Tuberculosis (TB) is a prominent infectious disease globally that imposes a substantial health burden. Genital TB (GTB), an extrapulmonary manifestation, leads to complications such as tubal adhesions, blockage, and diminished ovarian function, culminating in infertility, and is recognized as a prevalent cause of infertility in nations with high-burden TB. In regions with low TB rates, infertility and active TB during pregnancy have been reported to be most common among female immigrants from countries with high-burden TB. In the context of TB, pregnant women often exhibit exacerbated symptoms after in vitro fertilization-embryo transfer (IVF-ET), heightening the risk of dissemination. Miliary pulmonary TB and tuberculous meningitis pose a serious threat to maternal and fetal health. This article integrates recent epidemiological data and clinical research findings, delineating the impact of TB on infertility and assisted reproduction and particularly focusing on the diagnosis and treatment of GTB, underscored by the imperative of TB screening before IVF-ET. Our objective is to increase awareness among respiratory and reproductive health professionals, promoting multidisciplinary management to enhance clinical vigilance. This approach seeks to provide patients with judicious reproductive plans and scientifically rigorous pregnancy management, thereby mitigating adverse pregnancy outcomes related to TB activity.

Objective:To investigate the incidence rate and development trend of birth defects in offspring after assisted reproductive technology (ART) in Beijing from 2010 to 2019.Methods:The institutions that carry out ART in Beijing were retrospectively investigated. The follow-up outcomes and the incidence of birth defects in a total of 389 978 ART treatment cycles were collected from 8 ART institutions between January 1, 2010 to December 31, 2019.Results:There were 1 367 ART pregnancies with birth defects, and the overall incidence rate was 120.87/10 000. The most common anomalies were malformations of circulatory system. The annual increase in birth defects was slightly higher during the pregnancy loss cycles (108.36%) than during the delivery cycles (103.77%). There was no significant difference in the prevalence of birth defects between artificial insemination (123.15?) and in vitro fertilization technology (105.23? , P=0.097). Conclusion:In recent 10 years, the incidence rate of birth defects in offspring conceived by ART at 8 reproductive centers in Beijing showed an increasing trend. The implementation of the tertiary prevention strategy of birth defects should be further strengthened to reduce the number of newborns with birth defects.

Objective:To explore the curative effect of fertility-preserving therapy for endometrial carcinoma patient with KRAS gene mutation and the choice of pregnancy-assisting strategy. Methods:We reported the fertility-preserving treatment and pregnancy-assisted process of a case of endometrial carcinoma patient with KRAS gene mutation and analyzed the related literatures. Results:After 20 months of treatment with highly effective progestogen and intrauterine levonorgestrel-releasing intrauterine system (LNG-IUS), the patient achieved complete remission. Antagonist plus letrozole was used to induce ovulation. After LNG-IUS was taken out, the pregnancy from blastocyst transfer was achieved after downregulation and artificial cycle, and a live baby girl was born at term.Conclusion:Endometrial carcinoma patient with KRAS gene mutation can achieve complete remission and fertility after combined treatment, but the treatment period is long, therefore, it is necessary to closely monitor changes of the disease.

Objective:To investigate the incidence rate and development trend of birth defects in offspring after assisted reproductive technology (ART) in Beijing from 2010 to 2019.Methods:The institutions that carry out ART in Beijing were retrospectively investigated. The follow-up outcomes and the incidence of birth defects in a total of 389 978 ART treatment cycles were collected from 8 ART institutions between January 1, 2010 to December 31, 2019.Results:There were 1 367 ART pregnancies with birth defects, and the overall incidence rate was 120.87/10 000. The most common anomalies were malformations of circulatory system. The annual increase in birth defects was slightly higher during the pregnancy loss cycles (108.36%) than during the delivery cycles (103.77%). There was no significant difference in the prevalence of birth defects between artificial insemination (123.15?) and in vitro fertilization technology (105.23? , P=0.097). Conclusion:In recent 10 years, the incidence rate of birth defects in offspring conceived by ART at 8 reproductive centers in Beijing showed an increasing trend. The implementation of the tertiary prevention strategy of birth defects should be further strengthened to reduce the number of newborns with birth defects.

