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Background: The global incidence of infertility is increasing, and infertility has become an important medical and social issue. With the widespread application of in vitro fertilization-embryo transfer (IVF-ET) technology, the mental health problems of patients undergoing this treatment have gradually attracted widespread attention. The purpose of this study was to explore the relationships among the level of hope, the fertility quality of life and negative emotions of patients who underwent IVF-ET treatment for the first time to provide a scientific basis for subsequent psychological support interventions. Methods: This study was a cross-sectional survey conducted at the Reproductive Medicine Center of Renmin Hospital of Wuhan University. From February 2023 to October 2023, 1425 patients who received IVF-ET treatment for the first time participated in the questionnaire survey. The survey content included the General Information Questionnaire, the Fertility Quality of Life (FertiQoL) Questionnaire, and the Herth Hope Index (HHI). Pearson correlation analysis was used to examine the relationships among the level of hope, fertility quality of life, and negative emotions. Results: The survey included 805 women and 620 men representing 603 couples. The level of hope in patients undergoing IVF-ET treatment for the first time was positively correlated with fertility quality of life (r = 0.247, P < 0.01), and the level of hope was negatively correlated with negative emotions (stress: r = − 0.135, P < 0.01; anxiety: r = − 0.105, P < 0.01; depression: r = − 0.189, P < 0.01). Fertility quality of life was negatively correlated with negative emotions (stress: r = − 0.609, P < 0.01; anxiety: r = − 0.533, P < 0.01; depression: r = − 0.591, P < 0.01). Among couples undergoing IVF-ET treatment for the first time, the husband's level of hope (r = 0.131, P < 0.01), fertility quality of life (r = 0.372, P < 0.01), and negative emotions (stress: r = 0.181, P < 0.01; anxiety: r = 0.163, P < 0.01; depression: r = 0.210, P < 0.01) were positively correlated with those of his wife. Conclusions: In patients undergoing their first IVF-ET treatment, there is a significant correlation among hope, fertility quality of life, and negative emotions. Moreover, within couples, the levels of hope, fertility quality of life, and negative emotions of husbands and wives mutually influence each other. Enhancing the level of hope in this population is conducive to alleviating negative emotions and improving their fertility quality of life. The mutual influence of spouses should not be overlooked in clinical practice, and psychological support for both partners should be emphasized. [ABSTRACT FROM AUTHOR]

To explore the relationships among fertility stress, dyadic coping and marital quality in couples undergoing in vitro fertilization‐embryo transfer (IVF‐ET). Couples receiving IVF‐ET treatment at the clinic of the reproductive medicine centre of a hospital in China from February 2023 to October 2023 were selected by convenience sampling. A general information questionnaire, the Infertility Fertility Stress Scale (COMP‐FPSS‐SF), the dyadic coping inventory, and the marital adjustment test were used to evaluate the results. AMOS24.0 software was used to construct an actor‐partner interdependence model that extended to mediation to analyze the relationships among couples' fertility stress, dyadic coping, and marital quality. The fertility stress level of IVF‐ET wives was significantly higher than that of their husbands (p < 0.05). Wives' levels of dyadic coping and marital quality were significantly lower than those of husbands (p < 0.05). Fertility stress, dyadic coping, and marital quality were positively correlated between IVF‐ET couples (p < 0.01). In terms of the actor effect, the fertility stress of IVF‐ET couples had a significant impact on their marital quality through their dyadic coping (β = −0.188, p < 0.05; β = −0.109, p < 0.05). In terms of partner effects, wives' fertility stress significantly affected their husbands' marital quality through their own or their husbands' dyadic coping (β = −0.055, p < 0.01; β = 0.157, p < 0.01). Dyadic coping mediates the relationship between fertility stress and marital quality in IVF‐ET couples. Nurses can use husbands and wives as central individuals and dyadic coping as the starting point to formulate intervention measures to reduce fertility stress and improve marital quality. [ABSTRACT FROM AUTHOR]

Abstract Background Due to the specific nature of interstitial pregnancy (IP), there are significant risks to both the mother and the foetus in women with a heterotopic interstitial pregnancy (HIP). IP alone has been analysed as a site-specific ectopic pregnancy (EP) in previous studies; however, according to the latest European Society of Human Reproduction and Embryology criteria, IP is classified as a tubal pregnancy. If IP can be classified as a tubal pregnancy, then there is no difference in the effects of these two methods on intrauterine pregnancies (IUPs). Under the premise of timely surgery, disposing of IPs and tubal pregnancy (excluding IPs) should also have no differential effect on IUPs. Methods Patients with heterotopic fallopian tubal pregnancy (HP-tube) and HIP seen at our hospital from January 2005 to December 2020 were included. All included patients were diagnosed by transvaginal sonography (TVS), and EPs were confirmed by surgery and pathological analysis. The IUP outcomes after surgical treatment of the EPs were compared between the HP-tube group (n = 464) and the HIP group (n = 206). The outcomes of IUPs were evaluated in patients with HIP who underwent either laparoscopy (169 cases) or laparotomy (36 cases). Results There was no significant difference in postoperative miscarriage (6.90% vs. 6.80%, odds ratio (OR) = 1.859, 95% confidence interval (CI) (0.807–4.279), p = 0.145); early spontaneous miscarriage (19.61% vs. 18.93%, OR = 0.788, 95% CI (0.495–1.255), p = 0.316); or late miscarriage (0.43% vs. 0.49%, OR = 0.823, 95% CI (0.070–9.661), p = 0.877) between the HP-tube group and the HIP group. There was no significant difference between the two groups in terms of preterm birth (7.33% vs. 6.80%, OR = 1.044, 95% CI (0.509–2.139), p = 0.907), live birth rate (71.60% vs. 73.30%, OR = 1.010, 95% CI (0.670–1.530), p = 0.980), or perinatal mortality rate (2.00% vs. 0.65%, OR = 0.580, 95% CI (0.030–3.590), p = 0.620). Compared to laparotomy for HIPs, laparoscopic treatment was associated with similar rates of postoperative miscarriage (5.33% vs. 13.90%, p = 0.076), live birth rate (72.80% vs. 75.00%, p = 0.948), caesarean Sect. (83.90% vs. 77.80%, p = 0.414). Conclusions After early diagnosis and treatment of EPs, patients in the HP-tube and HIP groups achieved comparable outcomes. Laparotomy and laparoscopy for treating HIPs yielded similar pregnancy outcomes.

Background: Due to the specific nature of interstitial pregnancy (IP), there are significant risks to both the mother and the foetus in women with a heterotopic interstitial pregnancy (HIP). IP alone has been analysed as a site-specific ectopic pregnancy (EP) in previous studies; however, according to the latest European Society of Human Reproduction and Embryology criteria, IP is classified as a tubal pregnancy. If IP can be classified as a tubal pregnancy, then there is no difference in the effects of these two methods on intrauterine pregnancies (IUPs). Under the premise of timely surgery, disposing of IPs and tubal pregnancy (excluding IPs) should also have no differential effect on IUPs. Methods: Patients with heterotopic fallopian tubal pregnancy (HP-tube) and HIP seen at our hospital from January 2005 to December 2020 were included. All included patients were diagnosed by transvaginal sonography (TVS), and EPs were confirmed by surgery and pathological analysis. The IUP outcomes after surgical treatment of the EPs were compared between the HP-tube group (n = 464) and the HIP group (n = 206). The outcomes of IUPs were evaluated in patients with HIP who underwent either laparoscopy (169 cases) or laparotomy (36 cases). Results: There was no significant difference in postoperative miscarriage (6.90% vs. 6.80%, odds ratio (OR) = 1.859, 95% confidence interval (CI) (0.807–4.279), p = 0.145); early spontaneous miscarriage (19.61% vs. 18.93%, OR = 0.788, 95% CI (0.495–1.255), p = 0.316); or late miscarriage (0.43% vs. 0.49%, OR = 0.823, 95% CI (0.070–9.661), p = 0.877) between the HP-tube group and the HIP group. There was no significant difference between the two groups in terms of preterm birth (7.33% vs. 6.80%, OR = 1.044, 95% CI (0.509–2.139), p = 0.907), live birth rate (71.60% vs. 73.30%, OR = 1.010, 95% CI (0.670–1.530), p = 0.980), or perinatal mortality rate (2.00% vs. 0.65%, OR = 0.580, 95% CI (0.030–3.590), p = 0.620). Compared to laparotomy for HIPs, laparoscopic treatment was associated with similar rates of postoperative miscarriage (5.33% vs. 13.90%, p = 0.076), live birth rate (72.80% vs. 75.00%, p = 0.948), caesarean Sect. (83.90% vs. 77.80%, p = 0.414). Conclusions: After early diagnosis and treatment of EPs, patients in the HP-tube and HIP groups achieved comparable outcomes. Laparotomy and laparoscopy for treating HIPs yielded similar pregnancy outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: In vitro fertilization-embryo transfer is commonly used to solve infertility, but its success rate is not high, the more common reasons are poor endometrial receptivity, poor egg quality, etc. The follicular fluid melatonin can inhibit the aging of the ovary, to a certain extent, can promote the development of embryos, improve the probability of conception, but whether there is a correlation between the two is not known. OBJECTIVE: To explore the correlation between follicular fluid melatonin level and pregnancy rate of single-cycle in vitro fertilization-embryo transfer women. METHODS: A total of 112 female patients who received in vitro fertilization-embryo transfer treatment in the First Affiliated Hospital of Anhui Medical University from December 2020 to April 2021 were selected as the study subjects. They were divided into quartile array (Q1-Q5) according to the follicular fluid melatonin level from low to high. Among them, the melatonin level of group Q1 was < 6.99 ng/L (n=18), that of group Q2 was 7.00-9.99 ng/L (n=26), that of group Q3 was 10.00-11.99 ng/L (n=27), and that of group Q4 was 12.00-13.99 ng/L (n=18); and melatonin levels in group Q5 were 14.00-19.99 ng/L (n=23). Clinical data characteristics of the five groups were compared. Multi-factor Logistic regression was used to analyze the correlation between follicular fluid melatonin level and pregnancy rate of women with single-cycle in vitro fertilization-embryo transfer and embryo transfer. A restricted cubic spline Logistic regression model was established to analyze the dose-response relationship, and the model was evaluated by clinical decision curve. RESULTS AND CONCLUSION: (1) Compared with the study population with the lowest melatonin quintile (Q1), with the increase of melatonin level (Q2-Q5), the levels of egg harvest and pregnancy success were gradually increased, and the body mass index was gradually decreased, and the differences were significant (P < 0.05). (2) Multivariate Logistic regression analysis showed that after adjusting for confounding factors such as global mass index, number of eggs retrieved, luteinizing hormone, estradiol, progesterone and other confounding factors, follicular fluid melatonin level was still independently correlated with pregnancy rate of single-cycle in vitro fertilization-embryo transfer women (OR=1.538, 95%CI: 1.032-1.837, P < 0.05), and there was significant difference in trend test of follicular fluid melatonin level from low to high quintile array (Ptrend < 0.05). (3) The sensitivity test analysis showed that E value was 2.117. Subgroup analysis showed that the study population with higher levels of luteinizing hormone in follicular fluid had a more significant association between follicular fluid melatonin and pregnancy rate in single-cycle in vitro fertilization-embryo transfer women (P interaction=0.008). (4) The results of restricted cubic spline model analysis showed that there was a nonlinear dose-response relationship between follicular fluid melatonin level and pregnancy rate of single-cycle in vitro fertilization-embryo transfer women (P < 0.05), and there was an overall positive correlation between follicular fluid melatonin level and pregnancy rate of single-cycle in vitro fertilization-embryo transfer women. (5) The results of clinical decision curve analysis showed that the follicular fluid melatonin level had important clinical value in predicting the pregnancy rate of single-cycle in vitro fertilization-embryo transfer women. (6) Follicular fluid melatonin level is closely related to the pregnancy rate of single-cycle in vitro fertilization-embryo transfer women, and with the decrease of follicular fluid melatonin level, the pregnancy rate of single-cycle in vitro fertilization-embryo transfer women also decreases. [ABSTRACT FROM AUTHOR]

