OBJECTIVES: To evaluate the strategies and outcomes of assisted reproductive technology (ART) for fertility preservation and promotion in women with malignant tumors, and to analyze ART outcomes across different tumor types. METHODS: We conducted a retrospective analysis of female patients who underwent ART for fertility preservation or treatment at the Reproductive Center of the Women's Hospital, Zhejiang University School of Medicine, between January 1, 2018, and December 31, 2023. A total of 163 ART-aided pregnancy patients with malignant tumors were included in the case group, among which 6 patients underwent embryo cryopreservation for fertility preservation before radiotherapy or chemotherapy. Additionally, 11 unmarried women underwent oocyte cryopreservation due to borderline ovarian tumors, ovarian cancer, breast cancer, or hematological malignancies. The control group was selected from women without a history of malignant tumors who received ART treatment during the same period, using propensity score matching at a ratio of 1∶2, resulting in 326 cases. Data were collected through the reproductive medical record system and telephone follow-up (as of October 31, 2024). Baseline characteristics, controlled ovarian hyperstimulation parameters, laboratory indicators, and pregnancy outcomes were compared between case and control groups and among patients with different tumor types, and the tumor recurrence of the patients was followed up. RESULTS: Patients in the case group had significantly lower ovarian reserve (AMH, AFC) and a higher proportion of diminished ovarian reserve compared to the control group (all P<0.01). Regarding the ovulation induction protocol, the proportion of patients using the minimal stimulation protocol in the case group was significantly higher than that in the control group (29.45% vs. 12.88%, P<0.01), and the total dosage of gonadotropins used was lower (P<0.01). In terms of assisted reproductive outcomes, there were no statistically significant differences between the two groups in the number of retrieved oocytes, number of high-quality embryos, fertilization rate, cumulative pregnancy rate, cumulative live birth rate, or miscarriage rate (all P>0.05). However, the number of oocyte retrieval cycles and embryo transfer cycles required to achieve a live birth outcome in the case group were significantly higher than those in the control group (both P<0.05). Subgroup analysis showed that there were no significant differences in cumulative pregnancy rate and live birth rate among patients with different tumor types (thyroid cancer, reproductive system tumors, breast cancer, lung cancer). Nevertheless, lung cancer patients had the lowest ovarian reserve and required the most oocyte retrieval cycles due to their older age; breast cancer patients had a relatively lower fertilization rate partially because some of them were complicated with male factors. A follow-up of 154 tumor patients (with a follow-up rate of 88.5%) revealed that 6 patients (4.20%) had tumor recurrence, and 1 breast cancer patient died due to tumor recurrence. None of the 11 unmarried patients who had undergone oocyte cryopreservation had used the cryopreserved oocytes for assisted pregnancy yet, and 1 patient who had undergone fertility preservation died due to tumor recurrence. CONCLUSIONS Women of reproductive age with malignant tumors are at risk of diminished fertility. ART can effectively preserve and promote fertility, enabling favorable pregnancy and live birth outcomes. It is recommended to initiate a multidisciplinary assessment promptly prior to radiotherapy/chemotherapy and formulate an individualized ART regimen for fertility preservation or promotion, so as to achieve reproductive goals or safeguard future fertility potential.

Objective To construct an evaluation index system of core competence of assisted reproductive technology specialist nurses,and to conduct preliminary validation,so as to provide reference standards for the training and evaluation of assisted reproductive technology specialist nurses.Methods Based on the core competence of specialist nurses of the International Council of Nurses and the Hamric Advanced Practice Nurse competence framework as the theoretical framework,through literature research and research group discussion,the core competence index of specialist nurses in assisted reproductive technology was preliminarily established.A total of 23 experts were consulted with 2 rounds of Delphi method to complete index and determine weight coefficients in April 2024.In August 2024,50 assisted reproductive technology specialist nurses from 18 provinces and cities across the country were selected to conduct a satisfaction survey on the evaluation index system,in order to preliminarily verify the application effect of indicators.Results The questionnaire recovery rates for 2 rounds of expert consultations were both 100％,and the expert authority coefficients were both 0.943.The coefficient of variation was 0～0.287 and 0～0.236,and the Kendall harmony coefficient was 0.241～0.337 and 0.250～0.431,respectively.The final evaluation index of core competence of assisted reproductive technology specialist nurses included 6 first-level indicators,20 second-level indicators and 57 third-level indicators.Assisted reproductive technology specialist nurses were satisfied with the evaluation index system of core competence,with a score of(18.26±2.52).Conclusion The evaluation index system of core competence of assisted reproductive technology specialist nurses is practical,with comprehensive content and outstanding professional characteristics.

