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1.
Medicine (Baltimore) ; 98(44): e17731, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689817

RESUMO

INTRODUCTION: Many infertile patients have used Korean medicines (KMs) as a primary or adjuvant therapeutic method to improve in vitro fertilization success rates. The aim of this multicenter observational study is to investigate the effects of KMs on poor ovarian reserve (POR) in infertile patients. METHODS AND ANALYSIS: We will perform a prospective multicenter observational study. This study will recruit 50 women between 25 and 44 years of age with infertility caused by POR from among patients who visit the KM clinic. All participants will visit the KM clinic on the 2nd or 3rd day of menstruation to receive the KMs. KM treatment will be delivered for 3 menstrual cycles (3 months) and will include herbal decoction, acupuncture, or moxibustion on demand. Every participant will be assessed based on KM clinical symptoms, a quality of life questionnaire, and ovarian reserve test results. ETHICS AND DISSEMINATION: The study was approved by Institutional Review Board of Semyung University (SMU-IM-190501). The results will be published in a peer-reviewed journal and will be disseminated electronically and in print. TRIAL REGISTRATION NUMBER: Clinical Research Information Service: KCT0004209.


Assuntos
Terapia por Acupuntura/métodos , Fertilização In Vitro/métodos , Infertilidade Feminina/terapia , Medicina Tradicional Coreana/métodos , Moxibustão/métodos , Fitoterapia/métodos , Insuficiência Ovariana Primária/terapia , Adulto , Feminino , Humanos , Infertilidade Feminina/etiologia , Estudos Observacionais como Assunto , Reserva Ovariana , Estudos Prospectivos , Qualidade de Vida , República da Coreia , Resultado do Tratamento
2.
Orv Hetil ; 160(41): 1633-1638, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31587576

RESUMO

Introduction: Bowel endometriosis is when endometrial-like tissue penetrates the bowel serosa, or it reaches the subserous neurovascular plexus. The effect of surgery for colorectal endometriosis on infertility and pregnancy is not fully proven. Aim: The aim of the present study was to analyse the pregnancy outcome and mode of delivery of patients who underwent 'nerve sparing' anterior resection of the colon. Method: Between 2009 and 2017, we operated 121 patients with bowel endometriosis, and built up a prospective database where we assessed their wish of pregnancy, the way of the conception, pathologies during pregnancy and mode of delivery. Statistical analysis: The relationship between endometriosis and pregnancy pathologies was tested by a χ2 probe and Fisher's exact test, additionally the odds ratio (OR) and 95% confidence interval (CI) were determined. For p<0.05, the result was considered significant. Results: Out of 121 bowel endometriosis patients, 48 (39.6%) women got pregnant, 37 (30.5%) of them with in vitro fertilisation. The control group was built from patients who underwent in vitro fertilisation because of andrological factors. We found that women with endometriosis have a significantly higher risk for praeeclampsia (p = 0.023) and placenta praevia (p = 0.045) during pregnancy. Conclusions: Our study is a unique description of pregnancy outcome and mode of delivery after surgery for bowel endometriosis, which, despite the small number of cases, has yielded similar results to the previous multicentric studies. Orv Hetil. 2019; 160(41): 1633-1638.


Assuntos
Endometriose/cirurgia , Fertilidade/fisiologia , Fertilização In Vitro/métodos , Infertilidade Feminina/complicações , Endometriose/fisiopatologia , Feminino , Humanos , Placenta Prévia/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Taxa de Gravidez , Estudos Prospectivos
3.
Medicine (Baltimore) ; 98(41): e17470, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593108

RESUMO

Antral follicle count (AFC) has been widely investigated for the prediction of clinical pregnancy or live birth. This study discussed the effects of AFC quartile levels on pregnancy outcomes combined with female age, female cause of infertility, and ovarian response undergoing in vitro fertilization (IVF) treatment. At present, many research about AFC mainly discuss its impact on clinical practice at different thresholds, or the analyses of AFC with respect to assisted reproductive technology outcomes under using different ovarian stimulation protocols. Factors that include ovarian sensitivity index, female age, and infertility cause are all independent predictors of live birth undergoing IVF/intracytoplasmic sperm injection, while few researchers discussed influence of female-related factors for clinical outcomes in different AFC fields.A total of 8269 infertile women who were stimulated with a long protocol with normal menstrual cycles were enrolled in the study, and patients were categorized into 4 groups based on AFC quartiles (1-8, 9-12, 13-17, and ≥18 antral follicles).The clinical pregnancy rates increased in the 4 AFC groups (28.25% vs 35.38% vs 37.38% vs 40.13%), and there was a negative association between age and the 4 AFC groups. In addition, female cause of infertility like polycystic ovary syndrome, Tubal factor, and other causes had great significance on clinical outcome, and ovarian response in medium (9-16 oocytes retrieved) had the highest clinical pregnancy rate at AFC quartiles of 1 to 8, 9 to 12, 13 to 17, and ≥18 antral follicles.This study concludes that the female-related parameters (female cause of infertility, female age, and ovarian response) combined with AFC can be useful to estimate the probability of clinical pregnancy.


