ObjectiveTo investigate the impact of three endometrial preparation protocols-hormone replacement therapy (HRT), natural cycle (NC), and down-regulation HRT-on pregnancy outcomes in frozen embryo transfer (FET) cycles among patients with a history of intrauterine adhesion (IUA) separation surgery.MethodA retrospective cohort study was conducted to analyze the data from FET cycles at reproductive medicine center from January 2017 to December 2023. The patients with a history of intrauterine adhesion separation surgery were classified into three groups: the HRT group (n=285), the NC group (n=200), and the down-regulation HRT group (n=104). Baseline characteristics and reproductive outcomes were compared between the groups. Chi-square tests were used for univariate analysis, and multivariate logistic regression analysis was conducted to adjust for confounding factors.ResultsThere were statistically significant differences among the three groups in terms of general charateristics (all P<0.05). The clinical pregnancy rates for the HRT group, NC group, and down-regulation-HRT group were 30.88% (88/285), 47.50% (95/200), and 40.38% (42/104) respectively. The biochemical pregnancy rates were 35.09% (100/285), 50.50% (101/200), and 45.19% (57/104) respectively. The early miscarriage rates were 21.59% (19/88), 13.68% (13/95), and 21.43% (9/42) respectively, and the live birth rates were 22.81% (65/285), 36.50% (73/200), and 30.77% (32/104) respectively. There were statistically significant differences in clinical pregnancy rate, biochemical pregnancy rate and live birth rate among the groups. Following adjusting for confounding factors, the NC group exhibited significantly higher clinical pregnancy rate (aOR=1.627, 95% CI: 1.079-2.453, P = 0.02) and biochemical pregnancy rate (aOR=1.532, 95% CI: 1.020~2.301, P = 0.04) relative to the HRT group. There were no statistically significant differences in live birth rate, and early miscarriage rate (all P>0.05). Similarly, there were no statistically significant differences in clinical pregnancy rate, biochemical pregnancy rate, live birth rate, and early miscarriage rate between the down-regulation-HRT group and the HRT group (all P>0.05).ConclusionFor patients undergoing FET cycle with a history of IUA separation surgery, the live birth rate is similar between three groups. However, the natural cycle endometrial preparation protocol yielded higher clinical and biochemical pregnancy rates than the HRT protocol, suggesting its potential clinical advantage for these patients.

ObjectiveThe objective was to analyze the impact of the uterine artery pulsatility index (PI) on pregnancy outcomes by measuring uterine artery blood flow on the day of endometrial transformation in patients undergoing frozen–thawed embryo transfer (FET).MethodsThis was a case-control study. In total, 2,036 patients who underwent FET at the Third Affiliated Hospital of Zhengzhou University from October 2019 to September 2020 were included. The patients were divided into a clinical pregnancy group and a nonclinical pregnancy group according to pregnancy outcome. A multivariate logistic regression model was used to analyze the factors affecting the clinical pregnancy rate. The receiver operating characteristic (ROC) curve was used to determine the optimal mean PI cutoff value of 1.75. After 1:1 propensity score matching (PSM), 562 patients were included. For statistical description and analysis, the patients were divided into two groups: a group with a mean PI > 1.75 and a group with a mean PI ≤ 1.75.ResultsThe clinical pregnancy group included 1,218 cycles, and the nonclinical pregnancy group included 818 cycles. There were significant differences in female age (P<0.01), infertility type (P=0.04), baseline follicle-stimulating hormone level (P=0.04), anti-Müllerian hormone (AMH) level (P<0.01), antral follicle count (P<0.01), number of transferred embryos (P=0.045) and type of transferred embryo (P<0.01). There was no significant difference in the mean bilateral PI (1.98 ± 0.34 vs. 1.95 ± 0.35, P=0.10). The multivariate analysis results showed that maternal age (AOR=0.95, 95% CI=0.93-0.98, P<0.01), AMH level (AOR=1.00, 95% CI=1.00-1.01, P=0.045), number of transferred embryos (AOR=1.98, 95% CI=1.47-2.70, P<0.01), and type of transferred embryo (AOR=3.10, 95% CI=2.27-4.23, P<0.01) were independent factors influencing the clinical pregnancy rate. The mean PI (AOR=0.85, 95% CI=0.70-1.05; P=0.13) was not an independent factor influencing the clinical pregnancy rate. Participants were divided into two groups according to the mean PI cutoff value of 1.75, and there was no significant difference between the two groups (P > 0.05).ConclusionIn this study, we found that the uterine artery PI on the day of endometrial transformation in patients undergoing FET is not a good predictor of pregnancy outcomes.

