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Assessment of fetal maturity is essential for timely termination of pregnancy, especially in pregnant women with pregnancy complications. However, there is a lack of methods to assess the maturity of fetal intestinal function. Here, we constructed erythrocyte membrane-camouflaged aggregation-induced emission (AIE) nanoparticles. Nanocore is formed using a hollow mesoporous silicon nanobox (HMSN) of different particle sizes loaded with AIE luminogens -PyTPA (P), which are then co-extruded with erythrocyte membranes (M) to construct M@HMSN@P. The 100 nm M@HMSN@P has a more effective cellular uptake efficiency in vitro and in vivo. Swallowing and intestinal function in fetal mice mature with the increase in gestational age. After intrauterine injection of M@HMSN@P, they were swallowed and absorbed by fetal mice, and their swallowed and absorbed amount was positively correlated with the gestational age with a correlation coefficient of 0.9625. Using the M@HMSN@P (fluorescence intensity) in fetal mice, the gestational age can be imputed, and the difference between this imputed gestational age and the actual gestational age is less than 1 day. Importantly, M@HMSN@P has no side effect on the health status of pregnant and fetal mice, showing good biocompatibility. In conclusion, we constructed M@HMSN@P nanoparticles with different particle sizes and confirmed that the smaller size M@HMSN@P has more efficient absorption efficiency and it can assess fetal intestinal maturity by the intensity of the fluorescence signal.

The culture medium plays an important role in embryonic development and subsequent pregnancy outcomes of in vitro fertilization (IVF) cycles. The sequential culture media of Vitrolife and Cook are the two most commonly used reagents in China. This study aimed to assess their effects on IVF success rates, obstetric outcomes and neonatal outcomes.This was a retrospective cohort study on 6352 patients undergoing first IVF attempts between January 2018 and December 2019, resulting in 3153 clinical pregnancies, 2646 live births, and 2668 babies. Patients were grouped according to the culture media they used. There were 4680 patients in the Vitrolife group and 1672 patients in the Cook group. The primary outcome measures were maternal and neonatal outcomes. ANOVA and Chi-square tests were used for statistical comparison, and multivariate logistic regression and multivariate general linear model were used to adjust for potential confounders.The rates of live birth, clinical pregnancy, monozygotic twins, miscarriage, and ectopic pregnancy were all comparable between the groups of Vitrolife and Cook. The incidence of placenta previa was higher in the Vitrolife group [4.86 vs. 3.09%, adjusted odds ratio = 2.048 (1.146-3.657)]. The incidence of macrosomia was higher in the Cook group [7.51 vs. 5.39%, adjusted odds ratio = 1.445 (1.010-2.069)].The culture media of Vitrolife and Cook are comparably effective in IVF success. Vitrolife is associated with a higher risk of placenta previa, while Cook is associated with a higher risk of macrosomia.

Efficient photocatalytic degradation of trace organic pollutants in aqueous environment by a hollow tubular carbon nitride co-doped with manganese and phosphorus under visible light.

Pregnancy complicated with juvenile granulosa cell tumor (JGCT) is very rare; thus, the experience on clinical diagnosis and management is limited. Two patients presented with abdominal pain, two were incidentally discovered, one by ultrasonography, and one during a caesarian section. One case received an emergency caesarian section because of tumor rupture at 38th week’s gestation, the rest were treated at full term and no abnormalities were detected in the newborns. Three cases received further staging surgery, two of which received postoperative adjuvant chemotherapy. No patient had recurrent disease after a follow-up period spanning from 13 to 57 months. In the absence of emergency, surgery can be delayed without affecting the fetus. More research is needed to determine the value of chemotherapy in FIGO stage I patients.

