Effects of Electroacupuncture on Expression of PI3K/Akt/Foxo3a in Granulosa Cells from Women with Shen (Kidney) Deficiency Syndrome Undergoing in vitro Fertilization-Embryo Transfer

Objective: To observe the effects of electroacupuncture(EA) on reproductive outcomes in women with Shen(Kidndy) deficiency syndrome after in vitro fertilization-embryo transfer(IVF-ET),and explore the underlying molecular mechanism.Methods: Sixty-six infertile patients with Shen de?ciency syndrome undergoing IVF-ET were divided into EA or control groups according to a random table,33 cases in each group.Before undergoing IVF,patients in the EA and control groups received EA therapy and placebo needle puncture,respectively,for 3 menstrual cycles.Shen de?ciency syndrome scores were assessed.Other outcome measures included the number of retrieved oocytes and fertilization,high-quality embryo and clinical pregnancy rates.Follicular ?uid was collected on the day of oocyte retrieval,and granulosa cell expression of phosphatidylinositide3-kinases(PI3 K),serine-threonine kinase(Akt) and forkhead box O3(Foxo3 a) m RNA were measured by reverse transcribed and quantitative real-time polymerase chain reaction.Results: Syndrome scores for pre-versus post-treatments decreased significantly(16.53±1.75 to 8.67±1.61) in the EA group(P0.05),but showed no signi?cant change in the control group(17.18±1.58 to 14.74±1.58).A signi?cant difference in score change was found between the EA and control groups(P0.05).High-quality embryo and clinical pregnancy rates were both increased in the EA group compared with the control group [69.15%(195/282) vs.60.27%(176/292) and 66.67%(22/33) vs.42.42%(14/33),respectively,P0.05].The fertilization rate was equivalent in EA and control groups.No difference was found in the number of retrieved oocytes between the two groups.Granulosa cell expression levels of PI3 K and Akt m RNA were signi?cantly increased in the EA group compared with the control group,while the expression of Foxo3 a was reduced(all P0.05).Conclusions: For infertile patients with Shen de?ciency syndrome undergoing IVF,EA for tonifying Shen as an adjunct treatment may alleviate clinical symptoms and improve the high-quality embryo rate.The EA-induced mechanism may involve regulation of PI3 K/Akt/Foxo3 a expression in granulosa cells to improve the developmental microenvironment of oocytes and inhibit granulosa cell apoptosis,possibly contributing to the improved clinical pregnancy rate(Registration No.Chi CTR 1800016217).     

Effect of Semen Quality on the Embryo Development

To investigate the influences of sperm quality on the zygotes and embryos development, as the role of the paternal factor in early human embryogenesis is gaining more attention because of the application of techniques such as intracytoplasmic sperm injection （ICSI） ior the treatment of men infertility. 136 infertility couples with men factors （Group Ⅰ） were included from May 2002 to January 2004. One hundred and seventy-two infertility couples with tube factors （Group Ⅱ） served as controls. The sperm parameters, geminates and embryos quality, implantation rate and pregnant rate in both groups were analyzed. It was found that there was no significant differences in the number of oocytes retrieved, the fertilization rate and number of embryos transferred between two groups. Sperm concentration, percentage of motile sperm and percentage of sperm with normal morphology were significantly lower in group Ⅰ than in group Ⅱ （P〈0.01）. The proportion of good quality zygotes and good quality embryos were significantly lower in,（he male infertility group than in the tubal disease group （P（0.05）. Implantation rate and pregnancy rate were similar in two groups. It was concluded that spermatozoa is involved in the embryo quality, even in the early stages of development, which limited the treatment potency of IVF procedure.     

