Causes of oocyte vitrification and its value in assisted reproductive technology / 南方医科大学学报

OBJECTIVE@#To explore the causes of oocyte vitrification and its application in assisted reproduction.@*METHODS@#We retrospectively analyzed the data of 26 patients with 27 cycles of oocyte vitrification cryopreservation undergoing intracytoplasmic sperm injection (ICSI) and embryo transfer between January, 2008 and October, 2018. The causes of oocyte vitrification and the outcomes of ICSI and clinical pregnancy were analyzed.@*RESULTS@#The causes of oocytes vitrification included mainly azoospermia or severe spermatogenesis disorder of the husband, failure to obtain sperms from the husband, failure of the husband to be present on the day of oocyte retrieval and acute diseases of the husband to not allow sperm collection. A total of 274 oocytes were frozen in 27 oocyte retrieval cycles, and 217 eggs were thawed in 19 cycles with a survival rate of 81.11% (176/217). The normal fertilization rate, cleavage rate and high-quality embryo rate was 74.81% (98/131), 89.80% (88/98) and 36.73% (36/98), respectively. Fifteen patients underwent embryo transfer, and the clinical pregnancy rate and live birth rate was 53.33% (8/15) and 33.33% (5/15), respectively. Compared with patients below 35 years of age, the patients aged above 35 years had significantly lower oocyte survival rate after thawing (82.76% 74.42%, =0.211), clinical pregnancy rate (77.78% 16.67%, =0.041) and live birth rate (55.56% 0, =0.044).@*CONCLUSIONS@#Oocytes vitrification can be used as a remedy for infertile couples who fail to provide sperms due to male factors on the day of oocyte retrieval. Vitrification of the oocytes does not significantly affect the fertilization rate or the clinical pregnancy rate. The survival rate of the thawed oocytes is related to the age of the wife, and an age younger than 35 years can be optimal for achieving favorable clinical pregnancy outcomes after oocyte vitrification.

Effects of cetrorelix versus ganirelix in gonadotropin-releasing hormone antagonist cycles for preventing premature luteinizing hormone surges and on clinical outcomes of IVF-ET cycles / 南方医科大学学报

OBJECTIVE@#To compare the effects of cetrorelix and ganirelix in gonadotropin-releasing hormone antagonist (GnRH-ant) cycles for preventing premature luteinizing hormone (LH) surges and on clinical outcomes of IVF-ET cycles.@*METHODS@#We retrospectively analyzed 2572 GnRH-ant cycles of fertilization and embryo transfer from January, 2013 to December, 2016, including 1368 cycles with cetrorelix treatment and 1204 cycles with ganirelix treatment. The baseline characteristics of the patients and the clinical outcomes of the two groups were compared.@*RESULTS@#Compared with those receiving ganirelix treatment, the patients with cetrorelix treatment had a significantly younger age (33.10 33.89 years, 0.05). The two groups also had comparable percentages of patients with LH > 10 U/L on the day of hCG triggering (3.7% 3.2%) and similar spontaneous ovulation rate (0.6% 0.5%), clinical pregnancy rate (47.7% 45.9%) and live birth rate (37.5% 33.6%) following fresh embryo transfer ( > 0.05). The incidence of moderate to severe ovarian hyperstimulation syndrome, however, was significantly higher in ganirelix group than in cetrorelix group (0.7% 0.1%, =0.006).@*CONCLUSIONS@#Cetrorelix and ganirelix can achieve comparable effects for preventing premature LH surges and can achieve similar clinical outcomes of GnRH-ant cycles, but ganirelix is associated with a significantly higher incidence of moderate to severe ovarian hyperstimulation syndrome.

Successful pregnancy in women with infertility following surgeries for gynecological malignancies: report of 3 cases and literature review / 南方医科大学学报

We report 3 cases of successful pregnancies in women with a history of surgeries for gynecological malignancies and postoperative infertility, achieved by in vitro fertilization-embryo transfer (IVF-ET) with controlled ovarian hyperstimulation. All the 3 patients had clinical pregnancies without cancer recurrence. In such cancer survivors with infertility, the ovarian reserve is severely impaired by cancer therapies and assisted reproductive techniques should be the primary option.

