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1.
Trials ; 23(1): 3, 2022 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34980220

RESUMO

BACKGROUND: In previous retrospective studies, low serum progesterone level on the embryo transfer day is associated with lower clinical pregnancy and ongoing pregnancy rates. Whether adding progesterone in low serum progesterone patients can rescue the outcome, there is no sufficient evidence from randomized controlled studies. METHODS: This trial is a clinical randomized controlled study (high serum progesterone vs low serum progesterone 1:1, 1:1 randomization ratio of intervention vs the control group with low serum progesterone). The eligible hormone replacement therapy-frozen embryo transfer (HRT-FET) cycles, will be recruited and randomly assigned to two parallel groups when serum progesterone is < 7.24µg/l on the day of embryo transfer for D3. The intervention group will be extrally given intramuscular progesterone 40 mg per day from D3 to 8 weeks of gestation if clinical pregnancy. The primary outcome is the ongoing pregnancy (beyond 12 weeks of gestation) rate. DISCUSSION: The findings of this study will provide strong evidence for whether the progesterone addition from the D3 in low serum progesterone patients can improve the outcome in the HRT-FET cycle. TRIAL REGISTRATION: ClinicalTrials.gov NCT04248309 . Registered on January 28, 2020.


Assuntos
Nascido Vivo , Progesterona , Transferência Embrionária , Feminino , Humanos , Gravidez , Taxa de Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos
2.
Theriogenology ; 178: 73-76, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34781068

RESUMO

In cattle there are two types of the corpus luteum (CL): homogeneous (CLhom) and cavitary (CLcav). Although they are considered equal in their hormonal activity, the function of the CLcav is questioned by many veterinarians. In consequence, females with the CLcav are considered less valuable for assisted reproductive techniques such as embryo transfer (ET), where recipients with the CLhom are preferred. The aim of our study was to compare the two types of CLs regarding morphological endpoints, serum progesterone (P4) concentrations and final pregnancy rate (PR) in recipient heifers after ET. The morphological type of the CL and the final PR after ET of 432 Holstein Friesian heifers were analyzed. Oestrus was synchronized with two i.m. inj. of 0.5 µg cloprostenol 14 days apart. The ET took place on the day 7 of the estrous cycle, only animals with visible oestrum were chosen for the procedure. Clinical and transrectal US examinations of ovaries were performed on the day of ET. The presence of the CLhom or CLcav was determined, and the CL diameter and cross-sectional area were measured. If present, measurements of the cavities were also taken. Only embryos recovered immediately prior to the ET at the morula or blastocyst stage were transferred to the randomly chosen recipient that underwent initial selection regardless of the CL morphology. Additionally, from randomly selected heifers (N = 53, CLhom = 33; CLcav = 20) blood samples for serum P4 concentration analysis were collected. Pregnancy was determined by transrectal palpation 2 months after ET. The medium-sized CLcav was larger in diameter (P < 0.001) and cross-sectional area (P < 0.01) than the CLhom (mean ± SD) - 23.29 ± 3.6 mm and 419.57 ± 135.01 mm2 compared to 21.87 ± 3.57 mm and 384.73 ± 145.46 mm2, respectively. The mean diameter and cross-sectional area of the cavity were 10.2 ± 4.36 mm and 97.59 ± 71.13 mm2, respectively. The volume of both types of CLs was similar (P = 0.3). The mean serum P4 concentration was 8.84 ng/ml, higher (P < 0.0001) for females with the CLcav (11.31 ng/ml) than for those with the CLhom (7.15 ng/ml). The PR was 36.1%, higher (P < 0.05) for recipients with the CLcav (47.7%) compared to the CLhom (29.9%). The presence of a CLcav in the recipient heifers did not negatively affect the potential of the CL to maintain pregnancy. On the contrary, the CLcav may give the embryo better chances of surviving the time of pregnancy recognition and in consequence, may have a positive effect on PR in heifers.


Assuntos
Corpo Lúteo , Progesterona , Animais , Bovinos , Transferência Embrionária/veterinária , Estro , Feminino , Gravidez , Taxa de Gravidez
3.
Int J Gynaecol Obstet ; 156(1): 55-63, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33459362

RESUMO

OBJECTIVE: To investigate the associations of endometrial thickness with pregnancy outcome in frozen embryo transfer (FET) cycles. METHODS: A retrospective cohort study was performed looking at 1627 FET cycles from the Reproductive Medicine Center of the study hospital between January 2017 and July 2018. Endometrial ultrasonographic characteristics were recorded on the embryo transfer day in FET cycles. RESULTS: A total of 1627 FET cycles were included. The endometrial thickness was independently associated with clinical pregnancy outcomes after adjusting for potential confounders (odds ratio 1.06; 95% confidence interval [CI] 1.01-1.12). A non-linear relationship was detected between endometrial thickness and pregnancy outcomes, whose point was 10.9 mm. The effect size of the left and right sides of the inflection point were 1.16 (95% CI 1.07-1.25) and 0.89 (95% CI 0.78-1.01), respectively. Subgroup analysis showed that the correlation between endometrial thickness and pregnancy outcome was consistent in all subgroups. CONCLUSION: The relationship between endometrial thickness and pregnancy outcome was non-linear and there is an inflection point. When endometrial thickness was less than 9.5 mm, it was positively related to clinical pregnancy rate. If it was beyond the inflection point, the pregnancy rate does not increase significantly.


