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Association between body mass index and in vitro fertilization/intra-cytoplasmic sperm injection outcomes: An analysis of 15,124 normal ovarian responders in China

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中华医学杂志(英文版) 2024年第7期137卷 837-845页

作者： Zheng Danlei Wang Yuanyuan Chen Lixue Zeng Lin Li Rong Department of Obstetrics and Gynecology Center for Reproductive Medicine Peking University Third Hospital Beijing 100191 China Research Center of Clinical Epidemiology

Background: High body mass index (BMI) results in decreased fecundity, and women with high BMI have reduced rates of clinical pregnancy and live birth inin vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI). Meanwhile, ovarian responses show great heterogeneity in patients with a high BMI. This study aimed to analyze the effects of a high BMI on IVF/ICSI outcomes in the Chinese female with normal ovarian response.Methods: We performed a retrospective cohort study comprising 15,124 patients from the medical record system of the Reproductive Center of Peking University Third Hospital, with 3530 (23.3%) in the overweight group and 1380 (9.1%) in the obese group, who had a normal ovarian response (5-15 oocytes retrieved) and underwent fresh embryo transfer (ET) cycles from January 2017 to December 2018, followed by linked frozen-thawed embryo transfer (FET) cycles from January 2017 to December 2020. Cumulative live birth rate (CLBR) was used as the primary outcome. Furthermore, a generalized additive model was applied to visually illustrate the curvilinear relationship between BMI and the outcomes. We used a decision tree to identify the specific population where high BMI had the greatest effect on IVF/ICSI outcomes.Results: High BMI was associated with poor IVF/ICSI outcomes, both in cumulative cycles and in separate fresh ET or FET cycles. In cumulative cycles, compared with the normal weight group, obesity was correlated with a lower positive pregnancy test rate (adjusted odds ratio [aOR]: 0.809, 95% confidence interval [CI]: 0.682-0.960), lower clinical pregnancy rate (aOR: 0.766, 95% CI: 0.646-0.907), lower live birth rate (aOR: 0.706, 95% CI: 0.595-0.838), higher cesarean section rate (aOR: 2.066, 95% CI: 1.533-2.785), and higher rate of large for gestational age (aOR: 2.273, 95% CI: 1.547-3.341). In the generalized additive model, we found that CLBR declined with increasing BMI, with 24 kg/m2 as an inflection point. In the decision tree, BMI only made a difference in the population aged ≤34.5 yea

关键词： Obesity Body mass index in vitro fertilization Live birth Decision trees Normal ovarian response

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Effect of Acupuncture on Endometrial Blood Flow in Women Undergoing in vitro fertilization Embryo Transfer: A Single Blind, Randomized Controlled Trial

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Chinese Journal of Integrative Medicine 2024年第1期30卷 10-17页

作者： DONG Hao-xu Wu Xiao ZHOU Qin HUANG Dong-mei ZHANG Ming-min HUANG Guang-ying YANG Wei Department of Integrated Traditional Chinese and Western Medicine Tongji HospitalHuazhong University of Science and TechnologyWuhan(430030)China Department of Obstetrics and Gynecoiogy Tongji HospitalHuazhong University of Science and TechnologyWuhan(430030)China Institute of Integrated Traditional Chinese and Western Medicine Tongji HospitalHuazhong University of Science and TechnologyWuhan(430030)China Department of Reproductive Medicine Tongji HospitalHuazhong University of Science and TechnologyWuhan(430030)China

