Effect of maternal age on the outcomes of in vitro fertilization and embryo transfer (IVF-ET)

This is a retrospective, observational study to evaluate the effect of maternal age on the outcomes of in vitro fertilization and embryo transfer (IVF-ET). 11830 IVF-ET cycles from 10268 women were included. Four groups of different maternal age periods were compared. The groups were 21?C30 years old group (4549 cycles), 31?C35 years old group (4424 cycles), 36?C40 years old group (2429 cycles), and over 40 years old group (428 cycles). The mean starting dose of Gn and mean total dose of Gn in each cycle were significantly higher (P<0.01), while the mean retrieved oocyte number was significantly lower (P<0.01) in groups of higher maternal age period than those in each of the lower groups. The biochemical pregnancy rate and the clinical pregnancy rate were significantly lower (P<0.01), while the miscarriage rate was significantly higher (P<0.01) in groups of higher maternal age period than those in the lower groups. No difference was found in two-pronuclear zygotes (2PN) rate and good quality embryo rate among different groups. Birth defect rate was also comparable in the born babies in different groups. In the group with patients?? age over 40 years old, the pregnancy rate was 26.87%, the clinical pregnancy rate was 19.39%, while the miscarriage rate after clinical pregnancy was 36.14%. To draw the conclusion, patients with higher maternal age had worse IVF outcomes. In women of fertile age, patients between 20 and 30 years old have the best IVF outcomes. Patients over 40 years old have poor IVF outcome and high miscarriage rate, which suggested the necessity of preimplantation genetic screening (PGS).     

通元针法对IVF-ET反复种植失败患者妊娠结局、性激素和焦虑抑郁影响的前瞻性随机对照研究

摘要 目的：观察通元针法对体外受精-胚胎移植（IVF-ET）反复种植失败（RIF）患者妊娠结局、性激素和焦虑抑郁影响。方法：前瞻性选取广州中医药大学第一附属医院2019年5月到2021年4月期间收治的IVF-ET RIF患者122例，采用随机数字表法将其分为对照组（61例，常规治疗）和研究组（61例，对照组的基础上接受通元针法治疗）。观察两组临床妊娠率、胚胎种植率，记录治疗期间不良反应发生情况，观察治疗前后子宫内膜厚度和子宫内膜血流参数、性激素和焦虑抑郁的变化情况。结果：研究组的临床妊娠率、胚胎种植率高于对照组（P<0.05）。治疗后，研究组孕酮、雌二醇水平高于对照组（P<0.05）。治疗后，研究组的子宫内膜血流搏动指数（PI）、子宫内膜血流阻力指数（RI）、子宫内膜血流收缩期最高血流速度/舒张末期血流速度（S/D）较治疗前降低，且低于对照组，子宫内膜厚度较对照组更厚（P<0.05）。治疗后，研究组Zung焦虑自评量表（SAS）、Zung抑郁自评量表（SDS）评分低于对照组（P<0.05）。两组不良反应发生率组间对比，无统计学差异（P>0.05）。结论：通元针法用于IVF-ET RIF患者，可有效调节人体性激素，缓解焦虑抑郁心情，改善妊娠结局，安全可靠。     