Objective: To understand the status and related factors of emotional inhibition among women receiving in vitro fertilization-embryo transfer (IVF-ET). Methods: A total of 791 women receiving IVF-ET from a specialized hospital in Changsha were selected, and surveyed with the General Questionnaire, Emotional Inhibition Scale (EIS), Locke-Wollance Marital Adjustment Questionnaire, Self-Compassion Scale and Medical Coping Mode Questionnaire. Results: The average score of EIS in women receiving IVF-ET was (28.0±6.4). Multiple linear regression analysis showed that the EIS scores in women receiving IVF-ET were negatively associated with infertility factors (β = -9.23, 4.56, 2.86), personality type (β = 1.11), and marital adjustment, confrontation and self-compassion scores (β = -0.03, 0.13,0.05), and positively associated with residence and surrender dimension scores (β = 0. 82, 0. 20). Conclusion: It suggests that women receiving IVF-ET have a certain degree of emotional inhibition, which is related to infertility factors, residence, personality type, self-compassion, marital adjustment, confrontation, and surrender. [ABSTRACT FROM AUTHOR]

Context Metabolic syndrome (MetS) is a cluster of metabolic risk factors that predict cardiovascular disease. Previous studies suggested that MetS impaired clinical outcomes in women with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF). Objective To evaluate the effects of MetS on IVF/intracytoplasmic sperm injection (ICSI) outcomes in women without PCOS. Methods This retrospective study collected 8539 eligible women without PCOS who came for their first cycle of IVF/ICSI to the Institute of Women, Children and Reproductive Health, Shandong University, from 2017 to 2020, including 1147 subjects in the MetS group and 7392 in the control group. The primary outcome was live birth. Secondary outcomes included other pregnancy outcomes and the risk of maternal and neonatal complications. Results Women in the MetS group had a lower live birth rate (50.6% vs 54.9%, adjusted odds ratio [aOR] 0.87, 95% CI 0.75-1.00, P =.045) and higher risks of late miscarriage (5.8% vs 3.3%, aOR 1.52, 95% CI 1.02-2.27, P =.041), gestational diabetes mellitus (13.7% vs 7.0%, aOR 1.84, 95% CI 1.30-2.60, P =.001), hypertensive disorder of pregnancy (7.8% vs 3.5%, aOR 1.79, 95% CI 1.14-2.83, P =.012), and preterm birth (9.0% vs 4.4%, aOR 2.03, 95% CI 1.33-3.08, P =.001). Singleton newborns in the MetS group were at higher risk of large for gestational age (33.3% vs 20.5%, aOR 1.66, 95% CI (1.31-2.13), P <.001) but at lower risk of small for gestational age (2.7% vs 6.2%, aOR 0.48, 95% CI 0.25-0.90, P =.023). Conclusion MetS was associated with adverse IVF/ICSI outcomes in women without PCOS. [ABSTRACT FROM AUTHOR]

Abstract Background Assisted reproductive technology (ART) is the most effective method to treat infertility and the pathogenesis of implantation failure after in vitro fertilization-embryo transfer (IVF-ET) is a challenging filed in infertility. Microbes in the female reproductive tract are considered to be associated with gynecological and obstetric diseases. However, its effects on embryo implantation failure are unsured. Purpose This study aimed to investigate reproductive tract dysbiosis, identify different bacteria in reproductive tract as potential biomarkers of embryo implantation failure and demonstrate the pathogenesis through metabolites analysis. Methods We compared the data from 16S rRNA gene and metagenome in reproductive tracts through QIIME2 and HUMAnN2 by the times of embryo implantation failure on 239 infertile patients and 17 healthy women. Results Our study revealed a strong positive correlation between Lactobacillus abundance and embryo implantation success (IS) after IVF-ET. The microbial community composition and structure in reproductive tract showed substantially difference between the embryo implantation failure (IF) and healthy control. Moreover, we established a diagnostic model through receiver operating characteristic (ROC) with 0.913 area under curve (AUC) in IS and multiple implantation failures (MIF), verified its effectiveness with an AUC = 0.784 demonstrating microbial community alterations could efficiently discriminate MIF patients. Metagenome functional analyses of vaginal samples from another independent infertile patients after IVF-ET revealed the L-lysine synthesis pathway enriched in IF patients, along with ascended vaginal pH and decreased Lactobacillus abundance. Conclusions This study clarifies several independent relationships of bacteria in vagina and endometrial fluid on embryo implantation failure and undoubtedly broadens the understanding about female reproductive health.

Background: Assisted reproductive technology (ART) is the most effective method to treat infertility and the pathogenesis of implantation failure after in vitro fertilization-embryo transfer (IVF-ET) is a challenging filed in infertility. Microbes in the female reproductive tract are considered to be associated with gynecological and obstetric diseases. However, its effects on embryo implantation failure are unsured. Purpose: This study aimed to investigate reproductive tract dysbiosis, identify different bacteria in reproductive tract as potential biomarkers of embryo implantation failure and demonstrate the pathogenesis through metabolites analysis. Methods: We compared the data from 16S rRNA gene and metagenome in reproductive tracts through QIIME2 and HUMAnN2 by the times of embryo implantation failure on 239 infertile patients and 17 healthy women. Results: Our study revealed a strong positive correlation between Lactobacillus abundance and embryo implantation success (IS) after IVF-ET. The microbial community composition and structure in reproductive tract showed substantially difference between the embryo implantation failure (IF) and healthy control. Moreover, we established a diagnostic model through receiver operating characteristic (ROC) with 0.913 area under curve (AUC) in IS and multiple implantation failures (MIF), verified its effectiveness with an AUC = 0.784 demonstrating microbial community alterations could efficiently discriminate MIF patients. Metagenome functional analyses of vaginal samples from another independent infertile patients after IVF-ET revealed the L-lysine synthesis pathway enriched in IF patients, along with ascended vaginal pH and decreased Lactobacillus abundance. Conclusions: This study clarifies several independent relationships of bacteria in vagina and endometrial fluid on embryo implantation failure and undoubtedly broadens the understanding about female reproductive health. [ABSTRACT FROM AUTHOR]

