Analysis of the influencing factors of embryo quality and pregnancy outcomes in frozen-thawed embryo transfer cycle in polycystic ovary syndrome patients北大核心CSCD

Objective To explore the influencing factors of embryos quality during the cycle of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and pregnancy outcomes of frozen-thawed embryo transfer (FET) in patients with polycystic ovary syndrome (PCOS). Methods A retrospective case-control study design was used to analyze patients who received IVF/ ICSI treatment at the Reproductive Medicine Center of Tianjin Central Obstetrics and Gynecology Hospital from January 2015 to December 2019, underwent whole embryo cryopreserved and performed the first FET. The 1233 cycles included were divided into control group (n=561) and PCOS group (n=672) according to PCOS diagnosis. The general clinical characteristics, laboratory-related indicators and pregnancy outcomes of patients between the two groups were compared, and the affecting factors of the late miscarriage rate were analyzed by multivariate logistic regression. Results 1) In terms of the general clinical characteristics between the two groups, the differences of duration of infertility [(3.95±2.01) years vs. (4.84±2.91) years, P=0.007], body mass index (BMI) [(21.96±2.52) kg/m2 vs. (23.96±3.50) kg/m2, P<0.001], basal luteinizing hormone [(4.71±2.38) mU/L vs. (8.18±5.40) mU/L, P<0.001], basal estradiol [(45.49±31.80) ng/L vs. (56.67±54.17) ng/L, P=0.032], basal testosterone [(42.80±13.45) ng/L vs. (53.45±38.67) ng/L, P=0.001], gonadortopin initial used dosage [(230.80±54.07) U vs. (192.11±53.79) U, P<0.001] were statistically significant. The endometrium preparation plan in the FET cycle, more PCOS group patients received hormone replacement treatment [64.1% (431/672) vs. 26.6% (149/561)], while more patients in control group received natural cycle transplantation [73.4% (412/561) vs. 35.9% (241/672)], and the differences were statistically significant (all P<0.001). 2) In terms of the laboratory results, the number of oocytes retrieved in PCOS group (23.36±9.53) was higher than that in control group (20.32±8.81, P=0.002). The number of high-quality embryos and the rate of high-quality embryos in PCOS group [2.94±3.13; 33.3% (2016/6048)] were lower than those in control group [4.17±3.65, P=0.034; 46.3% (2339/ 5049), P<0.001], and the differences were statistically significant. 3) In the pregnancy outcomes, the high-quality embryo transfer rate and the biochemical pregnancy rate in control group were higher than those in PCOS group [71.0% (743/1046) vs. 59.3% (761/1284), P<0.001; 7.3% (41/561) vs. 4.5% (30/672), P=0.033], and the late miscarriage rate in PCOS group [10.3% (43/418)] was higher than that in control group [4.3% (16/326), P=0.002]. 4) Logistic regression analysis was performed on the influencing factors of late miscarriage. After correcting the confounding factors, PCOS (OR=2.573, 95% CI=1.270-5.212, P=0.009) and maternal high BMI (OR=1.080, 95% CI=0.991-1.176, P=0.031) were the risk factors for late miscarriage. Conclusion The number of high-quality embryos and the rate of high-quality embryos in PCOS patients were lower than those in non-PCOS patients. PCOS and high BMI were risk factors for late miscarriage in patients. Improving endocrine disorders and weight control in PCOS patients before fertility treatment is of positive significance for improving the pregnancy outcome of patients. © 2022 Chinese Medical Journals Publishing House Co.Ltd. All rights reserved.     

Comparative analysis of perinatal outcome of intracytoplasmic sperm injection and frozen-thawed embryo transfer between donor and autologous oocytes北大核心CSCD

