Caihong Ma

Ovarian suppression treatment prior to in-vitro fertilization and embryo transfer in Chinese women with stage III or IV endometriosis

To evaluate the efficacy of a 2‐month treatment with a gonadotropin‐releasing hormone (GnRH) agonist prior to in‐vitro fertilization in Chinese women with moderate or severe endometriosis.

The individualized choice of embryo transfer timing for patients with elevated serum progesterone level on the HCG day in IVF/ICSI cycles: a prospective randomized clinical study

Abstract This study analyzed the clinical outcomes of patients with elevated progesterone level on the HCG day in IVF/ICSI cycles, with different timing of embryo transfer. A total of 123 patients were involved in this prospective randomized clinical study. Group 1: blastocyst transfer group, 38 cases; Group 2: frozen–thawed embryo transfer group (first FET cycle), 42 cases; Group 3: fresh embryo transfer group, 43 cases. The basal FSH level was comparable among three groups (6.7 ± 3 versus 7.0 ± 2 versus 6.9 ± 2.4, p = 0.897). The clinical pregnancy rate was highest in group 2, lowest in group 3, with significantly difference (31.6% versus 38.1% versus 13.9%, p = 0.037). The implantation rate and live birth rate were still lowest in group 3 (21.9% versus 19.8% versus 6.7%, p = 0.016 and 18.4% versus 31% versus 11.6%, p = 0.081). In conclusion, the elevated progesterone level will affect clinical pregnancy rate in fresh embryo transfer cycles. We suggest frozen-thawed embryo transfer for these patients. However, for those patients who expressed the wish to have fresh embryo transfer, they should be suggested fresh blastocyst transfer, if they have more than five good quality embryos.

A randomized controlled trial of the GnRH antagonist ganirelix in Chinese normal responders: high efficacy and pregnancy rates

Gonadotropin-releasing hormone (GnRH) antagonists for controlled ovarian stimulation (COS) were only recently introduced into China. The efficacy and safety of the GnRH antagonist ganirelix was assessed in a multicenter, controlled, open-label study, in which Chinese women were randomized to either ganirelix (n = 113) or a long GnRH agonist protocol of triptorelin (n = 120). The primary end point was the amount of recombinant follicle-stimulating hormone (rFSH) required to meet the human chorionic gonadotropin criterion (three follicles ≥17 mm). The amount of rFSH needed was significantly lower for ganirelix (1272 IU) vs. triptorelin (1416 IU; P< 0.001). Ongoing pregnancy rates per started cycle were 39.8% (ganirelix) and 39.2% (triptorelin). Although both treatments were well tolerated, cancellation due to risk of ovarian hyperstimulation syndrome (OHSS) was less frequent with ganirelix (1.8%) than triptorelin (7.5%) (P = 0.06). Less rFSH was needed in the ganirelix protocol than the long GnRH agonist protocol, with fewer reported cases of OHSS and similar pregnancy rates.

Retain singleton or twins? Multifetal pregnancy reduction strategies in triplet pregnancies with monochorionic twins

