Objective:To investigate the awareness levels of doctors from various departments regarding fertility preservation to provide reference and suggestions for further improving awareness and promoting multidisciplinary development in fertility preservation.Methods:From November to December 2023, the China Alliance of Fertility Preservation initiated this survey covering 88 hospitals in 23 cities across 20 provinces in China. The survey focused on the degree of understanding of basic concepts, technological perceptions, treatment concepts, and related challenges regarding fertility preservation. Descriptive statistics and Fisher's exact test were used to analyze the difference in awareness levels across various departments.Results:There was a significant difference in the awareness of fertility preservation guidelines among physicians from different departments ( P<0.001). Reproductive center physicians had the highest level of understanding [68.3% (41/60)]. Doctors in the reproductive centers had a higher awareness rate of the five fertility preservation techniques (ovarian tissue cryopreservation, oocyte cryopreservation, sperm cryopreservation, testicular tissue cryopreservation, and embryo cryopreservation) than that in other departments (all P<0.05). Regarding treatment concepts, more reproductive center physicians believed that psychological counselling about fertility preservation before oncological treatment was necessary ( P=0.016). Hematologists had more worries and concerns about fertility preservation treatment. Additionally, 96.7% (58/60) of reproductive center physicians expressed the need to establish effective referral mechanisms within the same city, province, or across provinces. However, 55.6% (35/63) of oncologists, 64.6% (31/48) of hematologists, and 77.8% (7/9) of pediatricians considered treating primary tumors far more important than fertility preservation. Conclusion:Doctors from different departments have varying levels of understanding regarding fertility preservation. It is necessary to strengthen the dissemination and training of fertility preservation knowledge among physicians from various departments, as well as to promote a multidisciplinary treatment model to improve efficiency, to establish a comprehensive referral mechanism to improve patients' opportunities for fertility preservation.

Objective:To investigate the awareness levels of doctors from various departments regarding fertility preservation to provide reference and suggestions for further improving awareness and promoting multidisciplinary development in fertility preservation.Methods:From November to December 2023, the China Alliance of Fertility Preservation initiated this survey covering 88 hospitals in 23 cities across 20 provinces in China. The survey focused on the degree of understanding of basic concepts, technological perceptions, treatment concepts, and related challenges regarding fertility preservation. Descriptive statistics and Fisher's exact test were used to analyze the difference in awareness levels across various departments.Results:There was a significant difference in the awareness of fertility preservation guidelines among physicians from different departments ( P<0.001). Reproductive center physicians had the highest level of understanding [68.3% (41/60)]. Doctors in the reproductive centers had a higher awareness rate of the five fertility preservation techniques (ovarian tissue cryopreservation, oocyte cryopreservation, sperm cryopreservation, testicular tissue cryopreservation, and embryo cryopreservation) than that in other departments (all P<0.05). Regarding treatment concepts, more reproductive center physicians believed that psychological counselling about fertility preservation before oncological treatment was necessary ( P=0.016). Hematologists had more worries and concerns about fertility preservation treatment. Additionally, 96.7% (58/60) of reproductive center physicians expressed the need to establish effective referral mechanisms within the same city, province, or across provinces. However, 55.6% (35/63) of oncologists, 64.6% (31/48) of hematologists, and 77.8% (7/9) of pediatricians considered treating primary tumors far more important than fertility preservation. Conclusion:Doctors from different departments have varying levels of understanding regarding fertility preservation. It is necessary to strengthen the dissemination and training of fertility preservation knowledge among physicians from various departments, as well as to promote a multidisciplinary treatment model to improve efficiency, to establish a comprehensive referral mechanism to improve patients' opportunities for fertility preservation.

Objective:To investigate the risk factors, pregnancy outcomes of intrauterine pregnancy with tubal pregnancy after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Methods:The study was a retrospective case-control study that collected clinical data of patients diagnosed with intrauterine combined with tubal pregnancy after IVF/ICSI for infertility at Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital from January 2009 to December 2021. The study group consisted of patients diagnosed with intrauterine combined with tubal pregnancy after IVF/ICSI and treated with surgery ( n=91). The control group consisted of patients diagnosed with early intrauterine pregnancy after IVF/ICSI in a 1∶4 ratio during the same period ( n=364). General information, assisted reproduction and pregnancy-related data of the two groups were analyzed, and risk factors for intrauterine combined with tubal pregnancy after IVF/ICSI were determined through univariate and logistic analyses. Furthermore, the study group was divided into two subgroups according to different pregnancy outcomes, miscarriage and live birth, and risk factors that may affect pregnancy outcomes of patients with intrauterine combined with tubal pregnancy were analyzed between the two subgroups. Results:There were no significant differences in age, body mass index, gestational times, basal hormone levels, endometrial thickness before transplantation and human chorionic gonadotropin level after transplantation between the study group and control group (all P>0.05). The live birth rate of the two groups was similar ( P>0.05). A history of ectopic pregnancy ( OR=2.605, 95% CI: 1.352-5.016, P=0.004) and hydrosalpinx ( OR=26.012, 95% CI: 2.942-229.974, P=0.003) were risk factors for intrauterine combined with tubal pregnancy after IVF/ICSI. Patients with intrauterine combined with tubal pregnancy were divided into live birth subgroup and abortion subgroup. There were no significant differences in the proportion of abdominal pain, uterine hemoperitoneum and other symptoms between the two subgroups (all P>0.05), and there were no statistical differences in operation time, gestational age and intraperitoneal hemorrhage between the two subgroups (all P>0.05). Vaginal bleeding after transplantation ( OR=3.128, 95% CI: 1.067-9.172, P=0.038) in the abortion subgroup may be a risk factor for miscarriage in intrauterine combined with tubal pregnancy. Conclusion:Live birth rate in intrauterine pregnancy combined with tubal pregnancy patients after surgery was similar with patients with normal intrauterine pregnancy. Ectopic pregnancy history and hydrosalpinx may be risk factors for patients with intrauterine pregnancy combined with tubal pregnancy after IVF/ICSI, and vaginal bleeding after transplantation may be a high risk factor for abortion in those patients.

