ObjectiveTo compare the cumulative live birth rate (CLBR) of the progestin-primed ovarian stimulation (PPOS) protocol with that of the flexible GnRH antagonist protocol in patients with poor prognosis diagnosed per the POSEIDON criteria.MethodsThis was a retrospective cohort study. Low-prognosis women who underwent IVF/ICSI at the Reproductive Center of Third Affiliated Hospital of Zhengzhou University between January 2016 and January 2019 were included according to the POSEIDON criteria. The CLBR was the primary outcome of interest. The secondary outcome measures were the numbers of oocytes retrieved, 2PN embryos, available embryos and time to live birth.ResultsA total of 1329 women met the POSEIDON criteria for analysis. For POSEIDON group 1, the dosage of gonadotropin (Gn) was higher in the PPOS group than in the GnRH antagonist group (2757.3 ± 863.1 vs 2419.2 ± 853.1, P=0.01). The CLBR of the PPOS protocols was 54.4%, which was similar to the rate of 53.8% in the GnRH antagonist group. For POSEIDON group 2, the number of available embryos was higher in the PPOS group (2.0 ± 1.7 vs 1.6 ± 1.4, P=0.02) than in the GnRH antagonist group. However, the CLBRs of the two groups were similar (18.1% vs 24.3%, P=0.09). For POSEIDON groups 3 and 4, there were no statistically significant differences in the number of oocytes retrieved, 2PN, available embryos or CLBR between the two protocols. After adjustments for confounding factors, the CLBR remained consistent with the unadjusted rates. In the POSEIDON group 1 population, the GnRH antagonist protocols had a shorter time to live birth (P=0.04).ConclusionFor low-prognosis patients diagnosed per the POSEIDON criteria, the CLBR of PPOS protocols is comparable to that of GnRH antagonist protocols. In the POSEIDON group 1 population, the GnRH antagonist protocols resulted in a shorter time to live birth.
ObjectiveTo explore the risk factors of ectopic pregnancy after in vitro fertilization.MethodsThis retrospective cohort study was conducted at the Reproductive Medical Center of the Third Affiliated Hospital of Zhengzhou University from January 2016 to April 2020. Univariate and multivariate analysis were used to analyze the related factors affecting the occurrence of ectopic pregnancy (EP) and to construct a nomographic prediction model for the incidence of ectopic pregnancy.ResultsA total of 12,766 cycles of 10109 patients were included, comprising 214 cases of EP and 12,552 cases of intrauterine pregnancy (IUP). Multivariate logistic regression analysis showed that the tubal factor was associated with a 2-fold increased risk for EP (aOR = 2.72, 95% CI: 1.69-4.39, P < 0.0001). A stratified analysis showed that women with an endometrial thickness (EMT) between 7.6 to 12.1mm (aOR = 0.57, 95%CI: 0.36-0.90, P = 0.0153) and >12.1mm (aOR = 0.42, 95%CI: 0.24-0.74, P = 0.0026) had a significant reduction of the risk of EP compared to women with an EMT of <7.6mm. Compared to cleavage stage transfer, blastocyst transfer can reduce the risk of ectopic pregnancy (aOR = 0.36, 95%CI: 0.26-0.50, P < 0.0001). The saturation model (full mode) establishes a nomographic prediction model with an AUC = 0.68 and a sensitivity and specificity of 0.67and 0.64, respectively. The nomination model was internally verified by self-sampling method (bootstrap sampling resampling times = 500). The resulting AUC = 0.68 (sensitivity: 0.65; specificity: 0.65) showed that the model was relatively stable.ConclusionsOur findings indicate that EMT is inversely proportional to the risk of EP. Embryo stage, number of embryos transferred were also significantly associated with EP rate. A simple nomogram for the predicting the risk of EP was established in order to reduce the occurrence of EP.
ObjectiveTo investigate the clinical outcomes of Day 7 (D7) frozen-thawed embryo transfer (FET) and to provide a reference value for clinical work.MethodsThis 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.ResultsIn 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).ConclusionsD7 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.
ObjectiveTo explore whether season and temperature on oocyte retrieval day affect the cumulative live birth rate and time to live birth.MethodsThis 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.ResultsThe 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).ConclusionAlthough 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.
Background: The number of frozen embryo transfer (FET) cycles has substantially increased in the past decade. Preparing the endometrium in artificial cycles is widely used in clinical practice. Therefore, how to optimize this program, improve the clinical outcome and ensure the safety of the perinatal period is the focus of our attention. The purpose of this study was to explore whether the duration of estrogen treatment before progesterone application affects neonatal and perinatal outcomes in single frozen blastocyst transfer cycles.Methods: It was a retrospective cohort study. Patients receiving single frozen blastocyst transfer and delivering a single live birth between January 2015 and December 2019 were included. Primary outcome was small for gestational age (SGA). Secondary outcomes were neonatal birthweight, gestational weeks at delivery, preterm birth, low birth weight (LBW), macrosomia, large for gestational age (LGA), neonatal malformation and rate of pregnancy-related complications.Cycles were allocated to four groups according to the estrogen-treatment duration before single frozen blastocyst transfer ①≤12 days (n=306), ②13-15 days (n=620), ③16-18 days (n=471), ④≥19 days (n=275).Results: In total, 1672 cycles were analyzed. Cycles were allocated to four groups according to the estrogen-treatment duration before single frozen blastocyst transfer ①≤12 days (n=306), ②13-15 days (n=620), ③16-18 days (n=471), ④≥19 days (n=275). The rates of SGA among the four groups were 7.8% (24/306), 4.8% (30/620), 5.7% (27/471), and 7.6% (21/275), with no statistical significance (P=0.20). Other neonatal outcomes, including mean neonatal birth weight, gestational weeks at delivery, preterm birth rate, LBW, macrosomia, LGA and neonatal malformation, were comparable among the groups (P=0.38, P=0.16, P=0.20, P=0.58, P=0.20, P=0.34, P=0.96). The rate of pregnancy-related complications was similar among the groups. Multiple logistics regression showed that the duration of estrogen treatment did not affect the rate of singleton SGA (13-15 days, AOR=1.37, 95% CI= 0.70-2.70, P=0.36; 16-18 days, AOR=0.74, 95% CI= 0.40-1.36, P=0.34; ≥19 days, AOR=0.81, 95% CI= 0.44-1.49, P=0.50).Conclusion: The estrogen-treatment duration before progesterone application does not affect neonatal and perinatal outcomes in single frozen blastocyst transfer cycles.
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