Object High targeting and efficient cytotoxicity toward tumor cells endow NPs excellent anti-tumor activity. Herein, a peptide polymer possessing dual-targeting ability and double therapeutic activity was developed and named TGMF, which can form NPs through self-assembly. It is composed of four functional modules: 1) Active targeting peptide TMTP1 (T) deliver NPs to tumors specifically; 2) Therapeutic peptide GO-203 (G), which can significantly inhibit tumor growth by disrupting the redox balance in cells; 3) A passively targeted enzyme-responsive peptide PLGLGA (M), which can be cleaved specifically by metalloproteinase-2 (MMP-2) highly expressed in the tumor microenvironment (TME); and 4) Hexadecyl (F), which has strong hydrophobicity, can promote the self-assembly of TGMF NPs. Methods Five modular peptide probes, namely, TGF, TMF, TGM, GMF, and TGMF were synthesized and self-assembled into NPs in solution. The characterization, enzyme reactivity, and cytotoxicity of NPs were evaluated in vitro, and the pharmacokinetics, bio-distribution, anti-tumor activity of NPs were investigated in vivo. In addition, transcriptome sequencing identified the intracellular signaling pathway-related genes involved in the anti-tumor effect of TGMF. Results Upon enzyme cleavage, two types of nanostructure, NPs and nanofibers (NFs), were detected under TEM. Moreover, the cytotoxicity and anti-invasion activity of TGMF against tumor cells used were strongest among the five modular probes examined in vitro. TGMF increased reactive oxygen species (ROS) levels in cytoplasm and produced numerous NFs in extracellular interval and intracellular space. Transcriptome sequencing revealed that TGMF caused 446 genes' down-regulation and 270 genes' up-regulation in HeLa cells. In vivo, TGMF has a good anti-tumor effect, effectively prolonging the survival time of HeLa-tumor-bearing mice without systemic side effects. Conclusion Integration of multiple functional modules into NPs could be a promising strategy for the future of nanomedicine design towards tumor treatment.

Nanoparticle drug delivery system (NDDS) is quite different from the widely studied traditional chemotherapy which suffers from drug resistance and side effect. NDDS offers the straightforward solution to the chemotherapy problem and provides an opportunity to monitor the drug delivery process in real time. In this vein, we developed one NDDS, namely Py-TPE/siRNA@PMP, to relieve resistance and side effects during chemotherapy against ovarian cancer. The Py-TPE/siRNA@PMP is a multifunctional polymeric nanoparticle contained several parts as follows: (1) a nanoparticle (NP) self-assembled by reduction-sensitive paclitaxel polymeric prodrug (PMP); (2) the glutathione (GSH)-responsive release of paclitaxel (PTX) for the suppression of ovarian cancer cells; (3) the P-glycoprotein (P-gp) siRNA for restoring the sensitivity of chemo-resistant tumor cells to chemotherapy; (4) the positively charged aggregation-induced emission fluorogen (AIEgen) Py-TPE for tumor imaging and promoting encapsulation of siRNA into the nanoparticle. Methods: The Py-TPE/siRNA@PMP nanoparticles were prepared by self-assembly method and characterized by the UV-Vis absorption spectra, zeta potentials, TEM image, stability assay and hydrodynamic size distributions. The combinational therapeutic effects of Py-TPE/siRNA@PMP on overcoming chemotherapy resistance were explored both in vitro and in vivo. Result: The Py-TPE/siRNA@PMP exhibited an average hydrodynamic size with a good stability. Meanwhile they gave rise to the remarkable chemotoxicity performances in vitro and suppressed the tumors growth in both SKOV-3/PTX (PTX resistance) subcutaneous and intraperitoneal metastasis tumor models. The investigations on ovarian cancer patient-derived xenografts (PDX) model revealed that Py-TPE/siRNA@PMP was able to effectively overcome their chemo-resistance with minimal side effects. Conclusion: Our findings demonstrated the Py-TPE/siRNA@PMP as a promising agent for the highly efficient treatment of PTX-resistant cells and overcoming the shortage of chemotherapy in ovarian cancer.

The aim of this study was to assess the relationship between early developmental kinetics and the competence to result in a live birth as well as the impact of maternal age and the number of retrieved oocytes. This retrospective cohort study included 3,021 single-embryo transfer cycles and assessed live birth outcomes paired with morphokinetic data; 1,412 transfers resulted in live births (LB), and 1,609 did not (NLB). Early morphokinetic parameters between LB and NLB embryos were compared from patients stratified into four age groups (20-25, 26-30, 31-36, and ≥37 years) and between embryos in the same competence groups within the age groups. Early morphokinetic parameters were also compared between LB and NLB embryos from patients stratified into four groups based on the number of oocytes harvested (≤7, 8-14, 15-21, and ≥22). The association between morphokinetic parameters and LB was tested using univariate and multivariate analyses. This study indicated that embryos resulting in LB generally exhibit faster developmental dynamic parameters than embryos that do not. However, this difference decreased in the younger (20-25 years) and older (≥37 years) age groups. In addition, when the number of harvested oocytes was low (≤7) or high (≥22), this difference was less obvious. The morphokinetic parameters of embryonic cleavage are an effective reference value for embryo selection strategies aimed at increasing live birth rates, especially for patients aged 26–36 years, with 8–21 harvested oocytes.