年轻POR女性拮抗剂方案与长方案的新鲜移植周期临床妊娠结局的比较分析

目的:比较分析拮抗剂方案与长方案对年轻卵巢低反应(POR)女性体外受精(IVF)新鲜移植周期临床妊娠结局的影响,以探讨拮抗剂方案的应用价值。方法:回顾性分析2014年1月至2017年6月在广东省妇幼保健院生殖中心行体外受精-胚胎移植(IVF-ET)治疗的204例妇女213个IVF新鲜移植周期的临床资料。按随机数字表法分为拮抗剂组83例(84治疗周期)与长方案组121例(129治疗周期),比较两组一般资料、实验室资料、促排卵资料及妊娠结局的差异。结果:拮抗剂组的窦卵泡计数(AFC)、抗苗勒氏激素(AMH)水平、促性腺激素(Gn)使用天数、Gn总量、HCG日雌二醇(E2)水平、HCG日内膜厚度、移植日内膜厚度、获卵数、成熟卵子数及正常受精数低于长方案组,基础FSH/LH、Gn启动量高于长方案组(P0.05),但两组优质胚胎数、移植胚胎数、移植囊胚比例、冷冻胚胎数、胚胎种植率及早期自然流产率比较均无统计学差异(P0.05)。拮抗剂组和长方案组的临床妊娠率较高,分别为58.14%和63.10%,但是两组临床妊娠率比较无统计学差异(P0.05)。结论:给予年轻POR患者两种方案均可获得较满意的IVF新鲜移植周期临床妊娠结局,拮抗剂方案获卵数较长方案少,但是其优势在于Gn使用量更少,使用时间更短。     

Impact of endometriosis on embryo quality and endometrial receptivity in women undergoing assisted reproductive technology

ART is an important treatment method for infertile patients with endometriosis. However, the effects of endometriosis on embryo quality and endometrial receptivity remain unclear. Thus, we aimed to simultaneously investigate the impact of endometriosis and its stage on embryo quality and endometrial receptivity in women undergoing ART. We retrospectively analyzed the data from patients with and without endometriosis who underwent oocyte retrieval and/or high-quality embryos transfer between July 2015 and December 2020, including 1312 IVF cycles and 608 IVF or frozen-thawed embryo transfer (FET) cycles, respectively. The endometriosis group had a lower percentage of good cleavage-stage embryos and fertilization rates than those in the control group (p = 0.038 and 0.008, respectively). The number of retrieved oocytes, MII oocytes, cleavage, blastocysts, and blastulation rates was comparable between two groups. We found no significant difference in clinical pregnancy, implantation, live birth, miscarriage, or multiple pregnancy rates between the two groups among patients who transferred high-quality embryos. Stratification analysis showed that patients with stage III-IV endometriosis had fewer retrieved oocytes than those with stage I-II endometriosis (p = 0.012) and marginally fewer retrieved oocytes than the control group (p = 0.051). The stage I-II group had the lowest percentage of good cleavage-stage embryos, which was significantly lower than that of the control group (p = 0.043). In FET cycles, patients with stage III-IV endometriosis had a higher miscarriage rate than those in the control group (p = 0.023). Our results suggest that endometriosis does not alter endometrial receptivity but affects embryo quality, oocyte fertilization ability, and ovarian response.     

Impact of highly purified versus recombinant follicle stimulating hormone on oocyte quality and embryo development in intracytoplasmic sperm injection cycles

The quality of oocytes and developing embryos are the most relevant factors determining the success of an in vitro fertilization (IVF) treatment. However, there are very few studies analyzing the effects of different gonadotrophin preparations on oocyte and embryo quality. A retrospective secondary analysis of data collected from a prospective randomized study was performed to compare highly purified versus recombinant follicle stimulating hormone (HP-FSH vs. rFSH). The main outcome measures were quantity and quality of oocytes and embryos, dynamics of embryo development, cryopreservation, clinical pregnancy and live birth rate. The number of retrieved and of mature (MII) oocytes showed no significant differences. Fertilization rate was significantly higher in the HP-FSH group (68.9% vs. 59.9%, p = 0.01). We also found significantly higher rate of cryopreserved embryos per all retrieved oocytes (23.4% vs. 14.5%, p = 0.002) in the HP-FSH group. There were no significant differences in clinical pregnancy and in live birth rates. Oocytes obtained with HP-FSH stimulation showed higher fertilisability, whereas pregnancy and live birth rates did not differ between the groups. However, patients treated with HP-FSH may benefit from the higher rate of embryos capable for cryopreservation, suggesting that cumulative pregnancy rates might be higher in this group.     

Single embryo transfer in IVF to prevent multiple pregnancies.