Assuntos
Criopreservação , Transferência Embrionária , Endométrio/diagnóstico por imagem , Feminino , Humanos , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Estudos Retrospectivos
4.
Int J Gynaecol Obstet ; 156(1): 102-106, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33507538

RESUMO

OBJECTIVE: To evaluate if high-dose letrozole can be used successfully to stimulate poor responders for in vitro fertilization (IVF). METHODS: This was a retrospective study conducted at a university hospital reproductive center. The analysis included women who were up to 42 years of age and were Rotterdam Consensus poor responders. A total of 247 patients received gonadotropins (300-450 IU daily) and 62 patients were stimulated with letrozole (20 mg daily) as part of an antagonist IVF protocol. RESULTS: The use of 20 mg of letrozole decreased the total dose of gonadotropins used (645 ± 175 IU vs. 5360 ± 1028 IU, P = 0.001) and resulted in lower costs of stimulation medications ($ 555.56 ± $ 150 vs. $ 4616 ± $ 885 Canadian Dollars; P = 0.001). Pregnancy per cycle (14.5%) and per transfer (16%) rates were legitimate for this low prognosis group and may have been better than or similar to those with high-dose gonadotropins. The rate of cycle cancellation may have been reduced in the letrozole versus gonadotropin group (11% vs. 38%; P = 0.001). CONCLUSION: Letrozole (20 mg daily) may be used to reduce the cost of ovarian stimulation in ultra-poor responders, significantly reducing the cost of the IVF cycle with probably at least similar outcomes to high-dose gonadotropins.


Assuntos
Fertilização In Vitro , Gonadotropinas , Canadá , Consenso , Feminino , Humanos , Letrozol , Indução da Ovulação , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
5.
Int J Gynaecol Obstet ; 156(1): 112-118, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33615469

RESUMO

OBJECTIVE: To analyze the cost-effectiveness of virtual sonographic hysteroscopy (VSH) performed before in vitro fertilization (IVF) (Scenario 1), frozen embryo transfer (Scenario 2), and oocyte donation (Scenario 3) attempts. METHODS: A retrospective analysis of data extracted from patients' files was conducted. Before undergoing the assigned treatment, VSH was offered to all patients. Cost-effectiveness was calculated on the basis of cost per live birth. The total cost was compared with a control group of patients who declined to have hysteroscopy before their treatment. RESULTS: A total of 292 women were involved. Virtual sonographic hysteroscopy was performed in 192 women. Conventional operative hysteroscopy was subsequently required in 34 of them (17.7%). Subsequent assisted reproduction attempts resulted in live birth in 111 women-34/69 (49.3%), 35/69 (50.7%), and 42/54 (77.8%) in Scenarios 1, 2, and 3, respectively. This compared favorably with 100 women who declined VSH, with live birth achieved in 15/39 (38.5%), 14/37 (37.8%), and 15/24 (62.5%) in Scenarios 1, 2, and 3, respectively. The overall cost-effectiveness of VSH compared favorably with straightforward treatment performed without this test. CONCLUSION: The overall cost-effectiveness of treatment attempts carried out after previous VSH compared favorably with straightforward treatment performed without this test.


Assuntos
Fertilização In Vitro , Histeroscopia , Análise Custo-Benefício , Feminino , Humanos , Nascido Vivo , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
6.
Zhonghua Nan Ke Xue ; 27(10): 917-926, 2021 10 20.
Artigo em Chinês | MEDLINE | ID: mdl-34914271

RESUMO

Objective: To evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) on the pregnancy outcome and sperm parameters in patients with idiopathic oligoasthenospermia. METHODS: We searched PubMed, EMBASE, Cochrane Library, CNKI, VIP and Wanfang from inception till January 2020 for randomized controlled trials (RCT) with the keywords male infertility, oligozoospermia, asthenozoospermia, acupuncture, transcutaneous electrical acupoint stimulation, etc. Using the Cochrane risk bias tool, we evaluated the quality of the identified RCTs, and analyzed the primary outcomes, including pregnancy and live birth, and secondary outcomes, such as sperm concentration, motility and morphology. RESULTS: Four RCTs with 321 subjects were included, of which none reported live birth and only one reported a pregnancy rate of 15% after treatment of 2 Hz TEAS. Neither 2 Hz (WMD: -3.01, 95% CI: -22.28 to 16.26) nor 100 Hz TEAS (WMD: -0.02, 95% CI: -5.29 to 5.56) had any significant effect on sperm concentration, while 100 Hz TEAS markedly improved the percentage of grade a sperm (WMD: 6.83, 95% CI: 2.10 to 11.57) compared with 2Hz TEAS (WMD: 2.31, 95% CI: 1.01 to 3.61). In comparison with the blank control, neither 2 Hz (WMD: 4.07, 95% CI: -5.15 to 13.29) nor 100 Hz TEAS (WMD: 6.59, 95% CI: -5.36 to 18.55) significantly affected the percentage of grade a + b sperm or total sperm motility. CONCLUSIONS: The effect of TEAS on the pregnancy outcome is not yet clear. 100 Hz TEAS significantly improved the percentage of grade a sperm in idiopathic oligoasthenospermia patients, which, however, is to be further verified with more high-quality clinical studies.