Effects of uterine adenomyosis on clinical outcomes of infertility patients treated with in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the effects of uterine adenomyosis on the clinical outcomes of infertility patients treated with in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET).</p><p><b>METHODS</b>A retrospective study was conducted of 61 IVF/ICSI-ET cycles as the study group, diagnosed with uterine adenomyosis by transvaginal ultrasound, and 164 IVF/ICSI-ET cycles of patients with tubal infertility as the control group. The baseline characteristics, ovary response and clinical outcomes were compared between the two groups.</p><p><b>RESULTS</b>The implantation rate, clinical pregnancy rate and live birth rate decreased significantly in the study group (P<0.05), and early abortion rate increased significantly (P<0.05). For patients with adenomyosis, GnRH-antagonist cycles tended to decrease clinical pregnancy rate and increase abortion rate (25.0% vs 45.0%, P=0.184; 66.7% vs 27.8%, P=0.247), and significantly decrease live birth rate (0% vs 30.8%, P=0.025), compared with GnRHa agonist cycles.</p><p><b>CONCLUSION</b>Uterine adenomyosis decreases implantation rate, clinical pregnancy rate and birth rate, and increases abortion rate significantly in patients with IVF/ICSI-ET. GnRH-antagonist cycles have adverse effects on the outcomes of adenomyosis; GnRH agonist long protocol cycles may increase clinical pregnancy rate and decrease abortion rate.</p>

Successful pregnancy following repeated implantation failure in patients with polycystic ovary syndrome: report of three cases / 南方医科大学学报

We report 3 cases of polycystic ovary syndrome (PCOS) in which the patients had successful pregnancy after repeated implantation failure in at least 8 in vitro fertilization and embryo transfer (IVF-ET) cycles. The patients were treated with gonadotropin-releasing hormone antagonist (GnRH-ant) protocol and gonadotropin-releasing hormone angonist (GnRHa) for triggering ovulation, and successful pregnancy and normal deliveries were achieved after 9 IVT-ET cycles. For young patients with PCOS but a good ovarian reserve and a high ovarian response, treatment with GnRH antagonist protocol and GnRHa alone with appropriate management of the factors that may affect implantation can prevent severe ovarian hyperstimulation syndrome to achieve favorable clinical outcomes.

Predictive value of anti-Mullerian hormone levels in serum and follicle fluid for IVF-ET outcomes in patients with polycystic ovarian syndrome / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the association of anti-Mullerian hormone (AMH) levels in the follicular fluid and serum with the outcomes of in vitro fertilization-embryo transfer (IVF-ET) cycles in patients with polycystic ovarian syndrome (PCOS).</p><p><b>METHODS</b>Serum and follicular fluid samples were obtained from 30 patients with PCOS and 34 healthy women (control) undergoing IVF/ICSI-ET in our center between October, 2007 and January, 2008. All the subjects received treatment with long luteal-phase down-regulation and controlled ovarian hyperstimulation protocol in IVF cycles, and their clinical characteristics were analyzed. The AMH levels in the serum and follicles fluid samples collected on the day of oocyte retrieval were assayed using an enzyme-linked immunosorbent assay (ELISA) kit.</p><p><b>RESULTS</b>The two groups showed no significant differences in the mean age, baseline levels of sex hormones, rate of high-quality embryos, implantation rate, pregnancy rate, abortion rate or ongoing pregnancy rate (P>0.05). Despite a significantly lower total gonadotropin dose, PCOS group had a significantly greater number of antral follicles than the control group (P<0.05). The recovery rates of oocytes in PCOS group were significantly lower than that in the control group (P<0.05). AMH levels in the serum and follicle fluid was significantly higher in PCOS group than in the control group (P<0.05), and in both groups, AMH levels in the follicular fluid were significantly higher in pregnant women than in non-pregnant women (P<0.05). AMH level in the follicular fluid was significantly correlated with the implantation rate in both PCOS and control groups (P<0.05).</p><p><b>CONCLUSION</b>AMH level in the serum and follicle fluid on the day of oocyte retrieval is predictive of the treatment outcome of controlled ovarian hyperstimulation in POCS patients but not of pregnancy outcomes after IVF-ET.</p>

