Adenomyosis(AM)is a common gynecologic disease,which could be more accurately diagnosed based on morphological uterus sonographic assessment(MUSA)criteria.MUSA criteria and clinical application for diagnosing AM were reviewed in this article.

Adenomyosis(AM)is a common gynecologic disease,which could be more accurately diagnosed based on morphological uterus sonographic assessment(MUSA)criteria.MUSA criteria and clinical application for diagnosing AM were reviewed in this article.

Endometriosis (EMS) is a common gynecological disease, usually occurs in women of reproductive age. EMS is characterized by pelvic pain, infertility and sexual discomfort, which seriously affects women's physical and mental health. There are a large number of microorganisms in various parts of the human body, which play an important role in various stages of reproduction through the microbial community itself or metabolites. Recent studies have found changes in the composition of microbiota in patients with EMS, and the effect of EMS on female fertility is closely related to imbalances in the human microecological environment. This article reviews the interaction between female microbiome and EMS, and the relationship between changes in microecological environment and adverse pregnancy outcomes in EMS patients.

Endometriosis (EMS) is a common gynecological disease, usually occurs in women of reproductive age. EMS is characterized by pelvic pain, infertility and sexual discomfort, which seriously affects women's physical and mental health. There are a large number of microorganisms in various parts of the human body, which play an important role in various stages of reproduction through the microbial community itself or metabolites. Recent studies have found changes in the composition of microbiota in patients with EMS, and the effect of EMS on female fertility is closely related to imbalances in the human microecological environment. This article reviews the interaction between female microbiome and EMS, and the relationship between changes in microecological environment and adverse pregnancy outcomes in EMS patients.

Objective:To improve the technique of oocyte retrieval in in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles and reduce the cancellation rate of IVF/ICSI cycle. Methods:The clinical data of a case of IVF/ICSI cycle using transvaginal combined with abdominal oocyte retrieval was reported.Results:The right ovary of one infertile patient who received ICSI due to male factors was not detected repeatedly by transvaginal ultrasound during ovulation induction. The right lower abdominal pain occurred day 5 after using gonadotropin. We considered that the position of the right ovary was high due to pelvic adhesion after previous appendectomy, and was further confirmed by abdominal ultrasound. Two mature oocytes were obtained from the left and right ovaries respectively. Four embryos were obtained after ICSI insemination, and biochemical pregnancy occurred after transplantation.Conclusion:Transabdominal ultrasound-guided oocyte retrieval is relatively safe and effective, and can obtain similar clinical outcomes as conventional transvaginal ultrasound-guided oocyte retrieval. For IVF/ICSI women with difficulty in obtaining oocytes through vagina, transabdominal ultrasound-guided oocyte retrieval can be tried. During IVF/ICSI treatment cycles, it is necessary to improve the quality of medical history inquiry, pre-cycle evaluation, ovulation induction monitoring, oocyte retrieval and embryo transfer.

Objective:To improve the technique of oocyte retrieval in in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles and reduce the cancellation rate of IVF/ICSI cycle. Methods:The clinical data of a case of IVF/ICSI cycle using transvaginal combined with abdominal oocyte retrieval was reported.Results:The right ovary of one infertile patient who received ICSI due to male factors was not detected repeatedly by transvaginal ultrasound during ovulation induction. The right lower abdominal pain occurred day 5 after using gonadotropin. We considered that the position of the right ovary was high due to pelvic adhesion after previous appendectomy, and was further confirmed by abdominal ultrasound. Two mature oocytes were obtained from the left and right ovaries respectively. Four embryos were obtained after ICSI insemination, and biochemical pregnancy occurred after transplantation.Conclusion:Transabdominal ultrasound-guided oocyte retrieval is relatively safe and effective, and can obtain similar clinical outcomes as conventional transvaginal ultrasound-guided oocyte retrieval. For IVF/ICSI women with difficulty in obtaining oocytes through vagina, transabdominal ultrasound-guided oocyte retrieval can be tried. During IVF/ICSI treatment cycles, it is necessary to improve the quality of medical history inquiry, pre-cycle evaluation, ovulation induction monitoring, oocyte retrieval and embryo transfer.

