Objective:To investigate the effect of the transfer of blastocysts that have not re-expanded after 2-4 h of thawing on pregnancy and neonatal outcomes.Methods:A retrospective cohort study was performed to analyze the clinical data from 2 428 vitrified frozen-thawed single blastocyst transfer cycles at the Reproductive Medicine Center of the 901st Hospital of the Joint Logistics Support Force of PLA between January 2015 and March 2024. Based on the re-expansion status of the blastocoel cavity after thawing, the cycles were divided into group A (110 non-re-expanded) and group B (2 318 re-expanded). After propensity score matching, there were 109 cycles in each group. Pregnancy and neonatal outcomes between the two groups were compared.Results:Before propensity score matching, there were statistical differences in percentage of good-quality blastocyst transfer, percentage of degree 4 blastocyst, percentage of endometriosis and others in reasons for infertility between the two groups (all P<0.05). After propensity score matching, there were no statistical differences in baseline characteristics between the two groups (all P>0.05). The clinical pregnancy rate [27.52% (30/109)], the ongoing pregnancy rate [21.10% (23/109)] and the live birth rate [19.27% (21/109)] in group A were all significantly lower than those in group B [61.47% (67/109), 51.38% (56/109), 47.70% (52/109), all P<0.001]. Neonatal outcomes showed no statistically significant differences between the two groups in terms of birth weight, neonatal length, malformation rate, monozygotic twin rate and male neonatal rate (all P>0.05). Conclusion:Transfer of non-re-expanded blastocysts after thawing may reduce clinical pregnancy rate but does not negatively affect neonatal outcomes.

Objective:To investigate the effect of the transfer of blastocysts that have not re-expanded after 2-4 h of thawing on pregnancy and neonatal outcomes.Methods:A retrospective cohort study was performed to analyze the clinical data from 2 428 vitrified frozen-thawed single blastocyst transfer cycles at the Reproductive Medicine Center of the 901st Hospital of the Joint Logistics Support Force of PLA between January 2015 and March 2024. Based on the re-expansion status of the blastocoel cavity after thawing, the cycles were divided into group A (110 non-re-expanded) and group B (2 318 re-expanded). After propensity score matching, there were 109 cycles in each group. Pregnancy and neonatal outcomes between the two groups were compared.Results:Before propensity score matching, there were statistical differences in percentage of good-quality blastocyst transfer, percentage of degree 4 blastocyst, percentage of endometriosis and others in reasons for infertility between the two groups (all P<0.05). After propensity score matching, there were no statistical differences in baseline characteristics between the two groups (all P>0.05). The clinical pregnancy rate [27.52% (30/109)], the ongoing pregnancy rate [21.10% (23/109)] and the live birth rate [19.27% (21/109)] in group A were all significantly lower than those in group B [61.47% (67/109), 51.38% (56/109), 47.70% (52/109), all P<0.001]. Neonatal outcomes showed no statistically significant differences between the two groups in terms of birth weight, neonatal length, malformation rate, monozygotic twin rate and male neonatal rate (all P>0.05). Conclusion:Transfer of non-re-expanded blastocysts after thawing may reduce clinical pregnancy rate but does not negatively affect neonatal outcomes.

Objective To construct nomogram models to predict the risk factors for early death in patients with metastatic melanoma(MM).Methods The study covered 2138 cases from the Surveillance,Epidemiology,and End Results Program(SEER)database and all these patients were diagnosed with MM between 2010 and 2015.Logistic regression was performed to identify independent risk factors affecting early death in MM patients.These risk factors were then used to construct nomograms of all-cause early death and cancer-specific early death.The efficacy of the model was assessed with receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA).In addition,external validation of the model was performed with clinicopathologic data of 105 patients diagnosed with MM at Sichuan Cancer Hospital between January 2015 and January 2020.Results According to the results of logistic regression,marital status,the primary site,N staging,surgery,chemotherapy,bone metastases,liver metastases,lung metastases,and brain metastases could be defined as independent predictive factors for early death.Based on these factors,2 nomograms were plotted to predict the risks of all-cause early death and cancer-specific early death,respectively.For the models for all-cause and cancer-specific early death,the areas under the curve(AUCs)for the training group were 0.751(95%confidence interval[CI]:0.726-0.776)and 0.740(95%CI:0.714-0.765),respectively.The AUCs for the internal validation group were 0.759(95%CI:0.722-0.797)and 0.757(95%CI:0.718-0.780),respectively,while the AUCs for the external validation group were 0.750(95%CI:0.649-0.850)and 0.741(95%CI:0.644-0.838),respectively.The calibration curves showed high agreement between the predicted and the observed probabilities.DCA analysis indicated high clinical application value of the models.Conclusion The nomogram models demonstrated good performance in predicting early death in MM patients and can be used to help clinical oncologists develop more individualized treatment strategies.