Objective:To explore whether the duration of oral estrogen treatment before progesterone application affects neonatal outcome in single frozen-thawed embryo transfer (FET) with artificial cycles.Methods:It was a retrospective cohort study. Patients who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), receiving single frozen blastocyst transfer with artificial cycle and delivering a single live birth in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University between January 2015 and December 2019 were included. All FET cycles were divided into four groups according to the estrogen treatment duration before progesterone application, ≤12 d ( n=306), 13-15 d ( n=620), 16-18 d ( n=471), and ≥19 d ( n=275). Primary outcome was the incidence of small for gestational age (SGA). Secondary outcomes were the incidence of preterm birth, low birth weight, macrosomia and large for gestational age (LGA). Results:A total of 1 672 single blastocyst transfer cycles were included. The incidence of SGA among the four groups was 7.8% (24/306), 4.8% (30/620), 5.7% (27/471), and 7.6% (21/275), respectively, with no statistically significant difference ( P=0.204). The results of multiple logistic regression analysis showed that the duration of estrogen used before progesterone application did not affect the incidence of SGA in singleton offspring (with ≤12 d as the reference, 13-15 d: a OR=1.37, 95% CI: 0.70-2.70, P=0.361; 16-18 d: a OR=0.74, 95% CI: 0.40-1.36, P=0.336; ≥19 d: a OR=0.81, 95% CI: 0.44-1.49, P=0.501). There were no significant differences in neonatal preterm birth rate ( P=0.204), low birth weight ( P=0.582), incidences of macrosomia ( P=0.201) and LGA infants ( P=0.335) among the four groups. Conclusion:In artificial FET cycle, the duration of oral estrogen treatment before progesterone application does not affect the outcome of singleton offspring after single blastocyst transfer.

Objective To compare the neonatal outcomes of progestin-primed ovarian stimulation (PPOS) and flexible gonadotropin-releasing hormone (GnRH) antagonist protocols. Methods This was a retrospective propensity score–matched (PSM) cohort study. Women who underwent their first frozen embryo transfer (FET) cycle with freezing of all embryos followed by PPOS or GnRH antagonist protocols between January 2016 and January 2022 were included. Patients using PPOS were matched with the patients using GnRH antagonist at a 1:1 ratio. The main focus of this study was the neonatal outcomes of singleton live births, including preterm birth (PTB), low birth weight (LBW), small for gestational age (SGA), macrosomia and large for gestational age (LGA). Results After 1:1 PSM, a total of 457 PPOS and 457 GnRH antagonist protocols were included for analysis. The average starting dose of gonadotropin (275.1 ± 68.1 vs. 249.3 ± 71.3, P<0.01) and total dose of gonadotropin (2799.6 ± 579.9 vs. 2634.4 ± 729.1, P<0.01) were significantly higher in the PPOS protocol than in the GnRH antagonist protocol. The other baseline and cycle characteristics were comparable between the two protocols. The rates of PTB (P=0.14), LBW (P=0.11), SGA (P=0.31), macrosomia (P=0.11) and LGA (P=0.49) did not differ significantly between the two groups. A total of 4 patients in the PPOS group and 3 patients in the GnRH antagonist group qualified as having congenital malformations. Conclusion PPOS resulted in singleton neonatal outcomes similar to those of a GnRH antagonist protocol. The application of the PPOS protocol is a safe option for infertility patients.

目的 比较高孕酮状态下促排卵(progestin-primed ovarian stimulation,PPOS)方案中地屈孕酮和醋酸甲羟孕酮(medroxyprogesterone acetate,MPA)在卵巢低反应(poor ovarian response,POR)人群中的临床应用结局.方法 本研究属于单中心回顾性队列研究.纳入2019年1月至2021年9月期间在郑州大学第三附属医院生殖医学科行PPOS方案助孕的POR患者.根据使用的孕激素药物不同,分为地屈孕酮组和MPA组.以1∶3进行倾向性评分匹配(propensity score matching,PSM)校正混杂因素.观察指标为可利用胚胎数、获卵数、双原核(two pronuclei,2PN)数、优质胚胎数、全胚冷冻第一周期移植临床妊娠率和持续妊娠率.结果 共纳入1 962个周期,其中地屈孕酮组共494个周期,MPA组共1 468个周期.两组间不孕因素差异有统计学意义(P=0.045),余基础资料差异均无统计学意义(均P>0.05).地屈孕酮组的促性腺激素(gonadotropin,Gn)启动量[300(225,300)U]低于MPA组[300(300,300)U,P<0.001].Gn使用时间、Gn使用总量、早发黄体生成素峰、获卵数、2PN数、可利用胚胎数和优质胚胎数在组间差异均无统计学意义(均P>0.05).共有1 331个周期进行了第1次冻融胚胎移植,其中地屈孕酮组268个周期,MPA组1 063个周期.移植日子宫内膜厚度、移植胚胎数、移植胚胎阶段、子宫内膜准备方案组间差异均无统计学意义(均P>0.05).两组间的临床妊娠率和持续妊娠率差异均无统计学意义(均P>0.05).结论 对于POR患者,PPOS方案中地屈孕酮和MPA可获得相似的临床结局,表明地屈孕酮可作为PPOS方案有效的选择之一.

