Recurrent implantation failure (RIF) remains clinically unresolved at this stage. Hydroxychloroquine, as an immunomodulator, is still lacking clinical evidence, but it is being used by increasing numbers of reproductive centers and physicians worldwide, so a well-designed randomized controlled trial (RCT) is urgently needed to elucidate whether hydroxychloroquine can improve pregnancy outcomes in patients with RIF. In this study, we plan to recruit 686 volunteers who will undergo IVF/ICSI at 5 reproductive centers from 6 December 2022. Participants will be randomized to two parallel groups and treated with hydroxychloroquine sulfate tablets or placebo from the start of endometrial preparation to 14 days after frozen embryo transfer (if not pregnant) or to 12 weeks of pregnancy (if pregnant). The primary outcome is live birth rate, and the secondary outcomes include biochemical pregnancy rate, clinical pregnancy rate, embryo attachment rate, first trimester abortion rate and ongoing pregnancy rate, birth weight, pregnancy and perinatal complications, congenital anomaly, and other adverse events. This study aims to evaluate whether hydroxychloroquine (HCQ) improves pregnancy outcomes in patients with recurrent implantation failure (RIF). Secondary objectives include comparative analysis of gestational complications between the intervention and control groups. ChiCTR2100047584 [Chinese Clinical Trial Registry (ChiCTR): registered on 20 June 2021]. LM2021267 [Ethics Committee of Peking University Third Hospital].

Immune checkpoint inhibitors (ICIs) are increasingly used across disease stages, including adjuvant, first-line metastatic, and later-line settings, leading to a growing population of women of reproductive age exposed to these agents. As survival improves, reproductive health considerations have become increasingly relevant. This review summarizes current evidence regarding reproductive risks associated with ICIs, fertility preservation (FP) strategies, and pregnancy outcomes following exposure. Preclinical studies suggest that PD-1/PD-L1 blockade may disrupt ovarian immune homeostasis, promote inflammatory cytokine activation, and accelerate primordial follicle depletion. However, clinical data remain limited, with no definitive evidence of consistent ovarian reserve decline or histologically confirmed follicular loss in humans. The potential impact of ICIs on oocyte quality, embryonic development, and ovarian tissue viability remains uncertain, reflecting a critical evidence gap between mechanistic and clinical data. FP strategies are categorized into embryo/oocyte cryopreservation and ovarian tissue cryopreservation, highlighting their distinct biological targets—developing oocytes versus dormant primordial follicles—and their differential susceptibility to immune-mediated injury. Key considerations include potential genotoxicity, reproductive and developmental toxicity, and the timing of FP relative to treatment line and disease stage. Available pharmacovigilance data on pregnancy during or after ICI exposure do not demonstrate a clear increase in congenital anomalies but suggest potential risks of immune-related obstetric complications. Given the expanding use of ICIs in curative-intent settings, early integration of reproductive counseling and individualized risk assessment is essential. Prospective registries and translational studies are urgently needed to define the true gonadotoxic and developmental risks of ICIs and to optimize fertility preservation strategies in this population.

