Objective:To explore the pregnancy outcomes of frozen-thawed embryo transfer (FET) after antibiotic treatment in patients with recurrent implantation failure (RIF) and chronic endometritis (CE).Methods:A retrospective cohort study was conducted to analyze 496 women with RIF undergoing hysteroscopy and endometrial biopsy before the next FET in Reproductive Medicine Center of Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology from January 2018 to December 2021. According to the pathological results of endometrial biopsy and subsequent treatment, the patients were divided into cured CE group (strong positive CD138 was converted to negative after antibiotic treatment, n=103), suspected CE group (weak positive CD138, n=76), non-CE group (negative CD138, n=230) and control group (hysteroscopy and diagnostic only, no CE-related histopathological screening, n=85). The pregnancy outcomes after FET were compared among the four groups. Results:The prevalence of CE in the patients with RIF was 25.5% (105/411), and the sensitivity of hysteroscopy for the diagnosis of CE was 55.2% and the specificity was 83.0%. The conversion rate of patients with CE was 86.7% (91/105) after 1 cycle of antibiotic treatment and 98.1% (103/105) after 2 cycles of treatment. After removing the confounding factors of age, ovarian reserve function, number of previous transfer cycles, number and type of embryos transferred in FET cycle, and number of high-quality embryos, multivariate regression analysis showed that the clinical pregnancy rate of the cured CE group improved significantly after antibiotic treatment ( OR=1.841, 95% CI: 1.123-3.020, P=0.029). Conclusion:Patients with RIF should be screened for CE, and if CE is diagnosed, pharmacological treatment is recommended prior to embryo transfer, which is beneficial to improve pregnancy outcomes in FET cycles.

Objective:To explore the pregnancy outcomes of frozen-thawed embryo transfer (FET) after antibiotic treatment in patients with recurrent implantation failure (RIF) and chronic endometritis (CE).Methods:A retrospective cohort study was conducted to analyze 496 women with RIF undergoing hysteroscopy and endometrial biopsy before the next FET in Reproductive Medicine Center of Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology from January 2018 to December 2021. According to the pathological results of endometrial biopsy and subsequent treatment, the patients were divided into cured CE group (strong positive CD138 was converted to negative after antibiotic treatment, n=103), suspected CE group (weak positive CD138, n=76), non-CE group (negative CD138, n=230) and control group (hysteroscopy and diagnostic only, no CE-related histopathological screening, n=85). The pregnancy outcomes after FET were compared among the four groups. Results:The prevalence of CE in the patients with RIF was 25.5% (105/411), and the sensitivity of hysteroscopy for the diagnosis of CE was 55.2% and the specificity was 83.0%. The conversion rate of patients with CE was 86.7% (91/105) after 1 cycle of antibiotic treatment and 98.1% (103/105) after 2 cycles of treatment. After removing the confounding factors of age, ovarian reserve function, number of previous transfer cycles, number and type of embryos transferred in FET cycle, and number of high-quality embryos, multivariate regression analysis showed that the clinical pregnancy rate of the cured CE group improved significantly after antibiotic treatment ( OR=1.841, 95% CI: 1.123-3.020, P=0.029). Conclusion:Patients with RIF should be screened for CE, and if CE is diagnosed, pharmacological treatment is recommended prior to embryo transfer, which is beneficial to improve pregnancy outcomes in FET cycles.

The increased levels of intracellular reactive oxygen species (ROS) in granulosa cells (GCs) may affect the pregnancy results in women with polycystic ovary syndrome (PCOS). In this study, we compared the in vitro fertilization and embryo transfer (IVF-ET) results of 22 patients with PCOS and 25 patients with tubal factor infertility and detected the ROS levels in the GCs of these two groups. Results showed that the PCOS group had significantly larger follicles on the administration day for human chorionic gonadotropin than the tubal factor group (P < 0.05); however, the number of retrieved oocytes was not significantly different between the two groups (P > 0.05). PCOS group had slightly lower fertilization, cleavage, grade I/II embryo, clinical pregnancy, and implantation rates and higher miscarriage rate than the tubal factor group (P > 0.05). We further found a significantly higher ROS level of GCs in the PCOS group than in the tubal factor group (P < 0.05). The increased ROS levels in GCs caused GC apoptosis, whereas NADPH oxidase 2 (NOX2) specific inhibitors (diphenyleneiodonium and apocynin) significantly reduced the ROS production in the PCOS group. In conclusion, the increased ROS expression levels in PCOS GCs greatly induced cell apoptosis, which further affected the oocyte quality and reduced the positive IVF-ET pregnancy results of women with PCOS. NADPH oxidase pathway may be involved in the mechanism of ROS production in GCs of women with PCOS.
Abortion, Spontaneous ; epidemiology ; Acetophenones ; therapeutic use ; Adult ; Apoptosis ; drug effects ; Embryo Transfer ; Female ; Fertilization in Vitro ; Granulosa Cells ; metabolism ; Humans ; NADPH Oxidases ; antagonists & inhibitors ; Onium Compounds ; therapeutic use ; Oocyte Retrieval ; Oxidative Stress ; Polycystic Ovary Syndrome ; drug therapy ; Pregnancy ; Pregnancy Rate ; Reactive Oxygen Species ; metabolism