Objective To investigate the obstetric outcomes of intracytoplasmic sperm injection and frozen-thawed embryo transfer (ICSI-FET) between donor and autologous oocytes. Methods A retrospective cohort study was conducted to analyze the clinical data of pregnant patients who underwent ICSI-FET in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from June 2016 to January 2020. Totally 73 patients with donor oocytes, and 550 patients who used autologous oocytes in the same period, and the patients were matched at 1∶3 with propensity score matching (PSM), then there were 47 patients in donor group and 131 patients in autologous group. The general conditions and obstetric outcomes were compared among donor group and autologous group. Multivariate logistic regression and linear regression were applied to analyze the factors affecting perinatal complications. Results The bilateral antral follicle count (3.08±4.78) and basal estradiol level [(71.55±45.29) pmol/L] in donor group were significantly lower than those in autologous group [14.95±6.42, (132.84±74.89) pmol/L, all P<0.001]. The birth weight of singleton in donor group [(2 916.48±537.55) g] was lower than that in autologous group [(3 326.67±503.43) g], and there was significant difference (P<0.001). There were no significant differences in premature birth rate [21.28% (10/47) vs. 16.03% (21/131), P=0.416] and incidence of hypertensive disorder complicating pregnancy [12.77% (6/47) vs. 7.63% (10/131), P=0.448] between donor group and autologous group, but both of them had an increasing trend in donor group. Oocyte-donated ICSI-FET reduced the birth weight of singleton (MD=-388.225, 95% CI= -625.914-150.537, P=0.002). Conclusion The perinatal outcome of oocyte-donated ICSI-FET is relatively safe, but the birth weight of singleton is lower than that of self-oocyte ICSI-FET. © 2022 Chinese Journal of Endocrine Surgery. All rights reserved.     

Analysis of major factors of mosic embryo in blastocyst stage北大核心CSCD

Objective To analyze of the main influecing factors of mosic embryos during the preimplantation genetic test for chromosomal structural rearrangement (PGT-SR) to avoid the increase of risk of abortion and genetic abnormalities and to improve the diagnostic rate of mosic embryos. Methods We used a retrospective cohort study to analyze 94 cycles of infertile patients undergoing PGT-SR and 551 cycles of intracytoplasmic sperm injection (ICSI) from January 2018 to December 2019 in the Reproductive Medical Center of the Maternal and Child Health Hospital. The relationship of mosic embryos was analyzed between the age, the number of oocytes, gonadotropin (Gn)/oocyte, the grade of blastocysts and chromosome carrier of different genders by the SPSS21.0 software. Results In the PGT-SR cycle, single factor analysis found that mosaic embryos were related to age and sperm concentration (P=0.02, P=0.04), but multivariate logistic regression analysis showed that age (OR=3.41, 95% CI=1.34-8.66, P=0.01), sperm concentration (OR=0.41, 95% CI=0.17-0.96, P=0.04) and chromosome carrier of different genders (OR=2.21, 95% CI=1.04- 4.70, P=0.04) were the main factors of embryo mosaicism. Conclusion Female age, sperm concentration and chromosome carrier of different genders maybe affect the formation of mosaic embryos, providing theoretical basis for selective transfer of mosaic embryos. © 2021 Chinese Medical Journals Publishing House Co.Ltdg. All rights reserved.     

The cost-effectiveness of growth hormone replacement therapy (Genotropin®) in hypopituitary adults in Sweden

Background

To evaluate the cost-effectiveness of growth hormone (GH) treatment (Genotropin®) compared with no GH treatment in adults with GH deficiency in a Swedish societal setting.

Methods

A Markov-type cost-utility simulation model was constructed and used to simulate, for men and women, morbidity and mortality for GH-treated and -untreated individuals over a 20-year period. The calculations were performed using current available prices concerning morbidity-related healthcare costs and costs for Genotropin®. All costs and treatment effects were discounted at 3%. Costs were expressed in Euro (1€?=?9.03 SEK). GH-treated Swedish patients (n?=?434) were identified from the KIMS database (Pfizer International Metabolic Database) and untreated patients (n?=?2135) from the Swedish Cancer Registry and the Hospital Discharge Registry.

Results

The results are reported as incremental cost per quality-adjusted life year (QALY) gained, including both direct and indirect costs for GH-treated versus untreated patients. The weighted sum of all subgroup incremental cost per QALY was €15,975 and €20,241 for men and women, respectively. Including indirect cost resulted in lower cost per QALY gained: €11,173 and €10,753 for men and women, respectively. Key drivers of the results were improvement in quality of life, increased survival, and intervention cost.

Conclusions

The incremental cost per QALY gained is moderate when compared with informal thresholds applied in Sweden. The simulations suggest that GH-treatment is cost-effective for both men and women at the €55,371 (SEK 500,000 – the informal Swedish cost-effectiveness threshold) per QALY threshold.

     

Has the impact of hormone replacement therapy on health-related quality of life been undervalued?

