Journal Detail Information

1

Cite

Share

Clinical application and outcomes of natural cycle and modified natural cycle IVF for individualized assisted reproduction among patients with DOR

Jiaxin LYU ; Wei GUO ; Nana LIU ; Tian TIAN ; Lixue CHEN ; Xiumei ZHEN ; Rong LI ; Rui YANG ; Jie QIAO

Chinese Journal of Reproduction and Contraception.2025;45(9):902-909. doi:10.3760/cma.j.cn101441-20250406-00171

Objective:To investigate the outcomes of natural cycle (NC) and modified natural cycle (MNC) assisted reproductive technology (ART) in patients with diminished ovarian reserve (DOR), and to provide a scientific basis for individualized treatment strategies for DOR patients.Methods:A retrospective cohort analysis was performed on the clinical data of DOR patients who underwent ART at the Center for Reproductive Medicine of the Department of Obstetrics and Gynecology, Peking University Third Hospital from January 1, 2015 to December 31, 2023. Patients were divided into the NC group ( n=801) and the MNC group ( n=385) based on their treatment protocol. The primary outcomes were cycle cancellation rate and oocyte retrieval rate. Secondary outcomes included clinical pregnancy rate and live birth rate per fresh embryo transfer cycle and frozen-thawed embryo transfer cycle, cumulative pregnancy rate and cumulative live birth rate per started cycle and per transfer cycle, as well as laboratory parameters such as the number of retrieved oocytes, the number of two pronuclei (2PN) fertilized oocytes, the number of transferable embryos, and transferable embryo formation rate. Further, multivariate logistic regression was used to analyze the impact of the treatment protocol on pregnancy and live birth outcomes. Results:There were no statistically significant differences between the NC and MNC groups in terms of general characteristics such as age, body mass index, and baseline hormone levels (all P>0.05). The cycle cancellation rate was significantly higher in the NC group [19.10% (153/801)] than in the MNC group [10.65% (41/385), P<0.001], and the oocyte retrieval rate was significantly lower in the NC group [66.31% (431/650)] than in the MNC group [74.86% (259/346), P=0.005]. The number of retrieved oocytes [1 (0,1)], the number of 2PN fertilized oocytes [1 (0,1)], and the number of transferable embryos [0 (0, 1)] were also significantly lower in the NC group than in the MNC group [1 (1, 2), P<0.001; 1 (1, 1), P<0.001; 0 (0, 1), P<0.001]. However, there were no statistically significant differences in 2PN fertilization rate and transferable embryo formation rate between the NC and MNC groups (all P>0.05). In both fresh embryo transfer cycles and frozen-thawed embryo transfer cycles, there were no statistically significant differences in clinical pregnancy rate and live birth rate between the NC and MNC groups (all P>0.05). The cumulative pregnancy rate per started cycle and transfer cycle, the cumulative live birth rate per started cycle and per transfer cycle were also not significantly different between the NC and MNC groups (all P>0.05). Multivariate logistic analysis showed no significant association between NC and clinical pregnancy or live birth compared with MNC. Conclusion:While MNC to some extent reduced the cycle cancellation rate and improved oocyte retrieval rates compared with NC, it did not ultimately improve pregnancy outcomes in DOR patients.

2

Cite

Share

Application progress of artificial intelligence in the evaluation of endometrial receptivity

Mengqi MA ; Zhengfang XIONG

Chinese Journal of Reproduction and Contraception.2025;45(11):1175-1178. doi:10.3760/cma.j.cn101441-20250508-00222

Successful embryo implantation requires high-quality embryos and endometrium with high receptivity. However, there is no universally recognized authoritative technique for evaluating endometrial receptivity (ER) at present. In recent years, the application of artificial intelligence (AI) technology in the assessment of ER has achieved remarkable progress. In ultrasound image analysis, AI has improved the accuracy of endometrial segmentation and measurement through deep learning technology, and can combine clinical data for pregnancy outcome prediction. In histological analysis, AI algorithms can quickly and accurately identify histological features of the endometrium and analyze the ratio of epithelial and stromal cells. In genomic diagnosis, AI analyzes endometrial gene expression through machine learning methods to provide scientific basis for personalized embryo transfer. Although AI shows great potential in the assessment of ER, its application still faces challenges such as data standardization and algorithm generalization ability. In the future, through multi-center data sharing and algorithm optimization, AI is expected to play a greater role in assisted reproductive technology. This article reviews the application of AI in ER assessment, summarizes the latest research progress, and provides references for further research.