As the success rates of IVF clinics improve, one of the adverse consequences is the increased incidence of twins, due largely to the number of embryos transferred. Even if the number of embryos transferred is restricted to two, the twinning rate can exceed 40% of the pregnancies. An obvious way to reduce this high twin rate would be to transfer only one embryo. This would require that cryopreservation of the supernumerary embryos be efficacious enough so that the chance of achieving an ongoing pregnancy is not diminished by transferring a single embryo in the stimulated cycle. Previous studies utilising embryos on day 2 and 3 of development have shown that the pregnancy rates can be acceptable (about 40%) and that the cumulative rate can be up to 60%. Most of these studies, however, do not include a comparison with the cumulative pregnancy rate with two embryos transferred in the stimulated cycle. Therefore, the efficacy has not been proven. We present clinical data from the past few years to illustrate the increase in success rates and the concomitant increase in twinning rates. The increased success in the cryopreservation program has enabled us to trial a single embryo transfer program and compare the results to the transfer of two embryos. The results strongly suggest that the transfer of a single embryo is the better clinical option.     

The use of embryo transfer to produce pregnancies in repeat-breeding dairy cattle

Repeat breeding is an important factor affecting economic success in dairy management. The objective of this study was to investigate the effectiveness of transfer of frozen-thawed IVF embryos in establishing pregnancy in repeat-breeding Holstein cattle. Cumulus oocyte complexes were collected by aspiration of 2-5 mm follicles from ovaries obtained at two local abattoirs. After IVF, days 7 and 8 blastocysts were frozen either in 1.5M ethylene glycol with 0.1M sucrose, or in 1.4M glycerol with 0.1M sucrose. Holstein recipients (122 heifers and 410 cows) included those that had not conceived after 3-21 inseminations. Embryos frozen in ethylene glycol were transferred directly, and embryos frozen in glycerol were transferred after dilution of the cryoprotectant in sucrose into recipients 7 or 8 days after estrus (without-AI group), or following AI (with-AI group). Pregnancy rates were compared by the Chi-square test. Significantly higher pregnancy rates were achieved by embryo transfer following AI (with-AI group) than by embryo transfer alone (without-AI group) in both heifers (49.2 and 29.5%, respectively) and cows (41.5 and 20.4%, respectively; P<0.05). Pregnancy rates were not significantly different between heifers and cows. However, pregnancy rate decreased as the number of inseminations prior to embryo transfer increased in the with-AI group, but not in the without-AI group. Therefore, transfer of frozen-thawed IVF embryos during the same cycle in which AI was done improved pregnancy rates in repeat-breeding Holstein heifers and cows, and suggested that embryo transfer is an alternative in the treatment of repeat breeding.     

游离睾酮指数联合血清GnSAF、SHBG对多囊卵巢综合征不孕患者IVF-ET治疗妊娠结局的预测价值

摘要 目的：探讨游离睾酮指数（FAI）联合血清促性腺激素平抑因子（GnSAF）、性激素结合球蛋白（SHBG）对多囊卵巢综合征（PCOS）不孕患者体外受精-胚胎移植（IVF-ET）治疗妊娠结局的预测价值。方法：选取2020年1月～2022年6月湖南省妇幼保健院生殖医学中心收治的197例PCOS不孕患者为PCOS组,根据IVF-ET治疗妊娠结局分为妊娠失败组和妊娠成功组,另选取同期68名体检健康妇女为对照组。收集PCOS不孕患者临床资料,计算FAI并检测血清GnSAF、SHBG水平。采用单因素和多因素Logistic回归分析PCOS不孕患者IVF-ET治疗妊娠结局的影响因素,采用受试者工作特征（ROC）曲线分析FAI和血清GnSAF、SHBG对PCOS不孕患者IVF-ET治疗妊娠结局的预测价值。结果：PCOS组FAI和血清GnSAF水平高于对照组,SHBG水平低于对照组（P＜0.05）。197例PCOS不孕患者IVF-ET治疗妊娠成功率为51.27%（101/197）。单因素分析显示,妊娠失败组体质指数、黄体生成素（LH）、LH/促卵泡生成素（FSH）、睾酮、抗苗勒管激素（AMH）、FAI、GnSAF高于妊娠成功组,FSH、受精率、优胚率、SHBG低于妊娠成功组（P＜0.05）。多因素Logistic回归分析显示,体质指数增加和LH、LH/FSH、AMH、FAI、GnSAF升高为PCOS不孕患者IVF-ET治疗妊娠失败的独立危险因素,SHBG升高为其独立保护因素（P＜0.05）。ROC曲线分析显示,FAI和血清GnSAF、SHBG联合预测PCOS不孕患者IVF-ET治疗妊娠结局的曲线下面积大于FAI、GnSAF、SHBG单独预测。结论：FAI和血清GnSAF、SHBG水平联合预测PCOS不孕患者IVF-ET治疗妊娠结局的价值较高。     