Previous economic evaluations of hormone replacement therapy (HRT) have restricted positive effects to alleviation of postmenopausal symptoms and negative effects to drug side effects. We studied the association between HRT use and postmenopausal women's valuation of both health-related quality of life and potential treatment side effects. Postmenopausal women with either a documented first vertebral fracture within the past 5 years or no history of osteoporotic fractures were recruited from Olmsted County, Minnesota, and from Dartmouth-Hitchcock Medical Center in New Hampshire to participate in a study to assess quality of life and women's attitudes toward osteoporosis prevention. Women's valuations of their current health and potential HRT-related side effects were quantified as quality-adjusted life years (QALYs) assessed by an automated utility assessment instrument (U-Titer) and the time tradeoff technique, by a vertical rating scale, and by estimated quality of well-being (QWB) scores. Health status was measured using the Medical Outcomes Study SF-36. Regression methods were used to assess the impact of current HRT use on health-related quality of life and valuation of side effects. There were 106 women with vertebral fracture and 180 with no history of hip, wrist, or vertebral fractures. Altogether, 116 (40.6%) women were currently taking HRT, 64 (22.2%) had taken HRT in the past, and 106 (37.1%) women had never taken HRT. Current HRT users had higher time tradeoff QALYs than never and past HRT users, with gains ranging from 15.0 to 83.7 days per year for current users relative to the others. Benefits were largest for women with a vertebral fracture and limitations in activities. The secondary QALY measures also showed significantly higher values for current HRT users compared with other women, as did SF-36 subscales for general health, physical function, role-emotional function, and vitality. There was substantial variability in women's perceptions of HRT side effects. Overall, the proportion of women willing to trade time to avoid bleeding was largest, at 95.5%, followed by breast tenderness, weight gain, and endometrial biopsy at 90.4%, 87.4%, and 82.7%, respectively. Current HRT users had higher health-related quality of life than past or never users according to all measures studied. Women's perceptions of potential side effects were highly variable and should be considered by physicians when prescribing an HRT regimen. If, as our results suggest, postmenopausal therapy has positive effects beyond the immediate postmenopausal years, previous economic studies may have underestimated the value of HRT.     

Clinical analysis for pregnancy outcome of previous TORCH infection patients evolved with in vitro fertilization/intracytoplasmic sperm injection-embryo transfer北大核心CSCD

Objective To investigate the influence of previous TORCH infection on pregnancy outcome of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ ICSI-ET). Methods A retrospective cohort study was carried out for infertile female patients who underwent IVF/ICSI-ET treatment from May 2016 to May 2018 at Department of Obstetrics and Gynecology, Reproductive Medicine Center, the Second Affiliated Hospital, Air Force Military Medical University. IgM and IgG in serum have been detected for cytomegalovirus (CMV), herpes simplex virus (HSV), rubella virus (RV) and Toxoplasma (TOX) by enzyme-linked immunosorbent assay (ELISA). Patients with IgM negative and IgG positive [IgM(-), IgG(+)] were assigned as the previous infection, while IgM-negative and IgG-negative [IgM(-), IgG(-)] were assigned as negative control. Four groups of CMV [1984 IgG(+) cases vs. 421 IgG(-) cases], HSV [1535 IgG(+) cases vs. 344 IgG(-) cases], RV [1795 IgG(+) cases vs. 261 IgG(-) cases] and TOX [75 IgG(+) cases vs. 2111 IgG(-) cases] were investigated for general data and pregnancy outcome of IVF/ICSI-ET. Results There were no significant differences between previous infection and negative control at age, body mass index (BMI), infertility duration, basal follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH) levels among four groups (all P>0.05). The number of oocytes retrieved (9.68±4.33, 10.04±3.99, 10.41±4.33), fertilization rate [82.01% (1627/1984), 82.74% (1270/1535), 82.95% (1489/1795)], clinical pregnancy rate [53.20% (1055/1984), 51.66% (793/1535), 52.98% (951/1795)] and live birth rate [50.25% (997/1984), 38.96% (598/1535), 40.33% (724/1795)] in CMV, HSV, and RV IgG positive groups were significantly lower than those in the negative control [10.18±4.41, 10.58±3.54, 11.08±3.90, P=0.032, P=0.021, P= 0.018; 86.46% (364/421), 87.21% (300/344), 88.12% (230/261), P=0.028, P=0.043, P=0.035; 58.4% (246/421), 58.14% (200/344), 60.54% (158/261), P=0.049, P=0.030, P=0.022; 55.58% (234/421), 46.51% (160/344), 47.89% (125/261), P=0.047, P=0.010, P=0.021]. However, the biochemical pregnancy rate [9.47% (188/1984), 9.12% (140/1535), 10.53% (189/1795)] and the miscarriage rate [10.48% (208/1984), 9.97% (153/1535), 10.97% (197/1795)] in CMV, HSV, and RV IgG positive groups were higher than those in the negative group [6.18% (26/421), 5.81% (20/344), 6.51% (17/ 261), P=0.031, P=0.047, P=0.044; 7.13% (30/421), 6.10% (21/344), 6.51% (17/261), P=0.036, P= 0.026, P=0.027]. There were no significant differences in the number of oocyte retrieved, fertilization rate, clinical pregnancy rate and live birth rate between the TOX IgG positive group and the negative control (all P>0.05). Conclusion Previous infections of CMV, HSV and RV may be the reason for the fewer number of oocyte retrived and lower fertilization rate, clinical pregnancy rate and live birth rate for patients undergoing IVF/ICSI-ET treatment. Previous infections of CMV, HSV and RV cause the higher biochemical pregnancy rate and miscarriage rate. The previous TOX infection has no infection on IVF/ICSI-ET pregnancy outcome. © 2022 Chinese Journal of Endocrine Surgery. All rights reserved.     

