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Successful live birth following hysteroscopic adhesiolysis under laparoscopic observation for Asherman’s syndrome: A case report

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World Journal of Clinical Cases 2022年第32期10卷 11949-11954页

作者： Toshiyuki Kakinuma Kaoru Kakinuma Yoshio Matsuda Michitaka Ohwada Kaoru Yanagida Department of Obstetrics and Gynecology International University of Health and Welfare HospitalNasushiobara-City 329-2763TochigiJapan

BACKGROUND Asherman’s syndrome is characterized by reduced menstrual volume and adhesions within the uterine cavity and cervix,resulting in inability to carry a pregnancy to term,placental malformation,or infertility.We present the case of a 40-year-old woman diagnosed with Asherman’s syndrome who successfully gave birth to a live full-term neonate after hysteroscopic adhesiolysis under laparoscopic observation,intrauterine device insertion,and Kaufmann therapy.CASE SUMMARY A 40-year-old woman(Gravida 3,Para 0)arrived at our hospital for specialist care to carry her pregnancy to term.She had previously undergone six sessions of dilation and curettage owing to a hydatidiform mole and persistent trophoblastic disease,followed by chemotherapy.She subsequently became pregnant twice,but both pregnancies resulted in spontaneous miscarriages during the first trimester.Her menstrual periods were very light and of short duration.Hysteroscopic adhesiolysis with concurrent laparoscopy was performed,and Asherman’s syndrome was diagnosed.The uterine adhesions covered the area from the internal cervical os to the uterine fundus.Postoperative Kaufmann therapy was administered,and endometrial regeneration was confirmed using hysteroscopy.She became pregnant 9 mo postoperatively and delivered through elective cesarean section at 37 wk of gestation.The postpartum course was uneventful,and she was discharged on postoperative day 7.CONCLUSION Hysteroscopic adhesiolysis with concurrent laparoscopy enables identification and resection of the affected area and safe and accurate surgery,without complications.

关键词： Hysteroscopic surgery Laparoscopy Intrauterine devices live birth Pregnancy Case report

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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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Use of a male antioxidant nutraceutical is associated with superior live birth rates during IVF treatment

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Asian Journal of Andrology 2021年第1期23卷 16-23页

作者： Kelton Tremellen Richard Woodman Amy Hill Helana Shehadeh Michelle Lane Deirdre Zander-Fox Repromed 180 Fullarton Road DulwichSouth Australia 5065Australia Department of Obstetrics Gynaecology and Reproductive Medicine Flinders UniversityBedford ParkSouth Australia 5042Australia Flinders Centre for Epidemiology and Biostatistics College of Medicine and Public HealthFlinders UniversityBedford ParkSouth Australia 5042Australia Robinson Research Institute University of AdelaideAdelaideSouth Australia 5000Australia Future Industries Institute University of South AustraliaAdelaideSouth Australia 5000Australia

Oxidative stress is prevalent among infertile men and is a significant cause of sperm DNA damage.Since sperm DNA damage may reduce embryo quality and increase miscarriage rates,it is possible that untreated sperm oxidative stress may impair in vitro fertilization(IVF)live birth rates.Given that the antioxidant Menevit is reported to reduce sperm DNA damage,it was hypothesized that men’s consumption of this supplement may alter IVF outcomes.Therefore,a retrospective cohort study was conducted analyzing outcomes for couples undergoing their first fresh embryo transfer.Men were classified as controls if they were taking no supplements,health conscious controls if taking“general health”supplements,or Menevit users.Men with karyotype abnormalities,or cycles using donated,frozen and surgically extracted sperm were excluded.Among the final study cohort of 657 men,live birth rates were significantly higher in Menevit users than controls(multivariate adjusted odds ratio[OR]:1.57,95%confidence interval[Cl]:1.01-2.45,P=0.046),but not between controls taking no supplements and those using general health supplements,thereby suggesting that potential health conscious behavior in supplement users is unlikely responsible for the superior outcomes in Menevit users.Interestingly,in a post hoc sensitivity analysis,live birth rates among Menevit users were statistically superior to controls for lean men(OR:2.73,95%Cl:1.18-6.28;P=0.019),not their overweight/obese counterparts(OR:1.29,95%Cl:0.75-2.22,P=0.37).The results of this large cohort study therefore support a positive association between men’s use of the Menevit antioxidant during IVF treatment and live birth rates,especially in lean individuals.

关键词： antioxidant body mass index in vitro fertilization live birth oxidative stress sperm

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Does Lower Dose of Long-acting Triptorelin Maintain Pituitary Suppression and Produce Good live birth Rate in Long Down-regulation Protocol for In-vitro Fertilization?