Objective: Gonadotropin-releasing hormone agonists (GnRHa), combined with other auxiliary treatments, can improve pregnancy outcomes in in vitro fertilization-embryo transfer (IVF-ET). This research investigated the effect of acupuncture combined with GnRHa in patients with recurrent implantation failure (RIF) of IVF-ET. Methods: A total of 164 patients who intended to undergo frozen-thawed embryo transfer after RIF of IVF-ET were selected for experiments and then divided into the control (received conventional hormone replacement therapy (HRT) for endometrial preparation) and study groups (received a combination of acupuncture, GnRHa, and HRT for endometrial preparation) (n = 82). Endometrial thickness (EMT), endometrial morphological classification, submucosal uterine blood flow classification, clinical pregnancy rate, embryo implantation rate, and early abortion rate for each transfer cycle were compared between the two groups. Results: EMT of the study group was higher than that of the control group 1 day before transfer. There were more patients with linear endometrium (A + B type) in the study group on the day of endometrial transformation than in the control group. The number of patients with type I submucosal uterine blood flow in the study group was decreased and the number of patients with type III was increased compared with the control group on the day of endometrial transformation. The clinical pregnancy rate and embryo implantation rate of the study group were higher than those of the control group. Conclusion: Acupuncture combined with GnRHa improves the endometrial receptivity of patients with RIF of IVF-ET, thereby increasing clinical pregnancy rates and improving pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Poor ovarian response (POR) is a pathological condition in which the ovary responds poorly to gonadotropins, and is a major constraint on the unsatisfactory outcome of in vitro fertilization-embryo transfer (IVF-ET). Follicular growth, development, maturation, and expulsion are all affected by the yin-yang balance between heart and kidney, as well as the elevation exchange. If the heart and kidney essence and blood are insufficient, water and fire are out of harmony, and qi movement is not smooth, fewer high-quality follicles will be recruited and acquired during the ovarian stimulation cycle, resulting in a low transferable embryo rate and unacceptable pregnancy result. Sympathetic treatment of heart and kidney should be based on the following principles at different stages of the IVF-ET cycle: replenishing the heart, kidney, essence, and blood before entering the cycle, in order to nourish the essence and assist in the growth of the follicles; nourishing renal water, and clearing heart fire during the pituitary down-regulation period, in order to lessen the negative effects of the down-regulation medicinals; regulating the depression of the heart, liver, spleen, and kidney meridians during the follicle's retrieval period, in order to encourage the smooth release of the ova; and warming heart and kidney fire to improve endometrial tolerance during the implantation period. The application of the theory of intercourse of heart and kidney to elucidate the pathogenesis of POR is critical to the development of clinical strategies for fertility enhancement, as well as providing new ideas for the clinical application of traditional Chinese medicine in the field of reproduction. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethods and measuresResultsConclusionA person’s marital satisfaction is a strong predictor of their own mental health outcomes. However, marital satisfaction results from both spouses’ experiences, so a partner’s marital satisfaction also affects his or her mental health outcomes. This study adopted the actor-partner interdependence model approach (APIM) to evaluate the relationship between marital satisfaction and sense of defeat in vitro fertilization-embryo transfer (IVF-ET) couples.In this cross-sectional study, 181 infertile couples undergoing IVF-ET treatment were recruited using the Marital Satisfaction Scale of the ENRICH Marital Quality Questionnaire and Defeat Scale. Through APIM and Pearson analysis, the path relationship between marital satisfaction and defeat was analyzed.The varying degrees of defeat in IVF-ET couples, are closely related to actors’ and partners’ marital satisfaction. In terms of actor effects, the Marital Satisfaction of both husbands (β = −0.71, p < 0.001) and wives (β = −0.46, p = 0.001) have a significant effect on individual Defeat. With regard to partner effects, husbands’ Marital Satisfaction (β = −0.23, p = 0.038) has a significant impact on wives’ Defeat and the wives’ Marital Satisfaction (β = −0.45, p = −0.005) has a significant impact on husbands’ Defeat.IVF-ET couples must be looked at as a whole, and it is critical to include couples and not just men or women when studying infertility. The importance of their interaction is essential to improve the psychosocial adaptation of infertile couples in IVF-ET treatment. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the efficacy of peri-trigger female reproductive hormones (FRHs) in the prediction of oocyte maturation in normal ovarian reserve patients during the in vitro fertilization-embryo transfer (IVF-ET) procedure. Materials and Methods: A hospital database was used to extract data on IVF-ET cases from January 2020 to September 2021. The levels of female reproductive hormones, including estradiol (E2), luteinizing hormone (LH), progesterone (P), and follicle-stimulating hormone (FSH), were initially evaluated at baseline, the day of the trigger, the day after the trigger, and the day of oocyte retrieval. The relative change in E2, LH, P, FSH between time point 1 (the day of trigger and baseline) and time point 2 (the day after the trigger and day on the trigger) was defined as E2_RoV1/2, LH_RoV1/2, P_RoV1/2, and FSH_RoV1/2, respectively. Univariable and multivariable regression were performed to screen the peri-trigger FRHs for the prediction of oocyte maturation. Results: A total of 118 patients were enrolled in our study. Univariable analysis revealed significant associations between E2_RoV1 and the rate of MII oocytes in the GnRH-agonist protocol group (p < 0.05), but not in the GnRH-antagonist protocol group. Conversely, P_RoV2 emerged as a potential predictor for the rate of MII oocytes in both protocol groups (p < 0.05). Multivariable analysis confirmed the significance of P_RoV2 in predicting oocyte maturation rate in both groups (p < 0.05), while the association of E2_RoV1 was not significant in either group. However, within the subgroup of high P_RoV2 in the GnRH-agonist protocol group, association was not observed to be significant. The C-index was 0.83 (95% CI [0.73–0.92]) for the GnRH-agonist protocol group and 0.77 (95% CI [0.63–0.90]) for the GnRH-antagonist protocol group. The ROC curve analysis further supported the satisfactory performance of the models, with area under the curve (AUC) values of 0.79 for the GnRH-agonist protocol group and 0.81 for the GnRH-antagonist protocol group. Conclusions: P_RoV2 showed significant predictive value for oocyte maturation in both GnRH-agonist and GnRH-antagonist protocol groups, which enhances the understanding of evaluating oocyte maturation and inform individualized treatment protocols in controlled ovarian hyperstimulation during IVF-ET for normal ovarian reserve patients. [ABSTRACT FROM AUTHOR]

This study was aimed to elucidate the relationship between sperm DNA fragmentation index (DFI) and semen parameters, and to investigate the impact of these parameters on in vitro fertilization-embryo transfer (IVF-ET) outcomes. The study was conducted on 159 couples undergoing IVF-ET treatment at the Department of Reproductive Health from January 2019 to October 2023. The case group was comprised of 79 patients with sperm DFI of ≥15%, and the control group had 80 patients with 0.05). However, marked differences were found in the rates of sperm progressive motility, total sperm motility, normal morphology, high-quality embryos, and transferable embryos (p < 0.05). The correlation analysis between sperm DFI and semen parameters exhibited positive correlation between sperm DFI and total sperm count (p < 0.05). The negative correlations were found between the sperm DFI and sperm progressive motility, total sperm motility, or normal morphology (p < 0.01). The findings demonstrated that incorporating sperm DFI as a standard component of semen analysis was advisable, and the sperm DFI as reference tool assisted in predicting the early embryonic development in IVF-ET patients.

Abstract Objective This study aims to investigate the effect of diminished ovarian reserve (DOR) on the clinical outcomes and maternal and infant safety of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) procedures in young women aged ≤ 35 years. Methods A retrospective cohort study was performed to analyze the clinical data of 4,203 infertile women aged ≤ 35 years who underwent fresh embryo transfer (ET) in IVF/ICSI cycles. The data were collected from their initial visits to Fujian Maternity and Child Health Hospital between January 2015 and January 2022. Based on their ovarian reserve, the participants were categorized into two groups: DOR group (n = 1,027) and non-DOR group (n = 3,176). A propensity score matching (PSM) method was employed to ensure a relatively balanced distribution of covariates. The primary outcome assessed in this study was the live birth rate, while the secondary observation indicators included rates of high-quality embryo development, blastocyst formation, clinical pregnancy, and miscarriage, along with perinatal complications, neonatal birth weight, and the incidence of low birth weight (LBW). Results The DOR group showed notably lowered rates of blastocyst formation (59.8% vs. 64.1%), embryo implantation (29.8% vs.33.3%), clinical pregnancy (47.9% vs. 53.6%), and live birth (40.6% vs. 45.7%) compared to the non-DOR group (all P 0.05). Conclusion DOR has been found to reduce both clinical pregnancy and live birth rates in young females undergoing fresh ET in IVF/ICSI cycles. However, this reduction does not increase the risk of perinatal complications or LBW of infants through live birth cycles.

Objective: Qu's formula 3 (QUF3) is a patented Chinese herbal medicine used to alleviate anxiety disorders during in vitro fertilization-embryo transfer (IVF-ET). This study aimed to identify the potential active constituents and molecular mechanisms of action of QUF3 in alleviating anxiety disorders during IVF-ET. Methods: The active constituents of QUF3 were identified from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform and literatures. Potential targets of anxiety disorder and IVF-ET were identified using GeneCards, Online Mendelian Inheritance in Man, and the UniProt Database. Protein-protein interaction (PPI) network, gene ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed to identify the potential mechanisms. Molecular docking and molecular dynamics (MD) simulations were performed to visualize and verify the results. Results: Quercetin, sophoranol, luteolin, kaempferol, and neurotoxin inhibitors were identified as the TOP 5 active constituents of QUF3. Forty common targets were shared among QUF3, anxiety disorders, and IVF-ET. Tumour necrosis factor, interleukin-6, vascular endothelial growth factor A, epidermal growth factor, interleukin-1B, cellular tumour antigen p53, matrix metalloproteinase-9, and oestrogen receptor were identified as the TOP 8 potential targets through PPI analysis. A total of 697 biological processes, 20 cellular components, and 54 molecular functions were identified. Further, 91 KEGG pathways were revealed to be enriched. The TOP 5 active constituents were verified to have good binding activity with the TOP 8 potential targets using molecular docking and MD simulations. Conclusions: The mechanism of QUF3 in alleviating anxiety disorders in patients undergoing IVF-ET may be related to the interleukin-17 and tumour necrosis factor signalling pathways, inhibiting inflammatory responses and antioxidants, which may provide a solid foundation for the clinical application and further study of QUF3.