Objective: To evaluate the effect of manual acupuncture on endometrial blood flow parameters by three-dimensional(3D) power Doppler ultrasound in women undergoing in vitro fertilization embryo transfer(IVF-ET). Methods: Seventy patients undergoing IVF-ET were equally randomized into traditional or sham acupuncture treatment group for totally 4 days(from the day of oocyte aspiration to the day of embryo transfer) of treatment by random envelope method at the Reproductive Medicine Center and Outpatient Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology from January 2013 to December 2015. Patients in the traditional acupuncture group accepted traditional acupuncture methods with manual acupuncture, and Zhongji(CV3), Qihai(CV 6), Sanyinjiao(SP6), Taichong(LR 3), Tianshu(ST 25), Guilai(ST 29) and Zusanli(ST 36) were chosen. Patients at the sham acupuncture group accepted shallow acupuncture methods at 4 non-meridian points at each shoulder and upper arm. Outcome measures included endometrial ultrasonic indices such as vascularization index(VI), flow index(FI) and vascularization flow index(VFI), endometrial thickness and volume, subendometrial VI(sVI), subendometrial FI(sFI), subendometrial VFI(sVFI), implantation rate, clinical pregnancy rate, abortion rate, live birth rate and number of live births. Results: Finally, 34 patients in the traditional acupuncture group and 35 in the sham acupuncture group completed this trial. VI, FI and VFI of the traditional acupuncture group were significantly higher than those in the sham acupuncture group(P0.05). Conclusions: Manual acupuncture performed after oocyte aspiration and before transplantation improved the endometrial blood flow parametersVI, RI and VFI in women

关键词： acupuncture endometrial blood flow endometrial receptivity in vitro fertilization randomized controlled trial

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Severe male factor in in vitro fertilization:definition,prevalence,and treatment.An update

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Asian Journal of Andrology 2022年第2期24卷 125-134页

作者： Rossella Mazzilli Alberto Vaiarelli Lisa Dovere Danilo Cimadomo NicolòUbaldi Susanna Ferrero Laura Rienzi Francesco Lombardo Andrea Lenzi Herman Tournaye Filippo Maria Ubaldi Clinica Valle Giulia GeneraLife IVF CentersVia G.De NotarisRome 2B 00197Italy Department of Clinical and Molecular Medicine University of Rome“Sapienza”Via di Grottarossa 1035Rome 00189Italy Catholic University of the Sacred Heart Via della Pineta Sacchetti 217Rome 00168Italy Department of Experimental Medicine “Sapienza”University of RomeViale del Policlinico 155Rome 00161Italy Centre for Reproductive Medicine Free University Brussels(UZ Brussel)Brussels 1090Belgium

Infertility affects 10%–15%of couples worldwide.Of all infertility cases,20%–70%are due to male factors.In the past,men with severe male factor(SMF)were considered sterile.Nevertheless,the development of intracytoplasmic sperm injection(ICSI)drastically modified this scenario.The advances in assisted reproductive technology(ART),specifically regarding surgical sperm retrieval procedures,allowed the efficacious treatment of these conditions.Yet,before undergoing ICSI,male factor infertility requires careful evaluation of clinical and lifestyle behavior together with medical treatment.Epidemiologically speaking,women whose male partner is azoospermic tend to be younger and with a better ovarian reserve.These couples,in fact,are proposed ART earlier in their life,and for this reason,their ovarian response after stimulation is generally good.Furthermore,in younger couples,azoospermia can be partially compensated by the efficient ovarian response,resulting in an acceptable fertility rate following in vitro fertilization(IVF)techniques.Conversely,when azoospermia is associated with a reduced ovarian reserve and/or advanced maternal age,the treatment becomes more challenging,with a consequent reduction in IVF outcomes.Nonetheless,azoospermia seems to impair neither the euploidy rate at the blastocyst stage nor the implantation of euploid blastocysts.Based on the current knowledge,the assessment of male infertility factors should involve:(1)evaluation–to diagnose and quantify seminologic alterations;(2)potentiality–to determine the real possibilities to improve sperm parameters and/or retrieve spermatozoa;(3)time–to consider the available“treatment window”,based on maternal age and ovarian reserve.This review represents an update of the definition,prevalence,causes,and treatment of SMF in a modern ART clinic.