Objective:To investigate the clinical value of single embryo transfer for the patients with gonadotropin-releasing hormone (GnRH) antagonist protocol.Methods:The clinical data of the patients underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in Reproductive Medicine Center, the 901th Hospital of the Joint Logistics Support Force of PLA from January 2017 to March 2021 were retrospectively analyzed in this cohort study. According to the days of embryo development and No. of embryos, patients were divided into day 3 (D3) single top-quality cleavage-stage embryo transfer group (single top-quality embryo group), D3 double top-quality cleavage-stage embryo transfer group (double top-quality embryos group), and single blastocyst transfer group. In fresh cycles, there were 301 patients in single top-quality embryo group, 253 patients in double top-quality embryos group and 127 patients in single blastocyst group in frozen-thawed embryo transfer (FET) cycles,there were 84 patients in single top-quality embryo group, 136 patients in double top-quality embryos group and 396 patients in single blastocyst group in first FET cycles after all embryos frozen,there were 69 patients in single top-quality group and 161 patients in single blastocyst group. The rates of clinical pregnancy, implantation, multiple pregnancy, early abortion and ongoing pregnancy in the fresh and FET cycles were compared among single top-quality embryo group, double top-quality embryos group and single blastocyst group. Also, the rates of clinical pregnancy, implantation, multiple pregnancy, early abortion and ongoing pregnancy of single top-quality embryo transfer and single blastocyst transfer were compared between the fresh cycle and the first FET cycle. One-way ANOVA and chi-square test were used in this study. Results:There were no significant difference in duration of infertility, body mass index (BMI), the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, anti-Müllerian hormone (AMH), gonadotropin (Gn) and the numbers of oocytes retrieved among all the groups (all P>0.05). There were no significant differences in the rates of clinical pregnancy, implantation, multiple pregnancy, early abortion and ongoing pregnancy between single top-quality embryo group and single blastocyst group (all P>0.05) in fresh cycle, while the clinical pregnancy rate [46.18% (139/301)], the ongoing pregnancy rate [40.86% (123/301)] and the multiple pregnancy rate [0% (0/139)] in single top-quality embryo group were significantly lower than those in double top-quality embryos group [58.89% (149/253), P<0.001; 52.17% (132/253), P<0.001; 30.20% (45/149), P<0.001], with the similar implantation rate between the two groups ( P>0.016 7). The rates of clinical pregnancy, implantation and ongoing pregnancy were comparable between single top-quality embryo group and double top-quality embryos group in FET cycle ( P>0.016 7), while which were all significantly lower than those in single blastocyst group [62.88% (249/396), P<0.001; 63.89% (253/396), P<0.001; 55.30% (219/396), P<0.001]. The multiple pregnancy rate of double top-quality embryos group [20.37% (11/54)] was significantly higher than that of single top-quality embryo group [0% (0/27), P=0.013] in FET cycle. The ongoing pregnancy rate of the single top-quality embryo transfer in first FET cycle [27.54% (19/69)] was significantly lower than that in fresh cycle [40.86% (123/301), P=0.040], while the clinical pregnancy rate [63.35% (102/161)] and the implantation rate [63.98% (103/161)] of single blastocyst transfer in first FET cycle were significantly higher than those in fresh cycle [50.39% (64/127), P=0.027; 51.97% (66/127), P=0.040]. Conclusion:The clinical outcomes of D3 single top-quality cleavage-stage embryo transfer were similar to D5 single blastocyst transfer in fresh cycle, while the clinical outcomes of single blastocyst transfer in FET cycle were better compared with fresh cycle for the patients with GnRH antagonist protocol. Single embryo transfer can significantly reduce the multiple pregnancy rate of IVF/ICSI .