Jingying Wang,1,2 Ying Fang,1,2 Tong Chen,1,2 Zhimin Xin,1,2 Yumei Wu,3,4,&ast; Xiaokui Yang1,2,&ast; 1Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Human Reproductive Medicine, Beijing Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 3Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People’s Republic of China; 4Department of Gynecological Oncology, Beijing Maternal and Child Health Care Hospital, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiaokui Yang, Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, People’s Republic of China, Tel +86 522 766 15, Email yangxiaokui@ccmu.edu.cn Yumei Wu, Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, People’s Republic of China, Tel +86 522 766 53, Email wym597118@ccmu.edu.cnAbstract: Preserving fertility is a vital concern for young women diagnosed with endometrial carcinoma. The clinical management of such patients is often disappointing. It is rare to have two consecutive successful pregnancies. We present a child-bearing-age woman who underwent fertility preservation therapy due to endometrial carcinoma. Following fertility preservation therapy, she underwent in vitro fertilization and embryo transfer. After receiving her first fresh embryo transfer, she successfully conceived and gave birth to a healthy child. Two years after the first embryo transfer and regular follow-up, she had another frozen embryo transfer of two cleavage embryos and successfully gave birth to another healthy baby. After the delivery of her second child, she underwent surgical treatment for endometrial carcinoma. For endometrial carcinoma patients who intend to preserve fertility, high-quality long-term follow-up and personalized treatment are necessary.Plain Language Summary: In this case report, we share the story of one young woman who had endometrial cancer but desired to have children. She received fertility-sparing treatment and in vitro fertilization to increase her chances of conceiving. She successfully delivered a healthy child after the first embryo transfer. Two years later, she had another healthy child through a second frozen embryo transfer. Rigorous monitoring showed no cancer recurrence throughout the entire treatment. There are currently few reported cases of a patient with endometrial cancer successfully and safely giving birth twice through assisted reproductive technology. This case report emphasizes that, with personalized treatment and monitoring, endometrial cancer patients can have multiple pregnancies safely. In summary, this case report brings hope to young women with early-stage endometrial cancer who aspire to become mothers. With the right support, they can overcome the challenges of cancer and have their own babies.Keywords: endometrial carcinoma, fertility preservation, pregnancy outcome, in vitro fertilization-embryo transfer

Objective To investigate the effect of insulin resistance (IR) in primary infertile couples on pregnancy outcomes in fresh cycle embryo transfer. Methods A total of 101 primary infertile couples who underwent first IVF-ET/ICSI assisted conception with fresh cycle embryo transfer in our reproductive medical center from October 2022 to October 2023 were retrospectively included. According to whether they had combined IR unilaterally, these couples were divided into female IR group (n=49) and female non-IR group (n=52), and male IR group (n=49) and male non-IR group (n=52). The basic data, ovulation promotion, embryo transfer and pregnancy outcome were compared between the female IR group and non-IR group, and between the male IR group and non-IR group. Logistic regression analysis was applied to determine the effect of IR on pregnancy outcome and laboratory indicators of ovulation promotion. Results ① The IR female group had significantly higher body weight and BMI, and lower antral follicle count (AFC) when compared with the non-IR female group (P < 0.05). ② Female fasting blood glucose was negatively correlated with the number of acquired eggs, number of metaphase Ⅱ (MII) oocytes, number of transferable embryos, and number of high-quality embryos (P < 0.05); and both female fasting insulin level and female HOMA-IR were positively correlated with the days and total amount of gonadotropin (GN) (P < 0.05). ③ Embryo implantation and clinical pregnancy rates were significantly lower in the female IR group than the female non-IR group (P < 0.05). ④ The male IR group had significantly higher BMI than the male non-IR group (P < 0.05). ⑤Embryo implantation rate and clinical pregnancy rate were in declining trend in all following 3 groups of couples (both IR groups, single IR group, and neither IR group). ⑥ Female fasting blood glucose level showed a negative effect on number of acquired eggs, number of MII oocytes, number of transferable embryos, and number of high-quality embryos. Conclusion IR affects embryo quality in IVF/ICSI cycles in women with primary infertility; IR in couples with primary infertility negatively affects embryo implantation rates and clinical pregnancy rates in IVF/ICSI cycles.

Objective: The probability of embryo implantation in an abnormal location is significantly higher in assisted reproductive technology (ART) than in natural pregnancies. Angular pregnancy is an eccentric intrauterine pregnancy with embryo implantation in the lateral superior angle of the uterine cavity. Cycle‐level factors associated with angular pregnancy in patients conceived with ART needed to be explored. Methods: A total of 11 336 clinical pregnancies cycles were included. Angular pregnancy rate was compared among groups according to the type of embryos transferred. Among them, 53 cases of angular pregnancy and 159 cases of normal intrauterine pregnancy were screened out using propensity score matching. Risk factors of angular pregnancy were explored. Results: The angular pregnancy rate was 0.31% (14/4572) in the day 5 blastocyst transfer group, 0.58% (39/6764) in non‐day 5 embryo transfer group, with 0.55% (29/5280) in day 3 embryo transfer and 0.67% (10/1484) in the day 6 blastocyst group, respectively. A multifactor regression analysis was performed and indicated that the number of embryos transferred was significantly associated with angular pregnancy (P = 0.031, OR, 2.23, 95% CI: 1.09–4.68). Conclusion: Multiple embryo transfer could possibly be associated with an increased incidence of angular pregnancy in patients conceived with ART. Synopsis: Multiple embryo transfer could possibly be associated with an increased incidence of angular pregnancy in patients conceived with ART. [ABSTRACT FROM AUTHOR]

Background: This study investigates the potential impact of high progesterone (P) level on the day following human chorionic gonadotropin (HCG) injection on the clinical pregnancy outcomes of in vitro fertilization-embryo transfer (IVF-ET). Methods: Retrospective analysis was conducted on 6418 cycles of IVF-ET performed at Liuzhou Maternal and Child Health Hospital between August 2020 to December 2021. Excluding cycles with progesterone levels ≥1.5ng/ml on HCG injection, a total of 781 cycles were identified according to the standard, and they were divided into five groups according to the progesterone level on the day after HCG: Group A: progesterone level < 2.5 ng/ml (n = 128); Group B: 2.5 ng/ml ≤ progesterone level < 3.5 ng/ml (n = 174); Group C: 3.5 ng/ml ≤ progesterone level < 4.5 ng/ml (n = 153); Group D: 4.5 ng/ml ≤ progesterone level < 5.5 ng/ml (n = 132); Group E progesterone level ≥5.5 ng/ml(n=194). Comparative analyses of clinical data, including general clinical data, and clinical pregnancy outcomes such as clinical pregnancy rate, miscarriage rate, and live birth rate were performed among these groups. Results: There were significant differences in estradiol levels on HCG injection, but there were no differences in available embryo rate, clinical pregnancy rate, miscarriage rate, and live birth rate. Binary logistic regression analysis showed that there was no significant correlation between P level on the day after HCG injection and the live birth rate. Conclusion: Under the condition of low P level on HCG injection, high progesterone levels on the day after HCG injection does not affect the clinical pregnancy outcomes of IVF-ET. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the effect of diminished ovarian reserve (DOR) on the clinical outcomes and maternal and infant safety of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) procedures in young women aged ≤ 35 years. Methods: A retrospective cohort study was performed to analyze the clinical data of 4,203 infertile women aged ≤ 35 years who underwent fresh embryo transfer (ET) in IVF/ICSI cycles. The data were collected from their initial visits to Fujian Maternity and Child Health Hospital between January 2015 and January 2022. Based on their ovarian reserve, the participants were categorized into two groups: DOR group (n = 1,027) and non-DOR group (n = 3,176). A propensity score matching (PSM) method was employed to ensure a relatively balanced distribution of covariates. The primary outcome assessed in this study was the live birth rate, while the secondary observation indicators included rates of high-quality embryo development, blastocyst formation, clinical pregnancy, and miscarriage, along with perinatal complications, neonatal birth weight, and the incidence of low birth weight (LBW). Results: The DOR group showed notably lowered rates of blastocyst formation (59.8% vs. 64.1%), embryo implantation (29.8% vs.33.3%), clinical pregnancy (47.9% vs. 53.6%), and live birth (40.6% vs. 45.7%) compared to the non-DOR group (all P < 0.05). However, no statistically significant differences were observed in the high-quality embryo rate, miscarriage rate, perinatal complications, neonatal birth weight, or LBW incidence in infants between both groups (all P > 0.05). Conclusion: DOR has been found to reduce both clinical pregnancy and live birth rates in young females undergoing fresh ET in IVF/ICSI cycles. However, this reduction does not increase the risk of perinatal complications or LBW of infants through live birth cycles. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the efficacy of peri-trigger female reproductive hormones (FRHs) in the prediction of oocyte maturation in normal ovarian reserve patients during the in vitro fertilization-embryo transfer (IVF-ET) procedure. Materials and Methods A hospital database was used to extract data on IVF-ET cases from January 2020 to September 2021. The levels of female reproductive hormones, including estradiol (E2), luteinizing hormone (LH), progesterone (P), and follicle-stimulating hormone (FSH), were initially evaluated at baseline, the day of the trigger, the day after the trigger, and the day of oocyte retrieval. The relative change in E2, LH, P, FSH between time point 1 (the day of trigger and baseline) and time point 2 (the day after the trigger and day on the trigger) was defined as E2_RoV1/2, LH_RoV1/2, P_RoV1/2, and FSH_RoV1/2, respectively. Univariable and multivariable regression were performed to screen the peri-trigger FRHs for the prediction of oocyte maturation. Results A total of 118 patients were enrolled in our study. Univariable analysis revealed significant associations between E2_RoV1 and the rate of MII oocytes in the GnRH-agonist protocol group (p

To investigate whether the treatment outcome of IVF can be improved by progesterone pretreatment of endometriosis. 168 cases with male factors and ovarian endometriosis cysts were divided into two groups: (1) experimental group: 12 days of natural cycle menstruation before IVF dystogesterone, 30 mg/day, 14 days, 3 months; (2) Control group: no intervention before IVF. Blood CA125 was measured before IVF, ovulation was induced by long luteal phase program, and CA125 was measured again one week after ovulation (pituitary hypo regulation day), and the endometrium was taken for ER, PR, HOXA-10 mrna detection and pathological examination. Endometrial thickness, morphology and blood flow were measured by HCG daily. Clinical data and outcomes were compared. The embryo implantation rate and clinical pregnancy rate were higher in the experimental group than in the control group (P<0.05); The endometrium was thicker in the control group than in the experimental group on HCG day. The ratio of endometrial type A blood flow in the experimental group was higher than that in the control group (P<0.05). The endometrial ratio of type A in the experimental group was higher than that in the control group, but there was no difference (P>0.05); CA125 was higher than the reference value in both groups before IVF, but there was no difference (P>0.05). The CA125 was lower in the experimental group than in the control group when the pituitary gland was retested on the day of pituitary downregulation, and lower in the experimental group than before the intervention; the expression of ER, PR and HOXA-10 mRNA in the endometrium was higher in the experimental group than in the control group, and the ratio of endometrium in the secretory phase was higher in the experimental group than in the control group(P<0.05); The pain scores of all symptoms were improved in both groups after treatment than before treatment, and the experimental group was better than the After treatment, the pain scores of both groups improved compared with those before treatment, and the experimental group was better than the control group(P<0.05). In IVF treatment of ovarian endometriosis cysts, preconditioning the endometrium with progesterone can reduce blood CA125, facilitate the transformation of endometrial tissue types, reduce endometrial thickness, increase endometrial blood flow, increase endometrial ER, PR, HOXA-10 mRNA expression, and improve endometrial receptivity, relieve symptoms and pain, Improve the clinical pregnancy rate. [ABSTRACT FROM AUTHOR]