Downregulating programmed cell death ligand 1(PD-L1) protein levels in tumor cells is an effective way to achieve immune system activation for oncology treatment, but current strategies are inadequate. Here, we design a caged peptide-AIEgen probe (GCP) to self-assemble with miR-140 forming GCP/miR-140 nanoparticles. After entering tumor cells, GCP/miR-140 disassembles in the presence of Cathepsin B (CB) and releases caged GO203 peptide, miR-140 and PyTPA. Peptide decages in the highly reductive intracellular environment and binds to mucin 1 (MUC1), thereby downregulating the expression of PD-L1. Meanwhile, miR-140 reduces PD-L1 expression by targeting downregulation of PD-L1 mRNA. Under the action of PyTPA-mediated photodynamic therapy (PDT), tumor-associated antigens are released, triggering immune cell attack on tumor cells. This multiple mechanism-based strategy of deeply downregulating PD-L1 in tumor cells activates the immune system and thus achieves effective immunotherapy.

BackgroundThe technique of embryo cryopreservation has been increasingly applied in clinical settings. However, there has been a concern about the safety and efficacy of long-term freezing of embryos. Therefore, the aim of this study was to evaluate whether storage time of vitrification had any effects on pregnancy as well as perinatal outcomes, further, to explore the appropriate time limit of vitrification.MethodsThe study included women who underwent at least one frozen-thawed cycle with single embryo transfer between January 1st, 2016 and September 30th, 2019. Patients were assigned into 3 groups according to the storage time (12 months) to evaluate the impact of embryo storage time on pregnancy and perinatal outcomes. To further investigate the time limit of vitrification, propensity score matching was used to compare the primary outcomes of patients with storage time of 1-3 years, 3-5 years, and >5 years to those stored for ≤1 year.ResultsA total of 9806 frozen-thawed embryo transfer cycles were included in our study. After adjustment for confounding variables, no significant differences were found in pregnancy outcomes among groups. However, postponement of transfer increased the risks of large for gestational age and placenta previa. In addition, after propensity score matching, 171 cycles with storage time >5 years were matched with those ≤1 year, both the clinical pregnancy rate and live birth rate decreased significantly when the storage time exceeded 5 years.ConclusionsThe duration of vitrification did not significantly affect the pregnancy outcomes within 5 years period. However, the clinical pregnancy rate and live birth rate both decreased significantly when the duration of vitrification exceeded 5 years. It is worth noting that the conclusion was drawn from a small sample study after propensity score matching and should be treated with caution. In addition, the cycles were from different time periods, which could have an impact on the results.

Immunotherapy maintains the cancer-immunity cycle via re-activating the immune system, so as to achieve the purpose of anti-tumor. However, the response rate of current tumor immunotherapy strategies is still low. Even the most reported immune checkpoint block (ICB), the objective response rate (ORR) is only about 10-30%. Here, aiming at obtaining a higher response rate, we designed a cascade amplification nanocomposite consisting of the immune adjuvant polyinosinic:polycytidylic acid [Poly (I:C)] and aggregation-induced emission luminogen (AIEgen)-modified modular peptide (named PMRA). The PMRA includes

Background down-regulation has been widely used in IVF treatment; however, it lacks reports on the impact of down-regulation on obstetrics and perinatal outcomes. The purpose of this study was to compare the obstetrics and perinatal outcomes among different down-regulation conditions. Methods this is a retrospective cohort study on 3578 patients achieving cumulative singleton clinical pregnancy after their first oocytes retrieval cycle. Patients were grouped according to the serum estradiol after down-regulation (E2D) into three groups: 55 pg/ml. The obstetrics and perinatal outcomes, and live-birth rate per clinical pregnancy were main outcome measures. In the subgroup analysis, patients were further divided according to the mode of transfer. ANOVA, chi-square test, multivariate logistic regression, and multivariate general linear model were performed for statistical analysis. Results the patients with E2D 55 pg/ml had similar live-birth rates. The patients with E2D 55 pg/ml. There was no difference in the risks of congenital anomalies or mortality among the three groups. No differences were found in the gestational week, percentages of preterm birth and very preterm birth, birth weight, percentages of low birth weight and very low birth weight, delivery mode, or sex of newborn. Subgroup analysis showed that E2D 30-55 pg/ml was associated with a higher risk of low birth weight in patients with one fresh transfer + frozen transfer(s). Conclusion Down-regulation has no effect on the live-birth rate per clinical pregnancy. Patients with E2D