Objective:To investigate the clinical value of single embryo transfer for the patients with gonadotropin-releasing hormone (GnRH) antagonist protocol.Methods:The clinical data of the patients underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in Reproductive Medicine Center, the 901th Hospital of the Joint Logistics Support Force of PLA from January 2017 to March 2021 were retrospectively analyzed in this cohort study. According to the days of embryo development and No. of embryos, patients were divided into day 3 (D3) single top-quality cleavage-stage embryo transfer group (single top-quality embryo group), D3 double top-quality cleavage-stage embryo transfer group (double top-quality embryos group), and single blastocyst transfer group. In fresh cycles, there were 301 patients in single top-quality embryo group, 253 patients in double top-quality embryos group and 127 patients in single blastocyst group in frozen-thawed embryo transfer (FET) cycles,there were 84 patients in single top-quality embryo group, 136 patients in double top-quality embryos group and 396 patients in single blastocyst group in first FET cycles after all embryos frozen,there were 69 patients in single top-quality group and 161 patients in single blastocyst group. The rates of clinical pregnancy, implantation, multiple pregnancy, early abortion and ongoing pregnancy in the fresh and FET cycles were compared among single top-quality embryo group, double top-quality embryos group and single blastocyst group. Also, the rates of clinical pregnancy, implantation, multiple pregnancy, early abortion and ongoing pregnancy of single top-quality embryo transfer and single blastocyst transfer were compared between the fresh cycle and the first FET cycle. One-way ANOVA and chi-square test were used in this study. Results:There were no significant difference in duration of infertility, body mass index (BMI), the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, anti-Müllerian hormone (AMH), gonadotropin (Gn) and the numbers of oocytes retrieved among all the groups (all P>0.05). There were no significant differences in the rates of clinical pregnancy, implantation, multiple pregnancy, early abortion and ongoing pregnancy between single top-quality embryo group and single blastocyst group (all P>0.05) in fresh cycle, while the clinical pregnancy rate [46.18% (139/301)], the ongoing pregnancy rate [40.86% (123/301)] and the multiple pregnancy rate [0% (0/139)] in single top-quality embryo group were significantly lower than those in double top-quality embryos group [58.89% (149/253), P<0.001; 52.17% (132/253), P<0.001; 30.20% (45/149), P<0.001], with the similar implantation rate between the two groups ( P>0.016 7). The rates of clinical pregnancy, implantation and ongoing pregnancy were comparable between single top-quality embryo group and double top-quality embryos group in FET cycle ( P>0.016 7), while which were all significantly lower than those in single blastocyst group [62.88% (249/396), P<0.001; 63.89% (253/396), P<0.001; 55.30% (219/396), P<0.001]. The multiple pregnancy rate of double top-quality embryos group [20.37% (11/54)] was significantly higher than that of single top-quality embryo group [0% (0/27), P=0.013] in FET cycle. The ongoing pregnancy rate of the single top-quality embryo transfer in first FET cycle [27.54% (19/69)] was significantly lower than that in fresh cycle [40.86% (123/301), P=0.040], while the clinical pregnancy rate [63.35% (102/161)] and the implantation rate [63.98% (103/161)] of single blastocyst transfer in first FET cycle were significantly higher than those in fresh cycle [50.39% (64/127), P=0.027; 51.97% (66/127), P=0.040]. Conclusion:The clinical outcomes of D3 single top-quality cleavage-stage embryo transfer were similar to D5 single blastocyst transfer in fresh cycle, while the clinical outcomes of single blastocyst transfer in FET cycle were better compared with fresh cycle for the patients with GnRH antagonist protocol. Single embryo transfer can significantly reduce the multiple pregnancy rate of IVF/ICSI .

Objective:To investigate the effects of blastulation and transferred blastocyst derived from the 4-5-cell grade I to III (4/I-5/III) embryos on day 3 on clinical outcomes of in vitro fertilization and embryo transfer (IVF-ET). Methods:A total of 884 IVF cycles with blastocyst culture in the 901st Hospital of the Joint Logistics Support Force of PLA from January 2016 to February 2019 were retrospectively analyzed. The blastocyst formation status was compared among the 4/I-5/III embryos. Blastocyst derived from 4/I-5/III embryos in transfer cycle was served as group A ( n=164), blastocyst derived from good-quality cleavage stage embryos (7/I-10/II) in transfer cycle was served as group B ( n=247) according to quality of cleavage stage embryos on day 3. The clinical outcomes were compared between the two groups. The effects of different blastomere number and grade on clinical pregnancy rate and spontaneous abortion rate were evaluated among the 4/I-5/III embryos. Results:Good-quality blastulation rate for 4/I, 4/II, 4/III, 5/I, 5/II and 5/III were 5.6%, 1.8%, 0.6%, 8.3%, 8.4% and 1.6%, respectively. The differences reached statistical significances ( P<0.05). There were no significant differences in number of oocytes retrieved, number of mature oocytes, fertilization rate, cleavage rate, number of transferred embryos, percentage of good-quality blastocyst transfer cycles, clinical pregnancy rate, spontaneous abortion rate, implantation rate and ongoing pregnancy rate between group A and group B ( P>0.05), group A had higher number of embryo transfer cycles ( P=0.034) and lower good-quality embryo rate on day 3 ( P<0.001). There were no significant differences in clinical pregnancy rate and spontaneous abortion rate between transferred blastocyst derived from the 4-cell and 5-cell embryo (51.6% vs. 50.0%；15.2% vs. 26.8%, respectively). There were no significant differences in clinical pregnancy rate and spontaneous abortion rate between transferred blastocyst derived from grade I+II and grade III (4/I-5/III) (53.6% vs. 41.2%； 22.4% vs. 21.4%, respectively). Conclusion:Blastocyst derived from 4/I-5/III embryos and good cleavage stage embryos both are similar clinical outcomes in blastocyst transfer cycles, there are no effects of blastomere number and grade on clinical pregnancy rate and abortion rate in blastocyst transfer cycles, but blastulation rate derived from 5-cell embryo was significantly higher than that of 4-cell embryo.

