Growth hormone co-treatment within a GnRH agonist long protocol improves implantation and pregnancy rates in patients undergoing IVF-ET.

OBJECTIVE: The efficacy of growth hormone (GH) co-treatment within a GnRH agonist long regimen, in women with a normal ovarian response to controlled ovarian hyperstimulation (COH), for IVF was assessed. METHODS: This retrospective clinical trial was performed in a private-assisted reproduction centre. The study involved 1114 patients who responded normally to high-dose gonadotropin treatment. The study group of 556 patients was given in a daily subcutaneous injection of 4.5 IU of GH co-treatment, starting from the initial day of gonadotropin treatment and lasting for 5 days. The control group of 558 patients received the same treatment protocol without the GH co-treatment. The participants were further divided into two subgroups: age ≥35 years and age <35 years. The primary endpoint of the study was IVF-ET outcomes. RESULTS: The demographic characteristics did not significantly differ between the groups. The implantation rate (36.7 vs. 20.4 %, P < 0.05) and clinical pregnancy rate (57.3 vs. 30.1 %, P < 0.05) were significantly higher in the study group than in the control group. An analysis using a multivariate logistic regression model showed that GH was a significant factor for predicting pregnancy outcomes (OR 3.125, 95 % CI 2.441-4.000). Furthermore, for the ≥35-year-old group, the endometrial thickness was significantly greater (11.99 ± 2.21 vs. 11.62 ± 2.45, P < 0.05) in the study group than in the control group; in contrast, for the <35-year-old group, the high-quality embryo rate was significantly higher (71.7 vs. 68.3 %, P < 0.05) in the study group than in the control group. CONCLUSION: Our study showed that co-treatment with GH in a GnRH agonist long protocol in patients who responded normally while undergoing IVF-ET could increase the implantation and pregnancy rates.

Circulating luteinizing hormone level after triggering oocyte maturation with GnRH agonist may predict oocyte yield in flexible GnRH antagonist protocol.

BACKGROUND: The use of gonadotrophin-releasing hormone (GnRH) agonist for triggering final oocyte maturation and ovulation can reduce ovarian hyperstimulation syndrome (OHSS) in high-risk patients. LH levels post-trigger with GnRH agonist might be correlated with oocyte yield and maturity. Our aim was to evaluate the relationship between serum LH level at 12-h post-trigger and oocyte yield, maturity and fertilization rate in patients at high risk of OHSS and therefore who were treated with a flexible GnRH antagonist protocol in which final oocyte maturation was triggered with GnRH agonist. METHODS: In a prospective cohort study, 91 patients at high risk of OHSS were treated with a flexible GnRH antagonist protocol and divided into six groups according to their serum LH levels at 12-h after GnRH agonist administration: ≤15.0, 15.1-30.0, 30.1-45.0, 45.1-60.0, 60.1-75.0 and >75.0 IU/l. The oocyte yield, maturity, fertilization rate and clinical outcomes for each LH interval were analyzed. RESULTS: There was a statistically significant reduction in oocyte yield with a concentration of serum LH ≤15.0 IU/l (P < 0.05), whereas no statistically significant differences in the oocyte maturity and fertilization rate among the six groups (P > 0.05) were seen. Only 5 out of 91 patients (5.5%) had a serum LH ≤15.0 IU/l at 12-h post-trigger with GnRH agonist. In addition, no statistically significant difference was seen regarding high-quality embryos, implantation rate, clinical pregnancy rate and early miscarriage between patients with LH ≤15.0 IU/l and >15.0 IU/l (P > 0.05). CONCLUSIONS: Serum LH level at 12-h post-trigger with GnRHa <15.0 IU/l is associated with a dramatically lower oocyte yield but not with the oocyte maturity and fertilization rate. Serum LH levels post-trigger with GnRH agonist do not affect clinical outcomes.

[Effects of antiarrhythmic drug use on atrial fibrillation recurrence in atrial fibrillation patients post circumferential pulmonary vein ablation].

OBJECTIVE: This prospective and randomize-controlled trial was designed to investigate the effects of antiarrhythmic drug use (AADs) on atrial fibrillation (AF) recurrence in atrial fibrillation patients post circumferential pulmonary vein ablation (CAPV). METHODS: Seventy-four consecutive AF patients underwent CAPV (41 paroxysmal and 33 drug refractory AF) were randomly assigned to receive placebo (Group A) or AADs (Group B) for 3 months. Monthly standard electrocardiograms (ECG) and Holter monitoring were performed to assess AF recurrences during 17 - 28 months follow-up. RESULTS: CAPV was successful in all patients. The recurrence rate of AF in Group B was significantly lower than that in Group A at 3 months post CAPV (13.5% vs. 37.8%, P < 0.01) and similar thereafter (29.7% vs. 24.3% at 12 months and 8.1% vs. 8.1% at more than 12 months, all P > 0.05). There was also no significant difference in terms of total recurrence rate between the two groups (37.8% vs. 32.4%, P > 0.05). CONCLUSION: Post CAPV antiarrhythmic drug therapy could only decrease the early AF recurrence rate but was not effective for decreasing AF recurrence rate on later stage.

