Objective: To investigate the association between the local renin-angiotensin system (RAS) in human follicular fluid (hFF) and age, ovarian function, in vitro fertilization (IVF) outcome. Design: Study on the correlation of non-intervention. Setting: Reproductive Medicine Center, First Affiliated Hospital of Soochow University. Sample: hFF of 139 women who received IVF simply because of their husband’s factors from January 2021 to February 2022. Methods: The correlation between age and RAS in hFF was analyzed by simple linear regression, and multivariate linear regression was used to further analyze the correlation between the RAS and IVF outcome. Main Outcome Measures: The levels of RAS components in hFF were measured, including Renin, ACE, ACE2, AngⅡ and Ang(1-7). Results: ①The influence of age on ACE-AngⅡ-AT1/2R axis was more significant than that on ACE2-Ang(1-7)-MAS axis in hFF; ②Provides evidence that gonadotropins mediate RAS activation of local ovarian follicles; ③It is still impossible to prove the effect of RAS on steroid hormone production, at least in ovarian follicles RAS cannot affect steroid hormones in the systemic circulation; ④Age and the level of RAS components in hFF have certain clinical value in predicting the number of oocyte retrieval and the rate of MⅡ maturation. Conclusions: The local RAS in ovarian follicles is affected by age and correlated with ovarian function and IVF outcome.
目的 探讨我国年轻未婚女性乳腺癌患者生育力保存的临床实践情况.方法 回顾性分析2019年1月至2020年12月期间在上海交通大学医学院国际和平妇幼保健院生殖医学中心因乳腺癌行生育力保存的13例未婚女性患者的临床数据.结果 患者年龄为(31.00±3.98)岁,9例采用卵泡期来曲唑+促性腺激素(gonadotropin,Gn)的卵巢刺激方案,3例采用黄体期来曲唑+Gn的卵巢刺激方案,1例采用自然周期方案.其中11例患者完成了生育力保存周期,Gn使用总量为(1865.91±501.03)U,扳机日雌二醇为(1223.85±709.75)ng/L,冷冻卵母细胞(9.91±4.41)枚,冷冻方式均为玻璃化冷冻.结论 来曲唑+Gn的卵巢刺激后卵母细胞玻璃化冷冻是年轻未婚女性乳腺癌患者首选的生育力保存方案,但增进医生及患者对生育力保存的认知、促进临床科室间的沟通以及推广生育力保存临床实践仍待加强.
Reproductive health is a basic element of human health and an important pillar of social sustainable development. Based on the 2030 sustainable development goal, a global perspective should be given to the broader relationship between human beings and the earth and the natural ecological environment. The purpose of reproductive health is not only to reduce the death rate and improve the quality and the rate of the birth, but also to promote the sustainable development of human beings, resources, and environment. This paper systematically discussed the development of reproductive health theory and the current situation of global reproductive health, in order to clarify the important status and role of reproductive health in the national health and to promote the high-quality development of maternal and child health.
