Neonatal outcomes of pregnancy resulting from in vitro fertilization and embryo transfer: analysis of 1274 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the neonatal outcomes of pregnancies resulting from in vitro fertilization and embryo transfer (IVF-ET) in relation to the occurrence of congenital malformations of the neonates.</p><p><b>METHODS</b>A total of 1274 infants born after IVF-ET were reviewed. The neonatal outcome was evaluated based on gestational weeks, body weight, congenital malformations, manner of spermatization, maternal age and multiple gestation.</p><p><b>RESULTS</b>IVF-ET resulted in 930 deliveries, giving birth to a total of 1274 newborns. Spontaneous delivery occurred in 115 cases (12.37%), with preterm birth in 224 cases (24.09%). Among these newborns, 363 (28.49%) had very low born weight (VLBW), 13 (1.02%) had congenital malformations, and neonatal mortality occurred in 15 cases (1.18%).</p><p><b>CONCLUSION</b>IVF increases the risks of twin pregnancies, preterm birth and VLBW, but does not increase the rate of congenital malformations and neonatal mortality. Intracytoplasmic sperm injection (ICSI) is at higher risk of congenital malformations. Maternal age and twin pregnancies are not associated with congenital malformations. IVF can be safe for treatment of infertility.</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>

Comparison of clinical outcomes of four protocols for frozen-thawed embryo transfer cycle / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the clinical outcome of 4 protocols of frozen-thawed embryo transfer cycle to select the optimal endometrial preparation method for frozen-thawed embryos transfer.</p><p><b>METHODS</b>A retrospective analysis of the 4 clinical protocols was conducted including natural cycle, down-regulated hormone replacement treatment (HRT) cycle, hMG cycle and natural cycle+hCG in endometrial preparation for 419 frozen-thawed embryos transfer cycle, and the clinical pregnancy rate, implantation rate, early abortion rate, ectopic pregnancy rate , ongoing pregnancy rate and delivery rate were compared between the 4 protocols.</p><p><b>RESULTS</b>There was no significant difference between the 4 groups with different clinical protocols in age, duration of infertility, reason of infertility, number of embryo transferred and endometrial thickness. The 4 protocols differed little in the implantation rate, clinical pregnancy rate, biochemical pregnancy rate, early abortion rate, ectopic pregnancy rate, ongoing pregnancy rate and delivery rate in the four clinical protocols.</p><p><b>CONCLUSION</b>The 4 clinical protocols for frozen-thawed embryos transfer all have favorable clinical outcome, and choice of a specific protocol should be made according to the a comprehensive consideration of the individual conditions of the patient.</p>

Combined use of methotrexate and mifepristone for ectopic pregnancy management: a meta- analysis / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the clinical effect and safety of combined use of methotrexate and mifepristone for treatment of ectopic pregnancy.</p><p><b>METHODS</b>By searching in the major databases of CNKI, CBMdisk and Pubmed according to the criteria of evidence-based medicine, we collected data of randomized controlled trials pertaining to combined use of methotrexate and mifepristone in the treatment of ectopic pregnancy.</p><p><b>RESULTS</b>Twenty-three randomized controlled trials involving totally 1 706 patients were collected according to the inclusion criteria, and meta-analysis of the data indicated that combined use of methotrexate and mifepristone can be of great value in the management of ectopic pregnancy in comparison with exclusive use of methotrexate [ combined odds ratio (OR) was 2.84 with 95%confidence interval [CI] (2.18, 3.69), Z=7.79, P<0.000 01].</p><p><b>CONCLUSION</b>The clinical evidence derived from the analysis suggests that the combination of methotrexate and mifepristone for ectopic pregnancy management can be effective with good safety security and minimal side effects, but still, this conclusion needs further verification by randomized, double-blind, and controlled trials with larger sample size and more rigorous trial design.</p>