Assuntos
Fatores Etários , Fertilização In Vitro/estatística & dados numéricos , Infertilidade Feminina/terapia , Indução da Ovulação/estatística & dados numéricos , Taxa de Gravidez , Adulto , Feminino , Fertilização In Vitro/métodos , Humanos , Infertilidade Feminina/etiologia , Nascimento Vivo , Modelos Logísticos , Análise Multivariada , Folículo Ovariano , Indução da Ovulação/métodos , Gravidez , Estudos Prospectivos , Curva ROC , Resultado do Tratamento
4.
Rev Med Suisse ; 15(668): 1909-1913, 2019 Oct 23.
Artigo em Francês | MEDLINE | ID: mdl-31643150

RESUMO

In Switzerland, since modifications of the law regulating reproductive medicine introduced the 1rst of September 2017, preimplantation genetic testing (PGT) has been legalised. Infertile couples undergoing in vitro fertilization (IVF) can benefit from this technology by detecting which embryos are aneuploid (ie abnormal number of chromosomes, PGT-A). This is performed in order to transfer euploid embryos (normal number of chromosomes) and to optimise success, though data are limited. Couples at risk of transmitting a severe monogenic disease or unbalanced translocation can undergo PGT for monogenic disease or chromosomal structural rearrangements (PGT-M/SR). These tests are subject to strict legal criteria. Their clinical application needs to be approved through a multidisciplinary approach taking into account legal and ethical issues while respecting the autonomy of the couples.


Assuntos
Testes Genéticos/ética , Testes Genéticos/legislação & jurisprudência , Diagnóstico Pré-Implantação/ética , Aneuploidia , Feminino , Fertilização In Vitro , Testes Genéticos/métodos , Humanos , Masculino , Gravidez , Diagnóstico Pré-Implantação/métodos , Suíça
5.
Zhen Ci Yan Jiu ; 44(8): 599-604, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31475495

RESUMO

OBJECTIVE: To observe the clinical effect of acupuncture plus medication in the treatment of poor ovarian response (POR) patients and to explore its mechanisms in assisting pregnancy. METHODS: A total of 100 volunteer POR women undergoing in vitro fertilization-embryo transplantation (IVF-ET) were recruited in the present study. On the 1st cycle of IVF-ET, these POR women received microstimulation of ovulation program (oral administration of Clomiphene, muscular injection of Menotrophin, Chorionic Gonadotrophin triggering, etc.). Before receiving the 2nd period of IVF-ET, these patients were equally and randomly divided into control, medication (Climen, composed of estradiol valerate and cyproterone acetate), acupuncture and acupuncture+medication (combined treatment) groups according to the random number table. Patients of the medication group were asked to orally take Climen (1 tablet/d for 21 days) beginning from the 3rd day of the menstruation, which was repeated for 3 menstrual cycles. Patients of the acupuncture group received manual acupuncture stimulation of Guanyuan (CV4), and bilateral Taixi (KI3), Sanyinjiao (SP6) of and Tai-chong (LR3) from day 8 to 15 of menstruation (follicular phase), once daily for 3 menstrual cycles. On the 2nd day of menstruation of the 1st and 2nd IVF-ET cycle, the ovarian reserve function was detected, including measurement of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) contents by using radioimmunoassay, and serum anti-mullerian hormone (AMH) level by using ELISA, and the antral follicles count (AFC) of the ovaries by using a color Doppler ultrasonic diagnosis apparatus. At the end of ovulation induction, the assisted pregnancy indexes and outcomes were detected, including administration of dosage and days of gonadotropin (Gn), the diameter of dominant oocyte, level of E2 on the trigger day, the numbers of ultrasound-guided-retrieved oocyte and the cultivated high-quality embryo (grade 1 and 2). RESULTS: After the treatment, the contents of serum FSH, LH and E2 in the medication, acupuncture and combined treatment groups were significantly reduced (P<0.05), and the content of serum AMH and ovary AFC in the medication, acupuncture and combined treatment groups were obviously increased (P<0.05) in comparison with their own pre-treatment (P<0.05). Compared with the control group, the levels of FSH, LH and E2 contents were notably decreased, and the AMH content and AFC significantly increased in the medication, acupuncture and combined treatment groups (P<0.05). Comparison among the three treatment groups showed that the levels of FSH, LH and E2 were notably lower in the combined treatment group than in the acupuncture group (P<0.05), and the AFC was markedly more in the combined treatment group than in the acupuncture group (P<0.05), and LH content was also significantly lower in the combined treatment group than in the medication group (P<0.05). Regarding the pregnancy-assistant indexes and outcomes, the dosage of Gn in the combined treatment group and the number of Gn administration days in the acupuncture and combined treatment groups were significantly fewer (P<0.05), serum E2 levels on the trigger day in the medication, acupuncture and combined treatment groups, and the high-quality embryo number in the combined treatment group were considerably higher in comparison with their own levels of the 1st IVF-ET cycle in each group (P<0.05). Comparison among the three groups showed that the dosage and number of administration days of Gn in the combined treatment group were fewer than those in the medication group(P<0.05), and the dosage of Gn in the combined treatment group were significantly lower than that in the acupuncture group (P<0.05), E2 content of the combined treatment group was markedly higher than that of the medication and acupuncture groups (P<0.05). The high-quality embryo number in the combined treatment group was obviously larger than that of the medication group (P<0.05). No significant differences were found between the 2nd and 1st IVF-ET cycles in the number of the obtained oocyte, between the acupuncture and medication groups in the E2 content at the trigger day, and the numbers of Gn administration days and the high-quality embryo (P>0.05). CONCLUSION: Acupuncture combined with medication improves the level of endocrinal hormones and ovarian reservation function in POR women undergoing IVF-ET, benefiting the ovary environment of pregnancy.