Objective:To investigate the effect of gonadotropin-releasing hormone agonist (GnRH-a) down-regulation combined with artificial cycle (AC) protocol on pregnancy outcomes in patients with unexplained repeated implantation failure (RIF).Methods:The clinical data of 1 285 frozen-thawed cycles of unexplained RIF patients who underwent frozen-thawed embryo transfer from January 2018 to December 2019 in the Reproductive Medical Center of Peking University Third Hospital were retrospectively analyzed. They were divided into two groups according to different endometrial preparation protocols: GnRH-a down-regulation combined with AC protocol group (named GnRH-a+AC group, 411 cycles) and AC group (874 cycles). The general clinical data, cycle characteristics and clinical outcomes between the two groups were compared. Multiple logistic regression analysis was used to analyze the influencing factors of clinical pregnancy and live birth.Results:There was no significant difference in the general data between the two groups ( P>0.05). The endometrial thickness of GnRH-a+AC group [(10.26±1.73) mm] was thicker than that of AC group [(9.66±1.54) mm], and the difference was statistically significant ( P=0.002). The clinical pregnancy rate [42.58% (175/411)] and the embryo implantation rate [32.52% (200/615)] of GnRH-a+AC group were higher than those of AC group [35.59% (311/874), P=0.016; 27.20% (346/1 271), P=0.017], and the differences were statistically significant. The live birth rate of GnRH-a+AC group [33.57% (138/411)] showed an increasing tendency, but there was no significant difference compared with AC group [28.73% (251/874), P>0.05]. The multivariate logistic regression analysis showed that the clinical pregnancy rate was negatively correlated with age and body mass index (BMI; OR=0.953, 95% CI: 0.924-0.982; OR=0.959, 95% CI: 0.926-0.994), and positively correlated with GnRH-a protocol ( OR=1.329, 95% CI: 1.039-1.699); the live birth rate was only negatively correlated with age and BMI ( OR=0.947, 95% CI: 0.917-0.977; OR=0.963, 95% CI: 0.927-0.998) and GnRH-a protocol was not an influencing factor ( P>0.05). Endometrial thickness ≥7 mm was not the influencing factor of clinical pregnancy rate and live birth rate (all P>0.05). Conclusion:For RIF patients, GnRH-a down-regulation combined with AC protocol can significantly increase endometrial thickness, improve endometrial receptivity and clinical pregnancy rate, but there is no statistical significance in the live birth rate, which still needs to be further studied in large scale.
Autophagy is an important metabolic process that maintains homeostasis of cells, tissues and organisms. In endometrial cells, autophagy is involved in regulating endometrial growth and receptivity through a variety of pathways, including AMPK/TSC/mTOR signaling pathway, PI3K/AKT/mTOR signaling pathway, ATG4C, ULK4, RB1CC1/FIP200 and other related signaling pathways. These pathways are essential for maintaining intracellular environmental homeostasis and the health of the female reproductive system. At the same time, abnormal autophagy can lead to decreased endometrial receptivity and is associated with the occurrence and development of a variety of endometria-related diseases, and the level of autophagy presents dynamic changes in different periods of disease. In this paper, the role and mechanism of autophagy in endometrium were reviewed in order to provide relevant evidence for new drug development and treatment strategies. Deep understanding of the role and mechanism of autophagy in endometrium is expected to provide new ideas and directions for the treatment of endometrial diseases.
Objective:To compare the pregnancy and perinatal outcomes following cleavage-stage embryo transfer and blastocyst-stage embryo transfer, and to explore the best strategy of embryo transfer for infertile patients.Methods:In this retrospective cohort study, data of patients who underwent in vitro fertilization/intracytoplasmic sperm injection from January 2021 to December 2022 in Reproductive Medicine Department of the Fifth Hospital and the First Hospital of Shanxi Medical University and Jinzhong Yingtai Women's and Children's Hospital were collected. Patients were divided into cleavage-stage embryo transfer group (named D3 group, n=2 827) and blastocyst-stage embryo transfer group (named D5 group, n=1 253). The main observation indicators were large for gestational age (LGA) and preterm birth (PTB). The secondary observation indicators were multiple pregnancy, gestational age, birth weight and newborn gender. Univariate and multivariate logistic regression were applied to analyze the correlation between embryo transfer type and adverse outcomes. Results:Clinical pregnancy rate [64.5% (808/1 253)], live birth rate [55.5% (696/1 253)], implantation rate [46.0% (1 026/2 230)], multiple pregnancy rate [22.6% (183/808)], male newborn rate [58.6% (515/879)], single LGA rate [19.8% (103/520)] and single PTB rate [21.7% (113/520)] in D5 group were significantly higher than those in D3 group [54.3% (1 535/2 827), P<0.001; 48.2% (1 362/2 827), P<0.001; 36.7% (1 962/5 346), P<0.001; 19.0% (291/1 535), P=0.026; 49.7% (822/1 653), P=0.001; 7.5% (80/1 071), P<0.001; 17.2% (184/1 071), P=0.029]. LGA rate [24.8% (72/290)] in the single frozen-embryo transfer and LGA rate [13.5% (31/230)] in the single fresh-embryo transfer of D5 group were significantly higher than those of D3 group [8.8% (36/409), P<0.001; 6.6% (44/662), P=0.002]. LGA in male newborns [24.8% (82/330)] and female newborns [11.1% (21/190)] of D5 group were significantly higher than those of D3 group [9.1% (54/592), a OR=2.95, 95% CI: 2.01-4.33, P<0.001; 5.4% (26/479), a OR=2.04, 95% CI: 1.10-3.77, P=0.024]. Conclusion:The risk of LGA and premature birth in blastocyst-stage embryo transfer is higher than that in cleavage-stage embryo transfer. In clinical practice, embryo transfer methods should be selected based on the condition of patient and embryo.