Extended Culture of Early Stage Embryos in Frozen-thawed Cycles

Objective To investigate the impact of extended culture of early stage embryos on pregnancy outcome of frozen embryo transfer （FET）. Methods The survival rates of embryos after thawing and pregnancy outcome following FET were compared retrospectively between zygote and cleavage embryos which cultured to cleavage stage or extended cultured to blastocysts. Results A total of 425 zygote embryos in 67 cycles were thawed. After thawing, the survival rate was 94.4% and with an average transfer of 2.8 embryos, the clinical pregnancy rate was 55.2% （37/67）. In 222 FET cycles, totally 1 270 cleavage stage embryos were thawed and the overall survival rates were 80.3%. With an average transfer of 2.7 embryos, the clinical pregnancy rate was 55.4% （123/222）. A significantly lower percentage of degenerated embryos were found for zygotes （5.6%） than that for cleavage stage embryos （19.7%） （P〈0.01）. The clinical pregnancy rate was 53.4% （116/217） in the group of transfer at cleavage stage, while the clinical pregnancy rate was 61.1% （44/72） in the group of transfer at blastocyst stage （P〉0.05）. Conclusion Although the clinical pregnancy rate was not different between patients with freeze-thaw zygote and cleavage stage embryo transfer, higher survival rate for zygote was shown compared with that for cleavage stage embryo. However, the present studies did not demonstrate that extended culture thawing embryos to blastocyst could achieve favor clinical outcome.     

A frozen-thawed embryo transfer program improves the embryo utilization rate

Background Frozen-thawed embryo transfer （FET） is the most common way to prevent serious late ovarian hyperstimulation syndrome and increase the cumulative pregnancy rate. We evaluated the effectiveness of an FET program for improving the embryo implantation and clinical pregnancy rates, and ultimate embryo utilization rate in infertility treatment. Methods Patients undergoing in vitro fertilisation （IVF） cycles from January 2006 to June 2008 were enrolled, including 179 patients who had undergone the first FET cycle after controlled ovarian hyperstimulation （COH） in which all embryos were frozen （group C1） and 1306 patients who had COH with fresh embryo transfer （ET） （group T1）. Logistic regression was used to model the embryo implantation and clinical pregnancy rates based on the mother＇s age, numbers of oocytes retrieved, embryos transferred and high-quality embryos transferred. The embryo implantation and clinical pregnancy rates were also compared between two groups after adjusting for age, the numbers of oocytes retrieved and the numbers of embryos transferred. Results Logistic regression analysis confirmed that embryo implantation and clinical pregnancy rates in group C1 were both significantly higher than those in group T1 after adjusting for confounding factors （43.6% vs 29.0%, 63.1% vs 47.0%, respectively; P 〈0.01）. The embryo implantation and clinical pregnancy rates were consistently higher in group C1 by comparing the age groups ≥35 or 〈35 years. The clinical pregnancy rates for the numbers of oocytes retrieved per cycle being ≥15 or 〈15 were higher in group C1, as was the embryo implantation rate. These differences were statistically significant for oocyte numbers 〉15 （P 〈0.05）. The embryo implantation and clinical pregnancy rates in group C1 were both significantly higher than in group T1 when two or three embryos were transferred （P 〈0.05）. Conclusion A program of freezing all embryos and performing FET improved the rates of embryo implantation and clinical pregnancy, and ultimately enhanced the embryo utilization rate.     

Chinese Medicine Sequential Therapy Improves Pregnancy Outcomes after Surgery for Endometriosis-Associated Infertility: A Multicenter Randomized Double-blind Placebo Parallel Controlled Clinical Trial

