Objective:To explore the strategy of pregnancy in patients with tubal pregnancy (TP) undergoing salpingectomy.Methods:A retrospective cohort study was conducted to analyze the clinical data of patients who underwent hysterosalpingo contrast sonography (HyCoSy) at Reproductive Medicine Center of Peking University Third Hospital from January 1, 2019 to December 31, 2020 due to salpingectomy for TP. Patients were divided into 3 groups according to the time of pregnancy test and infertility history at the time to HyCoSy (TTH), group A: patients with no history of infertility, attempted pregnancy <1 year after TP ( n=33); group B: patients with history of infertility, attempted pregnancy <1 year after TP ( n=22); group C: patients attempted pregnancy ≥1 year after TP ( n=64). The remaining tubal patency and clinical outcome were analyzed. Results:There were no significant differences in age, number of pregnancies, history of repeated TP (RTP), number of antral follicles, pregnancy rate treated with in vitro fertilization (IVF), incidence of RTP in IVF and spontaneous pregnancy, and the time to pregnancy (TTP) from HyCoSy among groups A, B and C (all P>0.05). TTH from salpingectomy in group C [30.0 (20.0, 42.0) months] was significantly longer than that in groups A and B [13.0 (7.5, 16.5) months, 8.0 (7.0, 10.0) months, P<0.001]. The proportion of unobstructed fallopian tubes and the spontaneous pregnancy rate in group A were significantly higher than those in group C [72.7% (24/33) vs. 43.8% (28/64), P=0.025; 42.4% (14/33) vs. 12.5% (8/64), P=0.004], and the IVF treatment rate in group A [30.3% (10/33)] was significantly lower than that in groups B and C [86.4% (19/22), 71.9% (46/64), P<0.001]. The proportion of unobstructed fallopian tubes and the spontaneous pregnancy rate in group B were higher than those in group C, and the differences were not statistically significant (all P>0.05). The time required for spontaneous pregnancy in group A was less than that in groups B and C, but the difference was not statistically significant ( P>0.05). Logistic regression analysis showed that infertility (history/symptom) was a related factor of tubal patency and pregnancy outcome ( OR=0.366, 95% CI: 0.148-0.904, P=0.029; OR=8.504, 95% CI: 2.294-31.519, P=0.014). Conclusion:After salpingectomy on one side, patients without infertility (history/symptoms) can actively try to conceive for 6 months, if they are not pregnant, tubal patency test can be actively performed and decide on fertility strategy; for patients with infertility (history/symptom), IVF was recommended actively without tubal patency evaluation.

Objective:To explore the strategy of pregnancy in patients with tubal pregnancy (TP) undergoing salpingectomy.Methods:A retrospective cohort study was conducted to analyze the clinical data of patients who underwent hysterosalpingo contrast sonography (HyCoSy) at Reproductive Medicine Center of Peking University Third Hospital from January 1, 2019 to December 31, 2020 due to salpingectomy for TP. Patients were divided into 3 groups according to the time of pregnancy test and infertility history at the time to HyCoSy (TTH), group A: patients with no history of infertility, attempted pregnancy <1 year after TP ( n=33); group B: patients with history of infertility, attempted pregnancy <1 year after TP ( n=22); group C: patients attempted pregnancy ≥1 year after TP ( n=64). The remaining tubal patency and clinical outcome were analyzed. Results:There were no significant differences in age, number of pregnancies, history of repeated TP (RTP), number of antral follicles, pregnancy rate treated with in vitro fertilization (IVF), incidence of RTP in IVF and spontaneous pregnancy, and the time to pregnancy (TTP) from HyCoSy among groups A, B and C (all P>0.05). TTH from salpingectomy in group C [30.0 (20.0, 42.0) months] was significantly longer than that in groups A and B [13.0 (7.5, 16.5) months, 8.0 (7.0, 10.0) months, P<0.001]. The proportion of unobstructed fallopian tubes and the spontaneous pregnancy rate in group A were significantly higher than those in group C [72.7% (24/33) vs. 43.8% (28/64), P=0.025; 42.4% (14/33) vs. 12.5% (8/64), P=0.004], and the IVF treatment rate in group A [30.3% (10/33)] was significantly lower than that in groups B and C [86.4% (19/22), 71.9% (46/64), P<0.001]. The proportion of unobstructed fallopian tubes and the spontaneous pregnancy rate in group B were higher than those in group C, and the differences were not statistically significant (all P>0.05). The time required for spontaneous pregnancy in group A was less than that in groups B and C, but the difference was not statistically significant ( P>0.05). Logistic regression analysis showed that infertility (history/symptom) was a related factor of tubal patency and pregnancy outcome ( OR=0.366, 95% CI: 0.148-0.904, P=0.029; OR=8.504, 95% CI: 2.294-31.519, P=0.014). Conclusion:After salpingectomy on one side, patients without infertility (history/symptoms) can actively try to conceive for 6 months, if they are not pregnant, tubal patency test can be actively performed and decide on fertility strategy; for patients with infertility (history/symptom), IVF was recommended actively without tubal patency evaluation.

