Objective: To investigate the relationship between magnetic resonance imaging (MRI) imaging characteristics and clinical symptoms and therapeutic efficacy in adenomyosis patients. Methods: The clinical characteristics of the adenomyosis questionnaire was self-designed. This was a retrospective study. From September 2015 to September 2020, totally 459 patients were diagnosed with adenomyosis and underwent pelvic MRI examination at Peking University Third Hospital. Clinical characteristics and treatment were collected, MRI was used to determine the lesion location, and to measure the maximum lesion thickness, the maximum myometrium thickness, uterine cavity length, uterine volume, the minimum distance between the lesion and serosa or endometrium, and whether combined with ovarian endometrioma. The difference of MRI imaging characteristics in patients with adenomyosis and its relationship with clinical symptoms and therapeutic efficacy were analyzed. Results: (1) Among the 459 patients, the age was (39.1±6.4) years. There were 376 patients (81.9%, 376/459) with dysmenorrhea. Whether patients had dysmenorrhea were related to uterine cavity length, uterine volume, ratio of the maximum lesion thickness to the maximum myometrium thickness, and whether patients had ovarian endometrioma (all P<0.001). Multivariate analysis suggested that ovarian endometrioma was the risk factor for dysmenorrhea (OR=0.438, 95%CI: 0.226-0.850, P=0.015). There were 195 patients (42.5%, 195/459) with menorrhagia. Whether patients had menorrhagia were related to age, whether patients had ovarian endometrioma, uterine cavity length, the minimum distance between lesion and endometrium or serosa, uterine volume, ratio of the maximum lesion thickness to the maximum myometrium thickness (all P<0.001). Multivariate analysis suggested that ratio of the maximum lesion thickness to the maximum myometrium thickness was the risk factor for menorrhagia (OR=774.791, 95%CI: 3.500-1.715×10⁵, P=0.016). There were 145 patients (31.6%, 145/459) with infertility. Whether the patients had infertility were related to age, the minimum distance between lesion and endometrium or serosa, and whether patients had ovarian endometrioma (all P<0.01). Multivariate analysis suggested that young and large uterine volume were risk factors for infertility (OR=0.845, 95%CI: 0.809-0.882, P<0.001; OR=1.001, 95%CI: 1.000-1.002, P=0.009). (2) The success rate of in vitro fertilization-embryo transfer (IVF-ET) was 39.2% (20/51). Dysmenorrhea, high maximum visual analogue scale score and large uterine volume affected the success rate of IVF-ET (all P<0.05). The smaller the maximum lesion thickness, the smaller the distance between the lesion and serosa, the larger the distance between the lesion and endometrium, the smaller the uterine volume, and the smaller the ratio of the maximum lesion thickness to the maximum myometrium thickness, the better the therapeutic efficacy of progesterones (all P<0.05). Conclusions: Concomitant ovarian endometrioma increases the risk of dysmenorrhea in patients with adenomyosis. The ratio of the maximum lesion thickness to the maximum myometrium thickness is an independent risk factor for menorrhagia. Young and large uterine volume may increase the risk of infertility. Severe dysmenorrhea and large uterine volume affect the success rate of IVF-ET. The therapeutic efficacy of progesterones is relatively better when the lesion is small and far away from the endometrium.
Female ; Humans ; Adult ; Middle Aged ; Adenomyosis/pathology* ; Dysmenorrhea/therapy* ; Menorrhagia/pathology* ; Endometriosis/therapy* ; Retrospective Studies ; Infertility/complications* ; Magnetic Resonance Imaging

To evaluate the outcomes of controlled ovarian hyperstimulation (COH)-in vitro fertilization (IVF) such as clinical pregnancy rate (CPR), implantation rate (IR) and live birth rate (LBR) for infertile patients with borderline ovarian tumor (BOT) after conservative treatment, 10 IVF cycles in five patients from January 1999 to July 2005 were analyzed. At the time of diagnosis with BOT, the mean age of patients was 30.0 yr (range, 22-40). For 8 cycles out of 10 attempted IVF cycles, except for 2 cancellation cycles, the mean number of oocytes retrieved was 5.6 (range, 2-16) with a mean fertilization rate of 74.4%. The CPR, IR, and LBR were 50.0% (4/8 cycles), 31.6% (6/19) and 50.0% (4/8 cycles) respectively. The mean follow-up period after COH-IVF initiation was 29.6 (range, 14-61) months. A gynecological oncologist followed all patients every 3 months during the first year and every 6 months thereafter. There was no recurrence during the follow-up period. Our results suggest that COH-IVF may be acceptable for infertile patients with BOT, especially in patients with early-stage BOT after conservative treatment.
Adult ; Embryo Transfer ; Female ; Fertilization in Vitro ; Humans ; Infertility, Female/*complications/*therapy ; Ovarian Neoplasms/*complications/pathology/*surgery ; Ovulation Induction/methods ; Pregnancy ; Pregnancy Complications, Neoplastic ; Prognosis ; Treatment Outcome