Objective:To explore the curative effect of fertility-preserving therapy for endometrial carcinoma patient with KRAS gene mutation and the choice of pregnancy-assisting strategy. Methods:We reported the fertility-preserving treatment and pregnancy-assisted process of a case of endometrial carcinoma patient with KRAS gene mutation and analyzed the related literatures. Results:After 20 months of treatment with highly effective progestogen and intrauterine levonorgestrel-releasing intrauterine system (LNG-IUS), the patient achieved complete remission. Antagonist plus letrozole was used to induce ovulation. After LNG-IUS was taken out, the pregnancy from blastocyst transfer was achieved after downregulation and artificial cycle, and a live baby girl was born at term.Conclusion:Endometrial carcinoma patient with KRAS gene mutation can achieve complete remission and fertility after combined treatment, but the treatment period is long, therefore, it is necessary to closely monitor changes of the disease.

Objective:To explore the economical and effective strategies for patients treated with intrauterine insemination (IUI).Methods:We retrospectively analyzed in a cohort study the clinical data of the first IUI cycle of 2266 couples who were treated from January 1, 2020 to December 31, 2020 in Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital. According to the times of insemination in one IUI treatment cycle, patients were divided into two groups: single IUI group (2158 cycles) and double IUI group (108 cycles). The differences in clinical pregnancy rate and cost-effectiveness were analyzed. According to the whether treated with ovulation induction and ovulation induction medicines, patients were divided into two groups: natural cycle group (1163 cycles) and ovulation induction cycle group (1103 cycles). The ovulation induction cycle group were further divided into three subgroups according to ovulation induction medicines: clomiphene (CC)/CC+human menopausal gonadotropin (hMG) subgroup ( n=324), letrozole (LE)/LE+hMG subgroup ( n=670) and hMG subgroup ( n=109). IUI outcomes were compared and analyzed in these groups. Results:1) There were no significant differences in age, body mass index (BMI), duration of infertility, endometrial thickness and clinical pregnancy rate between single IUI group and double IUI group (all P>0.05). The medical expenses of the double IUI group was significantly higher than that of the single IUI group [(1 786.06±173.80) yuan vs. (3 172.99±174.91) yuan, P<0.001]. 2) There was no statistically significant difference in the clinical pregnancy rate between single IUI and double IUI group with female factor, male factor, unexplained infertility, natural cycle and ovulation induction cycle (all P>0.05). For single IUI, there was a significant difference in the clinical pregnancy rate among the three different causes of infertility ( P=0.012), and the difference between the female infertility and the unknown cause of infertility was statistically significant ( P=0.003). For double IUI, there was no significant difference in the clinical pregnancy rate among the three groups ( P=0.477). The clinical pregnancy rate of ovulation induction cycle [14.0% (145/1039)] was higher than that of natural cycle [7.8% (87/1119), P<0.001]. There was no significant difference in clinical pregnancy rate between ovulation induction cycle group and natural cycle group in patients with double IUI ( P=0.774). 3) After ovulation induction, the clinical pregnancy rates of CC/CC+hMG and LE/LE+hMG subgroups [13.9% (45/324),14.6% (98/670)] were significantly higher than that of the natural cycle group [7.9% (92/1163); P=0.001, P<0.001]. Ovulation induction with CC/CC+hMG or LE/LE+hMG was an independent factor improving the clinical pregnancy rate of IUI by multivariate logistic regression analysis [ OR(95% CI)=1.794(1.216-2.647), P=0.003; OR(95% CI)=1.892(1.382-2.589), P<0.001]. Conclusion:Double IUI had similar clinical pregnancy rate with the single IUI, but the treatment cost was higher. So the double IUI is not recommended. Ovulation induction therapy could improve the clinical pregnancy rate. Ovulation induction with LE/LE+hMG had the highest clinical pregnancy rate and good security as well.