BackgroundThe scoring system for human blastocysts is traditionally based on morphology; however, there are controversies on the effect of morphology parameters on pregnancy outcomes. The aim of this study is to evaluate the predicting value of each morphology parameter on pregnancy outcomes in a setting of single embryo transfer.MethodsThis is a retrospective cohort study on patients undergoing frozen-thawed single blastocyst transfer at our center, between Jan. 2009 and Dec. 2018. A total of 10,482 cycles were analyzed. The blastocysts were scored according to the expansion and hatching status, morphology of inner cell mass (ICM), and cells of trophectoderm (TE). The primary outcome measure was live birth rate. One-way analysis of variance, chi-square test, and multiple logistic regression were used for statistical analysis.ResultsThe clinical pregnancy rate was lower in the blastocysts of stage 3 (48.15%), compared with those of stage 4 (56.15%), stage 5 (54.91%), and stage 6 (53.37%). The live birth rate was lower in the blastocysts of stage 3 (37.07%), compared with those of stage 4 (44.21%) and stage 5 (41.67%). The rates of clinical pregnancy (A: 66.60%, B: 53.25%, C: 39.33%) and live birth (A: 54.62%, B: 41.29%, C: 28.45%) were both decreased with decreasing grade of ICM morphology, and these differences were pairwise significant. The miscarriage rate of blastocysts with ICM grade A was lower, compared with ICM grade C (17.53 vs. 27.66%). Blastocysts with TE morphology of C had lower rates of clinical pregnancy (43.53%) and live birth (32.57%), compared with those with TE morphology of A and B (clinical pregnancy rate: 64.26% for A, 58.11% for B; live birth rate: 52.74% for A, 45.64% for B). There were no significant differences in rates of clinical pregnancy, live birth, and miscarriage between the blastocysts with TE grade A and B.ConclusionsThe blastocyst expansion stage, ICM grade, and TE grade are all associated with pregnancy outcomes. ICM grade is the strongest predictor of live birth. A blastocyst with stage 4–5, ICM grade A, and TE grade A/B should be given priority for single embryo transfer.

OBJECTIVE To investigate whether the estradiol/oocyte ratio (E2 /O) can predict ovarian response and pregnancy outcomes. METHODS This is a retrospective cohort study on 1838 individuals undergoing in vitro fertilization with a depot gonadotropin-releasing hormone agonist (GnRH-a) long protocol. The patients were grouped by the quartiles of E2 /O: 242.9 pg/mL. ANOVA and χ2 test with the Bonferroni adjustment were used for statistical analysis. RESULTS With the rise of E2 /O, the MII oocyte rate increased, whereas the number of oocytes retrieved decreased. The number of MII oocytes, fertilization rate, and the number of high-grade embryos were similar among the four groups. There were no differences in live-birth rate, clinical pregnancy rate, ectopic pregnancy rate, and miscarriage rate, but there was a trend towards a higher miscarriage rate in the patients with E2 /O between 131.2 and 242.9 pg/mL. CONCLUSION E2 /O indicates the percentage of MII oocytes, but not the quality of an individual follicle. E2 /O does not predict live birth in a depot GnRH-a long protocol; however, there is a trend towards a higher risk for miscarriage in the patients with E2 /O between 131.2 and 242.9 pg/mL.

Pretreatment with oral contraceptive pills (OCP) has been widely applied in IVF/ICSI –ET treatment. However, it remains unclear whether OCP influences pregnancy rate of fresh cycle and subsequent cumulative pregnancy rate in patients with endometriosis. In this retrospective study, a total of 512 first attempt IVF/ICSI cycles of patients with endometriosis were included and divided into two groups: the study group included 216 cycles of patients undergoing pretreatment with OCP before pituitary suppression and ovarian stimulation, while 296 cycles of patients without pretreatment were considered as control. The ovarian stimulation performance and pregnancy results were compared between the two groups. Patients with OCP pretreatment required shorter duration, a lower dosage of gonadotropins, but obtained higher E2 level and more retrieved oocytes. Patients in the two groups obtained comparable fertilization rate, cleavage rate, but the number and rate of day 3 high-quality embryos were higher in OCP-pretreated patients. No differences were found in IVF/ICSI-ET outcomes, in terms of implantation rate, clinical pregnancy rates, live birth pregnancy rate, and cumulative pregnancy rate. In addition, despite the lack of statistical significance, a trend toward higher clinical pregnancy rate in a fresh cycle and cumulative pregnancy rate was found in OCP pretreated patients. It should be recommended that patients with endometriosis take OCP pretreatment before ovarian stimulation, since it offers advantages of lower cost and higher embryo-quality, and does not negatively influence pregnancy rates.Chakrabartty et al., International Current Pharmaceutical Journal, July 2017, 6(8): 44-48http://www.icpjonline.com/documents/Vol6Issue8/01.pdf

