Relationship between antithyroid antibody and pregnancy outcome following in vitro fertilization and embryo transfer

Objective: To investigate the impact of antithyroid antibody on pregnancy outcome following the in vitro fertilization and embryo transfer (IVF-ET).Methods: A total of 90 patients (156 cycles) positive for antithyroid antibody (ATA+ group) and 676 infertile women (1062 cycles) negative for antithyroid antibody (ATA- group) undergoing IVF/ICSI from August 2009 to August 2010 were retrospectively analyzed.Results: There was no significant difference in the days of ovarian stimulation, total gonadotropin dose, serum E2 level of HCG day and number of oocytes retrieved between the two groups. The fertilization rate, implantation rate and pregnancy rate following IVF-ET were significantly lower in women with antithyroid antibody than in control group (64.3% vs 74.6%, 17.8% vs 27.1% and 33.3% vs 46.7%, respectively), but the abortion rate was significantly higher in patients with antithyroid antibody (26.9% vs 11.8%).Conclusion: Patients with antithyroid antibody showed significantly lower fertilization rate, implantation rate and pregnancy rate and higher risk for abortion following IVF-ET when compared with those without antithyroid antibody. Thus, the presence of antithyroid antibody is detrimental for the pregnancy outcome following IVF-ET.     

Antinuclear Antibodies Predicts a Poor IVF-ET Outcome: Impaired Egg and Embryo Development and Reduced Pregnancy Rate

To investigate the impact of anti-nuclear antibodies (ANAs) on the outcome of in vitro fertilization-embryo transfer (IVF-ET), 66 (96 cycles) infertile women positive for anti-nuclear antibodies (ANA+ group), and 233(285 cycles) infertile women negative for ANAs (ANA? group) were enrolled. The clinical characteristics and IVF outcome were compared between the two groups. In the ANA+ group, the proportion of MII oocytes and two-pronuclear zygotes (2PN), cleavage rate, number of available embryos and proportion of available embryos, number of high-quality embryos and proportion of high-quality embryos were significantly lower than those in the ANA? group. In addition, the pregnancy rate and implantation rate in patients positive for ANA was markedly lower than the ANA? patients (28.1% vs 46.4%, 15% vs 25.7%, respectively). Thus, our findings suggest that the presence of ANAs significantly interfere with the oocyte and embryo development, as well as reduce implantation and pregnancy rate in patients undergoing IVF treatment.     

Antinuclear antibodies predicts a poor IVF-ET outcome: impaired egg and embryo development and reduced pregnancy rate

To investigate the impact of anti-nuclear antibodies (ANAs) on the outcome of in vitro fertilization-embryo transfer (IVF-ET), 66 (96 cycles) infertile women positive for anti-nuclear antibodies (ANA+ group), and 233(285 cycles) infertile women negative for ANAs (ANA- group) were enrolled. The clinical characteristics and IVF outcome were compared between the two groups. In the ANA+ group, the proportion of MII oocytes and two-pronuclear zygotes (2PN), cleavage rate, number of available embryos and proportion of available embryos, number of high-quality embryos and proportion of high-quality embryos were significantly lower than those in the ANA- group. In addition, the pregnancy rate and implantation rate in patients positive for ANA was markedly lower than the ANA- patients (28.1% vs 46.4%, 15% vs 25.7%, respectively). Thus, our findings suggest that the presence of ANAs significantly interfere with the oocyte and embryo development, as well as reduce implantation and pregnancy rate in patients undergoing IVF treatment.     

High expression of L-selectin ligand in secretory endometrium is associated with better endometrial receptivity and facilitates embryo implantation in human being

PROBLEM: L-selectin ligand has displayed mediating adhesion at the maternal-fetal interface. Therefore, we investigated the impact of L-selectin ligand on establishing pregnancy in women undergoing in vitro fertilization and embryo transfer (IVF-ET). METHOD OF STUDY: Endometrium between cycle days LH +6 to +9 was obtained from 56 Chinese women referred for IVF and tested for L-selectin ligand by immunohistochemistry and Western blot. The standard gonadotropin-releasing hormone agonist long protocol was used for ovarian stimulation. RESULTS: L-selectin ligand was localized in the endometrial gland and luminal epithelial cells. Western blot analysis of endometrium identified four bands and levels of component 1, 2 and 4 were significantly higher in the pregnancy group than in the non-pregnancy group (P < 0.05). Clinical pregnancy and implantation rates were higher in patients with high level L-selectin ligand compared with those with low level (53.6%versus 25.0%, and 27.1%versus 12.1%, respectively, P < 0.05). CONCLUSION: The presence of higher level L-selectin ligand was associated with a better pregnancy outcome.     