Assuntos
Pontos de Acupuntura , Motilidade Espermática , Feminino , Humanos , Gravidez , Taxa de Gravidez , Contagem de Espermatozoides
7.
Trials ; 22(1): 917, 2021 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-34903263

RESUMO

INTRODUCTION: In recent years, the prevalence of infertility has significantly increased and has become a global reproductive health problem. The female ovarian reserves have been shown to decrease progressively with an increase in age. Besides, the rate of embryo implantation and clinical pregnancy also decreases. Traditional Chinese medicine has been widely applied in assisted reproductive technology. It is reported to have a significant influence on improving the quality of oocytes, improving endometrial receptivity, increasing clinical pregnancy rate, reducing pregnancy-related complications, etc. Therefore, this study will investigate the effect of Guilu Xian, a traditional Chinese medicine formula on IVF-ET outcome in older women with low prognosis. METHODS AND ANALYSIS: This trial is a prospective, multicenter, randomized double-blind clinical trial. A total of 120 infertile patients with low prognosis and receiving IVF or ICSI in 3 public hospitals in China will be randomly divided into two parallel groups: Guilu Xian group (n = 60) and placebo group (n = 60). Patients in both groups will be treated with antagonist regimens to promote ovulation, and all the patients will be required to take the medication from the 2nd to 4th day of the menstrual cycle to the day of egg retrieval. A comparison of the total number of oocytes obtained, the fertilization rate, clinical pregnancy rate, embryo quality, embryo implantation rate, and early spontaneous abortion rate between the experimental group and the placebo group will be performed. TRIAL REGISTRATION: Chinese Clinical Trials Registry ChiCTR1900028255 . Registered on 16 December 2019.


Assuntos
Medicina Tradicional Chinesa , Injeções de Esperma Intracitoplásmicas , Idoso , Método Duplo-Cego , Transferência Embrionária , Feminino , Fertilização In Vitro , Humanos , Estudos Multicêntricos como Assunto , Indução da Ovulação , Gravidez , Taxa de Gravidez , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Minerva Obstet Gynecol ; 73(6): 776-781, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34905881

RESUMO

BACKGROUND: There is emerging evidence that frozen embryo transfers provide a more favorable environment for implantation as compared to fresh embryo transfers. Our objective was to determine if there is a clinical benefit to frozen versus fresh blastocyst transfers in good prognosis patients. METHODS: Subjects undergoing their first or second IVF/ICSI cycle <38 years of age in an OCP pretreated GnRH antagonist stimulation protocol with supernumerary embryos available for blastocyst cryopreservation were eligible for analysis. Primary transfer was exclusively blastocyst transfer. Exclusion criteria consisted of rescue ICSI, preimplantation genetic testing, donor oocytes, and surrogacy. The cohort was divided into two groups based on whether they underwent a fresh vs. frozen primary transfer. The implantation rates were compared using mixed-effects logistic regression. The clinical pregnancy and live birth rates were compared using logistic regression adjusted for number of oocytes retrieved and number of embryos transferred. All models included age, reason for treatment, and number of prior births as covariates. RESULTS: A total of 615 subjects were included in the study. There were no differences in the two groups with respect to age, BMI, baseline ovarian reserve testing, total gonadotropin dosage, and duration of stimulation. The implantation rate was higher in the frozen-embryo group as compared to the fresh-embryo group (59% and 48% respectively; OR 1.58; 95% CI 1.02-2.44). There was a trend towards higher clinical pregnancy and live birth rates in the frozen-embryo group. These differences persisted in the adjusted analysis. CONCLUSIONS: Among good prognosis patients undergoing IVF, frozen embryo transfer was associated with improved implantation rates. Consideration should be given to primary frozen blastocyst transfer in this population.


