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@#【Objective】The aim of this study was to investigate the proportion of dominant follicles（PDF）on HCG day in young and aged women.【Methods】In total，3 064 cycles of GnRH agonist long protocol and 918 cycles of GnRH antagonist protocol from 2014 to 2016 were retrospectively included. Patients were divided into 3 groups（low PDF，< 20%； medium PDF，≥20% and ≤40% ；high PDF，> 40%）. The measurements regarding the ovarian stimulation characteris? tics ，clinical pregnancy rate was compared between different PDF groups stratified by age and protocol. 【Results】 In patients aged ≤30 years who received the GnRH agonist long protocol，no significant difference was found in the clinical pregnancy rate between the different PDF groups（P > 0.05）. Regarding the GnRH antagonist protocol，no significant difference was found in the clinical pregnancy rate and moderate or severe OHSS rate（P > 0.05）. In patients aged ≥40 years， the clinical pregnancy rate in the low PDF group was higher than that in the high PDF groups（40% vs. 30.88%）in GnRH agonist long protocol. Concerning the GnRH antagonist protocol，patients in the low PDF group had a significantly higher clinical pregnancy rate than those in the other two groups（27.27% vs. 9.09% ，7.40% ；P = 0.002）.【Conclusions】PDF within 20% is recommended for older patients（≥40 years），especially in those receiving the GnRH antagonist protocol.
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@#【Objective】To evaluate the role of serum antimullerian hormone （AMH） concentration in predicting clinical outcomes in controlled ovarian stimulation and intrauterine insemination （IUI）. 【Methods】 A retrospective analysis of IUI data from patients with polycystic ovary syndrome and infertility in our reproductive center from January 2014 to August 2017. According to the clinical outcomes，data was divided into three groups：clinical pregnancy group，non-pregnant group，and cancellation cycle group due to multiple follicular or no dominant follicular develop. The ovarian function evaluation indexes were compared such as serum AMH，basal FSH and basal sinus follicle（AFC）. The cutoff values of the AMH to predict multi- follicular development or no dominant follicular development which IUI cycles were cancelled，and to predict obtain cumulative clinical pregnancy outcomes were calculated according to the ROC curve to cancel the cycle. 【Results】 The clinical pregnancy rates of PCOS patients were from 15.9% to 17.1% ，while the cumulative clinical pregnancy rate increased in repeat cycles （≤3 cycles） was 21.6% ，significantly higher than the average clinical pregnancy rate（16.7%）during the first cycle. AMH levels in the cancelled cycle group were significantly higher than those in the non-cancelled cycle group［（14.1±6.5）vs（10.3±4.3）ng/mL，（14.1±6.5）vs（9.3±4.3）ng/mL， P<0.025］. Compared with the clinical pregnancy group，cancel cycle group and non- pregnant group，the mean AFC of the former two groups were significantly higher［（34.5±11.4）vs（30.7±11.3），（7.8±10.8）vs（30.7±11.3），P<0.025］. In addition，we found that women′ s age，baseline FSH were negatively correlated with the cumulative pregnancy rate of repeated IUI cycles，and women′s baseline BMI，baseline LH，AFC，and AMH were positively correlated with cumulative pregnancy rates. The number of mature follicles on the HCG triggering day，as well as the value of AMH，may be the influencing factor of IUI cumulative clinical pregnancy. By ROC curve analysis，we assume that AMH is more suitable than the AFC to predict IUI cycle cancellation rate and the cumulative pregnancy rate.【Conclusion】Repeated IUI cycles can be improved cumulative pregnancy rate of PCOS infertile couples. AMH，as an important index to measure ovarian reserve function，can be used to predict the the IUI cumulative clinical pregnancy outcomes and cancelled cycle rates：as AMH increased to more than 6.56 ng/mL，the pregnancy rate increased；but when AMH ≥14.72 ng/mL，the risk of cancelled IUI cycles was increased，becasues of multi-follicular developing and absence of dominant follicle development.