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2016年第2期36卷 215-220页

作者：陈薪冯淑娴郭萍萍何于夏刘玉东叶德盛陈士岭 Center for Reproductive Medicine Department of Gynecology and ObstetricsNanfang HospitalSouthern Medical University

The effects of pituitary suppression with one-third depot of long-acting gonadotropin-releasing hormone（Gn RH） agonist in Gn RH agonist long protocol for in vitro fertilization（IVF）/intracytoplasmic sperm injection（ICSI） were investigated. A retrospective cohort study was performed on 3186 cycles undergoing IVF/ICSI with Gn RH agonist long protocol in a university-affiliated infertility center. The pituitary was suppressed with depot triptorelin of 1.25 mg or 1.875 mg. There was no significant difference in live birth rate between 1.25 mg triptorelin group and 1.875 mg triptorelin group（41.2% vs. 43.7%）. The mean luteinizing hormone（LH） level on follicle-stimulating hormone（FSH） starting day was significantly higher in 1.25 mg triptorelin group. The mean LH level on the day of human chorionic gonadotrophin（h CG） administration was slightly but statistically higher in 1.25 mg triptorelin group. There was no significant difference in the total FSH dose between the two groups. The number of retrieved oocytes was slightly but statistically less in 1.25 mg triptorelin group than in 1.875 mg triptorelin group（12.90±5.82 vs. 13.52±6.97）. There was no significant difference in clinical pregnancy rate between the two groups（50.5% vs. 54.5%）. It was suggested that one-third depot triptorelin can achieve satisfactory pituitary suppression and produce good live birth rates in a long protocol for IVF/ICSI.

关键词： in vitro fertilization gonadotropin-releasing hormone agonist one-third dose pituitary suppression live birth

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Predicting a live birth by artificial intelligence incorporating both the blastocyst image and conventional embryo evaluation parameters

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Artificial Intelligence in Medical Imaging 2020年第3期1卷 94-107页

作者： Yasunari Miyagi Toshihiro Habara Rei Hirata Nobuyoshi Hayashi Department of Artificial Intelligence Medical Data LaboOkayama 703-8267Japan Department of Gynecologic Oncology Saitama Medical University International Medical CenterHidaka 350-1298SaitamaJapan Department of Reproduction Okayama Couples'ClinicOkayama 701-1152Japan

BACKGROUND The achievement of live birth is the goal of assisted reproductive technology in reproductive medicine.When the selected blastocyst is transferred to the uterus,the degree of implantation of the blastocyst is evaluated by microscopic inspection,and the result is only about 30%-40%,and the method of predicting live birth from the blastocyst image is unknown.live births correlate with several clinical conventional embryo evaluation parameters(CEE),such as maternal age.Therefore,it is necessary to develop artificial intelligence(AI)that combines blastocyst images and CEE to predict live births.AIM To develop an AI classifier for blastocyst images and CEE to predict the probability of achieving a live birth.METHODS A total of 5691 images of blastocysts on the fifth day after oocyte retrieval obtained from consecutive patients from January 2009 to April 2017 with fully deidentified data were retrospectively enrolled with explanations to patients and a website containing additional information with an opt-out option.We have developed a system in which the original architecture of the deep learning neural network is used to predict the probability of live birth from a blastocyst image and CEE.RESULTS The live birth rate was 0.387(=1587/4104 cases).The number of independent clinical information for predicting live birth is 10,which significantly avoids multicollinearity.A single AI classifier is composed of ten layers of convolutional neural networks,and each elementwise layer of ten factors is developed and obtained with 42792 as the number of training data points and 0.001 as the L2 regularization value.The accuracy,sensitivity,specificity,negative predictive value,positive predictive value,Youden J index,and area under the curve values for predicting live birth are 0.743,0.638,0.789,0.831,0.573,0.427,and 0.740,respectively.The optimal cut-off point of the receiver operator characteristic curve is 0.207.CONCLUSION AI classifiers have the potential of predicting live births that humans cannot predict.Artifici

关键词： Artificial intelligence Blastocyst Deep learning live birth Machine learning Neural network

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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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Source of human oocytes for infertility treatment and fertility preservation

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Reproductive and Developmental Medicine 2022年第1期6卷 6-12页

作者： Ri-Cheng Chian Center for Reproductive Medicine Shanghai 10th People's Hospital of Tongji UniversityShanghai 200072China

The source of human oocytes is directly associated with the success of infertility treatment and fertility preservation. The number of oocytes obtained is possibly correlated with the success rate in terms of live birth rates. However, oocyte quality must be refined such that the number of oocytes is not positively correlated with the quality of oocytes. Different ovarian stimulation protocols can be used to obtain numerous oocytes. However, oocyte quality should be considered the most important factor affecting infertility treatment and fertility preservation. Infertile women are generally willing to take health-related risks to achieve a live birth, and ovarian stimulation using high-dose hormonal treatments may be harmful for both women and infants. Therefore, successful infertility treatment and fertility preservation should be defined as the birth of a healthy baby at term without compromising the health and safety of the mother and infant. Therefore, the source of high-quality oocytes must be carefully considered prior to infertility treatment and fertility preservation.