Assuntos
Implantação do Embrião , Transferência Embrionária , Coeficiente de Natalidade , Feminino , Humanos , Gravidez , Taxa de Gravidez , Prognóstico
9.
Zhonghua Fu Chan Ke Za Zhi ; 56(12): 868-875, 2021 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-34954966

RESUMO

Objective: To investigate the impact of body mass index (BMI) on clinical effect and fresh cycle embryo transfer pregnancy outcome of in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) in patients with early follicular phase prolonged protocol. Methods: From January 1st, 2018 to July 1st, 2020, 2 257 cases of early follicular long-term protocol in IVF/ICSI and embryo transfer were collected using the clinical assisted reproductive technologies management system software database of the First Affiliated Hospital of Nanjing Medical University. Patients were divided into three groups according to the recommended Asian BMI cut-off points: low body mass group (BMI<18.5 kg/m2), normal body mass group (18.5≤BMI<24.0 kg/m2), and high body mass group (BMI≥24.0 kg/m2). The ovarian stimulation characteristics among the groups were investigated. Then 1 741 fresh embryo transfer cycles were selected and divided into three groups as above, and then the ovulation induction and clinical outcomes were analyzed among the groups. Results: There were significant differences in the starting dosage of gonadotrophin (Gn), total dosage of Gn and days of Gn used among the low body mass group, normal body mass group, and high body mass group in the 2 257 IVF/ICSI cycles (all P<0.01). The high body mass group needed the most amount of Gn [(2 159±668) U] and longest Gn days [(12.3±2.5) days]. The estradiol and progesterone levels [(7 474±4 852) pmol/L, (3.4±1.9) nmol/L] on hCG trigger day in the high body mass group were lower than those in the low body mass group and normal body mass group (all P<0.01). The oocytes retrieved in high body mass group (8.4±4.1) were significantly lower than normal body mass group (P<0.05). The normal fertilization number, the available embryo number and high quality embryo number were all lower in the high body mass group than other two groups, while no significant difference showed (all P>0.05). In 1 741 cycles of fresh embryo transfer, the average number of transplanted embryos in the low body mass group (1.2±0.4) was decreased compared with the other two groups (P<0.05), while the biochemical pregnancy rate, clinical pregnancy rate and live birth rate in the normal body mass group were higher compared with the other two groups, but the differences showed no statistically significance (all P>0.05). Conclusions: Increased BMI might affect ovulation induction response in early follicular phase prolonged protocol IVF/ICSI patients, leading to the increase of Gn dosage and the extension of Gn induction days. Although there is no significant difference in pregnancy outcome among different BMI groups, considering the increased risk of adverse perinatal outcomes during subsequent pregnancy in overweight or obese patients, certain attention should still be paid to the control of BMI in patients receiving assisted reproduction treatment with early follicular phase prolonged protocol.


Assuntos
Fase Folicular , Injeções de Esperma Intracitoplásmicas , Índice de Massa Corporal , Transferência Embrionária , Feminino , Fertilização In Vitro , Humanos , Indução da Ovulação , Gravidez , Taxa de Gravidez , Técnicas de Reprodução Assistida , Estudos Retrospectivos
10.
Zhongguo Zhen Jiu ; 41(12): 1338-42, 2021 Dec 12.
Artigo em Chinês | MEDLINE | ID: mdl-34936271

RESUMO

OBJECTIVE: To compare the effect of Tongyuan acupuncture combined with medication and medication alone on pregnancy outcome in patients with recurrent implantation failure (RIF) of thin endometrium type. METHODS: A total of 74 patients with RIF of thin endometrium type undergoing freeze-thaw embryo transfer were randomly divided into an observation group (37 cases) and a control group (37 cases). The patients in the control group were treated with freeze-thaw embryo transfer in hormone replacement cycle, and the estradiol valerate tablets were taken orally from the fifth day of menstruation, 2 mg per day. On the basis of the control group, the observation group was additionally treated with Tongyuan acupuncture at Baihui (GV 20), Dazhui (GV 14), Qihai (CV 6), Guanyuan (CV 4), etc., combined with other acupoints based on syndrome differentiation and menstrual stage, once every other day. Both groups were treated for 3 menstrual cycles. The clinical pregnancy rate and embryo implantation rate of the two groups were observed after transplantation; the endometrial thickness and type, resistance index (RI) and pulsatility index (PI) of endometrial blood flow were measured before treatment and one day before transplantation, and adverse reactions was recorded. RESULTS: The clinical pregnancy rate was 37.8% (14/37) in the observation group, which was higher than 16.2% (6/37) in the control group (P<0.05). There was no significant difference in embryo implantation rate between the two groups (P>0.05). One day before transplantation, the endometrial thickness and the proportion of type A in endometrial classification in the two groups were increased compared with those before treatment (P<0.01), and those in the observation group were higher than the control group (P<0.01, P<0.05). The PI and RI of endometrial blood flow in the two groups were lower than those before treatment (P<0.01), and those in the observation group were lower than the control group (P<0.01, P<0.05). During the treatment, 6 patients in the control group had discomfort such as breast distending pain, stomach pain, dizziness and nausea, and there were no adverse reaction in the observation group. CONCLUSION: On the basis of conventional medication, Tongyuan acupuncture could increase the endometrial thickness, improve endometrial receptivity, improve pregnancy outcome and reduce adverse reactions in patients with RIF of thin endometrial type.