Potential researchable areas in ARTs--oocyte maturation and embryo development

Infertility is a commonly encountered situation occurring equally in both sexes. In vitro fertilization and embryo transfer (IVF-ET) and other assisted reproductive technologies (ARTs) have enhanced the possibilities for successful treatment to tackle infertility. However, ARTs currently face limitations due to the fact that although success rate is high for the initial stages such as ovulation induction and fertilization, it dwindles progressively so that the success rate of a take home baby is as low as 15-20%. Research centred around various stages in an IVF programme is therefore necessary to devise protocols that ensure a higher success rate. This review takes a look at the potential areas currently under research in the field of ARTs, such as, in vitro oocyte maturation, oocyte/embryo cryopreservation, embryo culture, preimplantation genetic diagnosis. Their applications, in clinical conditions such as cancer, have been discussed.     

Establishment of predictive model for analyzing clinical pregnancy outcome based on IVF-ET and ICSI assisted reproductive technology

ObjectiveIn order to explore the predictive model for analyzing clinical pregnancy outcomes based on IVF-ET (in vitro fertilization and embryo transfer) and ICSI (Intracytoplasmic sperm injection) assisted reproductive technology (ART). Methods: this study selected the embryo transfer (fresh) patients who received IVF-ET or ICSI treatment in the First Affiliated Hospital of Guangxi Medical University as the subjects. Moreover, the controlled ovarian stimulation (COS) and follow-up were conducted to collect relevant data for analysis, and finally a prediction model was established. Results: The results showed that the patients were divided into different ovarian response groups at first. The age, bFSH and bFSH/bLH were the highest in the poor ovarian response group (POR), followed by the normal ovarian response group (NOR) and the lowest in the high ovarian response group (HOR). The area under the ROC curve was 0.669 according to the predictive model of pregnancy-related factors. The confidence interval of 94% was 0.629–0.697, with statistical significance (P = 0.000, P < 0.01). Conclusion: it can be concluded that in clinical pregnancy, for many related factors, regression equation can be used to establish a prediction model to diagnose the success rate of pregnancy. In conclusion, a prediction model can be built based on the relevant experimental results, to provide experimental reference ideas for increasing the success rate of ART in late clinical pregnancy, which is of great research significance.     