Ectopic pregnancy (EP) is a common yet fatal complication of in vitro fertilization-embryo transfer (IVF-ET) and intracytoplasmic sperm injection (ICSI). We aim to establish and validate a nomogram in patients undergoing double fresh cleavage-stage embryo transfer, which remains a mainstream strategy in infertile patients. Data from 7456 patients were reviewed and divided into training and validation sets. Logistic analyses were conducted to identify the risk factors, with calibration and decision-curve analyses performed to evaluate model performance. The model divided patients into high- and low-risk groups, showing different 48-h serum beta-human chorionic gonadotropin (HCG) rising thresholds. It showed that Tubal factor infertility (Odds Ratio [OR] = 1.680, 95% Confidence Interval [CI] 1.129-2.500, P = 0.011), previous tubal surgery (OR = 2.667, 95% CI 1.772-4.015, P < 0.001), polycystic ovarian syndrome (PCOS) (OR = 1.809, 95% CI 1.169-2.799, P = 0.008), uterine malformation (OR = 5.663, 95% CI 1.524-21.043, P = 0.010), endometrial thickness (OR = 0.585, 95% CI 0.522-0.655, P < 0.001) and serum estradiol levels (OR = 1.000, 95% CI 1.000-1.000, P < 0.001) on triggering day were independent risk factors for EP after double fresh cleavage-stage embryo transfer. The area under curve (AUC) values for the training and validation sets were 0.768 (95% CI 0.732-0.805, P < 0.001) and 0.756 (95% CI 0.703-0.810, P < 0.001), respectively. The nomogram further divided all participants into high EP risk and low EP risk with a cut-off score of 86.1 based on the maximum value of Youden Index in order to investigate different subsequent interventions based on serum HCG level. Patients in high EP risk group suffered significantly higher incidence of EP (OR = 4.902, 95% CI 3.597-6.667, P < 0.001 and OR = 4.587, 95% CI 2.899-7.246, P < 0.001). Higher 48-h serum HCG rising thresholds (2.18 vs. 1.74 and 2.10 vs. 1.66) also applied to patients from high EP risk group. The nomogram effectively predicts individual EP probability in patients receiving double fresh cleavage-stage embryo transfer, thereby aiding screening high-risk patients.

Research question: Is there an association between intrauterine haematoma (IUH) and pregnancy outcomes in patients who undergo fetal reduction after double embryo transfer (DET), and if so, what is the relationship between IUH-related characteristics and pregnancy outcomes? Design: Clinical information and pregnancy outcomes of women who underwent fetal reduction after DET were analysed. Patients with other systematic diseases, ectopic pregnancy or heterotopic pregnancy, monochorionic twin pregnancies and incomplete data were excluded. Stratification of IUH pregnancies was undertaken based on IUH-related characteristics. The main outcome was incidence of fetal demise (<24 weeks), with other adverse pregnancy outcomes considered as secondary outcomes. Results: Thirty-four IUH patients and 136 non-IUH patients who underwent fetal reduction after DET were included based on a 1:4 match for age, cycle type and fertilization method. IUH patients had a higher incidence of early fetal demise (20.6% versus 7.4%, P = 0.048), threatened abortion (48.1% versus 10.3%, P<0.001) and postpartum haemorrhage (PPH; 14.8% versus 4.0%, P = 0.043) compared with non-IUH patients. IUH was an independent risk factor for early fetal demise [adjusted OR (aOR) 3.34, 95% CI 1.14-9.77] and threatened abortion (aOR 8.61, 95% CI 3.28-22.61) after adjusting for potential confounders. IUH pregnancies undergoing fetal reduction that resulted in miscarriage had larger IUH volumes and earlier diagnosis (both P < 0.03). However, IUH characteristics (i.e. volume, changing pattern, presence or absence of cardiac activity) were not associated with threatened abortion or PPH. Conclusions: Fetal reduction should be performed with caution in IUH pregnancies after DET as the risk of fetal demise is relatively high. Particular attention should be given to IUH patients with early signs of threatened abortion and inevitable fetal demise.

Objective: To investigate the clinical characteristics, treatments and fertility recovery of rudimentary horn pregnancy (RHP). Methods: The clinical data of 12 cases with RHP diagnosed and treated in Peking University Third Hospital from January 1, 2010 to December 31, 2022 were retrospectively analyzed. Clinical informations, diagnosis and treatments of RHP and the pregnancy status after surgery were analyzed. Results: The median age of 12 RHP patients was 29 years (range: 24-37 years). Eight cases of pregnancy in residual horn of uterus occurred in type Ⅰ residual horn of uterus, 4 cases occurred in type Ⅱ residual horn of uterus; among which 5 cases were misdiagnosed by ultrasound before surgery. All patients underwent excision of residual horn of uterus and affected salpingectomy. After surgery, 9 patients expected future pregnancy, and 3 cases of natural pregnancy, 2 cases of successful pregnancy through assisted reproductive technology. Four pregnancies resulted in live birth with cesarean section, and 1 case resulted in spontaneous abortion during the first trimester of pregnancy. No uterine rupture or ectopic pregnancy occurred in subsequent pregnancies. Conclusions: Ultrasonography could aid early diagnosis of RHP while misdiagnosis occurred in certain cases. Thus, a comprehensive judgment and decision ought to be made based on medical history, physical examination and assisted examination. Surgical exploration is necessary for diagnosis and treatment of RHP. For infertile patients, assisted reproductive technology should be applied when necessary. Caution to prevent the occurrence of pregnancy complications such as uterine rupture, and application of cesarean section to terminate pregnancy are recommended.