Purpose: In the context of in vitro fertilization–embryo transfer (IVF–ET), factors other than egg quality may be key determinants of treatment success, in particular, maternal factors related to uterine endometrial receptivity and unidentified factors. We therefore aimed to analyze the metabolome and microbiome in IVF–ET patients who did and did not achieve pregnancy. Methods: Cervicovaginal mucus was collected from patients undergoing IVF–ET. Metabolite analysis was conducted by liquid chromatography‐mass spectrometry and the microbiota were determined by the polymerase chain reaction using universal 16S‐rRNA gene bacterial primers by MiSeq sequencing. Patients were classified as pregnant (N = 10) or nonpregnant (N = 13). Metabolic pathways were examined by MetaboAnalyst. Results: Three metabolic pathways, including alanine‐aspartate–glutamate metabolism, arginine biosynthesis, and cysteine‐methionine metabolism, were commonly decreased at the time of embryo transfer irrespective pregnant outcomes. Notably, pyruvate was decreased in the pregnant group. Amino acid metabolites showed inverse correlations with the presence of anaerobic microbiota in the nonpregnant group. Conclusions: Metabolism decreased during embryo transplantation, with a notable decrease in pyruvate metabolism, particularly in patients who became pregnant. The behavior of metabolites in the pregnant and nonpregnant groups suggests that metabolome analysis in the cervicovaginal mucus may be a diagnostic marker for predicting pregnancy. [ABSTRACT FROM AUTHOR]

Controlled ovarian hyperstimulation (COH) is an essential for in vitro fertilization-embryo transfer (IVF-ET) and an important aspect of assisted reproductive technology (ART). Individual starting doses of gonadotropin (Gn) is a critical decision in the process of COH. It has a crucial impact on the number of retrieved oocytes, the cancelling rate of ART cycles, and complications such as ovarian hyperstimulation syndrome (OHSS), as well as pregnancy outcomes. How to make clinical team more standardized and accurate in determining the starting dose of Gn is an important issue in reproductive medicine. In the past 20 years, research teams worldwide have explored prediction models for Gn starting doses. With the integration of artificial intelligence (AI) and deep learning, it is hoped that there will be more suitable predictive model for Gn starting dose in the future. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effectiveness of double ABCX-based psychotherapy for psychological distress during in vitro fertilization-embryo transfer (IVF-ET) among a female group (FG), couple group (CoG) and control group (CG). A total of 201 women undergoing their first IVF-ET cycle were randomized into three groups. The 6-session intervention was delivered at each visit to the IVF clinic. The primary outcomes were depression and anxiety, and the secondary outcomes included sleep quality, serum cortisol (nmol/L) levels and the clinical pregnancy rate, which were assessed before and after the intervention. The group-by-time effects were significant for depression, anxiety, sleep quality and serum cortisol levels, with larger effect sizes in the FG than in the CoG. There was no significant difference in the pregnancy rate among the three groups. Psychotherapy effectively mitigated psychological distress, suggesting greater effectiveness for couples undergoing IVF couples than for women only. It is structured and easy to use during the IVF treatment cycle. (NCT03931187, retrospectively registered on April 23, 2019) Double ABCX-based psychotherapy, which was developed in this study, effectively mitigated depression, anxiety, sleep disturbance and increased cortisol levels, suggesting greater effectiveness for couples undergoing IVF-ET than women only. Double ABCX-based psychotherapy is structured and easy to use during the IVF-ET treatment cycle, thereby presenting a promising and feasible approach to improve care for couples or women with assisted reproductive technique-related stress. [ABSTRACT FROM AUTHOR]

Abstract A retrospective study was conducted to investigate a convenient simple scoring system for the prediction of early pregnancy loss (EPL) based on simple demographics. A total of 13,977 women undergoing transvaginal ultrasound scans on Days 27–29 after in vitro fertilization-embryo transfer (IVF-ET) from June 2016 and December 2017 were included. The first trimester pregnancy outcome was recorded at 12 weeks of gestation. The areas under the curve of this scoring system were 0.884 (95% confidence interval (CI) 0.870–0.899) and 0.890 (95% CI 0.878–0.903) in the training set and test set, respectively. The score totals ranged from -8 to 14 points. A score of 5 points, which offered the highest predictive accuracy (94.01%) and corresponded to a 30% miscarriage risk, was chosen as the cutoff value, with a sensitivity of 62.84%, specificity of 98.79%, positive predictive value (PPV) of 88.87% and negative predictive value (NPV) of 94.54% for the prediction of EPL in the training set. In the test set, a score of 5 points had a sensitivity of 64.69%, specificity of 98.78%, PPV of 89.87% and NPV of 93.62%, and 93.91% of the cases were correctly predicted. Therefore, the simple scoring system using conventionally collected data can be conveniently used to predict EPL after ET. However, considering the limitations, its predictive value needs to be further verified in future clinical practice.

BackgroundSequential embryo transfer has been recognized as a strategy to increase pregnancy rates in women undergoing in vitro fertilization and embryo transfer (IVF-ET). However, its impact on assisted reproductive outcomes remains to be substantiated by robust evidence. This systematic review aims to summarize and analyze the available evidence to investigate the effect of sequential embryo transfer on assisted reproductive outcomes.MethodsA comprehensive literature search was executed across the Pubmed, Cochrane Library, Web of Science, and Scopus databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were aggregated utilizing a random effects model, and the resultant outcomes were articulated as odds ratios (ORs) along with their 95% confidence intervals (CIs).ResultsThe pooled results revealed a statistically significant enhancement in reproductive outcomes for infertile patients undergoing sequential embryo transfer as evidenced by elevated rates of chemical pregnancy (OR = 1.67, 95% CI = 1.23–2.27), clinical pregnancy (OR = 1.78, 95% CI = 1.43–2.21), and ongoing pregnancy (OR = 1.54, 95% CI = 1.03–2.31). Compared with cleavage-stage embryo transfer, sequential transfer yielded superior outcomes in terms of chemical pregnancy rate (OR = 2.08, 95% CI = 1.35–3.19) and clinical pregnancy rate (OR = 1.78, 95% CI = 1.37–2.31). Furthermore, among the repeated implantation failure (RIF) cohort, sequential embryo transfer surpassed blastocyst-stage transfer, delivering a heightened chemical pregnancy rate (OR = 1.66, 95% CI = 1.19–2.53) and clinical pregnancy rate (OR = 1.65, 95% CI = 1.19–2.27).ConclusionOur meta-analysis indicates that sequential transfer may enhance clinical pregnancy rate in a small subgroup of well-selected women. While promising, further evidence from prospective studies is needed.

Introduction: Embryo implantation is a complex and poorly understood process. Most studies to date have focused on the analysis of the endometrium at the end of the estrogenic phase, while the available data on its importance after secretory transformation are limited and inconsistent. Current evidence does not allow for a conclusive interpretation of the changes observed in the pre-implantation endometrium, whether in the natural or replacement cycle, and their relevance in the development of a pregnancy or the implications for clinical practice. Methods: Multicenter prospective observational cohort study. Based on our sample size calculation, the study group will consist of 206 women (exposed or “compaction” group: 103 women with a decrease of ≥ 5% in endometrial thickness between the estrogenic phase and the day of embryo transfer; non-exposed “non-compaction” group: 103 women with similar or greater endometrial thickness between these time points). The main objective of this study is to compare the ongoing pregnancy rates in natural cycles for euploid embryo transfer in patients who present endometrial compaction at the time of transfer versus those who with a stable or greater endometrial thickness with respect to the estrogenic phase. The estimated duration of the study is 30 months. Inclusion criteria are: 18 to 50 years of age, with primary or secondary infertility, subjected to endometrial preparation in a modified natural cycle for transfer of a genetically euploid blastocyst, from their own oocyte or oocyte donation, with a normal uterine cavity. Exclusion criteria are: uterine or endometrial disease (e.g., multiple myomatosis, severe adenomyosis, Asherman syndrome, refractory endometrium), conditions that prevent correct ultrasound assessment (tilted uterus), or a history of recurrent implantation failure or repeated miscarriages. [ABSTRACT FROM AUTHOR]

Endometrial receptivity is key to clinical pregnancy by in vitro fertilization-embryo transfer （IVF-ET） technique. Endometrial thickness （EMT） is a major index for pregnancy monitoring, but the optimal time indicating endometrial receptivity is controversially uncertain. Multiple studies have demonstrated the correlation between EMT and IVF pregnancy outcomes and EMT of a moderate range is essential for good pregnancy outcomes and a thin endometrium produces negative pregnancy outcomes. In this paper, we reviewed the research on the impact of EMT on IVF-ET pregnancy outcomes in terms of timing of EMT measurement, clinical pregnancy rate, live birth rate, ectopic pregnancy rate, placenta praevia, and low birth weight, investigating the mechanism of occurrence and treatment of thin endometrium so as to provide clinical references for improving IVF pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Only a small number of studies have reported the use of progesterone vaginal gel in combination with dydrogesterone as part of the antagonist protocol for fresh embryo transfer. Therefore, this study aimed to compare the effects of two types of luteal support on pregnancy outcomes following the antagonist protocol for fresh embryo transfer. Methods We performed a retrospective analysis of clinical data from infertile patients who underwent fresh embryo transfer via the antagonist protocol (2785 cycles) between February and July 2019 and between February and July 2021 at the Peking University Third Hospital Reproductive Medicine Centre. According to the luteal support received, the cycle groups were divided into the progesterone vaginal gel group (single medication or VP group; 1170 cycles) and the progesterone vaginal gel plus dydrogesterone group (combination medication or DYD + VP group; 1615 cycles). After propensity score matching, the clinical pregnancy, ongoing pregnancy, early miscarriage, and ectopic pregnancy rates were compared between the two groups. Results In total, 1057 pairs of cycles were successfully matched via propensity scores. The clinical and ongoing pregnancy rates in the combination medication group were significantly higher than those in the single medication group (P 0.05). Conclusions Combined luteal support after the antagonist protocol is preferred for patients undergoing fresh cycle embryo transfer.

