OBJECTIVE To observe the efficacy of cetrorelix combined with aspirin in preventing early-onset ovarian hyperstimulation syndrome （OHSS）. METHODS A retrospective analysis was conducted on clinical data from 38 early-onset OHSS patients， who received treatment in our hospital from January 1st to July 1st， 2022. These patients were divided into intervention group （19 cases） and control group （19 cases） according to the therapy regimen. On the first day after oocyte retrieval surgery， the control group was given aspirin enteric-coated tablets 100 mg orally until menstruation began. The intervention group was given cetrorelix for injection 0.25 mg subcutaneously， for consecutive 3 days+aspirin enteric-coated tablets （same usage and dosage as the control group）. The first luteal phase， the degree of OHSS， and the ovarian volume， ascites volume， serum estradiol （E2）， white blood cell count （WBC）， hematocrit （HCT）， neutrophil ratio （NEUT%）， D-dimer （DD）， prothrombin time （PT）， fibrinogen （Fib） after oocyte retrieval surgery were observed and measured in 2 groups. RESULTS The first luteal phase was significantly shorter， and the proportions of median and severe OHSS cases were significantly lower in the intervention group compared to the control group （P＜0.05 or P＜0.01）. After oocyte retrieval surgery， the intervention group showed significantly lower ovarian volume， ascites volume， serum E2， WBC， NEUT%， HCT， DD and Fib compared to the control group， but PT of intervention group was signiticantly higher than that of control group （P＜0.05）. CONCLUSIONS Cetrorelix combined with aspirin is more effective in preventing early-onset OHSS than aspirin alone.

Objective:To analyze the clinical outcomes of the first frozen-thawed embryo transfer (FET) in patients <35 years old applying natural cycle (NC) and hormone replacement therapy (HRT).Methods:A retrospective cohort study was conducted to analyze 4 814 young infertility patients who underwent the first FET in Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University from January 2016 to June 2021. According to different endometrial preparation protocols, they were divided into 2 groups: NC group and HRT group, who were matched the baseline data using 1∶1 propensity score matching (PSM). After the matching, the two groups of their baseline data, pregnancy outcomes and perinatal outcomes were compared, and then we adjusted the confounding factors which affect live birth rate by univariate and multivariate logistic regression analysis. Based on antral follicle count (AFC), number of embryos transferred and number of high-quality embryos transferred, the effect of NC and HRT on the live birth rate were further analyzed.Results:Before PSM, 2 131 patients in NC group and 2 683 patients in HRT group were included. The differences in female age, male age, body mass index (BMI), basal follicle-stimulating hormone (bFSH), anti-Müllerian hormone (AMH), AFC, endometrial thickness on conversion day, and number of embryos transferred were all statistically significant between the two groups (all P<0.05). And the differences in number of high-quality embryos transferred and type of embryos transferred between the two groups were not statistically significant (all P>0.05). After PSM, 1 441 patients in each of NC group and HRT group were included, and there were no significant differences in their baseline characteristics such as female age, male age and BMI between the two groups (all P<0.05). The live birth rate [50.66% (730/1 441)] and the clinical pregnancy rate [60.31% (869/1 441)] in NC group were significantly higher than those in HRT group [44.69% (644/1 441), P=0.001; 54.27% (782/1 441), P=0.001], and the incidence of very low birth weight in NC group was significantly lower than that in HRT group, and there were no statistical significances in other indicators between the two groups (all P>0.05). After adjusting confounders including bFSH, AMH, AFC, endometrial thickness on conversion day, number of embryos transferred and high-quality embryos transferred using multivariate logistic regression analysis, the results showed that NC was an independent protective factor for live birth rate in the first FET cycle ( aOR=1.280, 95% CI: 1.103-1.486, P=0.001). Stratified analysis showed that those with AFC<11, AFC 11-12, 2 embryos transferred and 2 high-quality embryos tranferred in NC group had significantly higher live birth rate [49.03% (151/308), 49.09% (349/711), 56.38% (442/784), 57.85% (350/605)] than those in HRT group [36.36% (120/330), P=0.001; 43.14% (286/663), P=0.027; 48.97% (379/774), P=0.003; 48.68% (294/604), P=0.001]. Conclusion:NC-FET had higher live birth rate and clinical pregnancy rate than HRT-FET in young patients.