Endometriosis (EMS) is a common disease in women of reproductive age. EMS may cause pain, infertility and mass. Because EMS affects the entire reproductive period of patients, it is easy to relapse, and difficult to cure. Therefore, a long-term management plan for patients with EMS should be formulated, including medical treatment, surgical treatment, and assisted reproductive technology. Fertility needs are one of the main needs of women with EMS of reproductive age. Therefore, long-term follow-up management is needed for women with EMS of reproductive age. The main purpose of treatment and consultation is to treat the pain caused by EMS and reduce the recurrence and progression of EMS, and give fertility guidance to patients when appropriate, and give appropriate treatment when patients are diagnosed with infertility. This article reviewed the long-term management of EMS patients of reproductive age.
Objective:To investigate the effect of trophoectoderm biopsy of blastocysts on serum β-human chorionic gonadotropin (β-hCG) in early pregnancy and perinatal outcome after frozen-thawed embryo transfer (FET) in the preimplantation genetic testing (PGT).Methods:It was a retrospective cohort study. Patients who underwent FET in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2017 to December 2021 were recruited. The patients were divided into two groups according to the progestation method: 308 patients underwent trophoectoderm biopsy (PGT group) and 802 patients underwent intracytoplasmic sperm injection (ICSI group). The patients were matched at 1∶2 with propensity score matching (PSM), then there were 300 patients in PGT group and 571 patients in ICSI group. The general conditions and perinatal outcomes were compared among PGT group and ICSI group before and after PSM. Multivariate linear regression was applied to analyze the effect of trophoectoderm biopsy to serum β-hCG level by day 14 after embryo transfer.Results:Before PSM, the female age in PGT group was significantly higher than that in ICSI group [(31.2±4.1) years vs. (30.4±4.3) years, P=0.007]. The anti-Müllerian hormone levels [(4.38±3.62) μg/L vs. (4.87±3.78) μg/L, P=0.049] and endometrial thickness on the day of embryo transfer [(9.1±1.6) mm vs. (9.6±1.6) mm, P<0.001] were lower in PGT group than in ICSI group. There was no significant difference in the general data between the two groups after PSM (all P>0.05). Before and after PSM, there was no significant difference in serum β-hCG level on day 14 after embryo transfer between PGT and ICSI groups of the all patients, clinical pregnancy patients, early abortion patients and live birth patients (all P>0.05). There were no significant differences in biochemical pregnancy rate, clinical pregnancy rate, early abortion rate and live birth rate between the two groups before and after matching (all P>0.05). Multivariate linear regression analysis showed that whether or not PGT was performed had no effect on serum β-hCG levels ( P=0.494), and female body mass index and type of blastocyst transferred had an effect on β-hCG levels (all P<0.001). There were no significant differences in the incidences of hypertensive disorder complicating pregnancy, gestational diabetes, hypothyroidism during pregnancy, premature rupture of membranes, placenta previa between the two groups (all P>0.05). The cesarean section rate, premature delivery rate, low birth weight rate, macrogenesis rate, sex ratio, neonatal body mass, neonatal length and neonatal birth defects rate were not significantly different between the two groups (all P>0.05). Conclusion:Trophoectoderm biopsy of blastocysts before FET does not affect serum β-hCG level in early pregnancy, and does not increase the risk of maternal and infant adverse complications.
