ABSTRACT
AIM:To explore the effect of MCSF and its receptor on the response of ovarian stimulation by comparing the expression of macrophage colony stimulating factor (M-CSF) and its receptor mRNA in luteinized granulosa cells in patients after using combinant human follicle stimulating hormone.METHODS:Ninety-six patients with polycystic ovary syndrome (PCOS) and 157 patients with non-PCOS underwent in vitro fertilization were divided into four groups,i.e.the PCOS fast and slow reaction group,and the non PCOS fast and slow reaction group,according to their response to recombinant human follicle stimulating hormone (r-FSH).Luteinized granulosa cells were then collected after mature follicular puncture.SYBR Green quantitative RT-PCR method was used to detect the expression of M-CSF,M-CSFR and GAPDH in the mRNA gene of the granulosa cells samples.The relative quantity of these genes were determined by comparing the threshold value (CT value of the target gene subtract CT value of housekeeping gene).The difference of gene expression between two groups was compared by t test,and Spearman correlation analysis was used to describe the data relationships.RESULTS:No significant difference was observed in the use of r-FSH among the different groups (P ＞ 0.05).Neither was there any significant difference in mRNA quantity of M-CSF or M-CSFR between the entire PCOS and non PCOS patients (P ＞ 0.05).After grouping,no significant difference was observed between any two groups in the expression of M-CSF (P ＞ 0.05).The expression of M-CSFR in PCOS slow response group was significantly lower than that of PCOS fast response group (P =0.006).Meanwhile,the Spearman analysis showed that the correlation between the quantification of M-CSFR mRNA and the days of r-FSH in PCOS group was statistically significant (P =0.023);the correlation coefficient was 0.511.CONCLUSION:The slow response to ovarian stimulation in PCOS patients is possibly related to the reduction of granulocyte MCSFR expression.The M-CSF and its receptor may be involved in the ovarian stimulation response process.
ABSTRACT
Objective To evaluate the effect of serum LH level on the day of superovulation start on the prolonged gonadotropin-releasing hormone ngonist therapy on the outcomes of in vitro fertilization and embryo transfer (IVF-ET) in patents with ovarian endometriomas. Methods 75 patients with ovarian en-dometriomas were treated by laparoscopic cystectomy or laparotomy cystectomy or ultrasound-mediated cysts puncture, and gonadotropin-releasing hormone agonist (GnRH-α) was given for 3 to 4 times every 28 days after the operation. Superovulation started after 14 ～ 84 days of the last injection. All the patients were di-vided into two groups according to the level of serum LH. Group A included 30 patients whose level of LH was less than 0. 5IU/L, and group B included 45 patients whose level of LH was over 0.5IU/L and less than 1.5IU/L. The outcomes of IVF-ET were evaluated. Results The total ampoules of Gn administration and the ampoules of hMG needed in group A[(32.28±7.7) ampoules, ( 12.0±8. 9) ampoules,]were sig-nificantly more than that in group B[( 25.84±7. 1 ) ampoules, ( 6. 19±7.4) ampoules, P < 0.05] . The successful embryo implantation rate in group A( 18. 1% ) was lower than group B(26. 7% ), and the differ-ence has statistical significance ( P <0. 05). Conclusion The low level of serum LH on the superovula-lion day on the prolonged gonadotropin-releasing hormone agonist protocol will increase the ampoules of Gn administration and decrease the successful embryo implantation rate of IVF-ET, thus LH should be a more important reference parameter of superovulation start.
ABSTRACT
Objective To evaluate the decreased level of serum inhibin B(INHB)treated by gunadotropin releasing hormone agonist(GNRH-a)in predicting ovarian response and pregnancy in in vitro fertilization-embryo transfer(IVF-ET).Methods The prospective study enrolled 124 women given by GnRH-a+recombine follicle stimulating hormone(rFSH)+human chorionic gonadotrophin(hCG)long term stimulation protocol undergone their first cycle of IVF-ET treatment.The following predictive factors were collected and analyzed,such as age,basal level of follicle stimulating hormone(FSH),the ratio of FSH/luteinizing hormone(LH),the concentration of INHB after down-regulation,total number of antral follicle count(AFC)and mean ovarian volume. Ovarian response was evaluated by the number of oecytes obtained.A multiple regression analysis and logistic regression model were used for all possible prognostic variables to evaluate the value of difierent hormones in predicting ovariall response and pregnancy after IVF-ET.Receiver operating characteristic(ROC) analysis was used to evaluate the level of INHB in predicting the number of oocytes obtained.The sensitivity and specificity were calculated at the discriminating cut-off point Results The concentration of INHB after down-regulation showed a highly significant positive correlations with the number of oocytes obtained(r=0.435,P<0.01).The multiple regression analyses showed INHB was the most significant predictor of the number of retrieved oocytes,but INHB was not associated with IVF-ET outcome significantly(P>0.05).ROC analyses showed INHB after down-regulation had the largest area under curve(AUC)0.933(95%CI:0.878-0.988).When a threshold of 15 ng/L of INHB was established,95.5%sensitivity and 50.0% specificity in ovarian response were observed.Conclusions The level of INHB Was the best factor in predicting ovarian response in IVF-ET.Decreased level of INHB Was the early sign of ovarian reserve function failure,however,useless in predicting IVF-ET outcome.