Assuntos
Terapia por Acupuntura , Resultado da Gravidez , Transferência Embrionária , Endométrio , Feminino , Humanos , Gravidez , Taxa de Gravidez
11.
Trials ; 22(1): 921, 2021 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-34906206

RESUMO

BACKGROUND: Diminished ovarian reserve (DOR) is the precursor state of ovarian failure and can cause the decline of women's reproductive function. DOR also leads to poor outcome of in vitro fertilization and embryo transfer (IVF-ET) by affecting the oocytes, high qualified embryo rate, pregnancy rate, etc. Some studies have demonstrated that acupuncture can improve ovarian function. But to date, there is limited evidence indicating that acupuncture or electro-acupuncture is efficient to DOR. This trial aims to evaluate the efficiency and safety of electro-acupuncture for the ovarian function and the following outcome of IVF-ET in DOR patients. METHODS: This will be a multicenter randomized controlled clinical trial. A total of more than 338 women with DOR will be randomly allocated to treatment and control groups in 1:1 ratio receiving acupuncture before undergoing IVF-ET. The primary outcome will be the clinical pregnancy rate per cycle of IVF-ET after acupuncture. The secondary outcomes will be ovarian reserve function, outcomes of IVT-ET, blood biochemical index, Massachusetts General Hospital Acupuncture Sensation Scale (MASS), scores from the self-rating anxiety and depression scale, quality of life, and pregnancy outcomes. The safety of acupuncture will also be assessed. DISCUSSION: The results of this trial may provide high-quality evidence regarding the effectiveness of electro-acupuncture in the treatment of DOR and following outcomes of IVF-ET. This will also help patients with DOR and their physicians by offering a new treatment option. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900024626 . Registered on 19 July 2019.


Assuntos
Terapia por Acupuntura , Reserva Ovariana , Terapia por Acupuntura/efeitos adversos , Transferência Embrionária , Feminino , Fertilização In Vitro , Humanos , Estudos Multicêntricos como Assunto , Gravidez , Taxa de Gravidez , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
BMC Pregnancy Childbirth ; 21(1): 835, 2021 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-34922467

RESUMO

BACKGROUND: The ideal protocols of endometrial preparation for polycystic ovary syndrome (PCOS) patients are lacking and need further declaration. Our objective was to compare the clinical outcomes of frozen-thawed embryo transfer (FET) with and without pretreatment gonadotropin-releasing hormone agonist (GnRHa) in PCOS patients. METHODS: In this retrospective cohort study, we used propensity score matching (PSM) to compare the live birth rate between patients who underwent FET with hormone replacement treatment (HRT) and patients with GnRHa pretreatment (GnRHa + HRT). Patients using GnRHa + HRT (n = 514) were matched with 514 patients using HRT. RESULTS: The live birth rate was higher in the GnRHa + HRT group compared with the HRT group with no significant difference (60.12% vs 56.03%, p = 0.073). The clinical pregnancy rate (75.29% vs 70.62%), miscarriage rate (14.20% vs 13.81%) and ectopic pregnancy rate (0.39% vs 0.19%) were similar between the two groups. The preterm birth rate in GnRHa + HRT was higher than HRT (20.23% vs 13.04%). No difference was found in live birth between GnRHa +HRT and HRT before adjusting for covariates (crude OR 1.22, 95%CI, 0.99-1.51, p = 0.062) and after PSM (OR 1.47, 95%CI, 0.99-2.83, p = 0.068). In addition, there is a marginally difference after adjusting for covariates (aOR 1.56, 95%CI, 1.001-2.41, p = 0.048), this finding with p-value close to 0.05 represent insufficient empirical evidence. Similar results were obtained after propensity score matching in the entire cohort. CONCLUSIONS: GnRHa pretreatment could not improve the live birth rate in women with PCOS.


Assuntos
Transferência Embrionária , Estrogênios/uso terapêutico , Hormônio Liberador de Gonadotropina/agonistas , Hormônio Liberador de Gonadotropina/uso terapêutico , Terapia de Reposição Hormonal , Síndrome do Ovário Policístico/complicações , Adulto , China/epidemiologia , Estudos de Coortes , Endométrio/efeitos dos fármacos , Feminino , Humanos , Nascido Vivo/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Taxa de Gravidez , Pontuação de Propensão , Estudos Retrospectivos
13.
J Int Med Res ; 49(11): 3000605211050798, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34772315

RESUMO

OBJECTIVE: The study aim was to examine the effects of cognitive behavioural therapy (CBT) on the pregnancy outcomes of women receiving in vitro fertilization-embryo transfer (IVF-ET) treatment. METHODS: A literature review was performed using the databases MEDLINE, the Cochrane Database, Embase, Chinese National Knowledge Infrastructure (CNKI) and WANFANG. Eligible studies were selected according to inclusion and exclusion criteria. Relevant data were extracted and the quality of studies assessed. Odds ratios with 95% confidence intervals were pooled to statistically analyse the difference between intervention and control groups. RESULTS: Ten studies were selected for the systematic review and meta-analysis. The findings showed that CBT and cognitive-related therapy significantly improved the pregnancy rate of women undergoing IVF-ET treatment. Subgroup analysis showed that patients who received CBT, rather than complex psychological interventions, and those who received interventions delivered by professional psychologists, were more likely to become pregnant during IVF-ET treatment. CONCLUSION: CBT and cognitive-related interventions had significant effects on the pregnancy outcomes of women receiving IVF-ET treatment. CBT treatment (rather than complex psychological interventions) provided by professional psychologists is strongly recommended.