OBJECTIVETo investigate the association of the clinical characteristics and the outcome of in vitro fertilization and embryo transfer (IVF-ET) in infertile women with polycystic ovarian syndrome (PCOS) of different subtypes.

METHODSA total of 189 infertile women with PCOS undergoing IVF-ET were enrolled in this study. According to Rotterdam PCOS diagnosis criteria, the patients were classified into 3 PCOS subtypes, namely type I with PCO ultrasonography and oligo-ovulation/anovulation and hyperandrogenism (54 women, for whom 58 fresh IVF-ET cycles were performed); type II with PCO ultrasonography and oligo-ovulation/anovulation (117 women with 126 cycles); type III with PCO ultrasonography and hyperandrogenism (18 women with 18 cycles). The number of retrieved oocytes, fertilization rate, implantation rate, clinical pregnancy rate, spontaneous abortion rates and incidence of ovarian hyperstimulation syndrome (OHSS) were compared between the 3 groups.

RESULTSExcept for the baseline serum T concentration in the early phase of menstrual cycle, which was significantly higher in groups I and III than in group II, no significant difference was found in the clinical characteristics between the 3 groups (P>0.05). Group I had the highest initial Gn dose, and the oocyte retrieval rates were significantly lower in groups I and III (P<0.05). The patients in group I had lower implantation rate and the clinical, on-going and cumulative pregnancy rates than groups II and III, but the differences were not statistically significant; the embryo early loss rate and spontaneous abortion rate appeared to be higher in groups I and III (P>0.05). Significantly elevated incidence of OHSS were noted in groups I and III (P<0.05).

CONCLUSIONThe women with different PCOS subtypes according to the Rotterdam criteria all have similar IVF-ET outcomes, and the increased embryo loss rate and spontaneous abortion rate in groups I and III might be associated with excessive androgen that disturbs oocyte and embryo development.

Adult ; Embryo Transfer ; Female ; Fertilization in Vitro ; Humans ; Infertility, Female ; etiology ; therapy ; Polycystic Ovary Syndrome ; classification ; complications ; Pregnancy ; Pregnancy Rate

OBJECTIVETo analyze the effect of autoimmune disorders on the outcome of in vitro fertilization and embryo transfer (IVF-ET) in infertile women.

METHODSA total of 236 infertile women underwent IVF-ET, including 34 with antiphospholipid antibody (APA) positive, 33 anti-trophoblast antibody (ATA) positive, 35 anti-hCG antibody (hCGAb) positive, 32 anti-endometrium antibody (EmAb) positive, and 102 with antibodies negative that comprised the control group. Those with two or more antibodies positive were excluded in this study. Comparisons were made in the rates of embryo implantation, clinical pregnancy, miscarriage and biochemical pregnancy between the positive groups and the negative controls.

RESULTSThere were no significant differences in the rates of embryo implantation and clinical pregnancy between the positive and negative groups (P > 0.05). The rate of biochemical pregnancy was higher in the APA, ATA and hCGAb positive than in the EmAb positive and the control group (P < 0.05). The miscarriage rate was higher while the ongoing pregnancy rate was lower in the positive groups than in the negative control (P < 0.05).

CONCLUSIONSuch autoantibodies as APA, ATA, HCG-Ab and EmAb may cause miscarriage in infertile women undergoing IVF and consequently reduce the rate of ongoing pregnancy, which necessitates the determination of these antibodies in these patients.

Adult ; Autoantibodies ; analysis ; Autoimmune Diseases ; complications ; immunology ; Female ; Fertilization in Vitro ; Humans ; Infertility, Female ; etiology ; immunology ; therapy ; Pregnancy ; Pregnancy Outcome

OBJECTIVETo investigate the changes in cytokines (IL-1beta, IL-2, TNF-alpha) of peripheral blood and cervical mucous of infertile women with mycoplasma infection and the effect of intervention of traditional Chinese medicines (TCMs).