Objective: To evaluate the efficacy and safety of Chinese medicine(CM) improving pregnancy outcomes after surgery for endometriosis-associated infertility. Methods: A multicenter, randomized, doubleblind placebo parallel controlled clinical trial was designed. A total of 202 patients who had laparoscopy for endometriosis-associated infertility with qi stagnation and blood stasis syndrome were included and randomly divided into the CM treatment group and placebo control group at a ratio of 1:1 using a central block randomization from May 2014 to September 2017, 101 patients in each group. The two groups received continuous intervention at 1–5 days after surgery, for 6 menstrual cycles. Before ovulation, the CM group was treated Huoxue Xiaoyi Granule(活血消异颗粒); after ovulation, Bushen Zhuyun Granule(补肾助孕颗粒) was involved. The control group was treated with placebo. Transvaginal ultrasonography was performed every menstrual cycle during the treatment, and female hormone levels in the follicular and luteal phases were measured during the 1 st, 3 rd and 6 th menstrual cycles. The analysis was continued until pregnancy. The primary outcomes were clinical pregnancy rate and pregnancy outcome, and the secondary outcomes were follicular development and endometrial receptivity. Safety evaluations were performed before and after treatment. Results:(1) Clinical pregnancy and live birth rates: the clinical pregnancy and live birth rates of the CM group were significantly higher than those of the placebo group [44.6%(45/101) vs. 29.7%(30/101), 34.7%(35/101) vs. 20.8%(21/101), both P0.05].(2) Follicle development: the incidence of dominant follicles, rate of cumulative cycle ovulation, and rate of cumulative cycle mature follicle ovulation were significantly higher in the CM group than those in the placebo group [93.8%(350/373) vs. 89.5%(341/381), 80.4%(275/342) vs. 69.1%(253/366), 65.8%(181/275) vs 56.1%(142/253), P 0.05 or P 0.01]). The incidence of cumulative cycle luteinized unruptured follicle syndrome was significantly lower in the CM group than in the placebo group [11.7%(40/342) vs. 17.8%(65/366), P0.05).(3) Endometrial receptivity: after treatment, both endometrial types and endometrial blood flow types in the CM group were mainly types A and B, while those in the placebo group were mainly types B and C, with a significant difference between the two groups(both P0.05).(4) Adverse events: the incidence of adverse events between the two groups was not significantly different(P0.05). Conclusion: Strategies for activating blood circulation-regulating Gan(Liver)-tonifying Shen(Kidney) sequential t h e r a p y c a n e f f e c t i v e l y i m p r o v e t h e c l i n i c a l pregnancy rate and live birth rate of endometriosis-associated infertility with qi stagnation and blood stasis after laparoscopy, improve follicular development, promote ovulation, improve endometrial receptivity, while being a safe treatment option.(Trial registration No. NCT02676713)     

Effect of interval after surgery on in vitro fertilization/ intracytoplasmic sperm injection outcomes in patients with stage III/IV endometriosis

Background For patients with severe endometriosis, the spontaneous pregnancy rates have been reported to be near 0 due to extreme distortion of normal pelvic anatomy.Surgery is one of the treatment options; however, if patients failed to conceive after surgery, in vitro fertilization （IVF） is effective.The objective of this retrospective study was to determine the clinical characteristics of IVF/intracytoplasmic sperm injection （ICSI） in patients with stage Ⅲ/Ⅳ endometriosis, and to determine the impact of the interval from surgery to IVF/ICSI on outcome.Methods One hundred and sixty patients who were diagnosed with stage Ⅲ/Ⅳ endometriosis underwent IVF/ICSI cycles between February 2004 and June 2009 were enrolled.The mean interval from surgery to IVF, number of oocytes retrieved, fertilization rate, implantation rate, embryos transferred, and good embryos transferred were compared between two age groups （≤35 years and 〉 35 years）.Results The mean interval from surgery to IVF was （37.9±28.9） months for the group ≤ 35 years of age and （57.6±39.7）months for the group 〉35 years of age.Twenty-five IVF/ICSI cycles （12.8%） were performed during the first year after surgery, and 34.9% IVF/ICSI cycles were performed 2 years after surgery.No significant differences existed between the two groups with respect to the fertilization rate, implantation rate, number of embryos transferred, number of good embryos,clinical pregnancy rates, live birth rates, and cumulative clinical pregnancy rates （P 〉0.05）.The probability of cumulative clinical pregnancies was 75%, 50%, and 25% （（29.0±4.8）, （61.0±7.6）, and （120.0±16.9） months after surgery, respectively）.Conclusions For infertile patients with stage Ⅲ/Ⅳ endometriosis, the optimal time to conceive by IVF/ICSI is 〈2 years after surgery; nevertheless, most of the patients took a longer time to conceive.     