Effects of different gonadotropins in progestin primed ovarian stimulation protocol on ovulation induction of patients with diminished ovarian reserve北大核心CSCD

Objective In order to discuss the ovulation induction effect and clinical significance of human menopausal gonadotropin (hMG) and follicle-stimulating hormone (FSH) on progestin primed ovarian stimulation (PPOS) protocol in patients with diminished ovarian reserve during in vitro fertilization (IVF) cycle. Methods Using retrospective cohort study method, the patients with diminished ovarian reserve who received PPOS in IVF assisted reproduction in the Reproductive Medicine Center of the First Affiliated Hospital of Fujian Medical University from November 2018 to June 2020 were included, 110 cycles met requirements and were divided into FSH group (63 cycles) and hMG group (47 cycles) according to the different gonadotropin (Gn) used. General information and the outcome of IVF between the two groups were compared. Results The total number of retrieved oocytes, MIIoocytes, fertilized oocytes, cleaved oocytes, day 3 (D3) embryos, all freezing embryo, two pronucleus (2PN) fertilization rate, the blastocyst formation rate, day 5 (D5) blastocyst rate and the utilization rate of oocytes, the biochemical pregnancy rate and the miscarriage rate had no statistical differences (all P>0.05). The rate of D3 high-quality embryos, the clinical pregnancy rate and the embryo implantation rate of FSH group were higher than those of hMG group [64.2% (111/173) vs. 50.0% (48/96), P=0.024; 45.8% (22/48) vs. 21.2% (7/33), P=0.023; 36.5% (27/74) vs. 16.7% (8/48), P=0.018] with statistical significances. Conclusion For patients with diminished ovarian reserve, the rate of D3 high-quality embryos, the clinical pregnancy rate and the embryo implantation rate of FSH group are higher. © 2021 Chinese Medical Journals Publishing House Co.Ltdg. All rights reserved.     

Advances in the window of implantation in patients with repeated implantation failure北大核心CSCD

Repeated implantation failure (RIF) affects the improvement of the success rate of assisted reproductive technology. Embryo factors play a crucial role in it, but causes of endometrial origin may also be an aspect that cannot be ignored. Studies on asynchronous window of implantation and endometrial functional defects have continued to emerge in recent years. However, the accuracy, credibility and effect of the results on the improvement of clinical outcomes are questionable. Along with the advance of related technologies, experiments should be well-designed in order to achieve reliable results, which should be verified by clinical outcomes. This kind of studies may help increase pregnancy rates in patients with RIF. © 2022 Chinese Journal of Endocrine Surgery. All rights reserved.     

Doubling in the use of thyroid hormone replacement therapy in Denmark: association to iodization of salt?

Iodization of salt is an effective strategy to prevent iodine deficiency disorders. Recent studies, however, indicate that increasing the iodine intake in a population may give rise to an increased incidence of hypothyroidism, but the association has not been fully clarified. In Denmark, iodization of salt was initiated in 1998 because of mild-to-moderate iodine deficiency. The aim of this study was to evaluate the effect of the raised iodine intake on the nationwide incident use of thyroid hormone replacement therapy (levothyroxine) to treat hypothyroidism. Data on all use of levothyroxine was extracted from the Register of Medicinal Product Statistics during the period 1995–2009 and linked to other nationwide registers by use of the Danish identification number. Persons with previous thyroid surgery were excluded. In the studied period 71,565 incident users were identified. The incidence rate increased 75% in the moderately iodine deficient region (72.2 incident users/100,000 person-years in 1997 to 126.6 in 2008) and 87% in the mildly deficient region (86.9–162.9). When stratified by sex and age-group (00–39, 40–64, 65+) the largest relative increase was seen among women in the youngest age-group, where more than a doubling was seen. The mechanisms behind the increase may be a result of iodine-induced hypothyroidism, although a higher diagnostic activity with regard to thyroid dysfunction and intensified treatment of subclinical hypothyroidism may also play a role. Our findings stress the need for caution when initiating iodine fortification programs to keep the intake within the optimal range, and the need for continuous monitoring.     