ObjectiveThe purpose of this study was to evaluate the cumulative live birth rate (CLBR) of mild stimulation and conventional stimulation for the low-prognosis population undergoing PPOS protocols.MethodsThis was a retrospective cohort study. We included women with a low prognosis. All women underwent PPOS protocols, and the starting gonadotropin (Gn) dose was 150 IU or 300 IU. The primary outcome measure was CLBR. The secondary outcome measures were the number of oocytes retrieved, number of 2PN oocytes and number of available embryos.ResultsIn total, 171 women with mild stimulation and 1810 women with conventional stimulation met the criteria. In the PSM model, 171 mild stimulation cycles were matched with 513 conventional stimulation cycles. The gonadotropin dosage in the mild stimulation group was significantly lower than that in the conventional stimulation group (1878.6 ± 1065.7 vs. 2854.7 ± 821.0, P<0.001). The numbers of oocytes retrieved, 2PN oocytes, available embryos and high-quality embryos were also higher in the conventional stimulation group than in the mild stimulation group (P<0.05). There was no significant between-group difference in the cumulative clinical pregnancy rate (26.3% vs. 27.5%, P=0.77). The CLBR after mild stimulation was similar to that after conventional stimulation (21.1% vs. 22.0%, P=0.79).ConclusionIn our study, we found that the CLBRs of mild stimulation and conventional stimulation were similar, despite conventional stimulation resulting in significantly more oocytes and embryos. Thus, mild stimulation can be considered an option for women with a low prognosis in PPOS protocols.

ObjectiveTo explore whether the duration of estrogen treatment before progesterone application affects neonatal and perinatal outcomes in artificial frozen embryo transfer (FET) cycles.MethodsThis was a retrospective cohort study. Patients who underwent FET via artificial cycles and delivered a singleton live birth between January 2015 and August 2019 were included in the analysis. According to the duration of estrogen treatment before progesterone application, we divided the cycles into four groups: ①≤12 days, ②13-15 days, ③16-19 days, and ④≥20 days. The ‘≤12 days group’ was considered the reference group. The main outcome measures were preterm birth (PTB), small-for-gestational age (SGA), low birth weight (LBW), macrosomia, large-for-gestational age (LGA), gestational diabetes mellitus (GDM), gestational hypertension, premature rupture and placenta previa.ResultsOverall, 2010 FET cycles with singleton live births were included for analysis. Cycles were allocated to four groups according to the duration of estrogen treatment before progesterone application: ①≤12 days (n=372), ②13-15 days (n=745), ③16-19 days (n=654), ④≥20 days (n=239). The neonatal outcomes, including PTB, SGA, LBW, macrosomia and LGA, were comparable among the groups (P=0.328, P=0.390, P=0.551, P=0.565, P=0.358). The rates of gestational hypertension, premature rupture and placenta previa (P=0.676, P=0.662, P=0.211) were similar among the groups. The rates of GDM among the four groups were 4.0% (15/372), 6.7% (50/745), 6.4% (42/654), and 11.3% (27/239), with statistical significance (P=0.006). After multiple logistic regression analysis, the duration of estrogen treatment did not affect the rate of GDM or other outcomes.ConclusionThe estrogen treatment duration before progesterone application does not affect neonatal and perinatal outcomes in single frozen blastocyst transfer cycles.