Bisphenol A (BPA) levels are high in women with polycystic ovary syndrome (PCOS). The mechanism by which BPA induces abnormal glucose metabolism in PCOS patients is largely unknown. Serum and urine samples were collected from women with and without PCOS (control) at the reproductive medicine center with informed consent. Non-PCOS patients who received in vitro fertilization were recruited for collection of ovarian follicular fluid and granular cells. Wild-type C57BL/6 and AhR −/− mice were used to verify the effects of BPA on PCOS. Real-time PCR, western blotting, and ELISA were conducted to analyze the function of BPA. Chip-qPCR verified the role of AhR in GLUT4 transcription. Flow cytometry was performed to determine glucose uptake. A positive correlation was observed between BPA concentration and serum BPA levels in PCOS patients. BPA aggravated the changes in PCOS with abnormal glucose metabolism, impaired fertility, and increased body fat. Mechanistically, we showed that BPA activated AhR and led to decreased glucose transport via GLUT4 downregulation in ovarian granular cells. Therefore, the use of inhibitors or knockout of AhR could effectively rescue BPA-induced metabolic disorders in PCOS mice. Our results revealed that BPA suppressed GLUT4 expression and induced abnormal glucose metabolism by activating AhR, causing insulin resistance, and is thus a potential contributor to the development of PCOS. Therefore, AhR could be a potential new therapeutic target for PCOS.

Objectives: To summarize the gynecopathology findings in the diagnosis and assessment of chronic endometritis (CE) and provide insights into the therapeutics of CE. Mechanism: Chronic endometritis (CE) refers to the inflammatory state of the endometrium, which might alter endometrial receptivity and impact embryo implantation. As a relatively asymptomatic disease, the diagnosis and assessment of CE mainly lies in endometrial biopsy and further morphological and functional examinations. The authors searched the electronic database with a combination of key terms including chronic endometritis, histopathology, hysteroscopy, microbiota, inflammation, vascularization, decidualization as well as autophagy and summarized the current findings.in the diagnosis and assessment of CE. Findings in Brief: Plasma cell infiltration with immune staining, hysteroscopic manifestations including swelling, hyperemia and micropolyps, and pathogenic diagnosis were the main criteria for diagnosing CE. Further assessment of CE revealed the release of proinflammatory cytokines, leukocyte infiltration, enhanced vascularization and autophagy. These factors all contribute to an inflammatory state of the endometrium and decreased flow reserve supplying the embryo, which lead to the pathway explaining implantation failure in CE patients. Conclusions: Gynecopathology plays an essential role in the diagnosis and assessment of CE. Understanding such methods can help to screen out asymptomatic patients and initiate proper treatment, which eventually promotes better knowledge of the relationship between CE and embryo implantation and a higher successful implantation rate.