Assuntos
Terapia por Acupuntura , Reserva Ovariana , Transferência Embrionária , Feminino , Fertilização In Vitro , Hormônio Foliculoestimulante , Humanos , Ovário , Gravidez
6.
Cochrane Database Syst Rev ; 9: CD012692, 2019 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-31486548

RESUMO

BACKGROUND: Clinical management for unexplained infertility includes expectant management as well as active treatments, including ovarian stimulation (OS), intrauterine insemination (IUI), OS-IUI,  and in vitro fertilisation (IVF) with or without intracytoplasmic sperm injection (ICSI).Existing systematic reviews have conducted head-to-head comparisons of these interventions using pairwise meta-analyses. As this approach allows only the comparison of two interventions at a time and is contingent on the availability of appropriate primary evaluative studies, it is difficult to identify the best intervention in terms of effectiveness and safety. Network meta-analysis compares multiple treatments simultaneously by using both direct and indirect evidence and provides a hierarchy of these treatments, which can potentially better inform clinical decision-making. OBJECTIVES: To evaluate the effectiveness and safety of different approaches to clinical management (expectant management, OS, IUI, OS-IUI, and IVF/ICSI) in couples with unexplained infertility. SEARCH METHODS: We performed a systematic review and network meta-analysis of relevant randomised controlled trials (RCTs). We searched electronic databases including the Cochrane Gynaecology and Fertility Group Specialised Register of Controlled Trials, the Cochrane Central Register of Studies Online, MEDLINE, Embase, PsycINFO and CINAHL, up to 6 September 2018, as well as reference lists, to identify eligible studies. We also searched trial registers for ongoing trials. SELECTION CRITERIA: We included RCTs comparing at least two of the following clinical management options in couples with unexplained infertility: expectant management, OS, IUI, OS-IUI, and IVF (or combined with ICSI). DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles and abstracts identified by the search strategy. We obtained the full texts of potentially eligible studies to assess eligibility and extracted data using standardised forms. The primary effectiveness outcome was a composite of cumulative live birth or ongoing pregnancy, and the primary safety outcome was multiple pregnancy. We performed a network meta-analysis within a random-effects multi-variate meta-analysis model. We presented treatment effects by using odds ratios (ORs) and 95% confidence intervals (CIs). For the network meta-analysis, we used Confidence in Network Meta-analysis (CINeMA) to evaluate the overall certainty of evidence. MAIN RESULTS: We included 27 RCTs (4349 couples) in this systematic review and 24 RCTs (3983 couples) in a subsequent network meta-analysis. Overall, the certainty of evidence was low to moderate: the main limitations were imprecision and/or heterogeneity.Ten RCTs including 2725 couples reported on live birth. Evidence of differences between OS, IUI, OS-IUI, or IVF/ICSI versus expectant management was insufficient (OR 1.01, 95% CI 0.51 to 1.98; low-certainty evidence; OR 1.21, 95% CI 0.61 to 2.43; low-certainty evidence; OR 1.61, 95% CI 0.88 to 2.94; low-certainty evidence; OR 1.88, 95 CI 0.81 to 4.38; low-certainty evidence). This suggests that if the chance of live birth following expectant management is assumed to be 17%, the chance following OS, IUI, OS-IUI, and IVF would be 9% to 28%, 11% to 33%, 15% to 37%, and 14% to 47%, respectively. When only including couples with poor prognosis of natural conception (3 trials, 725 couples) we found OS-IUI and IVF/ICSI increased live birth rate compared to expectant management (OR 4.48, 95% CI 2.00 to 10.1; moderate-certainty evidence; OR 4.99, 95 CI 2.07 to 12.04; moderate-certainty evidence), while there was insufficient evidence of a difference between IVF/ICSI and OS-IUI (OR 1.11, 95% CI 0.78 to 1.60; low-certainty evidence).Eleven RCTs including 2564 couples reported on multiple pregnancy. Compared to expectant management/IUI, OS (OR 3.07, 95% CI 1.00 to 9.41; low-certainty evidence) and OS-IUI (OR 3.34 95% CI 1.09 to 10.29; moderate-certainty evidence) increased the odds of multiple pregnancy, and there was insufficient evidence of a difference between IVF/ICSI and expectant management/IUI (OR 2.66, 95% CI 0.68 to 10.43; low-certainty evidence). These findings suggest that if the chance of multiple pregnancy following expectant management or IUI is assumed to be 0.6%, the chance following OS, OS-IUI, and IVF/ICSI would be 0.6% to 5.0%, 0.6% to 5.4%, and 0.4% to 5.5%, respectively.Trial results show insufficient evidence of a difference between IVF/ICSI and OS-IUI for moderate/severe ovarian hyperstimulation syndrome (OHSS) (OR 2.50, 95% CI 0.92 to 6.76; 5 studies; 985 women; moderate-certainty evidence). This suggests that if the chance of moderate/severe OHSS following OS-IUI is assumed to be 1.1%, the chance following IVF/ICSI would be between 1.0% and 7.2%. AUTHORS' CONCLUSIONS: There is insufficient evidence of differences in live birth between expectant management and the other four interventions (OS, IUI, OS-IUI, and IVF/ICSI). Compared to expectant management/IUI, OS may increase the odds of multiple pregnancy, and OS-IUI probably increases the odds of multiple pregnancy. Evidence on differences between IVF/ICSI and expectant management for multiple pregnancy is insufficient, as is evidence of a difference for moderate or severe OHSS between IVF/ICSI and OS-IUI.