Assuntos
Terapia Cognitivo-Comportamental , Resultado da Gravidez , Transferência Embrionária , Feminino , Fertilização In Vitro , Humanos , Gravidez , Taxa de Gravidez
14.
Minerva Obstet Gynecol ; 73(5): 632-637, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34751530

RESUMO

BACKGROUND: Many variables, including woman's age, embryo quality and endometrial receptivity, influence the success rate of either fresh embryo transfer (ET) or frozen-thawed ET (FT-ET) cycles. This study aims to examine whether the results of a fresh in-vitro fertilization (IVF) cycle correlate with its frozen-thawed embryos transfer outcomes. METHODS: A retrospective cohort study conducted in a tertiary medical center single IVF unit between 2014-2017. The study population was comprised of women who underwent fresh ET with the remaining embryos frozen using vitrification and at least one consecutive FT-ET cycle. Comparison of FT-ET cycle's details and outcomes were assessed in relation to the outcome of preceding fresh ET cycle. RESULTS: A total of 599 women underwent fresh ET and at least one consecutive FT-ET cycle. Significantly higher rates of successful FT-ET cycle outcomes were observed in the group of patients with a successful fresh cycle compared to the group with an unsuccessful fresh cycle (48.9% vs. 20.8%, P<0.001). Logistic regression demonstrated an adjusted OR of 5.02 for successful FT-ET after a successful fresh cycle. CONCLUSIONS: Frozen-thawed embryos generated from successful fresh IVF cycles have higher potential to implant when compared to frozen-thawed embryos obtained in an unsuccessful fresh cycle.


Assuntos
Transferência Embrionária , Fertilização In Vitro , Feminino , Humanos , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Vitrificação
15.
Medicine (Baltimore) ; 100(41): e27531, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34731147

RESUMO

ABSTRACT: To evaluate the relationship between uterine cesarean scar diverticulum (CSD) and subsequent infertility in patients who underwent cesarean section, and determine the effects of pelvic fluid-releasing inflammations on infertility.A retrospective analysis was designed among patients with CSD who were admitted to our hospital from January 1, 2018 to December 31, 2019. A total of 60 patients with CSD and uterine fibroids or benign ovarian tumors who underwent cesarean section were included, and divided into the CSD group and control group. Baseline characteristics of all patients were collected, and the pelvic adhesion scores and the percents of tubal patency were evaluated. Furthermore, the postoperative clinical outcomes were followed up. The levels of inflammatory factors in pelvic fluid were tested using Elisa kits.Preoperative data indicated that the size of the uterine scar diverticulum was (1.68 ±â€Š0.52) cm, the pelvic adhesion scores were higher in CSD group than control group (4.67 ±â€Š0.90 vs 0.47 ±â€Š0.90, P < .05), and 21 of 30 patients with unobstructed fallopian tubes. The levels of tumor necrosis factor-α, interleukin-1ß, and interleukin-6 in patients with CSD were obviously higher than control group (P < .05). After the follow-up, the data displayed that no CSD was found in all patients, the time of menstrual period in patients with CSD was shortened to 7.80 ±â€Š1.27 days, and the myometrial thickness at uterine scar was significantly increased (P < .05). Additionally, the pregnancy rate was increased, and 12 of 30 patients were repregnant. Correlation analysis showed that the levels of inflammatory factors (tumor necrosis factor-α, interleukin-1ß, interleukin-6), the size of uterine scar diverticulum, and the myometrial thickness at uterine scar were significantly correlated with subsequent infertility (r = 0.307, 0.083, 0.147, 0.405, 0.291, P < .05).Uterine scar diverticulum repair could improve menstrual prolongation, increased the thickness of myometrium and repregnant rate. Subsequent infertility was positively correlated with uterine scar diverticulum and the levels of inflammatory factors.


Assuntos
Cesárea/efeitos adversos , Cicatriz/patologia , Divertículo/complicações , Infertilidade/etiologia , Miométrio/patologia , Adulto , Estudos de Casos e Controles , China/epidemiologia , Divertículo/cirurgia , Feminino , Seguimentos , Humanos , Inflamação/metabolismo , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Leiomioma/patologia , Leiomioma/cirurgia , Menstruação/fisiologia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Período Pós-Operatório , Gravidez , Taxa de Gravidez/tendências , Estudos Retrospectivos , Fator de Necrose Tumoral alfa/metabolismo , Útero/patologia , Útero/cirurgia
16.
Fertil Steril ; 116(5): 1255-1265, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34607703

RESUMO

Diagnostic evaluation for infertility in women should be conducted in a systematic, expeditious, and cost-effective manner to identify all the relevant factors with an initial emphasis on the least invasive methods for detecting the most common causes of infertility. The purpose of this committee opinion is to provide a critical review of the current methods and procedures for the evaluation of in fertile women, and it replaces the document of the same name, last published in 2015 (Fertil Steril 2015;103:e44-50). This guidance is intended for any provider evaluating women for infertility.


