A quasi-randomized controlled trial of Ninjin'yoeito for the treatment of postpartum anemia and the prevention of postpartum depression.

AIM: To study the effect of Ninjin'yoeito (NYT) on postpartum anemia and on the development of postpartum depression (PPD). METHODS: In this prospective, single-center, open-label, quasi-randomized controlled trial, patients with anemia 1-2 days postdelivery were randomized to receive either NYT or an oral iron preparation for 4 weeks. The primary endpoint was the hemoglobin (Hb) level. Secondary endpoints were fatigue (assessed by the numerical rating scale [NRS]) and prevalence of postpartum depressive symptoms, as defined by an Edinburgh postnatal depression scale (EPDS) score ≥9. Hb levels and fatigue were measured before, and 4 weeks after, treatment and the EPDS was measured 4 weeks posttreatment. RESULTS: Of 1066 participants (NYT group: 532, iron group: 534) 1061 (NYT group: 529, iron group: 532) underwent full analysis. The Hb level increased significantly in both groups (p < 0.001), and there were no significant differences between the groups in terms of the change in Hb levels (NYT: 2.4 ± 0.8 g/dL vs. iron: 2.5 ± 0.7 g/dL, p = 0.098). Fatigue decreased significantly in the NYT group (p < 0.001) but did not change in the iron group, and the difference was significant (p < 0.001). There was a significant difference between the two groups in terms of the prevalence of postpartum depressive symptoms (NYT: 5.7% vs. iron: 9.4%, odds ratio [OR] = 0.58, 95% confidence interval [CI] = 0.36-0.93). CONCLUSION: The results suggest that NYT improves postpartum anemia and fatigue, and may be able to prevent the development of PPD.

Poor pregnancy outcome following assisted reproductive technology among women operated on for bilateral endometriomas.

Purpose: To determine the first line of infertility treatment for managing patients with unilateral or bilateral ovarian endometriomas. Methods: We evaluated pregnancy outcome in patients who had received ovarian surgery for unilateral (Group U, n = 47) or bilateral endometriomas (Group B, n = 38) and aspiration with or without alcohol fixation for unilateral (Group u, n = 37) or bilateral endometriomas (Group b, n = 22). Subsequently, 64 of these women, excluding 29 dropouts, underwent assisted reproductive technology. We compared the clinical pregnancy rates of the four groups. Results: The cumulative pregnancy rate after operation of Group B (18%) was significantly lower than that of a cyst-free control group (n = 143; 44%) and Group U (43%). Group B had fewer oocytes fertilized during ART than did Group b (P < 0.005) and fewer blastocysts available for transfer (P < 0.005). The cumulative pregnancy rate of Group B was also lower than in Group b (P = 0.052). Conclusions: Pregnancy outcomes of Group B were not better than for Group b. Therefore, encouraging such women to move directly to ART might help avoid ovarian damage and improve their ability to achieve a pregnancy.

Elective cryopreservation of all day 5 blastocysts is more effective than using day 6 blastocysts for improving pregnancy outcome in stimulated cycles.

Aim: To evaluate the efficacy of cryopreservation of all blastocysts for future transfers in stimulated cycles. Methods: We carried out fresh blastocyst transfer cycles on day 5 (n = 290) or day 6 (n = 119) and thawed blastocyst transfer cycles that were frozen on day 5 (n = 136), day 6 (n = 71) or day 6 electively (n = 21). We retrospectively compared the clinical outcome of fresh blastocyst transfers with thawed blastocyst transfers according to the day of blastocyst transfer or freezing. Results: The clinical implantation rates in women with stimulated cycles were significantly higher after the transfer of thawed blastocysts compared with the transfer of fresh blastocysts (day 5, P < 0.0005; day 6, P < 0.00005). Although the implantation rate of fresh day 6 transfer cycles was lower than that of elective day 6 frozen-thawed cycles, this difference was not statistically significant (P = 0.17). Conclusions: Thawed blastocysts demonstrated a better potential for implantation when compared with fresh blastocysts in stimulated cycles. We concluded that elective cryopreservation of all blastocysts on day 5 is an effective option to improve the clinical outcome in stimulated cycles. Additionally, with cryopreservation of all day 6 blastocysts, the implantation rates of first embryo transfers may increase by allowing the best-quality blastocysts to be transferred in thawed cycles. (Reprod Med Biol 2008; 7: 75-83).

Beneficial effect of long zona dissection on frozen-thawed blastocysts at a young age.

Aim: To assess the appropriateness of assisted hatching using long zona dissection of human frozen-thawed blastocysts at the time of warming, especially in women over 35 years of age or with repeated implantation failures. Methods: Of 177 frozen-thawed blastocyst transfer cycles, 89 control cycles had an intact zona and 88 cycles had assisted hatching using long zona dissection of human thawed blastocyst at the time of warming. These two groups were further subdivided by age to a total of four subgroups: ≤34 years (assisted hatching, n = 39; controls, n = 39) and ≥35 years (assisted hatching, n = 49; controls, n = 50). Twenty-seven cycles in the control group and 28 cycles in the assisted-hatching group had repeated implantation failures. The clinical and ongoing pregnancy rates and the implantation rate between the two groups were analyzed retrospectively. Results: The clinical pregnancy and implantation rates in women ≤34 years were significantly higher after the application of assisted hatching compared with the control group (87.2% and 71.2%vs 56.4% and 46.6%, P < 0.001). The clinical pregnancy and implantation rates of women with repeated implantation failures were higher after the application of assisted hatching compared with the control group (64.3% and 46.3%vs 48.1% and 34.1%), but this difference was not statistically significant. Conclusions: Routine assisted hatching using long zona dissection at the time of warming on frozen-thawed blastocysts is a safe and easy method to perform and is extremely beneficial for increasing the pregnancy rate in young women ≤34 years of age, but not in women ≥35 years of age. Despite increased pregnancy and implantation rates in patients with repeated implantation failures, statistical significance was not achieved. (Reprod Med Biol 2007; 6: 211-218).