Assuntos
Infertilidade Feminina/terapia , Taxa de Gravidez , Técnicas de Reprodução Assistida , Coeficiente de Natalidade , Feminino , Fármacos para a Fertilidade Feminina/uso terapêutico , Fertilização In Vitro/métodos , Humanos , Infertilidade Feminina/etiologia , Meta-Análise em Rede , Indução da Ovulação/métodos , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Injeções de Esperma Intracitoplásmicas/métodos
7.
Cochrane Database Syst Rev ; 9: CD012192, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31529804

RESUMO

BACKGROUND: 'Infertility' is defined as the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. One in six couples experience a delay in becoming pregnant. In vitro fertilisation (IVF) is one of the assisted reproductive techniques used to enable couples to achieve a live birth. One of the processes involved in IVF is embryo culture in an incubator, where a stable environment is created and maintained. The incubators are set at approximately 37°C, which is based on the human core body temperature, although several studies have shown that this temperature may in fact be lower in the female reproductive tract and that this could be beneficial. In this review we have included randomised controlled trials which compared different temperatures of embryo culture. OBJECTIVES: To assess different temperatures of embryo culture for human assisted reproduction, which may lead to higher live birth rates. SEARCH METHODS: We searched the following databases and trial registers: the Cochrane Gynaecology and Fertility (CGF) Group Specialised Register of Controlled Trials, the Cochrane Central Register of Studies Online, MEDLINE, Embase, PsycINFO, CINAHL, clinicaltrials.gov, The World Health Organization International Trials Registry Platform search portal, DARE, Web of Knowledge, OpenGrey, LILACS database, PubMed and Google Scholar. Furthermore, we manually searched the references of relevant articles and contacted experts in the field to obtain additional data. We did not restrict the search by language or publication status. We performed the last search on 6 March 2019. SELECTION CRITERIA: Two review authors independently screened the titles and abstracts of articles retrieved by the search. Full texts of potentially eligible randomised controlled trials (RCTs) were obtained and screened. We included all RCTs which compared different temperatures of embryo culture in IVF or intracytoplasmic sperm injection (ICSI), with a minimum difference in temperature between the two incubators of ≥ 0.5°C. The search process is shown in the PRISMA flow chart. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial eligibility and risk of bias and extracted data from the included studies; the third review author resolved any disagreements. We contacted trial authors to provide additional data. The primary review outcomes were live birth and miscarriage. Clinical pregnancy, ongoing pregnancy, multiple pregnancy and adverse events were secondary outcomes. All extracted data were dichotomous outcomes, and odds ratios (OR) were calculated with 95% confidence intervals (CIs) on an intention-to-treat basis. We assessed the overall quality of the evidence for the main comparisons using GRADE methods. MAIN RESULTS: We included three RCTs, with a total of 563 women, that compared incubation of embryos at 37.0°C or 37.1°C with a lower incubator temperature (37.0°C versus 36.6°C, 37.1°C versus 36.0°C, 37.0° versus 36.5°C). Live birth, miscarriage, clinical pregnancy, ongoing pregnancy and multiple pregnancy were reported. After additional information from the authors, we confirmed one study as having no adverse events; the other two studies did not report adverse events. We did not perform a meta-analysis as there were not enough studies included per outcome. Live birth was not graded since there were no data of interest available. The evidence for the primary outcome, miscarriage, was of very low quality. The evidence for the secondary outcomes, clinical pregnancy, ongoing pregnancy and multiple pregnancy was also of very low quality. We downgraded the evidence because of high risk of bias (for performance bias) and imprecision due to limited included studies and wide CIs.Only one study reported the primary outcome, live birth (n = 52). They performed randomisation at the level of oocytes and not per woman, and used a paired design whereby two embryos, one from 36.0°C and one from 37.0°C, were transferred. The data from this study were not interpretable in a meaningful way and therefore not presented. Only one study reported miscarriage. We are uncertain whether incubation at a lower temperature decreases the miscarriage (odds ratio (OR) 0.90, 95% CI 0.52 to 1.55; 1 study, N = 412; very low-quality evidence).Of the two studies that reported clinical pregnancy, only one of them performed randomisation per woman. We are uncertain whether a lower temperature improves clinical pregnancy compared to 37°C for embryo incubation (OR 1.08, 95% CI 0.73 to 1.60; 1 study, N = 412; very low-quality evidence). For the outcome, ongoing pregnancy, we are uncertain if a lower temperature is better than 37°C (OR 1.10, 95% CI 0.75 to 1.62; 1 study, N = 412; very low quality-evidence). Multiple pregnancy was reported by two studies, one of which used a paired design, which made it impossible to report the data per temperature. We are uncertain if a temperature lower than 37°C reduces multiple pregnancy (OR 0.80, 95% CI 0.31 to 2.07; 1 study, N = 412; very low-quality evidence). There was insufficient evidence to make a conclusion regarding adverse events, as no studies reported data suitable for analysis. AUTHORS' CONCLUSIONS: This review evaluated different temperatures for embryo culture during IVF. There is a lack of evidence for the majority of outcomes in this review. Based on very low-quality evidence, we are uncertain if incubating at a lower temperature than 37°C improves pregnancy outcomes. More RCTs are needed for comparing different temperatures of embryo culture which require reporting of clinical outcomes as live birth, miscarriage, clinical pregnancy and adverse events.


