Pregnancy and obstetric outcomes of fresh embryo transfer versus frozen-thawed embryo transfer in women below 35 years of age / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the obstetric and perinatal outcomes between fresh embryo transfer (ET) and frozen-thawed ET (the "freeze-all" strategy) and evaluate the benefits of the "freeze-all" embryo strategy for young patients.</p><p><b>METHODS</b>We reviewed a total of 2091 ET cycles performed between January, 2011 and December, 2015 in women aged 20-35 years, including 1295 fresh ET cycles and 796 frozen-thawed ET cycles. The demographic characteristics, ovarian stimulation syndrome, clinical pregnancy rates, live birth rate and the obstetric outcomes (gestational age, preterm delivery rate and mean birth weight) were compared between the two groups.</p><p><b>RESULTS</b>The mean age of the patients receiving frozen-thawed ET cycles had a significantly younger age than those having fresh ET cycles (29.5 vs 30.2 years, P<0.05); the patients undergoing frozen-thawed ET cycles also had significantly higher estradiol level on the day of trigger (12 973 pmol/L vs 8673 pmol/L) and a greater oocyte number retrieved (12.7 vs 8.7). The incidence of severe ovarian hyperstimulation syndrome was significantly lower in patients with frozen ET than those with fresh ET (P<0.05). No significant differences were found in the pregnancy rate (59.5% vs 56.0%; P>0.05), live birth rate (50.3% vs 47.0%; P>0.05), mean birth weight or gestational age between the two groups.</p><p><b>CONCLUSIONS</b>The freeze-all policy produces similar pregnancy and obstetric outcomes with those of fresh ET. Our results support the hypothesis that the freeze-all strategy help to prevent OHSS with a good pregnancy rate.</p>

Effects of luteinizing hormone supplementation on outcomes of in vitro fertilization and embryo transfer in patients undergoing GnRH-agonist long protocol / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the clinical outcomes of in vitro fertilization and embryo transfer (IVF-ET) among patients in different conditions receiving luteinizing hormone supplementation in GnRH-agonist long protocol.</p><p><b>METHODS</b>Between June, 2010 and December, 2015, 671 IVF-ET cycles with GnRH-agonist long protocol were performed at our center. These cycles were divided into group A with FSH only and group B with FSH and recombinant luteinizing hormone (r-LH) supplementation, and each group was divided into 4 subgroups according to age (<35 or ≥35) and the LH level on the initial day (<1.0 U/L or ≥1.0 U/L). The effects of LH supplementation on the clinical pregnancy rate and implantation rate were compared among different subgroups.</p><p><b>RESULTS</b>No statistical significances were found between groups A and B in age, body mass index (BMI), basal FSH, basal LH, basal E2, Gn dosage, Gn day, LH on HCG day, E2 on HCG day, P on HCG day, number of oocytes, fertilization rate, available embryo rate or good quality embryo rate per oocyte, but the endometrium thickness on HCG day differed significantly between the two groups. In women below 35 years of age with a LH level on HCG day over 1.0 U/L, r-LH supplementation resulted in a clinical pregnancy rate of 60%, significantly lower than the rate of 79.55% in women without r-LH supplementation (P<0.05). In women over 35 years with a LH level below 1.0 U/L, r-LH supplementation resulted in an implantation rate of 44.74%, as compared with 24.74% in women without r-LH supplementation (P<0.05).</p><p><b>CONCLUSION</b>In the long protocol, LH supplementation does not improve the oocyte number, fertilization rate, or good quality embryo per oocyte, and does not bring benefits to women below 35 years with a low LH level (<1.0 U/L) or those over 35 years with normal LH level (≥1.0 U/L) after GnRH-agonist administration. But for women over 35 years with low LH levels, r-LH supplementation may improve the clinical pregnancy rate and implantation rate of IVF-ET cycles.</p>

Pregnancy and obstetric outcomes of elective single versus double cleavage-stage embryo transfer / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the pregnancy and obstetric outcomes in elective single versus two cleavage-stage embryo transfer.</p><p><b>METHODS</b>Fresh cleavage-stage embryo transfer cycles between January, 2014 and October, 2015 were reviewed, including 39 single embryo transfer (eSET) cycles and 200 double embryo transfer (DET) cycles. The clinical pregnancy rates, implantation rates, multiple pregnancy rates, live birth rate, and obstetric outcomes (gestational age, preterm delivery rate and mean birth weight) were compared between the two groups.</p><p><b>RESULTS</b>The baseline characteristics were comparable between the two groups. The estradiol level on the day of trigger and the oocyte number were significantly higher in eSET group than in DET group (10654.4 pmol/L vs 8284.2 pmol/L and 8.4 vs 7.0, respectively). No significant difference was found in the pregnancy rate (56.4% vs 66.0%) or live birth rate (48.7% vs 51.5%) between the two groups, and their implantation rates differed significantly (56.4% vs 37.8%). No multiple pregnancies occurred in eSET group while the rate of multiple pregnancies was 22.7% in DET group. The gestational age and mean birth weight were significantly higher in eSET group (P<0.05), and the preterm delivery rate after DET was nearly three times of that after eSET, although this difference was not statistically significant.</p><p><b>CONCLUSIONS</b>Elective single embryo transfer can be performed without compromising the live birth rates. Multiple pregnancy rates can be significantly reduced with eSET, which also results in a higher chance of delivering a term singleton live birth compared with DET.</p>