METHODAccording to the results of culture of mycoplasma from genital tracts, 72 patients with positive mycoplasma were randomly divided into the TCM group (38 cases) and the western medicine group (34 cases). The western medicine group was treated with 0.5 g azithromycin for 3 days and consecutively treated for six courses of treatment, each course of treatment of 4 days. The TCM group were treated with Xiaozhi decoction twice every day for 6 weeks. The IL-1beta, IL-2 and TNF-alpha levels of the peripheral blood and cervical mucous of the two groups were measured by the Ria testing before and after the treatment, and the mycoplasma culture (-) of 32 infertile women as set for control.

RESULTBefore the treatment, TNF-alpha and IL-1beta in levels of the two treatment groups were higher than those of the control group (P < 0.01). In the TCM group, TNF-alpha and IL-1beta levels showed significant differences compared with those before the treatment (P < 0.05) and those of the western group after the treatment (P < 0.01); and IL-2 level didn't have significant change before and after the treatment. The cytokines in peripheral blood of the two treatment groups showed notable difference compared with those of the control group (P < 0.01). In TCM group, IL-2 level had remarkable difference compared with that before the treatment (P < 0.01) and compared with the control group after the treatment (P < 0.01).

CONCLUSIONCytokines (IL-1beta, IL-2, TNF-alpha) in the peripheral blood and cervical mucous increase in infertile women with the mycoplasma infection, suggesting that TCMs can effectively inhibit the levels of IL-1beta, IL-2, TNF-alpha in the peripheral blood and IL-1beta, TNF-alpha in cervical mucous. It is proved that Xiaozhi decoction can be used to treat infertile women with mycoplasma infection.

Adult ; Cytokines ; blood ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Infertility, Female ; blood ; complications ; drug therapy ; immunology ; Mycoplasma Infections ; blood ; complications ; drug therapy ; immunology ; Young Adult

Patients with Klinefelter's syndrome are generally characterized by a 47, XXY karyotype, seminiferous tubule dysgenesis, azoospermia and infertility. However, focal spermatogenesis and severe oligozoospermia have been found in a few cases of 47, XXY, too. With the recent development in assisted reproductive technologies, the recovered spermatozoa by testicular biopsy from Klinefelter patients have been used for intracytoplasmic sperm injection (ICSI) and over 30 healthy neonates have been born. The conception of one 47, XXY fetus was found and then underwent abortion. This review focuses on the ICSI treatment of infertility in Klinefelter patients and the risk of chromosome anomaly in the offspring of these patients.
Chromosome Disorders ; etiology ; Female ; Humans ; Infertility, Male ; etiology ; therapy ; Karyotyping ; Klinefelter Syndrome ; complications ; genetics ; Male ; Pregnancy ; Sperm Injections, Intracytoplasmic

OBJECTIVETo compare the effect of treatment of fallopian tube obstructive infertility by salpingostomy alone and in combination with TCM drugs for Bushen Huoxue (invigorating Shen and promoting blood circulation).

METHODSTo all the patients, salpingostomy was performed 3 to 7 days after menstruation and hydrotubation with Xiangdan Injection (XI) was applied once in the next menstrual cycle. Bushen Huoxue Decoction (BHD) was administrated additionally to patients in the treated group, 1 dose every day starting from the 5th day of menstrual cycle for 14 days. Three months' treatment was taken as one therapeutic course and the observation lasted for 4 courses.

RESULTSThe condition of follicular development, thickness of endometrium and level of serum estradiol in the preovulatory phase after treatment were all significantly increased in the two groups (P < 0.05 and P < 0.01); but the improvement in the treated group was significantly superior to that in the control group, showing significant difference. Moreover, the pregnancy rate was also higher in the former than in the latter (P < 0.05).

CONCLUSIONThe combined therapy of salpingostomy and TCM drugs for invigorating Shen and promoting blood circulation is an effective therapy for fallopian tube obstructive infertility, it has the effect of enhancing follicular development and increasing thickness of endometrium, and could elevate the pregnancy rate in patients.

Adult ; Combined Modality Therapy ; Drugs, Chinese Herbal ; therapeutic use ; Fallopian Tube Diseases ; complications ; therapy ; Female ; Humans ; Infertility, Female ; etiology ; therapy ; Medicine, Chinese Traditional ; Phytotherapy ; Salpingostomy ; Treatment Outcome

OBJECTIVETo study the clinical features and outcomes of in vitro fertilization and embryo transfer (IVF-ET) in infertile patients due to polycystic ovary syndrome (PCOS) or polycystic ovaries (PCO).