Ying-Jie Ma,1,&ast; Meng-Yao Li,1,&ast; Jing-Yan Song,1,2 Zhen-Gao Sun1,2 1The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250011, People’s Republic of China; 2Reproductive and Genetic Center of Integrative Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250014, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhen-Gao Sun; Jing-Yan Song, Reproductive and Genetic Center of Integrative Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 42, Wenhua Road (W), Lixia District, Jinan, Shandong, 250014, People’s Republic of China, Email sunzhengao77@126.com; hanlingjuzei91@126.comBackground: Gonadotropin-releasing hormone antagonists (GnRH-ant) are widely used in current in vitro fertilization-embryo transfer (IVF-ET), however, whether the lowest daily dose of GnRH-ant is individualized remains unknown. Due to the negative effect of GnRH-ant on endometrial receptivity, lessening the amount of GnRH-antagonists used during controlled ovarian stimulation may be helpful for embryo implantation. As such, a randomized controlled study is essential to validate the feasibility and efficacy of daily GnRH-ant dose reduction to 0.125 mg geared towards providing scientific evidence for guidance in clinical practice.Methods: In total, 620 infertile women undergoing in vitro fertilization will be enrolled in the multicentered, randomized, parallel controlled trial. Based on a computer-generated random list, they will be randomly and equally subdivided into half-dose GnRH-ant group or conventional-dose GnRH-ant group. The primary outcome is ongoing pregnancy ie, intrauterine pregnancy diagnosed by pelvic ultrasonography at more than 12 weeks of gestation accompanied by normal fetal heartbeats. Secondary outcomes include cycle cancellation, premature luteinizing hormone surge, positive pregnancy, embryo implantation rate, clinical pregnancy, early spontaneous abortion, and live birth. The intention-to-treat and per protocol analyses will be used to initially analyze the difference in ongoing pregnancy rate between the two groups, while the multiple imputation method was used to handle missing values in the data.Discussion: At present, no randomized controlled trials (RCTs) have been performed on the use of the half-dose GnRH-ant protocol (0.125mg/d) to improve reproductive outcomes of IVF-ET in predicted normal responder, compared to conventional-dose GnRH-ant protocol (0.25mg/d). Half-dose GnRH-ant protocol might provide a suitable clinical solution for predicted normal responder undergoing IVF treatment. Thus, it is critical to conduct a well-designed RCT to evaluate the impact of a half-dose GnRH-ant protocol on the reproductive outcomes of IVF-ET in predicted normal responder.Trial Registration: This study was registered in the Chinese Clinical Trials Registry Platform on August 29, 2020. (chictr.org.cn; identifier: ChiCTR2000037629). This trial is version 1.3.Keywords: gonadotropin-releasing hormone antagonist, in vitro fertilization-embryo transfer, half-dose GnRH-ant protocol, predicted normal responder, randomized controlled trial

IntroductionEmbryo implantation is a complex and poorly understood process. Most studies to date have focused on the analysis of the endometrium at the end of the estrogenic phase, while the available data on its importance after secretory transformation are limited and inconsistent. Current evidence does not allow for a conclusive interpretation of the changes observed in the pre-implantation endometrium, whether in the natural or replacement cycle, and their relevance in the development of a pregnancy or the implications for clinical practice.MethodsMulticenter prospective observational cohort study. Based on our sample size calculation, the study group will consist of 206 women (exposed or “compaction” group: 103 women with a decrease of ≥ 5% in endometrial thickness between the estrogenic phase and the day of embryo transfer; non-exposed “non-compaction” group: 103 women with similar or greater endometrial thickness between these time points). The main objective of this study is to compare the ongoing pregnancy rates in natural cycles for euploid embryo transfer in patients who present endometrial compaction at the time of transfer versus those who with a stable or greater endometrial thickness with respect to the estrogenic phase. The estimated duration of the study is 30 months. Inclusion criteria are: 18 to 50 years of age, with primary or secondary infertility, subjected to endometrial preparation in a modified natural cycle for transfer of a genetically euploid blastocyst, from their own oocyte or oocyte donation, with a normal uterine cavity. Exclusion criteria are: uterine or endometrial disease (e.g., multiple myomatosis, severe adenomyosis, Asherman syndrome, refractory endometrium), conditions that prevent correct ultrasound assessment (tilted uterus), or a history of recurrent implantation failure or repeated miscarriages.DiscussionThe findings from this study will provide valuable insights into the potential influence of the “endometrial compaction” phenomenon on reproductive outcomes during natural cycle endometrial preparation. By examining this aspect, we aim to contribute to a better understanding of the factors that may impact successful outcomes in fertility treatments.

This study aimed to investigate the effect of anti-Mullerian hormone (AMH) on the pregnancy outcome of infertility assisted by IVF/Micro-Insemination/Embryo Transfer Infertility Assistance (IVF/ICSI-ET). A total of 324 patients under the age of 35 who received IVF/ICSI-ET assistance in our center were included in this analysis. AMH levels of these patients were measured by chemiluminescence method and divided into clinical pregnancy group (175 cases) and nonpregnancy group (149 cases) according to the final pregnancy outcome. The relationship between the two groups' pregnancy outcomes and AMH levels was analyzed. The above association was re-evaluated after excluding patients with polycystic ovary syndrome. There was no significant difference in age, body mass index (BMI), follicle-stimulating hormone (FSH), and 2 pronucleus (PN) between clinical and non-clinical pregnancy groups. Compared with the clinical pregnancy group, the level of AMH in the non-pregnancy group was significantly lower (p < 0.05). A higher AMH level was closely related to better IVF/ICSI-ET assisted pregnancy outcome in vitro. After excluding AMH abnormalities, the AMH level was still significantly associated with pregnancy outcomes of in vitro IVF/ICSI-ET-assisted pregnancy. Our results show a correlation between AMH level and pregnancy outcome of in vitro IVF/ICSI-ET assisted pregnancy. For women under age 35, lower AMH levels may be one of the predictors of adverse pregnancy outcomes. For patients with low AMH level, it is suggested to strengthen monitoring to ensure the safety and smoothness of the pregnancy process. [ABSTRACT FROM AUTHOR]

A retrospective study was conducted to investigate a convenient simple scoring system for the prediction of early pregnancy loss (EPL) based on simple demographics. A total of 13,977 women undergoing transvaginal ultrasound scans on Days 27–29 after in vitro fertilization-embryo transfer (IVF-ET) from June 2016 and December 2017 were included. The first trimester pregnancy outcome was recorded at 12 weeks of gestation. The areas under the curve of this scoring system were 0.884 (95% confidence interval (CI) 0.870–0.899) and 0.890 (95% CI 0.878–0.903) in the training set and test set, respectively. The score totals ranged from -8 to 14 points. A score of 5 points, which offered the highest predictive accuracy (94.01%) and corresponded to a 30% miscarriage risk, was chosen as the cutoff value, with a sensitivity of 62.84%, specificity of 98.79%, positive predictive value (PPV) of 88.87% and negative predictive value (NPV) of 94.54% for the prediction of EPL in the training set. In the test set, a score of 5 points had a sensitivity of 64.69%, specificity of 98.78%, PPV of 89.87% and NPV of 93.62%, and 93.91% of the cases were correctly predicted. Therefore, the simple scoring system using conventionally collected data can be conveniently used to predict EPL after ET. However, considering the limitations, its predictive value needs to be further verified in future clinical practice. [ABSTRACT FROM AUTHOR]

Objective To compare the effects of different levels of serum luteinizing hormone （LH） on the day of antagonist addition on the pregnancy outcomes of infertile patients undergoing in vitro fertilization-embryo transfer （IVF-ET） with gonadotropin-releasing hormone antagonist （GnRH-ant） flexible protocol. Methods Totally 607 infertile patients receiving antagonist flexible protocol treatment were divided into the group A of 189 cases with LH<10 mIU/mL, group B of 285 cases with 10 mIU/mL ≤ LH<20 mIU/mL, and group C of 133 cases with LH ≥ 20 mIU/mL according to the serum LH level on the day of antagonist addition. We observed and recorded the number of oocytes obtained, oocytes maturation rate, 2PN fertilization rate, the cleavage rate, high-quality embryo rate, fresh embryo implantation rate, fresh cycle transfer rate, clinical pregnancy rate, miscarriage rate, and live birth rate in patients of three groups. Results Compared with patients in the group A, the patients in the group B had higher cleavage rate, high-quality embryo rate, and live birth rate, while lower miscarriage rate （all P<0. 05). Compared with the group B, group C had lower cleavage rate, highquality embryo rate, and live birth rate, but higher miscarriage rate （all P<0. 05). Conclusions Serum with 10 mIU/mL ≤ LH<20 mIU/mL on the day of antagonist addition resulted in better ovulation in promoting effects and better pregnancy outcomes in IVF-ET on infertile patients. [ABSTRACT FROM AUTHOR]

Abstract Background This study aims to study whether the change of endometrial thickness between the day of human chorionic gonadotrophin (HCG) administration and the day of embryo transfer (ET) has any effect on ectopic pregnancy (EP) rate following fresh in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. Methods This study retrospectively analyzed 3134 patients who underwent fresh IVF/ICSI ET, including 3022 intrauterine, 112 ectopic cycles. Multiple logistic regression analysis and stratified analysis were used to study the effect of endometrial compaction after HCG administration on EP in patients with non-thin endometrium after adjusting for confounding factors. Results After adjusting for confounders, multiple logistic regression analysis found that the risk of EP in the compaction group was significantly lower than that in the non-compaction group (OR = 0.49; 95% CI: 0.31–0.78; P = 0.0023). The results of the stratified analysis demonstrated the EP rate in patients with an endometrial thickness ≥ 8 mm on the day of ET; the compaction group significantly reduced the incidence of EP (OR = 0.49; 95% CI: 0.31–0.79; P = 0.0036). In patients with an endometrial thickness ≥ 8 mm on the day of ET, the incidence of EP had no statistical significance in two group (OR = 1.02; 95% CI: 0.18–5.88; P = 9790). Conclusion(s) In patients with non-thin endometrium, endometrial thickness compaction from the day of HCG to the ET day reduced the risk of EP significantly.