Effect of Yiqi Yangyin Decoction(益气养阴方) on the Quality of Life of Patients with Unstable Angina Pectoris

<正>Objective:To observe the effect of Yiqi Yangyin Decoction(益气养阴方,YQYYD) on the quality of life(QOL) of patients with unstable angina pectoris(UAP).Methods:A total of 108 patients with UAP of qi-yin deficiency syndrome confirmed by coronary angiography were enrolled and assigned to the treated group(treated with YQYYD and conventional therapy of Western medicine) and the control group(treated with conventional therapy of Western medicine),by the use of the PROC PLAN of the SAS 6.12 software,in a prospective, randomized,controlled design.The clinical total effective rate,symptom score,QOL scale[Seattle Angina Questionnaire(SAQ)]and incidence of important clinical events were defined as the observation indices to evaluate the interventional effect of YQYYD on the QOL of patients with UAP of the qi-yin deficiency syndrome. Results:During the study,three cases dropped out in the treated group,one case dropped out in the control group,and 104 cases,including 51 cases in the treatment group and 53 cases in the control group,finished the trial.After four weeks of treatment,the total clinical effective rates in the treated group and the control group were 80.4%and 75.5%respectively,and there was no obvious difference between them(P0.05).However,the symptom score of the treated group(9.31±2.02) was significantly lesser than that of the control group(11.62±3.04,P0.05),and the total score of the QOL scale of the treated group(68.76±5.74) was significantly higher than that of the control group(61.06±3.31,P0.01).Among those in the treated group physical limitation, angina stability,angina frequency,and treatment satisfaction were significantly ameliorated when compared with the control group after treatment(P0.05,P0.01).The incidence of important clinical events in the treated group(3.9%) was lower than that in the control group(5.7%) during the 8-month follow-up period,but the difference was insignificant(P0.05).Conclusion:YQYYD could improve the clinical symptoms of patients with UAP of qi-yin deficiency syndrome and greatly improve their QOL.     

Factors Influencing Pregnancy Outcome Following Slow Cooling Cryoembryo Transfer and Risk of Multiple Conception

Objective To investigate the factors that influence the potential for cryoembryo implantation and multiple pregnancy.
Methods In this retrospective study, a total of 93 7 thawing cycles （859 couples） in which 3286 d 3-embryos were thawed. Rates of implantation, clinical pregnancy and multiple conception following FET were observed.
Results There were significant differences in female age （P〈0.05） and number of good quality embryos （P〈0. 05） between cycles that resulted in pregnancy and those did not. There was a trend toward decreasing rates of implantation, clinical pregnancy and multiple pregnancy with increasing female age. Compared with transferring 1 good quality embryo, clinical pregnancy rate of transferring 2 and 3 good quality embryos was increased significantly （P〈0. 001）, there was no significant difference in clinical pregnancy rate between transferring 2 and 3 good quality embryos. Multiple pregnancy rate was increased significantly in the group of transferring 3 good quality embryos （P〈0.05）,but there was no significant differences in multiple pregnancy rate between transferring 1 and 2 good quality embryos. Younger women （≤ 30 years） also had a significantly higher multiple pregnancy rates （28.13%） than the older ones（〉35 years） （13.64%）. With an increase in age from ≤ 30 years to〉40 years, clinical pregnancy rate declined from 47 61% to 25.00%.
Conclusion Female age and the number of gooa quality embryos transferred are important factors influencing the clinical and multiple pregnancy rate, reducing the number of good quality embryos transferred may decrease the rate of multiple pregnancy but do not affect the clinical pregnancy rate.     

Reducing the Trigger Dose of Human Chorionic Gonadotrophin Does Not Affect Final Oocyte Maturation and Subsequently Pregnancy Outcome of Frozen-thawed Embryo Transfer

To compare the efficacy of human chorionic gonadotrophin （hCG） at reduced doses of 2 000 IU and 3 000 IU for moderate or high responders with the dose of 5 000 IU in term of inducing final oocyte maturation for IVF/ICSI and the subsequent pregnancy outcome in frozen-thawed embryo transfer （FET）. Methods In the retrospective cohort study, 2 166patients undergoing IVF/ICSI with moderate or high response were recruited and classified into three groups according to the trigger dose of hCG： 2 000 IU （group A, n=722）, 3 000 IU （group B, n=722） and 5 000 IU （group C, n= 722）. The main outcome was the proportion of mature oocytes retrieved, fertilization rates, clinical pregnancy rates, cumulative pregnancy rates and incidence of ovarian hyperstimulation syndrome （OHSS）. Results No evidence of statistically difference was found in the proportion of mature oocytes retrieved （89.92%, 91.40%, 90.20%, respectively） and fertilization rate （79.8%, 80.07%, 80.51%, respectively） among groups A, B and C. Serum E2 level on the day of hCG injection, the number of mature oocytes retrieved and good-quality embryos in group A were significantly higher than those in group B and group C. Clinical pregnancy rates per transfer cycle （45.95%, 43.97% and 44.25%）, ongoing pregnancy rates （43.17%, 40.91% and 42,53%）, implantation rates （30, 74%, 2Z 78% and 29.86%） and cumulative pregnancy rates per patient （58.31%, 53.6% and 54.85%）A reduced hCG dose of 2 000 IUfor moderate or high responders leads     

