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Outcomes of patients who have undergone laparoscopic abdominal cerclage:A retrospective study

Laparoscopic, Endoscopic and Robotic Surgery 2022年第3期5卷 111-115页

作者： Cuiyu Yang Dong Huang Yang Yang Jingyan Yang Yuyang Chen Mei Pan Songying Zhang Assisted Reproduction Unit Department of Obstetrics and GynecologySir Run Run Shaw HospitalZhejiang University School of MedicineHangzhou 310016China

Objective:This study aims to evaluate the surgical morbidity and obstetric outcomes following in-pregnancy or pre-pregnancy laparoscopic abdominal cerclage(LAC)for patients who were diagnosed with refractory cervical insufficiency or had a short cervix.Methods:A retrospective study was conducted on patients undergoing LAC between May 2017 and May 2019 at the Department of Obstetrics and Gynecology,Sir Run Run Shaw Hospital.The patients were diagnosed with refractory cervical insufficiency based upon a previous failed transvaginal cervical cerclage(TVC),or had a short cervix who were considered unsuitable for a TVC after a previous cervical procedure.All patients were followed-up after surgery with transperineal ultrasonography until May 2020.Subsequently,surgical and obstetric data were collected and analyzed.Results:In total,44 patients underwent LAC,with 8 patients in-pregnancy and 36 pre-pregnancy.For the patient with pre-pregancy LAC,the pregnancy rate was 80.6%(29/36),including 3 patients with first-trimester loss,1 patient with an ectopic pregnancy,and 25 patients with a delivery.For the remaining 7 patients,3 did not conceive,and another 4 had no pregnancy plans.All the patients with in-pregnancy LAC had a delivery.The“take-home baby”rate was 89.2%(33/37),with a live-birth rate of 100%and a neonatal survival rate of 100%for both patients with in-pregnancy and pre-pregnancy LAC.For patients with in-pregnancy LAC,75.0%(6/8)patients delivered at≥37 wk of gestation,12.5%(1/8)delivered between 34 and 36^(+6)wk,and 12.5%(1/8)delivered between 28 and 33^(+6)wk.For patients with pre-pregnancy LAC,80.0%(20/25)patients delivered at≥37 wk of gestation,16.0%(4/25)delivered between 34 and 36^(+6)wk,and 4.0%(1/25)delivered between 28 and 33^(+6)wk.No adverse-event intra-operative or post-operative sequelae were noted.Conclusions:LAC is an effective and safe procedure that results in remarkable obstetric outcomes for women with refractory cervical insufficiency,or with a short cervix who are considered unsuitable for a T

关键词： Cervical cerclage Cervical insufficiency Laparoscopic Conization Preterm birth

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AMP-activated kinase in human spermatozoa： identification, intracellular localization, and key function in the reRulation of sperm motility

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Asian Journal of Andrology 2017年第6期19卷 707-714页

作者： Violeta Calle-Guisado Ana Hurtado de Llera David Martin-Hidalgo Jose Mijares Maria C Gil Ignacio S Alvarez Maria J Bragado Luis J Garcia-Marin Research Group of Intracellular Signalling and Technology of reproduction (SINTREP) School of Veterinary Medicine University of Extremadura Caceres Spain Assisted Reproduction Unit at the-Minimally Invasive surgery Center Jesos Uson (CCMIJU) Caceres Spain Norba Clinic Caceres Spain Research Group of reproduction and Embryo Development (REDES) University of Extremadura Badajoz Spain Extremadura Institute of assisted reproduction (IERA) Badajoz Spain.

AMP-activated kinase （AMPK）, a protein that regulates energy balance and metabolism, has recently been identified in boar spermatozoa where regulates key functional sperm processes essential for fertilization. This work＇s aims are AMPK identification, intracellular localization, and their role in human spermatozoa function. Semen was obtained from healthy human donors. Sperm AMPK and phospho-Thr172-AMPK were analyzed by Western blotting and indirect immunofluorescence. High- and low-quality sperm populations were separated by a 40%-80% density gradient. Human spermatozoa motility was evaluated by an Integrated Semen Analysis System （ISAS） in the presence or absence of the AMPK inhibitor compound C （CC）. AMPK is localized along the human spermatozoa, at the entire acrosome, midpiece and tail with variable intensity, whereas its active form, phospho-Thr172-AMPK, shows a prominent staining at the acrosome and sperm tail with a weaker staining in the midpiece and the postacrosomal region. Interestingly, spermatozoa bearing an excess residual cytoplasm show strong AMPK staining in this subcellular compartment. Both AMPK and phospho-Thr172-AMPK human spermatozoa contents exhibit important individual variations. Moreover, active AMPK is predominant in the high motility sperm population, where shows a stronger intensity compared with the low motility sperm population. Inhibition of AMPK activity in human spermatozoa by CC treatment leads to a significant reduction in any sperm motility parameter analyzed： percent of motile sperm, sperm velocities, progressivity, and other motility coefficients. This work identifies and points out AMPK as a new molecular mechanism involved in human spermatozoa motility. Further AMPK implications in the clinical efficiency of assisted reproduction and in other reproductive areas need to be studied.