With the continuous development of cancer treatment technology, the cure rate for tumors in children is increasing. However, the irreversible damage to ovarian development and function by chemotherapy and radiation in surviving children often leads to iatrogenic premature ovarian failure and even infertility. Therefore, it is of great significance to develop fertility preservation techniques for children with tumors. International and domestic guidelines indicate that ovarian tissue cryopreservation and transplantation should be considered first for female children. However, the application of this technique in children is not yet mature. Current research suggests that there are significant structural and functional differences between children's ovaries and adults', and fertility preservation strategies for adults are not fully applicable to children. Therefore, this paper analyzes and reviews the structure and function of children's ovaries, the mechanism of damage to ovarian tissues by chemotherapy and radiation, and the current research and application status of fertility preservation techniques for female children. It also looks forward to the development direction of fertility preservation techniques for female children.

Objective To explore the potential value of coagulation indicators and their combinations for metastasis and postoperative recurrence in renal cell carcinoma(RCC)patients.Methods A total of 39 RCC patients with metastasis and postoperative recurrence were enrolled,and the controls groups included 64 RCC patients without metastasis,15 patients with renal vascular leiomyoma/oncocy-toma and 118 patients with renal cysts.All the patients were diagnosed and hospitalized in the Department of Urology of Nanjing Hospi-tal of Chinese Medicine affiliated with Nanjing University of Chinese Medicine and Jinling Hospital affiliated with Nanjing University School of Medicine from January 2018 to June 2024.The coagulation indicators in the blood samples were measured.The levels of plas-ma prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)and fibrinogen(Fib)were analyzed by clotting method.The levels of fibrinogen degradation products(FDP)and D-Dimer(DD)were analyzed by immunological turbidim-etry assay,and the levels of antithrombin Ⅲ(AT3)were analyzed by chromogenic substrate method,respectively.The differences of coagulation indicators between RCC patients with metastasis and postoperative recurrence and the controls were assessed by Mann-Whit-ney U test.The potential value of coagulation indicators and their combinations for predicating metastasis and postoperative recurrence in RCC patients was evaluated through Logistic regression and ROC curve analysis.Results The plasma levels of the seven coagulation indicators showed significant differences between the patients with RCC metastatic/recurrent and the controls(all with P＜0.05).The results of ROC curve analysis showed that the plasma levels of all the 7 coagulation index could distinguish the metastatic/recurrent RCC patients from the controls,and the DD level showed the highest value with the AUCROC=0.913(95％CI:0.859 to 0.967).Multi-ple logistic regression analysis revealed that the plasma levels of Fib,FDP,DD,and AT3 were associated with RCC metastasis/recur-rence.Logistic regression analysis combined with ROC curve analysis revealed that the panel of Fib,FDP,DD and AT3 had the best performance for discriminating RCC metastasis/recurrence along with the AUCROC of 0.920(95％CI:0.865 to 0.974).Conclusion Alterations of the levels of plasma Fib,DD,FDP and AT3 may be closely related to postoperative recurrence and metastasis in RCC patients,and the panel of Fib,FDP,DD and AT3 has the potential to serve as the monitoring and evaluation indicators for RCC recur-rence and metastasis.