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Background@#There is no absolute consensus for the best time for triggering. The aim of this study was to investigate the effect of different proportion of dominant follicles (PDF) on the human chorionic gonadotropin (HCG) day for the clinical outcomes in patients with polycystic ovary syndrome (PCOS) of different ovarian stimulation protocols.@*Methods@#A total of 371 cycles of the gonadotropin-releasing hormone (GnRH) agonist long protocol and 347 cycles of GnRH antagonist protocol from January 2014 to December 2016 were included in this retrospective study. Based on the PDF on the day of the HCG administration, the included patients were divided into three groups: Group A (low PDF), PDF <20%; Group B (medium PDF), 20%≤ PDF ≤40%; Group C (high PDF), PDF >40%. The measurements regarding ovarian stimulation characteristics, fertilization rate, top quality embryo rate, clinical pregnancy rate, and ovarian hyperstimualtion syndrome (OHSS) rate were compared in different PDF groups with different protocols.@*Results@#In both the GnRH antagonist protocol and GnRH agonist long protocol, the characteristics such as mean age, anti-Mullerian hormone, antral follicle count (AFC), and body mass index were comparable between groups. The number of oocytes retrieved decreased statistically significantly as the PDF and rate of matured oocytes increased. In the GnRH agonist long protocol, the rate of normally fertilized oocytes was highest in Group A (59.74 ± 31.21 vs. 49.70 ± 37.95, 49.67 ± 36.62; F = 3.743, P = 0.025). There were no significant differences in the rate of top-quality embryos and the clinical pregnancy rate between the groups. The clinical pregnancy rate was similar in the three groups (63.6%, 62.5%, 67.5%, respectively, χ2 = 0.989, P = 0.911). The moderate and severe OHSS rate increased statistically significantly when the PDF increased, which was highest in group C (1.4%, 3.1%, 6.7%, respectively, χ2 = 12.014, P = 0.017). In the GnRH antagonist protocol, there were no significant differences in the rate of top-quality embryos, the rate of normally fertilized oocytes, the clinical pregnancy rate, and the moderate and severe OHSS rate between the groups. The clinical pregnancy rate in Group C was higher than that in Group A (57.9% vs. 46.6%, χ2 = 10.850, P = 0.093).@*Conclusions@#In the GnRH antagonist protocol, PDF on the HCG day of less than 20% may be unfavorable to the clinical pregnancy rate in PCOS. In the GnRH agonist long protocol, delaying the HCG trigger timing has no good effect on clinical pregnancy and the risk of OHSS might increase in patients with PCOS.
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BACKGROUND@#There is no absolute consensus for the best time for triggering. The aim of this study was to investigate the effect of different proportion of dominant follicles (PDF) on the human chorionic gonadotropin (HCG) day for the clinical outcomes in patients with polycystic ovary syndrome (PCOS) of different ovarian stimulation protocols.@*METHODS@#A total of 371 cycles of the gonadotropin-releasing hormone (GnRH) agonist long protocol and 347 cycles of GnRH antagonist protocol from January 2014 to December 2016 were included in this retrospective study. Based on the PDF on the day of the HCG administration, the included patients were divided into three groups: Group A (low PDF), PDF 40%. The measurements regarding ovarian stimulation characteristics, fertilization rate, top quality embryo rate, clinical pregnancy rate, and ovarian hyperstimualtion syndrome (OHSS) rate were compared in different PDF groups with different protocols.