Objective:To follow-up the previous phase Ⅲ clinical trial of recombinant human follicle-stimulating hormone (Follitrope ?), and to evaluate the cumulative pregnancy rate, the cumulative live birth rate, and the neonatal outcomes of subjects. Methods:The phase Ⅲ clinical study of Follitrope ? in China (CTR20150341/CTR20150341, May 15, 2015—June 27, 2016) was followed up until December 31, 2022. Patients were divided into Follitrope ? group and Gonal-F ? group. According to the age, patients were divided into three subgroups: 20-30 years old subgroup, 31-35 years old subgroup and 36-39 years old subgroup. Cumulative pregnancy rate, cumulative live birth rate, number of embryos transferred per cycle, live births per embryo transfer cycle, live births per oocyte retrieved, and neonatal characteristics were analyzed. Results:A total of 446 patients were included in the analysis, of which 336 (75.3%) were in the Follitrope ? group and 110 (24.7%) in the Gonal-F ? group, with a follow-up period of 6.5 years. There were no statistically significant differences between the Follitrope ? group and the Gonal-F ? group in terms of cumulative pregnancy rate and cumulative live birth rate (all P>0.05). Similar cumulative pregnancy rates and cumulative live birth rates were observed between the two groups within each age subgroup (all P>0.05). In the 36-39 years old subgroup, the Follitrope ? group showed a trend towards higher cumulative pregnancy rate [60.0% (12/20)] and cumulative live birth rate [55.0% (11/20)] compared with the Gonal-F ? group [28.6% (2/7), 14.3% (1/7)], however, none of the differences were statistically significant (all P>0.05). Twin pregnancy rates, live births per embryo, live birth per oocyte, newborn gender, birth weight, and birth defect rates were similar between the Follitrope ? group and the Gonal-F ? group without statistically significant differences (all P>0.05). Conclusion:The safety and effectiveness of Follitrope ? in controlled ovarian hyperstimulation are similar to those of Gonal-F ?. Compared with Gonal-F ?, there is a trend toward higher cumulative pregnancy rates and cumulative live birth rates in elderly patients with Follitrope ?, although there is no statistical difference.

Objective:To analyze the clinical outcomes of the first frozen-thawed embryo transfer (FET) in patients <35 years old applying natural cycle (NC) and hormone replacement therapy (HRT).Methods:A retrospective cohort study was conducted to analyze 4 814 young infertility patients who underwent the first FET in Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University from January 2016 to June 2021. According to different endometrial preparation protocols, they were divided into 2 groups: NC group and HRT group, who were matched the baseline data using 1∶1 propensity score matching (PSM). After the matching, the two groups of their baseline data, pregnancy outcomes and perinatal outcomes were compared, and then we adjusted the confounding factors which affect live birth rate by univariate and multivariate logistic regression analysis. Based on antral follicle count (AFC), number of embryos transferred and number of high-quality embryos transferred, the effect of NC and HRT on the live birth rate were further analyzed.Results:Before PSM, 2 131 patients in NC group and 2 683 patients in HRT group were included. The differences in female age, male age, body mass index (BMI), basal follicle-stimulating hormone (bFSH), anti-Müllerian hormone (AMH), AFC, endometrial thickness on conversion day, and number of embryos transferred were all statistically significant between the two groups (all P<0.05). And the differences in number of high-quality embryos transferred and type of embryos transferred between the two groups