9 %) and ongoing pregnancy rate (29.3 vs. 7.4 %) significantly increased (P < 0.05) with antibiotic treatment, and higher intrauterine pregnancy rate in treatment group (29.3 vs. 11.1 %). In reviewing the chosen 60 RIF cases, the histological CE rates were similar in both pregnancy and non-pregnancy group after subsequent embryo transfer. CONCLUSIONS: CE occurs frequently in RIF patients; hysteroscopy has more diagnostic and treatment value for them.

[Intervention of controlled ovarian hyperstimulation cycle by Chinese medical herbs for Shen tonifying, blood nourishing and activating: a randomized clinical trial].

OBJECTIVE: To study the effect of Chinese medical herbs for Shen tonifying, blood nourishing and activating (CMHSTBNA) on the cycle of controlled ovarian hyperstimulation (COH) of assisted reproductive technique (ART). METHODS: A large sample randomized control trial was performed. Infertility women patients, younger than 42 years (infertility due to tubal factor and/or male factor) were randomly assigned to the CMHSTBNA intervention group (abbreviated as the treated group) and the control group, 184 cases in each group. All underwent COH. Those in the treated group received assist therapy of CMHSTBNA from the menstrual period day 2 -3 of COH to the day of oocytes retrieved. The serum hormone level [including estrogen (E2), progesterone(P), luteal hormone (LH) on the day of human chorionic gonadotrophin (hCG) administration], the medication days and dosage of gonadotropin (Gn), the number of oocytes retrieved, the fertilization rate, and the good-quality embryo rate were observed and compared with the control group. RESULTS: The endometrial thickness on the day of oocytes retrieved was 10.85 +/- 1.63 mm in the treated group, larger than that in the control group (10.50 +/- 1.49 mm) (P <0.05). The good-quality embryo rate and the frozen rate were 48. 9% and 39. 7% respectively in the treated group, superior to those of the control group (45. 4% and 35. 8% respectively), showing statistical difference (P < 0.05). On the day of hCG administration, favorable tendency was shown in the serum levels of estradial (E2), progesterone (P), luteinizing hormone (LH), the medication days and dosage of Gn, the number of oocytes retrieved, the fertilization rate, and the cleavage rate, showing no statistical difference when compared with the control group (P >0.05). CONCLUSION: The combined application of CMHSTBNA and gonado-trophic hormones in COH cycle could elevate the embryo quality, improve the endometrial state, thus laying foundation for successful in vitro fertilization/intracytoplasmic sperm embryo transfer.

Lower expression of ER-α36 is associated with the development of endometrial hyperplasia in PCOS patients.

OBJECTIVE: To explore the expression change of ER-α36 in endometria of PCOS patients. METHODS: Proliferative endometria were collected and divided into three groups: CE group (n=30), proliferative endometria from control women; PCOSE group (n=30), proliferative endometria from PCOS patients; HPCOSE group (n=15), hyperplastic endometria from PCOS patients. The cellular localization of ER-α36 and ER-α66 was analyzed by immunohistochemistry, and expression of ER-α36 and ER-α66 was determined by immunohistochemistry and Real-Time Quantitative PCR. The correlation between serum hormone concentration and expression of ER-α36 and ER-α66 was analyzed. RESULTS: ER-α36 was localized on the cell surface, cytoplasm and nucleus of glandular epithelial cells of both CE and PCOSE groups, mainly on the cell surface, and ER-α66 was localized on the nucleus. The protein and mRNA expression of ER-α36 was decreased from CE, PCOSE to HPCOSE group, while expression of ER-α66 showed no obvious difference among groups. The expression ratio of ER-α36 to ER-α66 of CE, PCOSE and HPCOSE group showed a decreasing tendency. The expression of ER-α36 and its expressive ratio to ER-α66 was negatively correlated with serum concentration of LH, LH/FSH, testosterone and androstenedione. CONCLUSIONS: Lower expression of ER-α66 is associated with the development of endometrial hyperplasia in PCOS patients.