Embryos with a poor morphological score at cleavage stage are usually discarded because they are considered unsuitable for transfer and cryopreservation. This study examined the in vitro blastocyst development after extended culture of these embryos and the clinical outcomes after transfer of these blastocysts in warming cycles. A total of 597 blastocysts (24.7%) were obtained from 2421 embryos with low morphological scores after extended culture. One hundred and sixty blastocysts (6.6%) with optimal morphology were vitrified. Embryo utilization rate was increased from 30.8% to 32.6%. After warming, 61 out of 92 blastocysts (66.3%) survived and were transferred in 44 cycles. The clinical pregnancy rate and the implantation rate were 40.9% (18/44) and 32.8% (20/61) respectively. Thirteen healthy babies were born, and 5 pregnancies aborted spontaneously. Our study suggested that some blastocysts derived from embryos with a poor morphological score can be successfully vitrified and give rise to live births. Selection and vitrification of viable embryos after extended culture of embryos with a poor morphological score may constitute a proposal to avoid embryo wastage.
Adult ; Cryopreservation ; methods ; Embryo Culture Techniques ; methods ; Embryo Transfer ; methods ; statistics & numerical data ; Female ; Fertilization in Vitro ; methods ; statistics & numerical data ; Humans ; Infertility ; pathology ; therapy ; Middle Aged ; Pregnancy ; Pregnancy Outcome ; Vitrification ; Young Adult

Embryos with a poor morphological score at cleavage stage are usually discarded because they are considered unsuitable for transfer and cryopreservation. This study examined the in vitro blastocyst development after extended culture of these embryos and the clinical outcomes after transfer of these blastocysts in warming cycles. A total of 597 blastocysts (24.7%) were obtained from 2421 embryos with low morphological scores after extended culture. One hundred and sixty blastocysts (6.6%) with optimal morphology were vitrified. Embryo utilization rate was increased from 30.8% to 32.6%. After warming, 61 out of 92 blastocysts (66.3%) survived and were transferred in 44 cycles. The clinical pregnancy rate and the implantation rate were 40.9% (18/44) and 32.8% (20/61) respectively. Thirteen healthy babies were born, and 5 pregnancies aborted spontaneously. Our study suggested that some blastocysts derived from embryos with a poor morphological score can be successfully vitrified and give rise to live births. Selection and vitrification of viable embryos after extended culture of embryos with a poor morphological score may constitute a proposal to avoid embryo wastage.

The debate exists whether or not gonadotropin-releasing hormone (GnRH) analogs used in controlled ovarian hyperstimulation (COH) impair endometrial receptivity. Homeobox A11 (Hoxa11), Meis homeobox 1 (Meis1), cadherin 1 (Cdh1), and catenin beta 1 (Ctnnb1) are well known to be involved in successful implantation. In this study, the endometrial expression of Hoxa11, Meis1, Cdh1, and Ctnnb1 during the peri-implantation period was investigated in an in vitro fertilization (IVF) mouse model by real-time RT-PCR and Western blot to evaluate the relationship between Hoxa11, Meis1, Cdh1, and Ctnnb1 expression and the impact of the COH on endometrial receptivity. The mimic COH protocols included GnRH agonist plus human menopausal gonadotropin (HMG) (GnRH agonist group), GnRH antagonist plus HMG (GnRH antagonist group), and HMG alone (HMG group). The expression levels of Hoxa11, Meis1, Cdh1, and Ctnnb1 mRNA and protein were decreased in all of the COH groups. The expression levels of Hoxa11 and Ctnnb1 were the lowest in the GnRH agonist group, and those of Meis1 and Cdh1 were lower in the GnRH analog groups than the HMG group. There were positive correlations between the expression of Hoxa11 and Ctnnb1, as well as the expression of Meis1 and Cdh1 among all the groups. In conclusion, the COH protocols, particularly with GnRH analogs, suppressed Hoxa11, Meis1, Ctnnb1 and Cdh1 expression, in mouse endometrium during the peri-implantation period. Our data reveal a novel molecular mechanism by which the COH protocols might impair endometrial receptivity.

