OBJECTIVE:To investigate the feasibility of performing frozen-thawed high-quality single blastocyst transfer in women of different ages. METHODS:A total of 1,279 women were divided into four groups: a 38-40-year-old group (n = 147), 35-37-year-old group (n = 164), 30-34-year-old group (n = 483), and < 30-year-old group (n = 485). Intergroup comparisons of baseline characteristics and pregnancy and neonatal outcomes were made. RESULTS:The clinical pregnancy rate (47.6%), and live birth rate (34.0%) in the 38-40-year-old group were significantly lower than those in the 30-34-year-old group (64.4%, 50.9%, respectively; all P < 0.001) and < 30-year-old group (62.9%, 50.7%, respectively; all P < 0.001). However, the 35-37-year-old group did not differ from the other three groups in these two dimensions (all P > 0.05). Moreover, there were no differences in the rates of biochemical pregnancy, miscarriage, or obstetric or neonatal complications among the four groups (all P > 0.05). According to the multivariate logistic regression analysis, the 35-37-year-old group was not associated with non-live birth outcomes, adverse pregnancy outcomes, or obstetric or neonatal complications. However, being 38-40 years of age was a risk factor for non-live birth (OR = 2.121, 95% CI: 1.233-3.647) and adverse pregnancy outcomes (OR = 1.630, 95% CI: 1.010-2.633). Post hoc power analysis showed that the study was sufficiently powered to detect meaningful differences. CONCLUSION:Frozen-thawed high-quality single blastocyst transfer produces the same satisfactory pregnancy outcomes for women aged 35-37 years as younger patients. Future prospective randomized controlled studies with larger populations are needed to verify the feasibility and safety of this method.

Objective:Additive human menopausal gonadotropin (HMG)/recombinant luteinizing hormone (r-LH) to follicle-stimulating hormone (FSH) can improve pregnancy outcomes in patients with poor ovarian response during assisted reproductive procedures. However, their effects on patients with normal ovarian response during such procedures are unclear, which formed the aim of this study.Methods:This retrospective study enrolled 456 infertile women who underwent in vitro fertilization or intracytoplasmic sperm injection treatment. Group 1 received FSH; Group 2 received FSH+HMG/r-LH; Group 3 received FSH+HMG+r-LH.Results:The age and Body Mass Index were significantly greater in Group III. The endometrial thickness was greater in Groups II and III, suggesting better endometrial receptivity. Better pregnancy and birth outcomes were seen in Group 3. In sub-cohorts of women older than 32 years old or with overweight/obesity, pregnancy and birth outcomes were also much better in Group 3, albeit without statistical significance.Conclusion:The addition of both HMG and r-LH to FSH may improve the chance of infertile women with normal ovarian responses to have more success in having live birth babies, specifically in those over 32 years of age or with overweight/obese patients who typically face challenges in conceiving and sustaining a pregnancy.

Background With the expanding utilization of prolonged protocol, switching from in vitro fertilization to in vitro maturation (IVF/M) was a choice to prevent ovarian hyperstimulation syndrome and to avoid cycle cancellation. Our aim was to explore the feasibility of IVF/M in polycystic ovarian syndrome (PCOS) patients with unexpected poor ovarian response (UPOR) underwent prolonged protocol by comparing with IVF. Methods A retrospective analysis was performed on PCOS patients who were treated with prolonged protocol from June 2016 to December 2022. A total of 444 patients were diagnosed with unexpected poor ovarian response during ovarian stimulation. 156 patients performed IVF/M and 288 patients were treated with IVF. Laboratorial and clinical outcomes were analyzed and compared in two Groups. Results The Positive β-hCG rate (57.9%), clinical pregnancy rate (52.6%), live birth rate (38.9%) in fresh embryo transfer and cumulative live birth rate (35.3%) in IVF/M Group were lower than those in IVF Group (76.1%,66.8%,53.3%, 67.7%, respectively;all P < 0.05). The number of oocytes retrieved, mature oocytes, 2 pronuclear zygotes, embryos on day3, available blastocysts and high-quality blastocysts in IVF/M Group were less than those in IVF Group (P < 0.001). IVF/M Group gained no case of ovarian hyperstimulation syndrome (OHSS) while 59 (20.5%) patients cancelled fresh embryo transfer for OHSS and 23 (8.0%) of them were moderate to severe OHSS in IVF Group (P < 0.05). The pregnancy and neonatal complications were comparable between two groups. No dominant risk factor was found for non-live birth in fresh embryo transfer cycle. The only independent risk factor for non-live birth in cumulative cycles was IVF/M protocol. (4.58, 95%CI:2.94–7.13, P < 0.001). Conclusion IVF/M was a complement feasible choice for PCOS with UPOR who underwent prolonged protocol. Though with a lower live birth rate compared with IVF, almost one third couples still could achieve live birth and avoid neither cycle cancellation nor OHSS.