关键词： AMP-activated kinase human spermatozoa immunolocalization sperm motility sperm quality

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Advanced Role of Hippo Signaling in Endometrial Fibrosis： Implications for Intrauterine Adhesion

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Chinese Medical Journal 2017年第22期130卷 2732-2737页

作者： Hai-Yan Zhu Tian-Xiang Ge Yi-Bin Pan Song-Ying Zhang Assisted Reproduction Unit Department of Obstetrics and Gynecology Sir Run Run Shaw Hospital School of Medicine Zhejiang University Hangzhou Zhejiang 310016 China

Objective： Intrauterine adhesion （IUA） is a major health problem that causes infertility, menstrual irregularities, and recurrent pregnancy losses in women. Unfortunately, treatments for IUA are limited, and there are currently no effective strategies for preventing IUA recurrence. In this review, we introduced the role of Hippo signaling in the normal endometrium and IUA and described the mechanisms by which the Hippo pathway integrates with the Wnt and transforming growth factor-β （TGF-β） signaling pathways to form an intricate network governing the development of fibrosis. Data Sources： Original research articles in English that were published until July 2017 were collected from the PubMed database. Study Selection： Literature search was conducted using the search terms ＂endometrial fibrosis OR fibrosis AND or OR intrauterine adhesion OR Asherman syndrome OR IUA,＂＂Hippo AND or OR Hippo/TAZ,＂＂TGF-β,＂ and ＂Wnt.＂ Related original research articles were included in the comprehensive analysis. Results： Endometrial fibrosis is recognized as a key pathological event in the development of IUA, which is characterized by epithelial/fibroblast-myofibroblast transition. Myofibroblasts play crucial roles in the pathogenesis of fibrous scarring, and myofibroblast differentiation can be triggered by multiple signaling pathways. H ippo signaling is a critical regulator of the epithelial/fibroblast-myofibroblast transition and α-smooth muscle actin, which exhibits a specific spatiotemporal expression in the endometrium. Conclusions： Hippo signaling plays a critical role in fibrous diseases and participates in cross talks with Wnt and TGF-β signaling. Our findings not only contributed to knowledge on the pathogenesis of endometrial fibrosis, but can also serve as a useful resource for developing specific molecular inhibitors for IUA treatment and prevention.

关键词： Endometrial Fibrosis： Hippo Signaling Intrauterine Adhesion Transforming Growth Factor-β Wnt Signaling

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Intracytoplasmic Sperm Injection Fertilization Rate Does Not-Depend on the Proportion of Round-headed Sperm, Small acrosomal Sperm, or Morphologically Normal Sperm in Patients with Partial Globozoospermia

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Chinese Medical Journal 2015年第12期128卷 1590-1595页

作者： Ling-Ying Jiang Ling-Yun Yang Xiao-Mei Tong Hai-Yan Zhu Ya-Mei Xue Wen-Zhi Xu Yang Yang Song-Ying Zhang Department of Obstetrics and Gynecology Assisted Reproduction Unit Sir Run Run Shaw Hospital Zhejiang University School of Medicine Hangzhou Zhejiang 310016 China