were not statistically significant (all P>0.05). After PSM, 1 441 patients in each of NC group and HRT group were included, and there were no significant differences in their baseline characteristics such as female age, male age and BMI between the two groups (all P<0.05). The live birth rate [50.66% (730/1 441)] and the clinical pregnancy rate [60.31% (869/1 441)] in NC group were significantly higher than those in HRT group [44.69% (644/1 441), P=0.001; 54.27% (782/1 441), P=0.001], and the incidence of very low birth weight in NC group was significantly lower than that in HRT group, and there were no statistical significances in other indicators between the two groups (all P>0.05). After adjusting confounders including bFSH, AMH, AFC, endometrial thickness on conversion day, number of embryos transferred and high-quality embryos transferred using multivariate logistic regression analysis, the results showed that NC was an independent protective factor for live birth rate in the first FET cycle ( aOR=1.280, 95% CI: 1.103-1.486, P=0.001). Stratified analysis showed that those with AFC<11, AFC 11-12, 2 embryos transferred and 2 high-quality embryos tranferred in NC group had significantly higher live birth rate [49.03% (151/308), 49.09% (349/711), 56.38% (442/784), 57.85% (350/605)] than those in HRT group [36.36% (120/330), P=0.001; 43.14% (286/663), P=0.027; 48.97% (379/774), P=0.003; 48.68% (294/604), P=0.001]. Conclusion:NC-FET had higher live birth rate and clinical pregnancy rate than HRT-FET in young patients.

Objective:To follow-up the previous phase Ⅲ clinical trial of recombinant human follicle-stimulating hormone (Follitrope ?), and to evaluate the cumulative pregnancy rate, the cumulative live birth rate, and the neonatal outcomes of subjects. Methods:The phase Ⅲ clinical study of Follitrope ? in China (CTR20150341/CTR20150341, May 15, 2015—June 27, 2016) was followed up until December 31, 2022. Patients were divided into Follitrope ? group and Gonal-F ? group. According to the age, patients were divided into three subgroups: 20-30 years old subgroup, 31-35 years old subgroup and 36-39 years old subgroup. Cumulative pregnancy rate, cumulative live birth rate, number of embryos transferred per cycle, live births per embryo transfer cycle, live births per oocyte retrieved, and neonatal characteristics were analyzed. Results:A total of 446 patients were included in the analysis, of which 336 (75.3%) were in the Follitrope ? group and 110 (24.7%) in the Gonal-F ? group, with a follow-up period of 6.5 years. There were no statistically significant differences between the Follitrope ? group and the Gonal-F ? group in terms of cumulative pregnancy rate and cumulative live birth rate (all P>0.05). Similar cumulative pregnancy rates and cumulative live birth rates were observed between the two groups within each age subgroup (all P>0.05). In the 36-39 years old subgroup, the Follitrope ? group showed a trend towards higher cumulative pregnancy rate [60.0% (12/20)] and cumulative live birth rate [55.0% (11/20)] compared with the Gonal-F ? group [28.6% (2/7), 14.3% (1/7)], however, none of the differences were statistically significant (all P>0.05). Twin pregnancy rates, live births per embryo, live birth per oocyte, newborn gender, birth weight, and birth defect rates were similar between the Follitrope ? group and the Gonal-F ? group without statistically significant differences (all P>0.05). Conclusion:The safety and effectiveness of Follitrope ? in controlled ovarian hyperstimulation are similar to those of Gonal-F ?. Compared with Gonal-F ?, there is a trend toward higher cumulative pregnancy rates and cumulative live birth rates in elderly patients with Follitrope ?, although there is no statistical difference.