Assuntos
Fertilidade , Infertilidade Feminina/diagnóstico , Ovário/fisiopatologia , Colo do Útero/anormalidades , Colo do Útero/fisiopatologia , Tubas Uterinas/fisiopatologia , Feminino , Humanos , Infertilidade Feminina/etiologia , Infertilidade Feminina/fisiopatologia , Infertilidade Feminina/terapia , Reserva Ovariana , Ovulação , Valor Preditivo dos Testes , Gravidez , Taxa de Gravidez , Técnicas de Reprodução Assistida , Fatores de Risco , Resultado do Tratamento
18.
Hum Reprod ; 36(11): 2921-2934, 2021 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-34601605

RESUMO

STUDY QUESTION: What were the utilization, effectiveness and safety of practices in assisted reproductive technologies (ART) globally in 2014 and what global trends could be observed? SUMMARY ANSWER: The estimated total number of ART cycles conducted in 76 participating countries in 2014 was 1.93 million representing ∼66% of global activity, with 5-year trends including an increase in success rates and proportion of frozen embryo transfer (FET) cycles, improvement in cumulative live birth rates per aspiration, a continued increase in single embryo transfer (SET) and thus a reduction in multiple birth rates, an increase in preimplantation genetic testing and stabilization in the use of intracytoplasmic sperm injection (ICSI). WHAT IS KNOWN ALREADY: ART is widely practiced throughout the world but continues to be characterized by significant disparities in utilization, practice, effectiveness and safety. The International Committee for Monitoring Assisted Reproductive Technologies (ICMART) annual world report series provides an important instrument for tracking trends in ART treatment and for providing clinical and public health data to ART professionals, health authorities, patients and the general public. STUDY DESIGN, SIZE, DURATION: A retrospective, cross-sectional survey on ART procedures performed globally during 2014 was carried out. A new method for calculating ART utilization rates and number of babies born was introduced in this latest ICMART world report. PARTICIPANTS/MATERIALS, SETTING, METHODS: Overall, 76 countries and 2 746 ART centres submitted data through national and regional ART registries on ART cycles performed during 2014 and their treatment and pregnancy outcomes. ART cycles and outcomes are described at a country level, regionally and globally. Aggregate country data are processed and analyzed based on methods developed by ICMART. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 1 629 179 ART cycles were reported for the treatment year 2014. After imputing data for missing values and non-reporting centres in reporting countries, an estimated 1 929 905 cycles resulted in >439 039 babies in reporting countries. From 2010 to 2014, the number of reported non-donor aspirations and FET cycles increased by 37.3% and 67.5%, respectively. The proportion of women aged ≥40 years undergoing non-donor ART increased from 23.2% in 2010 to 27.0% in 2014. ICSI, as a percentage of non-donor aspiration cycles, remained relatively stable at 64.8%. The IVF/ICSI combined delivery rates per fresh aspiration and FET cycle were 19.9% and 24.3%, respectively. In fresh non-donor cycles, SET increased from 30.0% in 2010 to 40.0% in 2014, while the average number of transferred embryos decreased from 1.95 to 1.73-but with wide country variation. The rate of twin deliveries following fresh non-donor transfers continued to decrease, from 20.4% in 2010 to 16.2% in 2014, and the triplet rate decreased from 1.1% to 0.5%. In FET non-donor cycles in 2014, the SET rate was 61.6%, with an average of 1.43 embryos transferred, resulting in twin and triplet rates of 10.1% and 0.2%, respectively. The cumulative delivery rate per aspiration increased from 27.1% in 2010 to 32.1% in 2014. The overall perinatal mortality rate per 1 000 births was 19.4 following fresh IVF/ICSI cycles and 9.5 following FET cycles. Among reporting countries, oocyte donation cycles represented 7.3% of all embryo transfers (89 751 transfer cycles) and resulted in 39 278 babies. LIMITATIONS, REASONS FOR CAUTION: The data presented are dependent on the quality and completeness of data submitted by individual countries to ICMART directly or through regional registries. This report covers approximately two-thirds of world ART activity. China is a major contributor of global cycles missing from this report. Continued efforts to improve the quality and consistency of ART data reported by registries are still needed, including the use of internationally agreed standard definitions (The International Glossary of Infertility and Fertility Care). A new method was introduced in this report to calculate ART utilization and number of babies born following ART; therefore, these results are not directly comparable with previous reports. WIDER IMPLICATIONS OF THE FINDINGS: The ICMART world reports provide the most comprehensive global statistical census and review of ART utilization, effectiveness, safety and quality. While ART treatment effectiveness and safety continue to increase globally, the wide disparities in access to treatment, procedures performed and embryo transfer practices warrant attention by clinicians and policymakers. The new method for estimating ART utilization and number of babies born provided more conservative estimates compared to the previuos method. STUDY FUNDING/COMPETING INTEREST(S): ICMART receives unrestricted grants from Abbott and Ferring Pharmaceuticals. ICMART also acknowledges financial support from the following organizations: American Society for Reproductive Medicine; Asia Pacific Initiative on Reproduction; European Society of Human Reproduction and Embryology; Fertility Society of Australia and New Zealand; Japan Society for Reproductive Medicine; Japan Society of Fertilization and Implantation; Red Latinoamericana de Reproducción Asistida; and the Society for Assisted Reproductive Technology. S.D. reports industry sponsorship for attendance of conference from Ferring, and research grants to support African Network and Registry of ART from Ferring and Merck outside the submitted work. F.Z.-H. reports lectures at organized webinars for Ferring and Merck. O.I. reports honoraria for consulting from Ferring, Merck and ObsEva, as well as honoraria for lectures from Ferring and Merck. G.M.C., J.d.M., M.B., M.S.K. and G.D.A. have nothing to disclose. TRIAL REGISTRATION NUMBER: N/A.