Effect of Galectin-1 on the function of endometrial epithelial cells with different receptivity北大核心CSCD

Objective To observe the expression of Galectin-1 in human ectopic endometrial cells with different receptivity and its role in the process of embryo implantation. Methods The expression and localization of Galectin-1 in high tolerance endometrial cell RL-95-2 and low tolerance endometrial cell HEC-1-A were detected by real-time quantitative PCR (RT-qPCR), Western blotting and immunofluorescence assay. The invasion and migration of the two kinds of cells were detected by Transwell assay and scratch assay. JAR cells were used to mimic embryos and to detect the migration rate. The expression levels of Galectin-1, epithelial-mesenchymal transition (EMT) -related proteins and WNT/β-catenin signaling pathway-related proteins were analyzed by transfecting Galection-1 siRNA and Galection-1 overexpression vector in the RL-95-2 cells and HEC-1-A cells, respectively. Then the transfected endometrial cells were added with WNT pathway inhibitor DKK1 and activator LiCl respectively, and the changes of EMT-related proteins and the invasion, migration of cells were examined. Results 1) RT-qPCR and Western blotting results showed that Galectin-1 was significantly higher in RL-95-2 than in HEC-1-A (P=0.020, P=0.030); immunofluorescence experiments showed that Galectin-1 was mainly expressed in the cytoplasm of RL-95-2, while in HEC-1-A cells, Galectin-1 was mainly expressed in the nucleus. 2) The results of cell adhesion assay showed that the adhesion rate of JAR cells to RL-95-2 cells was significantly higher than that to HEC-1-A cells (P=0.010). 3) After Galectin-1 overexpression, the expression of E-cadherin protein was decreased in the HEC-1-A cells (P=0.001), and the expressions of N-cadherin and Vimentin were increased (P=0.003, P=0.023); the exprssioins of β-catenin, WNT4a, WNT5a, and WNT7a were increased (P=0.025, P=0.004, P=0.005, P=0.001), and the migration ability and invasion ability of HEC-1-A cells were significantly enhanced (P=0.022, P=0.003). 4) After DKK1 treatment of HEC-1-A cells overexpressing Galectin-1, E-cadherin protein expression was decreased (P=0.003), N-cadherin and Vimentin protein expressions were increased (P=0.015, P=0.033), and the migratory ability as well as invasive ability of HEC-1-A cells were significantly increased (P= 0.030, P=0.040). 5) After down-regulation of Galectin-1 expression in RL-95-2 cells, E-cadherin protein expression was increased (P=0.004), N-cadherin and Vimentin protein expressions were significantly decreased (P=0.030, P=0.023), and β-catenin, WNT4a, WNT5a, and WNT7a protein expressions were reduced (P=0.001, P=0.005, P=0.023, P=0.020). 6) After LiCl treatment of RL-95-2 cells with down-regulated Galectin-1 expression, E-cadherin protein expression was increased, and N-cadherin protein and Vimentin protein expressions were decreased compared with LiCl-treated RL-95-2 cells (P=0.012, P=0.035, P=0.020); RL-95-2 cells migration rate, and invasion number were decreased (P=0.040, P=0.020). Conclusion The expression level of Galectin-1 was increased in highly receptivity endometrium compared with low receptivity endometrium. Galectin-1 may regulate the expression of EMT-related proteins through WNT/β-catenin signaling pathway, thus affecting embryo implantation. © 2021 Chinese Medical Journals Publishing House Co.Ltdg. All rights reserved.     