Effects of oral dydrogesterone on clinical outcomes of frozen-thawed embryo transfer cycles / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effects of oral dydrogesterone for luteal phase support after frozen embryo transfer (FET) cycles on the clinical outcomes.</p><p><b>METHODS</b>A total of 1643 FET cycles in our center between January, 2010 and September, 2011 were analyzed. The patients were divided into group A with natural-cycle FET and group B with hormone replacement cycle (HRT-FET). The two groups were further divided into two subgroups to receive oral dydrogesterone (groups AI and BI, n=358 and 185, respectively) or intramuscular progesterone with progynova (groups AII and BII, n=634 and 466, respectively) as luteal phase support. The clinical pregnancy rates, implantation rates, early miscarriage rates, ectopic pregnancy rates, ongoing pregnancy rates and delivery rates were compared between the subgroups.</p><p><b>RESULTS</b>There were no significant differences in the clinical outcomes between the patients receiving dydrogesterone and intramuscular progesterone as luteal phase support in either natural-cycle FET or HRT FET (P>0.05).</p><p><b>CONCLUSION</b>In the FET cycles, oral dydrogesterone tablets for luteal support can achieve good clinical outcomes comparable with those by intramuscular progesterone and serves as a good alternative for luteal phase support.</p>

Estimation of ovarian response using multiple predictors of ovarian reserve in women undergoing in vitro fertilization-embryo transfer / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the value of ovarian reserve markers for predicting ovarian response in women undergoing in vitro fertilization-embryo transfer.</p><p><b>METHODS</b>According to the ovarian response, 331 patients undergoing oocyte retrieval cycles were divided into of normal, poor, and high response groups. Serum anti-Mvllerian hormone (AMH) was determined using AMH ELISA kit on day 3 of the menstrual cycle, antral follicle count (AFC) was measured using vaginal ultrasound, and basal serum follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E(2)) levels were detected using chemiluminescence method.</p><p><b>RESULTS</b>Serum AMH and FSH levels, FSH/LH ratio, AFC, and the patients age, but not the basal E(2) level (P>0.05), were correlated with the number of oocytes collected (×1000/ampules of Gn) (P<0.001). AFC and serum AMH were the strongest single predictors for low ovarian response, with the areas under curve (AUC) of 0.855 (0.787-0.924) and 0.832 (0.764-0.900) (P<0.05), and cutoff values of ≤9 and ≤1.88 ng/ml, respectively. AFC was the strongest single predictor for high ovarian response, with an AUC of 0.787 (0.728-0.847) and the cutoff value of ≥15. Logistic regression model found that the combination of AFC, serum AMH and FSH improved the predictive power for poor ovarian response, but not for high ovarian response.</p><p><b>CONCLUSION</b>AFC, serum AMH, FSH, FSH/LH, and age are all predictors of ovarian response, among which AFC is the strongest single predictor. A multivariable model can improve the predictive power for low ovarian response but not for high ovarian response.</p>

Regulation of invasion behavior of ERK-mediated trophoblast by focal adhesion kinase / 中南大学学报(医学版)

OBJECTIVE@#To investigate the role of focal adhesion kinase (FAK) in extracellular signal-regulated kinase (ERK) signaling pathway mediated invadsion of trophoblasts.@*METHODS@#We established a human extravillous cytotrophoblasts in vitro invasion model. Different concentrations of herbimycin A(FAK inhibitor)and PD98059 (ERK inhibitor) were given to observe the influence on the growth of trophoblast cells, FAK, ERK phosphorylation, and trophoblast invasion abilities.@*RESULTS@#The expression of phosphorylated FAK in the extravillous cytotrophoblasts (EVCT) was inhibited by herbimycin A in a concentration-dependent manner and expression of phosphorylated ERK1/2 was also partially reduced. PD98059 had no effect on the expression of phosphorylated FAK. Herbimycin A and PD98059 suppressed the in vitro invasion of EVCT to various degrees.@*CONCLUSION@#ERK signaling pathway may be the common pathway for many invasive signals,and play a key role in the regulation of trophoblast invasion.