Embryo transfer is not just a simple process of implanting the embryos into the uterus. A successful and effective embryo transfer requires not only high-quality embryos and appropriate uterine environment, but also high technical level of embryo transfer itself. Emphasis on and mastering the embryo transfer techniques will help to increase the success rate of in vitro fertilization-embryo transfer. In this article, the role of embryo transfer techniques and clinical skills in improving pregnancy outcomes was investigated, aiming to provide practical reference for clinical practitioners.

Objective: To investigate the predictive value of free androgen index (FAI) combined with serum gonadotropin surge attenuation factor (GnSAF) and sex hormone-binding globulin (SHBG) on pregnancy outcome in in vitro fertilization-embryo transfer (IVF-ET) treatment for infertile patients with polycystic ovary syndrome (PCOS). Methods: 197 patients with PCOS who were admitted to the Reproductive Medicine Centre of Hunan Maternal and Child Health Hospital from January 2020 to June 2022 were selected as the PCOS group, and were divided into the pregnancy failure group and the pregnancy success group according to the pregnancy outcome of IVF-ET treatment. Another 68 healthy women in the same period were selected as the control group.Clinical data were collected from patients with PCOS infertility, FAI was calculated and serum GnSAF and SHBG levels were measured. Multi-factor logistic regression was used to analyze the factors influencing pregnancy outcome infertile patients with PCOS treated with IVF-ET. ROC curves were used to analyze the predictive value of FAI and serum GnSAF and SHBG on pregnancy outcome in PCOS infertile patients treated with IVF-ET.Results: The levels of FAI and serum GnSAF were higher and SHBG was lower in the PCOS group than in the control group (P＜0.05).The success rate of IVF-ET treated pregnancies in 197 infertile patients with PCOS was 51.27% (101/197). Univariate analysis showed that body mass index, luteinizing hormone (LH), LH/follicle stimulating hormone (FSH), testosterone, anti-mullerian hormone (AMH),FAI, and GnSAF were higher in pregnancy failure group than in pregnancy success group, while FSH, fertilization rate, good embryo rate, and SHBG were lower in pregnancy success group (P＜0.05). Multivariate logistic regression analysis revealed that increased body mass index and elevated LH, LH/FSH, AMH, FAI, and GnSAF were independent risk factors for pregnancy failure in infertile women with PCOS treated with IVF-ET, while increased SHBG was an independent protective factor (P＜0.05). ROC curve analysis showed that the area under the curve of the combination of FAI and serum GnSAF SHBG in predicting the pregnancy outcome of IVF-ET treatment in infertile women with PCOS was larger than that predicted by FAI, GnSAF, SHBG alone. Conclusion: The combination of FAI and serum levels of GnSAF and SHBG has a high value in predicting the pregnancy outcome of IVF-ET treatment in infertile patients with PCOS. [ABSTRACT FROM AUTHOR]

Background: Only a small number of studies have reported the use of progesterone vaginal gel in combination with dydrogesterone as part of the antagonist protocol for fresh embryo transfer. Therefore, this study aimed to compare the effects of two types of luteal support on pregnancy outcomes following the antagonist protocol for fresh embryo transfer. Methods: We performed a retrospective analysis of clinical data from infertile patients who underwent fresh embryo transfer via the antagonist protocol (2785 cycles) between February and July 2019 and between February and July 2021 at the Peking University Third Hospital Reproductive Medicine Centre. According to the luteal support received, the cycle groups were divided into the progesterone vaginal gel group (single medication or VP group; 1170 cycles) and the progesterone vaginal gel plus dydrogesterone group (combination medication or DYD + VP group; 1615 cycles). After propensity score matching, the clinical pregnancy, ongoing pregnancy, early miscarriage, and ectopic pregnancy rates were compared between the two groups. Results: In total, 1057 pairs of cycles were successfully matched via propensity scores. The clinical and ongoing pregnancy rates in the combination medication group were significantly higher than those in the single medication group (P < 0.05), whereas no significant differences were noted in the early miscarriage and ectopic pregnancy rates between the two groups (both P > 0.05). Conclusions: Combined luteal support after the antagonist protocol is preferred for patients undergoing fresh cycle embryo transfer. [ABSTRACT FROM AUTHOR]

To analyze the rules of acupoint selection in adjuvant interventions for in vitro fertilization-embryo transfer (IVF-ET) with acupuncture and moxibustion, with the use of complex network technology. Articles on clinical trials of acupuncture and moxibustion for IVF-ET were searched in the China National Knowledge Infrastructure (CNKI), Wanfang, VIP, PubMed, and Web of Science databases from inception to January 31, 2020. A database of acupoint prescriptions has been established. Descriptive analysis was conducted using Microsoft Excel 2019, association rule analysis was conducted using SPSS Modeler 18.0 Apriori algorithm, clustering analysis of high-frequency acupoints was performed using SPSS 25.0 Ward, and complex network analysis of acupoints was performed by using Gephi 0.9.2. A total of 124 clinical trials were included, and 187 acupoint prescriptions were extracted, for a total of 91 acupoints. The total frequency of using these acupoints was 1,296 times, with Sānyīnjiāo (三阴交SP6) used the most frequently. The acupoints were generally located around the conception vessel, spleen meridian, and stomach meridian, and they were mainly distributed in the lower extremities, chest, and abdomen. Considerable consideration was paid to the specific points. The association rule analysis showed that the highest correlation presented between Guānyuán (关元CV4) and Zĭgōng (子宫EX-CA1). Complex network k-core hierarchical analysis discovered that CV4, SP6, Xuèhăi (血海SP10), Hégŭ (合谷LI4), Tàichōng (太冲LR3), Qìhăi (气海CV6), and EX-CA1 were the core acupoints in adjuvant interventions with acupuncture-moxibustion for IVF-ET. In adjuvant interventions with acupuncture-moxibustion, acupoints were commonly located around the conception vessel, spleen meridian, and stomach meridian, and the convergent point was particularly used as a specific point. The acupoints were selected to smooth the liver qi , remove stagnation, activate blood circulation, resolve stasis, and benefit the liver and kidney. "CV4→SP6→EX-CA1→ST36" were the core points, and CV4 was the core prescription in adjuvant treatments with acupuncture-moxibustion in IVF-ET. [ABSTRACT FROM AUTHOR]

Objectives: What is the role of transvaginal sonography (TVS) in the early diagnosis of hectopic interstitial pregnancy (HIP) after in vitro fertilization‐embryo transfer (IVF‐ET)? Methods: A retrospective observational study was conducted from January 2005 to December 2018. Routine two‐dimensional and three‐dimensional TVS were used to confirm clinical pregnancy. Women were diagnosed with HIP when an intrauterine gestational sac was combined with an extrauterine chorionic sac, which was at least 1 cm away from the uterine cavity and surrounded by a thin myometrial layer (<5 mm). Surgery and pathology results were the gold standard for diagnosing interstitial pregnancy. Non‐surgical patients were excluded from the study. The performance of TVS and the pregnancy outcomes of intrauterine pregnancies (IUPs) were evaluated. Results: A total of 97,161 women underwent IVF treatment and TVS examinations in our hospital during this study. Of these, 194 patients were diagnosed with HIP, with an incidence of 0.2% (194/97,161). Surgical and pathological findings confirmed 179 interstitial pregnancies, of which 174 were diagnosed by TVS, 4 were missed, and 1 was misdiagnosed. The sensitivity of TVS diagnosis was 97.8% and the positive predictive value was 99.4%. The mean time to diagnosis was 31 days after transplantation. One hundred and thirty‐nine cases of HIP (77.7%) were diagnosed at the time of initial TVS examination. In 132 patients (73.7%), IUPs resulted in live births. Conclusions: In our practice, most HIPs following IVF‐ET can be accurately diagnosed by TVS, which facilitates early management of interstitial pregnancies and enables high live birth rates for IUPs. [ABSTRACT FROM AUTHOR]

Objective: To explore the effects of Zishen Yutai Pills (ZYPs) on the quality of oocytes and embryos, as well as pregnancy outcomes in patients with diminished ovarian reserve (DOR) receiving in vitro fertilization-embryo transfer (IVF-ET). The possible mechanisms, involving the regulation of bone morphogenetic protein 15 (BMP15) and growth differentiation factor 9 (GDF9), were also investigated. Methods: A total of 120 patients with DOR who underwent their IVF-ET cycle were randomly allocated to 2 groups in a 1:1 ratio. The patients in the treatment group (60 cases) received ZYPs from the mid-luteal phase of the former menstrual cycle by using gonadotropin-releasing hormone (GnRH) antagonist protocol. The patients in the control group (60 cases) received the same protocol but without ZYPs. The primary outcomes were the number of oocytes retrieved and high-quality embryos. Secondary outcomes included other oocyte or embryo indices as well as pregnancy outcomes. Adverse events were assessed by comparison of the incidence of ectopic pregnancy, pregnancy complications, pregnancy loss, and preterm birth. Contents of BMP15 and GDF9 in the follicle fluids (FF) were also quantified with enzyme-linked immunosorbent assay. Results: Compared with the control group, the numbers of oocytes retrieved and high-quality embryos were significantly increased in the ZYPs group (both P<0.05). After treatment with ZYPs, a significant regulation of serum sex hormones was observed, including progesterone and estradiol. Both hormones were up-regulated compared with the control group (P=0.014 and 0.008), respectively. No significant differences were observed with regard to pregnancy outcomes including implantation rates, biochemical pregnancy rates, clinical pregnancy rates, live birth rates, and pregnancy loss rates (all P>0.05). The administration of ZYPs did not increase the incidence of adverse events. The expressions of BMP15 and GDF9 in the ZYPs group were significantly up-regulated compared with the control group (both P<0.05). Conclusions: ZYPs exhibited beneficial effects in DOR patients undergoing IVF-ET, resulting in increments of oocytes and embryos, and up-regulation of BMP15 and GDF9 expressions in the FF. However, the effects of ZYPs on pregnancy outcomes should be assessed in clinical trials with larger sample sizes (Trial reqistration No. ChiCTR2100048441). [ABSTRACT FROM AUTHOR]

