OBJECTIVE: To explore the effect of electroacupuncture on endometrial receptivity and the pregnancy outcomes of in vitro fertilization and embryo transfer (IVF-ET) in the patients with diminished ovarian reserve (DOR). METHODS: Sixty-eight patients of DOR undertaken IVF-ET were randomized into an observation group (34 cases, 2 cases dropped off) and a control group (34 cases, 1 case dropped off). In the control group, endometrial preparation was performed according to the routine protocol. In the observation group, on the base of the treatment as the control group, acupuncture was applied to Geshu (BL 17), Shenshu (BL 23), Mingmen (GV 4), Shiqizhui (EX-B 8), Ciliao (BL 32), Zhongliao (BL 33), Tianshu (ST 25), Qihai (CV 6) and Guanyuan (CV 4), etc. Electric stimulation was given at Ciliao (BL 32)-Zhongliao(BL 33), Tianshu (ST 25)-Zigong (EX-CA 1), with disperse-dense wave, 2 Hz/15 Hz in frequency and tolerable current in intensity. Electroacupuncture was given once every two days, 3 times weekly, lasing 3 menstrual cycles till 1 day before embryo transfer. The endometrial thickness and morphology were observed on the day of human chorionic gonadotropin (HCG) of egg retrieval cycle, the day of endometrial transformation in frozen-thawed embryo transfer (FET) cycle and the day of embryo transfer in both groups successively; as well as HCG positive rate, clinical pregnancy rate, embryo implantation rate and live birth rate. RESULTS: In the observation group, the proportion of type A endometrium on the embryo transfer day was higher than those on HCG day of the egg retrieval cycle and the endometrial transformation day of FET cycle (P<0.05), and also higher than that of the control group (P<0.01). In the observation group, HCG positive rate, clinical pregnancy rate, embryo implantation rate and live birth rate were 75.0% (24/32), 71.9% (23/32), 47.4% (27/57) and 56.3% (18/32) respectively, and all higher than 36.4% (12/33), 30.3% (10/33), 18.0% (11/61) and 15.2% (5/33) in the control group separately (P<0.01). CONCLUSION Electroacupuncture improves the endometrial receptivity and IVF-ET pregnancy outcomes in the patients of diminished ovarian reserve.
Chorionic Gonadotropin ; Electroacupuncture ; Endometrium ; Female ; Fertilization in Vitro ; Humans ; Ovarian Diseases ; Ovarian Reserve ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate

Objective: To summarize the experience in diagnosis and treatment of 45, X Turner syndrome (TS) with gonadal Y chromosome mosaicism and bilateral gonadoblastoma (Gb) secreting human chorionic gonadotrophin(HCG). Methods: A female patient aged 5 years and 3 months was admitted to the hospital with a complaint of "enlarged breasts for 27 months, and elevated blood β-HCG for 8 months". The clinical data were summarized, and related literature up to March 2022 with the key words"Turner syndrome" "Gonadoblastoma" "Y chromosome" "human chorionic gonadotropin" "precocious" in PubMed, CNKI and Wanfang databases were reviewed. Results: The girl went to the local hospital for 2-month breast development at age of 3 years, and was found with a heart murmur diagnosed with "pulmonary venous malformation and atrial septal defect (secondary foramen type)". Surgical correction was performed. She experienced the progressive breast development, rapid linear growth and markedly advanced skeletal age, which cannot be explained by partial activation in the hypothalamic-pituitary-gonadal axis determined at the age of 3 years and 7 months in local hospital. Then whole-exome sequencing revealed chromosome number abnormality 45, X, which was confirmed by Karyotyping. At the age of 4 years and 6 months, serum β-HCG was found to be elevated (24.9 U/L) with no lesion found at the local hospital. On physical examination, she was found with breast development, pubic hair development and clitoromegaly with elevated serum testosterone (1.96 μg/L) and β-HCG (32.3 U/L). Sex determining region Y(SRY) gene was negative in peripheral blood sample. Thoracic and abdominal CT, head and pelvic magnetic resonance imaging were normal. Exploratory laparotomy confirmed the presence of a left adnexal tumor and a right fibrous streak gonad. During surgery, simultaneous samples of bilateral gonadal and peripheral venous blood were obtained and serum β-HCG, estradiol and testosteron concentrations was higher to lower from left gonadal venous blood, right gonadal venous blood, to peripheral venous blood. Bilateral gonadectomy was performed. Histopathology revealed bilateral gonadoblastomas. SRY was positive in bilateral gonadal tissues. After surgery, serum E₂, testerone and β-HCG returned to normal. So far 4 cases of HCG-secreting gonadoblastoma had been reported worldwide. The phenotypes of the 4 cases were all female, with virilization or amenorrhea, and the preoperative peripheral blood β-HCG concentrations were 74.4, 5.0, 40 456.0, and 42.4 U/L, respectively. Conclusions: There is a high risk of Gb in TS with Y chromosome components. Gb is infrequently presented with breast development, and Gb associated with HCG secretion is rare. Karyotyping should be performed in a phenotypic female with masculinization, and virilization in TS indicates the presence of Y chromosome material with concurrent androgen secreting tumors.
Humans ; Female ; Child, Preschool ; Gonadoblastoma/surgery* ; Turner Syndrome/complications* ; Virilism ; Chorionic Gonadotropin ; Ovarian Neoplasms