Levothyroxine treatment in thyroid peroxidase antibody-positive women undergoing assisted reproduction technologies: a prospective study

BACKGROUND: Infertile women positive for thyroid antibodies suffer from a poor pregnancy/delivery outcome, although conflicting data have been published. Our objective was to investigate if levothyroxine (LT4) exerts any effect on pregnancy and/or delivery rates in thyroid peroxidase antibody (TPOAb)-positive (+) women undergoing assisted reproductive technologies. METHODS: Patients undergoing treatment were screened for TPOAb, thyroid-stimulating hormone (TSH) and free thyroxine (FT4). A total of 72 (15%) out of the 484 euthyroid women selected were TPOAb (+). These 72 patients were randomly divided into two groups: group A (n = 36) underwent LT4 treatment, group B (n = 36) placebo. Group C consisted of 412 women (85%) who were TPOAb negative (-). All patients received controlled ovarian stimulation. The endpoints of treatment were pregnancy rate, miscarriage rate and delivery rate. RESULTS: No differences in pregnancy rate were observed between the three groups. Miscarriage rate was higher in TPOAb (+) in comparison to TPOAb (-) [relative risk: 2.01 (95% CI = 1.13-3.56), P = 0.028]. CONCLUSIONS: The pregnancy rate is not affected either by presence of TPOAb or treatment with LT4. However, TPOAb (+) women show a poorer delivery rate compared to TPOAb (-). LT4 treatment in TPOAb (+) does not affect the delivery rate.     

抗磷脂抗体与体外受精-胚胎移植结局的关系

目的探讨IVF—ET反复失败与抗磷脂抗体（anti—phospholipid antibodies，APA），包括抗心磷脂抗体（anti—cardiolipin antibodies，ACA）和狼疮抗凝抗体（lupus anticoagulant antibodies，LA）的关系。方法188例种植失败和种植后妊娠丢失的患者225个周期（研究组）和75例同期接受IVF—ET治疗受孕的患者89个周期（对照组），分别采用酶联免疫吸附法和活性部分凝血酶原时间法，测定静脉血清中的APA。其中，研究组分为种植后妊娠丢失组（26周期）、一次种植失败组（126周期）和反复种植失败组（73周期）。结果研究组中APA、ACA、LA的阳性百分比均高于对照组，与对照组相比，差异均有显著性（P〈0．01）。种植后妊娠丢失组和反复种植失败组此3项指标的阳性百分比分别与对照组比较，差异有显著性（P〈0．01），一次种植失败组与对照组相比，差异无显著性（P〉0．05）。结论APA与IVF—ET种植失败有关，尤其是种植后妊娠丢失和多次种植失败。因此，应对预进行体外受精-胚胎移植患者常规筛查APA，以利于尽早干预治疗以期提高IVF临床妊娠率，降低妊娠丢失率。     

Influence of Antithyroid Antibodies in Euthyroid Women on In Vitro Fertilization-Embryo Transfer Outcome

