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.     

Clinical outcomes of using three gonadatropins and medroxyprogestrone acetate(MPA) during ovarian stimulation in normal ovulatory women undergoing IVF/ICSI treatments

Objective To compare the clinical characteristics in a gonadotropin(Gn)and medroxyprogestrone acetate(MPA)protocol using three types of Gn in normal ovulatory women undergoing IVF/ICSI treatments.Methods A total of 258 normal ovulatory IVF/ICSI patients undergoing ovarian stimulation in a Gn and MPA protocol were analyzed in this retrospective study and allocated into three groups according to the Gn used:group A,hM G-A(brand name:Fengyuan,n=105);group B,hM G-B(brand name:Lebaode,n=90);group C:u-FSH(brand name:Lishenbao,n=63).The hormone profile,embryological characteristics,and the pregnant results after frozen-thawed embryo transfer(FET)were compared among the three groups.Results There was no significant difference in the number of oocytes retrieved among the three groups(12.1±6.9 vs 12.1±5.6 vs 13.1±8.8,P>0.05).Other indicators such as the number of mature oocyte,fertilization,cleavage and viable embryo were similar(P>0.05).No premature LH surges were detected,with a range of 0.04-7.38 IU/L.No differences were found in the clinical pregnancy rate per transfer(43.48%vs37.93%vs 40.74%,P>0.05)and the implantation rate(34.88%vs 22.22%vs 26.42%,P>0.05).Conclusion MPA is an effective oral alternative for the prevention of premature LH surges.Progestin-primed ovarian stimulation(PPOS)is a novel regimen of ovarian stimulation in combination with embryo cryopreservation,in which the two types of hM G are as effective as u-FSH.     

Impact of Semen Liquefaction and Viscosity on the Outcomes of in vitro Fertilization

Objective To compare the outcomes of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) between semen liquefaction and viscosity with normal and abnormal. Methods Semen that liquefied within 60 min and normal viscosity was assigned to the normal group, while semen that unliquefied more than 60 min or high viscosity was assigned to abnormal group. Equal volumes of culture medium were added to abnormal group and normal control group, followed by repeated pipetting, to induce liquefaction. Sperm parameters, fertilization and cleavage rates, good-quality embryo rate, implantation rate and pregnancy rate were analyzed. Results The abnormal group ratio was much higher in the ICSI group (30.5%) than in the IVF group (21.9%) (P<0.05). The age of the husbands and total progressive motility (PR) sperm in abnormal IVF group were higher than those in normal IVF group (P<0.05). Fertilization rate (80.7%) in the abnormal IVF group was higher than that in the normal IVF group (75.6%) and normal control group (P<0.05). There were no differences in outcomes of the ICSI patients between the normal and abnormal groups. There was no difference between normal group and normal control group. Conclusion Equal volume of culture media was added to non-liquefied semen may be used to high viscosity and unliquefied semen, and may have a positive effect on fertilization outcomes.     

Impact of Blood Clot in Oocyte-Corona-Cumulus Complex during in vitro Fertilization and Embryo Transfer

Objective To study the impact of blood clots in the oocyte-corona-cumulus complexes (OCCC) during in vitro fertilization and embryo transfer (IVF-ET). Methods The OCCCs were harvested from the patients undergoing long protocol ovarian hyperstimulation. The OCCCs with blood clots removed or not, were randomly grouped into A or B. The OCCCs without blood clots were group C (the control). Results The patient’s age, infertility duration, the average GN consumption, the average days of superovulation and an average number of harvested oocytes showed no significant difference in the 3 groups. The fertilization rate and 2PN rate in group A were the highest, which were 85.4% and 71.1%, respectively, followed by group C, which were 77.5% and 64.9%, respectively. The lowest fertilization rate and 2PN rate were in group B, 75.8% and 62.2%, respectively. Those in group A were significantly higher than those in groups B and C (P<0.01), while there was no significant difference between group B and group C . The implantation rates and pregnancy rates showed no significant difference in the 3 groups after transplantation, even if group A got the highest rate among the 3 groups. Conclusion Removing the blood clots in OCCC can improve the outcome of IVF-ET without increasing the cost and complexity of the operation.     