Objective:To explore the impact of female body mass index (BMI) on clinical outcomes in patients treated with intrauterine insemination (IUI).Methods:This study was a retrospective cohort study. A total of 21 137 patients who visited the Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University from January 2010 to December 2021 were recruited. The patients underwent the first IUI cycles, including artificial insemination by husband (AIH) and artificial insemination by donor (AID). According to clinical pregnancy or not, it is divided into pregnancy group and non-pregnancy group. The basic parameters between clinical pregnancy group and non-clinical pregnancy group were compared. According to the BMI, patients were divided into 4 groups, group A: BMI≤18.5 kg/m 2, group B: 18.6-23.9 kg/m 2, group C: 24.0-27.9 kg/m 2and group D: BMI≥28.0 kg/m 2. Patients' basic parameters and clinical outcomes were compared among the four groups. Multivariate logistic regression analysis was used to explore the impact of BMI on pregnancy outcomes. Results:In all IUI cycles, BMI was significantly different between pregnant patients and non-pregnant patients [(24.58±3.52) kg/m 2vs. (23.35±4.20) kg/m 2, P<0.001]. In AIH cycles, clinical pregnancy rate [18.21% (877/4 815), 17.12% (222/1 297)] and early spontaneous miscarriage rate [17.10% (150/877), 21.62% (48/222)] were significantly higher in patients of group C and group D than in group A [11.24% (130/1 157), 10.77% (14/130)] and group B [13.40% (1 229/9 174), 15.30% (188/1 229)]. The differences among the 4 groups were statistically significant ( P=0.012, P=0.003). However, BMI was not associated with clinical pregnancy rate in multivariate logistic analysis, but obesity was a predictor for early spontaneous miscarriage ( OR=1.63, 95% CI: 1.25-1.95, P=0.003). In AID cycles, pregnancy outcomes were comparable among the four BMI groups. Obesity significantly increased early spontaneous miscarriage rate ( OR=1.58, 95% CI: 1.14-1.87, P=0.016). Conclusion:Female BMI is not associated with clinical outcomes in IUI cycles. Obesity is a predictor for early spontaneous miscarriage in both AIH and AID cycles.

Objective:To explore the effect of inactive tuberculosis on the assisted reproductive outcome of the first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) in infertile patients. Methods:A retrospective cohort study was conducted to analyze the data of 15 412 infertile patients who underwent the first fresh-cycle embryo transfer in the Reproductive and Genetics Hospital of the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2021. They were divided into inactive tuberculosis group (635 cases) and control group (1 270 cases) according to the ratio of 1∶2 by propensity score matching (PSM). The inactive tuberculosis group was divided into three subgroups: tuberculosis (group A, 378 cases), pelvic tuberculosis (group B, 214 cases) and other tuberculosis (group C, 43 cases) according to the location. The inactive tuberculosis group was also divided into the treatment subgroup (377 cases) and the non-treatment subgroup (258 cases) according to whether they had undergone treatment. The assisted reproductive outcomes were compared and the influencing factors were analyzed.Results:After PSM, the difference of the baseline data between the inactive tuberculosis group and control group was not statistically significant (all P>0.05). The fertilization rate [65.2% (5 207/7 991)] of patients in the inactive tuberculosis group was significantly higher than that of control group [63.7% (9 889/15 524), P=0.027], but the implantation rate [41.9% (483/1 152)], the clinical pregnancy rate [58.4% (371/635) ] and the live birth rate [46.5% (295/635)] were significantly lower than those of control group [48.8% (1 112/2 279), P<0.001; 67.2% (853/1 270), P<0.001; 57.9% (735/1 270), P<0.001], and the miscarriage rate [20.5% (76/371)] was significantly higher than that of control group [13.8% (118/853), P=0.003], and the endometrium thickness [(11.8±2.6) mm] was thinner than that of control group [(12.5±3.9) mm, P<0.001]. For subgroup analysis, the high-quality embryo rate in group B [62.3% (1 111/1 784)] was significantly lower than that in group A [66.5% (2 027/3 048), P=0.007] and control group [65.9% (6 516/9 889), P=0.007], and the difference was statistically significant. The implantation rate [46.6% (318/682)], the clinical pregnancy rate [64.5% (243/377)] and the live birth rate [51.7% (195/377)] in the treatment group were higher than those in the non-treatment group [35.1% (165/470), P<0.001;49.6% (128/258), P<0.001;38.8% (100/258), P=0.001]. In addition, logistic regression showed that inactive tuberculosis was an independent risk factor for clinical pregnancy, live birth, and miscarriage ( OR=0.71, 95% CI: 0.58-0.87, P=0.002; OR=0.65, 95% CI: 0.54-0.80, P<0.001; OR=1.58, 95% CI: 1.15-2.19, P=0.045). Conclusion:Inactive tuberculosis is an independent risk factor for adverse assisted reproductive outcomes. Compared with non-tuberculosis infertile patients, the pregnancy outcomes of inactive tuberculosis infertile patients who received IVF/ICSI-ET for the first time are poorer, especially the patients with pelvic tuberculosis in the past. Regular anti-tuberculosis treatment for tuberculosis patients can help to improve pregnancy outcomes.