PROBLEM: To investigate whether antithyroid antibodies (ATAs) affect the pregnancy outcome in euthyroid women undergoing in vitro fertilization-embryo transfer (IVF-ET). METHOD OF STUDY: Thyroid peroxidase antibody (TPOA) and thyroglobulin antibody (TGA) were measured by radioligand assay kits that were used as ATAs in 79 patients with tubal or unexplained infertility who were enrolled in an IVF-ET program. Women who were positive for antinuclear antibody, lupus anticoagulant, anticardiolipin antibody, and rheumatoid factor were excluded from our study. The study group comprised 28 (29.1%) euthyroid women who were positive for TPOAs, TGAs, or both. Fifty-one euthyroid women without ATAs served as control subjects. The results were analyzed with linear regression analysis, Student's f-test, Mann-Whitney U test, Kruskal-Wallis analysis of variance, χ² test, and Fisher's exact test. RESULTS: There were no significant differences between the study group and the control group in patient characteristics such as age, infertility duration, and hormonal profile. There were also no significant differences between the two groups with respect to the number of retrieved oocytes, the fertilization rate, the number of embryos frozen, and the number of embryos transferred. There were no correlations between ATA (TPOA and TGA) titers and the fertilization rate. The clinical pregnancy rate per cycle was significantly lower in the study group, with 26.3% (10/38), compared with 39.3% (35/89) in the control group. The biochemical pregnancy rate per cycle and the miscarriage rate were significantly higher in the study group, 18.4% (7/38) and 40.0% (4/10), respectively, compared with 5.6% (5/89) and 11.4% (4/35), respectively, in the control group. In the study group, both TPOA and TGA titers were significantly higher in the biochemical pregnancy group than in the clinical pregnancy group or the nonpregnancy group. In 10 women with ATAs who achieved pregnancy after IVF-ET, both TPOA and TGA titers were significantly higher in the miscarriage group than in the ongoing pregnancy/delivery group. CONCLUSION: ATAs in euthyroid women with tubal or unexplained infertility have an association with a poor pregnancy outcome after IVF-ET treatment.     

Antinuclear antibody reduces the pregnancy rate in the first IVF-ET treatment cycle but not the cumulative pregnancy rate without specific medication

PROBLEM: It has been shown that the presence of antinuclear antibody (ANA) might reduce pregnancy rates after in vitro fertilization-embryo transfer (IVF-ET). However, the mechanism of implantation failure by ANA has not yet been clarified. This study was performed to investigate the impact of ANA on pregnancy rates after IVF-ET, and the necessity of specific medication for infertile women who have ANA in their sera. METHOD OF STUDY: A total of 108 infertile women were treated by IVF-ET or intracytoplasmic sperm injection (ICSI)-ET. ANA was examined by an indirect fluorescent antibody procedure. Data from women under 40 years old were analyzed retrospectively. RESULTS: The implantation rates per embryo transferred in the first treatment cycles were 14.8% (eight of 54) and 32.4% (33 of 102), in women with and without ANA, respectively. There was a significant difference in the implantation rates between the two groups (P < 0.05). The pregnancy rates per ET in the first treatment cycles were 28% (seven of 25) and 54.2% (26 of 48), respectively. There was also a significant difference in the pregnancy rates between the two groups (P < 0.05). Afterwards, treatments with IVF-ET or ICSI-ET were repeatedly performed for unsuccessful patients, without any specific medication for ANA. The average ET cycles were 1.80 +/- 1.13 and 1.27 +/- 0.54, in women with and without ANA, respectively. The cumulative pregnancy rates per patient were 68% (17 of 25) and 55.6% (35 of 63), respectively. There was no significant difference in the overall pregnancy rates between the two groups. CONCLUSIONS: These findings suggest that ANA might have an impact on implantation failure in women treated by IVF-ET or ICSI-ET. ANA reduced the pregnancy rates in the first IVF-ET or ICSI-ET cycles but not the cumulative pregnancy rates without medication. This indicates that the mechanisms of implantation failure by ANA could be solved, and effective and safe medication should be developed for better implantation rates, especially in the first treatment cycle.     

卵泡液中Leptin与体外受精-胚胎移植结局的关系

目的探讨瘦素(leptin)及性激素(sex hormone)与体外受精-胚胎移植(IVF-ET)结局的关系及其规律,评价其在IVF-ET过程中对卵子受精、胚胎发育及妊娠结局的作用及临床应用价值。方法对38例不孕症患者进行IVF-ET,均为输卵管和男性因素的不孕。促排卵方案均采用短方案,用药剂量个体化,取卵同时留取卵泡液,检测卵泡液leptin、睾酮(T)雌二醇(E2)的含量。分析卵泡液中leptin的含量以及其与体重指数(BM I)获卵数、妊娠结局的关系。结果卵泡液中leptin的含量与T、BM I呈正相关(P<0.05);与E2负相关;在妊娠组明显低于非妊娠组(P<0.05)。结论卵泡液中leptin与胚胎质量、妊娠的成功有直接的因果关系,可以作为预测妊娠结局的指标。     