ObjectiveTo compare the effects of five different frozen-thaw embryo transfer (FET) strategies in women aged 35–40 years.MethodsData from 1,060 patients were divided into five groups according to the number and quality of transferred blastocysts: a high-quality single blastocyst group (group A, n= 303), a high-quality double blastocysts group (group B, n= 176), a high-quality plus poor-quality double blastocysts group (group C, n= 273), a poor-quality double blastocysts group (group D, n= 189), and a poor-quality single blastocyst group (group E, n= 119). Comparative analyses were then performed between groups with regard to primary conditions, pregnancy, and neonatal outcomes.ResultsGroup A had the lowest twin pregnancy rate (1.97%) and incidence of low-birth-weight infants (3.45%), which were significantly different from groups B, C, and D. In addition, the preterm birth rate (7.89%), neonatal birth weight (3300 g [3000, 3637.5]), and neonatal birth age (39.14 weeks [38.43, 39.61]) in group A were different from those in groups B and C. Double blastocyst transfer (DBT) was associated with a 20.558-fold (Risk Ratio [RR]=20.558, 95% confidence interval [CI], 6.628–63.763) and 3.091-fold (RR=3.091, 95% CI, 1.69–5.653) increased risk of twin pregnancy and preterm delivery in unadjusted analysis, respectively, when compared with single blastocyst transfer (SBT). In the adjusted analysis, we observed similar risk estimates (adjusted RR=26.501, 95% CI, 8.503–82.592; adjusted RR=3.586, 95% CI, 1.899–6.769).ConclusionAlthough, high-quality SBT resulted in a lower live birth rate than high-quality DBT, it also significantly reduced the risk of adverse pregnancies, thus resulting in more benefits for both the mother and baby. Collectively, our data indicate that high-quality SBT remains the optimal FET strategy for women aged 35–40 years and warrants further clinical application.

Objective:To compare the assisted-reproduction outcomes of two long-acting gonadotropin-releasing hormone agonists (GnRH-a) in patients undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) during the long-term early follicular phase. Methods:A retrospective cohort study was conducted in the Reproductive Center of the Second Affiliated Hospital of Wenzhou Medical University from March 1, 2019 to July 31, 2019. A total of 802 patients were divided into leuprorelin acetate group (group A) and triptorelin group (group B) according to the difference of long-acting GnRH-a in the long-term early follicular phase, and the clinical and laboratory outcomes between the two groups were compared.Results:There were no significant differences in age, infertility duration, body mass index (BMI), basic hormone levels, infertility type, sex hormone level on the day of initiation of injection of gonadotropin (Gn), total duration and dosage of Gn used, duration of down-regulation, estradiol level and endometrial thickness on hCG injection day, the number of embryos transferred, clinical outcomes, total treatment cost, and owing to the uneven inner membrane, elevated progesterone, embryo quality problems, individual factors resulting in cancelling the transplant, between the two groups ( P>0.05). However, antral follicle count (AFC) (19.59±7.93), the number of retrieved oocytes (15.39±7.59), fertilized oocytes (11.20±6.53), cleaved oocytes (10.85±6.42), good-quality embryos on Day 3 (3.01±2.66), and blastocysts (5.27±4.02) in group B was larger than that in group A (17.68±7.23, 13.70±6.94, 9.50±5.43, 9.26±5.34, 2.57±2.33, 4.49±3.40) ( P=0.001, P=0.002, P<0.001, P=0.001, P=0.017, P=0.007). The levels of luteinizing hormone (LH) [(0.78±0.64) IU/L] and progesterone [(0.72±0.39) μg/L] on hCG injection day in group A were higher than those in group B [(0.55±0.30) IU/L, (0.64±0.36) μg/L] ( P<0.001, P=0.005). The rate of preventing the occurrence of ovarian hyperstimulation syndrome (OHSS) in group A [28.52% (75/263)] was higher than that in group B [14.95% (16/107), P=0.006]. Conclusion:Two long-acting GnRH-a drugs can achieve satisfactory down-regulation effect, laboratory and clinical outcomes in the long-term early follicular phase. Compared with the triptorelin, leuprolide acetate is relatively mild to pituitary inhibition, with an increasing trend of the clinical pregnancy rate.

目的:评估生长激素在无优质囊胚形成患者中的应用效果.方法:研究纳入2019年1月前于某院就诊的无优质囊胚形成患者,其中对照组204例,实验组135例.实验组在促排卵周期启动前一次月经期第3～5d开始使用生长激素至取卵前注射HCG日,对照组则不使用生长激素.结果:两组之间的胚胎植入率、临床妊娠率、卵泡液IGF1和IGF2无统计学差异;实验组囊胚数大于对照组,实验组的促性腺激素总量少于对照组(P<0.05).两组卵泡液IGF1和IGF2与促性腺激素总量、囊胚数、优质囊胚数之间无明显相关性.结论:生长激素预治疗提高胚胎质量,但没有提高胚胎植入率以及妊娠率.

目的 比较两种高孕酮方案即高孕激素环境下超促排卵方案(PPOS)和黄体期促排卵方案(LPOS)在卵巢低反应患者(POR)中的应用效果.方法 回顾性分析2016年1月至2016年12月205个体外受精/卵胞浆内单精子显微注射技术-胚胎移植周期.根据用药方式不同分为两组,PPOS 138个周期,LPOS 67个周期.比较两组促排卵结果、实验室相关指标及临床妊娠结局.结果 两组年龄、获卵数、D3优质胚胎数比较差异均无统计学意义(均P＞0.05).PPOS方案较LPOS方案触发日促黄体生成素(LH)水平更高(P＜0.05),而触发日孕酮(P)水平、Gn总量、卵子成熟率则更低(P＜0.05).两组优质胚胎率、后期冻融胚胎移植的I临床妊娠率比较差异均无统计学意义(均P ＞0.05).两组中均未发生早发LH峰和卵巢过度刺激综合征.结论 LPOS和PPOS均能使POR患者获得理想的优胚率以及冻融胚胎移植临床妊娠率,两种方案均适用于POR患者,使促排卵受月经周期影响减小,启动时间更加灵活.