Objective:To explore the impact of female body mass index (BMI) on clinical outcomes in patients treated with intrauterine insemination (IUI).Methods:This study was a retrospective cohort study. A total of 21 137 patients who visited the Reproductive Medical Center, the First Affiliated Hospital of Zhengzhou University from January 2010 to December 2021 were recruited. The patients underwent the first IUI cycles, including artificial insemination by husband (AIH) and artificial insemination by donor (AID). According to clinical pregnancy or not, it is divided into pregnancy group and non-pregnancy group. The basic parameters between clinical pregnancy group and non-clinical pregnancy group were compared. According to the BMI, patients were divided into 4 groups, group A: BMI≤18.5 kg/m 2, group B: 18.6-23.9 kg/m 2, group C: 24.0-27.9 kg/m 2and group D: BMI≥28.0 kg/m 2. Patients' basic parameters and clinical outcomes were compared among the four groups. Multivariate logistic regression analysis was used to explore the impact of BMI on pregnancy outcomes. Results:In all IUI cycles, BMI was significantly different between pregnant patients and non-pregnant patients [(24.58±3.52) kg/m 2vs. (23.35±4.20) kg/m 2, P<0.001]. In AIH cycles, clinical pregnancy rate [18.21% (877/4 815), 17.12% (222/1 297)] and early spontaneous miscarriage rate [17.10% (150/877), 21.62% (48/222)] were significantly higher in patients of group C and group D than in group A [11.24% (130/1 157), 10.77% (14/130)] and group B [13.40% (1 229/9 174), 15.30% (188/1 229)]. The differences among the 4 groups were statistically significant ( P=0.012, P=0.003). However, BMI was not associated with clinical pregnancy rate in multivariate logistic analysis, but obesity was a predictor for early spontaneous miscarriage ( OR=1.63, 95% CI: 1.25-1.95, P=0.003). In AID cycles, pregnancy outcomes were comparable among the four BMI groups. Obesity significantly increased early spontaneous miscarriage rate ( OR=1.58, 95% CI: 1.14-1.87, P=0.016). Conclusion:Female BMI is not associated with clinical outcomes in IUI cycles. Obesity is a predictor for early spontaneous miscarriage in both AIH and AID cycles.