3

Cite

Share

Association between homocysteine and recurrent pregnancy loss (RPL) and its effects on IVF/ICSI-ET outcomes in RPL patients

Manman LIU ; Rui ZHANG ; Hebo ZHANG ; Mengfan YUAN ; Bingnan REN ; Junwei ZHANG ; Feng LI ; Wenjuan ZHANG ; Chaozhao LIU ; Yichun GUAN

Chinese Journal of Reproduction and Contraception.2025;45(8):779-786. doi:10.3760/cma.j.cn101441-20250306-00109

Objective:To investigate the association between homocysteine (Hcy) and recurrent pregnancy loss (RPL), as well as its impact on clinical pregnancy outcomes in patients undergoing in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET). Methods:This retrospective cohort study collected clinical data from patients undergoing IVF/ICSI-ET at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University between December 2020 and March 2024. Patients were divided into no history of pregnancy loss group (named control group, n=1 027) and RPL group ( n=743) based on history of pregnancy loss. Peripheral blood Hcy levels were compared between the two groups. Multivariate logistic regression was performed to adjust for confounding factors and determine whether Hcy is an independent risk factor for RPL. RPL patients were divided into four subgroups based on Hcy quartiles, named Q1 subgroup (Hcy<7.03 μmol/L), Q2 subgroup (7.03 μmol/L≤Hcy<8.63 μmol/L), Q3 subgroup (8.63 μmol/L≤Hcy<10.44 μmol/L), and Q4 subgroup (Hcy≥10.44 μmol/L), to further analyze the impact of Hcy level on pregnancy outcomes after IVF/ICSI-ET in these patients. Results:1) Baseline characteristics between control and RPL groups: statistically significant differences were observed in female age, male age, female body mass index (BMI), duration of infertility, cause of infertility, and peripheral blood Hcy levels (all P<0.05). 2) After adjusting for female age, male age, female BMI, duration of infertility, and cause of infertility via multivariate logistic regression, elevated Hcy levels was identified as an independent risk factor for RPL (a OR=1.366, 95% CI: 1.298-1.438, P<0.001). 3) Baseline characteristics of the four RPL subgroups: antral follicle count (AFC) differed significantly among Q1, Q2, Q3 and Q4 subgroups [17.00 (11.00, 24.00), 15.00 (10.00, 24.00), 14.00 (7.00, 22.25), 15.50 (8.00, 22.00), P=0.043]. No statistically significant differences were observed in other baseline characteristics (all P>0.05). 4) Pregnancy outcomes across the four RPL subgroups: miscarriage rates in the Q1, Q2, Q3 and Q4 subgroups were 18.18% (18/99), 30.61% (30/98), 33.70% (31/92), and 35.96% (32/89), respectively, live birth rates were 44.26% (81/183), 36.17% (68/188), 32.80% (61/186), and 30.65% (57/186), respectively. Intergroup differences in miscarriage rate and live birth rate were statistically significant ( P=0.033, P=0.036). Specifically, miscarriage rate in the Q3 and Q4 subgroups, and live birth rate in the Q4 subgroup were significantly higher than those in the Q1 subgroup (all q<0.05). However, no significant differences were observed in clinical pregnancy rate or early miscarriage rate among the four groups (all P>0.05). After adjusting for confounding factors using multivariate logistic regression, taking the Q1 subgroup as the control, there were no statistically significant differences in the clinical pregnancy rate between the remaining groups and the Q1 subgroup (all P>0.05). The early miscarriage rate in the Q3 subgroup (a OR=2.184, 95% CI: 1.077-4.426, P=0.030) and the early miscarriage rate in the Q4 subgroup (a OR=2.290, 95% CI: 1.116-4.697, P=0.024) were significantly higher than those in the Q1 subgroup; the miscarriage rate in the Q3 subgroup (a OR=2.207, 95% CI: 1.125-4.330, P=0.021) and the miscarriage rate in the Q4 subgroup (a OR=2.377, 95% CI: 1.209-4.674, P=0.012) were significantly higher than those in the Q1 subgroup; the live birth rate in the Q3 subgroup (a OR=0.615, 95% CI: 0.401-0.944, P=0.026) and the live birth rate in the Q4 subgroup (a OR=0.560, 95% CI: 0.364-0.863, P=0.009) were significantly lower than those in the Q1 subgroup. Conclusion:Elevated Hcy is a high-risk factor for RPL in IVF/ICSI-ET patients and may adversely affect pregnancy outcomes.

