Rui Yang

The hysteroscopy and histological diagnosis and treatment value of chronic endometritis in recurrent implantation failure patients

PurposeTo study the consistency of hysteroscopy findings and histological chronic endometritis (CE) in recurrent implantation failure (RIF) cases, and to compare their values in indicating antibiotic treatment.MethodsSixty RIF cases (January 2009–January 2010) and 202 consecutive RIF cases (May 2010–April 2012) in Peking University Third Hospital reproductive medical center were studied. 60 RIF patients’ endometrial samples redid section and CD38/CD138 immunohistochemical stain for CE screening. In 202 RIF cases, the presence of hyperemia, mucosal edema, and micropolyps under hysteroscopy were considered CE diagnostic parameters. Antibiotic was offered to part of the patients. The patients’ clinical outcomes were analyzed by statistical methods.ResultsIn 202 RIF cases, the hysteroscopy CE rate was 66.3xa0%, while histological CE rate was 43.6xa0%. The sensitivity and specificity of hysteroscopy were 35.2 and 67.5xa0%. In histological CE patients, 68 cases underwent regular antibiotic treatment and 20 did not. Two groups had similar clinical pregnancy rates (35.3 vs. 30.0xa0%), embryo implantation rates (18.9 vs. 20.4xa0%) and ongoing pregnancy rates (29.4 vs. 25.0xa0%). In hysteroscopy CE patients, the implantation rate (18.6 vs. 4.9xa0%) and ongoing pregnancy rate (29.3 vs. 7.4xa0%) significantly increased (Pxa0<xa00.05) with antibiotic treatment, and higher intrauterine pregnancy rate in treatment group (29.3 vs. 11.1xa0%). In reviewing the chosen 60 RIF cases, the histological CE rates were similar in both pregnancy and non-pregnancy group after subsequent embryo transfer.ConclusionsCE occurs frequently in RIF patients; hysteroscopy has more diagnostic and treatment value for them.

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 (6.7u2009±u20093 versus 7.0u2009±u20092 versus 6.9u2009±u20092.4, pu2009=u20090.897). The clinical pregnancy rate was highest in group 2, lowest in group 3, with significantly difference (31.6% versus 38.1% versus 13.9%, pu2009=u20090.037). The implantation rate and live birth rate were still lowest in group 3 (21.9% versus 19.8% versus 6.7%, pu2009=u20090.016 and 18.4% versus 31% versus 11.6%, pu2009=u20090.081). 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.

Effects of hyperandrogenism on metabolic abnormalities in patients with polycystic ovary syndrome: a meta-analysis.

BackgroundThe study evaluated the effect of hyperandrogenism (HA) in polycystic ovary syndrome (PCOS) on metabolic parameters.MethodsWe searched PubMed, EMBASE, Cochrane, Web of Science, Chinese Biomedical Database (CBM), China National Knowledge Infrastructure (CNKI), WanFang data and VIP for clinical observational studies. The study evaluated PCOS patients with or without HA on metabolic parameters was included. Prevalence of metabolic syndrome, indexes of insulin resistance (IR) including homeostasis model assessment IR index (HOMA-IR), incidence of IR, biomarkers of serum lipid metabolism such as total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), and low density lipoprotein (LDL).ResultsOf 4457 identified trials, 32 observational studies were included for the final analysis comprising 9556 female with PCOS. 6482 cases were having HA, and the others were negative. There were significant differences in the incidence of metabolic syndrome, HOMA-IR, rate of IR, TC level and HDL level between PCOS patients with or without HA, except for LDL level. No significant publication bias was found as P value of Egger’s test was 0.82.ConclusionsHA play an important role in metabolic disorders in PCOS patients. The incidence of metabolic syndrome, IR indexes, and most biomarkers of serum lipid metabolism were significantly different between patients with and without HA.

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

OBJECTIVEnTo assess the effectiveness and feasibility of retaining a singleton or twins for multifetal pregnancy reduction (MFPR) in triplet pregnancy with monochorionic twins.nnnSTUDY DESIGNnThis 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.nnnRESULTSnPatients 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.nnnCONCLUSIONSnRetaining 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

OBJECTIVEnTo 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.nnnSTUDY DESIGNnThis 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.nnnRESULTSnAmong 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.nnnCONCLUSIONSnFor 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.

