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Journal of Reproduction and Contraception 2015年第3期26卷 141-150页

作者： Hui KE Li-zheng YAN Reproductive Medicine Center Affiliated Hospital of Hainan Medical College

Objective To explore the predictive factors for clinical pregnancies of poor responders diagnosed according to the Bologna criteria in ovarian stimulation in vitro fertilization （ivf） .Methods The present study included 392 poor responders diagnosed according to the Bologna criteria （392 first poor response cycles and 247 subsequent conventional stimulation cycles） in our ivf center. Binary Logistic regression analysis was used to study the association between possible predictive factors and clinical pregnancy of poor responders in ovarian stimulation ivf.Results The significant predictive factors for clinical pregnancies of poor responders in ovarian stimulation ivf were female age, number of embryos transferred and ovarian stimulation protocol. Female age had the best predictive value for clinical pregnancy of poor ovarian responders.Conclusion Poor responders should be encouraged to attempt Jurther ovarian stimulation ivf treatment as soon as possible because the pregnancy rate decreases with advancing female age. Growth hormone supplementation, intracytoplasmic sperm injection （ICSI） procedure or assisted hatching seem not be able to prominently improve the pregnancy outcomes of poor responders diagnosed according to the Bologna criteria in ovarian stimulation ivf.

关键词： in vitro fertilization （ivf） Bologna criteria poor responders clinical pregnancy

A preliminary observation on efficacy of growth hormone on poor ovarian responders in ivf/ICSI cycles

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Journal of Reproduction and Contraception 2016年第1期27卷 12-17页

作者： Jian-ping OU Wei-jie XING Tao LI Jie-ru ZHU Wei-jie ZHU Center for Reproductive Medicine the Third Affiliated Hospital of Sun Yat-sen University Department of Developmental and Regenerative Biology College of Life Science and Technology Jinan University

Objective To determine efficacy of gonadotropin （Gn） co-treated with growth hormone （GH） on poor ovarian response （POR） patients undergoing in vitro fertiliza- tion/intracytoplasmic sperm injection （1VF/ICSI）. Methods A total of 58 ivf/ICSI-embryo transfer （ET） cycles in POR patients were retrospectively identified. The POR criteria were defined by Bologna consensus. The cycles were divided into two groups： Gn co-treated with GH group （GH~ group, 25 cycles） and Gn only group （GH- group, 33 cycles）. Results of lVF/ICSI for these two groups were compared. Results The number of oocyte retrieved and the normal fertilization rate in the two groups were no difference （P〉O.05）. High-quality embryo rate and implantation rate in the GH＋ group were 39.6% and 38.5%, respectively, which were slightly higher than those in the GH group （35.9% and 25.0%）, but no difference was found on these two parameters （P〉0. 05）. Conclusion GH, to some extent, can improve the quality of embryo and the implantation rate. Whether GH co-therapy has a definite role in improving the outcome of POR patients still needs further evaluation.

关键词： growth hormone （GH） poor ovarian response （POR） in vitro fertilization （ivf） intracytoplasmic sperm injection （ICSI）

Reproductive Challenges in Young Female Cancer Patients

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Journal of Reproduction and Contraception 2014年第4期25卷 241-257页

作者： Ibrahim I BOLAJI Arabinda Saha Ka yan Shirley SZE Department of Obstetrics and Gynaecology DianaPrincess of Wales HospitalNLG Foundation NHS TrustHull York Medical School

The last three decades have seen a significant improvement and advancement in both the diagnostic and therapeutic modalities with improved surgical technique, chemoradio and supportive therapy in cancer treatment. This has produced a correspondingly increase in the 5-year relative survival rate for many cancers and for all races. However, the chemo-radiotherapy which is often gonadotoxic, has a substantial impact on quality of life issues especially that of reproduction in young female patients on account of increasing survival rates and delayed childbearing in the western hemisphere. This case based discussion paper using two real life case scenarios from our department focuses on the negative impact of cancer treatments on fertility and various options available for fertility preservation and / or fertility preservation measures. It is concluded that a lot of variables have to be considered when deciding upon fertility preservation treatments including patient＇s age, cancer stage, proposed treatment regime and time before it is initiated, availability of partner sperm and issues of individual patients. The latter include surgical complications, ovarian hyperstimu-lation syndrome, delay in cancer treatment and reintroduction of cancer cells, cost, low success rates and experimental nature of these treatments and the disposition of gametes in the event that the patient does not survive her cancer. It is very important for physician to advise patients of all these factors so that they can make an informed decision regarding the fertility preservation options and each case is unique and requires a different strategy of fertility preservation.