Correlation Analysis of the Results of Double Fluorescence （AO/PI） Staining and Clinical Outcomes

Objective To estimate the predictive value of double fluorescence [acridine orange(AO)/propidium iodide(PI)] staining results for fertilization rate and clinical outcomes and analyze the correlation between the results of AO/PI staining and sperm apoptosis.Methods A prospective study was carried out,235 infertile couples remedied using traditional in vitro fertilization(IVF) were included.Semen collected from 235 patients were stained by fluorescence dye,AO and PI,at the same time the spermatozoa apoptosis rate was calculated by using flow cytometry to detect the rate of Annexin V+/PI-.The result of fluorescence was divided into 3 groups as green(G),yellow(Y) and red(R) according to the color of fluorescence.The correlation between the percent of the 3 colors and clinical outcomes and spermatozoa apoptosis rate was evaluated.Results Significant negative correlation was observed between the percentage of Y and fertilization rate(r=-0.42,P=0.04),no significant correlation was observed between the percentage of G,R and fertilization rate.The percentage of G,Y,R was not significantly different between pregnant patients and non-pregnant patients,respectively,while the percentage of Y was significant different between miscarriage patients and liveborn patients(r=0.61,P=0.01) and no significant difference exist in the percentage of G and R between liveborn patients and miscarriage patients.There was a significant positive correlation between the percentage of Y and the rate of Annexin V+/PI-(r=0.53,P=0.04),and no significant correlation was shown between the percentage of G,R and the rate of Annexin V+/PI-.Conclusion The percentage of yellow group of double fluorescence(AO/PI) staining will affect the fertilization rate and the miscarriage rate,and this group of spermatozoa may be connected with the spermatozoa apoptosis.     

Rescue ICSI: Choose the Optimal Rescue Window before Oocyte Aging

Objective To evaluate the application value of rescue ICSI in fertilization failure after conventional IVF and choose the best rescue window before oocyte aging according to the results of rescue ICSI performed in different time. Methods The data of 93 IVF cycles were analyzed retrospectively. Rescue ICSI was performed in these cycles after conventional IVF failure. Because of the different rescue time, these cycles were divided into two groups: early rescue group (group A, 77 cycles, rescue ICSI performed 4-8 h after conventional IVF) and late rescue group (group B, 16 cycles, rescue ICSI performed 20-22 h after conventional IVF). Results There were no statistically significant differences in age of female, duration of infertility, number of oocytes retrieved every cycle. The normal fertilization rate, pregnancy rate and implantation rate were decreased in group B compared with those in group A (P<0.05). In group A, the normal fertilization rate of rescue ICSI performed 4-6 h after conventional IVF (group A1) was increased compared with that of rescue ICSI performed 6-8 h (including 6 h) after conventional IVF (group A2)(66.5% vs 55.9%)(P<0.05); while the abnormal fertilization rate in group A1 was decreased compared with group A2 (9.0% vs 14.4%)(P<0.05). Clinical pregnancy rate was slight higher in group A1 than in group A2, though this failed to be significantly different. Conclusion Rescue ICSI is effective if fertilization was failure after conventional IVF, the most important thing is to choose the reasonable rescue window before oocyte aging when ICSI is performed.     

Outcome of in vitro fertilization in endometriosis-associated infertility: a 5-year database cohort study

Background  Endometriosis affects natural fertility through various approaches, and in vitro fertilization (IVF) is a good treatment. But the IVF result of endometriosis patients is still under debate. We investigated the effect of endometriosis on IVF by analyzing the data from a single reproductive center.

Methods  A retrospective, database-searched cohort study was performed. Relevant information was collected from the electronic records of women who underwent IVF/intracytoplasmic sperm injection between January 2006 and December 2010 in the Assisted Reproductive Unit of Sir Run Run Shaw Hospital. Patients with endometriosis were enrolled the study group. The rest of the women formed the control group. The main outcome was the clinical pregnancy rate. Secondary outcomes were oocytes retrieved number, fertilization rate, high-quality embryo rate, number of high-quality embryo for embryo transplantation, and implantation embryo/high-quality embryo ratio (IE/HQE ratio). Comparisons were performed by the  c²-test and independent t-test.

Results  The endometriosis group (n=177) had a markedly lower oocytes retrieved number, fertilization rate, implantation rate, and clinical pregnancy rate (7.6±5.1, 63.6%, 27.7%, and 45.2%, respectively) compared with the non-endometriosis group (n=4267; 11.8±7.3, 68.4%, 36.2%, and 55.2%, respectively).  Stratified analysis showed that this difference was found in the subgroup younger than 35-years old, while only fertilization rate and implantation rate were different in the elder subgroup. The ratio of high-quality embryos transferred is lower in endometriosis group (53.7% vs. 71.8%, P <0.05), but there is no difference in IE/HQE ratio between two groups. There is no significant difference in fertilization rate, implantation rate, and clinical pregnancy rate between mild and severe endometriosis patients.