A comparison among different methods of letrozole combined with gonadotropin in an antagonist protocol and high-dose gonadotropin ovarian stimulation antagonist protocol in poor ovarian responders undergoing in vitro fertilization

PurposeThis study aimed at comparing the effects of different methods of letrozole combined with gonadotropin (Gn) and high-dose Gn ovarian stimulation in antagonist protocol.MethodsRetrospectively reviewed 220 poor responders from August 2012 to July 2014 at Peking University Third Hospital Reproductive Medical Center. Patients were divided into Group 1 (LZ 5xa0mg for 5xa0days sequentially overlapping with Gn cycles; nxa0=xa060), group 2 (LZ 7.5xa0mg for 3xa0days sequentially with Gn cycles; nxa0=xa060), and group 3 (high-dose Gn cycles; nxa0=xa0100). We compared the basic status of patients and clinical outcomes of the three groups.ResultsBasic characteristics of patients were comparable among groups. Group 1 had significantly higher LH levels on day 7 and hCG than Group 2 and 3 (Pxa0<xa00.05). Group 1 had significantly higher early LH elevation rate (>20xa0IU/L) on the hCG day than Groups 2 and 3 (11.7 vs. 6.7 and 2.0xa0%; Pxa0<xa00.05). The amount of Gn used in LZ groups was significantly lower than Group 3 (Pxa0<xa00.01). However, the clinical pregnancy rate and live birth rate were comparable among groups.ConclusionIn conclusion, the LZ/antagonist protocol is a cost-effective and patient friendly protocol, LZ 5xa0mg for 5xa0days sequentially overlapping with Gn protocol has comparable pregnancy outcomes, and LZ 7.5xa0mg for 3xa0days sequentially with the Gn protocol even has better clinical outcomes when compared with the standard GnRH antagonist protocol in poor responders. LZ 7.5xa0mg for 3xa0days sequentially with the Gn protocol appeared to have resulted in fewer improper LH surges and better outcomes than LZ 5xa0mg for 5xa0days sequentially overlapping with Gn in antagonist protocol.

Biochemical pregnancy and spontaneous abortion in first IVF cycles are negative predictors for subsequent cycles: an over 10,000 cases cohort study

PurposeTo identify whether biochemical pregnancy (BP) and spontaneous abortion (SA) cases have the same clinical characteristics in assisted reproductive therapy (ART), and to assess its predictive value for the subsequent cycles.MethodsRetrospectively reviewed 12,174 cycles in the first in vitro fertilization and embryo transfer (IVF-ET) cycle from January 2009 to December 2012 of Peking University Third Hospital Reproductive Medical Center. Besides those patients who reached ongoing pregnancy stage, 7,598 cases were divided into three groups: group 1, lack of pregnancy (nxa0=xa06,651); group 2, BP (nxa0=xa0520); and group 3, SA (nxa0=xa0427). We compared the basic status of patients of the three groups, including ages, body mass index, basic hormone levels, controlled ovarian hyperstimulation protocols, amount of gonadotropin use, and endometrium thickness. The reproductive outcome of the next embryo transfer cycles of the three groups was analyzed.Results520 patients ended as BP, and 427 patients ended as SA. The age, primary infertility proportion, body mass index, basic FSH level and basic E2 level were similar among groups. Endometrial thickness, controlled ovarian hyperstimulation protocol, Gn dosage, average oocyte retrieval and ET numbers were also similar. Multivariate analysis showed that only the age (Pxa0=xa00.037, OR 1.060, 95xa0% CI 1.001–1.120) and endometrium thickness on hCG administration day (Pxa0=xa00.029, OR 1.136, 95xa0% CI 1.013–1.275) may result in the differences between BP and SA groups. In the subsequent ET cycles, the total BP rate was 4.37xa0%, clinical pregnancy rate was 37.28xa0%, and miscarriage rate was 8.18xa0%. The clinical pregnancy rates were similar among groups. However, BP group still had the highest BP rate (Pxa0<xa00.05, 7.97 vs. 4.01xa0% and 5.28xa0%), BP and SA group had higher miscarriage rate (Pxa0<xa00.05, 11.76xa0% and 14.75 vs. 7.41xa0%).ConclusionBP and SA in first IVF cycles had negative predictive value for subsequent ART outcomes.