Gonadotrophin dose and ovarian response: relations to the clinical outcome of in vitro fertilization and embryo transfer / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the association of gonadotrophin (Gn) dose and ovarian response with the clinical outcome of in vitro fertilization and embryo transfer (IVF-ET).</p><p><b>METHODS</b>Patients undergoing IVF-ET with Gn stimulation for no more than 15 days were enrolled in this study. The patients were divided into 3 groups, namely group A (390 cycles) with total Gn dose :3375 IU and retrieved oocytes:4, group B (64 cycles) with total Gn dose :3375 IU and retrieved oocytes < or =3, and group C (97 cycles) with total Gn dose< or =3300 IU and retrieved oocytes< or =3. The clinical characteristics and outcomes of these 3 groups were comparatively analyzed.</p><p><b>RESULTS</b>The clinical pregnancy rate and delivery rate were 38.8% and 32.5% in group A, 16.7% and 10.4% in group B, and 27.3% and 23.4% in group C, respectively. The follicle number, oocyte number, number of embryo transferred, peak serum E2 level, clinical pregnancy rate and delivery rate were significantly higher in group A than in groups B and C (P<0.05). Groups B and C had similar follicle number, oocyte number, and number of available embryos, but group C had significantly lower total Gn dose (P<0.05); the peak serum E2 level, clinical pregnancy rate and delivery rate were lower in group B than in group C, but the difference was not statistically significant (P>0.05).</p><p><b>CONCLUSIONS</b>In patients receiving a relatively low dose of Gn with smaller number of retrieved oocytes, Gn dose increment can improve the clinical pregnancy rate and delivery rate, suggesting a state of relatively poor ovarian response or mild ovarian reserve decrease; failure of increasing the number of oocytes retrieved with greater Gn dose suggests severely decreased ovarian responsiveness or ovarian reserve and also poor clinical prognosis.</p>

Influence of chronic HBV infection in the husband on the outcome of IVF-ET treatment / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the outcome of in vitro fertilization and embryo transfer (IVF-ET) in couples with the husband positive for chronic infection of hepatitis B virus (HBV).</p><p><b>METHODS</b>This study involved 102 infertile couples receiving IVF-ET with the husbands(but not the wives) positive for hepatitis B surface antigen (HBsAg), and another 204 couples negative for HBsAg receiving the treatment served as the control group. The cumulative embryo score, fertilization rate, cleavage rate, rate of good quality embryos, implantation rate, clinical pregnancy rate, first trimester and late miscarriage rates, delivery rate, and neonatal malformation rate were recorded and compared between the two groups.</p><p><b>RESULTS</b>Between the HBsAg-positive and the control groups, the cumulative embryo score (52.8-/+18.7 vs 55.4-/+16.9), insemination rate (66.9% vs 66.1%), cleavage rate (97.6% vs 97.2%), rate of good quality embryos (34.0% vs 37.1%), implantation rate (40.9% vs 34.6%), clinical pregnancy rate (56.9% vs 50%), first trimester miscarriage rate (6.9% vs 5.9%) and late pregnancy miscarriage rate (8.6% vs 4.9%), delivery rate (40.2% vs 43.6%) and neonatal malformation rate (0 vs 0) were all similar (P>0.05;).</p><p><b>CONCLUSION</b>Chronic HBV infection in the husband might not affect the outcome of IVF-ET treatment.</p>

Clinical application of gonadotropin-releasing hormone antagonist in Chinese women undergoing controlled ovarian hyperstimulation for in vitro fertilization and embryo transfer / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the clinical characteristics and cycle outcome of Chinese women with gonadotropin-releasing hormone (GnRH) antagonist treatment during controlled ovarian hyperstimulation (COH) for in vitro fertilization and embryo transfer (IVF-ET).</p><p><b>METHODS</b>A retrospective review was conducted in patients who completed 54 consecutive cycles of IVF-ET with GnRH antagonist treatment for luteinizing hormone (LH) surge prevention. Descriptive statistics were recorded for the patients' age, GnRH treatment duration (days) and dose, timing and duration of GnRH antagonist treatment, serum E2 and LH level on the day of antagonist use and hCG injection, number of oocytes retrieved, and clinical pregnancy rate.</p><p><b>RESULTS</b>The clinical pregnancy rate was 46.2% per ET cycle for GnRH antagonist group and 56.8% in GnRH agonist group, showing no significant difference between the two protocols. The age of the patients with GnRH antagonist averaged 35.7-/+3.8 years. Gn and GnRH antagonist treatment lasted for 8.5-/+1.6 and 4.5-/+1.1 days, respectively. On the day of ovulation triggered by hCG, the serum estradiol level was 1616.7-/+721.1 pg/ml, and a mean of 7.4-/+4.6 oocytes was collected per retrieval. The number of the embryos transferred was 2.4-/+0.6, with an implantation rate of 27.7%, resulting in a clinical pregnancy rate of 50.0% in the fixed protocol (antagonist initiation on day 4 or 5 of stimulation) and 37.5% in the flexible protocol (antagonist treatment initiated for a follicle of 12-15 mm, on day 6 to 9 of stimulation).</p><p><b>CONCLUSIONS</b>GnRH antagonists treatment results in good outcomes and can be safe, short, convenient and effective for Chinese women undergoing COH for IVF. GnRH antagonist treatment can be initiated on day 4 to 9 of Gn stimulation to obtain comparable pregnancy rate.</p>