Xinna Chen

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.

Letrozole as primary therapy for endometrial hyperplasia in young women

To study letrozole as a primary therapeutic agent for endometrial hyperplasia with or without atypia in young women.

The role of family history in clinical symptoms and therapeutic outcomes of women with polycystic ovary syndrome

To investigate the association between family history and clinical symptoms of polycystic ovary syndrome (PCOS) that were thought to be inherited, by treating women with PCOS with contraceptive pills and metformin, and assessing outcomes.

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.

Acute Cerebral Thrombosis Following Ovarian Hyperstimulation Syndrome: A Case Report

To the Editor: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of ovulation induction, with ovarian enlargement and acute fluid shift from the intravascular space. The incidence of severe OHSS is approximately 1–2% of treatment cycles and usually following in vitro fertilization embryo transfer (IVF-ET) treatment.[1,2] OHSS is self-limiting, and treatment is primarily supportive with an aim to reduce the incidence of associated complications. The complications of severe OHSS include renal failure, hypovolemic shock, venous thromboembolism, respiratory distress syndrome, and even death. A particularly severe feature of OHSS is thromboembolism, for which a prevalence of 0.78%, has been reported and which accounts for most deaths associated with the syndrome.[2] We present a case of acute cerebral thrombosis with OHSS following ovarian induction. The woman, a 30-year-old nulliparous, presented to our emergency department with progressive abdominal distension for more than 20 days, following ovarian induction. She failed to get pregnancy for 2 months and then accepted ovarian induction with letrozole and human menopausal gonadotropin, and human chorionic gonadotropin (hCG) injection about 15 days before. She had no previous medical history and was a nonsmoker. She had no family or personal history of thrombophilia. The physical examination revealed tachycardia and tachypnea, bilateral absent air entry to the lower pulmonary zones and a severe distended abdomen with shifting dullness to percussion, and edema lower extremities. Blood profile indicated hemoconcentration (hematocrit 0.5). The coagulation profile showed D-Dimer 0.63 μg/ml. Serum biochemical examination was normal. Blood hCG test was 78 mIU/ml. Transvaginal ultrasonography (TVS) confirmed the diagnosis of OHSS with large amount of fluid and markedly enlarged ovaries. She admitted for supportive treatment and paracentesis. She complained a severe headache and blurred vision after urinating on the 2nd day of hospitalization. Physical examination revealed right homonymous hemianopia, without other neurological positive signs. Magnetic renounce imaging showed an abnormal signal of left occipital lobe, dorsal thalamus, and partial insular [Figure 1]. The coagulation profile showed remarkably elevate of D-Dimer (5.3 μg/ml). The acute cerebral thrombosis was diagnosed and after getting the couple, we arranged emergency thrombolytic therapy and then transfer to Intensive Care Unit for continuous therapy, including supportive and anticoagulation treatments. The neurologist gave low dose aspirin (100 mg/d) combined with low molecular weight heparin (4100 IU Q12h). Considered that pregnant will prolong the course of OHSS and the early stage of pregnancy, we gave mifepristone. However, the patients had an unexpected decrease of blood platelet (36 × 109/L). We changed for Warfarin, considering the immunological reaction to low molecular weight heparin might be the reason for blood platelet decrease. After supportive treatment and several times of paracentesis and pleurocentesis, the patients condition was stable. However, the serum hCG raised to 1449 mIU/ml, and the TVS showed intrauterine pregnancy (triplet). Because the pregnancy, especially triplet, will aggravate the condition, we advised curettage with ultrasonographic monitoring, under intravenous anesthesia. Figure 1 Magnetic resonance imaging showing an abnormal signal of left occipital lobe, dorsal thalamus, and partial insular. The symptoms and signs of OHSS improved rapidly after the surgery. She was discharged on the day there after surgery with tubular visual field. Neurologist suggested continuation of anticoagulation. As far as we know, prior to this, there is no relevant report of ovarian induction treatment resulted in OHSS, complicated with acute cerebral thrombosis event. Thrombosis is a very rare, but serious even mortality complication of the hypercoagulate state conferred by OHSS. The factors contribute to the thrombophilia of OHSS, including hemoconcentration, leukocytosis, thrombocytosis, altered coagulation, and reduced fibrinolysis.[2] Most of the reported thromboembolic events with OHSS were following IVF-ET treatment. A review analyzed the assisted reproductive technology and thromboembolic complications (58 articles reported 70 cases). Among these cases, 69% were pregnant and 95% were following OHSS. There were 25 cases with arterial thrombosis and 14 involved cerebrovascular events (2 died), the last 45 cases with venous thrombosis, which usually occurred days to weeks after the resolution of OHSS.[3] It has been reported that the prevalence of thrombophilia or a tendency to thrombosis is significantly increased in women who develop severe OHSS after ovulation induction.[4,5] However, there was another research showed that the prevalence of thrombophilia is not increased in women with severe OHSS, screening for V Leiden and prothrombin G20210A mutation in an IVF general population is not cost-effective.[2] In this patient, the thrombophilia and cerebral magnetic resonance angiography were all negative. OHSS is an iatrogenic disease with increased risk of thromboembolic events. The most important thing is proper hold of the indications of ovarian induction with suitable dosage, to minimize the risk of OHSS. During the ovarian induction, it is important to recognize the signs of OHSS and cancel the cycle, if necessary. For those high-risk patients, the clinician should avoid using hCG and even suggest contraception. As the most severe complication of OHSS, the rapid recognition and proper anticoagulation treatments are very important for patients with thromboembolism events. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

The ‘normal’ range of FMR1 triple CGG repeats may be associated with primary ovarian insufficiency in China

The aim of this study was to investigate the relationship between normal Fragile X mental retardation gene 1 (FMR1) CGG repeat numbers and primary ovarian insufficiency (POI) occurrence or subsequent resumption of ovarian function. A total of 122 women with POI and 105 controls were followed up and analysed in our centre. The prevalence of premutation and intermediate range of FMR1 CGG repeats in Han Chinese women with POI was only 0.81% (1/122) and 1.64% (2/122), respectively. The risk of POI occurrence for less than 26 CGG repeats and 29 or more CGG repeats in allele1 (smaller allele) was significantly higher than that for 26-28 CGG repeats (odds ratio 13.50, 95% confidence interval: 3.21 to 56.77 and 6.32, 95% confidence interval: 2.49 to 16.09 respectively; both P < 0.001). No significant difference was found in the CGG repeat distribution (<26, 26-28, or ≥29) in FMR1 allele1 between POI cases whose ovarian function resumed and those whose ovarian function did not. It is suggested that the CGG repeat number in allele1, but not that in allele2 (longer allele), was significantly associated with POI occurrence (P < 0.001). Fewer than 26 or more than 28 CGG repeats in FMR1 allele1 were both risk factors of POI occurrence.