BACKGROUND: Increasing scientific evidences suggest that body weight is a risk factor for breast cancer-related lymphedema (LE) in breast cancer patients, but many existing studies have yielded inconclusive results. This meta-analysis aims to provide a more precise estimation of the effects of body mass index (BMI) on LE in breast cancer patients. METHODS: Two authors searched independently in the main English-language databases, including PubMed, Embase, and Cochrane Central Register of Controlled Trials, and the main Chinese databases, including China National Knowledge Infrastructure and WanFang Data from inception through June 1, 2018 in human. Odds ratios with 95% confidence interval were calculated to evaluate the effect of BMI on LE. RESULTS: Twelve studies were identified with a total of 8,039 breast cancer patients, including 2102 patients who were suffered from LE; therefore, the total incidence of LE was 26.15%.The meta-analysis results reveal that the odds ratios were 1.42 [95% confidence interval (CI), 1.20 to 1.68] for BMI 25–30 kg/m(2) versus BMI

Embryo implantation is a complicated physiological process tightly regulated by multiple biological molecules including growth factors. Transforming growth factor-betas (TGF-βs) and their most specific signal transduction factors, Smads, are expressed in the endometrium during the window of implantation. Recent researches indicated that Smad dependent TGF-β signaling may play an important role in the process of embryo implantation. In this study, we measured the expression of TGF-β1, TGF-β receptor type I (TβRI), Smad3 and p-Smad3 in the endometrium of mice and observed their elevation on day 4, 5 and 6 of pseudopregnancy. Then we administrated a specific Smad3 inhibitor (Sis3) into the uterine cavity of mice on day 3 of pregnancy. The results showed a reduction in insulin-like growth factor-1 (IGFBP-1) expression and the decreased number of implanted embryo after the administration. In addition, Sis3 was found to reduce the IGFBP-1 secretion in decidualized endometrial stromal cells. Taken all together, our findings demonstrated that TGF-β/Smad3 signaling is involved in the process of embryo implantation.

A novel α/β-Bi2O3 hetero-phase junction (xBB) was successfully prepared by a simple in-situ growth method without further calcination, in which α-Bi2O3 served as the substrate for the growth of β-Bi2O3 nanosheets. The nanocomposites were well characterized by XRD, SEM, TEM, UV–vis DRS, XPS, EIS, etc. The characterizations testified that the bismuth oxides of two crystal phases were in close contact, and the hetero-phase junction was formed. The photocatalytic performance was evaluated by degradation of rhodamine B (RhB) and tetracycline hydrochloride (TC-HCl) under visible light illumination. With the optimum mass ratio, 0.5BB sample exhibited the highest photocatalytic activity, the removal rates were 82.7 % for TC-HCl in 120 min and 94.9 % for RhB in 90 min, and a rate constant of 0.0297min−1 was evaluated for RhB degradation, which were higher than that of pure α-Bi2O3 (0.0019 min−1) and β-Bi2O3 (0.0028 min−1) by a factor of 15.6 and 11.9, respectively. The synthetic method provides a promising route for the in-situ construction of hetero-phase junction nanocomposites.

Efficient separation of photo-induced charge carriers is highly desired for improving photocatalytic activity. Herein, morphology control and element doping are adopted to overcome the shortcomings of insufficient contact with pollutants and limited light-harvesting capability of the pristine g-C3N4. Petal-like Cl-doped g-C3N4 nanosheets are fabricated by a flexible self-assembly route using melamine and cyanuric as precursors, with different amounts of NH4Cl added to adjust the chlorine doping ratio. Benefiting from the enlarged specific surface area (98.330 m2 g−1), tunable band structure and the effective charge separation, the prepared chlorine doping g-C3N4 nanosheets show obviously higher efficiency in the removal of rhodamine B (90 min, 94.3 %) and tetracycline hydrochloride (120 min, 65.7 %), with degradation kinetic rates about 15.8 and 2.3 times than that of pristine g-C3N4. The supramolecular self-assembly and chlorine doping display a noticeable synergy on enhancing the photocatalytic performance, enabled g-C3N4-based nano-sized photocatalysts to be highly competitive candidates for pollutant elimination.

Currently, there is an increasing prevalence of adolescent exposure to methamphetamine (MA). However, there is a paucity of information concerning the long-term impact of early exposure to MA upon female fertility and ovarian reserve. The aim of this study was to investigate the effect of long-term MA exposure in adolescents on their ovarian reserve in adulthood. Adolescent mice received intraperitoneal injections of MA (5mg/kg, three times per week) or saline from the 21st postnatal day for an 8 week period. Morphological, histological, biochemical, hormonal and ethological parameters were evaluated. An impaired ovarian reserve and vitality was found in the group treated with MA, manifesting in morphological-apparent mitochondrial damage, an activated apoptosis pathway in the ovarian tissue, a downward expression of ovarian anti-Mullerian hormone (AMH), a decreased number of primordial and growing follicles, an increased number of atretic follicles, and a depressed secretion of AMH, estradiol and progesterone from granulosa cells. However, no significant difference was noticed regarding the estrous cycle, the mating ability and the fertility outcome in the reproductive age of the mice after a period of non-medication. The present results confirmed that a long term exposure to methamphetamine in adolescent mice does have an adverse impact on their ovarian reserve, which indicates that such an early abuse of MA might influence the fertility lifespan of the female mouse.

