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 effect of alpha-linolenic acid (ALA) on human oocytes maturation and the mitochondrial DNA (mtDNA) copy numbers of oocyte. Methods: A total of 441 morphologically normal immature oocytes were recruited from 273 infertile women underwent ICSI in our Center from October 2014 to October 2015. There were 179 oocytes at MⅠ stage and 262 oocytes at GⅤ stage. Oocytes with the same proportion of MⅠand GⅤwere randomly divided into 5 groups, and in vitro cultured for 24 hours in the medium with ALA at different level [0 (as control), 10 μmol/L, 50 μmol/L, 100 μmol/L, 200 μmol/L]. The oocyte maturation was observed, and the mtDNA copy numbers in the ALA 0μmol/L (as control) group and the ALA 50μmol/L group were determined by real-time PCR. Results: ①The total maturation rate of the ALA 50 μmol/L group (70.1%) was significantly higher than that of the control group (42.1%) and the ALA 200 μmol/L group (34.1%, both P<0.05). ②The total maturation rate of GⅤ in the ALA 50 μmol/L group (64.4%) was significantly higher than that in the control group (28.9%) and the ALA 200 μmol/L group (18.2%, both P<0.05).③The mtDNA copy number of in vitro matured oocytes in the ALA 50μmol/L group (3.64×107±1.85×106) was significantly higher than that in the ALA 0 μmol/L group (3.42×106±1.95×105, P<0.05). Conclusions: 50μmol/L ALA can increase the mtDNA copy number of the in vitro matured human oocyte, suggesting that ALA can promote the in vitro maturation of human oocyte.

目的: 探讨影响冻融胚胎移植(FET)妊娠结局的相关因素。方法: 回顾性分析324个周期行FET患者的临床资料, 分析患者年龄、体质量指数(BMI)、移植日子宫内膜厚度、内膜准备方案、移植胚胎数等相关因素对FET妊娠结局的影响。结果: 324个周期共解冻胚胎727个, 复苏成活720个(99.0%), 临床妊娠144例(44.4%), 胚胎植入196例(27.2%)。其中自然内膜准备周期组和激素替代内膜准备周期组患者年龄、不孕年限、基础卵泡刺激素(bFSH)、基础黄体生成素(bLH)、基础雌二醇(bE2)、复苏胚胎数、移植胚胎数、移植日子宫内膜厚度、胚胎种植率及临床妊娠率组间均无统计学差异(P>0.05)。年龄≤35岁组的临床妊娠率高于年龄>35岁组, 差异有统计学意义(P<0.05); BMI≥24.0 kg/m2的肥胖组临床妊娠率与正常体质量(BMI=18.5～23.9 kg/m2)组无统计学差异(P>0.05);移植日子宫内膜厚度≥7 mm组的临床妊娠率高于移植日子宫内膜厚度<7 mm组, 但差异无统计学意义(P>0.05);各移植胚胎数组间临床妊娠率无统计学差异(P>0.05)。结论: 年龄是影响FET临床结局的重要因素, 内膜准备方案、BMI、移植日内膜厚度、移植胚胎数对冻融胚胎移植临床结局无影响。

目的:探讨不同促排卵方案对子宫内膜异位症(endometriosis,EMs)患者体外受精-胚胎移植(in vitro fertilizationembryotransfer,IVF-ET)妊娠结局的影响.方法:回顾性分析郑州大学第三附属医院生殖中心2010年1月至2012年12月因EMs行IVF-ET共108个周期的患者临床资料,根据促排方案不同,分为长方案组(33个周期)和超长方案组(75个周期),比较2组患者助孕结局.结果:2组患者年龄、不孕年限及基础卵泡刺激素(follicle-stimulation homone,FSH)、基础黄体生成素(luteinizing hormone,LH)、基础雌二醇(estradion,E2)比较差异均无统计学意义(P＞0.05);超长方案组患者促性腺激素(gonadotmpin,Gn)总量、Gn总天数均高于长方案组,但获卵数、卵裂数、可利用胚胎数和优质胚胎数均低于长方案组,差异具有统计学意义(P＜0.05);超长方案组的临床妊娠率和胚胎植入率均高于长方案组,差异具有统计学意义(P＜0.05).结论:Ⅲ～Ⅳ期EMs患者使用超长方案促排卵可以提高IVF-ET的临床妊娠率及胚胎植入率.