Objective:To investigate the clinical effects and pregnancy outcomes of the early follicular long-term protocol and antagonist protocol in the treatment of unexplained infertility patients.Methods:From January 2018 to January 2019, 642 cases of unexplained infertility patients with early follicular long-term protocol and antagonist protocol in in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) were collected using the clinical assisted reproductive technologies management system software database of the Department of Reproductive Medicine of the First Affiliated Hospital of Nanjing Medical University. Patients were divided into early follicular long-term protocol ( n=283) and antagonist protocol ( n=359) groups. The clinical outcomes of the two groups were analyzed retrospectively, including the implantation rate, the clinical pregnancy rate, and the live birth rate. Furthermore, the pregnancy outcomes of different age and body mass index (BMI) patients were further analyzed. Results:1) The BMI in the antagonist protocol group was higher than that in early follicular long-term protocol group [(22.17±2.96) kg/m 2vs. (21.68±2.29) kg/m 2, P=0.018]. The other based data did not exhibit remarkable difference between the two groups ( P>0.05). 2) The starting dosage of gonadotropin (Gn) in early follicular long-term protocol group was less than that of antagonist group [(149.74±36.24) IU vs. (177.97±38.85) IU, P<0.001]. While the total duration and dosage of Gn used in early follicular long-term protocol group were significantly higher than those in antagonist group [(11.93±2.26) d vs. (8.86±1.45) d, P<0.001; (1 908.35±632.36) IU vs. (1 638.57±497.23) IU, P<0.001). The cleavage embryo implantation rate, the clinical pregnancy rate and the live pregnancy rate in fresh cycle in early follicular long-term protocol group were significantly higher than those in the antagonist group [57.14% (152/266) vs. 39.53% (68/172), P<0.001; 66.48% (121/182) vs. 51.72% (60/116), P=0.011; 59.89% (109/182) vs. 40.52% (47/116) , P=0.001]. The incidence of moderate and severe ovarian hyperstimulation syndrome between the two groups were not statistically different ( P>0.05). Multivariate logistic regression analysis showed that different protocols and age were both risk factors for clinical pregnancy and live birth of cleavage embryo transfer [2.261(95% CI=1.333-3.836), P=0.002; 0.928(95% CI=0.869-0.991), P=0.026; 2.598(95% CI=1.535-4.397), P<0.001; 0.906(95% CI=0.849-0.967), P=0.003]. 3) In patients under 35 years old, the clinical pregnancy rate and the live birth rate in early follicular long-term protocol group were higher than those of the antagonist group, but there was no statistical difference (all P>0.05). The fresh embryo cycle implantation rate, the clinical pregnancy rate and the live birth rate of 35-39 years old patients in the early follicular long-term protocol group were higher than those in the antagonist group, but there was no statistical difference (all P>0.05). 4) In normal BMI group, the implantation rate, the clinical pregnancy rate and the live birth rate in early follicular long-term protocol group were significantly higher than those in the antagonist group [55.71% (122/219) vs. 37.82% (45/119), P=0.002; 63.58% (96/151) vs. 46.99% (39/83), P=0.014; 58.94% (89/151) vs. 39.76% (33/83), P=0.005]. In the overweight population, the implantation rate and the clinical pregnancy rate in early follicular long-term protocol group were significantly higher than those in the antagonist group [68.09% (32/47) vs. 43.40% (23/53), P=0.013; 81.25% (26/32) vs. 57.14% (20/35), P=0.034], but there was no statistically significant difference in the live birth rate ( P>0.05). Conclusion:Compared with the antagonist protocol, early follicular long-term protocol for unexplained infertility patients may achieve higher clinical pregnancy outcomes in IVF fresh cycle, but it could increased the duration of descending, the duration and dosage of Gn used.