Objective:By comparing standard gonadotropin-releasing hormone antagonist regimen and gonadotropin-releasing hormone agonist-antagonist protocol (AAP regimen) in Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) group 3 and group 4 patients with low prognosis, to study if AAP regimen could improve the clinical outcomes in low prognosis patients.Methods:A case-control study was performed, the clinical data of 646 cycles of prospective poor ovarian response (POR) patients (POSEIDON group 3 and 4) who received in vitro fertilization and embryo transfer (IVF-ET) in Peking University Third Hospital Department of Obstetrics and Gynecology, Reproductive Medical Center from January 2016 to May 2018 were retrospectively analyzed. The total number of AAP cycle was 323, and control group was selected from the database with 1∶1 matching of contemporaneous prospective POR patients (POSEIDON group 3 and group 4) with similar age and approaching date of oocyte retrieval. Patients' general information, ovarian stimulation indexes and clinical outcomes were compared. Results:AAP group had fewer antral follicle count (AFC) [3.00(2.00,4.00) vs. 4.00(2.00,5.00), P<0.001] and similar anti-Müllerian hormone (AMH) level [0.51(0.25,0.83) μg/L vs. 0.53(0.31,0.81) μg/L, P>0.05] compared with control group. AAP group had shorter duration of gonadotropin (Gn) used [10.00(8.00,11.00) d vs. 10.00(9.00,11.00) d, P=0.020] and lower dosage of Gn used [2 675.00(2 100.00,3 300.00) U vs. 3 075.00(2 550.00,3 750.00) U, P<0.001] than control group. AAP group had similar number of oocytes obtained [3.00(2.00,5.00) vs. 4.00(2.00,6.00), P>0.05] compared with control group. Under the same proportion of fertilization schemes (routine or intracytoplasmic sperm injection methods), AAP group had higher fertilization rate [74.15% (955/1288) vs. 69.13% (918/1328), P=0.004] and good-quality embryo rate [62.57% (585/935) vs. 56.94% (509/894), P=0.014], and ultimately had higher embryo implantation rate [22.31% (87/390) vs. 15.84% (64/404), P=0.020], cumulative clinical pregnancy rate [32.50% (78/240) vs. 22.86% (56/245), P=0.018] and cumulative live birth rate [25.83% (62/240) vs. 17.96% (44/245), P=0.036]. Conclusion:For POSEIDON patients with low prognosis and POR, controlled ovarian hyperstimulation with AAP regimen had better clinical outcomes compared with conventional antagonist regimen.

Objective:By comparing standard gonadotropin-releasing hormone antagonist regimen and gonadotropin-releasing hormone agonist-antagonist protocol (AAP regimen) in Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) group 3 and group 4 patients with low prognosis, to study if AAP regimen could improve the clinical outcomes in low prognosis patients.Methods:A case-control study was performed, the clinical data of 646 cycles of prospective poor ovarian response (POR) patients (POSEIDON group 3 and 4) who received in vitro fertilization and embryo transfer (IVF-ET) in Peking University Third Hospital Department of Obstetrics and Gynecology, Reproductive Medical Center from January 2016 to May 2018 were retrospectively analyzed. The total number of AAP cycle was 323, and control group was selected from the database with 1∶1 matching of contemporaneous prospective POR patients (POSEIDON group 3 and group 4) with similar age and approaching date of oocyte retrieval. Patients' general information, ovarian stimulation indexes and clinical outcomes were compared. Results:AAP group had fewer antral follicle count (AFC) [3.00(2.00,4.00) vs. 4.00(2.00,5.00), P<0.001] and similar anti-Müllerian hormone (AMH) level [0.51(0.25,0.83) μg/L vs. 0.53(0.31,0.81) μg/L, P>0.05] compared with control group. AAP group had shorter duration of gonadotropin (Gn) used [10.00(8.00,11.00) d vs. 10.00(9.00,11.00) d, P=0.020] and lower dosage of Gn used [2 675.00(2 100.00,3 300.00) U vs. 3 075.00(2 550.00,3 750.00) U, P<0.001] than control group. AAP group had similar number of oocytes obtained [3.00(2.00,5.00) vs. 4.00(2.00,6.00), P>0.05] compared with control group. Under the same proportion of fertilization schemes (routine or intracytoplasmic sperm injection methods), AAP group had higher fertilization rate [74.15% (955/1288) vs. 69.13% (918/1328), P=0.004] and good-quality embryo rate [62.57% (585/935) vs. 56.94% (509/894), P=0.014], and ultimately had higher embryo implantation rate [22.31% (87/390) vs. 15.84% (64/404), P=0.020], cumulative clinical pregnancy rate [32.50% (78/240) vs. 22.86% (56/245), P=0.018] and cumulative live birth rate [25.83% (62/240) vs. 17.96% (44/245), P=0.036]. Conclusion:For POSEIDON patients with low prognosis and POR, controlled ovarian hyperstimulation with AAP regimen had better clinical outcomes compared with conventional antagonist regimen.