Objective To investigate the clinical application of the modified super-long downregulation protocol in patients with inviro fertilization-embryo transferation (IVF-ET).Methods The clinical data of 95 patients with lower ovarian reponse underwent IVF-ET were analyzed retrospectively.Among them,50 cases (group A) accepted modified super-long down-regulation protocol,45 cases (group B) accepted long down-regulation protocol.Fifteen patients in group A were given first long down-regulation protocol without success(group C),and then were given modified super-long down-regulation protocol(Group D).The duration of stimulation,total dose of Gn,E2 level on HCG day,number of eggs retrieved,rate of high quality embryo,clinical pregnancy rate were compared between the groups.Results ①There were no significant differences in age,infertility duration,BMI,various endocrine hormone levels or the number of the bilateral antral follicle (P ＞ 0.05).②The days of using Gn,endometrial thickness on HCG injecting day in group A were higher than those in group B (P ＜ 0.05),the level of LH on HCG injecting day in group A was lower than that in group B(P ＜0.05),there were no significant differences in the dosage of Gn,E2 and P levels on HCG injecting day between the two groups (P ＞ O.05).③There were no significant differences in the number of oocyte,the rate of cancellation,the rate of fertilization,the rate of cleavage,the rate of high-quality embryo or clinical pregnancy rate (P ＞ 0.05) between the two groups.④ The days of using Gn,endometrial thickness on HCG injecting day in group D were higher than those in group C (P ＜ 0.05),the level of LH on HCG injecting day in group D was lower than that in group C (P ＜ 0.05).⑤ There were no significant differences in the number of oocyte,the rate of cancellation,the rate of fertilization,the rate of cleavage,the rate of high-quality embryo or clinical pregnancy rate between the two groups (P ＞ 0.05).Conclusions Modified super-long down-regulation protocol is an effective method for ovulation.

Objective: To explore the application of mild-stimulate ovulation in in vitro fertilization and embryo transfer(IVF-ET) among patients with poor ovarian response.Methods: Retrospective analysis of IVF/ICSI poor ovarian response patients with a total of 114 cycles was performed.According to the difference of the ovarian stimulation,patients were divided into 3 groups: group A(letrozole group,LE group,34 cycles),group B(clomiphene citrate group,CC group,41 cycles),group C(short protocol group,39 cycles).The general situation of the patients,Gn dosage and period,indicators associated with IVF lab and clinical outcomes in the 3 groups were compared.Results: 1) Age,body mass index(BMI),infertility duration,the basis of endocrine were not statistically different(P>0.05) in 3 groups.2) Gn dosage and treatment period,E2 level on hCG injection day and excellent embryo rate in group A were lower than those in group C(P<0.05);LH level on hCG injection day and ahead of ovulation rate in group A were higher than those in group C(P<0.05);average number of oocyte retrieved,fertilization rate,cleavage rate,implantation rate,clinical pregnancy rate were not significantly different between the groups(P>0.05).3) Gn dosage and treatment period,E2 level on hCG injection day,the average number of oocyte retrieved and cleavage rate in group B were lower than those in group C(P<0.05);LH level on hCG injection day in group B was higher than those in group C(P<0.05);ahead of ovulation rate,fertilization rate,the rate of excellent embryos,implantation rate,clinical pregnancy rate were not significantly different between the groups(P>0.05).4) Gn dosage and treatment period in group B were higher than those in group A(P<0.05);other indicators between group A and group B were not significantly different(P>0.05).Conclusion: The mild-stimulation ovulation protocol can be used to obtain similar clinical effects as GnRH-a short protocol,while it could reduce the Gn dosage and the cost of treatment.It may be the ideal protocol for poor ovarian response patients in IVF.