Background：Generally,intracytoplasmic sperm injection （ICSI） may be the preferable method to treat partial globozoospermia,but whether there exist some correlations between ICSI fertilization rate and the proportion of round-headed sperm or morphologically normal sperm remains open.This study was to explore the correlation between ICSI fertilization rate and the sperm morphology in patients with partial globozoospermia.Methods：Thirty-four patients diagnosed with partial globozoospermia accepted the following assisted fertilization treatments-2 cases accepted in-vitro fertilization （IvF） alone,26 cases accepted ICSI alone,and 6 accepted split IVF/ICSI.Detailed morphological characteristics were described using Diff-Quik rapid staining.Sixty cases accepting IVF or ICSI treatment in our reproductive center were considered as the control group after being matched by relevant criteria.Fertilization rate,embryo quality,embryo implantation rate and clinical pregnancy rate were calculated.Results：Besides very high proportion of round-headed sperm,partial globozoospermia also showed very high proportion of small-acrosomal sperm and very low proportion of morphologically normal sperm.Fertilization rate of IVF （IVF alone plus split IVF） was very low in partial globozoospermia （25.4% ± 17.4%）,but ICSI （ICSI alone plus split ICSI） achieved satisfying fertilization rate compared with the control group （66.2% ± 22.5% vs.68.8% ± 29.4%,P 〉 0.05）.In patients with partial globozoospermia,there were no correlations between ICSI fertilization rate and the proportion of round-headed sperm,small-acrosomal sperm,or morphologically normal sperm.Conclusions：There was high proportion of small-acrosomal sperm in partial globozoospermia.For patients with partial globozoospermia,ICSI is more preferable than IVF.ICSI fertilization rate does not depend on the proportion of round-headed sperm,small-acrosomal sperm,or morphologically normal sperm.

关键词： Fertilization Rate Globozoospermia Intracytoplasmic Sperm Injection In-vitro Fertilization Sperm Acrosome

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Outcome of in vitro fertilization in endometriosis-associated infertility： a 5-year database cohort study

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Chinese Medical Journal 2012年第15期125卷 2688-2693页

作者： LIN Xiao-na WEI Min-ling TONG Xiao-mei XU Wei-hai ZHOU Feng HUANG Qiong-xiao WEN Guo-feng ZHANG Song-ying Assisted Reproduction Unit Department of Obstetrics andGynecology Sir Run Run Shaw Hospital Zhejiang UniversitySchool of Medicine Hangzhou Zhejiang 310016 China

Background Endometriosis affects natural fertility through various approaches, and in vitro fertilization （IVF） is a good treatment. But the IVF result of endometriosis patients is still under debate. We investigated the effect of endometriosis on IVF by analyzing the data from a single reproductive center. Methods A retrospective, database-searched cohort study was performed. Relevant information was collected from the electronic records of women who underwent IVF/intracytoplasmic sperm injection between January 2006 and December 2010 in the assisted Reproductive unit of Sir Run Run Shaw Hospital. Patients with endometriosis were enrolled the study group. The rest of the women formed the control group. The main outcome was the clinical pregnancy rate. Secondary outcomes were oocytes retrieved number, fertilization rate, high-quality embryo rate, number of high-quality embryo for embryo transplantation, and implantation embryo/high-quality embryo ratio （IE/HQE ratio）. Comparisons were performed by the z2-test and independent t-test. Results The endometriosis group （n=177） had a markedly lower oocytes retrieved number, fertilization rate, implantation rate, and clinical pregnancy rate （7.6_＋5.1, 63.6%, 27.7%, and 45.2%, respectively） compared with the non-endometriosis group （n=4267; 11.8＋7.3, 68.4%, 36.2%, and 55.2%, respectively）. Stratified analysis showed that this difference was found in the subgroup younger than 35-years old, while only fertilization rate and implantation rate were different in the elder subgroup. The ratio of high-quality embryos transferred is lower in endometriosis group （53.7% vs. 71.8%, P 〈0.05）, but there is no difference in IE/HQE ratio between two groups. There is no significant difference in fertilization rate, implantation rate, and clinical pregnancy rate between mild and severe endometriosis patients. Conclusions Endometriosis patients suffer a decreasing IVF pregnancy rates mainly caused by reducing oocytes number and fertilization rate, regardless of the severity of the disease

关键词： fertilization in vitro, endometriosis pregnancy rate cohort study

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Outcome of conservative treatment and subsequent assisted reproductive technology for patients with early-stage endometrial adenocarcinoma and poor fertility potential

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Chinese Medical Journal 2012年第19期125卷 3578-3580页

作者： TONG Xiao-mei ZHU Hai-yan LIN Xiao-na JIANG Ling-ying XU Wei-hai LIU Liu ZHANG Song-ying Assisted Reproduction Unit Department of Obstetrics and GynecologySir Run Run Shaw HospitalZhejiang UniversityZhejiangHangzhouZhejiang 310016China

Conservative treatment with high doses of progestin is an alternative to standard hysterectomy for young patients with early-stage endometrial adenocarcinoma who desire to preserve their fertility. Here we report a patient with well-differentiated early-stage endometrial adenocarcinoma and poor fertility potential who failed to become pregnant in two in vitro fertilization-embryo transfer cycles and suffered a relapse after conservative treatment. This case illustrates that assessment of fertility potential is critical at the time of initial evaluation and conservative treatment planning for patients with endometrial adenocarcinoma.