@*RESULTS@#In both the GnRH antagonist protocol and GnRH agonist long protocol, the characteristics such as mean age, anti-Mullerian hormone, antral follicle count (AFC), and body mass index were comparable between groups. The number of oocytes retrieved decreased statistically significantly as the PDF and rate of matured oocytes increased. In the GnRH agonist long protocol, the rate of normally fertilized oocytes was highest in Group A (59.74 ± 31.21 vs. 49.70 ± 37.95, 49.67 ± 36.62; F = 3.743, P = 0.025). There were no significant differences in the rate of top-quality embryos and the clinical pregnancy rate between the groups. The clinical pregnancy rate was similar in the three groups (63.6%, 62.5%, 67.5%, respectively, χ = 0.989, P = 0.911). The moderate and severe OHSS rate increased statistically significantly when the PDF increased, which was highest in group C (1.4%, 3.1%, 6.7%, respectively, χ = 12.014, P = 0.017). In the GnRH antagonist protocol, there were no significant differences in the rate of top-quality embryos, the rate of normally fertilized oocytes, the clinical pregnancy rate, and the moderate and severe OHSS rate between the groups. The clinical pregnancy rate in Group C was higher than that in Group A (57.9% vs. 46.6%, χ = 10.850, P = 0.093).@*CONCLUSIONS@#In the GnRH antagonist protocol, PDF on the HCG day of less than 20% may be unfavorable to the clinical pregnancy rate in PCOS. In the GnRH agonist long protocol, delaying the HCG trigger timing has no good effect on clinical pregnancy and the risk of OHSS might increase in patients with PCOS.
Subject(s)
Adult , Female , Humans , Pregnancy , Chorionic Gonadotropin , Therapeutic Uses , Embryo Transfer , Methods , Fertilization in Vitro , Methods , Gonadotropin-Releasing Hormone , Metabolism , Therapeutic Uses , Hormone Antagonists , Therapeutic Uses , Ovarian Follicle , Physiology , Polycystic Ovary Syndrome , Drug Therapy , Pregnancy Rate , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To investigate ovarian follicular damage induced by chemotherapeutic agents and gonadotropin- releasing hormone receptor (GnRHR) expression in the damaged ovaries in rats.</p><p><b>METHODS</b>Two groups of adult SD rats were subjected to intraperitoneal injection of a single-dose cyclophosphamide and saline, respectively, and 8 weeks later, the ovaries were taken for observing the ovarian damages. The distribution of GnRHR was detected with immunohistochemistry, and RT-PCR was used to determine the expression of GnRHR mRNA in the rat ovaries.</p><p><b>RESULTS</b>Massive primordial follicular loss occurred in the ovaries of rats exposed to cyclophosphamide with also evident stromal ovarian blood vessel damages and focal fibrosis. Both the protein and mRNA expressions of GnRHR were detected in normal rat ovaries, but in rats exposed to cyclophosphamide, the expressions were significantly lowered in the ovaries (P<0.05).</p><p><b>CONCLUSION</b>Low-level GnRHR expressions in the ovaries of rats with cyclophosphamide exposure suggest microenvironment disturbances in the damaged rat ovaries in advanced stage of chemotherapy.</p>
Subject(s)
Animals , Female , Humans , Rats , Cyclophosphamide , Ovary , Metabolism , Pathology , Rats, Sprague-Dawley , Receptors, LHRH , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To investigate the possible pathways for ovarian injury after administration of cyclophosphamide in rats.</p><p><b>METHODS</b>Adult SD rats received a single injection of saline vehicle or chemotherapeutic agent cyclophosphamide, and 8 weeks later, the ovaries were removed, fixed and serially sectioned for pathological examination and ovarian follicle counting. The expression of stem cell factor (SCF) protein was evaluated by immunohistochemistry and immunoreactive score, and SCF mRNA expression determined by RT-PCR in rat ovaries.</p><p><b>RESULTS</b>Cyclophosphamide had a detrimental effect on ovarian stromal function and lead to primordial follicle loss. Immunoreactive SCF antigens were expressed on the oocytes in the primordial and primary follicles of rat ovaries, and also in the granulosa cells of the secondary follicles and early antral follicles. There was a higher granulosa SCF, lower oocyte SCF and higher SCF mRNA level in the ovaries of the rats exposed to cyclophosphamide as compared with those in control rat ovaries (P <0.05).</p><p><b>CONCLUSION</b>Altered SCF expression in the ovaries of rats exposed to cyclophosphamide can be helpful for understanding the mechanisms for chemotherapeutic drug-induced ovarian damage.</p>