Effects of β-endosulfan on the growth and reproduction of zebrafish (Danio rerio)

Because of persistent organic pollution in aquatic environments, the widely used organochlorine pesticide endosulfan, which is a potential endocrine disruptor, is expected to pose a significant risk to aquatic organisms. In the present study, we explored the potential endocrine-disrupting risk of β-endosulfan by investigating its effect on the growth, reproduction, plasma vitellogenin, and organ histology of adult zebrafish. We found that, although β-endosulfan did not significantly affect the growth of zebrafish, it greatly decreased the hatching rate, even at a concentration as low as 10 ng/L. Interestingly, the decrease of the hatching rate was highly correlated with pathological alterations of the testes. Additionally, the values of the gonadosomatic index were significantly reduced in female zebrafish treated with 200 ng/L β-endosulfan, which was also closely associated with ovarian histological changes. More importantly, a significant increase in the level of vitellogenin was observed in all male fish treated with β-endosulfan. Based on these findings, we conclude that β-endosulfan severely affects the reproductive function of zebrafish and the synthesis of vitellogenin in the liver, and thus, β-endosulfan has a serious endocrine disruption function in zebrafish.     

Effects of a purported aromatase and 5α-reductase inhibitor on hormone profiles in college-age men

The purpose of this study was to determine the effects of an alleged aromatase and 5-α reductase inhibitor (AI) on strength, body composition, and hormonal profiles in resistance-trained men. Thirty resistance-trained men were randomly assigned in a double-blind manner to ingest 500 mg of either a placebo (PL) or AI once per day for 8 wk. Participants participated in a 4-d/wk resistance-training program for 8 wk. At Weeks 0, 4, and 8, body composition, 1-repetition-maximum (1RM) bench press and leg press, muscle endurance, anaerobic power, and hormonal profiles were assessed. Statistical analyses used a 2-way ANOVA with repeated measures for all criterion variables (p ≤ .05). Significant Group × Time interaction effects occurred over the 8-wk period for percent body fat (AI: -1.77% ± 1.52%, PL: -0.55% ± 1.72%; p = .048), total testosterone (AI: 0.97 ± 2.67 ng/ml, PL: -2.10 ± 3.75 ng/ml; p = .018), and bioavailable testosterone (AI: 1.32 ± 3.45 ng/ml, PL: -1.69 ± 3.94 ng/ml; p = .049). Significant main effects for time (p ≤ .05) were noted for bench- and leg-press 1RM, lean body mass, and estradiol. No significant changes were detected among groups for Wingate peak or mean power, total body weight, dihydrotestosterone, hemodynamic variables, or clinical safety data (p > .05). The authors concluded that 500 mg of dailyAI supplementation significantly affected percent body fat, total testosterone, and bioavailable testosterone compared with a placebo in a double-blind fashion.     

Research progress of maternal-fetal interface microenvironment in recurrent abortion北大核心CSCD

Recurrent spontaneous abortion (RSA) is a common adverse pregnancy outcome in women of childbearing age and its etiology is complex and still not clear. The maternal-fetal interface microenvironment plays a key role in maintaining pregnancy. There are trophoblast cells, decidual stromal cells and immune cells in the maternal-fetal interface microenvironment. The abnormal number or function of these cells may induce changes in the microenvironment of maternal-fetal interface, such as spiral artery remodeling disorder and abnormal decidualization, which may lead to RSA. This review discusses the role and mechanism of these three main cells in RSA. © 2022 by the authors.     

Comparison of the early follicular long-term protocol and antagonist protocol in unexplained infertility patients北大核心CSCD