STUDY QUESTION Do the preferences for fertility care of infertile Chinese patients differ from those of fertility care providers? SUMMARY ANSWER Infertile Chinese patients attached the greatest importance to physicians' attitude but, in contrast, fertility care providers in China considered treatment effectiveness to be the most important factor in fertility care. WHAT IS KNOWN ALREADY In Europe, physicians underestimate the importance of patient-centred infertility care. STUDY DESIGN, SIZE, DURATION A conjoint survey was distributed among 417 female infertile Chinese patients and 83 fertility care providers from February 2013 to August 2013. PARTICIPANTS/MATERIALS, SETTING, METHODS In this pilot study, 389 patients and 83 fertility care providers completed the survey at three reproductive medicine centres. Rating-based conjoint analysis was performed to elicit patients' and their caregivers' preferences regarding fertility care. Cluster analysis was used to explore the heterogeneity among patients' preferences. MAIN RESULTS AND THE ROLE OF CHANCE When searching for fertility care, patients valued the physicians' attitude the most, followed by success rates, distance from home to the fertility centre, physician continuity throughout the treatment period and type of fertility centre. Fertility care providers considered success rates (effectiveness) to be the most important factor when recommending a fertility centre. Fertility patients and care providers had significantly different views on the value of treatment effectiveness, physician attitude and physician continuity (P-values

The objective of this study is to investigate whether the degree of down-regulation using GnRH-agonists is associated with pregnancy outcomes.This retrospective analysis was performed on 2708 cycles from 2514 patients undergoing down-regulation with the luteal phase long protocol. The serum oestradiol (E2D) and luteinising hormone (LHD) levels, the diameter of the largest follicle (DLFD) and the endometrial-thickness (ENTD) after down-regulation were used to evaluate the degree of down-regulation. One-way analysis of variance with the Bonferroni adjustment, the chi-square test and multivariate logistic regression analyses were used for the statistical analysis.The cumulative clinical pregnancy rates (CCPR) and the cumulative live birth rates (CLBR) were higher in the cycles with E2D 30 pg/ml (63.7%, OR = 1.405 (1.055-1.870) and 56.8%, OR = 1.372 (1.039-1.813)) and 30-55pg/ml (66.8%, OR = 1.439 (1.104-1.874) and 59.8%, OR = 1.397 (1.080-1.806)) than in those with E2D 55 pg/ml (62.8% and 54.7%). There was a trend towards lower CCPRs and CLBRs in the cycles with DLFD 10 mm or ENTD ≥ 6 mm; however, this difference was not significant.The degree of down-regulation is associated with ovarian response, pregnancy, and live birth. We propose the following criteria for optimal down-regulation: E2D 30-55 pg/ml, ENTD 6 mm, and no apparent ovarian activity.

The purpose of this study was to investigate the impact of body mass index (BMI) on the outcomes of IVF/ICSI treatment cycles in Chinese patients with polycystic ovary syndrome (PCOS). Women with PCOS (n = 128) and tubal factor (n = 128) underwent a conventional long GnRH agonist suppressive protocol. Women with PCOS had significantly more oocytes retrieved (P < 0.05) and available embryos (P < 0.05), as compared to patients with tubal infertility. No significant differences were observed in clinical pregnancy rate, miscarriage rate and live birth rate between two groups. Patients were further divided into two subgroups. In total, 49 patients in PCOS group and 19 patients in tubal factor group were overweight or obese (BMI ≥ 24 kg/m2). Lean women (BMI < 24 kg/m2) with PCOS showed higher clinical pregnancy rate (P < 0.05). Live birth rate and miscarriage rate were also higher in lean PCOS women, but the differences were not significant. Similar clinical outcomes of IVF/ICSI success were achieved between two subgroups in tubal factor patients. In conclusion, lean PCOS patients obtained higher clinical pregnancy rate compared with overweight/obese PCOS patients in Chinese populations.