Objective:To explore the effect of inactive tuberculosis on the assisted reproductive outcome of the first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) in infertile patients. Methods:A retrospective cohort study was conducted to analyze the data of 15 412 infertile patients who underwent the first fresh-cycle embryo transfer in the Reproductive and Genetics Hospital of the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2021. They were divided into inactive tuberculosis group (635 cases) and control group (1 270 cases) according to the ratio of 1∶2 by propensity score matching (PSM). The inactive tuberculosis group was divided into three subgroups: tuberculosis (group A, 378 cases), pelvic tuberculosis (group B, 214 cases) and other tuberculosis (group C, 43 cases) according to the location. The inactive tuberculosis group was also divided into the treatment subgroup (377 cases) and the non-treatment subgroup (258 cases) according to whether they had undergone treatment. The assisted reproductive outcomes were compared and the influencing factors were analyzed.Results:After PSM, the difference of the baseline data between the inactive tuberculosis group and control group was not statistically significant (all P>0.05). The fertilization rate [65.2% (5 207/7 991)] of patients in the inactive tuberculosis group was significantly higher than that of control group [63.7% (9 889/15 524), P=0.027], but the implantation rate [41.9% (483/1 152)], the clinical pregnancy rate [58.4% (371/635) ] and the live birth rate [46.5% (295/635)] were significantly lower than those of control group [48.8% (1 112/2 279), P<0.001; 67.2% (853/1 270), P<0.001; 57.9% (735/1 270), P<0.001], and the miscarriage rate [20.5% (76/371)] was significantly higher than that of control group [13.8% (118/853), P=0.003], and the endometrium thickness [(11.8±2.6) mm] was thinner than that of control group [(12.5±3.9) mm, P<0.001]. For subgroup analysis, the high-quality embryo rate in group B [62.3% (1 111/1 784)] was significantly lower than that in group A [66.5% (2 027/3 048), P=0.007] and control group [65.9% (6 516/9 889), P=0.007], and the difference was statistically significant. The implantation rate [46.6% (318/682)], the clinical pregnancy rate [64.5% (243/377)] and the live birth rate [51.7% (195/377)] in the treatment group were higher than those in the non-treatment group [35.1% (165/470), P<0.001;49.6% (128/258), P<0.001;38.8% (100/258), P=0.001]. In addition, logistic regression showed that inactive tuberculosis was an independent risk factor for clinical pregnancy, live birth, and miscarriage ( OR=0.71, 95% CI: 0.58-0.87, P=0.002; OR=0.65, 95% CI: 0.54-0.80, P<0.001; OR=1.58, 95% CI: 1.15-2.19, P=0.045). Conclusion:Inactive tuberculosis is an independent risk factor for adverse assisted reproductive outcomes. Compared with non-tuberculosis infertile patients, the pregnancy outcomes of inactive tuberculosis infertile patients who received IVF/ICSI-ET for the first time are poorer, especially the patients with pelvic tuberculosis in the past. Regular anti-tuberculosis treatment for tuberculosis patients can help to improve pregnancy outcomes.

Objective:The present study aimed to explore the clinical value of neutrophil to lymphocyte and platelet ratio (NLPR) for acute kidney injury (AKI) in elderly patients with sepsis.Methods:This was a retrospective analysis of 360 elderly patients with sepsis or septic shock who were admitted to Intensive Care Unit (ICU) of Zhongnan Hospital of Wuhan University. They were divided into AKI and non-AKI groups based on the KDIGO-AKI criteria. The independent risk factors of AKI were identified via logistic regression analysis, and the calculation of the receiver-operating characteristic (ROC) curves were used to evaluate the diagnostic capability of NLPR for AKI and the short-term outcome of sepsis patients.Results:Total of 195 (54.2%) patients were attributed to the AKI group, while 165 (45.8%) patients were allocated to the non-AKI group. The median of NLPR was significantly higher in the AKI group compared with the non-AKI group ( Z=8.640, P<0.001). Compared with the non-AKI group, the in-hospital death and the length of ICU stay increased (all P<0.05). Patients with AKI required more vasoactive drugs, mechanical ventilation, and renal replacement therapy (all P<0.05). After adjusting the demographic and clinical variables, multivariate logistic regression analysis showed that NLPR was an independent risk factor of AKI ( OR=1.016, 95% CI 1.002-1.030, P=0.027). The ROC curves showed the excellent clinical value of NLPR and which was significantly higher than the neutrophil to lymphocyte ratio (NLR) and serum creatinine. In addition, the present study revealed that the NLPR was also positively correlated with the stage of AKI ( r=0.525, P<0.001). Conclusions:The NLPR is derived from a complete blood cell count, as a new comprehensive inflammatory parameter that is simple and easily available, it is an independent risk factor for AKI in elderly sepsis patients, and should be paid attention in the clinical practice.