Objective:To explore the economical and effective strategies for patients treated with intrauterine insemination (IUI).Methods:We retrospectively analyzed in a cohort study the clinical data of the first IUI cycle of 2266 couples who were treated from January 1, 2020 to December 31, 2020 in Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital. According to the times of insemination in one IUI treatment cycle, patients were divided into two groups: single IUI group (2158 cycles) and double IUI group (108 cycles). The differences in clinical pregnancy rate and cost-effectiveness were analyzed. According to the whether treated with ovulation induction and ovulation induction medicines, patients were divided into two groups: natural cycle group (1163 cycles) and ovulation induction cycle group (1103 cycles). The ovulation induction cycle group were further divided into three subgroups according to ovulation induction medicines: clomiphene (CC)/CC+human menopausal gonadotropin (hMG) subgroup ( n=324), letrozole (LE)/LE+hMG subgroup ( n=670) and hMG subgroup ( n=109). IUI outcomes were compared and analyzed in these groups. Results:1) There were no significant differences in age, body mass index (BMI), duration of infertility, endometrial thickness and clinical pregnancy rate between single IUI group and double IUI group (all P>0.05). The medical expenses of the double IUI group was significantly higher than that of the single IUI group [(1 786.06±173.80) yuan vs. (3 172.99±174.91) yuan, P<0.001]. 2) There was no statistically significant difference in the clinical pregnancy rate between single IUI and double IUI group with female factor, male factor, unexplained infertility, natural cycle and ovulation induction cycle (all P>0.05). For single IUI, there was a significant difference in the clinical pregnancy rate among the three different causes of infertility ( P=0.012), and the difference between the female infertility and the unknown cause of infertility was statistically significant ( P=0.003). For double IUI, there was no significant difference in the clinical pregnancy rate among the three groups ( P=0.477). The clinical pregnancy rate of ovulation induction cycle [14.0% (145/1039)] was higher than that of natural cycle [7.8% (87/1119), P<0.001]. There was no significant difference in clinical pregnancy rate between ovulation induction cycle group and natural cycle group in patients with double IUI ( P=0.774). 3) After ovulation induction, the clinical pregnancy rates of CC/CC+hMG and LE/LE+hMG subgroups [13.9% (45/324),14.6% (98/670)] were significantly higher than that of the natural cycle group [7.9% (92/1163); P=0.001, P<0.001]. Ovulation induction with CC/CC+hMG or LE/LE+hMG was an independent factor improving the clinical pregnancy rate of IUI by multivariate logistic regression analysis [ OR(95% CI)=1.794(1.216-2.647), P=0.003; OR(95% CI)=1.892(1.382-2.589), P<0.001]. Conclusion:Double IUI had similar clinical pregnancy rate with the single IUI, but the treatment cost was higher. So the double IUI is not recommended. Ovulation induction therapy could improve the clinical pregnancy rate. Ovulation induction with LE/LE+hMG had the highest clinical pregnancy rate and good security as well.

Inflammatory bowel disease (IBD) is more common in young and middle-aged people and they face the problems of childbirth and eugenics. Therefore, the evaluation of fertility in patients with IBD is important to guide pregnancy and fertility. This article reviews the common indicators of fertility evaluation and the changes of fertility in patients with IBD. It is recommended to evaluate the fertility of women and men before pregnancy if it is necessary, especially to evaluate the disease activity and medications. Multidisciplinary team (MDT) consultation including departments of gastroenterology, surgery, obstetrics and gynecology, reproductive medicine and andrology should be carried out when conditions permit, so as to increase pregnancy success rate, reduce pregnancy complications and pregnancy loss rates, achieve safe and rational use of medication and the goal of eugenics.

Inflammatory bowel disease (IBD) is more common in young and middle-aged people and they face the problems of childbirth and eugenics. Therefore, the evaluation of fertility in patients with IBD is important to guide pregnancy and fertility. This article reviews the common indicators of fertility evaluation and the changes of fertility in patients with IBD. It is recommended to evaluate the fertility of women and men before pregnancy if it is necessary, especially to evaluate the disease activity and medications. Multidisciplinary team (MDT) consultation including departments of gastroenterology, surgery, obstetrics and gynecology, reproductive medicine and andrology should be carried out when conditions permit, so as to increase pregnancy success rate, reduce pregnancy complications and pregnancy loss rates, achieve safe and rational use of medication and the goal of eugenics.