Objective To construct an evaluation index system of core competence of assisted reproductive technology specialist nurses,and to conduct preliminary validation,so as to provide reference standards for the training and evaluation of assisted reproductive technology specialist nurses.Methods Based on the core competence of specialist nurses of the International Council of Nurses and the Hamric Advanced Practice Nurse competence framework as the theoretical framework,through literature research and research group discussion,the core competence index of specialist nurses in assisted reproductive technology was preliminarily established.A total of 23 experts were consulted with 2 rounds of Delphi method to complete index and determine weight coefficients in April 2024.In August 2024,50 assisted reproductive technology specialist nurses from 18 provinces and cities across the country were selected to conduct a satisfaction survey on the evaluation index system,in order to preliminarily verify the application effect of indicators.Results The questionnaire recovery rates for 2 rounds of expert consultations were both 100％,and the expert authority coefficients were both 0.943.The coefficient of variation was 0～0.287 and 0～0.236,and the Kendall harmony coefficient was 0.241～0.337 and 0.250～0.431,respectively.The final evaluation index of core competence of assisted reproductive technology specialist nurses included 6 first-level indicators,20 second-level indicators and 57 third-level indicators.Assisted reproductive technology specialist nurses were satisfied with the evaluation index system of core competence,with a score of(18.26±2.52).Conclusion The evaluation index system of core competence of assisted reproductive technology specialist nurses is practical,with comprehensive content and outstanding professional characteristics.

Objective:To deeply understand the man′s feelings and psychological experience of temporary ejaculation disorder on the day of retrieving ova during in vitro fertilization-embryo transfer (IVF-ET) treatment, and to provide theoretical basis for targeted intervention measures.Methods:Using the phenomenological method,13 male patients with temporary ejaculation disorder were interviewed individually on the day of retrieving ova from July to October 2021 in the department of Reproductive Endocrinology, Women′s Hospital, School of Medicine Zhejiang University and a semi-structured interview was recruited with them. The interview data were analyzed, summarized and refined according to Colaizzi′s 7-step method.Results:Totally 6 classification topics were formed: Somatization discomfort; Negative emotion; Stress and frustration; Change of intimacy between infertile couples; Imperfect social support system; Fertility pressure.Conclusions:Medical staff should pay close attention to the emotional reaction and psychological state of patients, establish emotional support, improve the intimate relationship between infertile couples, provide effective psychological counseling, provide diversified and personalized information support and multi-dimension social support, arrange reasonably the sperm collection room, improve the medical environment and improve the quality of assisted reproductive services.

Objective:To explore the effect of pregnancy outcome of the first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and embryo transfer cycle on the next frozen-thawed embryo transfer cycle. Methods:A retrospective cohort study was designed by collecting data from 6658 infertile patients in Department of Reproductive Endocrinology, Women's Hospital of Zhejiang University from January 2010 to December 2019. Two groups were included, the fresh embryo-frozen embryo group ( n=4310) and the frozen embryo-frozen embryo group ( n=2348), and each group was divided into four subgroups according to the pregnancy outcome of the first transfer cycle: non-pregnancy subgroup, biochemical pregnancy subgroup, pregnancy loss subgroup, and live birth subgroup. In each group, the live birth rate (LBR) of the second transfer cycle was compared among the four subgroups. Results:In the second transfer cycle of the fresh embryo-frozen embryo group, LBR in each subgroup was 31.3% (972/3109), 33.7% (92/273), 33.3% (169/507), and 39.2% (165/421), respectively. Compared with non-pregnancy subgroup, the difference of LBR in the live birth subgroup was statistically significant [after adjustment, a P<0.001, a OR(95% CI)=1.555(1.245-1.942)]. In the second transfer cycle of the frozen embryo-frozen embryo group, LBR in each subgroup was 37.3% (655/1754), 47.0% (79/168), 45.4% (122/269), and 44.6% (70/157), respectively. Compared with non-pregnancy subgroup, the differences of LBR in biochemical pregnancy subgroup, pregnancy loss subgroup and live birth subgroup were statistically significant [after adjustment, a P=0.018, a OR(95% CI)=1.471(1.069-2.026); a P=0.014, a OR(95% CI)=1.388 (1.069-1.802); a P=0.035, a OR(95% CI)=1.452(1.026-2.054)]. Conclusion:In the fresh embryo-frozen embryo group, live birth in the first transfer cycle is associated with increased LBR in the subsequent cycles, while in the frozen embryo-frozen embryo group, biochemical pregnancy, pregnancy loss, or live birth in the first transfer cycle are associated with increased LBR in the following cycles.