Conclusions  Endometriosis patients suffer a decreasing IVF pregnancy rates mainly caused by reducing oocytes number and fertilization rate, regardless of the severity of the disease. Appropriate intracytoplasmic sperm injection manipulation might improve the outcomes of IVF.

     

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 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.     

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     

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.     

Assessment of Uterine Receptivity by Endometrial and Subendometrial Blood Flows Measured by Vaginal Color Doppler Ultrasound in Women Undergoing IVF Treatment

Objective To evaluate endometrial and subendometrial blood flows measured by vaginal color Doppler ultrasound as a predicator of endometrial receptivity in women undergoing IVF treatment. Methods A total of 119 infertile patients undergoing the first IVF/ICSI-ET cycle were recruited. Three groups were divided according to a color Doppler ultrasound exami- nation performed on the day of hCG injection. Group A, endometrial and subendometrial blood flows were 2 branches and below; group B, endometrial and subendometrial blood flows were between 3 and 4 branches; group C, endometrial and subendometrial blood flows were 5 branches and above. Patients were transferred 1-3 embryos each. Demographic data, ovarian responses, endometrial thickness, PI, RI, development of embryo and IVF result among groups were compared. Results Demographic data, ovarian responses, endometrial thickness, PI, RI and development of embryo among groups have no significant difference. The pregnancy rate of group A was significantly lower than that of group B (P<0.05) and group C (P<0.01). The implantation rate of group A was significantly lower than than of group C (P<0.01). There was no significant difference of the rate of pregnancy and implantation between group B and group C (P>0.05). Conclusion Endometrial and subendometrial blood flows measured by vaginal color Doppler ultrasound is a good predicator of pregnancy during IVF treatment. A good endometrial and subendometrial blood flows is benefit for the result of IVF.     

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.     

Selective Short-term Fertilization Combined with Early Rescue ICSh An Optimal Strategy for Patients at High Risk for Fertilization Failure

Objective To investigate clinical outcomes in patients who were at more precise criteria risks for fertilization failure and were treated with selective, short-term fertilization （oocytes and sperm co-incubated for 4 h） and early rescue intracytoplasmic sperm injection （ICSI）. Methods A retrospective analysis was performed on 2023 women undergoing assisted reproductive technology （ART）. They were assigned to 4 groups： short-term in vitro fertilization （short-term IVF,, group A, n=217）, regular IVF （oocytes and sperm coincubated overnight, group B, n=1475）, short-term IVF and early rescue ICSI （shortterm ICSI, group C, n=94）, and regular ICSI （group D, n=237）. Results In group A, 69.8% （217/311） achieved normal fertilization rates, and the complete fertilization failure rate （fertilization rate was 0%） was 12.9% （40/311）. But all of the fertilization failure oocytes got rescue ICSI. In group B, the complete fertilization failure rate was 1.1% （19/1 692）. The fertilization rate, 2 PN （pronucleus） rate, and i PN rate were significantly lower in group A than those in group B （70.9% vs 80.8%, 57.8% vs 66.3%, and 3.5% vs 6.2%, respectively）. No significant differences were observed in clinical pregnancy rates and birth defect rates between groups A and B. The fertilization rates in groups C and D did not significantly differ （77.9% vs 76.2%）, which was also true for birth defect rates. The clinical pregnancy rate of group C was higher than that of group D （51.2% vs 42.3%）, but this difference was not significant （P〉0. 05）.Conclusion These results suggested that selective, short-term fertilization can result in effective outcomes for patients who were at high risk for fertilization failure.     

Study on relationship between perifollicular blood flow and in vitro fertilization-embryo transfer

Objective: To study the relationship between perifoUicular blood flow and follicule development, oocyte maturing rate, fertilizing rate, cleaving rate, embryo quality and the outcomes of embryo transfer. Methods: The samples were selected from 66 suffers who underwent in vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI). Eeach patients' perifollicular blood flow(diameter≥12mm )was estimated on the day of human chorionic gonadotropin(HCG)administration. Results:Among 66 cycles, 26(39.4%) cycles resulted in pregnancy, perifollicular blood flow resistance index(Rl), peak systolic velocity/end diastasis velocity(S/D) of non-preg-nant group was significantly higher than that of the pregnant group (P ＜ 0.004). When RI＜0.49, the pregnancy rates, fecundation rates, fertilization rates, metaphase numbers for the of second meiosis oocytes increased evidently(P＜0.05), but there were no statistical difference in gonadotropin dosage, cycle frequency, infertility years, ages, estradiol(E2)on the day of HCG administration,numbers of oocyet retrieved and high-quality embryo rates (P ＞ 0.05 ). There were no statistical difference between non-pregnant group and pregnant group in S and D (P＞0.05). There was no correlation between periFollicular blood flow RI and follicular diameter by linear regression analysis. Conclusion:Our study shows that perifollicular blood flow RI and S/D are effective indices of predicting the pregnancy outcome of IVF-ET.     