Assuntos
Técnicas de Cultura Embrionária/métodos , Técnicas de Reprodução Assistida , Temperatura Ambiente , Feminino , Fertilização In Vitro , Humanos , Infertilidade , Nascimento Vivo , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Gravidez Múltipla , Ensaios Clínicos Controlados Aleatórios como Assunto , Injeções de Esperma Intracitoplásmicas
8.
BMJ ; 366: l5214, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31554611

RESUMO

OBJECTIVE: To compare the risk and severity of prostate cancer between men achieving fatherhood by assisted reproduction and men conceiving naturally. DESIGN: National register based cohort study. SETTING: Sweden from January 1994 to December 2014. PARTICIPANTS: 1 181 490 children born alive in Sweden during 1994-2014 to the same number of fathers. Fathers were grouped according to fertility status by mode of conception: 20 618 by in vitro fertilisation (IVF), 14 882 by intra-cytoplasmic sperm injection (ICSI), and 1 145 990 by natural conception. MAIN OUTCOME MEASURES: Prostate cancer diagnosis, age of onset, and androgen deprivation therapy (serving as proxy for advanced or metastatic malignancy). RESULTS: Among men achieving fatherhood by IVF, by ICSI, and by non-assisted means, 77 (0.37%), 63 (0.42%), and 3244 (0.28%), respectively, were diagnosed as having prostate cancer. Mean age at onset was 55.9, 55.1, and 57.1 years, respectively. Men who became fathers through assisted reproduction had a statistically significantly increased risk of prostate cancer compared with men who conceived naturally (hazard ratio 1.64, 95% confidence interval 1.25 to 2.15, for ICSI; 1.33, 1.06 to 1.66, for IVF). They also had an increased risk of early onset disease (that is, diagnosis before age 55 years) (hazard ratio 1.86, 1.25 to 2.77, for ICSI; 1.51, 1.09 to 2.08, for IVF). Fathers who conceived through ICSI and developed prostate cancer received androgen deprivation therapy to at least the same extent as the reference group (odds ratio 1.91; P=0.07). CONCLUSIONS: Men who achieved fatherhood through assisted reproduction techniques, particularly through ICSI, are at increased risk for early onset prostate cancer and thus constitute a risk group in which testing and careful long term follow-up for prostate cancer may be beneficial.


Assuntos
Antagonistas de Androgênios/uso terapêutico , Fertilização In Vitro/estatística & dados numéricos , Infertilidade Masculina/epidemiologia , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/epidemiologia , Adulto , Idade de Início , Estudos de Coortes , Fertilização , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Risco , Injeções de Esperma Intracitoplásmicas/estatística & dados numéricos , Análise de Sobrevida , Suécia/epidemiologia
9.
Zhongguo Zhen Jiu ; 39(9): 923-6, 2019 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-31544377

RESUMO

OBJECTIVE: To observe the clinical effect of warm acupuncture on endometrial cavity fluid (ECF) from in vitro fertilization-embryo transfer (IVF-ET), and to explore the mechanism of warm acupuncture on ECF. METHODS: Twenty-nine patients who were prepared for IVF-ET from 2016 to 2019 and whose transplantation was cancelled due to ECF found by vaginal B-ultrasound examination were divided into an observation group (14 cases) and a control group (15 cases) according to random number table method. The warm acupuncture was applied at Zhongwan (CV 12), Qihai (CV 6), Guanyuan (CV 4), Zhongji (CV 3), Guilai (ST 29), Zigong (EX-CA 1), Zusanli (ST 36), Sanyinjiao (SP 6) after the end of menstruation in the observation group, the treatment lasted for 60 min, once a day, 5 times as a course, with 2 days interval between the courses and 3 consecutive courses of treatment were given, until the embryo transfer was performed in the IVF assisted pregnancy cycle. After the end of menstruation, fresh leonurus japonicus capsule was given in the control group, 3 times a day, 0.8 g each time, 7 days as a course, and 3 courses of continuous treatment were received, until the embryo transfer was performed in the IVF assisted pregnancy cycle. The changes of ECF before and after treatment, the time required to prepare for embryo transfer during IVF assisted pregnancy cycle, and the clinical outcome of embryo transfer were observed in the two groups. RESULTS: The decrease of ECF in the observation group was more significant than that in the control group (P<0.05). The time required for the embryo transfer in the IVF assisted pregnancy cycle in the observation group was shorter than that in the control group (P<0.05). The clinical pregnancy rate in the observation group was 42.9% (6/14), which was significantly higher than 26.7% (4/15) in the control group (P<0.05). CONCLUSION: Warm acupuncture may improve the clinical pregnancy rate by raising the local temperature of the lower abdomen, accelerating the blood circulation around the uterus and appendages, promoting the absorption of ECF, improving the uterine environment and endometrial receptivity.