关键词： Oocytes In fertility Fertility preservation Ovarian stimulation live birth

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A 12-month prospective survey of perinatal outcome of liveborn neonates in Julu County, China

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Chinese Medical Journal 2010年第20期123卷 2781-2785页

作者： MA Li LIU Cui-qing ZHENG Xiu-ling XIN Shen-fang JI Zeng-liang LI Ya-mei YAN Guo-ping TIAN Chao-fang TANG Long-mei SUN Bo Department of Pediatrics Children's Hospital of Fudan UniversityShanghai 201012China Department of Neonatology Hebei Provincial Children's HospitalShijiazhuangHebei 050031China Departments of Obstetrics and Pediatrics Julu County HospitalJuluHebei 055250China Departments of Obstetrics and Pediatrics Julu Women and Children's Health CenterJuluHebei 055250China Julu County Hospital for Traditional Chinese Medicine JuluHebei 055250China Department of Statistics Hebei Medical UniversityShijiazhuangHebei 050000China

Background Population based epidemiologic study on the main diseases and birth status of liveborn neonates remains scarce in China, especially in rural areas where a large number of neonates are born. The aim of this study was to establish an epidemiological basis of live births in Julu County, a representative of the northern and mid-western parts of China in terms of demography, disease pattern and women and children＇s health care infrastructure.Methods The perinatal data of all live births were prospectively collected in three participating county-level hospitals from September 1, 2007 to August 30, 2008.Results There were 5822 live births in these hospitals. Among all live births, 53.7% were male and 4.5% were bornprematurely. Mean （SD） birth weight （BW） was （3348±503） g. The low （〈2500 g） and very low BW （〈1500 g） infants accounted for 3.8% and 0.5% of the total births, with 6.5% as small for gestational age and 2.8% as multi-births.Cesarean section rate was 30.2%, of which 68.6% were elective. There were 745 infants （12.8% of the live births）admitted to local neonatal wards within 7 days of postnatal life, in which 48.3% and 19.3% were due to perinatal asphyxia and prematurity, respectively. The incidences of perinatal aspiration syndrome, transient tachypnea and respiratory distress syndrome were 4.9%, 0.6% and 0.5%, respectively. Neonatal mortality was 7.6%. （44/5822）, with 16 in delivery room and 28 in neonatal ward before discharge.Conclusions This study provided a population-based perinatal data of live births and neonatal mortality in a northern China county with limited resources. Neonatal disorders related to perinatal asphyxia remain a serious clinical problem,which calls for sustained education of advanced neonatal resuscitation and improvement in the quality of perinatal-neonatal care.

关键词： live birth acute respiratory disorders mortality epidemiology

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Comparison of the Developmental Potential and Clinical Results of In Vivo Matured Oocytes Cryopreserved with Different Vitrification Media

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Chinese Medical Journal 2015年第22期128卷 3029-3034页

作者： Mei Li Miao-Miao Wang Hui Liu Ke-Liang Wu Shui-Ying Ma Cheng Li Hai-Bin Zhao Zi-Jiang Chen Center for Reproductive Medicine Provincial Hospital Affiliated to Shandong University National Research Center for Assisted Reproductive Technology andReproductive Genetics Key Laboratory for Reproductive Endocrinology of Ministry of EducatLon Shandong Provincial Key Laboratory of Reproductive Medicine Jinan Shandong 250021 China

Background： Oocyte vitrification is widely used throughout the world, but its clinical efficacy is inconsistent and depends on the vitrification media. This study compared the developmental potential and clinical results of in vivo matured oocytes cryopreserved with different vitrification media. Methods： This retrospective study involved vitrified-warmed oocytes at one in vitro fertilization laboratory. Vitrification media kits comprised the MC kit （ethylene glycol （EG] plus 1,2-propanediol [PROH]）, the KT kit （EG plus dimethyl sulphoxide [DMSO]）, and the Modified kit （EG plus DMSO and PROH kit）. Rates of oocyte survival and subsequent developmental potential were recorded and analyzed. The t-test and the Chi-square test were used to evaluate each method＇s efficacy. Results： Oocyte survival rate was significantly higher for the Modified kit （92.0%） than for the MC kit （88.2%）（P 〈 0.05） and the KT kit （77.3%）（P 〈 0.001）. The rate of high-quality embryo development in the Modified kit group （35.8%） was significantly higher than in the MC kit group （29.0%） and the KT kit group （28.3%）（P 〈 0.001 ）. No significant differences were observed in the clinical pregnancy and implantation rates among the MC, KT, and Modified kit groups （37.2% vs. 30.2% vs. 39.6%; 21.9% vs. 18.8% vs. 27.4%, respectively）（P 〉 0.05）. The high-quality embryo rate per warmed oocyte was significantly higher （23.4%） in the Modified kit group than in the other groups （P 〈 0.001）. The embryo utilization and live birth rates per warmed oocyte were the highest in the Modified kit group, but not significantly （P 〉 0.05）. Conclusions： Modified vitrification media are efficient for oocyte vitrification and. with further verification, may be able to replace commercially available media in future clinical applications.

关键词： Fertilization live birth Oocytes Pregnancy Vitrification Media

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