黄体酮对子宫内膜异位症在位内膜预处理与IVF治疗结局关系

摘要 目的：研究黄体酮对子宫内膜异位症在位内膜预处理改善IVF结局。方法：男性因素并卵巢子宫内膜异位囊肿168例,分两组：（1）实验组：IVF前自然周期月经第12天地屈孕酮30 mg/日、14天,3个月;（2）对照组：IVF前无干预。IVF前测血CA125,黄体期长方案促排卵,排卵后一周（垂体降调日）再测CA125并取子宫内膜行ER、PR、HOXA-10mRNA检测。HCG日测子宫内膜厚度、形态、血流。比较临床资料及结局、症状疼痛评分。结果：实验组胚胎种植率、临床妊娠率高于对照组（P<0.05）;HCG日对照组子宫内膜厚于实验组。实验组子宫内膜A型血流比率高于对照组（P<0.05）。实验组A型子宫内膜比率高于对照组,但无明显差异（P>0.05）;IVF前两组CA125均高于参考值,但无明显差异（P>0.05）。垂体降调日复查CA125,实验组明显低于对照组,实验组治疗后低于治疗前;实验组子宫内膜ER、PR、HOXA-10 mRNA表达量高于对照组,实验组分泌期子宫内膜比率高于对照组（P<0.05）;治疗后两组各项症状疼痛评分均较治疗前改善,且实验组优于对照组（P<0.05）。结论：IVF治疗中合并卵巢子宫内膜异位囊肿用黄体酮预处理在位内膜,可以降低血CA125,有利于转变子宫内膜组织类型、减小子宫内膜厚度、增加子宫内膜血流、增加子宫内膜ER、PR、HOXA-10 mRNA表达,改善在位内膜容受性,缓解症状疼痛,提高临床妊娠率。     

Role of endometrial blood flow assessment with color Doppler energy in predicting pregnancy outcome of IVF-ET cycles

This is a prospective study of 182 women (38 yrs or younger) undergoing IVF-ET. Endometrial thickness, echo pattern and blood flow on transvaginal ultrasonography were recorded eight hours prior to hCG administration. The patients were divided into three groups: A (n = 10) with undetectable endometrial blood flow; B (n = 82) with sub-endometrial blood flow; C (n = 90) with both endometrial and sub-endometrial blood flow. According to IVF-ET outcomes, all patients were re-divided into three groups: 1 non-pregnancy (n = 92); 2 intrauterine pregnancy with live fetus (n = 70); 3 others (n = 20 including biochemical pregnancy, embryonic diapause, ectopic pregnancy and miscarriage). Intrauterine pregnancy with live fetus in Group C (62.2%) was much higher than that in Group A and B (0% and 17.1%, p less than or equal to 0.001). The implantation rate (33.2%) was much higher than that in Group A and B (0% and 19.90%, p less than or equal to 0.001). The pulsatility index, resistance index, and S/D of endometrial spiral arteries were 0.1 +/- 0.2, 0.6 +/- 0.1 and 2.5 +/- 0.4 in Group 2, which were much lower than those in Group 1 and Group 3 (p1-2 less than 0.001, p2-3 less than 0.05). The patients with detectable endometrial blood flow had higher clinical pregnancy rates and implantation rates.     

Proteomic Insights into Endometrial Receptivity and Embryo‐Endometrial Epithelium Interaction for Implantation Reveal Critical Determinants of Fertility

In vitro fertilization has overcome infertility issues for many couples. However, achieving implantation of a viable embryo into the maternal endometrium remains a limiting step in optimizing pregnancy success. The molecular mechanisms which characterize the transient state of endometrial receptivity, critical in enabling embryo‐endometrial interactions, and proteins which underpin adhesion at the implantation interface, are limited in humans despite these temporally regulated processes fundamental to life. Hence, failure of implantation remains the “final frontier” in infertility. A human coculture model is utilized utilizing spheroids of a trophectoderm (trophoblast stem) cell line, derived from pre‐implantation human embryos, and primary human endometrial epithelial cells, to functionally identify “fertile” versus “infertile” endometrial epithelium based on adhesion between these cell types. Quantitative proteomics identified proteins associated with human endometrial epithelial receptivity (“epithelial receptome”) and trophectoderm adhesion (“adhesome”). As validation, key “epithelial receptome” proteins (MAGT‐1/CDA/LGMN/KYNU/PC4) localized to the epithelium of receptive phase (mid‐secretory) endometrium obtained from fertile, normally cycling women but is largely absent from non‐receptive (proliferative) phase tissues. Factors involved in embryo‐epithelium interaction in successive temporal stages of endometrial receptivity and implantation are demonstrated and potential targets for improving fertility are provided, enhancing potential to become pregnant either naturally or in a clinical setting.     