Clomiphene Citrate as An Adjuvant to hMG Stimulation of the Ovaries in Mid-to-late Follicular Phase and Subsequently Pregnancy Outcome of Frozen-thawed Embryo Transfers

Objective To compare the results of a novel regimen of human menopausal gonadotrophin (hMG) in combination with clomiphene citrate (CC) in mid-to-late follicular phase with those of a short protocol of GnRH agonist (GnRHa) and hMG used for IVF. Methods In the retrospective study, 842 patients undergoing IVF were collected and classified into two groups: hMG in combination with CC in mid-to-late follicular phase (group A, n=319) and short protocol of GnRHa-hMG (group B, n=523). The main outcome measures were ovarian responses in stimulation cycles and pregnancy outcomes in subsequent frozen-thawed embryo transfer (FET) cycles. Results In group A, the serum LH concentration on day 8-10 was similar with that on the day of hCG administration (2.43 ± 1.92 IU vs 2.51 ± 2.05 IU). The number of mature follicles and oocytes retrieved was significantly lower in group A than in group B while the fertilization rate and the cleavage rate were comparable. The clinical pregnancy rate (47.79% vs 48.04%), the implantation rate (32.49% vs 33.11%) and the cumulative pregnancy rate (58.09% vs 60.22%) were respectively similar in group A and group B. Conclusion hMG in combination with CC in mid-to-late follicular phase results in the same pregnancy outcome as short protocol. The novel protocol may take the advantage of eliminating the occurrence of a premature endogenous LH surge.     

Effects of abnormal zona pellucida on fertilization and pregnancy in IVF/ICSI-ET

Objective To analyze the fertilization rate, embryo development and clinical outcome of oocytes with abnormal zona pellucida after in vitro fertilization(IVF) or intracytoplasmic sperm injection(ICSI).Methods A retrospective analysis included a total of 43 cycles(27 IVF cycles and 16 ICSI cycles) in which oocytes displaying abnormal zona pellucida were retrieved between January 2006 and December 2011. The fertilization rate, embryo quality,and the cumulative clinical pregnancy rate were analyzed.Results Rescue ICSI was applied in 27 IVF cycles in which failed extrusion of the second polar body after conventional IVF was observed, and of them, complete failure to fertilize occurred in 23 IVF cycles. The fertilization rate and the normal fertilization rate for IVF(64.83% and 59.32%, respectively) were significantly lower than those for ICSI(85.19% and 79.01%, respectively), whereas the cleavage rate(94.12%) with IVF did not differ significantly from that with ICSI(95.65%, P>0.05). The percentages of good-quality embryos in IVF group(52.67%) and ICSI group(43.75%) also did not differ significantly(P>0.05). Although the rates of implantation and pregnancy appeared to be greater in IVF group(33.33% and 40.00%, respectively) compared with those in ICSI group(25.00% and 35.71%, respectively), the differences were not significant(P>0.05).Conclusions ICSI should be carried out for oocytes with abnormal zona pellucida,for which the risk of IVF failure is high. Rescue ICSI improves the likelihood of fertili-zation of oocytes with abnormal zona pellucida, but cannot improve the clinical outcome.     