The debate exists whether or not gonadotropin-releasing hormone (GnRH) analogs used in controlled ovarian hyperstimulation (COH) impair endometrial receptivity.Homeobox A11 (Hoxall),Meis homeobox 1 (Meisl),cadherin 1 (Cdhl),and catenin beta 1 (Ctnnbl) are well known to be involved in successful implantation.In this study,the endometrial expression of Hoxall,Meisl,Cdhl,and Ctnnbl during the peri-implantation period was investigated in an in vitro fertilization (IVF) mouse model by real-time RT-PCR and Western blot to evaluate the relationship between Hoxall,Meisl,Cdhl,and Ctnnbl expression and the impact of the COH on endometrial receptivity.The mimic COH protocols included GnRH agonist plus human menopausal gonadotropin (HMG) (GnRH agonist group),GnRH antagonist plus HMG (GnRH antagonist group),and HMG alone (HMG group).The expression levels of Hoxall,Meisl,Cdhl,and Ctnnbl mRNA and protein were decreased in all of the COH groups.The expression levels of Hoxall and Ctnnbl were the lowest in the GnRH agonist group,and those of Meisl and Cdbl were lower in the GnRH analog groups than the HMG group.There were positive correlations between the expression of Hoxall and Ctnnbl,as well as the expression of Meisl and Cdhl among all the groups.In conclusion,the COH protocols,particularly with GnRH analogs,suppressed Hoxall,Meisl,Ctnnbl and Cdhl expression,in mouse endometrium during the peri-implantation period.Our data reveal a novel molecular mechanism by which the COH protocols might impair endometrial receptivity.

To assess the relationship between pronuclear scoring and day-3 embryo quality and pregnancy outcome and to determine the clinical value of pronuclear stage scoring system in human in vitro fertilization-embryo transfer (IVF-ET) program, a pronuclear scoring system was used to score zygotes 16-20 h after insemination during conventional IVF or intracytoplasmic sperm injection (ICSI). The embryos were classified into groups Z1, Z2, Z3 and Z4. Comparisons were made of the rates of arrested embryos and excellent embryos on day 3. Comparisons of pregnancy outcome were made only in those patients in whom cohorts of similarly Z-scored embryos were transferred. The results showed that there were less arrested embryos and more excellent embryos on day 3 in groups Z1 and Z2 than those in group Z3 and Z4. More embryos arrested and less excellent embryos developed in group Z4 than group Z3. The clinical pregnancy rates resulting from the transfer of single pronuclear score homologous embryo types were similar among groups Z1, Z2 and Z3. Implantation rates of group Z1 were higher (P<0.05) than that of group Z3. These findings suggests that pronuclear scoring can predict developmental ability on day 3 and implantation potential. A evaluation that combines the Z-score and day 3 embryo morphology is useful in the determination of the most viable embryos and the number of embryos for transfer.
Cell Nucleus/*metabolism ; Embryo Implantation ; Embryo Transfer/*methods ; Fertilization in Vitro ; Infertility/therapy ; Models, Biological ; Oocytes/metabolism ; Ovary/*metabolism ; Pregnancy Outcome ; Spermatozoa/metabolism

To assess the relationship between pronuclear scoring and day-3 embryo quality and pregnancy outcome and to determine the clinical value of pronuclear stage scoring system in human in vitro fertilization-embryo transfer (WF-ET) program, a pronuclear scoring system was used to score zygotes 16-20 h after insemination during conventional WF or intracytoplasmic sperm injec- tion (ICS1). The embryos were classified into groups Z1, Z2, Z3 and Z4. Comparisons were made of the rates of arrested embryos and excellent embryos on day 3. Comparisons of pregnancy outcome were made only in those patients in whom cohorts of similarly Z-scored embryos were transferred. The results showed that there were less arrested embryos and more excellent embryos on day 3 in groups Z1 and Z2 than those in group Z3 and Z4. More embryos arrested and less excellent embryos developed in group Z4 than group Z3. The clinical pregnancy rates resulting from the transfer of single pronuclear score homologous embryo types were similar among groups Z1, Z2 and Z3. Implanta- tion rates of group Z1 were higher (P<0.05) than that of group Z3. These findings suggests that pro- nuclear scoring can predict developmental ability on day 3 and implantation potential. A evaluation that combines the Z-score and day 3 embryo morphology is useful in the determination of the most viable embryos and the number of embryos for transfer.

Summary: In order to compare GnRH agonist with antagonist protocol for the same patient during controlled ovarian stimulation cycles, the in vitro fertilization and embryo transfer (IVF-ET) outcome was retrospectively studied in 81 patients undergoing 105 agonist protocols and 88 antagonist protocols. The results showed that there was no statistically significant difference in duration of ovarian stimulation, number of ampoules, oocytes retrieved, serum estradiol (E2) and progesterone (P) levels,thickness of endometrium, the zygote-and blastocyst-developmcnt rate between GnRH agonist and antagonist protocols (P>0.05). High quality embryo rate was higher in antagonist protocols, but there was no significant difference between two protocols. Implantation rate and clinical pregnant rate were significantly higher in antagonist protocol (15.82% and 30.26%, respectively) than in agonist protocol (5.26% and 10.64% respectively (P<0.05). It was concluded GnRH antagonist protocol probably improved the outcome of pregnancy of older patients with a history of multiple failure of IVF-ET in a GnRH protocol.