Assisted reproductive technologies (ART), including in vitro fertilization-embryo transfer (IVF-ET) and intracytoplasmic sperm injection (ICSI), are known to contribute a higher risk of birth defects; however, studies have rarely evaluated the association between IVF-ET and diagnostic hearing loss (HL). This study aimed to evaluate the prevalence of and risk factors for HL and to clarify the association between IVF-ET and HL among twinborn infants. We enrolled 1860 live-born twin neonates born at a hospital in China from January 2017 to December 2020. After multi-step hearing screening, participants were diagnosed with HL by pediatric audiologists at 6 months of age. The prevalence of hearing loss and the adjusted odds ratios (AORs) for specific risk factors were estimated using generalized estimation equation (GEE) models in twin-born infants. Characteristics and prevalence of failure for hearing screening and HL were measured in IVF-ET twin infants. IVF-ET conception and preterm birth conferred a higher risk of hearing loss, with increased adjusted odds ratios (AOR [95% confidence intervals (CI)] IVF-ET: 2.82 [1.17–6.80], P = 0.021; preterm birth: 6.14 [2.30–16.40], P < 0.001) than the control group, respectively. Among the 1860 twin infants, more IVF-ET twins failed in dual-step hearing screening (3.26%) and were diagnosed with hearing loss (2.21%) than those conceived by spontaneous pregnancy. Conclusion: IVF-ET conception and premature birth were associated with a higher risk of hearing impairment. Twin infants conceived by IVF-ET tended to fail in hearing screening and be diagnosed with hearing loss. These observations provide a more comprehensive approach for the prevention and management of deafness in twin-born children. What is Known: • IVF-ET technologies conferred a higher risk of birth defects. What is New: • Premature birth and IVF-ET conception were associated with a higher risk of hearing loss among twin infants. • Twin infants conceived by IVF-ET tended to fail in hearing screening and diagnosed with hearing loss. [ABSTRACT FROM AUTHOR]

Aging has a major detrimental effect on the optimal function of the ovary with changes in this organ preceding the age-related deterioration in other tissues, with the middle-aged shutdown leading to infertility. Reduced fertility and consequent inability to conceive by women in present-day societies who choose to have children later in life leads to increased frustration. Melatonin is known to have anti-aging properties related to its antioxidant and anti-inflammatory actions. Its higher follicular fluid levels relative to blood concentrations and its likely synthesis in the oocyte, granulosa, and luteal cells suggest that it is optimally positioned to interfere with age-associated deterioration of the ovary. Additionally, the end of the female reproductive span coincides with a significant reduction in endogenous melatonin levels. Thus, the aims are to review the literature indicating melatonin production in mitochondria of oocytes, granulosa cells, and luteal cells, identify the multiple processes underlying changes in the ovary, especially late in the cessation of the reproductive life span, summarize the physiological and molecular actions of melatonin in the maintenance of normal ovaries and in the aging ovaries, and integrate the acquired information into an explanation for considering melatonin in the treatment of age-related infertility. Use of supplemental melatonin may help preserve fertility later in life and alleviate frustration in women delaying childbearing age, reduce the necessity of in vitro fertilization–embryo transfer (IVF-ET) procedures, and help solve the progressively increasing problem of non-aging-related infertility in women throughout their reproductive life span. While additional research is needed to fully understand the effects of melatonin supplementation on potentially enhancing fertility, studies published to date suggest it may be a promising option for those struggling with infertility. [ABSTRACT FROM AUTHOR]

Abstract Objective To examine the effects and mechanisms of transcutaneous electrical acupoint stimulation (TEAS) on pregnancy outcomes in women undergoing in vitro fertilization (IVF)-embryo transfer (ET). Design, setting, and participants This efficacy study was a multicenter, randomized, controlled clinical trial (RCT) in women receiving IVF-ET. The mechanistic study was a single-center RCT. Interventions The participants received TEAS vs. no TEAS treatment. Main outcome measures In the efficacy study, the primary outcomes were the rates of clinical pregnancy, embryo implantation, and live birth. In the mechanistic study, sex hormones and endometrial protein expression were examined. Results Ultimately, 739 participants were enrolled (367 and 372 in the TEAS and control groups, respectively). The clinical pregnancy rate was higher in the TEAS group than in the controls (55.1% vs. 46.7%, P = 0.03). There were no significant differences in embryo implantation, biochemical pregnancy, and live birth rates between the two groups (all P > 0.05) in the study population. In women > 35 years, the clinical pregnancy rates, embryo implantation rates and live birth rates in the TEAS and control groups were 48.9% vs. 23.7% (P = 0.004),30.8 vs. 13.9% (P = 0.001) and 34.0% vs. 19.7% (P = 0.06) respectively. In the mechanistic study with 120 participants, on the theoretical embryo implantation day, better developed endometrial pinopodes, elevated endometrial integrin α1β1/αVβ3, leukemia inhibitory factor, and elevated serum progesterone levels were found in the TEAS group compared with controls. Conclusion TEAS significantly improved the clinical pregnancy rate in women undergoing IVF-ET, especially in women of older age. It might be due to improved endometrial receptivity. Trial registration ChiCTR-TRC-13003950.

Abstract Background Endometrial fibrosis caused by intrauterine adhesion (IUA) can lead to hypomenorrhea, amenorrhea, and even infertility and abortion. The postoperative recurrence rate of severe IUA remains high, giving rise to low pregnancy rates. An extracellular matrix (ECM) scaffold, a new biological material that can promote cell proliferation and differentiation at lesions, has been widely used in general surgery and neurosurgery. The present study applied ECM scaffolds in obstetrics and gynecology for the first time to improve endometrial fibrosis, repair severe IUA, and improve pregnancy outcomes for infertile patients. Methods This paper presents a prospective randomized single-blind controlled superiority study of infertile women aged ≤40 years with IUA. According to the scoring criteria for IUA established by the American Fertility Society, patients with moderate or severe IUA were randomized into two groups at a ratio of 1:1; patients in the experimental group were treated with an ECM scaffold (small intestinal submucosa [SIS]) + intrauterine balloon, while patients in the control group were treated with an intrauterine balloon only. A hysteroscopic examination of adhesion repair was performed again after 2 months of postoperative hormone replacement therapy. Endometrial tissue was sampled during the two operations, and immunohistochemistry was used to observe endometrial and microvascular proliferation. After thawing and resuscitation, a postoperative frozen embryo transfer was performed on the participants in both groups, and their endometrial thickness, intrauterine volume, endometrial vascularization flow index, endometrial flow index, and uterine artery blood flow resistance were evaluated by 3D ultrasonography. The rates of embryo implantation, clinical pregnancy, and early spontaneous abortion were observed. Discussion The ECM scaffold (SIS) + intrauterine balloon method was able to repair endometrial fibrosis and improve IUA. This new technique represents a novel treatment method for improving the pregnancy outcome of infertile patients with moderate/severe IUA. Trial registration Chinese Clinical Trial Register ChiCTR2100052027 . Registered on October 14, 2021.

Objective To analyze and compare the clinical features and outcomes of in vitro fertilization-embryo transfer (IVF-ET) cycles in normal responders using gonadotrophin (Gn) releasing hormone (GnRH) antagonist or GnRH agonist long protocol. Methods The clinical data of patients who received IVF treatment and had normal ovarian response to GnRH antagonist or GnRH agonist long protocol in our reproductive center from January 2017 to March 2019 were collected. According to the treatment protocol and the fresh embryo transplanted or not, these patients were divided into Group A (receiving GnRH antagonist, but no fresh embryo transplanted, n=128), Group B (GnRH antagonist, with fresh embryo transplanted, n=138), and Group C (GnRH agonist long protocol, with fresh embryo transplanted, n=720). Besides, the frozen embryo transfer (FET) cycles of Group A were analyzed, and served as Group D. The thickness of endometrium on luteal conversion day and outcome of Group D were compared with those of Group B and Group C. Results ① The duration and dosage of Gn were shorter and less in Group A and B than Group C, and statistical difference was seen in Gn duration (P < 0.05), and in Gn dosage only between Group A and C (P < 0.05). ②On HCG day, the serum estradiol (E2) level were lower in Group A and B than Group C (P < 0.05), the endometrium of Group C was the thickest, and the thickness of endometrium on luteal conversion day of Group D was lower than that on the HCG day of Group A, B and C, where the differences between Group A and B, and Group C and D were statistically significant (P < 0.05). ③ The number of oocytes obtained in Group A and B were less than that in Group C (P < 0.05), but there were no statistical difference in metaphase Ⅱ (MⅡ) oocyte rate, normal fertilization rate and high-quality embryo rate among Group A, B and C. ④ Biochemical pregnancy rate and clinical pregnancy rate had no statistical differences among Group B, C, and D (P < 0.05). Group B had the lowest implantation rate but the highest miscarriage rate, and had obvious differences with Group C (P < 0.05). Conclusion GnRH antagonist protocol can obtain similar oocytes and embryos as the GnRH-a long protocol in normal response population. However, the antagonist may exert negative impact on endometrial receptivity and result in low pregnancy rate and high abortion rate.