Objective:To investigate the effects of blastulation and transferred blastocyst derived from the 4-5-cell grade I to III (4/I-5/III) embryos on day 3 on clinical outcomes of in vitro fertilization and embryo transfer (IVF-ET). Methods:A total of 884 IVF cycles with blastocyst culture in the 901st Hospital of the Joint Logistics Support Force of PLA from January 2016 to February 2019 were retrospectively analyzed. The blastocyst formation status was compared among the 4/I-5/III embryos. Blastocyst derived from 4/I-5/III embryos in transfer cycle was served as group A ( n=164), blastocyst derived from good-quality cleavage stage embryos (7/I-10/II) in transfer cycle was served as group B ( n=247) according to quality of cleavage stage embryos on day 3. The clinical outcomes were compared between the two groups. The effects of different blastomere number and grade on clinical pregnancy rate and spontaneous abortion rate were evaluated among the 4/I-5/III embryos. Results:Good-quality blastulation rate for 4/I, 4/II, 4/III, 5/I, 5/II and 5/III were 5.6%, 1.8%, 0.6%, 8.3%, 8.4% and 1.6%, respectively. The differences reached statistical significances ( P<0.05). There were no significant differences in number of oocytes retrieved, number of mature oocytes, fertilization rate, cleavage rate, number of transferred embryos, percentage of good-quality blastocyst transfer cycles, clinical pregnancy rate, spontaneous abortion rate, implantation rate and ongoing pregnancy rate between group A and group B ( P>0.05), group A had higher number of embryo transfer cycles ( P=0.034) and lower good-quality embryo rate on day 3 ( P<0.001). There were no significant differences in clinical pregnancy rate and spontaneous abortion rate between transferred blastocyst derived from the 4-cell and 5-cell embryo (51.6% vs. 50.0%；15.2% vs. 26.8%, respectively). There were no significant differences in clinical pregnancy rate and spontaneous abortion rate between transferred blastocyst derived from grade I+II and grade III (4/I-5/III) (53.6% vs. 41.2%； 22.4% vs. 21.4%, respectively). Conclusion:Blastocyst derived from 4/I-5/III embryos and good cleavage stage embryos both are similar clinical outcomes in blastocyst transfer cycles, there are no effects of blastomere number and grade on clinical pregnancy rate and abortion rate in blastocyst transfer cycles, but blastulation rate derived from 5-cell embryo was significantly higher than that of 4-cell embryo.

OBJECTIVE: The aim of this study was to investigate associations between the morphology score of blastocysts and blastocoele re-expansion speed after warming with clinical outcomes, which could assist in making correct and cost-effective decisions regarding the appropriate time to vitrify blastocysts and to transfer vitrified-warmed blastocysts. METHODS: A total of 327 vitrified-warmed two-blastocyst transfer cycles in women 38 years old and younger were included in this retrospective study. RESULTS: The clinical pregnancy rate (CPR) and implantation rate (IR) of transfers of two good-morphology grade 4 blastocysts vitrified on day 5 (64.1% and 46.8%, respectively) were significantly higher than the CPR and IR associated with the transfers of two good-morphology grade 3 blastocysts vitrified on day 5 (46.7% and 32.2%, respectively). No significant differences were found in the CPR and IR among the transfers of two good-morphology grade 4 blastocysts regardless of the day of cryopreservation. Logistic regression analysis showed that blastocoele re-expansion speed after warming was associated with the CPR. CONCLUSION: The selection of a good-morphology grade 4 blastocyst to be vitrified could be superior to the choice of a grade 3 blastocyst. Extending the culture of grade 3 blastocysts and freezing grade 4 or higher blastocysts on day 6 could lead to a greater likelihood of pregnancy. Since re-expansion was shown to be a morphological marker of superior blastocyst viability, blastocysts that quickly re-expand after warming should be prioritized for transfer.
Blastocyst* ; Cardiopulmonary Resuscitation ; Cryopreservation ; Embryo Transfer ; Embryonic Development ; Female ; Freezing ; Humans ; Logistic Models ; Pregnancy ; Pregnancy Outcome* ; Pregnancy Rate ; Pregnancy* ; Retrospective Studies