关键词： endometrial carcinoma progestin assisted reproductive technology

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Reduction in sperm aneuploidy levels in severe oligoasthenoteratospermic patients after medical therapy： a preliminary report

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Asian Journal of Andrology 2012年第4期14卷 591-598页

作者： Giorgio Cavallini Maria Cristina Magli Andor Crippa Anna Pia Ferraretti Luca Gianaroli Medicitalia Andrological Section Outpatient Clinic of Ferrara Ferrara 44100 Italy Laboratory of assisted reproduction Societa Italiana di Medicina della Riproduzione (SISMER) Bologna 40138 Italy Operative unit of assisted reproduction Societa Italiana di Medicina della Riproduzione (SISMER) Bologna 40138 Italy

The objective of this study was to investigate whether medical therapy can reduce sperm aneuploidy levels and irfiprove the results of intracytoplasmic sperm injection （ICSI） in patients with severe idiopathic oligoasthenoteratospermia （OAT）. Thirty-three infertile couples requiring ICSI because of severe idiopathic OAT after at least one unsuccessful ICSI cycle were considered. Semen parameters （concentration, motility and morphology）, the percentage of aneuploid sperm and the results of ICSI （the number of oocytes fertilized, embryos transferred, biochemical pregnancies, clinical pregnancies and live births） were compared before and after a 3-month course of treatment with L-carnitine 1 g given twice per day＋acetyI-L-carnitine 500 mg given twice per day＋one 30-mg cinnoxicam tablet every 4 days. Aneuploidy was assessed using fluorescent in situ hybridisation （FISH） performed on chromosomes X, Y, 13, 15, 16, 17, 18, 21 and 22. The results showed that 22 of the 33 patients had a reduced frequency of aneuploid sperm and improved sperm morphology after treatment （group 1）, and 11 showed no change （group 2）. The numbers of biochemical pregnancies, clinical pregnancies and live births were significantly higher in group I than in group 2. No significant difference was found between the groups regarding the numbers of oocytes fertilized and embryos transferred. The side effects were negligible. The numbers of ICSI pregnancies and live births in severe idiopathic OAT patients improved with a course of L-carnitine, acetyI-L-carnitine and cinnoxicam.

关键词： acetyI-L-carnitine cinnoxicam ICSl L-carnitine male infertility oligoasthenoteratospermia sperm aneuploidy

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Three-dimensional cultures of human endometrial cells on Matrigel mimic in vivo morphology

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Chinese Medical Journal 2012年第5期125卷 863-868页

作者： ZHU Hai-yan WANG Jun-xia TONG Xiao-mei XU Wei-hai JIANG Ling-ying JING Xiao-ying YANG Ling-yun ZHOU Feng ZHANG Song-ying Assisted Reproduction Unit Department of Obstetrics and GynecologySir Run Run Shaw HospitalCollege of MedicineZhejiang UniversityHangzhouZhejiang 310016China

Background The regulation of endometrial physiology and morphogenesis by the paracrine effectors has been well established using in vivo studies. A more complete understanding of the endometrial function has been delayed due, in part, to a lack of appropriate culture models. In this study, we aimed to simulate the in vivo three-dimensional （3-D） growth pattern of endometrial cells using a 3-D in vitro culture system.