血清和卵泡液中抗精子抗体对体外受精——胚胎移植的影响

目的 评价女性抗精子抗体对体外受精－－胚胎移植（ＩＶＦ－ＥＴ）的影响。方法 采用ＥＬＩＳＡ法测定施行ＩＶＦ－ＥＴ的妇女的血清和卵泡液中抗精子抗体（ＡｓＡｂ）。Ａ组：血清ＡｓＡｂ阳性１３例;Ｂ组：血清及卵泡液ＡｓＡｂ均阳性２９例;Ｃ组：ＡｓＡｂ阴性１５８例。分析３组受精率、卵裂率、胚胎发育情况及临床妊娠率和流产率的关系。结果：Ａ、Ｂ组受精率、卵裂率明显低于Ｃ组（Ｐ〈０．０１）。移植日,Ａ、Ｂ组Ⅰ－Ⅱ级胚胎率较Ｃ组低,Ⅳ级胚胎及２原核受精细胞增加（Ｐ〈０．０５）。各组妊娠率及流产率无显著差异（Ｐ〉０．０５）。结论 ＡｓＡｂ对ＩＶＦ和早期胚胎发育有损害,体外培养不能完全清除ＡｓＡｂ对ＩＶＦ－ＥＴ的影响。     

Low-dose aspirin does not improve ovarian responsiveness or pregnancy rate in IVF and ICSI patients: a randomized, placebo-controlled double-blind study

BACKGROUND: Poor ovarian and endometrial responses to gonadotrophin stimulation in assisted reproduction techniques lead to decreased pregnancy rates. The aim of the present study was to test the hypothesis that low-dose aspirin started prior to controlled ovarian stimulation improves ovarian responsiveness, pregnancy rate (PR) and pregnancy outcome. METHODS: A total of 374 women who were to undergo IVF/ICSI were randomized to receive 100 mg of aspirin (n=186) or placebo (n=188) daily. Treatment was started on the first day of controlled ovarian stimulation. It was continued until menstruation or a negative pregnancy test. Pregnant women continued the medication until delivery. The main outcome measures were the number of oocytes, number and quality of embryos, the clinical PR and pregnancy outcome. RESULTS: The mean (+/-SD) number of oocytes (12.0+/-7.0 versus 12.7+/-7.2), the total mean number of embryos (5.82+/-4.35 versus 5.99+/-4.66), the mean number of top quality embryos (0.99+/-1.39 versus 1.18+/-1.51) and the number of embryos transferred (1.64+/-0.64 versus 1.63+/-0.71) did not differ in the aspirin and placebo groups. Between the aspirin and placebo group, there was no statistically significant difference in clinical PR per embryo transfer (25.3%, n=44 out of 174 versus 27.4%, n=48 out of 175) or clinical PR per cycle initiated (23.7% versus 25.5%). Birth rate per embryo transfer did not differ significantly between the aspirin (18.4%) and placebo (21.1%) groups. The incidence of poor responders [12 (6.5%) versus 13 (6.9%)] was similar in both groups. CONCLUSIONS: The present results indicate that low-dose aspirin treatment does not have any beneficial effect on ovarian responsiveness, PR and pregnancy outcome in unselected women undergoing IVF/ICSI.     

Improvement of pregnancy and implantation rates in cyclic women undergoing oocyte donation after long-term down-regulation

An oocyte donation programme was carried out in 122 patientsaged between 40 and 49 years for a total of 225 replacementcycles. Eggs were donated by 103 women undergoing assisted reproductiontechnologies in our infertility centre. Recipients were dividedinto different groups according to whether they were menopausal(group A) or cyclic and treated with short- (group B) or long-term(group C) gonadotrophin-releasing hormone analogues. In groupC, the ovarian suppression of the patients was prolonged withthe aim of producing a type of artificial menopause. Oocytedonors were aged between 21 and 35 years, and were equally distributedbetween the different groups. There were significant differencesin pregnancy and implantation rates according to ovarian status:30.8 and 16.1% respectively in group A, 30.6 and 17.7% respectivelyin group C versus 10.4 and 5.6% respectively in group B. Apartfrom improved pregnancy and implantation rates in cyclic womenaged >40 years after long-term down-regulation, these dataseem to demonstrate an important role for the endometrium inthe implantation process.     