The long gonadotrophin releasing-hormone agonists (GnRH-a) protocol of pituitary down regulation was widely used in controlled ovarian hyperstimulation (COH). Some clinicians prefer to use one cycle of oral contraceptives (OC) pretreatment before the traditional long GnRH-a protocol. This study was aimed to investigate whether such pretreatment could reduce the incidence of ovarian hyperstimulation syndrome (OHSS) for patients with different ovarian responses in IVF/ICSI treatment. Participants undergoing IVF/ICSI treatment with long GnRH-a protocol of pituitary down regulation in luteal phase were recruited by their potential risk of OHSS into one group of suspected high responders (227 participants) and the other group of suspected normal responders (665 participants). As for the suspected high responders, pretreatment with OC could lower the serum LH level, LH/FSH ratio and E2 level right after 14 days of pituitary down regulation. It could also lower the serum E2 level before oocytes retrieval and the count of oocytes collected. The incidence of severe OHSS was also significantly decreased. Such effect of OC on hormone profile, follicular dynamics and incidence of OHSS was not discovered in the group of suspected normal responders.

The aim of this retrospective cohort study was to investigate which preparation method is optimal for frozen-thawed embryo transfer (FET) treatment. Analyses were performed on 3160 FET cycles, including 654 cycles with a natural cycle (NC) protocol and 2506 cycles with an artificial cycle (AC) protocol. The primary outcome measures were the clinical pregnancy rate (CPR) and the live birth rate (LBR) per transfer. The Student's t-test, chi-square test and multiple logistic regression were used for statistical analysis. The CPR per transfer was 49.4% in the NC group and 58.6% in the AC group (OR = 1.270, 95% CI: 1.037-1.554). The LBR per transfer was 42.2% and 50.8% in the NC and AC groups, respectively (OR = 1.269, 95% CI: 1.037-1.552). Dividing the patients according to the type of transferred embryos, the CPR (67.3% versus 57.0%, p

Endometrial preparation with exogenous estrogen is a common practice in frozen-thawed embryo transfer (FET) cycles. The objective of this study was to compare the clinical outcomes of two endometrial preparation groups, oral estradiol valerate tablets (OEV) group versus vaginal estradiol (VE) tablets group, in inadequate endometrium patients. This retrospective, single-center, cohort study of patients undergoing FET treatment between Jan. 2012 and Jun. 2013, at an academic IVF center, included 247 patients (cycles) with endometrial thickness < 8 mm on day 13 of the hormone replacement cycle: OEV group included 69 patients (cycles) who received continuous OEV from day 1 onwards up to the day of progesterone supplement, while VE group included 178 patients (cycles) who taken OEV from day 1 to day 12, and used VE tablets from day 13 till the day of progesterone supplement. Patients in VE group required more days and higher dosage of estradiol, but had thinner endometrium on the day of transfer. However, the increase of endometrial thickness was more, when compared to OEV-treated patients. The implantation rate and pregnancy rate were, though not significantly, higher in VE group. Conclusions: Longer time of administration and higher dosage of estradiol usage did not have adverse effects on the clinical pregnancy rate. VE tablets may promote endometrial development and pregnancy success in FET cycles could not verify. Further study is needed to confirm the vaginal estradiol action on frozen-thawed embryo transfer cycles.

The impact of surgical treatment for endometrioma prior to assisted reproductive treatment (ART) on pregnancy outcomes remains controversy. The aim of this study is to investigate whether surgery provides benefits in subsequent ART outcomes. We retrospectively analyzed the data of 292 patients who underwent their first attempted IVF/ICSI treatment at fertility center in a university hospital, from 2011 to 2013. The primary outcomes included clinical pregnancy rate (CPR), live birth/ongoing pregnancy rate (LB/OPR). Although patients with no history of surgery and with visual endometriomas during IVF/ICSI treatment had fewer antral follicles (9.3±4.9 vs. 11.0±5.3, P=0.046), and required higher dosage of gonadotropin (3122.8±1118.1 vs. 2741.7±1096.0, P=0.043) when compared to patients who underwent surgery for endometriomas and without visual endometriomas during IVF/ICSI, the CPR and LB/OPR was not significantly affected (OR=0.771, 95%CI=0.398-1.495, and OR=1.043, 95%CI=0.526-2.069, respectively). In conclusion, surgical treatment does not significantly improve pregnancy outcomes in patients who plan to take IVF/ICSI treatment.