Cost-effect Analysis of 3 Types of Chemotherapy Schemes for Small Cell Lung Cancer / 昆明医科大学学报

Objective To analyze the Cost-effect of small cell lung cancer by drug economics.Methods 55 patients of small cell lung cancer were devided into 3 groups,CAV,PE and GP scheme,we evaluated the cost and effect based on drug economics.Results The effectiveness rate of CAV was 50 %,the cost of CAV was 340.76 yuan(RMB),the cost of 1 % increasing of effectiveness rate was 6.82 yuan(RMB);The effectiveness rate of PE was 71.9%,the cost of PE was 755.26 yuan(RMB),the cost of 1% increasing of effectiveness rate was 10.5 yuan(RMB);The effectiveness rate of GP was 85.7%,the cost of GP was 12 372.04 yuan(RMB),the cost of 1% increasing of effectiveness rate was 144.36 yuan(RMB).Conclusion PE is the most reasonable chemotherapy scheme for small cell lung cancer.

Assessment of ovarian response with color Doppler ultrasonography in vitro fertilization-embryo transfer / 中华超声影像学杂志

8 oocytes) according to the number of oocytes collected in one ovary. On day of human chorionic gonadotrophin injection, PSV, EDV, PI, RI, S/D of ovarian stromal artery in the ovarian were detected and perifollicular vascularity were graded with color Doppler ultrasonography. Results Not only PSV and EDV of stromal artery but also perifollicular vascularity in low-response group was significantly lower than that of normal-response and high-response groups. PSV and EDV of ovarian stromal artery and perifollicular vascularity were highly interrelated with ovarian response. Conclusions The increase of PSV and EDV of ovarian stromal artery and perifollicular vascilarity indicate the improvement of perfusion in ovary and ovarian response.

Effects of leptin on estradiol and progesterone production by human luteinized granulosa cells in vitro / 中华妇产科杂志

Objective　To investigate the effects of leptin on steroidogenesis of human luteinized granulosa cell in vitro. Methods　Human luteinized granulosa cells were isolated from follicular fluid obtained during oocyte retrieval of in vitro fertilization-embryo transfer program and were cultured with M199 medium plus various concentration of leptin (0, 10, 30, 100, 300 ng/ml)，human menopausal gonadotropin (hMG, 0, 0.1, 0.2, 0.5, 1, 2, 5, 10 IU/ml) and testosterone 100 μg/ml. For 2 days the media were collected for estradiol and progesterone measurements. Results　Addition of leptin alone did not alter estradiol and progesterone production (P>0.05) by human luteinized granulosa cells. Leptin of 10～30 ng/ml concentrations caused a dose-dependent inhibition of estradiol production (P<0.05) while greater than 0.5 IU/ml of hMG were added. There was no effect of leptin on hMG -stimulated progesterone production (P>0.05). Conclusion　Leptin can directly inhibit hMG-stimulated estradiol production by human luteinized granulosa cells in vitro, but has no effect on progesterone production. Leptin may play an important role in follicle development and luteinization.