GnRH agonist protocol administration in the luteal phase in ICSI-ET cycles stimulated with the long GnRH agonist protocol: a randomized, controlled double blind study

BACKGROUND: GnRH agonist administration in the luteal phase was reported to beneficially affect the clinical outcome of intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) cycles. This double blind, randomized, placebo controlled trial evaluates whether a single dose GnRH agonist administered 6 days after ICSI increases ongoing pregnancy rates following ET in cycles stimulated with the long GnRH agonist protocol. METHODS: Five hundred and seventy women undergoing ET following controlled ovarian stimulation with a long GnRH agonist protocol were included. In addition to routine luteal phase support with progesterone, women were randomized to receive a single 0.1 mg dose of triptorelin or placebo 6 days after ICSI. Randomization was done on the day of ET according to a computer generated randomization table. Ongoing pregnancy rate beyond 20th week of gestation was the primary outcome measure. The trial was powered to detect a 12% absolute increase from an assumed 38% ongoing pregnancy rate in the placebo group, with an alpha error level of 0.05 and a beta error level of 0.2. RESULTS: There were 89 (31.2%) ongoing pregnancies in the GnRH agonist group, and 84 (29.5%) in the control group (absolute difference +1.7%, 95% confidence interval -5.8% to +9.2%). Implantation, clinical pregnancy and multiple pregnancy rates were likewise similar in the GnRH agonist and placebo groups. CONCLUSIONS: Single 0.1 mg triptorelin administration 6 days after ICSI following ovarian stimulation with the long GnRH agonist protocol does not seem to result in an increase >or=12% in ongoing pregnancy rates.     

Use of microdose GnRH agonist protocol in women with low ovarian volumes undergoing IVF

Ovarian volume measurements have been recently shown to be predictive of response to ovarian stimulation. Women with small ovarian volumes, i.e. <3 cm(3), have a higher incidence of cycle cancellation, together with a lower peak oestradiol concentration, lower number of retrieved oocytes, and lower pregnancy rates, compared with women with larger ovarian volumes. We prospectively investigated whether a higher dose, microdose flare gonadotrophin-releasing hormone (GnRH) agonist protocol, can improve IVF outcome in women with a small ovarian volume. Only the first IVF cycle was reviewed. In total, 109 women aged <40 years undergoing 109 cycles were prospectively evaluated. Women with an ovarian volume of < or =3 cm(3) noted on the day of luteal GnRH agonist administration had their stimulation regimen changed to a more aggressive microdose flare GnRH agonist protocol. In all, 30 women (27.5%) with an ovarian volume of <3 cm(3), and 79 women (72.5%) with an ovarian volume of >3 cm(3) were compared. Women with an ovarian volume of <3 cm(3) had a significantly higher incidence of unexplained infertility as their presenting aetiology, compared with women with a larger ovarian volume (33 and 8.6%, P = 0.0036). There was a significant negative correlation between age and ovarian volume, and between day 3 FSH concentration and ovarian volume. We also report a significant positive correlation between body mass index and ovarian volume. There was also a significant positive correlation between ovarian volume and the number of oocytes retrieved. Despite a trend towards higher day 3 FSH concentrations, a significantly longer duration of stimulation, higher gonadotrophin requirements, and lower oocyte yield, the implantation and pregnancy rates were comparable between the two groups. Women with a small ovarian volume noted at baseline ultrasound can have comparable implantation and pregnancy rates to those with larger ovarian volumes with the use of a higher dose gonadotrophin, microdose GnRH agonist stimulation.     

Marked variation in antiphospholipid antibodies during pregnancy: relationships to pregnancy outcome.