Increased incidence of ectopic pregnancy after in vitro fertilization in women with decreased ovarian reserve

The incidence of ectopic pregnancy after assisted reproductive technology is increased approximately 2.5–5-fold compared with natural conceptions. Strategies were used to decrease the incidence of ectopic pregnancy, but ectopic pregnancy still occurs. In the present study, women were selected with decreased ovarian reserve (defined as FSH > 10 IU/L) aged 20 to 38 years who underwent IVF-ET between 2009 and 2014. These 2,061 women were age-matched with an equal number of women with normal ovarian reserve (defined as FSH ≤ 10 IU/L). During cycles following fresh embryo transfer, 93 patients were diagnosed with ectopic pregnancy. The incidence of ectopic pregnancy in clinical pregnancies was significantly higher in the decreased ovarian reserve than in the normal ovarian reserve group (5.51% vs. 2.99%). After adjusting for confounding factors, the incidence of ectopic pregnancy was significantly associated with decreased ovarian reserve. Our results showed that decreased ovarian reserve is an independent risk factor for ectopic pregnancy after in vitro fertilization-embryo transfer.

Intracranial KCl injection--an alternative method for multifetal pregnancy reduction in the early second trimester.

Objective: This study aimed to assess the effectiveness and feasibility of transabdominal intracranial KCl injection as an alternative to intrathoracic KCl injection for multifetal pregnancy reduction (MFPR) in the early second trimester. Methods: In this study, 40 cases who underwent fetal reduction between 12 and 18 weeks of gestation at the Reproductive Medical Center of Peking University Third Hospital from January 2006 to December 2011 were divided into two groups: group A (16 cases of intracranial injection) and group B (24 cases of intrathoracic injection). The groups were compared for clinical procedures and outcomes. Results: The two groups were similar in terms of patient age, gestation, as well as starting and finishing fetal numbers. Group A needed significantly fewer punctures for each fetus than group B did (1.1 ± 0.2 vs. 1.4 ± 0.6), but both groups received similar doses of KCl (2.6 ± 0.8 ml vs. 2.6 ± 1.2 ml per fetus). All cases succeeded in the first procedure, with no heartbeat recovery. The two groups had similar miscarriage rates and gestational ages at delivery. Conclusion: MFPR by intracranial KCl injection was as effective as, but an easier procedure than intrathoracic KCl injection between 12 and 18 weeks of gestation.

Retrospective cohort study: AMH is the best ovarian reserve markers in predicting ovarian response but has unfavorable value in predicting clinical pregnancy in GnRH antagonist protocol

BackgroundVarious ovarian reserve markers have been used to predict ovarian response and pregnancy. However, concerning Chinese population, fewer trials have been performed using the combined ovarian reserve markers to predict ovarian response and pregnancy in GnRH antagonist protocols.MethodsData from a total of 373 patients’ in vitro fertilization cycles using GnRH antagonist protocol was retrospectively included. According to our center’s daily practice, circulating follicle-stimulating hormone, luteinizing hormone, and estradiol (E2) were tested on menstrual cycle day 2–4 or hCG trigger day, and the concentration of AMH was determined despite of menstrual cycle. The antral follicle count (AFC) was assessed by transvaginal ultrasound on day 2–4 of menstrual cycle. Different ovarian response was defined as 0–4 and 5–15 and >15 oocyte retrieved for low and normal and high ovarian response, respectively. Gestational sac with fetal heartbeat detected by ultrasound was considered as clinical pregnancy.ResultsSerum AMH levels was the most accurate marker in predicting ovarian response [area under the receiver operating characteristic (ROC) curvexa0=xa00.767]. Significant difference was found in age between non-clinical pregnancy and clinical pregnancy groups (pxa0<xa00.001).ConclusionsOur data demonstrated that the circulating AMH despite of menstrual cycle was preferable in prediction of oocyte retrieved outcome during GnRH antagonist protocol than age, AFC and the other currently used hormone markers. Furthermore, age is the only marker in predicting clinical pregnancy.