Research question Is there an association between intrauterine hematoma (IUH), vanishing twin syndrome (VTS), and subsequent complications in twin pregnancies after in vitro fertilization (IVF)? What are the risk factors for these complications? Design Women who presented with two live gestational sacs following double embryo transfer were included. Patients with systematic diseases, artificial fetal reduction, and incomplete data were excluded. Further stratification of IUH pregnancies was performed according to IUH-related characteristics (i.e., volume, changing pattern, and relationship with fetal cardiac activities). The primary outcome was the incidence of VTS, while adverse outcomes in the surviving singleton and the gestational age of VTS were secondary outcomes. Results The incidence of IUH was 13.8%. A total of 1,078 twin pregnancies including 539 IUH pregnancies and 539 non-IUH pregnancies were included. IUH pregnancy was associated with higher risks of VTS (26.9% vs. 18.7%, p = 0.001) as well as a higher incidence of preterm birth ( p = 0.001, crude OR = 1.98, 95% CI 1.28–3.09, adjusted OR = 1.19, 95% CI 1.09–1.24), threatened abortion ( p < 0.001, crude OR = 9.12, 95% CI 2.90–28.69, adjusted OR = 6.63, 95% CI 1.69–14.67), and postpartum hemorrhage ( p = 0.024, crude OR = 3.13, 95% CI 1.09–8.99, adjusted OR = 1.16, 95% CI 1.08–1.32) in the surviving singleton. There was no significant difference in risks of other complications. The absence of fetal cardiac activities at the diagnosis of IUH predicted VTS ( p < 0.001, crude OR 4.67, 95% CI 3.67–5.78, adjusted OR 3.33, 95% CI 1.56–5.14) and fetal loss at smaller gestational age (7.81 ± 2.10 vs. 11.39 ± 5.60 weeks, p < 0.001), while an IUH with an increasing volume did not increase the risk of VTS but might induce threatened abortion in the surviving fetus ( p < 0.001, crude OR 1.84, 95% CI 1.32–2.55, adjusted OR 1.72, 95% CI 1.13–2.13). Conclusions IUH was a risk factor for VTS in twin pregnancies following double embryo transfer and elevated the risks of threatened abortion, preterm birth, and postpartum hemorrhage in the surviving singleton. The absence of fetal cardiac activities at the diagnosis of IUH elevated the risks of VTS, while an IUH with an increasing volume was associated with threatened abortion without elevating the risks of VTS. An IUH diagnosed before the presence of fetal cardiac activities also resulted in an earlier miscarriage. The study suggests that attention be paid to twin pregnancies with first-trimester IUH to prevent VTS and subsequent adverse perinatal outcomes. Highlights First-trimester intrauterine hematoma (IUH) following double embryo transfer is associated with a higher incidence of vanishing twin syndrome (VTS) and elevated subsequent risk of threatened abortion, preterm birth, and postpartum hemorrhage in the surviving singleton. Other perinatal outcomes were not associated with the diagnosis of first-trimester IUH. The absence of fetal cardiac activities at the diagnosis of IUH was of predictive value toward VTS, while an IUH with an increasing size was associated with threatened abortion without elevating the risk of VTS. Incomplete fetal cardiac activities and earlier detection of an IUH might also predict miscarriage at smaller gestational age.

胚胎着床是正常妊娠的关键步骤之一,依赖于胚胎与子宫内膜之间的相互作用. 子宫内膜容受性(endometrial receptivity)即为子宫内膜对胚胎的接受能力,是评价子宫内膜作为胚胎"生物感受器"的重要指标,也是内膜在着床窗口期( window of implantation)为有发育潜能的胚胎提供着床环境的必需条件[1] . 良好的子宫内膜容受性有助于帮助胚胎着床,而子宫内膜容受性下降则可造成着床失败、流产、生化妊娠等不良妊娠结局. 近2/3 的着床失败可能是由于子宫内膜容受性下降所致[2] .

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.