OBJECTIVE: To summarize and analyze the clinical characteristics of children with basal ganglia germinoma and to improve the level of early clinical diagnosis. METHODS: The clinical data of children diagnosed with basal ganglia germinoma admitted to the Pediatric Surgery Ward of Peking University First Hospital from January 2013 to December 2020 were retrospectively analyzed, and descriptive statistics were used to analyze the clinical characteristics of children with basal ganglia germinoma. RESULTS: A total of 30 patients were included in the study, 28 were male, 2 were female, the mean age at onset was (9.7±2.2) years, the median disease duration was 7 months, 27 had unilateral disease, and 3 had bilateral disease. The clinical manifestations were decreased limb muscle strength, cognitive function disorders, polydipsia, precocious puberty, intracranial hypertension, dysphonia and swallowing dysfunction. The serum and cerebrospinal fluid tumor marker alpha-fetoprotein (AFP) were normal in the 30 patients, and the serum and cerebrospinal fluid tumor marker β-human chorionic gonadotropin (β-HCG) were normal in 8 patients.The serum β-HCG was normal in 11 patients but the cerebrospinal fluid β-HCG was slightly elevated, and the serum and cerebrospinal fluid β-HCG were slightly elevated in 11 patients. A total of 33 lesions with irregular shapes were found by imaging examination, including 15 (45.5%) patchy lesions, 10 (30.3%) patchy lesions, and 8 (24.2%) round-like high-density lesions. Tumors showed obvious high-density shadows on computed tomography (CT) scan. Magnetic resonance imaging (MRI) scan of the tumors showed low or isointensity on T1WI and isointensity on T2WI, accompanied by mild peritumoral edema, hemispheric atrophy, cerebral peduncle atrophy, calcification, cystic degeneration, ventricular dilatation and wallerian degeneration. On contrast-enhanced scans, the tumor showed no enhancement or heterogeneous enhancement. CONCLUSION The main age of onset of germ cell tumors in the basal ganglia in children is about 10 years old, and males are absolutely dominant. The clinical features and imaging manifestations have certain characteristics. With both combined, the early diagnosis of germ cell tumors in the basal ganglia can be improved.
Atrophy/pathology* ; Basal Ganglia/pathology* ; Biomarkers, Tumor ; Brain Neoplasms/diagnostic imaging* ; Child ; Chorionic Gonadotropin, beta Subunit, Human ; Female ; Germinoma/pathology* ; Humans ; Magnetic Resonance Imaging ; Male ; Neoplasms, Germ Cell and Embryonal ; Retrospective Studies