关键词： fertility preservation chemotherapy radiotherapy in vitro fertilization （ivf） cryopreservation cancer treatment in young females

Effects of Growth Hormone Supplementation in Patients Undergoing ivf/ICSI-ET with Poor Ovarian Response to Gonadotropin

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Journal of Reproduction and Contraception 2014年第1期25卷 32-40页

作者： Zhi-ping HU Ying WANG Xiao-guo DU Rong LI Xin-na CHEN Hai-yan WANG Ping LIU Cai-hong MA Jie QIAO Reproductive Medical Center Peking University Third Hospital

Objective To analyze the effects of growth hormone （GH） supplementation during ivf/ ICSI-ET in Chinese patients who had prior ivf cycle with poor response to gonadot- ropin （Gn）. Methods Ovulation was stimulated in 389 consecutive patients who all had poor ovarian response, among them, 102 patients （GH cycle） received 4 IU GH and the other 287 patients （non-GH cycle） underwent ivf without GH. Fisher＇s exact test, Chi square test and Student＇s t-test were used to analyze ivf/ICSI-ET outcomes. Results After GH treatment, 102 patients had significantly more large- and medium- sized follicles, oocytes retrieved, 2 pronucleus oocytes, metaphase H stage （M^I） oocytes, and high-quality embryos than in previous cycles without GH. However, the number of embryos transferred, clinical pregnancy rate, transfer rate and biochemical pregnancy rate were not significantly different. Furthermore, the 102 patients given GH had significantly lower luteinizing hormone levels and biochemical pregnancy rates; thicker endometrium and more Gn administration days; and more large- and medium-sized follicles and M^I oocytes than 287 other patients undergoing ivf/ICSI-ET without GH. However, these groups did not differ significantly in clinical pregnancies, high-quality embryos, Mn oocytes, and embryo implantation rates. Conclusion GH may improve some ivf/ICSI-ET outcomes for women with poor ovarian response.

关键词： assisted reproductive technology （ART） growth factor in vitro fertilization （ivf） superovulation

Revised Super-long Down-regulation Protocol Improves the Outcome of Infertile Patients with Repeated Implantation Failure in ivf/ICSI-ET

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Journal of Reproduction and Contraception 2014年第2期25卷 89-96页

作者： Min-feng SHI Tie ZHOU Ying WANG Guang-hua CHEN Ming ZHU Jun OU Hui DU Tao-fei YAN Di SONG Ju-fen ZHENG Hui-qin ZHANG Ning HUI Ying-hao SUN Reproductive Centre Changhai Hospital the Second Military Medical University Department of Urology Changhai Hospital the Second Military Medical University

Objective To investigate the outcome of revised super-long down-regulation protocol （RSDP） for in vitro fertilization / intracytoplasmic sperm injection-embryo transfer （1VF/1CS1-ET） in the special infertile patients with repeated implantation failure （RIF）. Methods Patients with RIF were divided into RSDP group and routine long downregulation protocol （RLDP） group. In RSDP group, gonadotropin releasing hormone agonist （GnRHa） was injected intramuscularly by 2.5 mg in mid-luteal phase for the ftrst time and 1.25 mg after 28 d; gonadotropin （Gn） was started 14 d later after the second GnRHa dose. ivf/ICSI-ET was performed according to the routine procedure. The clinical outcomes of RSDP group were compared with those of RLDP group. Results In RSDP group, the number of retrieved oocytes and valid embryos was significantly lower （P〈0.05）; there were no significant differences about fertilization rate （P〉0. 05）; both good-quality embryo rate and implantation rate were significantly increased （P〈0. 005）; clinical pregnancy rate was obviously improved （P〈0. 05）, as compared with RLDP group.Conclusion RSDP can improve the ivf outcomes significantly in RIF patients.