Abstract ObjectivesTo evaluate the visual functions and vision-related quality of life in T2DM patients undergoing different hypoglycemic therapeutics and determine how these different treatments impact on patients’ visual performances as well as the changing pattern of visual performances as T2DM progressed. MethodsWe performed an online survey among 193 T2DM patients. The survey was consisted of three parts, each documenting patients’ demographic feature, severity and therapeutics of T2DM, and patients’ visual functions. The third part was assessed with National Eye Institute Visual Functioning questionnaire-25 (NEI VFQ-25). All data was analyzed by independent t-test, chi-square test and non-linear regression model.ResultsPatients undergoing either oral, injected or combined hypoglycemic therapy demonstrated similar visual performances after demographic features and other related clinical information were matched, except for the oral group had significant higher scores than the other groups in terms of social functioning. When T2DM patients on oral and injected monotherapy were compared, it turned out that oral treatment was associated with higher scores in almost all sub-scales and slower deterioration in visual functions as age grew, diabetic duration lengthened (especially after 15 years) and BCVA worsened. Comparison regarding dual therapy indicated favorable result in those taking two kinds of oral drugs rather than one oral plus one injected in terms of social functioning, color vision and total score, while triple therapy comparisons showed no significant results. When triple and dual oral therapy were compared, we suggested that the former were valid in optimizing visual performances.ConclusionsOral hypoglycemic therapeutics were generally associated with better visual functions, higher vision-related quality of life and slower deterioration of visual performances in T2DM patients while injected therapy-treated T2DM patients were more prone to have gone through more significant visual decline. The disparities in visual performances were more significant in those taking monotherapy and less significant when more hypoglycemic drugs were added, however, the adding on of hypoglycemic drugs were proved to be useful in enhancing visual performances.

Purpose To determine the impact of type 2 diabetes mellitus (T2DM) on visual functions, identify different modifiers as risk or protective factors, and find out how these factors affect patients’ visual symptoms and visual functions as a whole. Methods We performed an online survey among 1030 participants (400 patients, 630 non-patients). Demographic features and severity of disease were documented, while visual functions were evaluated using National Eye Institute Visual Functioning questionnaire-25 (NEI VFQ-25). Independent t-test, analysis of variance, linear and nonlinear regression models were used to assess all data. Results Scores other than color vision among T2DM patients were significantly lower compared with non-T2DM participants. There was significant difference after stratification of age and education, but no significant difference between different genders was observed. Parameters including duration of T2DM, fasting plasma glucose (FPG) and glycosylated hemoglobin A1c (HbA1c) negatively impacted on the scores, with 20 years’ of diabetic duration, 10 mmol/L of FPG, 7.5% of HbA1c being potential cut-off points. Poorer best corrected visual acuity (BCVA) and diagnosis of diabetic retinopathy were risk factors, while they simultaneously produced mediation effect, contributing 5%-78% of effect in the deterioration of visual functions caused by longer diabetic duration and higher blood glucose. Conclusion Significant visual impairments and faster deterioration in visual functions were seen in T2DM patients, with older age, lower educational level, longer diabetic duration, poorer blood glucose administration, limited BCVA, and the presence of diabetic retinopathy identified as risk factors. Average BCVA and diabetic retinopathy also yielded mediation effect as diabetic duration lengthened and blood glucose elevated.