关键词： Matrigel endometrium three-dimensional culture morphology

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A frozen-thawed embryo transfer program improves the embryo utilization rate

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Chinese Medical Journal 2009年第17期122卷 1974-1978页

作者： ZHOU Feng LIN Xiao-na TONG Xiao-mei LI Chao LIU Liu JIN Xiao-ying ZHU Hai-yan ZHANG Song-ying Assisted Reproduction Unit Department of Obstetrics andGynecology Sir Run Run Shaw Hospital Zhejiang UniversitySchool of Medicine Hangzhou Zhejiang 310016 China

Background Frozen-thawed embryo transfer （FET） is the most common way to prevent serious late ovarian hyperstimulation syndrome and increase the cumulative pregnancy rate. We evaluated the effectiveness of an FET program for improving the embryo implantation and clinical pregnancy rates, and ultimate embryo utilization rate in infertility treatment. Methods Patients undergoing in vitro fertilisation （IVF） cycles from January 2006 to June 2008 were enrolled, including 179 patients who had undergone the first FET cycle after controlled ovarian hyperstimulation （COH） in which all embryos were frozen （group C1） and 1306 patients who had COH with fresh embryo transfer （ET）（group T1）. Logistic regression was used to model the embryo implantation and clinical pregnancy rates based on the mother＇s age, numbers of oocytes retrieved, embryos transferred and high-quality embryos transferred. The embryo implantation and clinical pregnancy rates were also compared between two groups after adjusting for age, the numbers of oocytes retrieved and the numbers of embryos transferred. Results Logistic regression analysis confirmed that embryo implantation and clinical pregnancy rates in group C1 were both significantly higher than those in group T1 after adjusting for confounding factors （43.6% vs 29.0%, 63.1% vs 47.0%, respectively; P 〈0.01）. The embryo implantation and clinical pregnancy rates were consistently higher in group C1 by comparing the age groups ≥35 or 〈35 years. The clinical pregnancy rates for the numbers of oocytes retrieved per cycle being ≥15 or 〈15 were higher in group C1, as was the embryo implantation rate. These differences were statistically significant for oocyte numbers 〉15 （P 〈0.05）. The embryo implantation and clinical pregnancy rates in group C1 were both significantly higher than in group T1 when two or three embryos were transferred （P 〈0.05）. Conclusion A program of freezing all embryos and performing FET improved the rates of embryo implantation and clinical pregnancy, and ultimately enhanced the e

关键词： embryo frozen-thawed embryo transfer pregnancy rate endometrial receptivity

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Factors associated with the incidence of ectopic pregnancy in women undergoing assisted reproductive treatment

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Chinese Medical Journal 2020年第17期133卷 2054-2060页

作者： Xiao-Ying Jin Chao Li Wen Xu Liu Liu Min-Ling Wei Hai-Yi Fei Jing Li Feng Zhou Song-Ying Zhang Assisted Reproduction Unit Department of Obstetrics and GynecologySir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouZhejiang 310016China Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province HangzhouZhejiang 310016China

Background:Ectopic pregnancy(EP)is a common complication in women undergoing assisted reproductive treatment,but the underlying causes for this remain unclear.This study aimed to explore factors affecting the incidence of EP in in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI).Methods:This was a retrospective study on the incidence of EP in IVF/ICSI cycles between January 1,2013 and December 31,2017.Patient age,infertility diagnosis(tubal factor or not),primary or secondary infertility,type of cycle(frozen-thawed or fresh),type of embryo(s)transferred(cleavage embryo or blastocyst),number of embryos transferred(one,two,or three),previous history of EP,and endometrial combined thickness were analyzed to explore their relationships with the incidence of EP.Based on clinical typing results,the patients were divided into an EP group or a non-EP group.Categorical variables were analyzed using Chi-squared test or Fisher exact test.Logistic regression analysis was performed to explore their associations with the incidence of EP.Results:The percentage of patients with primary infertility in EP group was significantly lower than that in non-EP group(31.3%vs.46.7%,χ^2=26.032,P<0.001).The percentage of patients with tubal infertility in EP group was also significantly higher than that in non-EP group(89.2%vs.63.6%,χ^2=77.410,P<0.001).The percentages of patients with transfer of cleavage-stage embryo or blastocyst(91.4%vs.84.4%,χ^2=10.132,P=0.001)and different endometrial combined thickness(ECT)(χ^2=18.373,P<0.001)differed significantly between EP and non-EP groups.For patients who had a previous history of one to four EPs,the percentage of patients undergoing transfer of a cleavage-stage embryo was significantly higher in EP group than that in non-EP group(92.2%vs.77.6%,χ^2=13.737,P<0.001).In multivariate logistic regression analysis,tubal infertility was strongly associated with EP(adjusted odds ratio:3.995,95%confidence interval:2.706-5.897,P<0.001).Conclusions:In IVF/ICSI cycles,transfer of a blastocyst-

关键词： Prognostic factor Ectopic pregnancy Tubal factor In vitro fertilization Intracytoplasmic sperm injection

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