Objective To investigate the clinical effects and pregnancy outcomes of the early follicular long-term protocol and antagonist protocol in the treatment of unexplained infertility patients. Methods From January 2018 to January 2019, 642 cases of unexplained infertility patients with early follicular long-term protocol and antagonist protocol in in vitro fertilization/ intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) were collected using the clinical assisted reproductive technologies management system software database of the Department of Reproductive Medicine of the First Affiliated Hospital of Nanjing Medical University. Patients were divided into early follicular long-term protocol (n=283) and antagonist protocol (n=359) groups. The clinical outcomes of the two groups were analyzed retrospectively, including the implantation rate, the clinical pregnancy rate, and the live birth rate. Furthermore, the pregnancy outcomes of different age and body mass index (BMI) patients were further analyzed. Results 1) The BMI in the antagonist protocol group was higher than that in early follicular long-term protocol group [(22.17±2.96) kg/m2vs. (21.68±2.29) kg/m2, P=0.018]. The other based data did not exhibit remarkable difference between the two groups (P>0.05). 2) The starting dosage of gonadotropin (Gn) in early follicular long-term protocol group was less than that of antagonist group [(149.74± 36.24) IU vs. (177.97±38.85) IU, P<0.001]. While the total duration and dosage of Gn used in early follicular long-term protocol group were significantly higher than those in antagonist group [(11.93± 2.26) d vs. (8.86±1.45) d, P<0.001; (1 908.35±632.36) IU vs. (1 638.57±497.23) IU, P<0.001). The cleavage embryo implantation rate, the clinical pregnancy rate and the live pregnancy rate in fresh cycle in early follicular long-term protocol group were significantly higher than those in the antagonist group [57.14% (152/266) vs. 39.53% (68/172), P<0.001; 66.48% (121/182) vs. 51.72% (60/116), P=0.011; 59.89% (109/182) vs. 40.52% (47/116), P=0.001]. The incidence of moderate and severe ovarian hyperstimulation syndrome between the two groups were not statistically different (P>0.05). Multivariate logistic regression analysis showed that different protocols and age were both risk factors for clinical pregnancy and live birth of cleavage embryo transfer [2.261 (95% CI=1.333-3.836), P=0.002; 0.928(95% CI=0.869-0.991), P=0.026; 2.598(95% CI=1.535-4.397), P<0.001; 0.906(95% CI=0.849-0.967), P=0.003]. 3) In patients under 35 years old, the clinical pregnancy rate and the live birth rate in early follicular long-term protocol group were higher than those of the antagonist group, but there was no statistical difference (all P>0.05). The fresh embryo cycle implantation rate, the clinical pregnancy rate and the live birth rate of 35-39 years old patients in the early follicular long-term protocol group were higher than those in the antagonist group, but there was no statistical difference (all P>0.05). 4) In normal BMI group, the implantation rate, the clinical pregnancy rate and the live birth rate in early follicular long-term protocol group were significantly higher than those in the antagonist group [55.71% (122/219) vs. 37.82% (45/119), P=0.002; 63.58% (96/151) vs. 46.99% (39/83), P=0.014; 58.94% (89/151) vs. 39.76% (33/83), P=0.005]. In the overweight population, the implantation rate and the clinical pregnancy rate in early follicular long-term protocol group were significantly higher than those in the antagonist group [68.09% (32/47) vs. 43.40% (23/53), P=0.013; 81.25% (26/32) vs. 57.14% (20/35), P=0.034], but there was no statistically significant difference in the live birth rate (P>0.05). Conclusion Compared with the antagonist protocol, early follicular long-term protocol for unexplained infertility patients may achieve higher clinical pregnancy outcomes in IVF fresh cycle, but it could increased the duration of descending, the duration and dosage of Gn used. © 2021 Chinese Medical Journals Publishing House Co.Ltdg. All rights reserved.     

Is growth hormone a feasible adjuvant in the treatment of children after small bowel resection?

The aim of our study was to assess the metabolic consequences of short-term administration of growth hormone in children after gut resection and influence on polyamine production in red blood cells (RBC). Twelve children aged 4-60 months were studied. All children remained on parenteral nutrition and 11 also received oral feeding. Total non-protein energy intake was 429 +/- 86 kJ/kg body weight (BW)/day. Recombinant growth hormone (GH) was administered subcutaneously at a dose of 0.3 IU/kg BW/day for 10 days. Resting energy expenditure (REE; kJ/kg BW/day) was: 316.07 +/- 54.08 before and 346.04 +/- 54.40 during GH administration (P < 0.02), but daily weight gain before GH administration was significantly lower than during treatment. A significant increase of polyamine concentrations was observed in the RBC (spermidine: 30.1 +/- 15.1 and 43.8 +/- 24.9 nmol/ml packed RBC, P < 0.003; spermine: 15.6 +/- 5.1 and 19.6 +/- 10.6 nmol/ml packed RBC, P < 0.02) and in jejunal mucosa (spermidine: 172.10 +/- 142.35 nmol/g tissue and 193.92 +/- 108.15 nmol/g tissue). The authors concluded that increased polyamine concentrations in the RBC and jejunal mucosa reflect a cellular response to GH administration. The anabolic effect of GH results in higher weight gain, although increased REE may indicate increased energy requirements during GH treatment.     