Objective:To investigate the clinical effects and pregnancy outcomes of the early follicular long-term protocol and antagonist protocol in the treatment of unexplained infertility patients.Methods:From January 2018 to January 2019, 642 cases of unexplained infertility patients with early follicular long-term protocol and antagonist protocol in in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) were collected using the clinical assisted reproductive technologies management system software database of the Department of Reproductive Medicine of the First Affiliated Hospital of Nanjing Medical University. Patients were divided into early follicular long-term protocol ( n=283) and antagonist protocol ( n=359) groups. The clinical outcomes of the two groups were analyzed retrospectively, including the implantation rate, the clinical pregnancy rate, and the live birth rate. Furthermore, the pregnancy outcomes of different age and body mass index (BMI) patients were further analyzed. Results:1) The BMI in the antagonist protocol group was higher than that in early follicular long-term protocol group [(22.17±2.96) kg/m 2vs. (21.68±2.29) kg/m 2, P=0.018]. The other based data did not exhibit remarkable difference between the two groups ( P>0.05). 2) The starting dosage of gonadotropin (Gn) in early follicular long-term protocol group was less than that of antagonist group [(149.74±36.24) IU vs. (177.97±38.85) IU, P<0.001]. While the total duration and dosage of Gn used in early follicular long-term protocol group were significantly higher than those in antagonist group [(11.93±2.26) d vs. (8.86±1.45) d, P<0.001; (1 908.35±632.36) IU vs. (1 638.57±497.23) IU, P<0.001). The cleavage embryo implantation rate, the clinical pregnancy rate and the live pregnancy rate in fresh cycle in early follicular long-term protocol group were significantly higher than those in the antagonist group [57.14% (152/266) vs. 39.53% (68/172), P<0.001; 66.48% (121/182) vs. 51.72% (60/116), P=0.011; 59.89% (109/182) vs. 40.52% (47/116) , P=0.001]. The incidence of moderate and severe ovarian hyperstimulation syndrome between the two groups were not statistically different ( P>0.05). Multivariate logistic regression analysis showed that different protocols and age were both risk factors for clinical pregnancy and live birth of cleavage embryo transfer [2.261(95% CI=1.333-3.836), P=0.002; 0.928(95% CI=0.869-0.991), P=0.026; 2.598(95% CI=1.535-4.397), P<0.001; 0.906(95% CI=0.849-0.967), P=0.003]. 3) In patients under 35 years old, the clinical pregnancy rate and the live birth rate in early follicular long-term protocol group were higher than those of the antagonist group, but there was no statistical difference (all P>0.05). The fresh embryo cycle implantation rate, the clinical pregnancy rate and the live birth rate of 35-39 years old patients in the early follicular long-term protocol group were higher than those in the antagonist group, but there was no statistical difference (all P>0.05). 4) In normal BMI group, the implantation rate, the clinical pregnancy rate and the live birth rate in early follicular long-term protocol group were significantly higher than those in the antagonist group [55.71% (122/219) vs. 37.82% (45/119), P=0.002; 63.58% (96/151) vs. 46.99% (39/83), P=0.014; 58.94% (89/151) vs. 39.76% (33/83), P=0.005]. In the overweight population, the implantation rate and the clinical pregnancy rate in early follicular long-term protocol group were significantly higher than those in the antagonist group [68.09% (32/47) vs. 43.40% (23/53), P=0.013; 81.25% (26/32) vs. 57.14% (20/35), P=0.034], but there was no statistically significant difference in the live birth rate ( P>0.05). Conclusion:Compared with the antagonist protocol, early follicular long-term protocol for unexplained infertility patients may achieve higher clinical pregnancy outcomes in IVF fresh cycle, but it could increased the duration of descending, the duration and dosage of Gn used.

Patients with endometriosis are often associated with follicular growth retardation and oocyte maturation disorders, severely affecting patient fertility. In patients with endometriosis, the occurrence of apoptosis and oxidative stress events in granulosa cells, impaired cellular energy metabolism and steroid synthesis in patients with endometriosis may be the cause of abnormal follicular development and decreased oocyte quality. The inflammatory response caused by endometrioma, which afterwards leads excessive activation of follicles and fibrosis of the ovarian cortex, which directly reduces ovarian reserve. This article discusses the oxidative stress and apoptosis of follicle granulosa cells, steroid hormone synthesis, energy metabolism abnormality in patients with endometriosis, and explains the adverse effects of endometrioma on ovarian reserve from the perspective of inflammatory response.

Patients with endometriosis are often associated with follicular growth retardation and oocyte maturation disorders, severely affecting patient fertility. In patients with endometriosis, the occurrence of apoptosis and oxidative stress events in granulosa cells, impaired cellular energy metabolism and steroid synthesis in patients with endometriosis may be the cause of abnormal follicular development and decreased oocyte quality. The inflammatory response caused by endometrioma, which afterwards leads excessive activation of follicles and fibrosis of the ovarian cortex, which directly reduces ovarian reserve. This article discusses the oxidative stress and apoptosis of follicle granulosa cells, steroid hormone synthesis, energy metabolism abnormality in patients with endometriosis, and explains the adverse effects of endometrioma on ovarian reserve from the perspective of inflammatory response.