Objective:To investigate the risk factors, pregnancy outcomes of intrauterine pregnancy with tubal pregnancy after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Methods:The study was a retrospective case-control study that collected clinical data of patients diagnosed with intrauterine combined with tubal pregnancy after IVF/ICSI for infertility at Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital from January 2009 to December 2021. The study group consisted of patients diagnosed with intrauterine combined with tubal pregnancy after IVF/ICSI and treated with surgery ( n=91). The control group consisted of patients diagnosed with early intrauterine pregnancy after IVF/ICSI in a 1∶4 ratio during the same period ( n=364). General information, assisted reproduction and pregnancy-related data of the two groups were analyzed, and risk factors for intrauterine combined with tubal pregnancy after IVF/ICSI were determined through univariate and logistic analyses. Furthermore, the study group was divided into two subgroups according to different pregnancy outcomes, miscarriage and live birth, and risk factors that may affect pregnancy outcomes of patients with intrauterine combined with tubal pregnancy were analyzed between the two subgroups. Results:There were no significant differences in age, body mass index, gestational times, basal hormone levels, endometrial thickness before transplantation and human chorionic gonadotropin level after transplantation between the study group and control group (all P>0.05). The live birth rate of the two groups was similar ( P>0.05). A history of ectopic pregnancy ( OR=2.605, 95% CI: 1.352-5.016, P=0.004) and hydrosalpinx ( OR=26.012, 95% CI: 2.942-229.974, P=0.003) were risk factors for intrauterine combined with tubal pregnancy after IVF/ICSI. Patients with intrauterine combined with tubal pregnancy were divided into live birth subgroup and abortion subgroup. There were no significant differences in the proportion of abdominal pain, uterine hemoperitoneum and other symptoms between the two subgroups (all P>0.05), and there were no statistical differences in operation time, gestational age and intraperitoneal hemorrhage between the two subgroups (all P>0.05). Vaginal bleeding after transplantation ( OR=3.128, 95% CI: 1.067-9.172, P=0.038) in the abortion subgroup may be a risk factor for miscarriage in intrauterine combined with tubal pregnancy. Conclusion:Live birth rate in intrauterine pregnancy combined with tubal pregnancy patients after surgery was similar with patients with normal intrauterine pregnancy. Ectopic pregnancy history and hydrosalpinx may be risk factors for patients with intrauterine pregnancy combined with tubal pregnancy after IVF/ICSI, and vaginal bleeding after transplantation may be a high risk factor for abortion in those patients.

With the continuous development of cancer treatment technology, the cure rate for tumors in children is increasing. However, the irreversible damage to ovarian development and function by chemotherapy and radiation in surviving children often leads to iatrogenic premature ovarian failure and even infertility. Therefore, it is of great significance to develop fertility preservation techniques for children with tumors. International and domestic guidelines indicate that ovarian tissue cryopreservation and transplantation should be considered first for female children. However, the application of this technique in children is not yet mature. Current research suggests that there are significant structural and functional differences between children's ovaries and adults', and fertility preservation strategies for adults are not fully applicable to children. Therefore, this paper analyzes and reviews the structure and function of children's ovaries, the mechanism of damage to ovarian tissues by chemotherapy and radiation, and the current research and application status of fertility preservation techniques for female children. It also looks forward to the development direction of fertility preservation techniques for female children.

Objective To explore the potential value of coagulation indicators and their combinations for metastasis and postoperative recurrence in renal cell carcinoma(RCC)patients.Methods A total of 39 RCC patients with metastasis and postoperative recurrence were enrolled,and the controls groups included 64 RCC patients without metastasis,15 patients with renal vascular leiomyoma/oncocy-toma and 118 patients with renal cysts.All the patients were diagnosed and hospitalized in the Department of Urology of Nanjing Hospi-tal of Chinese Medicine affiliated with Nanjing University of Chinese Medicine and Jinling Hospital affiliated with Nanjing University School of Medicine from January 2018 to June 2024.The coagulation indicators in the blood samples were measured.The levels of plas-ma prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)and fibrinogen(Fib)were analyzed by clotting method.The levels of fibrinogen degradation products(FDP)and D-Dimer(DD)were analyzed by immunological turbidim-etry assay,and the levels of antithrombin Ⅲ(AT3)were analyzed by chromogenic substrate method,respectively.The differences of coagulation indicators between RCC patients with metastasis and postoperative recurrence and the controls were assessed by Mann-Whit-ney U test.The potential value of coagulation indicators and their combinations for predicating metastasis and postoperative recurrence in RCC patients was evaluated through Logistic regression and ROC curve analysis.Results The plasma levels of the seven coagulation indicators showed significant differences between the patients with RCC metastatic/recurrent and the controls(all with P＜0.05).The results of ROC curve analysis showed that the plasma levels of all the 7 coagulation index could distinguish the metastatic/recurrent RCC patients from the controls,and the DD level showed the highest value with the AUCROC=0.913(95％CI:0.859 to 0.967).Multi-ple logistic regression analysis revealed that the plasma levels of Fib,FDP,DD,and AT3 were associated with RCC metastasis/recur-rence.Logistic regression analysis combined with ROC curve analysis revealed that the panel of Fib,FDP,DD and AT3 had the best performance for discriminating RCC metastasis/recurrence along with the AUCROC of 0.920(95％CI:0.865 to 0.974).Conclusion Alterations of the levels of plasma Fib,DD,FDP and AT3 may be closely related to postoperative recurrence and metastasis in RCC patients,and the panel of Fib,FDP,DD and AT3 has the potential to serve as the monitoring and evaluation indicators for RCC recur-rence and metastasis.

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.