Objective: To investigate the diagnosis and treatment for enterocutaneous fistula (ECF) in China, and to explore the prognostic factors of ECF. Methods: A multi-center cross-sectional study was conducted based on the Registration System of Chinese Gastrointestinal Fistula and Intra-Abdominal Infections to collect the clinical data of ECF patients from 54 medical centers in 22 provinces/municipalities from January 1, 2018 to December 31, 2018. The clinical data included patient gender, age, length of hospital stay, intensive care unit (ICU) admission, underlying diseases, primary diseases, direct causes of ECF, location and type of ECF, complications, treatment and outcomes. All medical records were carefully filled in by the attending physicians, and then re-examined by more than two specialists. The diagnosis of ECF was based on the clinical manifestations, laboratory/imaging findings and intraoperative exploration. Results: A total of 1521 patients with ECF were enrolled, including 1099 males and 422 females, with a median age of 55 years. The top three primary diseases of ECF were malignant tumors in 626 cases (41.2%, including 540 gastrointestinal tumors, accounting for 86.3% of malignant tumors), gastrointestinal ulcers and perforations in 202 cases (13.3%), and trauma in 157 cases (10.3%). The direct causes of ECF were mainly surgical operation in 1194 cases (78.5%), followed by trauma in 156 (10.3%), spontaneous fistula due to Crohn′s disease in 92 (6.0%), radiation intestinal injury in 41 (2.7%), severe pancreatitis in 20 (1.3%), endoscopic treatment in 13 (0.9%) and 5 cases (0.3%) of unknown reasons. All the patients were divided into three groups: 1350 cases (88.7%) with simple ECF, 150 (9.9%) with multiple ECF, and 21 (1.4%) with combined internal fistula. Among the patients with simple ECF, 438 cases (28.8%) were jejuno-ileal fistula, 313 (20.6%) colon fistula, 170 (11.2%) rectal fistula, 111 (7.3%) duodenal fistula, 76 (5.0%) ileocecal fistula, 65 (4.3%) ileocolic anastomotic fistula, 55 (3.6%) duodenal stump fistula, 36 (2.4%) gastrointestinal anastomotic fistula, 36 (2.4%) esophagogastric/esophagojejunal anastomotic fistula, 29 (1.9%) gastric fistula and 21 (1.4%) cholangiopancreatiointestinal. Among all the simple ECF patients, 991 were tubular fistula and 359 were labial fistula. A total of 1146 patients finished the treatment, of whom 1061 (92.6%) were healed (586 by surgery and 475 self-healing) and 85 (7.4%) died. A total of 1043 patients (91.0%) received nutritional support therapy, and 77 (6.7%) received fistuloclysis. Infectious source control procedures were applied to 1042 patients, including 711 (62.0%) with active lavage and drainage and 331 (28.9%) with passive drainage. Among them, 841 patients (73.4%) underwent minimally invasive procedures of infectious source control (replacement of drainage tube through sinus tract, puncture drainage, etc.), 201 (17.5%) underwent laparotomy drainage, while 104 (9.1%) did not undergo any drainage measures. A total of 610 patients (53.2%) received definitive operation, 24 patients died within postoperative 30-day with mortality of 3.9% (24/610), 69 (11.3%) developed surgical site infection (SSI), and 24 (3.9%) had a relapse of fistula. The highest cure rate was achieved in ileocecal fistula (100%), followed by rectal fistula (96.2%, 128/133) and duodenal stump fistula (95.7%,44/46). The highest mortality was found in combined internal fistula (3/12) and no death in ileocecal fistula. Univariate prognostic analysis showed that primary diseases as Crohn′s disease (χ²=6.570, P=0.010) and appendicitis/appendiceal abscess (P=0.012), intestinal fistula combining with internal fistula (χ²=5.460, P=0.019), multiple ECF (χ²=7.135, P=0.008), esophagogastric / esophagojejunal anastomotic fistula (χ²=9.501, P=0.002), ECF at ileocecal junction (P=0.012), non-drainage/passive drainage before the diagnosis of intestinal fistula (χ²=9.688, P=0.008), non-drainage/passive drainage after the diagnosis of intestinal fistula (χ²=9.711, P=0.008), complicating with multiple organ dysfunction syndrome (MODS) (χ²=179.699, P<0.001), sepsis (χ²=211.851, P<0.001), hemorrhage (χ²=85.300, P<0.001), pulmonary infection (χ²=60.096, P<0.001), catheter-associated infection (χ²=10.617, P=0.001) and malnutrition (χ²=21.199, P<0.001) were associated with mortality. Multivariate prognostic analysis cofirmed that sepsis (OR=7.103, 95%CI:3.694-13.657, P<0.001), complicating with MODS (OR=5.018, 95%CI:2.170-11.604, P<0.001), and hemorrhage (OR=4.703, 95%CI: 2.300-9.618, P<0.001) were independent risk factors of the death for ECF patients. Meanwhile, active lavage and drainage after the definite ECF diagnosis was the protective factor (OR=0.223, 95%CI: 0.067-0.745, P=0.015). Conclusions The overall mortality of ECF is still high. Surgical operation is the most common cause of ECF. Complications e.g. sepsis, MODS, hemorrhage, and catheter-associated infection, are the main causes of death. Active lavage and drainage is important to improve the prognosis of ECF.