Objective:To investigate whether there is an association between season, temperature, as well as cumulative sunlight exposure on the day of oocyte retrieval and clinical outcomes of in vitro fertilization (IVF) and fresh embryo transfer. Methods:It was a retrospective cohort study, including patients who underwent IVF in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from August 2015 to October 2019. They were divided into four groups according to the oocyte retrieval date. Spring group: the oocyte retrieval date was from March to May. Summer group: the date of oocyte retrieval was from June to August. Autumn group: the date of oocyte retrieval was from September to November. Winter group: the date of oocyte retrieval was from December to February of the next year. The main outcome measures were clinical pregnancy rate and live birth rate. Binary logistic regression was used to explore the factors affecting clinical pregnancy rate and live birth rate.Results:There were no significant differences in the miscarriage rate and the live birth rate among the four groups (all P>0.05). The pairwise comparison between the groups indicated that the clinical pregnancy rate in the winter group [56.9% (816/1 435)] was lower than that in the summer group [61.5% (1 359/2 210), P=0.005]. Taking winter as the reference, the clinical pregnancy rate in summer was higher (a OR=1.25, 95% CI: 1.09-1.44, P=0.002). The clinical pregnancy rate in spring (a OR=1.14, 95% CI: 0.99-1.32, P=0.073) and autumn (a OR=1.09, 95% CI: 0.94-1.26, P=0.254) was not significantly different from winter. Binary logistic regression analysis showed that higher mean temperature was associated with higher clinical pregnancy rate (a OR=1.01, 95% CI: 1.00-1.01, P=0.005). Season, temperature and cumulative sunshine on the day of egg retrieval had no significant effect on the live birth rate. Conclusion:Summer and high temperature are independent and favorable influencing factors of clinical pregnancy rate. However, different seasons, temperatures and cumulative sunshine had no significant effect on live birth rate.

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.

Objective:To evaluate the cumulative live birth rate (CLBR) of mild stimulation and conventional stimulation in Poseidon 4 group for progestin-primed ovarian stimulation protocols (PPOS).Methods:It was a single-center, retrospective cohort study. The study included the first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2017 to March 2020, and included patients met the criteria of Poseidon 4 group and accepted PPOS. According to the different starting dosage of gonadotropin (Gn), it was divided into mild stimulation group and conventional stimulation group. In mild stimulation group, Gn starting dosage was 150 U, and in conventional stimulation group Gn starting dosage was 300 U. The primary outcome measure was CLBR. Secondary observation indicators were No. of oocytes retrieved, No. of two pronuclei (2PN), No. of available embryos, No. of high-quality embryos and cumulative pregnancy rate. Results:A total of 1 334 cycles met the inclusion and exclusion criteria. After 1∶3 propensity score matching (PSM) model, 116 cycles of mild stimulation and 348 cycles of conventional stimulation were included for analysis. The total dosage of Gn used in the conventional ovarian stimulation group was significantly higher than that in the mild stimulation group [2 700.00 (2 400.00, 3 300.00) U vs. 1 500.00 (918.75, 2 456.25) U, P<0.001]. The number of oocytes retrieved [3.00 (2.00, 4.00)], 2PN [2.00 (1.00, 3.00)], available embryos [1.00 (1.00, 2.00)] and high-quality embryos [1.00 (0.00, 1.00)] in the conventional stimulation group were significantly higher than those in the mild stimulation group [2.00 (1.00, 3.00), P<0.001; 1.00 (1.00, 2.00), P=0.002; 1.00 (0.00,2.00), P=0.002; 0.00 (0.00, 1.00), P=0.025]. There was no statistical difference in the cumulative pregnancy rate between mild stimulation and conventional stimulation [15.52% (18/116) vs. 19.54% (68/348), P=0.334]. The CLBR of the mild stimulation group was 11.21% (13/116), and the CLBR of the conventional stimulation group was 14.08% (49/348), with no significant difference between the two groups ( P=0.431). Conclusion:Conventional stimulation increased the dosage of Gn used, and the number of oocytes retrieved and available embryos were more than those in mild stimulation, but the CLBR was similar between the two protocols. Therefore, mild stimulation is also an important clinical option for patients with low ovarian prognosis.

Objective:To explore whether season and temperature on oocyte retrieval day affect the cumulative live birth rate and time to live birth.Methods:This was a retrospective cohort study. A total of 14420 oocyte retrieval cycles from October 2015 to September 2019. According to the date of oocyte retrieval, the patients were divided into four groups (Spring(n=3634);Summer(n=4414); Autumn(n=3706); Winter(n=2666)). The primary outcome measures were cumulative live birth rate and time to live birth. The secondary outcome measures included the number of oocytes retrieved, number of 2PN, number of available embryos and number of high-quality embryos.Results:The number of oocytes retrieved was similar among the groups. Other outcomes, including the number of 2PN (P=0.02), number of available embryos (p=0.04), and number of high-quality embryos (p<0.01) were different among the groups. The quality of embryos in summer was relatively poor. There were no differences between the four groups in terms of cumulative live birth rate (P=0.17) or time to live birth (P=0.08). After adjusting for confounding factors by binary logistic regression, temperature (P=0.80), season (P=0.47) and duration of sunshine(P=0.46) had no effect on cumulative live births. Only maternal age (P<0.01) and basal FSH (P<0.01) had an effect on cumulative live births. Cox regression analysis suggested no effect of season(P=0.18) and temperature(P=0.89) on time to live birth. Maternal age did have an effect on time to live birth (P<0.01).Conclusion:Although season has an effect on the embryo, there was no evidence that season or temperature affect the cumulative live birth rate or time to live birth. It is not necessary to select a specific season when preparing for IVF.