关键词： implantation failure revised super-long down-regulation protocol （RSDP） routine long protocol in vitro fertilization （ivf）

Outcome of the ivf for the Patients with Endometrioma Associated Infertility

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Journal of Reproduction and Contraception 2009年第1期20卷 19-26页

作者： Yan-hong MAO Chun ZHOU Annie Zaccabri Gynecology-Obstetrical Service Zhongnan Hospital Wuhan 430071 China PMA Maternite Regional de Nancy France

Objective To evaluate the ovarian response to the gonadotrophin （Gn） in the COH and observe the outcome of lVF for the patients with endometriomas. Methods A retrospective analysis of 32 patients with endometrioma undergoing ivfET. It included 71 cycles, and 59 cycles in 32 patients with tubal factor associated infertility were as the control. Results There were statistically significant differences between the two groups in the cancelling rate （P〈0.01）, the E： concentration in the day of hCG injection （P〈0.05）, retrieval eggs（P〈0.001）, rate of fertilization （P〈0.05）, rate of cleavage （P〈0.05）, obtained embryos （P〈0. 001）. There were no statistically significant differences in the clinical pregnancy rate, implantation rate and delivery rate, P all〉0.05. Conclusion The patients with endometriomas had a poor response to the Gn in the COH. The endometrial accessibility in patients with endometriomas seemed not to be affected by the presence of endometriomas. But considering the higher cancelling rate, the prognostic for the patients with endometriomas was worth than the patients with tubal factor associated infertility.

关键词： endometriosis endometrioma infertility in vitro fertilization （ivf）

Endometrial Collagen Fibril Hyperplasia is Associated with Implantation Failure in Women Undergoing ivf-ET

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Journal of Reproduction and Contraception 2009年第3期20卷 131-144页

作者： Min-zhi GAO Mei-zhen XIN Xiao-ming ZHAO Zhong ZHENG Yan HONG Yun SUN Hui-qin ZHANG Department of Reproductive Medicine Renji Hospital School of Medicine Shanghai Jiaotong University Shanghai 200001 China Shanghai Medical College of Fudan University Shanghai 200032 China Staff Room of Pathology School of Medicine Shanghai Jiaotong University Shanghai 200025 China

Objective To analyse the effects of controlled ovarian hyperstimulation （ COH） on the endometrial expression of collagen fibril （CF） during the peri-implantation period in patients undergoing ivf, and its relation to endometrial receptivity （ER） in repeated implantation failure（RIF）. Methods Peripheral blood and endometrial biopsies were obtained from 45 infertile women on days 5, 7 or 9 after oocytes retrieval or ovulation in a stimulated cycle （SC） and natural cycle （NC） respectively. CF was assayed by transmission electron microscope and quantified by modified Masson dyeing. The outcome of subsequent embryo transfer（ET） was observed. Results Levels of both E2 and progesterone were higher in the peripheral blood in SC than in NC. Also the expression of CF in the stroma in each secretory phase was increased significantly in SC （P 〈O.05）. After embryo transferring, expression levels of CF in the pregnancy group dropped between the mid- and late-secretory phase, but no change in the non-pregnancy group. In the same term, all patients undergone endometrial curettage had higher pregnancy rate than those without. Conclusion Imbalance of production and degradation of endometrial CF in the secretory phase resulting from COH may be the cause of defective ER and implantation failure in some RIF patients. Endometrial curettage may improve implantation rate by inducing appropriate CF hyperplasia and degradation.

关键词： controlled ovarian hyperstimulation （COH） endometrial receptivity collagen fibril repeated implantation failure （RIF） in vitro fertilization （ivf）

Comparison of the Effects and Safety of Mild Ovarian Stimulation and Conventional Ovarian Stimulation with A Long GnRH Agonist Protocol on ivf Outcomes

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Journal of Reproduction and Contraception 2013年第3期24卷 159-172页

作者： Rong-rong TAN Dan-hua PU Jia-yin LIU Jie WU State Key Laboratory of Reproductive Medicine Department of Obstetrics and Gynecologythe First Affiliated Hospital of Nanjing Medical University