Purpose: To characterize the choroidal morphologic and vascular features in different levels of myopes and patients with myopic choroidal neovascularization (mCNV).Methods: A total of 148 subjects were enrolled in this cross-sectional study, including 78 low-to-moderate myopes (LMM), 53 high myopes (HM), and 17 high myopic patients with mCNV. Ocular biometrics were measured using an optical low-coherence reflectometry device. Retinal and choroidal imaging was performed using enhanced depth imaging (EDI) spectral domain optical coherence tomography (OCT). Retinal parameters including retinal thickness and retinal volume were obtained from a built-in software. Binarization technique was adopted to investigate choroidal parameters including choroidal thickness (CT), vascular area, stromal area, and choroidal vascularity index (CVI). Choroidal parameters were measured at five locations to cover as much area of choroid as possible, and their patterns of distribution were further analyzed.Results: Patients with mCNV had an atrophic retina of comparable thickness to HM (273.65 ± 17.28 vs. 276.49 ± 13.29 μm, p = 0.47), but the choroid was thinner than that of HM (153.94 ± 15.12 vs. 236.09 ± 38.51 μm, p < 0.001). Subfoveal CVI was greatest in the mCNV eyes (0.651 ± 0.009), followed by HM (0.645 ± 0.012) and LMM eyes (0.636 ± 0.012). Similar to CT, CVI was also found significantly different among these three groups at all five locations (p for trend < 0.001 for all locations). Axial length (AL) was negatively correlated with retinal volume (r = −0.236, p = 0.009), which is the only significant finding in associations between ocular factors and retinal parameters. Strong, negative correlations were identified between AL and subfoveal choroidal thickness (SFCT, r = −0.820, p < 0.001). However, AL was positively correlated with subfoveal CVI (r = 0.668, p < 0.001). CVI was greater in myopic eyes with thinner choroid (r = −0.578, p < 0.001). BCVA exhibited no significant association with CVI (r = 0.139, p = 0.092), but was negatively correlated with SFCT (r = −0.386, p < 0.001) and positively correlated with AL (r = 0.351, p < 0.001).Conclusion: Choroid in patients with mCNV was thinner yet more vascularized than that in HM and LMM subjects. CVI increased with a longer AL which was associated with a smaller SFCT, choroidal vascular area (VA), and total choroidal area (TCA). Better BCVA was achieved in subjects with thicker SFCT and shorter AL.

PURPOSE:To develop an automated image recognition software for the objective quantification of choroidal vascularity index (CVI) and choroidal thickness (CT) at different choroidal locations on images obtained from enhanced depth imaging optical coherence tomography (EDI-OCT), and to validate its reliability and investigate the difference and correlation between measurements made by manual and software.METHODS:A total of 390 EDI-OCT scans, captured from 130 eligible emmetropic or myopic subjects, were categorized into four grades in terms of their accessibility to identify the choroidal-scleral interface (CSI) and were further assessed for CT and CVI at five locations (subfoveal, nasal, temporal, superior and inferior) by the newly developed Choroidal Vascularity Index Software (CVIS) and three ophthalmologists. Choroidal parameters acquired from CVIS were evaluated for its reliability and correlation with ocular factors, in comparison to manual measurements. Distribution of difference and correlation coefficient between CVIS and manual measurements were also analysed.RESULTS:Choroidal Vascularity Index Software (CVIS) demonstrated excellent intra-session reliability for CT (ICC: 0.992) and CVI (ICC: 0.978) measurements, compared to the relatively lower intra- and inter-observer reliability of manual measurements. Choroidal Vascularity Index Software (CVIS) and manual assessments had the highest correlation at nasal choroid (CT: r = 0.829, p < 0.001; CVI: r = 0.665, p < 0.001). Choroidal parameters identified with CVIS showed stronger correlations with axial length than manual measurements.CONCLUSION:This automated software, CVIS, exhibited excellent reliability compared to manual measurements, which are subject to image quality and clinical experience. With its validated clinical relevance, CVIS holds promise to serve as a flexible and robust tool in future vitreoretinal and chorioretinal studies.