ObjectiveThe purpose of this study was to explore the effects of different methods of obtaining sperm for intracytoplasmic sperm injection (ICSI) cycles on the live birth rate (LBR) and neonatal outcomes. MethodsThis was a single-center retrospective cohort study conducted from January 2016 to December 2019. A total of 3557 ICSI cycles were included in the analysis, including 540 cycles in the surgically acquired sperm group and 3017 cycles in the ejaculated sperm group. The main outcome measure was the LBR. ResultsThe clinical pregnancy rate in the surgically acquired sperm group was 69.4%, which was significantly higher than the 59.7% clinical pregnancy rate in the ejaculated sperm group (P=0.01). The LBR of the surgically acquired sperm group was significantly higher than that of the ejaculated sperm group (63.1% vs. 51.2%, P<0.01). Similarly, the singleton LBR was also higher in the surgically acquired sperm group than in the ejaculated sperm group (45.4% vs. 39.2%, P=0.04). Due to differences in the baseline characteristics of the two groups, multiple logistic regression analysis was performed. After multiple logistic regression analysis, the different methods of obtaining sperm were independent risk factors influencing the clinical pregnancy rate (adjusted odds ratio (AOR)=0.73, 95% confidence (CI)=0.56-0.95, P=0.02) and LBR (AOR=0.69, 95% CI=0.54-0.89, P=0.01). The preterm birth rate (AOR=1.42, 95% CI=0.62-3.25, P=0.41) and the incidence of low birth weight (AOR=1.03, 95% CI=0.45-2.34, P=0.95), small for gestational age (AOR=0.81, 95% CI=0.39-1.68, P=0.57), macrosomia (AOR=0.88, 95% CI=0.47-1.66, P=0.70) and large for gestational age (AOR=1.08, 95% CI=0.65-1.82, P=0.76) were not affected by the different methods. ConclusionThe clinical pregnancy rate and LBR of the surgically acquired sperm group were higher than those of the ejaculated sperm group. There was no significant difference between the neonatal outcomes of the two groups.

Objective:To compare the cumulative live birth rate (CLBR) of gonadotropin-releasing hormone (GnRH) antagonist protocol, medroxyprogesterone (MPA) protocol and clomiphene citrate (CC) protocol in low prognosis population with decreased ovarian reserve.Methods:It was a retrospective cohort study. Patients who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2015 to May 2018 were recruited. Including POSEIDON group 3 and group 4, GnRH-antagonist protocol, MPA, and CC protocol were used for ovulation stimulation. The basic data and clinical outcomes of the three protocols were analyzed. The main outcome measure was CLBR. With the GnRH-antagonist group as the reference, the adjusted odds ratio ( aOR) and 95% confidence interval ( CI) of the MPA group and the CC group were calculated. Results:In the POSEIDON group 3, the CLBR of the three protocols was not statistically different. After logistic regression analysis, the ovulation stimulation protocols did not affect the CLBR of POSEIDON 3 group ( P=0.226, P=0.468). In the POSEIDON group 4, the CLBR of the MPA group was higher than that of the CC group (10.7% vs. 5.4%, P=0.002). Using binary logistic regression and GnRH-antagonist group as the control, the CLBR of the MPA protocol was higher (a OR=2.22, 95% CI=1.17-4.24, P=0.021), the CLBR of the CC protocol was not significantly different from the GnRH-antagonist group (a OR=0.95, 95% CI=0.48-1.85, P=0.868). Conclusion:For patients under 35 years old with low ovarian reserve, the clinical outcomes of the three ovulation stimulation protocols were similar. For patients who are 35 years or older with low ovarian reserve, the CLBR of the MPA protocol was higher.