BACKGROUND: Compared to adult studies, studies which involve the treatment of pediatric congenital hypogonadotropic hypogonadism (CHH) are limited and no universal treatment regimen is available. The aim of this study was to evaluate the feasibility of human chorionic gonadotropin (hCG)/human menopausal gonadotropin (hMG) therapy for treating male adolescents with CHH. METHODS: Male adolescent CHH patients were treated with hCG/hMG (n = 20) or a gonadotropin-releasing hormone (GnRH) pump (n = 21). The treatment was divided into a study phase (0-3 months) and a follow-up phase (3-12 months). The testicular volume (TV), penile length (PL), penis diameter (PD), and sex hormone levels were compared between the two groups. The TV and other indicators between the groups were analyzed using a t-test (equal variance) or a rank sum test (unequal variance). RESULTS: Before treatment, there was no statistical difference between the two groups in terms of the biochemistry, hormones, and other demographic indicators. After 3 months of treatment, the TV of the hCG/hMG and GnRH groups increased to 5.1 ± 2.3 mL and 4.1 ± 1.8 mL, respectively; however, the difference was not statistically significant (P > 0.05, t = 1.394). The PL reached 6.9 ± 1.8 cm and 5.1 ± 1.6 cm (P < 0.05, t = 3.083), the PD reached 2.4 ± 0.5 cm and 2.0 ± 0.6 cm (P < 0.05, t = 2.224), respectively, in the two groups. At the end of 6 months of treatment, biomarkers were in normal range in the two groups. Compared with the GnRH group, the testosterone (T) level and growth of PL and PD were significantly greater in the hCG/hMG group (all P < 0.05). While the TV of both groups increased, the difference was not statistically significant (P > 0.05, t = 0.314). After 9 to 12 months of treatment, the T level was higher in the hCG/hMG group. Other parameters did not exhibit a statistical difference. CONCLUSIONS: The hCG/hMG regimen is feasible and effective for treating male adolescents with CHH. The initial 3 months of treatment may be a window to optimally observe the strongest effects of therapy. Furthermore, results from the extended time-period showed positive outcomes at the 1-year mark; however, the long-term effectiveness, strengths, and weaknesses of the hCG/hMG regimen require further research. TRIAL REGISTRATION ClinicalTrials.gov, NCT02880280; https://clinicaltrials.gov/ct2/show/NCT02880280.
Adolescent ; Adult ; Child ; Chorionic Gonadotropin/therapeutic use* ; Gonadotropin-Releasing Hormone ; Humans ; Hypogonadism/drug therapy* ; Male ; Menotropins/therapeutic use* ; Spermatogenesis ; Testosterone

Heterotopic pregnancies are rare and difficult to be diagnosed early. A patient with combined intrauterine pregnancy and cervical pregnancy was admitted in Qingdao Municipal Hospital in 2019. The patient complained of abnormal vaginal bleeding after menopause and was misdiagnosed as simple intrauterine pregnancy. She underwent artificial abortion and suffered intraoperative hemorrhage. To stop bleeding, she received the treatment of uterine artery embolization immediately. Afterwards, cervical residual pregnancy tissues started necrosis, blood β-human chorionic gonadotropin level and the cervix appearance gradually returned to normal. This report suggests that cervical heterotopic pregnancy inclines to be mis diagnosed. Correct diagnosis should be made as soon as possible. Selective uterine artery embolization is an effective measure to prevent and treat massive bleeding.
Chorionic Gonadotropin, beta Subunit, Human ; Female ; Humans ; Pregnancy ; Pregnancy, Heterotopic/surgery* ; Uterine Artery Embolization ; Uterine Hemorrhage

Chorionic Gonadotropin ; Fertilization in Vitro ; Humans ; Oocytes ; Ovulation Induction

A 28-year old, G5P4 (4014), noted neck lymph nodes associated with cough. A chest X-ray was done showing a left nodular opacity. Antibiotics were prescribed with a resolution of symptoms. Five months after, a routine chest X-ray revealed interval progression in size of the lung nodule. A chest computed tomography (CT) scan and positron-emission tomography scan were done subsequently showing the precise location and size of the nodule and with no other focus of tumor seen. Transvaginal ultrasound was normal. With an initial diagnosis of lung carcinoma, a percutaneous needle aspiration biopsy under CT scan guidance was done. Immunohistochemical staining panel showed that beta-human chorionic gonadotropin (hCG) was positive. Subsequently, a serum beta-hCG done showed low levels from 33.48 to 59.7 mIU/ml. The final diagnosis given was a poorly differentiated malignancy highly suggestive of malignant trophoblastic tumor. A video-assisted left upper lobectomy was performed with histopathology and immunohistochemistry consistent with epithelioid trophoblastic tumor with co-existing choriocarcinoma elements. Postoperative beta-hCG level dropped to normal and remained so for 2½ years.
Choriocarcinoma ; Chorionic Gonadotropin