Objective:To investigate the impact of uterine volume prior to fresh embryo transfer on reproductive outcomes in infertile patients with adenomyosis.Methods:A retrospective cohort study was conducted for the clinical data of patients diagnosed with adenomyosis and aged ≤40 years undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) with ultra-long downregulation stimulation protocol in Center for Reproductive Medicine, Department of Obstetrics and Gynecology of Peking University Third Hospital between January 2009 and December 2018. Logistic regression model was used to analyze the correlation between uterine volume and clinical outcomes. Study subjects were divided into three groups based on uterine volume before embryo transfer: group A 56-90 cm 3 (equivalent to uterine size within 6 weeks of pregnancy); group B 90-130 cm 3 (equivalent to 6-8 weeks gestation); group C ≥130 cm 3 (equivalent to uterine size greater than 8 weeks gestation), the effect of uterine volume on clinical outcomes was compared. Results:Totally 232 patients were included, 153 patients in group A, 52 patients in group B, 27 patients in group C. The data showed no statistical difference among the three groups in basic characteristics ( P>0.05). There was no significant difference in clinical pregnancy rate among three groups ( P>0.05). The incidence of miscarriage among three groups were significantly different [group A, 24.59% (15/61); group B, 64.71% (11/17); group C, 55.56% (5/9), P=0.018]. Compared with group A [30.07% (46/153)], the live birth rate of group B [11.54% (6/52)] was significantly reduced ( P=0.009). Logistic regression analysis showed that uterine volume before ET was not related to clinical pregnancy rate ( OR=0.762, 95% CI=0.481-1.208, P=0.248), and was positively related to miscarriage rate ( OR=2.822, 95% CI=1.165-6.835, P=0.022) while negatively correlated with live birth rate ( OR=0.458, 95% CI=0.238-0.881, P=0.019). Conclusion:An increased level of uterine volume prior to embryo transfer (especially larger than 90 cm 3) increases miscarriage rate and reduces the live birth rate in infertile patients with adenomyosis. Therefore, controlling uterine volume is still a key to improve the clinical outcome of IVF-ET in adenomyosis patients.

To determine the role of vaginal microbiota in the efficacy of cervical cerclage in obstetric outcomes of twin pregnancies. This retrospective study enrolled 68 twin pregnant women diagnosed with cervical incompetence (CIC) and 68 twin pregnancies without CIC. The CIC group was further divided into two subgroups: cerclage group (n = 51) and non-cerclage group (n = 17), according to whether cervical cerclage was performed in the second trimester. Data of vaginal microbiota and obstetric outcomes were collected and compared. Cervical incompetence had harmful effect on both pregnancy outcomes and vaginal microecology, characterized by earlier gestational week at delivery (30.3 ± 5.6 vs 35.6 ± 1.1, P < 0.001), a lower birth weight of newborns (OR 0.40; 95% CI 0.22–0.74), a higher vaginal pH value (OR 0.11; 95% CI 0.04–0.30) and a lower abundance of Lactobacillus (OR 0.34; 95% CI 0.17–0.70). In addition, compared with the vaginal microbiota after cerclage, less normal diversity of bacterial flora (OR 0.35; 95% CI 0.12–1.01), less Lactobacillus (OR 0.40; 95% CI 0.18–0.91) and more Gardnerella vaginalis (OR 18.92; 95% CI 2.38–150.35) appeared before cerclage. Besides, the unhealthy vaginal environment also had an unfavorable influence on the neonatal outcomes, increased neonatal mortality rate was observed in the group of vaginal pH > 4.5 (P < 0.05). Fortunately, compared with the non-cerclage group, the cerclage group had a longer interval from diagnosis to delivery (≥ 8 weeks) and more of the newborns’ birth weight were not less than 1500 g (P < 0.05). A healthy vaginal environment is essential to improve the obstetric outcome for twin pregnancies with cervical cerclage.

目的 探讨有环形电刀切除(loop electrosurgical excision procedure,LEEP)手术史的孕妇在孕期行宫颈环扎术后对妊娠结局及阴道内菌群的影响.方法 回顾性单中心研究,43例有LEEP手术史孕期行宫颈环扎术作为LEEP组,67例无LEEP手术史孕期行宫颈环扎作为对照组,比较2组环扎术后至分娩时间、分娩孕周、分娩方式、新生儿体重及Apgar评分、阴道微生态Nugent评分、菌群密集度、菌群多样性、优势菌群及pH值情况.结果 LEEP组环扎孕周明显短于对照组[16.0(14.4,18.6)周vs.18.9(15.4,23.7)周,Z=-2.712,P=0.007],宫颈环扎术后至分娩时间中位数明显延长[128.0(81.0,159.0)d vs.87.0(48.0,144.0)d,Z=-2.374,P=0.018].2组孕妇流产、顺产及剖宫产3种妊娠结局差异无显著性(χ2=0.319,P=0.852).宫颈环扎术前LEEP组中阴道菌群优势菌为乳酸杆菌的孕妇比例明显少于对照组(24例vs.50例,χ2=4.210,P=0.040),但环扎术后Nugent评分≥7分患者明显减少(5例vs.22例,χ2=6.553,P=0.038).对照组环扎术后pH值较术前明显好转(47例vs.43例,配对χ2检验,P=0.009),优势菌群为乳酸杆菌的孕妇比例明显增多(50例vs.49例,配对χ2检验,P=0.000).结论 既往有LEEP手术史的孕妇在孕期行宫颈环扎手术后可以明显改善阴道微生态,对妊娠结局无显著影响.