Analyses of optimal body mass index for infertile patients with either polycystic or non-polycystic ovary syndrome during assisted reproductive treatment in China.

We observed the effect of body mass index (BMI) on pregnancy outcomes in Chinese patients undergoing assisted reproductive treatment (ART). All the patients were divided into polycystic ovary syndrome (PCOS) group and non-PCOS group, and then according to BMI, each group was subdivided into 6 subgroups: group 1 (BMI < 18 kg/m2), group 2 (18-20 kg/m2), group 3 (20-22 kg/m2), group 4 (22-24 kg/m2), group 5 (24-26 kg/m2) and group 6 (BMI > 26.0 kg/m2). We found that in 20 to 25-year-old patients, the pregnancy rate was not significantly correlated with BMI in PCOS patients; while in non-POCS patients, the pregnancy rate significantly decreased at the BMI cut-off point value of 24-26 kg/m2. The pregnancy rate significantly declined at the BMI cut-off point values of 22-24 kg/m2 and 18-20 kg/m2, respectively in 25 to 35-year-old and in over 35-year-old PCOS patients; while in over 25-year-old non-PCOS patients, no significant correlation between pregnancy rate and BMI was observed. We conclude that for under 25-year-old non-PCOS patients, ART should be performed after BMI is controlled under 26 kg/m2. For PCOS patients, if age is 25 to 35 years or over 35 years, BMI should be controlled below 24 kg/m2 or below 20 kg/m2, respectively.

Inhibitory effect of the paraoxonase gene on the formation of rabbit coronary atherosclerosis.

OBJECTIVE: To observe the effect on the inhibition of coronary atherosclerosis hardening of the paraoxonase gene (PON-1) which transfected to the rabbit epicardial adipose tissue. METHODS: Rabbit coronary atherosclerosis model was established by high-fat feeding, liposome-encapsulated recombinant plasmid pEGFP-PON-1 50 µ L was injected to the rabbit pericardial cavity, and was harvested 4 weeks after transfection. RESULTS: The epicardial fat transfected PON-1 gene had effect on the high lipid level. It significantly increased expression of PON-1 in peripheral arterial vascular tissue (P <0.05); and significantly reduced total cholesterol and low-density lipoprotein cholesterol levels (P<0.05), and the thickness ratio of coronary artery intima/media (P <0.05). CONCLUSIONS: The injection of the PON-1 gene in the pericardial cavity can effectively suppress the formation of coronary atherosclerosis.

Ovarian damage after laparoscopic endometrioma excision might be related to the size of cyst.

OBJECTIVE: To investigate the relationship between the size of an excised endometrioma and the magnitude of damage to the ovary after the surgery. DESIGN: A retrospective, controlled study. SETTING: A university hospital. PATIENT(S): Eighty-five women with a history of laparoscopic excision of unilateral endometrioma who underwent in vitro fertilization (IVF). INTERVENTION(S): IVF-embryo transfer procedures. MAIN OUTCOME MEASURE(S): Antral follicle counts (AFC), number of dominant follicles (follicles ≥ 15 mm), and number of oocytes retrieved. RESULT(S): In the group with cyst diameters of ≥ 4 cm and group with cyst diameters of <4 cm, the AFC, number of dominant follicles, and number of oocytes retrieved were decreased in the operated ovaries when compared with those in intact ovaries; in the former group, a statistically significant reduction was observed. The differences of AFC, number of dominant follicles, and number of oocytes retrieved from both ovaries were further compared among the two groups: the decrease in the group with cyst diameters of ≥ 4 cm was higher than in the group with cyst diameters of <4 cm. After adjusting for age and AFC in intact ovaries, similar results were obtained, although AFC only showed a tendency. In addition, the receiver operating characteristic curve analysis revealed a statistically significant, positive correlation between the size of excised cysts and the incidence of fewer than four oocytes retrieved from an operated ovary. CONCLUSION(S): The magnitude of the ovarian damage after laparoscopic endometrioma excision might be related to the size of cyst; the damage to ovaries is more severe when an endometrioma ≥ 4 cm is excised.