Assuntos
Terapia por Acupuntura , Transferência Embrionária , Fertilização In Vitro , Endométrio , Feminino , Humanos , Gravidez , Taxa de Gravidez
10.
Nan Fang Yi Ke Da Xue Xue Bao ; 39(8): 937-943, 2019 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-31511214

RESUMO

OBJECTIVE: To study the association of the level of advanced oxidation protein products (AOPPs) in seminal plasma with teratospermia and the outcome parameters of in vitro fertilization (IVF). METHODS: We conducted a cross-sectional study among 272 male patients receiving assisted reproduction treatment in the Center for Reproductive Medicine of our hospital between October, 2018 and March, 2019. The levels of seminal AOPPs and reactive oxygen species (ROS), demographic data, sperm parameters and IVF outcome parameters were analyzed for all the patients. According to the percentage of sperms with normal morphology, the patients were divided before IVF into teratozoospermia group and normal sperm morphology group, and those in teratozoospermia group were further divided into 3 subgroups with mild, moderate and severe teratozoospermia. The patients were also divided on the day oocyte retrieval into 2 groups with fertilizing rates lower (group Ⅰ) and higher (group Ⅱ) than the median rate. RESULTS: We found a significant negative correlation of seminal AOPP level before treatment with the percentage of normal sperm morphology (P=0.003) and seminal ROS level (P=0.013). The seminal levels of AOPPs (P= 0.027) and ROS (P=0.036) were significantly elevated in patients with teratospermia, and seminal AOPP level was significantly higher in severe teratospermia group than in mild (P=0.019) and moderate (P=0.015) teratospermia groups. The seminal levels of AOPPs (P=0.003) and ROS (P=0.017) on the day of oocyte retrieval were negatively correlated with the fertilization rate in IVF cycles, and the levels of AOPPs (P=0.049) and ROS (P=0.036) were significantly higher in group Ⅰ than in group Ⅱ. CONCLUSIONS: An elevated level of seminal AOPPs may indicate an increased risk of severe teratospermia and a lower fertilization rate in IVF.


Assuntos
Sêmen , Teratozoospermia , Produtos da Oxidação Avançada de Proteínas , Estudos Transversais , Fertilização In Vitro , Humanos , Masculino , Espermatozoides
11.
Gene ; 720: 144056, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31437466

RESUMO

Repeated implantation failure (RIF) was mainly due to poor endometrium receptivity. Long noncoding RNAs (lncRNAs) could regulate endometrium receptivity and act in competing endogenous RNA (ceRNA) theory. However, the regulatory mechanism of the lncRNA-miRNA-mRNA network in repeated implantation failure (RIF) is unclear. We obtained RIF-related expression profiles of lncRNAs, mRNAs, and miRNAs using mid-secretory endometrial tissue samples from 5 women with RIF and 5 controls by RNA-sequencing. Co-expression analysis revealed that three functional modules were enriched in immune response/inflammation process; two functional modules were enriched in metabolic/ biosynthetic process, and one functional module were enriched in cell cycle pathway. By adding the miRNA data, ceRNA regulatory relationship of each module was reconstructed. The ceRNA network of the whole differentially expressed RNAs revealed 10 hub lncRNAs. Among them, TRG-AS1, SIMM25, and NEAT1 were involved in the module1, module2, and module3, respectively; LNC00511 and SLC26A4-AS1 in the module4; H19 in the module5. The real-time polymerase chain reaction (RT-PCR) results of 15 randomly selected RNAs were consistent with our sequencing data. These can be used as novel potential biomarkers for RIF. Furthermore, they might be involved in endometrium receptivity by acting as ceRNA.


Assuntos
Biomarcadores/metabolismo , Endométrio/metabolismo , Redes Reguladoras de Genes , Genoma Humano , MicroRNAs/genética , RNA Longo não Codificante/genética , RNA Mensageiro/genética , Adulto , Estudos de Casos e Controles , Implantação do Embrião , Endométrio/patologia , Feminino , Fertilização In Vitro , Regulação da Expressão Gênica , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos
12.
Zhonghua Yi Xue Za Zhi ; 99(29): 2308-2310, 2019 Aug 06.
Artigo em Chinês | MEDLINE | ID: mdl-31434408

RESUMO

Objective: To summarize the clinical outcome of abnormal prokaryotic embryos [0PN (non-pronuclear), 1PN (one-pronuclear)] transfer for reference in clinical work. Methods: To collect the clinical data of infertility patients who received in vitro fertilization/intracytoplasmic sperm microinjection-embryo transfer from January 1, 2013 to December 31, 2018 at the reproductive center of Beijing Chaoyang Hospital Affiliated to Capital Medical University, and to retrospectively analyze the pregnancy outcome of the cases of embryo transfer from 0PN and 1PN sources. Results: Forty-seven patients were transplanted non-2PN-derived embryos during 50 cycles. There were 18 cycles which only 0PN embryos were transplanted, and the clinical pregnancy rate was 50.0%. There were 17 cycles which only 1PN embryos were transplanted, and the clinical pregnancy rate was 29.4% (compared with 0PN, the difference was not statistically significant, P>0.05). No abnormalities were found in the delivered newborns. Conclusions: In the absence of 2PN-derived embryos, patients can be transplanted blastocysts from 0PN and 1PN sources. Acceptable clinical pregnancy outcomes can be achieved, and the clinical outcomes of 0PN may be better than 1PN.