关键词： azoospermia in vitro fertilization infertility intracytoplasmic sperm injection severe male factor sperm

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Modified strict sperm morphology threshold aids in the clinical selection of conventional in vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI)

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Asian Journal of Andrology 2022年第1期24卷 62-66页

作者： Yong Zhu Feng Zhang Hua Cheng Xiao-Xi Sun Feng Jiang Obstetrics and Gynecology Hospital Fudan UniversityShanghai 200011China Shanghai Ji Ai Genetics and IVF Institute Obstetrics and Gynecology HospitalFudan UniversityShanghai 200011China

For infertility treatment,the selection of in vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI)is decided by multiplying indicators(including fallopian tube factors,semen count,and semen motility),except for sperm morphology.In this study,we conducted a retrospective analysis,from implantation to birth,over a period of 5 years.A total of 1873 couples with primary or secondary fallopian tube factors and an increased defective sperm morphology rate(DSMR)were divided into different groups to receive IVF or ICSI cycles.By comparing the outcomes,we found that the F1 group(DSMR98%,IVF group 3;P98%,ICSI group 3)had higher cleavage rate(Pfertilization rate than the IVF subgroup(P<0.05).Our data suggest that the sperm morphology should also be considered when selecting IVF or ICSI combined with other semen parameters before the first assisted reproductive technologies(ART)cycle,especially for males with severe sperm defects.

关键词： clinical outcome in vitro fertilization intracytoplasmic sperm injection sperm morphology

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Improving the health and treatment success rates of in vitro fertilization patients with traditional Chinese medicine:Need for more robust evidence and innovative approaches

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Journal of Integrative Medicine 2022年第3期20卷 187-192页

作者： Marisa Casale School of Public Health University of the Western CapeRobert Sobukwe RoadBellville 7535South Africa

Maximising access to and the success of fertility treatments should be a priority for global reproductive health,as should overall patient well-being.The demand for in vitro fertilization(IVF)and other assisted fertility treatments has increased over the past decade and is likely to further increase in years to come.Nevertheless,there is still considerable unmet demand for infertility support worldwide.Moreover,the high emotional,physical and financial burden experienced by individuals undergoing IVF cycles can be a risk for their mental and physical health,which in turn can influence treatment continuation and the likelihood of IVF success.Studies from various parts of the world show that most individuals undergoing IVF also use adjunct alternative medicines and procedures,the most common being traditional Chinese medicine(TCM).The complementary and synergistic role of TCM for individuals undergoing IVF is an area that merits further attention and research,both for its potential positive effects on IVF success rates and for its broader physical and mental health benefits.However,much of the existing evidence is not sufficiently robust or consistent for findings to be adopted with confidence.This commentary argues that much work must be done to understand the efficacy and clinical best practices for these integrated approaches.This can be achieved in part by developing more robust and clinically relevant randomized controlled trial protocols,collecting and triangulating evidence through a variety of study designs and methods,and strengthening the collection and pooling of clinic-level data.

关键词： in vitro fertilization Traditional Chinese medicine Mental health Pregnancy rates

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Intramural pregnancy after in vitro fertilization and embryo transfer:A case report

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World Journal of Clinical Cases 2022年第9期10卷 2871-2877页

作者： Qi-Jun Xie Xin Li Dan-Yu Ni Hui Ji Chun Zhao Xiu-Feng Ling Department of Reproductive Medicine Nanjing Maternity and Child Health Care HospitalNanjing 210004Jiangsu ProvinceChina

BACKGROUND Intramural pregnancy is a rare type of ectopic pregnancy,which is diagnosed by transvaginal ultrasound and magnetic resonance imaging.Management strategies vary depending on the site of the pregnancy,the gestational age and the desire to maintain fertility.The incidence of intramural pregnancy in assisted reproductive technology is higher than that in natural pregnancy.CASE SUMMARY We present a case of intramural pregnancy after in vitro fertilization and elective single embryo transfer following salpingectomy.The patient was completely asymptomatic and her serumβ-human chorionic gonadotropin level increased from 290 m IU/m L to 1759 m IU/m L.Three-dimensional transvaginal ultrasound indicated a heterogeneous echogenic mass arising from the uterine fundus which was surrounded by myometrium and a slender and extremely hypoechoic area stretching to the uterine cavity which was thought to be a fistulous tract.Therefore,we considered a diagnosis of intramural pregnancy and laparoscopic surgery was conducted at 7 wk gestation.CONCLUSION Early diagnosis and treatment of intramural pregnancy is significant for maintaining fertility.