Objective:To explore the effect of thin endometrial thickness (EMT) on the low birth weight (LBW) of singleton in fresh embryo transfer cycle.Methods:It was a retrospective cohort study. The data of singleton deliveries achieved after fresh cleavage embryo transfer in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2015 to February 2019 were included. A total of 2247 cycles were included and were divided into three groups depending on the EMT: group A≤7.5 mm, group B 7.6-12.0 mm and group C>12.0 mm. The major outcome measure was LBW. Binary logistic regression was performed to correct for confounding factors.Results:Singleton birthweight was lower in group A [3000(2525, 3350) g] compared with group B and group C [3350(3050, 3650) g, 3400(3100, 3690) g, all P<0.001]. The incidence of LBW in group A [24.7% (20/81)] was significantly higher than that in groups B and C [4.0% (57/1414), 5.3% (40/752), all P<0.001], while there was no statistical difference between groups B and C ( P>0.05). Body mass index ( P=0.029), estrogen level on the human chorionic gonadotropin (hCG) trigger day ( P=0.027), EMT ( P<0.001), gestational age ( P<0.001) and the gender of the newborn ( P<0.001) were independent factors of LBW. The incidence of LBW increased when the body mass index and gestational age were smaller and estrogen level on the hCG trigger day was ≥4000 ng/L. Taking group B as control group, the incidence of LBW in group A increased significantly and was an independent risk factor for LBW (a OR=4.39, 95% CI=1.85-10.46, P<0.001), while the incidence of LBW in group C had no significant difference (a OR=0.90, 95% CI=0.51-1.59, P=0.723). Conclusion:In the fresh cleavage stage embryo transfer cycle, singleton birth weight was lower in thin EMT group. And thin EMT was an independent risk factor for LBW of singleton delivery.

Objective:To investigate the effect of anti-Müllerian hormone (AMH) level on early pregnancy loss and cumulative pregnancy outcome of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), and whether AMH level can be used as an indicator to evaluate the quality of oocytes. Methods:A retrospective cohort analysis was performed on 3701 women undergoing their first oocyte retrieval for IVF/ICSI at the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from December 2015 to December 2019. According to the age, patients were divided into elderly group (≥35 years old) and younger group (<35 years old). References to the Bologna criteria and POSEIDON criteria, patients were divided into three groups: low AMH group (AMH≤1 μg/L), moderately low AMH group (1 μg/L<AMH<2 μg/L), normal AMH group (2 μg/L≤AMH<6 μg/L). The basic data and clinical data, the differences of early pregnancy loss, cumulative pregnancy rate and cumulative live birth rate among each group were compared. Binary logistic regression was used to analyze the effect of AMH on pregnancy outcome by control confounders (such as age, infertility reason, stimulation protocol, endometrial thickness on the day of human chorionic gonadotropin injection, basic follicle-stimulating hormone level).Results:There were no significant differences in clinical pregnancy rate, live birth rate and early pregnancy loss rate among the three groups (all P>0.05) whether in the elderly group or the younger group. The cumulative pregnancy rates were 61.9% (211/341), 66.0% (319/483), 69.3% (1219/1760), and the cumulative live birth rates were 50.1% (171/341), 57.8% (279/483), 57.1% (1005/1760) in low AMH group, moderately low AMH group and normal AMH group of the younger group, respectively,and there were statistical differences ( P=0.020, P=0.047). After adjusting for confounding factors, in the younger group, cumulative pregnancy rate and cumulative live birth rate in the low AMH group were lower than those in the normal AMH group ( OR=0.617, 95% CI=0.460-0.829, P=0.001; OR=0.660, 95% CI=0.496-0.878, P=0.004), the cumulative pregnancy rate and the cumulative live birth rate in the moderately low AMH group were lower than those in the normal AMH group, but there was no statistical difference (all P>0.05). There were no significant differences in cumulative pregnancy rate and cumulative live birth rate among the three groups with different AMH levels in the elderly group (all P>0.05). Conclusion:AMH is not associated with the incidence of early pregnancy loss during the their first oocyte retrieval in IVF/ICSI. AMH level is an independent factor affecting the cumulative pregnancy outcome in the younger group, the pregnancy outcome of women with AMH ≤1 μg/L decreased significantly. In the eldly women, AMH was not significantly associated with cumulative pregnancy outcome. AMH level may not be an indicator of oocyte quality.