Effect of Patient Age and Embryo Parameters on Pregnancy Outcome in In Vitro Fertilization-Embryo Transfer （IVF-ET）

Objective To study the effect of patient age, the number and quality of embryos transferred on pregnancy outcome in in vitro fertilization-embryo transfer procedures （IVF-ETs）. Methods A retrospective study was conducted with infertile women who underwent a total of 1 800 cycles of lVF-ET and intracytoplasmic sperm injection （ICSI） at the Reproductive Medicine Center of the Third Affiliated Hospital of Guangzhou Medical College from Jan. 2006 to Dec. 2007. The patients were divided into three groups based on age （year）. 〈30, 30-34 and 235. The rates of clinical pregnancy and multiple pregnancies were compared in each group when 1-3 embryos and 0-3 goodquality embryos were transferred respectively. Results 1） In the group of patients aged 〈30 years, there was no significant difference in pregnancy outcomes with 1-3 embryos transferred. However, pregnancy rates were similar when 2 3 good-quality embryos were transferred, which was significantly higher compared with 0-1 good-quality embryos transferred; the incidence of multiple pregnancies was not an issue when only 1 embryo was transferred. 2） The pregnancy rate of the patients aged 30 34 was not significant not only when only 2-3 embryos were transferred but also when 2-3 good-quality embryos were transferred, which was significant compared with when 1 embryo or 0 1 good-quality embryo was transferred. The subgroup of 3 good-quality embryos transferred, at the same time, was expected to significantly increase multiple pregnancy rate. 3） For the patients aged 235, there were similar pregnancy rates in the subgroup involving 1-3 embryos transferred. Compared with 0-2 good-quality embryos transferred, the pregnancy rate was significantly higher in the patients with 3 good-quality embryos transferred. An increased trend toward multiple pregnancies was observed among not only the subgroups with 1-3 embryos transferred, but also when 1-3 good-quality embryos were transferred, although it was significantly higher in patients with 3 good-quality embryo transferred. Conclusion In an effort to achieve the ideal pregnancy rate without the risk of multiple pregnancies, it is desirable to employ a single good-quality embryo transfer for patients aged 〈30 years and 2 good-quality embryos for patients aged 330. As older women （aged 335 years）, this is important, need to abstain from poor-quality embryo transferred by increasing the number of embryos transferred in an effort to improve the rate of clinical pregnancy, if the patients have had enough 2 high-quality embryos.     

Effect of Acupuncture on CXCL8 Receptors in Rats Suffering from Embryo Implantation Failure简

To observe the effect of acupuncture on CXCL8 receptors（CXCR1 and CXCR2） in rat endometrium experiencing embryo implantation failure, 72 pregnant rats were randomly divided into four groups： normal group（N）, embryo implantation failure group（M）, acupuncture treatment group（A）, and progestin treatment group（W）. Then the rats in each group were equally randomized into a day-6（D6） group, a day-8（D8） group, and a day-10（D10） group. The rats in group M, group A, and group W were treated with mifepristone-sesame oil solution on day 1, while the rats in group N were injected with the same amount of sesame oil. Meanwhile, ＂Housanli＂ and ＂Sanyinjiao＂ were selected for acupuncture. From day 1 to the time of death, the rats in group A were fastened up and then acupuncture was administered while the rats in group N and group M were only fixed, and the rats in group W were given progestin. The number of implanted embryos was calculated. The expression of CXCR1 and CXCR2 in rat endometrium was detected by immunohistochemistry, Western blotting and real-time PCR. Compared to group N, the average number of implanted embryos, the protein and mRNA expression of CXCR1（D6, D8 and D10）, and the protein and mRNA expression of CXCR2（D8 and D10） in rat endometrium were significantly decreased in group M. Compared to group M, there was significant elevation in the average number of implanted embryos, the protein expression（D6, D8 and D10） and mRNA expression（D8） of CXCR1 in rat endometrium of group A, and the protein expression（D8 and D10） and mRNA expression（D8） of CXCR2 in rat endometrium of group W. These findings indicated that acupuncture can increase the number of implanted embryos in rats of embryo implantation failure, which may be relevant with up-regulation the expression of CXCR1 and CXCR2 at maternal-fetal interface of rats with embryo implantation failure.     