4

Cite

Share

Impact of cryostorage duration on clinical outcomes: a retrospective cohort study of vitrified high-quality embryos

Xiaoni GUO ; Xiaojie LIU ; Xiaodong ZHANG ; Guoning HUANG ; Qi ZHANG

Chinese Journal of Reproduction and Contraception.2025;45(8):802-808. doi:10.3760/cma.j.cn101441-20250319-00130

Objective:To evaluate the effect of prolonged cryopreservation duration of high-quality embryos on clinical outcomes.Methods:A retrospective cohort study was conducted, analyzing 8 988 frozen-thawed embryo transfer cycles performed from January 2016 to December 2023 at the Center for Reproductive Medicine, Chongqing Maternal and Child Healthcare Hospital where patients underwent endometrial preparation with artificial cycles and subsequent transfer of high-quality embryos. Embryos were divided into four groups according to the length of time they had been cryopreserved: ≤3-month group ( n=3 030), 4-6-month group ( n=3 193), 7-12-month group ( n=1 465), and >12-month group ( n=1 300). High-quality cleavage-stage embryos and blastocysts were selected according to the Istanbul Consensus and Gardner grading system. High-quality cleavage-stage embryos were defined as those graded ≤2, while high-quality blastocysts were defined as those graded ≥4BB. Generalized estimating equations were employed for multivariate analysis. Primary outcome indicator was clinical pregnancy rate, with secondary outcome indicators comprising live birth rate, miscarriage rate and preterm birth rate. Results:Significant intergroup differences were observed in baseline characteristics, including age, body mass index, anti-Müllerian hormone levels, fertilization method, endometrial thickness on transfer day, infertility etiology, infertility type, number of embryos transferred, embryo culture duration, number of eggs obtained, and preimplantation genetic testing (all P<0.05). Clinical pregnancy rates for the ≤3-month, 4-6-month, 7-12-month, and >12-month groups were 69.04% (2 092/3 030), 70.15% (2 240/3 193), 61.16% (896/1 465), and 57.69% (750/1 300), respectively, and live birth rates were 58.58% (1 775/3 030), 60.04% (1 917/3 193), 51.40% (753/1 465), and 47.00% (611/1 300), with significantly differences (all P<0.001). After adjusting for confounders via multivariate analysis, the 4-6-month group showed no statistically significant difference in clinical pregnancy rate or live birth rate compared with the ≤3-month group (clinical pregnancy: OR=0.982, 95% CI: 0.874-1.103, P=0.754; live birth: OR=0.989, 95% CI: 0.887-1.102, P=0.835). However, both the 7-12-month group (clinical pregnancy: OR=0.772, 95% CI: 0.671-0.888, P<0.001; live birth: OR=0.805, 95% CI: 0.704-0.921, P=0.002) and >12-month group (clinical pregnancy: OR=0.765, 95% CI: 0.662-0.885, P<0.001; live birth: OR=0.772, 95% CI: 0.671-0.888, P<0.001) exhibited significant decreases in clinical pregnancy rate and live birth rate. No significant differences were observed in miscarriage rate and preterm birth rate among the four groups (all P>0.05). Stratified by age, the results were consistent with the total population. Conclusion:The duration of high-quality embryo vitrification freezing exceeding 6 months is negatively correlated with clinical pregnancy rate and live birth rate, and cryostorage time should be considered as a relevant factor in embryo selection.

5

Cite

Share

Etiology and treatment of empty follicle syndrome

Xiaolei CHEN ; Ping YANG ; Yikun WANG ; Zijiang CHEN ; Han ZHAO

Chinese Journal of Reproduction and Contraception.2025;45(8):769-774. doi:10.3760/cma.j.cn101441-20250330-00160

Empty follicle syndrome (EFS), defined by the failure to retrieve oocytes despite normal follicle development following controlled ovarian stimulation, is a multifactorial condition in assisted reproductive treatment and categorized into genuine EFS (GEFS) and false EFS (FEFS). The etiology of GEFS is complex, involving genetic factors and ovarian dysfunction, with mutations in LHCGR and ZP genes being the major causes. However, the underlying cause remains unknown in most patients. Targeted therapies based on specific etiologies are crucial in GEFS management. Oocyte donation is considered as a final viable option when other precision treatments prove ineffective. The etiology of FEFS is relatively clear, primarily associated with inappropriate administration of ovulation-triggering drugs, which can be rescued by a second injection of human chorionic gonadotropin or change the medication regimen. This review summaries current advances in the diagnosis and treatment of EFS, aiming to provide guidance for clinical management and further etiology research.

6

Cite

Share

Clinical characteristics based on the phenotypic classification system of polycystic ovary syndrome

Yajie WANG ; Xiaoyu LONG

Chinese Journal of Reproduction and Contraception.2025;45(10):1058-1066. doi:10.3760/cma.j.cn101441-20250415-00190

Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder among women of reproductive age, and its pathogenesis has not been fully elucidated. According to the Rotterdam diagnostic criteria, PCOS can be classified into four clinical phenotypes, which significantly differ in physical parameters such as waist circumference and body mass index (BMI), as well as in sex hormones, anti-Müllerian hormone levels, metabolic diseases, ultrasound findings, and outcomes of assisted reproductive technology. In recent years, with the deepening of research, new classification systems, such as biology-based phenotyping and BMI/insulin resistance classification, have provided new theoretical perspectives for the clinical classification of PCOS. This article systematically reviews the characteristics of different clinical phenotypes of PCOS, aiming to provide a theoretical basis for its clinical diagnosis, individualized management, and patient health education.