关键词： Intramural pregnancy in vitro fertilization Embryo transfer Transvaginal ultrasound Laparoscopic surgery Case report

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Real value oftheoocyteswith smooth endoplasmic reticulum aggregates in in vitro fertilization/intracytoplasmic sperm injection cycle: a retrospective cohort study

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Reproductive and Developmental Medicine 2023年第3期7卷 142-148页

作者： Zheng Zhang Xiao-Na Liu Ying Wang Xue-Yao Bai Tao Shangguan Hong-Mei Li Lin Zhu Yu-Yan Li Wei He Departments of Obstetrics and Gynecology Center of Reproductive medicineFirst Affiliated Hospital of Army Medical UniversityChongqingChina

objective:The management of oocytes affected by smooth endoplasmic reticulum aggregates(SERa)remains debatable.To understand how to manage SERa+oocytes and cycles,we performed a retrospective cohort study and analyzed the impact of SERa+cycles and oocytes on clinical and neonatal outcomes.Methods:We included 4856 cycles(149 SERa+and 4707 SERa-)from 4201 women(age:21-42 years)who received in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSl)treatments at the Center of Reproductive Medicine,First Affliated Hospital of Army Military University,from 2016 to 2019.SERa+cycles had at least one SERa oocyte in the oocyte cohort.All 1722 oocytes in the SERa+cycle were divided into SERa+(405)and SERa-(1317)oocytes.Results:The rates of two pronuclei(2PN)and high-quality embryos were lower in SERa+cycles than in SERa-cycles,regardless of IVF or ICSI(P0.05).conclusion:Normal fertilization with SERa+cycles and oocytes was substantially reduced,regardless of the insemination method.Embryos originating from SERa+oocytes can be transferred when there are no other options,but fully informed consent and strict follow-up of fetal development are mandatory.

关键词： Smooth endoplasmic reticulum aggregates in vitro fertilization Intracytoplasmic sperm injection Outcome

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Ectopic pregnancy and failed oocyte retrieval during in vitro fertilization stimulation:Two case reports

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World Journal of Clinical Cases 2022年第28期10卷 10310-10316页

作者： Wen-Jie Zhou Bu-Fang Xu Zhi-Hong Niu Department of Obstetrics and Gynecology Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China

BACKGROUND Due to a slight rise in beta-human chorionic(β-h CG)levels that are undetectable,and vaginal bleeding that is similar to regular menstruation,ectopic pregnancy(EP)that occurs during the expected menstrual cycle prior to ovulation induction as part of in vitro fertilization(IVF)is likely to be undiagnosed.We present two cases of unexpected EP and emphasize the importance of theβ-h CG assay when an unexplained increase in progesterone is present prior to the triggering of ovulation during controlled ovarian stimulation(COS).CASE SUMMARY A 26-year-old woman with primary infertility and a 31-year-old woman with secondary infertility.Both patients sought IVF treatment due to fallopian tube obstruction and underwent COS using the gonadotropin-releasing-hormone(Gn RH)-antagonist protocol.In the late stage of COS,progesterone levels in both patients significantly increased,and luteinizing hormone levels decreased,followed by oocyte retrieval failure.A right salpingectomy was performed and tubal ectopic pregnancy was diagnosed by pathology in the first patient,and the second patients was diagnosed with a suspected EP abortion because herβ-h CG levels declined to 12.5 m IU/m L.After full recovery for 2 mo,the first patient entered a new IVF treatment cycle with a Gn RH-antagonist regimen and successfully achieved eight oocytes and three viable embryos.After 6 mo,the second patient received another COS treatment with a progestin-primed ovarian stimulation protocol and successfully achieved nine oocytes and five viable embryos.CONCLUSIONβ-h CG levels in the initial and midterm phases of COS must be considered in patients with unusual hormone dynamics.