Objective:To observe the effect of early elevation of luteinizing hormone (LH) with flexible gonadotropin-releasing hormone antagonist (GnRH-A) protocol on pregnancy outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) fresh embryo transfer. Methods:A retrospective cohort study was conducted to analyze patients with normal ovarian reserve function who underwent IVF/ICSI with flexible GnRH-A protocol at the Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University from January 2016 to September 2021. According to the level of LH before antagonist addition, the patients were divided into two groups, group A: early elevation of LH (LH >10 U/L before the addition of antagonist, n=65), group B: the patients whose LH≤10 U/L before the addition of antagonist ( n=193), which was matched with group A using the 1∶3 propensity score matching by age, duration of infertility, anti-Müllerian hormone, body mass index and antral follicle count. The general conditions, clinical data, embryonic laboratory indicators and clinical outcomes were compared between the two groups. Results:There were no significant differences in the baseline characteristics between the two groups (all P>0.05). There were no significant differences in basic LH levels, gonadotropin (Gn) initiation dosage, total dosage and duration of Gn used, duration of Gn used when adding antagonists and estradiol (E 2) level on the trigger day between group A and group B (all P>0.05). The LH level [12.2 (11.1, 17.5) U/L], E 2 level [3 301.0 (2 708.0, 4 275.0) pmol/L] and follicle diameter [14.0 (12.6, 15.5) mm] were significantly higher in group A than in group B [3.5 (2.2, 5.2) U/L, 2 178.5 (1 208.0, 3 218.0) pmol/L, 13.0 (12.0, 14.0) mm] when adding antagonist (all P<0.001). The level of LH in group A decreased rapidly after adding antagonist, LH level in group A after antagonist application [3.4 (2.0, 5.2) U/L] and the LH level on the trigger day [3.0 (1.7, 4.7) U/L] were still higher than those in group B [2.1 (1.5, 3.3) U/L, P<0.001; 2.1 (1.4, 3.3) U /L, P=0.004], the level of progesterone on the trigger day was not significantly higher than that in group B ( P>0.05). There were no statistically significant differences in the number of oocytes retrieved, two pronuclei fertilization rate, the rate of high-quality embryo, the rate of blastocyst formation, endometrial thickness on the day of transplantation, the number of transferred embryos, the proportion of transferred blastocysts and the implantation rate between the two groups (all P>0.05). The clinical pregnancy rate, the early abortion rate, and the live birth rate were not statistically different between the two groups (all P>0.05). Conclusion:In patients with normal ovarian reserve, LH level was elevated early with antagonist flexible protocol, and decreased rapidly after the timely addition of antagonist, which did not lead to an increase of progesterone on the trigger day, and ultimately did not affect the clinical outcomes of IVF/ICSI fresh embryo transfer.
Objective:To explore the curative effect of fertility-preserving therapy for endometrial carcinoma patient with KRAS gene mutation and the choice of pregnancy-assisting strategy. Methods:We reported the fertility-preserving treatment and pregnancy-assisted process of a case of endometrial carcinoma patient with KRAS gene mutation and analyzed the related literatures. Results:After 20 months of treatment with highly effective progestogen and intrauterine levonorgestrel-releasing intrauterine system (LNG-IUS), the patient achieved complete remission. Antagonist plus letrozole was used to induce ovulation. After LNG-IUS was taken out, the pregnancy from blastocyst transfer was achieved after downregulation and artificial cycle, and a live baby girl was born at term.Conclusion:Endometrial carcinoma patient with KRAS gene mutation can achieve complete remission and fertility after combined treatment, but the treatment period is long, therefore, it is necessary to closely monitor changes of the disease.
Objective:To clarify the key genes and biological processes in spermatogenesis, integrate and analyze the differentially expressed genes (DEGs) and key signaling pathways in the differentiation process of human spermatogonia (SPG), and to explore the early molecular mechanism of spermatogenesis, increase the molecular biology understanding of SPG differentiation process.Methods:The transcriptome data of human undifferentiated spermatogonia and differentiated spermatogonia (dSPG) were downloaded from the public database. Hisat2 and StingTie were used to screen DEGs. DEGs were analyzed by gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) functional enrichment analysis. MACS2 software was used to analyze the open chromatin regions (OCRs) in ATAC-seq data.Results:A total of 8 532 DEGs were screened, including 4 127 up-regulated genes and 4 405 down-regulated genes. They regulate the differentiation of SPG through some important biological processes, such as cell cycle, cytokine-mediated signaling pathways, organic matter metabolism, cell movement, and methylation. KEGG enrichment analysis showed that some important signaling pathways including FoxO signaling pathway and JAK-STAT signaling pathway played an important role in SPG differentiation. GO enrichment analysis showed that methylation played an important role in the differentiation of SPG, and the expression of methylation-related genes was significantly different. The TDRDs family was significantly enriched, and 9 TDRDs genes were found to be more active in dSPG. Conclusion:In this study, the differentially expressed genes during SPG differentiation were identified by bioinformatics analysis, and the differences in transcription and chromatin levels of key genes were clarified, which laid an important theoretical foundation for the study of SPG differentiation mechanism.