Variations in blood concentrations of antiphospholipid antibodies (APA) were investigated through the course of pregnancy in women who had a history of recurrent pregnancy loss, and were related to changes in pregnancy outcome. Serial measurements of APA were made in 16 women with antiphospholipid syndrome (APS) and 16 with negative APA tests pre-pregnancy. There was considerable intraindividual variation in test results through pregnancy. There was a significantly higher ratio of dilute Russell's viper venom time and IgG ACA titre in the first trimester compared with results pre-pregnancy in women with APS. Furthermore, transiently positive APA results were noted in the control group during pregnancy and some women with antiphospholipid syndrome tested negative for APA in mid- and late pregnancy. We have demonstrated clinically important variations in the results of tests for APA during pregnancy in women with APS.     

输卵管积水患者在胚胎解冻周期三种治疗方法的研究

目的探讨输卵管积水患者在胚胎解冻移植(FET)周期中的最佳治疗方案。方法对输卵管积水致不孕而接受体外受精-胚胎移植(IVF-ET)未妊娠而且有冷冻胚胎的患者91例,分为三组:A组,采用积水输卵管切除术30例;B组,采用体外短波治疗加经阴道抽吸输卵管积水31例;C组,仅采取体外短波治疗30例。比较患者FET的胚胎种植率、临床妊娠率、妊娠后的早期流产率和异位妊娠发生率。结果A组的胚胎种植率、临床妊娠率、早期流产率、异位妊娠发生率分别为14.8%,36.7%,18.2%,0。B组的分别为16.3%,38.7%,16.7%,8.3%。C组的分别为11.2%,26.7%,25%,12.5%。A,B组之间胚胎种植率、临床妊娠率、早期流产率的比较差异均无显著性,异位妊娠发生率的比较差异有显著性。A,B组与C组之间临床妊娠率、早期流产率的比较差异有显著性。结论输卵管积水患者在FET前行输卵管切除术或者用体外短波治疗加经阴道抽吸输卵管积水可以改善其FET结局。     

Oocyte and embryo quality after coasting: the experience from oocyte donation

BACKGROUND: Oocyte donation provides us with an opportunity to study the clinical outcome of oocytes, retrieved from women undergoing coasting, in recipients in whom endometrial receptivity is unaltered by the coasting procedure. Thus, our aim was to describe oocyte donation outcome in donors undergoing coasting, the oocyte and embryo quality obtained from these cycles, and to determine the influence of coasting duration in the cycle outcome. METHODS: Matched-paired analysis included 15 oocyte donors with high response to ovarian stimulation and submitted to coasting and 15 oocyte donors with normal response to ovarian stimulation and not undergoing coasting. There were 38 oocyte recipients who shared oocytes from the donors under coasting and 37 from donors not undergoing coasting. RESULTS: Both groups of donors were comparable in terms of days and dose of ovarian stimulation, oocytes retrieved, metaphase II oocytes obtained, and in the appearance of ovarian hyperstimulation syndrome. Both groups of oocyte recipients were comparable in male-associated factor, pregnancy and implantation rates, as well as in embryo quality. Recipients from donors with coasting for >4 days had significantly lower implantation and pregnancy rates. CONCLUSIONS: the outcome of oocyte donation from donors undergoing coasting is not impaired, as good implantation and pregnancy rates are achieved. Embryo quality, according to our current standards, does not seem to be compromised by coasting itself. However, if coasting in oocyte donors is prolonged for >4 days there is a significant decrease in both implantation and pregnancy rates.     

多囊卵巢综合征不孕患者体外受精与胚胎移植治疗结果分析

目的 分析多囊卵巢综合征(PCOS)不孕患者行体外受精与胚胎移植(IVF-ET)治疗的结果.方法 回顾性分析本中心同期完成IVF-ET的PCOS组74周期和盆腔卵管因素对照组657周期,比较两组治疗周期患者的促性腺激素(Gn)的使用总量和天数、获卵数、正常受精率、卵裂率、移植胚胎数、可利用胚胎率、种植率、基础血清性激素及超排卵中血清性激素水平以及妊娠和分娩结局.结果 基础血清激素中PCOS组促卵泡素(FSH)低于对照组[(5.74±1.74)U/L比(6.63±1.95)U/L];黄体生成素(LH)[(7.68±4.84)U/L比(4.76±2.61)U/L]、LH/FSH(1.38±0.88比0.75±0.42)、总睾酮(T)[(2.07±1.0)nmol/L比(1.54±0.60)nmol/L]高于对照组,差异有统计学意义(P<0.01);基础血催乳素(PRL)、雌二醇(E2)、Gn启动日FSH、LH、E2以及注射绒毛膜促性腺激素日LH、E2、孕酮差异无统计学意义(P>0.05).两组使用Gn的总量与天数、获卵数、正常受精率、卵裂率、平均移植胚胎数及可利用胚胎率差异无统计学意义(P>0.05);PCOS组的妊娠丢失率高于对照组(50%比20%),分娩率(46%比80%)及每周期的活产率(16%比30%)低于对照组,差异有统计学意义(P<0.05);两组生化妊娠率、临床妊娠率、种植率、多胎妊娠率、异位妊娠率及早产率差异无统计学意义(P>0.05).结论 IVF-ET是治疗PCOS不孕症的有效方法,但妊娠丢失率显著增高,应探讨其发生机制及更有效的方法改善妊娠结局.     