METHODSThis study involved 189 infertile patients with polycystic ovary syndrome (PCOS), with 129 polycystic ovaries (PCO), and 142 without PCOS or PCO (control) undergoing IVF-ET. The dosage of gonadotrophin (Gn), sex hormone level on the day of HCG administration, clinical pregnancy rate, spontaneous abortion rate and ovarian hyperstimulation syndrome (OHSS) rate were analyzed and compared between the 3 groups.

RESULTSNo significant differences were found in the clinical pregnancy rate between the PCOS group (202 cycles), PCO group (134 cycles) and control group (150 cycles) (51.0%, 53.0% and 46.0%, respectively). The levels of LH and T and early spontaneous abortion rates were significantly higher in PCOS group than in PCO group and control group (P<0.05). The P level on HCG day was the highest in PCO group (P<0.05). The early spontaneous abortion rates and clinical pregnancy rate showed no significant differences between PCO group and control group (P>0.05). The dosage of Gn was significantly lower and OHSS rate higher in PCOS and PCO groups than in the control group (P<0.05).

CONCLUSIONSThe clinical pregnancy rate of infertile patients with PCOS is similar with that of PCO patients and control patients undergoing IVF-ET treatment. PCOS, however, is associated with increased spontaneous abortion rate, possibly due to abnormality of LH and T release. The clinical outcomes in PCO patients are similar with those in the control patients, and elevated P level in the late follicular phase does not obviously influence the outcomes of IVF. Both PCOS and PCO are associated with increased risk of OHSS.

Adult ; Case-Control Studies ; Embryo Transfer ; Female ; Fertilization in Vitro ; Humans ; Infertility, Female ; etiology ; therapy ; Ovarian Cysts ; complications ; Polycystic Ovary Syndrome ; complications ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies

The aim of this study was to evaluate the clinical efficacy of body mass index (BMI) as a predictor of in vitro fertilization and embryo transfer (IVF-ET) outcomes. Two hundred twenty-three IVF-ET cycles in 164 patients under 37 yr using GnRH agonist long protocols were included in this retrospective study. All of the selected cases were divided into two groups by a cutoff of 24 kg/m2 and these two groups were compared in regard to the outcomes of IVF-ET. There were no significant differences between group 1 (BMI <24 kg/m2) and group 2 (BMI > or = 24 kg/m2) in age, basal serum FSH level, estradiol (E2) level and endometrial thickness on hCG day, number of retrieved oocytes and transferred embryos. However, higher doses of gonadotropins were used in group 2 (30.8+/-12.7 ampoules vs. 35.4+/-15.3 ampoules, p=0.051). The clinical pregnancy rate was significantly lower in group 2 (25.9% vs. 10.5%, p=0.041) and implantation rate tended to be lower in group 2 (12.7% vs. 6.8%, p=0.085). BMI > or = 24 kg/m2 can be a candidate prognosticator of IVF-ET outcomes.
Treatment Outcome ; Prognosis ; Pregnancy ; Obesity/complications/pathology ; Infertility, Female/complications/pathology/therapy ; Humans ; *Fertilization in Vitro ; Female ; *Embryo Transfer ; Embryo Implantation ; *Body Mass Index ; Adult

OBJECTIVETo explore the therapeutic effects of combination of varicocelectomy with hyperbaric oxygenation (HBO) in treating infertile patients with varicocele.

METHODSNinety-six patients were randomly divided into two groups: 40 patients in group A treated by varicocelectomy with HBO, and 56 in group B treated by solitary varicocelectomy.

RESULTSThe sperm density, sperm motility, sperm vigor, normality, serum testosterone, the pregnant rate of patients spouses were improved respectively in both two groups (P <0.01 or P < 0.05), and group A had better results than group B (P < 0.05). LH, FSH in group A decreased significantly after the therapy. Group A had higher sperm penetration asay (SPA) percentages than group B(P < 0.05), and the pregnant time of patient's spouses in group A was earlier than that in group B (P < 0.05).

CONCLUSIONVaricocelectomy with HBO can more effectively regulate reproductive hormone, improve semen quality, SPA index and pregnant rate than solitary varicocelectomy in treating infertile patients with varicocele and can markedly shorten the pregnant time.

Adult ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Hyperbaric Oxygenation ; Infertility, Male ; etiology ; therapy ; Ligation ; Male ; Pregnancy ; Pregnancy Rate ; Varicocele ; complications ; surgery ; therapy