This study aimed to assess frozen-thawed embryo transfer (FET) outcomes in natural, hormone replacement treatment (HRT) and semi-HRT cycles. This was a retrospective cohort study of 5414 cycles of patients in an academic hospital. Patients were grouped as 2216 natural cycles, 1180 semi-HRT cycles, and 2018 HRT cycles. Primary outcome measures were implantation rate, clinical pregnancy rate and live birth rate. Other parameters, such as peak endometria-thickness, were also analyzed. Patients undergoing FET with HRT obtained higher implantation rate and clinical pregnancy rate than patients with natural or semi-HR cycles (29.3% vs. 21.5% vs. 25.6%, P=0.01, and 48.7% vs. 42.7% vs. 36.1%, P=0.01, respectively). This finding was not changed in patients with thin endometrium (≤8 mm). A Subanalysis in patients with HRT showed that the implantation and clinical pregnancy rate was higher in patients without ovulation than ovulatory patients (29.8% vs. 16.9%, P

This retrospective cohort study was aimed to investigate the impact of endometriosis on the IVF/ICSI outcomes. A total of 1027 cycles of patients undergoing IVF/ICSI treatment in a reproductive medicine unit of academic hospital were enrolled. In the present study, 431 cycles of patients with endometriosis constituted the study group, including 152 cycles of patients with stage I-II endometriosis and 279 cycles of patients with stage III-IV endometriosis, while 596 cycles of patients with tubal factors infertility were considered as the control group. Ovarian stimulation parameters and IVF/ICSI outcomes were compared. Patients with stage I-II and stage III-IV endometriosis required higher dosage and longer duration of gonadotropins, but had lower day 3 high-quality embryos rate, when compared to patients with tubal infertility. In addition, the number of oocytes retrieved, the number of obtained embryos, the number of day 3 high-quality embryos, serum E2 level on the day of hCG, fertilization rate were lower in patients with stage III-IV endometriosis than those in tubal factors group. Except reduced implantation rate in stage III-IV endometriosis group, no differences were found in other pregnancy parameters. This study suggests that IVF/ICSI yielded similar pregnancy outcomes in patients with different stages of endometriosis and patients with tubal infertility. Therefore, IVF/ICSI can be considered as an effective approach for managing endometriosis-associated infertility.

Polycystic ovary syndrome is a common heterogeneous endocrine disorder in reproductive-age women, with prevalence around 4-12%. The present study was performed to investigate whether progesterone-induced endometrial bleed before ovulation induction affects pregnancy in patients with PCOS who underwent intrauterine insemination (IUI) treatment. A total of 241 IUI cycles were retrospectively analyzed. Patients enrolled in this study underwent ovulation induction with IUI treatment from Jan. 2011 to Dec. 2012. The study group consisted of 184 cycles with progesterone-withdrawal bleed before ovulation induction. The control group included 57 cycles with spontaneous menses. The clinical characteristics, ovulation induction parameters and IUI outcomes, such as pregnancy rate and live birth/ongoing pregnancy rate, were compared between the two groups. We found that patients in induced shedding group had thinner peak endometrium in ovulation induction cycles. Additionally, the ratio of peak endometrial-thickness to baseline endometrial-thickness was lower in induced menses patients. However, the pregnancy rate and live birth/ongoing pregnancy rate per cycle were similar with the control group. Excluding the peak E(2) level, peak E(2)/number of follicles15 mm and peak endometrial-thickness/baseline endometrial-thickness, no differences were found in ovulation induction or IUI results between patients used Letrozole or Clomiphene Citrate. In patients undergoing administration with Letrozole, those taking progesterone had thinner endometrium and lower peak endometrial-thickness/baseline endometrial-thickness. However, the pregnancy rate and live birth/ongoing pregnancy rate were not statistically different from patients with spontaneous menses. In conclusion, our study showed that progesterone exerted a negative effect on endometrial development, which seemed to be associated with reduced pregnancy results in ovulation induction with IUI cycles.

The artificial regime was widespread used in frozen-thawed embryo transfer (FET). Some researchers asserted that if dominant follicles developed or ovulation occurred in hormone replacement FET cycles, this cycle should be cancelled because the fitting timing of transfer was hard to determine. In this study, we compared the difference between the outcome of frozen-thawed blastula transfer in hormone replacement treatment cycle (HRT) with or without dominant follicle development/ovulation. A total of 171 cases of frozen-thawed blastula transferred successfully in HRT cycle were retrospectively analyzed. Patients were divided into three groups according to dominant follicle development, ovulation or not: Group A, cycles without dominant follicle developing. Group B, cycles with dominant follicle developing but without ovulation. Group C, ovulated cycles. The results showed that there was no significant difference in the pregnancy rates or other parameters among the three groups, but the abortion rate was higher in group C than those of other two groups. To conclude, dominant follicle development/ovulation was not the necessary indication to cancel transfer cycles in HRT cycles, and our cautious decision would save many valuable cycles.