Choriocarcinoma is an aggressively growing and widely metastasizing tumor that originates from trophoblastic cells. A primary gastric choriocarcinoma (PGC), however, is very rare. A 76-year-old female patient visited the emergency department of Wonkwang University Hospital with abdominal discomfort and melena. Esophagogastroduodenoscopy revealed a huge ulceroinfiltrative mass lesion with blood clots on the boundary between the greater curvature side and the posterior wall side of the stomach lower body. CT showed a 3-cm exophytic mass lesion with heterogeneous enhancement, an ulcer lesion at the posterior wall side of the stomach lower body, and multiple enlarged lymph nodes at the splenic artery and left gastric artery nodal stations. She underwent a radical subtotal gastrectomy with a D2 lymph node dissection. The final diagnosis was PGC coexisting with adenocarcinoma based on the pathology results. This paper reports a rare case of primary gastric choriocarcinoma coexisting with adenocarcinoma and discusses the characteristics of this neoplasm with reference to the literature.
Adenocarcinoma ; Aged ; Arteries ; Choriocarcinoma ; Chorionic Gonadotropin ; Diagnosis ; Emergency Service, Hospital ; Endoscopy, Digestive System ; Female ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Melena ; Pathology ; Pregnancy ; Splenic Artery ; Stomach ; Trophoblasts ; Ulcer

To investigate whether intrauterine injection of human chorionic gonadotropin (hCG) before the embryo transfer in a frozen-thawed transfer cycle can improve the pregnancy outcome in the patients with repeated implantation failure (RIF).
 Methods: Prospective randomized-controlled trial was adopted. A total of 140 patients, who underwent thawed embryo transplantation and were in line with the diagnosis of RIF, were included. Other patients with some factors, such as uterine malformation, postoperative uterine cavity sticking, tubal effusion, endocrine diseases and endometriosis, were excluded. The patients were randomly divided into 2 groups through the computer random number table: an hCG intrauterine perfusion group and a control group. There was no significant difference in the age, the estradiol level, the number of transplanted embryos, the number of optimal embryos, and the thickness of the endometrium before transplantation between the 2 group (all P>0.05). The hCG+G2 fluid and the G2 fluid were prepared on the day of embryo transfer, and 40 μL of which was injected at an intrauterine site at 3 minutes before embryo transfer in the hCG intrauterine perfusion group and the control group, respectively. The clinical pregnancy rate and implantation rate in the 2 groups were compared.
 Results: The implantation rate and the clinical pregnancy rate in the hCG intrauterine perfusion group were higher than those in the control group (both P<0.05).
 Conclusion: The intrauterine injection of hCG can improve the implantation rate and pregnancy rate in cryopreserved embryo transfer in patients with RIF.
Chorionic Gonadotropin ; Embryo Implantation ; Embryo Transfer ; Female ; Humans ; Pregnancy ; Pregnancy Outcome ; Prospective Studies

The objective of this study was to evaluate the feasibility of posterior colpotomy for the surgical treatment of tubal ectopic pregnancy in hemodynamically stable women. We performed a retrospective analysis of medical records obtained over a period of 18 months. Twelve cases were identified, with the following characteristics: mean gestational age, 7.7 weeks; mean serum β-human chorionic gonadotropin level, 7,786 mIU/mL; and greater diameter of the mass, 15–69 mm. Treatment was successful in all cases. Salpingectomy was performed in 10 patients (83.3%) and salpingostomy, in 1 patient. The remaining patient only received peritoneal lavage, as the evidence of ectopic abortion with only a slightly dilated uterine tube was found during surgery. The mean surgical time was 42.5 minutes. In the analyzed cases, posterior colpotomy was found to be a feasible alternative method for the surgical treatment of tubal ectopic pregnancy in hemodynamically stable women.
Chorionic Gonadotropin ; Colpotomy ; Fallopian Tubes ; Female ; Gestational Age ; Humans ; Medical Records ; Methods ; Operative Time ; Peritoneal Lavage ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Tubal ; Retrospective Studies ; Salpingectomy ; Salpingostomy ; Surgical Procedures, Operative