Endometriosis is a common and frequently occurring disease among women of childbearing age, which seriously affects the the patient's fertility and quality of life. Ubiquitin proteins exist widely in all kinds of cells and participate in many physiological or pathological processes, such as cell cycle regulation, transcriptional regulation, signal transduction, inflammatory response, apoptosis. Recent studies have shown that ubiquitin proteins are involved in the origin and development of endometriosis, so this article reviews the roles of different ubiquitin proteins in endometriosis.
Mitochondria are the most abundant organelles in oocytes, and their quantity and quality directly affect the quality and developmental potential of oocytes, thus determining the outcome of female fertility. Mitophagy, as a large autophagy that selectively degrades dysfunctional mitochondria, is crucial for mitochondrial function maintenance and homeostasis in oocytes. In recent years, studies on the functions and mechanisms of mitophagy in oocytes have gradually become a research hotspot in the field of female reproduction. This paper reviews the mitochondrial autophagy in oocyte maturation, oocyte aging, and mitochondria autophagy involving in drugs and environmental stimuli which affects oocyte quality, and its significance in assisted reproductive technology. We expect to benefit for further understanding the biological significance of mitophagy in oocytes, and to inform the improvement of oocyte quality invitro or invivo.
Objective:To explore the possible of clinical application value after transferred with day 3 extremely low-grade cleavage-stage embryos during in vitro fertilization and embryo transfer. Methods:The clinical outcomes of four cases with extremely low-grade cleavage-stage embryos on day 3 undergoing IVF-ET were retrospectively analyzed and the related literatures were reviewed.Results:Four cases successfully got pregnant after 12 days of transplantation of extremely low-grade embryos detected by human chorionic gonadotropin testing, and all of them were intrauterine singleton pregnancies. Finally these four patients had successful live births, and three of them were full-term delivery, one of them was delivery prematurely. All the babies were in the good health.Conclusion:There is still a degree of successful pregnancy and live birth rate after transferred with day 3 extremely low-grade cleavage-stage embryos. If the quality of all the embryos was extremely low-grade on day 3, we can provide new attempts and choices for the patients who were often giving up embryos transfer.
Objective:To investigate the effects of different semen sample collection methods on sperm DNA fragmentation index (DFI) test results, then to evaluate the accuracy of the current semen sample collection method in the assessment of male fertility.Methods:In this study, 50 semen sample obtained on the day of oocyte retrieval from patients undergoing in vitro fertilization at the Reproductive Medical Center in Maternity and Child Health Hospital of Guangxi Zhuang Autonomous Region from August 2021 to January 2022 were collected. For each semen, a small amount of samples were collected in three different retention methods for routine semen and sperm DFI testing. Three different ways of retaining samples were as follows: group A, after mixing of the semen, 50 μL sample was directly collected; group B, after density gradient centrifugation, 50 μL sample was collected at the interface between semen and gradient fluid; group C, after density gradient centrifugation, the sperm pellet was upstream, then 50 μL sample was collected from upstream liquid. After semen treatment, routine semen testing and sperm DFI testing were performed. Pearson was used to analyze the correlation between DFI and the percentage of immobile sperm and the percentage of forward sperm movement. Results:The sperm motility rate of group C [(96.83±2.28)%] was significantly higher than that of group A [(57.16±11.28)%, P<0.001] and group B [(22.54±9.35)%, P<0.001], and there was a statistical difference among the three groups. The immotile sperm rate of group B sample was (77.46±9.35)%, which was significantly higher than that of samples from group C [(3.14±2.31)%, P<0.001] and group A [(42.83±11.28)%, P<0.001]. There was also a statistical difference in DFI among the three groups ( P<0.001). The DFI of group B [37.18% (30.41%, 47.80%)] was significantly higher than that of group A [22.00% (14.75%, 29.25%), P<0.001] and group C [0.78% (0.00%, 2.07%), P<0.001]. Pearson analysis results showed that the DFI of group A and group B was positively correlated with the percentage of immobile sperm ( r=0.304, P=0.032; r=0.612, P<0.001), while the DFI of group B was negatively correlated with the percentage of sperm forward movement ( r=-0.517, P<0.001). Conclusion:For the same semen, the DFI of immotile sperm was significantly higher than that of motile sperm. Therefore, due to the interference of immotile sperm, the DFI value by the current sample retention method cannot accurately reflect the DNA status of active sperm participating in fertilization. This suggests that the samples used for DFI testing should be collected from motile sperm collected by gradient centrifugation, upstream or other methods, which can more accurately assess male fertility.