Objective:To explore the effect of pregnancy outcome of the first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and embryo transfer cycle on the next frozen-thawed embryo transfer cycle. Methods:A retrospective cohort study was designed by collecting data from 6658 infertile patients in Department of Reproductive Endocrinology, Women's Hospital of Zhejiang University from January 2010 to December 2019. Two groups were included, the fresh embryo-frozen embryo group ( n=4310) and the frozen embryo-frozen embryo group ( n=2348), and each group was divided into four subgroups according to the pregnancy outcome of the first transfer cycle: non-pregnancy subgroup, biochemical pregnancy subgroup, pregnancy loss subgroup, and live birth subgroup. In each group, the live birth rate (LBR) of the second transfer cycle was compared among the four subgroups. Results:In the second transfer cycle of the fresh embryo-frozen embryo group, LBR in each subgroup was 31.3% (972/3109), 33.7% (92/273), 33.3% (169/507), and 39.2% (165/421), respectively. Compared with non-pregnancy subgroup, the difference of LBR in the live birth subgroup was statistically significant [after adjustment, a P<0.001, a OR(95% CI)=1.555(1.245-1.942)]. In the second transfer cycle of the frozen embryo-frozen embryo group, LBR in each subgroup was 37.3% (655/1754), 47.0% (79/168), 45.4% (122/269), and 44.6% (70/157), respectively. Compared with non-pregnancy subgroup, the differences of LBR in biochemical pregnancy subgroup, pregnancy loss subgroup and live birth subgroup were statistically significant [after adjustment, a P=0.018, a OR(95% CI)=1.471(1.069-2.026); a P=0.014, a OR(95% CI)=1.388 (1.069-1.802); a P=0.035, a OR(95% CI)=1.452(1.026-2.054)]. Conclusion:In the fresh embryo-frozen embryo group, live birth in the first transfer cycle is associated with increased LBR in the subsequent cycles, while in the frozen embryo-frozen embryo group, biochemical pregnancy, pregnancy loss, or live birth in the first transfer cycle are associated with increased LBR in the following cycles.

Objective:To evaluate the application effect of problem-based learning (PBL) combined with tutorial system mode in the capacity of literature retrieval and academic writing in specialist nurses of assisted reproductive technology (ART).Methods:A total of 61 ART nurse specialists trained in Women's Hospital, School of Medicine, Zhejiang University from 2017 to 2018 were recruited in the study. These specialist nurses were trained with PBL combined with tutorial system mode during the training. Nursing Research Capacity of Self-Evaluation Scale and questionnaires were used to evaluate the capacity of literature retrieval and academic writing before and after the training. The data was analyzed by SPSS 19.0.Results:After the training, the total score of nursing research capacity was significantly higher than before ( P<0.05), and the capacity of literature retrieval, the publication number of papers and research projects were also higher than before ( P<0.01). Conclusion:PBL combined with tutorial system is an effective way to improve the capacity of literature retrieval and academic writing of ART clinical specialist nurses.

Objective We sought to summarize the experience in nursing the patients of Robertsonian translocation receiving pre-implantation genetic diagnosis (PGD).Methods Thirty-eight patients with Robertsonian translocation received PGD.These patients received health education and psychological nursing except for routine therapy and nursing.Results All these patients had no obvious negative emotion and complied with the therapy.Nine patients were successfully pregnant and pregnancy rate was 23.7％,7 of them delivered healthy neonates.Conclusions Health education,psychology nursing together with controlled ovarian stimulation,egg retrieval and embryonic transplantation can reduce negative emotion,improve compliance of therapy,and benefit the process of PGD and clinical outcomes.