Objective To investigate the clinical outcomes of Day 7 (D7) frozen-thawed embryo transfer (FET) and to provide a reference value for clinical work. Methods This was a retrospective cohort study. Patients undergoing FET cycles in the Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University between December 2015 and January 2021 were included. According to the developmental stage of the embryos at transfer, the embryos were divided into three groups: Day (D) 5, D6 and D7 blastocysts. Group D7 was compared with Groups D5 and D6. Simultaneously, the preimplantation genetic testing (PGT) and non-PGT cycles in Group D7 were analyzed and compared. The main outcomes were the clinical pregnancy, live birth and miscarriage rates. The secondary outcomes were the implantation and euploidy rates. Results In total, 5945, 4094 and 137 FET cycles were included in the D5, D6 and D7 groups, respectively. The clinical pregnancy rate was significantly lower in Group D7 than in Groups D5 (13.9% vs 62.9%, P < 0.001) and D6 (13.9% vs 51.4%, P < 0.001). Additionally, the live birth rate was significantly lower in Group D7 than in Groups D5 (7.3% vs 50.7%, P < 0.001) and D6 (7.3% vs 40.5%, P < 0.001). However, the miscarriage rate was significantly higher in Group D7 than in Groups D5 (47.4% vs 18.2%, P =0.001) and D6 (47.4% vs 20.6%, P =0.004). The clinical pregnancy and live birth rates for D7 blastocysts were significantly higher in the PGT group than in the non-PGT group (41.7% vs 13.9%, P =0.012; 33.3% vs 7.3%, P = 0.003). Conclusions D7 blastocyst transfer can yield a live birth rate that is lower than that for D5 and D6 blastocysts but has value for transfer. PGT for D7 blastocysts may reduce the number of ineffective transfers and improve the outcome of D7 blastocyst transfer, which can be performed according to a patient’s situation.

ObjectiveThe present study analyzed the effect of hCG trigger day progesterone (P) levels on the live birth rate (LBR) in the gonadotropin-releasing hormone (GnRH) antagonist protocol.Materials and methodsThis study was a single-center retrospective study. In vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles performed from January 2017 to December 2020 were included in the analysis. This study included people with a normal ovarian response to fresh embryo transfer of GnRH antagonist protocols. All cycles were divided into 2 groups by P level on the day of human chorionic gonadotropin (hCG) trigger, P<1.0 ng/ml and P≥1.0 ng/ml. The primary outcome measure was LBR.ResultA total of 867 cycles with P<1.0 ng/ml and 362 cycles with P≥1.0 ng/ml were included in the analysis. The clinical pregnancy rate (CPR) was higher in the P<1.0 ng/ml group than the P≥1.0 ng/ml group (44.9% vs. 37.6%, P=0.02). The early spontaneous abortion rate was comparable between the groups (14.4% vs. 14.7%, P=0.93). For live birth, the rate for the P<1.0 ng/ml group was 35.3%, which was significantly higher than the 29.0% in the P≥1.0 ng/ml group (P=0.03). After binary logistic regression analysis, the P level on the hCG trigger day (adjusted odds ratio=0.74, 95% CI=0.55-0.99, P=0.04) was an independent risk factor for LBR. For the P level on the hCG trigger day, the LBR was lower in the P≥1.0 ng/ml group compared to the P<1.0 ng/ml group.ConclusionFor normal ovarian response patients using the GnRH antagonist protocol, serum P≥1.0 ng/ml on the hCG trigger day resulted in a lower LBR than the P<1.0 ng/ml group. When P≥1.0 ng/ml, whole embryo freezing may be considered.

Abstract The effects of supraphysiological estradiol (E2) on neonatal outcomes and the significance of specific E2 concentrations remain unclear. The purpose of this study was to investigate whether supraphysiological E2 levels on the human chorionic gonadotropin (hCG) trigger day are associated with small size for gestational age (SGA) in singletons born from fresh embryo transfer (ET) cycles. Patients with singleton pregnancies who delivered after the transfer of fresh embryos, during the period from July 2012 to December 2017, at our center were included. We excluded cycles involving a vanishing twin, maternal age >35 years, basal follicle-stimulating hormone ≥10 mIU/ml, or anti-Müllerian hormone ≤1 ng/ml. We then divided all cycles into five groups by E2 level on trigger day: group A, <2000 pg/ml (reference group); group B, 2000 pg/ml≤E2<2999 pg/ml; group C, 3000 pg/ml≤E2<3999 pg/ml; group D, 4000 pg/ml≤E2<4999 pg/ml; and group E, ≥5000 pg/ml. The prevalence of SGA among singletons from fresh ET was the primary outcome. The SGA rate significantly increased when the E2 level was ≥4000 pg/ml, as observed by comparing groups D (odds ratio [OR]: 1·79, 95% confidence interval [CI]: 1·16–2·76, P = 0·01) and E (OR: 1·68, 95% CI: 1·10–2·56, P = 0·02) with the reference group. Multivariate logistic regression indicated that a serum E2 level of at least 4000 pg/ml on the hCG trigger day was associated with increased SGA and with significant differences for groups D (adjusted OR [AOR]: 1·65, 95% CI: 1·05–2·59, P = 0·03) and E (AOR: 1·60, 95% CI: 1·03–2·53, P = 0·04) relative to the reference group. In conclusion, in fresh ET cycles, the supraphysiological E2 ≥4000 pg/ml on the hCG trigger day increases the risk of SGA.