Objective:To explore the impact on the fertility and outcomes of females with squamous intraepithelial lesion (SIL) undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and obstetric outcomes after local treatment. Methods:Patients with SIL undergoing IVF/ICSI were set as the SIL group in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2016 to December 2020. While, control group was matched using the propensity scoring method in a 1∶3 ratio in accordance with the age, body mass index, and basic follicle-stimulating hormone, antral follicle count and the oocytes retrieval time. Pregnancy outcomes were compared by analyzing the basic conditions of the two groups, the index of the IVF/ICSI cycles, the clinical pregnancy rate and the implantation rate of the fresh cycles, the cumulative pregnancy rate, the cumulative live birth rate, and obstetric outcomes of patients giving live birth after local treatment were also analyzed.Results:The demographic characteristics were of no significant differences between the SIL group and control group (all P>0.05). As for the IVF/ICSI results, no significant differences were observed in the duration of gonadotropins (Gn) used, total dosage of Gn used, No. of oocytes retrieved, normal fertilization rate, No. of available embryos, No. of high-quality embryos, and No. of blastocyst formation between the two groups (all P>0.05). For fresh embryo transfer cycles, the number of transferred embryos was lower, the clinical pregnancy rate and the implantation rate in the SIL group were higher than those in control group, while the differences were not significant (all P>0.05). The differences of time to pregnancy,the cumulative pregnancy rate and the cumulative live birth rate between SIL group and control group were not statistically significant (all P>0.05). There were no statistically significant differences in delivery methods, gestational age, newborn birth weight, and incidence of pregnancy complications between the two groups (all P>0.05). According to local surgical treatment, 79 patients with SIL who achieved live birth were divided into cold knife conization subgroup, loop electrosurgical excisional procedure subgroup, and no-operation subgroup. There were no statistically significant differences in delivery methods, gestational age, newborn birth weight and incidence of pregnancy complications among the three subgroups (all P>0.05). Conclusion:SIL did not affect fertility of patients or assisted pregnancy outcomes of IVF/ICSI, and local surgical treatment does not increase the risk of preterm birth, low birth weight infants.
Ectopic pregnancy is one of the most common adverse pregnancy outcomes during first trimester, and is generally believed to be caused by disorders of the fallopian tube, the endometrium and the embryo, accompanying genetic, environmental, immune, pathogen infection and other endocrine abnormalities. With the development of the macro genome sequencing, the female genital tract flora was confirmed to be closely linked with the establishment of endometrium receptivity, the regulation of genital tract inflammation and maintaining immune environment stability. It also plays an essential role in ovulation, fertilization, embryo transport and implantation. Studies suggested that genital tract dysbiosis might cause adverse pregnancy outcomes such as infertility, miscarriage, preterm birth, and ectopic pregnancy, which severely endanger women's security and safety. It suggests that genital tract microbiota may be associated with impaired functions of the reproductive system that potentially lead to ectopic pregnancy. This article mainly summarizes the research progress of the correlation between female genital tract microbiota and ectopic pregnancy, discusses the normal composition of genital tract microbiota and the potential mechanism of ectopic pregnancy caused by microbiota dysbiosis, so as to provide reference for clinical intervention.
