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.