ABSTRACT
n occurring after the treatment of IVM in women with PCOS are not mounting. However, the relative high rates of multiple pregnancies, low birth weight and preterm labor were increased.
ABSTRACT
Objective To investigate clinical effect of in vitro maturation(IVM)of immature oocytes transferred from conventional in vitro fertilization embryo transfer(IVF-ET) cycles.Methods From January 2008 to June 2009.medical documents of 155 infertile patients underwent IVF-ET in the Reproductive Medical Center of Fimt Affiliated Hospital of Wenzhou Medical College were analyzed retrospectively.If more than 20 oocytes were monitored after 5-7 days of ovulation induction or follicular developmental retardation were confirmed after 8-13 days of ovulation induction.according to patients' wish,IVM were transferred in 60 cycles(group A).In the mean time.IVF was continued in 95 cycles (group B).The mean dosage of gonadotropin,the cancel lation rate of cycles,the mean numbers of oocytes retrieved and maturation,the rate of fertilization and excellent quality embryos.pregnancy outcome and the incidence rate of ovarian hyperstimulation syndrome(OHSS)were compared and analyzed.Results The rates of embryo transfer were 92%(55/60)in group A and 63%(60/95)in group B,which showed significant differences (P<0.05).In group A,the mean dosage of the gonadotropin,the mean number of oocytes retrieved,the cleavage rate and OHSS rate were(1030±468)U,10±6,82.2%(231/281)and O,and were(1544±338)U,14±4,94.0%(502/534)and 35%(21/60)in group B,respectively,all data abeve exhibited statistieal difference between two groups(P<0.05).However,the rates of fertilization and excellent quality embryos had no significant differences between two groups(P>0.05).In group A,the rate of clinical pregnancy per transfer was 53%(29/55)and multiple pregnancy was 14%(4/29),and were 47%(28/60) and 32%(9/28)in group B,they all had no significant differences (P>0.05).Conclusion IVM of immature oocytes used in conventional IVF cycles not only obtained a high clinical pregnancy rate,but also reduced gonadotropin using dosage and avoided OHSS completely.
ABSTRACT
Objective To explore the prevalence of nonalcoholic fatty liver disease(NAFLD)in patients with polycystic ovary syndrome(PCOS).MethodsA case-control study employing 60 non pregnant patients with PCOS and 60 non-pregnant patients without PCOS as control was conducted to compare the prevalence of NAFLD.Resuits The aminotransferase(ALT),fasting insulin and homeostasis model assessment of insulin resistance(HOMA-IR)levels were(29±15)U/L,(19±12)mU/L and 0.47±0.29 in PCOS group,which were significantly higher(P＜0.05)than corresponding parameters in control group[(15±13)U/L,(11±8)mU/L and 0.31±0.21)].The occurrence of insulin resistance and NAFLD was 63％(38/60)and 42％(25/60),higher than those in control group[35％(21/60)and 20％(12/60),P＜0.05].The increment of ALT was 40％(24/60)in PCOS group,higher than that of 3％(2/60)in control group(P＜0.01).Compared with patients witIlout NAFLD,patients with NAFLD had significantly increased body mass index(P＜0.01),waist-hip ratio,AIJT,C-reaction protein,fasting insulin,insulin and HOMA-IR levels 2 hours after oral glucose tolerance test(P＜0.05).Conchsion The increased prevalence of NAFLD in PCOS patients suggests an association between these two conditions and the necessity of hepatic screening among PCOS patients for potential NAFLD.