Subject(s)
Animals , Female , Rats , Cyclophosphamide , Gene Expression , Granulosa Cells , Metabolism , Oocytes , Metabolism , Ovary , Cell Biology , Wounds and Injuries , Metabolism , Rats, Sprague-Dawley , Stem Cell Factor , Genetics , MetabolismABSTRACT
Objective To explore the psychomotor development in 12 month old infants born after in vitro fertilization with a control group of infants concieved naturally.Methods A matched control study was performed on psychomotor development of 12-month-old infants concieved with use of assisted reproductive technology(in vitro fertilization only).The control group was matched according to maternal age,parity,social class and level of parental education.The suitable mothers were invited to participate at the 28th week of gestation and were followed up to delivery.The infants of the two groups were followed up to 12 months old and a formal developmental assessment was done with the Children Development Center of China(CDCC) scales of infant development.Results The incidences of preterm birth,low birth weight and twin pregnancy were significantly higher in the assisted conception group.No statistically significant difference was found in the mental development index and psychomotor development index between assisted conception and control groups.Conclusions The levels of psychomotor development in 12 months old infants born after in vitro fertilization are normal.But as the incidences of preterm birth,low birth weight and multifetation are significantly higher in vitro fertilization group,it need to follow up the ongoing development of these children.
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Objective To investigate the effects of gonadotropin releasing hormone agonist (GnRH- a) and antagonist (GnRH-ant) on cyclophosphamide (CTX)-induced ovarian damage in rats.Methods Seventy-two Sprague-Dawley female rats were divided randomly into six groups,which received normal saline (NS),CTX,GnRH-a+NS,GnRH-a+CTX,GnRH-ant+NS,and GnRH-ant+CTX respectively.Levels of serum follicle-stimulating hormone (FSH),luteinizing hormone (LH) and estradiol (E_2) were measured successively by the enzyme-linked immunosorbent assay method,and half of the rats were killed in the first week and between the fourth and the fifth week after stop of medication,respectively to compare the weight of the ovaries and the number of the primordial follicles and the growth follicles.Results (1) Throughout experiment,the serum levels of FSH,LH and E_2 of the control group fluctuated slightly,while those in the CTX group kept rising.During medication treatment,compared with the control group[(118?16) ?g/L, (350?35) ?g/L] and the CTX group[(113?15) ?g/L,(289?42) ?g/L],the concentrations of LH [(42 ?8)-(47?7) ?g/L,(31?5)-(36?7) ?g/L] and FSH [(124?45)-(136?32)?g/L,(178 ?54)-(198+27)?g/L] in the GnRH-a groups and the GnRH-ant groups were maintained at low levels significantly and the levels of LH in the GnRH-ant groups were significantly lower than that in the GnRH-a groups,but the levels of FSH in the GnRH-ant groups were significantly higher than that in the GnRH-a groups(P0.05),but the levels of FSH,LH and E_2 of the GnRH-ant+CTX group rose obviously and were similar to the levels of the CTX group,especially the FSH,and the levels of LH and FSH of the GnRH- ant + CTX group [(156?12) ?g/L,(520?44) ?g/L] and the CTX group [(178?18) ?g/L,(546?36) ?g/L] were significantly higher than that of the other four groups [(121?15)-(132?13) ?g/L,(335 ?35)-(359?26) ?g/L] at the 4~(th)-5~(th) week after stop of treatment(P0.05),but the number of all kinds of follicles declined significantly in the GnRH-ant+CTX group[(195?15),(36?12)] and the CTX group [(212?11),(36?9)] compared to the other four groups[(302?15)-(690?43),(44?12)-(58?11),P