Assuntos
Resultado da Gravidez , Transferência Embrionária , Feminino , Fertilização In Vitro , Humanos , Recém-Nascido , Gravidez , Taxa de Gravidez , Células Procarióticas , Estudos Retrospectivos
13.
Life Sci ; 234: 116792, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31465733

RESUMO

AIMS: Assisted reproductive technologies (ART) have been widely used to treat infertility, which may impact on fetuses and offspring. This study investigated the effects of in vitro fertilization-embryo transfer (IVF-ET) on angiotensin II (AII)-mediated vasoconstrictions in umbilical cord vein, and explored possible reprogrammed methylation mechanism. MATERIALS AND METHODS: Human umbilical cords were randomly divided into ordinary pregnancy and IVF-ET pregnancy. Vascular studies with AII as well as its specific receptor antagonists losartan and PD123,319 were conducted. Real-time quantitative PCR, Western blotting, and methylation analysis by bisulfite sequencing were performed with the cord vessel samples. KEY FINDINGS: In IVF-ET group, the maximal response to AII in umbilical vessels was significantly greater than that in the ordinary pregnancy. Using losartan and PD123,319, angiotensin receptor subtype 1 (AT1R) was found mainly responsible for the enhanced contraction in the umbilical vein of IVF-ET pregnancy. Decreased mRNA expression of DNMT3A was found in umbilical vein of IVF-ET group. Hypomethylation of the AGTR1 gene (gene encoding AT1R) in the umbilical veins of the IVF group was found. The data suggested that the IVF-ET treatments altered AII-mediated vasoconstrictions in umbilical veins, which could be partially attributed to the increased expression of AT1R. SIGNIFICANCE: The hypo-methylation of the AGTR1 gene caused by IVF-ET might play important roles in altered vasoconstrictions, impacting on cardiovascular systems in the long run.


Assuntos
Angiotensina II/metabolismo , Metilação de DNA , Transferência Embrionária/métodos , Fertilização In Vitro/métodos , Receptor Tipo 1 de Angiotensina/genética , Cordão Umbilical/irrigação sanguínea , Vasoconstrição , Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Bloqueadores do Receptor Tipo 2 de Angiotensina II/farmacologia , Anti-Hipertensivos/farmacologia , Transferência Embrionária/efeitos adversos , Feminino , Fertilização In Vitro/efeitos adversos , Humanos , Imidazóis/farmacologia , Losartan/farmacologia , Gravidez , Piridinas/farmacologia , Vasoconstrição/efeitos dos fármacos , Vasoconstritores/farmacologia
14.
Cell Physiol Biochem ; 53(3): 439-452, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31436397

RESUMO

BACKGROUND/AIMS: Among the assisted reproductive techniques, the in vitro maturation of oocytes (IVM) is less developed than other techniques, but its implementation would entail a qualitative advance. This technique consists in the extraction of immature oocytes from antral ovarian follicles with the patient under low hormone stimulation or without hormone to mature exogenously in culture media supplemented with different molecules to promote maturation. In this sense, we are interested in the role that cannabinoids could have as IVM promoters because cannabinoid's molecular pathway is similar to the one by which oocyte's meiosis resumption is activated. With the intention of advancing in the possible use of cannabinoids as supplements for the media for in vitro maturation of oocytes, we intend to deepen the study of the function of the phytocannabinoid Δ-9-tetrahydrocannabinol (THC) in the IVM process. METHODS: By immunocytochemistry, we detected the location pattern of cannabinoid receptor type 1 (CB1) and type 2 (CB2) during oocyte maturation in presence or absence of THC, as well as, the staining pattern of p-AKT and p-ERK. We used a genetic/ pharmacological approach generating knockout oocytes for CB1 and/or CB2 and they were incubated with THC during the oocyte maturation to visualize the physiological effects of THC, observing the rate of blastocyst achieved by oocyte. RESULTS: This study confirms that the incubation of oocytes with THC during IVM accelerated some events of that process like the phosphorylation pattern of ERK and AKT and was able to increase the blastocyst rate in response to IVF. Moreover, it seems that both CB1 and CB2 are necessary to maintain a healthy oocyte maturation. CONCLUSION: Our data suggest that THC may be useful IVM supplements in clinic as is more feasible and reliable than any synthetic cannabinoid.


Assuntos
Blastocisto/efeitos dos fármacos , Dronabinol/farmacologia , Oócitos/efeitos dos fármacos , Animais , Apoptose/efeitos dos fármacos , Blastocisto/citologia , Blastocisto/metabolismo , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Feminino , Fertilização In Vitro , Técnicas de Maturação in Vitro de Oócitos , Meiose/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Oócitos/citologia , Oócitos/metabolismo , Fosforilação/efeitos dos fármacos , Proteínas Proto-Oncogênicas c-akt/metabolismo , Receptor CB1 de Canabinoide/genética , Receptor CB1 de Canabinoide/metabolismo , Receptor CB2 de Canabinoide/genética , Receptor CB2 de Canabinoide/metabolismo
15.
Ceska Gynekol ; 84(3): 177-183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31324106