Assuntos
Transferência Embrionária , Técnicas de Reprodução Assistida , Estudos Transversais , Feminino , Fertilização In Vitro , Humanos , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
19.
J Coll Physicians Surg Pak ; 31(10): 1163-1167, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34601835

RESUMO

OBJECTIVE: To compare duration of Cook balloon uterine stent on re-adhesions formation, and observe its effect on serum transforming growth factor ß1 (TGF-ß1) and plasminogen activator inhibitor-1 (PAI-1) levels in patients with intrauterine adhesions (IUA) undergoing hysteroscopic transcervical resection of adhesion (TCRA). STUDY DESIGN: Randomised controlled trial. PLACE AND DURATION OF STUDY: No. 215 Hospital of Shaanxi Nuclear Industry, Shaanxi Province, China, from January 2018 to January 2019. METHODOLOGY: A total of 98 patients with IUA, who underwent hysteroscopic TCRA with cold scissors, were randomly divided into Group A (n=49) and Group B (n=49). Cook balloon uterine stent was placed for 37 days in Group A and 7 days in Group B. Efficacy of two groups was compared. RESULTS: Total effective rate in Group A was higher than that in Group B (p=0.021). After treatment, levels of serum TGF-ß1 and PAI-1 in Group A were lower than those in Group B (p <0.001, and p=0.001, respectively). Recurrence rate of IUA at three months after treatment and total incidence of complications in Group A were lower than those in Group B (p=0.012, and 0.037, respectively). Pregnancy rate in the 2-year follow-up period in Group A was higher than that in Group B (p= 0.043). CONCLUSION: Placement of Cook balloon uterine stent for 37 days after hysteroscopic TCRA in patients with IUA can effectively prevent postoperative intrauterine re-adhesion, have few complications, low recurrence rate of IUA and high re-pregnancy rate, and reduce levels of serum TGF-ß1 and PAI-1. Key Words: Intrauterine adhesions (IUA), Transcervical resection of adhesion (TCRA), Transforming growth factor ß1 (TGF-ß1), Plasminogen activator inhibitor-1 (PAI-1), Pregnancy.


Assuntos
Histeroscopia , Doenças Uterinas , Feminino , Humanos , Gravidez , Taxa de Gravidez , Stents/efeitos adversos , Doenças Uterinas/cirurgia
20.
Einstein (Sao Paulo) ; 19: eAO6290, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34644745

RESUMO

OBJECTIVE: To answer the question if the freeze-all strategy and subsequent frozen embryo transfer is preferable to fresh embryo transfer for patients with normal response to ovarian stimulation (4 to 15 oocytes recovered) during in vitro fertilization treatments. METHODS: A retrospective cohort from two human reproduction centers between 2013 and 2017. A total of 471 frozen embryo transfers from freeze-all cycles, and 3,208 fresh transfers were included. RESULTS: After propensity score matching adjustment for age and number of eggs, 467 freeze-all cycles and 934 fresh cycles were analyzed, revealing no statistically significant difference between groups in relation to clinical pregnancy rate (32.5% in the Freeze-all Group and 32.3% in the Fresh Group, p=0.936). For women aged 40 years and older, we observed a statistically significant higher clinical pregnancy rate when freeze-all strategy was used (29.3% in the Freeze-all Group and 19.8% in the Fresh Group, p=0.04). CONCLUSION: Freeze-all strategy was not superior to fresh transfer for all patients with normal response to ovarian stimulation. However, women aged 40 years and older could benefit from this strategy. This deserves further investigation in future research, preferable in a prospective randomized study.


Assuntos
Fertilização In Vitro , Indução da Ovulação , Adulto , Criopreservação , Feminino , Humanos , Pessoa de Meia-Idade , Políticas , Gravidez , Taxa de Gravidez , Estudos Prospectivos , Estudos Retrospectivos
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