Objective:To analyze the effect of different pretreatments on the in vitrofertilization (IVF) outcome of expected poor ovarian response (POR) patients according to POSEIDON criteria, and explore the appropriate treatment for POR patients. Methods:A retrospective analysis of the clinical data of 364 cycles of expected POR patients who received in vitro fertilization-embryo transfer (IVF-ET) in the Center of Reproductive Medicine, Department of Obstetrics & Gynecology， Peking University Third Hospital from January 2016 to May 2018 was performed. According to the pretreatment prior to gonadotropin (Gn) stimulation, the cycles were divided into oral contraceptive (OCP) group (group A, n=167), estradiol valerate group (group B, n=56) and no pretreatment group (group C, n=141). The clinical data,ovarian stimulation indexes, laboratory status and the clinical pregnancy rate were compared among the three groups. Results:The age of patients in group A [(34.8±4.9) years] was significantly younger than that of group B [(38.0±4.9) years] and group C [(37.9±4.7) years] ( P<0.001). The body mass index (BMI) of group B [(21.9±3.1) kg/m 2] was significantly lower than that of group A [(23.5±3.6) kg/m 2] and group C [(23.2±3.1) kg/m 2] ( P=0.014). There were significant differences in the antral follicle count (AFC) among group A (2.4±2.0), group B (4.1±1.9) and group C (3.5±2.0) ( P<0.001). The proportion of anovulation in group A (32.9%) was significantly higher than that in group B (10.7%) and group C (11.3%) ( P<0.001). The number of IVF cycles in group C (3.0±1.7) was higher than that in group A (2.5±1.5)（ P=0.017）. There was no significant difference in type of infertility, duration of infertility, basal follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH) among the three groups ( P>0.05). The endometrial thickness on the day of human chorionic gonadotropin (hCG) injection in group A [(9.4±1.9) mm] was thinner than that in group B [(10.6±1.5) mm] and group C [(10.1±2.0) mm] ( P<0.001). The fertilization rate of group A (77.1%) and group B (77.6%) was significantly higher than that of group C (71.3%) ( P=0.041). There were no significant differences in Gn used dosage, duration of Gn stimulation, number of eggs obtained, intracytoplasmic sperm injection (ICSI) proportion, cleavage rate, number of embryos available for transfer and number of high-quality embryos among the three groups ( P>0.05). The implantation rate and the clinical pregnancy rate in group A (26.2%, 36.1%) and group B (26.8%, 42.0%) were significantly higher than those in group C (14.5%, 21.2%) ( P=0.014). There were no significant differences in embryo transfer cycle, number of embryos transferred, proportion of blastocyst transfer cycle, abortion rate and cycle cancellation rate among the three groups ( P>0.05). Conclusion:Pretreatment with OCP or estradiol valerate in luteal phase prior to Gn stimulation can improve the clinical outcomes of patients with expected POR. OCP pretreatment is suitable for POR patients with ovulation disorder, while estradiol pretreatment in luteal phase is suitable for POR patients with ovulation.