RESUMO

INTRODUCTION: A successful embryo implantation is crucial for a positive outcome of in vitro fertilization. But there is only a short period during which the endometrium is receptive for embryo, this so called implantation window can be detected by a molecular diagnostic method endometrial receptivity analysis (ERA). OBJECTIVE: To find out the percentage of patients with a non-receptive endometrium in the time of ERA and to learn what part of them got pregnant after the identification of their personalized implantation window. DESIGN: A retrospective study. SETTING: REPROMEDA Biology Park, Centre of Reproductive Medicine and Preimplantation Genetic Diagnosis, Brno. METHODS: A cohort of 85 patients undergoing ERA from August 2015 to October 2018 was studied. 74 patients experienced a previous implantation failure, the average number of preceding unsuccessful frozen embryo transfers was 2,5 in this group, 11 women went through ERA due to the preventive reason before the first FET. In all women one euploid embryo was transferred. 48 patients were prepared either for ERA or FET in a natural menstrual cycle, 37 women in HRT cycle. We were interested in a percentage of non-receptive patients in the time of ERA and wanted to discover what part of non-receptive women got pregnant after the identification of their personal implantation window. The average number of frozen embryo transfers needed to achieve the pregnancy was also calculated. RESULTS: 31 of 85 patients (36.5%) were found to have a non-receptive endometrium. In the natural cycle 13 of 48 (27.1%) were non-receptive: five were pre-receptive, three early receptive, two late receptive and three post-receptive. In the HRT cycle 18 of 37 patients (48.6%) were non-receptive: 12 were pre-receptive, four early receptive, one late receptive, one post-receptive. Personalized FET was done in 26 of total 31 initially non-receptive patients, 18 of them got pregnant (69.2%). In the natural cycle 6 of 11 (54.5%) achieved the pregnancy, in the HRT cycle 12 of 15 women (80.0%) got pregnant. To achieve the clinical pregnancy 1.5 frozen embryo transfer in average was needed. CONCLUSION: A displaced implantation window was found in more than 1/3 of patients undergoing an assisted reproductive treatment. After the personalized FET the clinical pregnancy was noticed in 69.2% of them. This result supports an individual approach to patients in IVF programme besides other at the timing of embryo transfer after the identification of pWOI.


Assuntos
Implantação do Embrião , Transferência Embrionária/métodos , Endométrio/fisiologia , Fertilização In Vitro/métodos , Infertilidade Feminina/terapia , Implantação do Embrião/fisiologia , Feminino , Humanos , Infertilidade Feminina/fisiopatologia , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
16.
Ceska Gynekol ; 84(3): 229-232, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31324115

RESUMO

OBJECTIVE: Summary of available literature concerning recommendation of antithrombotic prophylaxis in the infertility treatment by in vitro fertilization (IVF) and in pregnancies after IVF. DESIGN: Review article. SETTINGS: Department of Obstetrics and Gynecology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc; Institute of Medical Genetics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký University Olomouc. METHODS: Analysis of literary sources and databases Medline, Web of Science, Scholar Google, 2010-2018. CONCLUSION: The incidence of thromboembolism in the first trimester of pregnancy after IVF is 0.2% e. g. 10-times higher compared to normal pregnant population. Pregnancies after IVF are complicated in 6-7% by ovarian hyperstimulation syndrome (OHSS), they then have the risk of venous thromboembolism (VTE) 1.7% in the first trimester, what is 100-times higher as compared to the general population. Women after IVF without OHSS have a 5-times higher risk of VTE compared to the general population. To lower the risk of thromboembolism during treatment, use of low dose gonadotrophin (mild) stimulation protocols, prioritization of antagonistic stimulation protocols, avoidance of OHSS using GnRH agonists instead of hCG, cryo embryotransfer in natural cycles, reduction of incidence of multiple pregnancy by single embryo transfer, use of prophylactic and therapeutic low molecular weight heparin (LMWH) is recommended. These strategies can reduce the risk of thromboembolism. The LMWH application is suitable in pregnant women in the first trimester of pregnancy after IVF where OHSS was present.


Assuntos
Fertilização In Vitro/efeitos adversos , Fibrinolíticos/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Síndrome de Hiperestimulação Ovariana/complicações , Complicações Hematológicas na Gravidez/etiologia , Tromboembolia/prevenção & controle , Transferência Embrionária , Feminino , Humanos , Indução da Ovulação , Gravidez , Complicações Hematológicas na Gravidez/tratamento farmacológico , Taxa de Gravidez , Tromboembolia/tratamento farmacológico , Tromboembolia/etiologia
19.
Zhongguo Zhen Jiu ; 39(7): 689-93, 2019 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-31286728

RESUMO

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 (E2) 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 P<0.01), and score in the observation group was superior to that in the control group (P<0.05). After treatment, the clinical efficacy in the observation group was superior to that in the control group (P<0.05). After treatment, the hormone levels (ß-HCG, E2, 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 P<0.05); except the levels of P and ß-HCG in 10-week pregnancy, the hormone levels in the observation group were superior to those in the control group (all P<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 (P<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 (P<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.


Assuntos
Ameaça de Aborto , Categute , Ameaça de Aborto/prevenção & controle , Pontos de Acupuntura , Transferência Embrionária , Feminino , Fertilização In Vitro , Humanos , Gravidez
20.
Zhongguo Zhen Jiu ; 39(7): 787-91, 2019 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-31286744

RESUMO

The article "Effect of acupuncture vs sham acupuncture on live births among women undergoing in vitro fertilization: a randomized clinical trial", published in JAMA 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.


Assuntos
Terapia por Acupuntura , Nascimento Vivo , Feminino , Fertilização In Vitro , Humanos , Gravidez , Reprodutibilidade dos Testes
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