Non-homogeneous hyperechogenic pattern 3 days after embryo transfer is associated with lower pregnancy rates

The purpose of this study was to investigate the relationship between mid-luteal phase echo patterns and IVF-embryo transfer outcome in women who have demonstrated adequate endometrial development by the late proliferative phase. A prospective study was carried out of 86 patients undergoing IVF-embryo transfer and 86 patients undergoing frozen embryo transfer who all underwent sonographic monitoring of the endometrium 3 days after embryo transfer. The cycles were classified into two groups: those with the homogeneous hyperechogenic (HH) pattern and those without it. The women who had an HH pattern had higher clinical pregnancy (32.8 versus 10.7%, P < 0.05) and implantation rates in stimulated cycles (14.3 versus 4.1%, P < 0.05 respectively) than those that did not. There was no significant difference in the clinical pregnancy or implantation rates by echo pattern (18.2 and 8.1% for non-HH and 18. 7 and 8.0% for HH respectively) in frozen embryo transfer cycles. These data demonstrate that in embryo transfer cycles where ovarian stimulation was used, there were decreased pregnancy and implantation rates in cycles where the HH pattern was not observed 3 days after transfer. The failure of the endometrium to display this pattern may indicate some endometrial abnormality resulting in implantation defects.     

In-vitro fertilization outcome in women with hydrosalpinx

Recent studies have suggested that the presence of hydro-salpinxhas a negative effect on in-vitro fertilization (IVF) outcome,with markedly diminished implantation and pregnancy rates, andincreased early pregnancy loss. We evaluated the impact of hydrosalpinxon IVF outcome in a large population with tubal factor infertility:63 patients with hydrosalpinx and 60 without hydrosalpinx (nohydro-salpinx) underwent 103 and 89 IVF cycles respectively.Hydrosalpinx was diagnosed by hysterosalpingography and/or laparoscopyprior to IVF. Patients were further subdivided into those withor without elevated quantitative serum Chlamydia trachomatisIgG antibody (Ab) titres. All couples with elevated serum Abtitres (I: 16 or more) were treated with doxycycline (100 mgbid.) 10 days prior to the first IVF cycle. In all, 88 women(71.5%) had elevated C. trachomatis Ab: 47 women (74.6%) withhydrosalpinx had elevated titres, compared to 41 (683%) in theno hydrosalpinx group. There were no significant differencesin mean age, number of mature oocytes obtained, and number ofembryos transferred between the two groups. There was a trendfor a higher implantation rate and ongoing pregnancy rate inthe no hydrosalpinx group compared to the hydrosalpinx group(12.6 versus 9.8%, and 33.7 versus 24.8% respectively); however,this did not reach statistical significance. The incidence ofearly pregnancy loss was similar in the two groups. Two ectopicpregnancies were noted in the hydrosalpinx group compared tonone in the no hydrosalpinx group. As expected, the prevalenceof elevated titres of C. trachomatis IgG Ab in patients withtubal factor infertility presenting for assisted reproductivetreatment was high. In contrast to recently published reports,our study did not confirm a negative effect of hydrosalpinxon IVF outcome when antibiotic treatment was given prior toassisted reproductive treatment. Prospective multicentre studiesevaluating the effect of hydrosalpinx and its treatment on IVFoutcome are needed.