Study of the role of calcitonin during the embryo implantation / 中华妇产科杂志

Objective To observe the role of calcitonin (CT) during the implantation. Methods Human endometrial epithelial cells were cultured. After stimulated with various concentrations of CT, intracellular calcium(Ca 2+)in the epithelial and stroma cells and pre-embryos were measured by the laser scanning confocal microscope. Resutls When stimulated with different concentrations of CT, mean fluorescence levels in the epithelial cells were similar to that of the control. However CT can improve intracellar Ca 2+ of preimplantation embryos and stroma cells in a dose-dependent manner and significantly higher than those of controls. When 10 nmol/L CT was added to the culture medium, the intracellular Ca 2+ concentration in 8-cell embryos rose immediately. Embryo exposure to CT was followed by a series of Ca 2+ bursts that persisted for at least 2 hours. No change in Ca 2+ was observed when culture medium alone was added to the embryos. Pre-loading embryos and stoma cells with the Ca 2+ chelator,prevented the increased fluorescence after CT addition. Conclusions CT play an important role during the procesess of implantation. It maybe improve intracellar of preembryos and accerate the development of preembryos.

Expression of HOXA10 gene in human endometrium and its relationship with unexplained infertility / 中华妇产科杂志

Objective To study the expression of HOXA10 gene in the endometrium of normal fertile women and patients with unexplained infertility during different phases of menstrual cycle. Methods Endometrium samples were obtained by curettage in 52 normal fertile women and 38 patients with unexplained infertility during different phases of menstrual cycle, HOXA10 mRNA expression were detected by in situ hybridization and reverse polymerase chain reaction (RT-PCR). Results (1) HOXA10 mRNA were detected in the glandular and stromal cells of endometrium of fertile women during the menstrual cycle. By in situ hybridization (positive unite, PU), HOXA10 mRNA levels were significantly higher in the mid-secretory phase [glandular cells (G) 5.69?0.57,stromal cells (S) 7.48?0.67] and late-secretory phase(G 5.99?0.40,S 7.98?1.08) than those in late proliferative phase (G 3.35?0.20,S 3.20?0.37) and early secretory phase (G 3.07?0.26,S 3.18?0.27)(P

Function of vascular endothelial growth factor in ovarian hyperstimulation syndrome / 中华妇产科杂志

Objective To evaluate the function of vascular endothelial growth factor (VEGF) and other clinical indexes to forcast ovarian hyperstimulation syndrome (OHSS). Method Collecting the serum and follicular fluid (FF) of 42 cases in the in vitro fertilization and embryo transfer (IVF-ET) cycles and then analysis the relationship of the clinical and detected indexes between the OHSS (10 cases) and the non-OHSS (32 cases). Results The concentration of VEGF in FF?E 2 on the day of human chorionic gonadotropin (hCG) injection, basal luteinizing hormone (LH) and the number of ovum retried much higher in the OHSS than in the non-OHSS. Conclusions The concentration of VEGF in FF of OHSS cases is higher than that of controls, supporting the role of VEGF as a mediator of OHSS. Therefore VEGF in FF is a forcast index of OHSS.

The function of Hoxa - 10 gene in the reproductive system / 中国病理生理杂志

Hoxa gene plays an essential role in the generation and development of the human female reproductive system. This gene is expressed in the Mullerian duct and the adult female reproductive system. Expression of Hoxa10 dramatically increased during the midsecretory phase of the menstrual cycle, corresponding to the time of implantation. Female mice lacking Hoxa10 have a uterine factor defect that results in death of the preimplantation embryo and failure of implantation. These results suggest Hoxa10 may have an important function in implantation. Hoxa10 - deficient males exhibit cryptorchidism that lead to male infertility.

Expression of HLA-G mRNA and protein in ectopic and eutopic endometrium in patients with endometriosis / 解放军医学杂志

Objective To investigate the expression of human leucocyte antigen-G (HLA-G) in the endometrium of patients with endometriosis (EM). Methods The expression of HLA-G protein was detected in ovarian endometriosis (OEM) and adenomyosis (AM) using immunohistochemistry method, and the expression of HLA-G mRNA was detected using in situ hybridization technique (ISH), to compare with that in the endometrium of hysteromyoma as the control group. Results The rate of positive HLA-G expression in EM (including AM and OEM) was significantly higher than that in control group (P0.05). The expression of HLA-G protein showed no relation with different clinical phase or different endometrial cycle. Conclusion HLA-G is overexpressed in EM, which may play certain role in the pathogenesis of the disease.