7

Cite

Share

Selective fetus reduction in a case of combined intrauterine and cesarean scar pregnancy: a case report

Shujia WANG ; Jie LI ; Sien MO ; Zhengxuan ZHANG ; Xiuhong AN ; Zhong LIN

Chinese Journal of Reproduction and Contraception.2025;45(9):945-947. doi:10.3760/cma.j.cn101441-20250319-00131

To evaluate the clinical efficacy of selective fetal reduction in the first trimester for the treatment of intrauterine pregnancy combined with cesarean scar pregnancy (CI-CSP), this article reports a 41-year-old pregnant woman diagnosed with CI-CSP after assisted reproductive technology. At 6 + weeks of gestation, mechanical fetal reduction surgery was performed under ultrasound guidance to eliminate the fetus at the scar site, and the fetal reduction was successful. The pregnancy lasted until 38 weeks of gestation. A healthy male infant was delivered by cesarean section. This case suggests that selective fetal reduction surgery can be a feasible option to preserve intrauterine pregnancy and reduce the risk of CI-CSP, but the indications and perioperative management need to be strictly controlled.

8

Cite

Share

Research advances in the immune microenvironment in polycystic ovary syndrome

Zhaokang QI ; Tingting WANG ; Jinxin REN ; Jinlong SUN ; Yuan LI ; Yi YU ; Fang LIAN

Chinese Journal of Reproduction and Contraception.2025;45(9):967-972. doi:10.3760/cma.j.cn101441-20250322-00138

The immune microenvironment plays a pivotal role in maintaining ovarian homeostasis. Polycystic ovary syndrome (PCOS), a common endocrine and metabolic disorder, is closely associated with immune microenvironment imbalance. This review systematically describes the dysregulation of innate immune cells (e.g., macrophages, natural killer cells and dendritic cells) and adaptive immune cells (e.g., Th1, Th2, Treg and Th17) in PCOS, highlighting their impacts on ovarian function, insulin resistance, and hyperandrogenemia. These findings underscore the central role of immune microenvironment disturbances in PCOS pathogenesis. Additionally, the association between gut microbiota dysbiosis and PCOS is explored, emphasizing how gut microbiota influences metabolic byproducts and hormonal levels to contribute to PCOS development. Furthermore, therapeutic strategies targeting immune microenvironment imbalance such as modulating macrophage polarization, restoring Th1/Th2 and Th17/Treg balance, and ameliorating gut microbiota dysbiosis are discussed, offering novel insights for PCOS immunotherapy. In conclusion, this review comprehensively analyzes the pathogenesis of PCOS from the perspective of the immune microenvironment, aiming to provide a theoretical foundation and reference for future research and clinical practice.

9

Cite

Share

A case report of application of third-generation sequencing technology in preimplantation genetic testing for patients with autosomal dominant polycystic kidney disease

Yanru LI ; Huijuan ZHANG ; Chenchen CUI ; Baoli YIN ; Cuilian ZHANG

Chinese Journal of Reproduction and Contraception.2025;45(10):1054-1057. doi:10.3760/cma.j.cn101441-20250425-00203

With the development of preimplantation genetic testing (PGT) technology, the application of third-generation sequencing technology in PGT has been increasing. This article reports the pregnancy outcome of a patient with autosomal dominant polycystic kidney disease who underwent PGT using the third-generation sequencing technology. It summarizes the technical characteristics of third-generation sequencing technology, as well as its significant advantages and limitations in PGT for families with de novo mutations.

10

Cite

Share

Expanded carrier screening in assisted reproduction: current clinical applications and emerging challenges

Lijing LIN ; Chenming XU

Chinese Journal of Reproduction and Contraception.2025;45(8):763-768. doi:10.3760/cma.j.cn101441-20250411-00185

Expanded carrier screening (ECS) is a novel genetic risk assessment approach that leverages next-generation sequencing technologies to simultaneously identify carrier status for hundreds of autosomal recessive or X-linked recessive monogenic disorders in a single assay. This strategy enables stratified risk evaluation and supports informed reproductive decision-making, particularly among individuals undergoing assisted reproductive technologies (ARTs). Despite its increasing utility, the clinical implementation of ECS remains constrained by several challenges, including inconsistencies in screening panel inclusion criteria and the complexity of genetic variant interpretation. To promote the precision application of ECS in ARTs populations, future efforts should prioritize the development of population-specific panels informed by comprehensive genetic data from Chinese cohorts. In addition, strengthening data security and privacy protection policies, along with establishing specialized training programs in reproductive genetic counseling, will be essential for ensuring the responsible and effective integration of ECS into clinical practice.

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share