Background: Both in vitro fertilization and embryo transfer (IVF-ET) and intracytoplasmic sperm injection and embryo transfer (ICSI-ET) have been recommended for unexplained primary infertility after recurrent artificial insemination with homologous semen failure (UAIHF), but few studies focused on the safety and efficiency of the IVF/ICSI-ET technique for these patients. In this study, we compared the IVF/ICSI-ET outcomes and perinatal and postnatal complications between UAIHF patients and tubal infertility (TI) patients. Methods: We conducted a retrospective study of UAIHF and TI patients who underwent IVF/ICSI-ET at Guangxi Reproductive Medical Center, the First Affiliated Hospital of Guangxi Medical University from January 2012 to March 2021. After propensity score matching (PSM), we analyzed the IVF/ICSI-ET outcomes and rates of perinatal and postnatal complications. Results: PSM analysis revealed that the baselines of age, infertility duration, and body mass index were comparable. The fertilization method was significantly different between the two groups. Through IVF/ICSI-ET, UAIHF patients had a similar clinical outcome compared to TI patients. Regarding perinatal and postnatal complications, the incidence of premature rupture of membranes (PROM) (7.54% vs. 3.17%, p = 0.030) was significantly higher in UAIHF patients. Conclusions: UAIHF patients could achieve satisfying pregnancy outcomes by IVF/ICSI-ET. ICSI-ET did not seem to improve the clinical outcomes of UAIHF patients compared to those of TI patients who underwent IVF-ET, which might be related to possible underlying diseases in these patients. In addition, the incidence of PROM was significantly higher in UAIHF patients, which might be related to the ICSI technique used and uncertain potential idiopathic diseases associated with unexplained infertility patients.
The female ovaries are critical for follicle growth and development in the process known as “folliculogenesis”. This complex process is regulated by various factors, among which the microenvironment around follicles appears to be crucial. According to previous studies, folliculogenesis is an energy-demanding process. In fact, well-balanced follicular energy metabolism is associated with ovarian function and female fertility. Consequently, glucose metabolism has been widely described as the main source of energy during folliculogenesis. Generally, the follicular glucose metabolism profiles change dynamically during follicular development. Metabolic abnormalities during folliculogenesis are associated with aging, primary ovarian insufficiency, and polycystic ovary syndrome, thereby leading to subfertility and infertility in females. The signaling pathways in follicles appear to form a link between glucose metabolism and folliculogenesis. Therefore, a better understanding of glucose metabolism dynamics at different stages of folliculogenesis and the associated signaling pathways will provide potential implications for follicle developmental competence. This review aimed to describe variations in glucose metabolism at different stages of folliculogenesis, provide new insights into glucose metabolic disorder-related diseases, and specifically discuss two major signaling pathways that regulate glucose metabolism during folliculogenesis: phosphatidylinositol 3-kinase, protein kinase B (PI3K-PKB/AKT) and AMP-activated protein kinase (AMPK) signaling pathways.
Objective: Some patients fail to obtain an embryo for transplantation during previous in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles, and require multiple reproductive treatments. This study aimed to evaluate whether changing the control ovarian stimulation (COS) protocol during the subsequent stimulation cycle could improve laboratory and clinical outcomes in these patients. Methods: Patients without a transplantable embryo (TE) in the previous IVF/ICSI cycles were recruited during their second cycles. They were classified into two groups according to their first cycle protocol: Group A, patients treated with a gonadotropin-releasing hormone agonist (GnRH-a), and Group B, patients treated with a gonadotropin-releasing hormone antagonist (GnRH-ant). The study group included patients whose stimulation protocols were changed, whereas the control group consisted of patients who used the same stimulation protocol in the second cycle. We then compared the numbers of oocytes collected (OC) and TE, the incidence of non-TE, the pregnancy rate (PR), and the live birth rate (LBR). Results: In Group A, the numbers of OC and TE were significantly lower (6.0 ± 4.7 vs. 9.4 ± 6.4, 2.3 ± 2.2 vs. 4.5 ± 3.8, P <0.05) in the study group compared with those in the control group. In Group B, the numbers of OC and TE were higher (7.0 ± 5.5 vs. 4.0 ± 4.3, 3.5 ± 3.4 vs. 1.8 ± 2.1, P <0.05) in the study group. There was a significant increase in the incidence of non-TE (adjusted odds ratio (AOR) = 2.12, 95% CI: 1.04–4.69) of the study group in Group A but not in Group B. No significant differences in the PR or LBR were found between the study and control groups in either Group A or B. Conclusion: Changing the COS protocol from GnRH-ant to GnRH-a or continuing the GnRH-a protocol can improve laboratory outcomes in patients with no TE in the previous IVF/ICSI cycle.
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