个体动态化体重管理对体外受精-胚胎移植超重肥胖患者体重控制及妊娠结局的影响

目的:针对接受体外受精-胚胎移植(IVF-ET)的超重肥胖患者实施个体动态化体重管理,探讨该干预方法对体重控制及妊娠结局的影响。方法:选择2017年5月至2018年12月就诊于我院拟行IVF-ET的超重肥胖患者共99例纳入本研究,随机分为实验组50例与对照组49例,分别采取个体动态化体重管理及常规干预的方法对两组进行体重管理,记录并统计干预前后相关指标的组间差异。结果:两组干预前后BMI的差值差异有统计学意义(P0.05);内膜厚度、获卵数、可用胚胎数、移植胚胎数的组间比较差异无统计学意义(P0.05)。两组临床妊娠率与活产率差异有统计学意义(P0.05);出生婴儿体重组间差异无统计学意义(P0.05);干预满意度评分差异有统计学意义(P0.05)。结论:个体动态化体重管理的干预方法可有效减轻接受IVF-ET的超重肥胖患者的体重,降低体重指数,提高IVF-ET的移植成功率、活产率,值得临床推广应用。     

Effect of coculture with oviduct epithelial cells on viability after transfer of vitrified in vitro produced goat embryos

This study evaluates the effect of coculture with goat oviduct epithelial cells (GOEC) on the pregnancy rate, embryo survival rate and offspring development after direct transfer of vitrified/thawed caprine in vitro produced (IVP) embryos. Oocytes were recovered from slaughterhouse goat ovaries, matured and inseminated with frozen/thawed capacitated semen, and presumptive zygotes were randomly cultured in synthetic oviduct fluid (SOF) (n=352) or GOEC (n=314). The percentage of cleaved embryos reaching the blastocyst stage was 28% and 20% in SOF and GOEC, respectively (P<0.05). Overall, 26 blastocysts of SOF were transferred freshly in pairs to recipient goats, whereas 58 of SOF and 36 of GOEC were vitrified and transferred directly in pairs to recipient goats after thawing without removal of cryoprotectants or morphological evaluation. The kidding rate was 92% for SOF fresh, 14% for SOF vitrified (P<0.001) and 56% for GOEC vitrified (P<0.05); the difference was also significant between vitrified groups (P<0.01). The embryo survival rate was 62% for SOF fresh, 9% for SOF vitrified (P<0.001) and 33% for GOEC vitrified (P<0.05) with a significant difference between vitrified groups (P<0.01). The results showed that the coculture of IVP goat embryos with GOEC significantly improves the pregnancy and embryo survival rates and leads to the birth of healthy offspring. However, further research using more defined GOEC coculture is required to confirm its capacity to increase the success rate of IVP embryo technology in goat.     

挥发性有机化合物(VOCs)对IVF实验室影响的研究进展

体外受精-胚胎移植技术已成为当今治疗不育症的主要手段,为取得令人满意的临床妊娠率,体外受精(IVF)实验室的空气质量控制成为生殖助孕工作者关注的重点。胚胎培养室的挥发性有机化合物(volatileorganiccompounds,VOCs)含量对配子-胚胎发育的影响至关重要,体外胚胎对VOCs的耐受能力差,其含量超过一定界限时则会对配子和胚胎造成影响。本文概述了IVF实验室VOCs的来源,VOCs的生殖毒性,VOCs的测定方法以及胚胎培养室内VOCs的控制途径等,旨在更严格的进行IVF实验室的空气质量控制,尽可能杜绝VOCs的污染,提高IVF的成功率。     

Excessive Intrauterine Fluid Cause Aberrant Implantation and Pregnancy Outcome in Mice