Transvaginal combined with transabdominal oocyte retrieval in IVF/ICSI cycle: a case report北大核心CSCD

Objective. To improve the technique of oocyte retrieval in in vitro fertilization/ intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles and reduce the cancellation rate of IVF/ICSI cycle. Methods. The clinical data of a case of IVF/ICSI cycle using transvaginal combined with abdominal oocyte retrieval was reported. Results. The right ovary of one infertile patient who received ICSI due to male factors was not detected repeatedly by transvaginal ultrasound during ovulation induction. The right lower abdominal pain occurred day 5 after using gonadotropin. We considered that the position of the right ovary was high due to pelvic adhesion after previous appendectomy, and was further confirmed by abdominal ultrasound. Two mature oocytes were obtained from the left and right ovaries respectively. Four embryos were obtained after ICSI insemination, and biochemical pregnancy occurred after transplantation. Conclusion. Transabdominal ultrasound-guided oocyte retrieval is relatively safe and effective, and can obtain similar clinical outcomes as conventional transvaginal ultrasound-guided oocyte retrieval. For IVF/ICSI women with difficulty in obtaining oocytes through vagina, transabdominal ultrasound-guided oocyte retrieval can be tried. During IVF/ICSI treatment cycles, it is necessary to improve the quality of medical history inquiry, pre-cycle evaluation, ovulation induction monitoring, oocyte retrieval and embryo transfer. © 2022 Chinese Journal of Psychiatry. All rights reserved.     

Effects of Kepone® on the sheepshead minnow in an entire life-cycle toxicity test

A life-cycle toxicity test with the estuarine sheepshead minnow (Cyprinodon variegatus) and the insecticide Kepone^® (chlordecone) in seawater showed that the maximum acceptable toxicant concentration (MATC) lies between 0.074 and 0.12 g Kepone/L, based on reduced standard length of progeny at 0.12g/L and higher concentrations. The application factor range (MATC/96-hr LC50) for sheepshead minnows exposed continuously to Kepone is from 0.001 to 0.002. Other adverse effects of Kepone exposure were: External signs of poisoning in fish exposed to concentrations 0.074g/L, fatty degeneration of the liver and histological evidence of vertebral damage in some fish exposed to 0.78g/L, reduced growth of parental fish at 0.39 and 0.78g/L, reduced fecundity and fertility of eggs at 0.78g/L, and reduced survival of embryos produced by fish exposed to 0.78g/L. Average bioconcentration factors (concentration in tissue ÷ average measured concentration in water) ranged from 2,600 for 21-day-old juveniles to 7,600 for adult males. ^®Registered trademark, Allied Chemical Corp., 40 Rector St., New York, NY 10006. Mention of trade names or commercial products does not constitute endorsement by the Environmental Protection AgencyGulf Breeze Contribution No. 425     

Effects of carotenoid‐rich food extracts on the development of preneoplastic lesions in rat liver and on in vivo and in vitro antioxidant status

The effect of dietary carotenoid‐rich extracts of carrots, tomatoes, and orange juice on rat liver γ‐glutamyl transpeptidase‐positive preneoplastic foci induced by afla‐toxin B₁ was investigated. Organic extracts were prepared from the foods, dissolved in tricaprylin oil to equivalent concentrations of the major food‐specific carotenoids, and fed by intubation to Fischer 344 male rats. The extracts were administered during the 2‐week aflatoxin‐dosing (initiation) period of the study or during the subsequent 12‐week post‐dosing (promotion) period. Vitamin status and antioxidant activities were measured in blood and liver. Extract feeding caused an accumulation of carotenoids in the liver, a substantial decrease in spontaneous erythrocyte hemolysis, and lowered plasma glutathione, blood superoxide dismutase, and blood catalase. Differences in foci development among the three extracts were not as consistent or profound as differences between initiation and promotion dosing. The number of γ‐glutamyl transpeptidase‐positive foci was decreased by extract feeding during the initiation period, whereas extract feeding during the promotion period caused a decrease in the average diameter of the foci. The total volume of foci was markedly reduced by extract feeding during either period. Extracts were compared with purified carotenoids and a‐tocopherol in their ability to affect in vitro antioxidation activity and were nearly as effective as the pure compounds. In summary, carotenoid‐rich extracts of these three foods substantially inhibited biochemical and cellular events thought to play a role in the early stages of hepatocarcinogenesis.     

The Effects of Years Lived in the United States on the General Health Status of California’s Foreign-Born Populations

The purpose of this study was to examine the effect of immigrant status and years lived in the United States on the general health status of California’s foreign-born populations. Two models were constructed using California’s aggregate adult population and the adult foreign-born population. A binary logistic regression was conducted using data from the 2003 California Health Interview Survey. California’s immigrant populations were found to enjoy a self-assessed health advantage compared to California’s US-born population. The results present evidence of a downward trend in self-assessed health amongst California’s foreign-born population associated with increased years lived in country. The initial health advantage found among California’s foreign-born appears to function mainly through socio-economic factors. These results suggest that the deterioration in health associated with increased years lived in the US may be an effect of immigrants’ exposure to California’s environmental determinants of human health rather that the loss of culture-specific protective factors.