OBJECTIVE To assess the effectiveness and feasibility of retaining a singleton or twins for multifetal pregnancy reduction (MFPR) in triplet pregnancy with monochorionic twins. STUDY DESIGN This retrospective study was conducted from January 2006 to September 2011 at a university reproductive medical center. Multifetal pregnant patients (n=35) with dichorionic triplets underwent MFPR in the first trimester to reduce one or both monochorionic twins. These cases were divided into two groups: Group A (9 MFPR cases to reduce one monochorionic twin) and Group B (26 MFPR for both monochorionic twins). Control A (for Group A) included another 18 cases of trichorionic triplet reduction to twins; Control B (for Group B) included 35 cases of trichorionic triplet reduction to singletons. MFPR was performed during the same period for all groups. Pregnancy outcomes were compared between groups. RESULTS Patients were 28-39 years old; the average gestation for fetal reduction was 6-8 weeks. The early abortion rate was lower in Group A than Group B (0 versus 11.5%, p=0.339), but the late abortion rate was significantly higher in Group A. (33.3% versus 0, p=0.000). Groups A and B did not differ significantly in premature labor rate, term birth rate, gestation at delivery and take-home baby rate. The rate of very low and low birth weight was significantly higher in Group A than Group B (50% versus 0, p=0.001), and the average birth weight was significantly lower in Group A (2391.7±318.5 versus 3119.6±523.9, p=0.001). Group A had significantly more low birth-weight newborns than Control A (50% versus 13.3%, p<0.05 [0.024]). Group B (retained singleton) had similar pregnancy outcomes and neonatal conditions as Control B. CONCLUSIONS Retaining a singleton is always the best choice when deciding about using MFPR to improve pregnancy outcomes. For patients having a triplet pregnancy with monochorionic twins and strongly desiring to keep twins, MFPR in one monochorionic twin was feasible by aspirating embryonic parts early in gestation (6-8 weeks) with no drug injection. Pregnancy outcomes are similar with twin reduction in trichorionic triplet pregnancy.

The usefulness of transvaginal hydrolaparoscopy in infertile women with abnormal hysterosalpingogram results but with no obvious pelvic pathology

OBJECTIVE To evaluate the value of transvaginal hydrolaparoscopy (THL) in infertile women with abnormal hysterosalpingogram results but with no history of previous pelvic surgery and with normal gynecological examination and vaginal sonography. STUDY DESIGN This is a retrospective study. From January 2008 to October 2009, 51 infertile women were planned to undergo standard laparoscopy because of abnormal HSG. None of the patients had any history of previous pelvic surgery and all had normal findings on gynecological examination and vaginal sonography. These women underwent THL. RESULTS Among the 51 cases, successful access to the pouch of Douglas was achieved in 49. There were two failures due to obesity, and the operation was converted to standard laparoscopy. No complication was observed in this study period. In 26 patients (53.1%) the THL procedure showed normal pelvic organs. Four patients were lost to follow-up. Of the remaining 22 cases, four became pregnant (4/22, 18.2%) through intercourse or intrauterine insemination (IUI). There were some morphologic abnormalities seen in the remaining 23 patients such as adhesions, endometriosis and hydrosalpinx. Six cases with mild adhesions and endometriosis were treated with THL alone, and four (4/6, 66.7%) became pregnant with or without IUI. Among the 19 who underwent standard laparoscopy, three were lost to follow-up. In the other 16 cases, natural pregnancy occurred in six (6/16, 37.5%) patients with or without IUI. CONCLUSIONS For women with abnormal HSG results but with no obvious pelvic pathology, THL should be recommended and about 50% could avoid an unnecessary laparoscopy. Adhesiolysis and coagulation of endometriotic lesions under THL in mild adhesion and endometriosis cases could lead to encouraging results.

Intraperitoneal bleeding following transvaginal oocyte retrieval

To investigate the risk factors for intraperitoneal bleeding following transvaginal oocyte retrieval (TVOR).

Consecutive repeat miscarriages are likely to occur in the same gestational period

This is a retrospective, observational study to determine how often repeated consecutive miscarriages occur consistently in the same gestational period, including 1589 miscarriages among 543 women with recurrent miscarriage. In women who had two miscarriages only, 49.17% of both miscarriages occurred in the same gestational period, which was significantly higher than the expected probability of 34.54% (P<0.01). The proportions of all miscarriages occurring in the same gestational period in women with three, four and five or more miscarriages were 28.72%, 19.44% and 18.60%, compared with the expected probabilities of 14.36% (P<0.01), 6.57% (P<0.05) and <3.15% (P<0.05). The proportions of miscarriages occurring consistently in the same gestational period are higher than the theoretical probabilities calculated for the whole population.