To improve the QOS of Layered P2P Live System,an incentive-based Tree-push/Mesh-pull strategy ICTMS(An Incentive based Tree-push/Mesh-pull strategy) was proposed. Compared with the traditional push and pull Mechanism,ICTMS considers the heterogeneity of peers fully and introduces the incentive mechanism,for the peers of different upload capacity,it uses push or pull strategy respectively.ICTMS includes the rapid data distribution advantage of push and high resource utilization of pull.In this strategy, it also reduces the pressure of cluster header by restricting the services of cluster header.The simulation results show that ICTMS improves the overall performance of the system and it is more suitable for large-scale streaming media applications.

Objective To investigate the comparison of assisted reproductive outcome of two kinds of mild-stimulation methods in IVF of ovarian poor response patients.Methods The ovarian poor response patients in IVF/ICSI with a total of 60 cycles was retrospectively analyzed.According to the difference of the ovarian stimulation,the patients were divided into two groups:letrozole group:a total of 30 cycles and clomiphene citrate group:a total of 30 cycles.The general situation of the patients,Gn dosage and period,indicators associated with IVF lab and IVF outcome in the two groups were compared.Results Age,body mass index,infertility period,the basis of endocrine were not statistically different (P ＞ 0.05) in the two groups; Gn dosage and treatment period in clomiphene citrate was higher than that in letrozole group (P ＜ 0.05) ; Average numbers of oocytes retrieved,fertilization rate,cleavage rate,implantation rate,clinical pregnancy rate,abortion rate had no significant difference in the two groups (P ＞ 0.05).Conclusions Two kinds of mild-stimulation methods for the ovarian poor response patients are both effective.Letrozole could reduce the Gn dosage and single cycle treatment costs and have the same pregnancy rate compared with clomiphene citrate.

目的:评价体外受精-胚胎移植(IVF-ET)超促排卵周期中卵泡晚期增加人绝经期促性腺激素(HMG)用量,同时补充重组人黄体生成素(r-hLH),对主要实验室指标和临床妊娠结局的影响.方法:选择行IVF-ET或卵胞浆内单精子显微注射(ICSI)技术助孕治疗的患者212例,采用标准长方案垂体降调节,根据超促排卵的卵泡晚期血清黄体生成素(LH)水平将所有病例分为两组:血清LH水平持续较低补充r-hLH者72例设为实验组(r-hLH组),血清LH水平持续正常未补充r-hLH者140例设为对照组(非r-hLH组),比较两组患者的年龄、基础内分泌状态、促性腺激素(Gn)使用时间及使用量、人绒毛膜促性腺激素(HCG)注射日各项内分泌激素值、获卵数、两组不同助孕方式的双原核(2PN)受精率、优质胚胎率、移植周期的着床率及临床妊娠率.结果:两组患者的年龄、基础LH、基础卵泡刺激素(FSH)、基础雌二醇(E2)水平、超促排卵天数、Gn总量、IVF/ ICSI助孕的2PN受精率、移植周期的着床率、临床妊娠率差异均无统计学意义(P＞0.05).r-hLH组超促排卵FSH总量低于非r-hLH组,差异有统计学意义(P＜0.05)；r-hLH组HMG总量高于非r-hLH组,差异有统计学意义(P ＜0.05)；HCG注射日r-hLH组血清LH水平低于非r-hLH组,差异有统计学意义(P＜0.05)；r-hLH组的优质胚胎率高于非r-hLH组,差异有统计学意义(P＜0.05).结论:激动剂标准长方案超促排卵周期卵泡晚期血清LH水平持续较低者增加HMG的用量,适量补充r-hLH可提升卵子成熟度,显著提高优质胚胎率,一定程度改善IVF/ICSI的助孕结局.

To improve the QoS of Layered P2P Live System, an incentive-based Tree-push/mesh-pull strategy ICTMS (An Incentive based Tree-push/Mesh-pull strategy) was proposed. Compared with the traditional push and pull Mechanism, ICTMS considers the heterogeneity of peers fully and introduces the incentive mechanism. According to a peer's different uploading capacity, it uses the push strategy or the pull strategy respectively. ICTMS not only has the rapid data distribution advantage of the push strategy, but also has that of high resource utilization of the pull strategy. In this strategy, it also alleviates the pressure of a cluster header by restricting its service. The simulation results show that ICTMS can improve the overall performance of the system, and it is suitable for large-scale streaming media applications.