Clinical effect of Jiutengzhuyu tablets on promoting blood circulation in women with oviducal obstruction

OBJECTIVE:To test the clinical curative effect of Jiutengzhuyu tablets,a patented Chinese vine-derived drug used for promoting blood circulation,on women with oviducal obstruction.METHODS:Patients with tubal infertility were divided randomly into two groups:58 patients in the treatment group and 57 in a control group.The treated patients took Jiutengzhuyu tablets orally for 25 days.The control group received an intrauterine infusion of 5 mg dexamethasone sodium phosphate,4000 units of chymotrypsin,80 000 units of gentamicin sulfate dissolved in 20 mL of normal saline at 1 mL/min.After 3 months of treatment,the curative effect on tubal patency was assessed and a 1-year follow-up visit was used to document any pregnancies.RESULTS:The total effective rate was 78% in the treatment group and 32% in the control group with a statistically significant difference(χ 2 =24.57,P<0.01).CONCLUSION:Jiutengzhuyu was effective in treating infertility caused by tubal infertility with aTraditional Chinese Medicine diagnosis of blood stasis.     

Application of Ultra-low-dose Incremental Gn Protocol in Controlled Ovarian Hyperstimulation of the Patients with Ovary Hyperreaction

Objective To explore the clinical outcome of ultra-low-dose incremental protocol in the controlled ovarian hyperstimulation （COH） for the ovary hyperreaction patient. Methods A prospective, randomized, controlled study was conducted between June 2006 and February 2008 on 120 women who underwent COH. The patients＇ clinic outcomes were compared between ultra-low-dose incremental protocal （experimental group, n=60） and other ovulation stimulating protocols （control group, n=60）. Results The mean number of large follicles （≥14 mm） on the day of oocytes retrivaling, the mean number of harvested oocytes and the incidence rate of OHSS were significantly lower in experimental group. However, the gonadotropin stimulating time was significantly longer in experimental group. And the rate of leading follicle punctuation was also higher in this group when compared with control group. The clinical pregnant rate, the mean number of gonadotropin ampoules, the cancel rate were similar in the two groups. Conclusion The application of ultra-low-dose incremental protocal in the COH for the ovarian hyperreaction patients is able to effectively reduce the risk of occurrence of OHSS under the precondition of assurance of pregnancy rate. It is a safe and more effective COH program.     

Effect of Long Protocol on the Outcome of In Vitro Fertilization-embryo Transfer in Patients with Endometriosis Compared with Prolonged Protocol

Objective To investigate the effect of different down-regulation protocol on the in vitro fertilization-embryo transfer （IVF-ET） outcomes in infertile patients with endometriosis （EMs）.Methods A retrospective case control study was performed. Totally 294 infertile patients with EMs were enrolled. And 109 patients （116 cycles） received prolongedprotocol as the control, 185 patients （193 cycles） received long protocol as case group, all followed by standard controlled ovarian hyperstimulation （COH）. Response to gonadotropins, the fertilization rate, the cleavage rate, the implantation rate, the clinical pregnancy rate and the miscarriage rate were measured and analyzed between the two groups. Results A trend toward better ovarian response was observed in long protocol group. Higher fertilization rate, lower total dose of rFSH, shorter duration of stimulation and more endometrial thickness on the day of hCG injection were observed in long protocol group compared with those of prolonged protocol group, and the difference was significant （P〈0.05）. In addition, the clinical pregnancy rate, the cleavage rate and the implantation rate also had an increase trend in long protocol group compared with those of prolonged protocol group, but without significant differences. Conclusion Long protocol regimen before IVF-ET in patients with EMs resulted in a trend toward better ovarian response and higher clinical pregnancy rates than prolonged protocol regimen did.     

TCM Treatment of Male Immune Infertility——A Report of 100 Cases

To observe the therapeutic effect of Yikang Tang （益抗汤 Yikang Decoction） for male immune infertility. Methods： 100 cases of male immune infertility in the treatment group were treated with Yikang Decoction, while 100 cases treated with prednisone as the controls. Physical exam, routine semen and prostate exams, and exams for presence of anti-sperm antibody （AsAb） and mycoplasma in the serum or seminal plasma were carded out. Results： 1） The serum and seminal plasma AsAb levels decreased significantly （P〈0.01） in both the groups after treatment, with a more remarkable effect in the treatment group. 2） The sperm density and percentage of motile spermatozoa increased significantly in the two groups, but more significantly in the treatment group after treatment. The pregnancy rate of their wives was higher in the treatment group than that in the control group （P〈0.01）. 3） The sperm agglutination rate in the two groups decreased, but more significantly in the treatment group after treatment. 4） The improvement rate of the symptoms and the stability of the therapeutic effect were more dramatic in the treatment group than that in the control group （P〈0.01） after termination of drug administration. Conclusion： The Yikang Decoction has a more stable effect for male immune infertility than prednisone.     