Objective:To analyze the effect of different pretreatments on the in vitrofertilization (IVF) outcome of expected poor ovarian response (POR) patients according to POSEIDON criteria, and explore the appropriate treatment for POR patients. Methods:A retrospective analysis of the clinical data of 364 cycles of expected POR patients who received in vitro fertilization-embryo transfer (IVF-ET) in the Center of Reproductive Medicine, Department of Obstetrics & Gynecology， Peking University Third Hospital from January 2016 to May 2018 was performed. According to the pretreatment prior to gonadotropin (Gn) stimulation, the cycles were divided into oral contraceptive (OCP) group (group A, n=167), estradiol valerate group (group B, n=56) and no pretreatment group (group C, n=141). The clinical data,ovarian stimulation indexes, laboratory status and the clinical pregnancy rate were compared among the three groups. Results:The age of patients in group A [(34.8±4.9) years] was significantly younger than that of group B [(38.0±4.9) years] and group C [(37.9±4.7) years] ( P<0.001). The body mass index (BMI) of group B [(21.9±3.1) kg/m 2] was significantly lower than that of group A [(23.5±3.6) kg/m 2] and group C [(23.2±3.1) kg/m 2] ( P=0.014). There were significant differences in the antral follicle count (AFC) among group A (2.4±2.0), group B (4.1±1.9) and group C (3.5±2.0) ( P<0.001). The proportion of anovulation in group A (32.9%) was significantly higher than that in group B (10.7%) and group C (11.3%) ( P<0.001). The number of IVF cycles in group C (3.0±1.7) was higher than that in group A (2.5±1.5)（ P=0.017）. There was no significant difference in type of infertility, duration of infertility, basal follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH) among the three groups ( P>0.05). The endometrial thickness on the day of human chorionic gonadotropin (hCG) injection in group A [(9.4±1.9) mm] was thinner than that in group B [(10.6±1.5) mm] and group C [(10.1±2.0) mm] ( P<0.001). The fertilization rate of group A (77.1%) and group B (77.6%) was significantly higher than that of group C (71.3%) ( P=0.041). There were no significant differences in Gn used dosage, duration of Gn stimulation, number of eggs obtained, intracytoplasmic sperm injection (ICSI) proportion, cleavage rate, number of embryos available for transfer and number of high-quality embryos among the three groups ( P>0.05). The implantation rate and the clinical pregnancy rate in group A (26.2%, 36.1%) and group B (26.8%, 42.0%) were significantly higher than those in group C (14.5%, 21.2%) ( P=0.014). There were no significant differences in embryo transfer cycle, number of embryos transferred, proportion of blastocyst transfer cycle, abortion rate and cycle cancellation rate among the three groups ( P>0.05). Conclusion:Pretreatment with OCP or estradiol valerate in luteal phase prior to Gn stimulation can improve the clinical outcomes of patients with expected POR. OCP pretreatment is suitable for POR patients with ovulation disorder, while estradiol pretreatment in luteal phase is suitable for POR patients with ovulation.

Objective To explore the relationship between the antiviral effect and peripheral blood mononuclear cell (PBMC) hepatitis B virus (HBV) DNA when the patients reach the standard of withdrawal of antiviral therapy in chronic hepatitis B (CHB).Methods Ninety CHB patients treated with interferon(n=44) or nucleot (s) ide(n=46) who reached the standard of withdrawal of antiviral therapy were recruited.HBV DNA levels in PBMCs were tested at the end of treatment,and its relationship with serum HBV DNA level before treatment in PBMC HBV DNA positive group and negative group were compared.The correlation between HBV DNA in PBMCs at the end of treatment and relapse were explored.Measurement data were analyzed by student t test and enumeration data were analyzed by X2 test.Results Among 90 patients,67(74.4%) were PBMC HBV DNA negative at the end of treatment,and 23(25.6%) were positive.The serum HBV DNA positive conversion rate in PBMC HBV DNA negative patients was 13.4%,which were significantly lower than that in positive group (73.9%) (X2=30. 4873, P<0.01 ). There were no significant differences of alanine aminotransferase (ALT) levels when hepatitis flare (t=0. 8729, P=0. 3913) and relapse time (t=1. 9222, P=0. 0665) between PBMC HBV DNA negative group and positive group after withdrawal of therapy, while the serum HBV DNA rebound was greater in positive group than that in negative group (t=2. 7493, P=0. 0112). There were five patients who achieved hepatitis B surface antigen (HBsAg) seroconversion, whose PBMC HBV DNA were all undetectable, and none relapsed during follow-up for 6-12 months. The pretreatment HBV DNA as level in PBMC HBV DNA positive was (7.2±1.1) lg copy/mL, which was much higher than that in negative group[(5.2±2.1) lg copy/mL] (t=4. 3557, P<0.01). Conclusions In patients who reach the standard of drug withdrawal,PBMC HBV DNA at the end of treatment is an important predictor for durability of antiviral therapy in CHB.