The Prognosis of IVF in Poor Responders Depending on the Bologna Criteria: A Large Sample Retrospective Study from China

Objective. To analyze the treatment outcomes of patients who accepted IVF/ICSI-ET, diagnosed POR according to Bologna criteria. Study Design. Retrospective cohort study of one reproductive medical center, from 1st Jan., 2009, to 31st Dec., 2014. All patients fulfilled the Bologna criteria and accept IVF/ICSI-ET treatment with stimulation cycle. The main outcome measures were clinical pregnancy rate (CPR) and live birth rate (LBR). Results. There were 5770 eligible cycles included in this study. The incidence of POR was 10.3% (6286/62194). The overall CPR was 18.7%, IR was 11.6%, LBR/ET was 11.5%, and LBR/OPU was 8.3%. The cycle cancellation for no available oocyte or embryo was 4.9% and 18.6%, respectively. The subgroup of younger POR patients got highest CPR and LBR/ET, which decreased while increasing maternal age. Within three attempts, the patients got similar CPR and LBR. Conclusion. In conclusion, our study supports the Bologna criteria that defined women with poor IVF outcomes. But those younger than 42 years old with the first 3 attempts of IVF could got acceptable CPR and LBR.

Trans-abdominal ultrasound guided transvaginal hydrolaparoscopy is associated with reduced complication rate

OBJECTIVE To evaluate the feasibility and value of abdominal ultrasound guided access for transvaginal hydrolaparoscopy (THL). STUDY DESIGN One hundred and ninety-three infertile women were retrospectively included. A total of 31 subjects were included in the study group, and 162 cases performed prior to the introduction of transabdominal ultrasound guidance constituted a comparison group. The indications for THL were: inconclusive hysterosalpingogram findings and ovarian drilling for clomiphene-resistant polycystic ovarian disease. The total of complications arising from trocar needle insertions are compared between the study (ultrasound guidance) and comparison (without ultrasound guidance) groups. RESULTS In the study group, two cases were transferred to standard laparoscopy without vaginal needle insertion because of no obvious fluid in the cul-de-sac. One of these cases was confirmed to have severe adhesions and the other had no pathology in the pelvic cavity. One further case was transferred due to severe adhesions found by THL. Twenty-nine patients had successful vaginal access including seven cases with a retroverted uterus (24.1%), as against only one case with retroverted uterus in the comparison group (0.6%). The difference was statistically significant (P<0.05). There were three cases of intestinal perforation and one case of uterine injury in the comparison group, but no case of complication in the study group. Fifteen cases were fully conducted by two novel medical doctors monitored by a senior doctor. CONCLUSIONS Trans-abdominal ultrasound guided vaginal access increases the safety of THL, especially in patients with a retroverted uterus, by seeking out a better puncture spot, and making training more intuitive and safe.

Double measurements of serum HCG concentration and its ratio may predict IVF outcome

Serum human chorionic gonadotrophin (HCG) concentration is nearly always used to predict pregnancy but there is little data on the clinical utility of the ratio of HCG(21)/HCG(14) combined with double measurement of serum HCG. A total of 1762 cycles were retrospectively analysed for serum HCG concentration and ratio of HCG(21)/HCG(14) on days 14 and 21 after embryo transfer to determine whether the ratio combined with concentration is the optimal predictor of pregnancy. The medians of HCG concentration on days 14 and 21 combined with the ratio of HCG(21)/HCG(14) were calculated for non-viable, viable and heterotopic pregnancies. HCG concentrations of 290IU/l on day 14 and 2970IU/l on day 21 were regarded as the cut-off values to predict viable pregnancy, and values of 630 and 12,000IU/l, respectively, were regarded as the cut-off values to predict multiple pregnancy. The ratio of HCG(21)/HCG(14) in the viable pregnancy group was significantly higher than that in the non-viable pregnancy group (15.86 versus 5.27, P<0.0001). For heterotopic pregnancy, the ratio of HCG(21)/HCG(14) was 11.93. It was concluded that HCG concentration on days 14 and 21 combined with the ratio of HCG(21)/HCG(14) provides a useful predictor of pregnancy outcome. A ratio >15 may predict viable pregnancy.