Effect of Yitangning Granule on Glycometabolism and Urinary Micro Albumin of Diabetes B Patients

One hundred and twenty patients with diabetes B that belong to the type of kidney deficiency andblood stasis were randomly divided into a treatment group treated with Yitangning Granule ( 益糖宁颗粒), a control group A treated with Jiangtangshu Capsule (降糖舒胶囊) and a control group B treated with Glurenorm Tablet (糖适平片). A better total effective rate was found in the treatment group, as compared with the two control groups, but there was no obvious difference. However, the treatment group was superior to the two control groups (P＜0.05 or P＜0.01) in the reduction of blood sugar and urinary micro albumin. It indicates that Yitangning Granule can improve the clinical symptoms and glycometabolism in patients with diabetes B and has a reverse effect on early diabetic nephropathy (DN).     

Modified super-long down-regulation protocol improves fertilization and pregnancy in patients with poor ovarian responses

Background  The successful end-point of in vitro fertilization (IVF) treatment is for a woman to give live birth. This outcome is based on various factors including adequate number of retrieved eggs. Failure to recruit adequate follicles, from which the eggs are retrieved, is called a “poor response”. How to improve the clinical pregnancy rates of poor responders was one of the tough problems for IVF.

Methods  The study involved 51 patients who responded poorly to high dose gonadotropin treatment in their previous cycles at our reproductive center, between April 2010 and February 2012. The previous cycle (group A) received routine long protocol; the subsequent cycle (group B) received modified super-long down-regulation protocol. The primary outcome of the study was the number of oocytes fertilized. The increase in the pregnancy rate was the secondary outcome. Differences between the groups were assessed by using Student’s t test and c² test where appropriate.

Results  The patients’ average age was (36.64±3.85) years. The mean duration of ovarian stimulation cycles of the group A patients was longer than those of the group B patients. The total dose of follicle-stimulating hormone (FSH) was significantly lower in the subsequent cycle. The peak value of serum estradiol on human chorionic gonadotrophin (hCG) day was lower in group A as compared with group B. The number of metaphase II oocytes recovered was significantly higher in group B. The cleavage rate in group A was significantly lower than in group B, 49 patients in group B reached embryo transfer stage, while 46 patients in group A reached this stage. Patients in group B received significantly more embryos per transfer as compared with group A. More pregnancies and more clinical pregnancies with fetal heart activity were achieved in group B.

Conclusions  This comparative trial shows that poor responder women undergoing repeated assisted reproduction treatment using modified super-long down-regulation protocol achieve more oocytes, leading to higher fertilization rate, compared to women receiving routine long protocol. Our study also showed that clinical pregnancy rate was significantly improved.

     

Effectiveness of Testosterone Undecanoate Treatment in Men with Asthenospermia

Objective To assess the effectiveness of testosterone undecanoate on sperm motility and pregnancy incidence in men with asthenospermia.Methods A clinical trial was performed.Fifty men with asthenospermia were included to receive placebo(control group,n=9) or T undecanoate 80 mg/d(study group,n=41).Pregnancy incidence and sperm characteristics after 1,2 and 3 months of medication and 3 months after the end of the trial were measured.Results Compared with the placebo,T undecanoate treatment produced a satisfactory improvement of seminal motility(F=55.904,P=0.000).In study group,the incidence of pregnancy was 28.2% while the incidence of pregnancy in control group was 11.1%.In study group,26 patients took T undecanoate for more than 3 months.In the 3 months,semen volume showed no statistical difference(F=1.206,P=0.312) before and after treatment,sperm concentration(F=0.023,P=0.000) and motility a,b,a+b(P=0.000) showed statistical differences.Motility grade a showed significantly higher increment in 2 and 3 months after treatment than 1 month and there was no statistical difference between 2 and 3 months.So did grade b.Conclusion The results indicate that T undecanoate increases seminal motility,leading to a higher incidence of pregnancy in couples with infertility related to asthenoaspermia.