Parturition is the physiological process of newborn birth; more and more evidences show that parturition is closely related to the occurrence and resolution of inflammation. However, the inflammatory media and the mechanism are not very clear during parturition. Here, we investigate the inflammatory event during human parturition and in mouse model. We found that the pro-inflammatory cytokines (IL-6, IL-8, and IL-1β) and cells (neutrophil and macrophage) are decreased in pregnant women in labor and in mouse labor model. Mechanistically, increased stress stimulates the high-level adrenaline production in labor. Then, adrenaline upregulates the expression of 12/15-LOX (lipoxygenase) to produce more lipoxin A4 (LXA4), which is an inflammation inhibitor. Thus, LXA4 promotes the elimination of inflammation during labor to protect the body from excessive inflammatory damages. In addition, using BOC-2, the inhibitor of LXA4 receptor could reboot the pro-inflammatory cytokines. Our study indicates that LXA4 is induced by adrenaline in labor and appropriate interference of this pathway may be a potential strategy to regulate the inflammatory process in parturition.

目的:比较反复着床失败(RIF)患者及患者中个别抗体异常者应用强的松+阿司匹林预防性治疗后解冻移植周期妊娠结局变化.方法:回顾性分析828例RIF的患者,根据移植前是否用强的松+阿司匹林治疗分为对照组与治疗组,同时分别筛选两组中抗核抗体(ANA)为1:80的患者,或补体C3、C4、免疫球蛋白A、免疫球蛋白G和免疫球蛋白E检查中任一项异常的患者,比较对照组与治疗组两组间及组内亚组间冷冻移植后胚胎着床率、临床妊娠率、早期流产率和持续妊娠率的情况.结果:RIF患者中预防性治疗组的胚胎着床率、临床妊娠率和持续妊娠率数值稍有增加,早期流产率数值稍有下降,但均无显著性差异(P>0.05);此外,针对ANA 1:80患者或者任何一个抗体阳性的患者,预防性治疗组也得出类似的结果.结论:预防性强的松+阿司匹林治疗不能显著提高包括个别抗体异常的RIF患者的解冻移植期妊娠结局,但需要加大样大量进一步研究.

目的 分析第1次妊娠为输卵管妊娠对后续宫内妊娠结局的影响.方法 单中心回顾性队列研究,收集既往第1次妊娠为输卵管妊娠此次为首次宫内妊娠住院保胎后分娩或住院分娩的孕妇资料,作为实验组,以同期第1次妊娠为宫内妊娠的孕妇为对照组,观察她们早产、低出生体重儿发生率、先兆子痫等孕期并发症发生情况.结果 实验组患者年龄较对照组大,12.41％的患者通过辅助生育技术受孕,其中89.12％通过体外受精-胚胎移植助孕,既往生化妊娠发生率13.12％;该组的早产率、低出生体重儿发生率、剖宫产率和胎盘粘连发生率较对照组显著增高(均P＜0.05);治疗方式亚组比较中,药物治疗组发生再次输卵管妊娠比例为25.15％,首次输卵管妊娠到此次宫内妊娠的间隔时间为(17.89±2.78)月(95％CI:17.68～18.10),但是早产发生率较手术治疗组低.结论 首次输卵管妊娠会影响患者后续宫内妊娠,增加产科并发症的发生.