The normal intrauterine fluid environment is essential for embryo implantation. In hydrosalpinx patients, the implantation and pregnancy rates are markedly decreased after IVF–embryo transfer, while salpingectomy could significantly improve the pregnancy rates. The leakage of hydrosalpinx fluid into the endometrial cavity was supposed to be the major cause for impaired fertility. However, the underlying mechanisms of hydrosalpinx fluids on implantation and ongoing pregnancy were not fully understood and remain controversial regarding its toxicity. In present study, by infusing different volume of non-toxic fluid (0.9% saline) into uterine lumen before embryo implantation in mice (Day4 08:30), we found that while the embryos were not “flushed out” from the uteri, the timing of implantation was deferred and normal intrauterine distribution (embryo spacing) was disrupted. The abnormal implantation at early pregnancy further lead to embryo growth retardation, miscarriage and increased pregnancy loss, which is similar to the adverse effects observed in hydrosalpinx patients undergoing IVF-ET. We further examined uterine receptivity related gene expression reported to be involved in human hydrosalpinx (Lif, Hoxa10, Integrin α(v) and β(3)). The results showed that expression of integrin α(v) and β(3) were increased in the fluid infused mouse uteri, implicating a compensatory effect to cope with the excessive fluid environment. Our data suggested that the adverse effects of excessive non-toxic luminal fluid on pregnancy are primarily due to the mechanical interference for normal timing and location of embryo apposition, which might be the major cause of decreased implantation rate in IVF-ET patients with hydrosalpinx.     

电针结合红外线照射对反复着床失败患者子宫内膜容受性、胚胎移植及妊娠情况的影响

目的:观察电针结合红外线照射对反复着床失败(RIF)患者子宫内膜容受性、胚胎移植及妊娠情况的影响。方法:选取102例于2015年5月-2018年5月在我院行复苏胚胎移植的RIF患者,按照随机数字表法将患者分为电针结合红外线照射治疗组(A组,38例)、安慰针刺组(B组,34例)及空白对照组(C组,30例)。比较三组治疗前后血清雌二醇、孕酮水平,于治疗前后检测子宫内膜容受性超声学指标,包括子宫内膜厚度、内膜容积、血管血流指数(VFI)、内膜血流指数(FI)、阻力指数(RI),比较三组胚胎移植及妊娠情况。结果:三组治疗前后血清雌二醇、孕酮水平比较无统计学差异(P0.05)。治疗后A组子宫内膜厚度、内膜容积大于治疗前及B组、C组,VFI、FI高于治疗前及B组、C组,RI低于治疗前及B组、C组(P0.05)。三组移植胚胎数、生化妊娠率、临床妊娠率比较无统计学差异(P0.05),A组胚胎着床率高于B组、C组(P0.05)。结论:电针结合红外线照射治疗RIF患者可以改善子宫内膜容受性,提高胚胎着床率。     

人类囊胚期胚胎培养-移植的研究现状

传统的体外受精-胚胎移植选择卵裂期胚胎进行移植,然而,多胎率高、成功率低始终困惑着生殖医学者,囊胚移植更符合生理过程,胚胎与子宫内膜更为同步性,因而可获得更高的胚胎种植率及临床妊娠率,且减少胚胎的移植数量,降低了多胎妊娠发生率,具有广泛的应用前景。     

Extended culture up to the blastocyst stage: a strategy to avoid multiple pregnancies in assisted reproductive technologies

The aim of this study was to review the experience and outcomes of assisted reproduction cycles with embryos grown up to day 5 of development, comparing different parameters according to the ages of the patients. We retrospectively studied 1,874 assisted reproduction cycles where embryo culture was extended up to the fifth or sixth day of development. All IVF and ICSI cycles were included, comparing, according to patient age, the following rates: blastocyst formation, pregnancy, implantation and abortion. As control, we analyzed cycles with donated oocytes from young donors (OD). The number of embryos reaching the blastocyst stage is similar in all groups of patients. Only the OD group was different in terms of blastocyst formation, pregnancy and implantation rates. Patients over 39 years of age had an abortion rate of 59.1 %, which is significantly higher than the other groups. Extended embryo culture up to the blastocyst stage can be implemented in programs of assisted reproduction in order to increase the pregnancy rate. The potential of blastocyst implantation is high, allowing us to transfer fewer embryos and reduce the probability of multiple pregnancies.