ABSTRACT
Objective To investigate clinical effect and safety of in vitro maturation(IVM)of human immature oocytes in infertile women with polycystic ovary syndrome by comparing with conventional in vitro fertilization(IVF)and intracytoplasmic sperm injection(ICSI).Methods From Jan.2003 to Dec.2009,157 infertile women with PCOS underwent 162 cycles IVM in Center for Reproductive Medicine,the First Affiliated Hospital of Anhui Medical University.In the mean time,109 patients with PCOS underwent 114 IVF/ICSI cycles as control group 1 and 106 patients with other factors underwent 106 IVF/ICSI cycles as control group 2.Treatment and outcome of pregnancy and infant were compared among those 3 groups.Results No statistically significant difference were found in terms of the positive rate of hCG in urine[35.7％(56/157),42.2％(46/109),44.3％(47/106)],the rate of clinical pregnancy[29.3％ (46/157),37.6％(41/109),41.5％(44/106)],the rate of entopic pregnancy[1.9％(3/157),1.8％ (2/109),0.9％(1/106)],the rate of miscarriage[18.6％(8/43),12.8％(5/39),20.9％(9/43)]and the rate of live-birth[22.3％(35/157),31.2％(34/109),32.1％(34/106)]among three grbups(IVM group,control group 1,control group 2,P ＞ 0.05).The rate of preterm labor,low weight newborn,mean birth weight,ratio of male to female did not show significantly difference among 3 groups(P ＞ 0.05).The average control ovarian stimulation was 6 days,the median dose of gonadotropin(Gn)was 675 IU,and the total hospital cost was(8392 ± 1328)RMB in IVM group,which were statistically lower than those in the other two control groups(P ＜ 0.01).The rate of multiple pregnancy was 4.7％(2/43)and ovarian hyperstimulation syndrome(OHSS)0 in IVM group,which were significantly lower than those in the other control group(P ＜0.01).Conclusion In vitro maturation is an effective treatment in infertile women with PCOS,it could obtain the similar pregnancy outcome and reduce total cost,the dosage of gonadotropinreleasing hormone and rate of OHSS compared with conventional IVF/ICSI.
ABSTRACT
Objective To evaluate the association between recurrent miscarriages and insulin resistance.Methods The case-control studies on the association between recurrent spontaneous abortion and insulin resistance from June 1996 to April 2012 were collected from Medline,Elsevier,Chinese Journal Fulltext Database,Chinese Biological Medicine Database,data base of Wanfang,Springer link and EMBASE.RevMan 5.1 software was used for Meta analysis.Results According to the included criteria,7 clinical trials were finally selected.Total 467 cases with recurrent pregnancy loss were enrolled in study group,while 413 women with no history of abnormal pregnancies were enrolled in control group.No significant difference was found in average age and body mass index between the two groups (P ＞ 0.05).Meta analysis results showed that the level of fasting glucose was no statistical difference between study group and control group (WMD =2.27,95％ CI:-1.11 to 5.65,P ＞0.05); fasting insulin level was higher 2.05 mU/L in study group than that of in control group,the difference was statistically significant (WMD =2.05,95％ CI:1.03 to 3.08,P ＜ 0.01).Case number of study group on Homa-insulin resistance ＞ 4.5 was more than that of control group (OR =3.36,95％ CI:1.72 to 6.57,P ＜ 0.01).Case number of study group on glucose/insulin ratio ＜ 4.5 was more than that of the control group,statistical difference was found (OR =3.37,95％ CI:1.90 to 5.99,P ＜ 0.01).Conclusion Insulin resistance is associated with the susceptibility to recurrent miscarriages,and it may contribute to the occurrence of recurrent miscarriages.