Objective To conduct a Meta-analysis of studies that compared the efficacies of mild ovarian stimulation and conventional long GnRH agonist protocol in patients under- going ivf or intracytoplasmic sperm injection （ICSI）. Methods Meta-analysis was performed. All studies were published by July 2012 with data related to outcomes following mild ovarian stimulation compared with the conventional protocol. Odds ratios （ORs） and weighted/standardized mean difference （WMD/SMD） from individual study were pooled in fixed and random effect models. Main outcome measure was the efficacy of mild ovarian stimulation. Results Six articles were included in this Meta-analysis. The number of oocytes retrieved was lower, the cycle cancellation rate was higher and the incidence of ovarian hyperstimulation syndrome （OHSS） was lower in the mild stimulation group than in conventional ovarian stimulation group. Clinical pregnancy rates were similar in both mild and conventional stimulation groups. Conclusions The level of evidence supporting the use of mild stimulation protocols in ivf is low, considering the fewer oocytes retrieved and the higher rates of cycle cancellation.

关键词： mild ovarian stimulation long GnRH agonist ovarian stimulation in vitro fertilization （ivf）

Improved Prediction of In vitro fertilization Clinical Outcomes by Combining Ultrasound, Serum Hormones and Body Mass Index

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Journal of Reproduction and Contraception 2014年第3期25卷 147-158页

作者： Xue DAI Jia-yin LIU Jie WU Center of Clinical Reproductive Medicine the Second Affiliated Hospital of Nanjing Medical University State Key Laboratory of Reproductive Medicine Department of Obstetrics and Gynecology the First Affiliated Hospital of Nanjing Medical University

Objective To identify efficient predictors of clinical outcomes of in vitro fertilization （ivf）. Methods Two hundred and one women undergoing their first ivf cycle were measured for antral follicle count （AFC） and endometrial thickness via ultrasound. On day 2 or 3 of the menstrual cycle and the day of human chorionic gonadotropin administration, serum levels of follicle-stimulating hormone （FSH）, luteinizing hormone （LH）, estradiol, and progesterone were determined. The difference of ovarian response and clinical pregnancy rates were measured. Results Basal FSH was the single best predictor of ovarian response in women 〈35 years old before the initiation of treatment, with an area under the receiver operating characteristic curve （A UC） of 0. 752. For women ≥ 35 years old, none of parameters was a single good predictor of lVF pregnancy. For women older than 35 years, adding body mass index （BMI） with AFC and basal FSH improved prediction of ovarian response （A UC=0. 859）. Prediction of clinical pregnancy for women ≥ 35 years was improved either by combining only AFC and basal FSH （AUC=0. 757） or adding BMI to the combined AFC and FSH （AUC=0. 722）. Conclusion Combining AFC, basal FSH, and BMI was the best predictor of ovarian response and clinical pregnancy after ivf in women ≥ 35 years.

关键词： in vitro fertilization （ivf） combining predictors ovarian response pregnancy the logistic model

Successful Pregnancy and Delivery after Multifetal Pregnancy Reduction in A Woman with Monochorionic Triplet Pregnancy Following Intracytoplasmic Sperm Injection and the Transfer of Frozen-thawed Embryos

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Journal of Reproduction and Contraception 2014年第2期25卷 119-122页

作者： Rui YANG Rong LI Xin-na CHEN Jie QIAO Department of Obstetrics and Gynecology Reproductive Medical Center Peking University Third Hospital

This was the first report of multifetal pregnancy reduction （MFPR） with mono- chorionic triplet pregnancy following ICSI and the transfer of frozen-thawed embryos. A 30-year-old woman who had undergone ICSI and the transfer of frozen-thawed embryos subsequently developed monochorionic triplet pregnancy. She did a multifetal pregnancy reduction to remove one embryo limb from the fetal sac and remained a singleton pregnancy after pregnancy reduction. At last she delivered a healthy baby girl at 40 weeks of gestation. In conclusions, an early stage fetal reduction, selection of the appropriate reduction week, and the expertise of a highly experienced doctor using ultrasound can ensure a wonderful pregnancy outcome in monozygotic multiple pregnancies.

关键词： in vitro fertilization （ivf） monochorionic triplet pregnancy multifetal pregnancyreduction （MFPR） intracytoplasmic sperm injection （ICSI）