Background The use of frozen embryo transfer (FET) cycles has dramatically risen. The optimal endometrial preparation method for women undergoing FET is of utmost importance to provide the optimal chances of pregnancy. For patients with abnormal ovulation in particular, there have been few studies on FET protocols; notably, most of these studies focus only on the clinical pregnancy rate or live birth rate (LBR) and pay little attention to the regimen’s safety for offspring. Methods It was a retrospective cohort study. First FET cycle with a single blastocyst from whole embryo frozen IVF/ICSI at the Reproductive Center of Third Affiliated Hospital of Zhengzhou University between January 2016 and January 2020. The LBR was the primary outcome of interest. The secondary outcome measures were miscarriage rate and offspring safety, including preterm birth, low birthweight (LBW), small-for-gestational age (SGA), macrosomia and large-for-gestational age (LGA). Results In total, 2782 FET cycles met the eligibility criteria for analysis. Additionally, there were 1178 singleton births from FET cycles. The clinical pregnancy rate was 58.4% in the L-FET group and 54.5% in the HRT group, with no statistical significance (P=.116). The miscarriage rate was higher in the HRT group than in the L-FET group (21.7% vs. 14.3%, P=.005). The LBR was significantly higher in the L-FET group than in the HRT group (49.6% vs. 41.7%, P=.001). Neonatal outcomes were similar between the two groups. After adjustments for confounding factors, the LBR was higher in the L-FET group (aOR 1.30, 95% CI 1.06-1.58). The rate of miscarriage was lower in the L-FET group (aOR 0.63, 95% CI 0.44-0.90). Conclusion For patients with abnormal ovulation, the L-FET regimen has a higher LBR and lower miscarriage rate than HRT. The neonatal outcomes were similar between the two groups.

Objective:To investigate the embryo transfer strategies of early follicular phase prolonged protocol, to reduce the risk of multiple birth rate while achieving a higher live birth rate.Methods:It was a retrospective cohort study. Patients who underwent gonadotropin-releasing hormone (GnRH) agonist protocols in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2017 to February 2019 were included. According to the type of embryos transferred, we divided all cycles into four groups, fresh cycle cleavage stage embryo transfer group (group A), fresh cycle blastocyst transfer group (group B), freeze-thaw cleavage stage embryo transfer group (group C), freeze-thaw blastocyst transfer group (group D). The main outcome measures were live birth rate and multiple birth rate. Binary logistic regression was used to correct confounding factors.Results:The risk of moderate to severe ovarian hyperstimulation syndrome (OHSS) in group A [4.8% (110/2283)] was higher than that in group C [1.0% (6/614), P<0.001] and group D [2.1% (16/762), P<0.001]. The risk of moderate to severe OHSS in group B [3.8% (42/1116)] was higher than that in group C ( P<0.001). The multiple birth rate of the two embryos transfer group [group A 23.4% (535/2283), group C 20.8% (128/614) ] was significantly higher than that of the one blastocyst transfer group [group B 1.4% (16/1116), group D 0.9% (7/762)], and the difference was statistically significant ( P<0.001). The clinical pregnancy rate [68.7% (767/1116)] and the live birth rate [59.6% (665/1116)] of group B were higher than those of group A [63.5% (1449/2283), P=0.003; 54.8% (1250/2283), P=0.008], group C [60.1% (369/614), P<0.001; 51.6% (317/614), P=0.001] and group D [62.7% (478/762), P=0.007; 52.8% (402/762), P=0.003], but there was no statistical difference among group A, group C and group D. Taking group B as a reference, the live birth rate of group A (a OR=0.86, 95% CI=0.74-0.99, P=0.044), group C (a OR=76, 95% CI=0.62-0.93, P=0.008) and group D (a OR=0.79, 95% CI=0.65-0.95, P=0.013) was lower than that of group B. Conclusion:For the early follicular phase prolonged protocol, based on the control of OHSS, fresh cycle single blastocyst transplantation is preferred. While obtaining a higher live birth rate, the multiple birth rate is significantly reduced.