Relationship between serum antisperm antibodies and anticardiolipin antibodies and clinical pregnancy outcome in an in vitro fertilization and embryo transfer program

Objective　To study the influence of maternal immunological factors on clinical pregnancy outcome in an in vitro fertilization and embryo transfer (IVF-ET) program. Methods　One hundred and fifty IVF-ET treatment cycles from November 1995 to November 1996 were studied. The indication for IVF-ET treatment was bilateral blocked tubes. Serum antisperm antibodies and anticardiolipin antibodies were measured using enzyme-linked immunosorbent assay (ELISA). Cleavage rate and successful pregnancy rate in relation to antibody status of infertile women after IVF-ET treatment were assessed. Results　Lower cleavage rate (64.2%±32.1%) was found in 44 cycles of antisperm antibody seropositive women, compared with 84.8%±18.7% in 106 cycles of seronegative women (P&lt;0.05). The clinical pregnancy rate was 31.8% in antisperm antibody-positive cycles and 20.8% in negative cycles (P&gt;0.05). The abortion rates of the two groups were similar (P&gt;0.05). Lower pregnancy rate (9.5%) was found in 21 cycles of serum anticardiolipin antibody-positive group, compared with 26.3% in 129 cycles of seronegative women (P&lt;0.05). Of patients with bio-chemical pregnancy and no pregnancy, 20.0% and 16.2%, respectively, had seropositive anticardiolipin antibody, compared with 5.6% of patients with clinical pregnancy (P&lt;0.05). Conclusion　Serum immunological factors may play a part in clinical pregnancy outcome in IVF-ET.     

Comparison of Effects of Recombinant FSH versus Highly Purified Urinary FSH for COH in the Outcome of IVF-ET

Objective To investigate the difference in the outcome of IVF-ET between the patients using recombinant FSH versus highly purified urinary FSH for controlled ovarian stimulation (COH). Methods A comparative retrospective analysis was performed between the patients undergoing IVF using recombinant FSH (rFSH) 562 cycles (rFSH group) versus using highly purified urinary FSH(uFSH) 555 cycles (uFSH group) for COH from August 2009 to July 2010. Main outcome measures included: duration of stimulation, total amount of FSH, E2 level on hCG injection day, number of oocytes collected, average number of frozen embryos, and the rate of cancellation, implantation, clinical pregnancy and miscarriage rate. Results uFSH group required a significantly higher total amount of FSH and a longer duration of stimulation than thouse rFSH group (19.3 ± 7.6 vs 18.3 ± 7.0 ampoules, P=0.02, and 9.1 ± 1.6 d vs 8.9 ± 1.5 d, P=0.04, respectively). There was no statistically significant difference in the implantation rate, clinical pregnancy rate and miscarriage rate between uFSH and rFSH groups (22.57% vs 20.16%, 38.15% vs 35.18%, and 10.6% vs 13.45%, respectively, P>0.05). The other measures including E2 level on hCG injection day, cancellation, number of oocytes collected, fertilization, average number of frozen embryos showed no difference between the two groups. Conclusion There is no significant difference in the outcome of IVF-ET between two groups in effects of recombinant FSH versus highly purified urinary FSH for COH.     

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.     

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.

     

Effect of Quyu Jiedu Granule (祛瘀解毒颗粒) on microenvironment of ova in patients with endometriosis

Objective:To observe the effect of Quyu Jiedu Granules(祛瘀解毒颗料,QJG) on the micro-environment of ova in patients with endometriosis(EM).Methods:Twenty EM patients who received in vitro fertilization and embryo transfer(IVF-ET) were randomized equally into a treated group and a control group. Further,20 patients who received IVF-ET due to oviduct factors were enrolled into a non-endometriosis group. The dosage of gonadotrophic hormone used,the number of ova attained,fertilization rate and clinical pregnancy...