Objective:To explore the impact of female body mass index (BMI) on clinical outcomes in patients treated with intrauterine insemination (IUI).Methods:This study was a retrospective cohort study. A total of 21 137 patients who visited the Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University from January 2010 to December 2021 were recruited. The patients underwent the first IUI cycles, including artificial insemination by husband (AIH) and artificial insemination by donor (AID). According to clinical pregnancy or not, it is divided into pregnancy group and non-pregnancy group. The basic parameters between clinical pregnancy group and non-clinical pregnancy group were compared. According to the BMI, patients were divided into 4 groups, group A: BMI≤18.5 kg/m 2, group B: 18.6-23.9 kg/m 2, group C: 24.0-27.9 kg/m 2and group D: BMI≥28.0 kg/m 2. Patients' basic parameters and clinical outcomes were compared among the four groups. Multivariate logistic regression analysis was used to explore the impact of BMI on pregnancy outcomes. Results:In all IUI cycles, BMI was significantly different between pregnant patients and non-pregnant patients [(24.58±3.52) kg/m 2vs. (23.35±4.20) kg/m 2, P<0.001]. In AIH cycles, clinical pregnancy rate [18.21% (877/4 815), 17.12% (222/1 297)] and early spontaneous miscarriage rate [17.10% (150/877), 21.62% (48/222)] were significantly higher in patients of group C and group D than in group A [11.24% (130/1 157), 10.77% (14/130)] and group B [13.40% (1 229/9 174), 15.30% (188/1 229)]. The differences among the 4 groups were statistically significant ( P=0.012, P=0.003). However, BMI was not associated with clinical pregnancy rate in multivariate logistic analysis, but obesity was a predictor for early spontaneous miscarriage ( OR=1.63, 95% CI: 1.25-1.95, P=0.003). In AID cycles, pregnancy outcomes were comparable among the four BMI groups. Obesity significantly increased early spontaneous miscarriage rate ( OR=1.58, 95% CI: 1.14-1.87, P=0.016). Conclusion:Female BMI is not associated with clinical outcomes in IUI cycles. Obesity is a predictor for early spontaneous miscarriage in both AIH and AID cycles.
Iron and iron metabolism are involved in regulating the physiological functions of the female reproductive system. Essential iron plays a positive role in female development and reproductive function, while iron overload can induce abnormal metabolic processes in the body. Ferroptosis is a cellular iron-dependent disorder of lipid oxide metabolism, accompanied by oxidative imbalance and accumulation of lipid reactive oxygen species. Studies have shown that ferroptosis occurred in the pathology of endometriosis, polycystic ovary syndrome and trophoblast dysfunction diseases. Besides, the pathways and related genes of ferroptosis are involved in early embryonic development, placental oxidative stress, and regulation of oocyte function, suggesting the possibility of key molecules of iron metabolism and ferroptosis as potential therapeutic targets. The regulation mechanism for ferroptosis in female reproduction-related diseases is unclear now.This review discussed and summarized the recent research progress of iron overload and ferroptosis in female reproductive system and related diseases, in order to provide reference for clinical treatment of related diseases.
With the rapid development of molecular diagnostic technology and the increased public awareness of eugenics, preimplantation genetic testing (PGT) technology has been widely used in clinical practice in recent years. Genetic counseling is provided throughout all stages of PGT and is an important guarantee for carrying on the PGT work smoothly. At present, there is a lack of laws and regulations governing how PGT genetic counseling should be conducted, there is also no nationally standardized training system and certification bodies, and expert consensus and guidelines are also scarce, so it is necessary to develop practical processes and standards for genetic counseling of PGT. Therefore, it is essential to develop practical procedures and standards for genetic counseling of PGT, to ensure the smooth implementation of the PGT process, and to minimize the risk of birth defects. This article makes a comprehensive review and discussion on the standardization of genetic counseling of PGT from the current situation and standardization construction of the genetic counseling system, combined with the actual situation worldwide and existing laws and regulations.