关键词： Infertility Ectopic pregnancy in vitro fertilization Ovarian induction Case report

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The barriers of joining in vitro fertilization programs among infertile couples in developing countries:A scoping review

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Asian pacific Journal of Reproduction 2023年第4期12卷 147-154,I0001-I0003页

作者： Andriana K Dewi Anggi L Wicaksana Muhammad Lutfi Agung Dewanto Department of Obstetrics and Gynecology FK-KMK Universitas Gadjah MadaYogyakartaIndonesia Faculty of Medicine Universitas TarumanagaraJakartaIndonesia Department of Medical Surgical Nursing FK-KMK Universitas Gadjah MadaYogyakartaIndonesia

Objective:To determine the barriers of joining in-vitro fertilization(IVF)programs among infertile couples in developing countries.Methods:This study assessed infertile couples and the barriers or associated factors resulting in delayed decision-making of joining IVF program by searching databases PubMed,ScienceDirect,EBSCO,ClinicalKey,and Cochrane Library from inception until December 31,2021.Additional search strategies were snowballing literature search and citation tracking.Results:Eleven articles were included in the scoping review.The cost was the greatest barrier of joining IVF program.Limited access and lack of assisted reproductive technology centers,few qualified infertility trained staff,insufficient government support,low priority in government policy,along with sociocultural factors,such as religion and false beliefs or myths were also majorly considered to be associated obstacles.Conclusions:The main barrier associated with IVF program among infertile couples in developing countries is the high cost of the IVF services.

关键词： in vitro fertilization Assisted reproductive technology Barrier Developing countries

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Live births from in vitro fertilization-embryo transfer following the administration of gonadotropin-releasing hormone agonist without gonadotropins:Two case reports

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World Journal of Clinical Cases 2023年第9期11卷 2067-2073页

作者： Mai Li Ping Su Li-Ming Zhou Reproductive Center Ningbo Women and Children’s HospitalNingbo 315000Zhejiang ProvinceChina Reproductive Center Institution of Reproductive HealthTongji Medical CollegeWuhan 430030Hubei ProvinceChina

BACKGROUND The prevalence of female infertility between the ages of 25 and 44 is 3.5%to 16.7%in developed countries and 6.9%to 9.3%in developing countries.This means that infertility affects one in six couples and is recognized by the World Health Organization as the fifth most serious global disability.The International Committee for Monitoring Assisted Reproductive Technology reported that the global total of babies born as a result of assisted reproductive technology procedures and other advanced fertility treatments is more than 8 million.Advancements in controlled ovarian hyperstimulation procedures led to crucial accomplishments in human fertility treatments.The European Society for Human Reproduction and Embryology guideline on ovarian stimulation gave us valuable evidence-based recommendations to optimize ovarian stimulation in assisted reproductive technology.Conventional ovarian stimulation protocols for in vitro fertilization(IVF)–embryo transfer are based upon the administration of gonadotropins combined with gonadotropin-releasing hormone(GnRH)analogues,either GnRH agonists(GnRHa)or antagonists.The development of ovarian cysts requires the combination of GnRHa and gonadotropins for controlled ovarian hyperstimulation.However,in rare cases patients may develop an ovarian hyper response after administration of GnRHa alone.CASE SUMMARY Here,two case studies were conducted.In the first case,a 33-year-old female diagnosed with polycystic ovary syndrome presented for her first IVF cycle at our reproductive center.Fourteen days after triptorelin acetate was administrated(day 18 of her menstrual cycle),bilateral ovaries presented polycystic manifestations.The patient was given 5000 IU of human chorionic gonadotropin.Twenty-two oocytes were obtained,and eight embryos formed.Two blastospheres were transferred in the frozen-thawed embryo transfer cycle,and the patient was impregnated.In the second case,a 37-year-old woman presented to the reproductive center for her first donor IVF cycle.Fourteen days after GnR

关键词： Gonadotropin-releasing hormone agonist Ovarian hyperstimulation in vitro fertilization Live birth Infertility Frozen-thawed embryo transfer Human chorionic gonadotropin Case report

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