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Objective: To explore the impact of poly-pronucleus (PN) incidence on the embryonic development and pregnancy outcome after intracytoplasmic sperm injection (ICSI). Methods: This is a retrospective cohort study, analyzing the clinical data of patients after ICSI between January 2016 and December 2021. The objects of study were divided into three groups according to the proportion of poly-PN: the control group (the proportion of poly-PN=0%, n=333), the low-frequency poly-PN group (0%＜the proportion of poly-PN＜20%, n=80) and the high -frequency poly -PN group (the proportion of poly -PN ≥20%, n =31). The embryonic development and pregnancy outcomes were compared among the groups, respectively. Results: The numbers of oocytes retrieved and available embryos on day 3 (D3) were higher in the low-frequency poly-PN group than those in the control group, but the rates of normal fertilization and high -scoring blastocyst formation were lower than those in the control group (all P＜0.017). Compared with the control group and the low-frequency poly-PN group, the high-frequency poly-PN group had lower rate of normal fertilization rate, lower number of available embryos on D3 (all P＜0.017), and low rate of biochemical pregnancy and high miscarriage rate (but P＞0.017). Multifactorial Logistic analysis showed that patients in the high-frequency poly-PN group had significantly lower biochemical pregnancy rate and live birth rate when compared with the control group (aOR=0.402, 95%CI: 0.186-0.870, aP=0.021; aOR=0.247, 95%CI: 0.068-0.901, aP=0.034). Conclusions: In the ICSI cycles, the incidence of poly-PN may reflect oocyte quality, and the incidence of poly -PN ≥20% may predict the poor embryo development, lower biochemical pregnancy rate and lower live birth rate. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship between the embryodynamic parameters using time-lapse system and the pregnancy outcomes, so as to establish a model of the optimal embryo selection. Methods: A total of 137 cycles with the time-lapse system (IVF/ICSI-ET cycle) were retrospectively analyzed from December 2016 to December 2017. The clinical data including basic information and pregnancy outcomes were collected. The morphokinetic parameters using the time -lapse system (t2、t3、t4、t5、t6、t7、t8、cc2、s2、cc3、s3) were compared between the implanted embryos and the unimplanted embryos. Based on those parameters related with embryo implantation, a multivariate classification model was developed. This model was then primarily verified. Results: ① Totally 171 embryos had one or more early abnormal division event, in which 16 were considered to be implantable, and then transplanted. There were 4 embryos implantated succesfully. ② There were no significant differences in all of 11 morphokinetic parameters between the implanted embryos and the unimplanted embryos (P>0.05).③Thet6(OR=1.462,95%CI:1.093-1.954, P=0.010)and t7 (OR=0.803,95%a:0.653-0.989, P=0.039) could be the best predictors of implantation. A classification model was developed with these two parameters combined with the exclusion standard of abnormal division event. The implantation rate was declined as the embryonic grade dropped. The area under the receiver operating characteristic curve (AUC) was 0.649 (95% CI: 0.528-0.770). Conclusions: Two of morphokinetic parameters (t6, t7) could be closely related to the implantation potential. We tried to develop an embryo selecting model with these two parameters combined with exclusion standard of abnormal division events. It is true that this model should be furtherly validated in our centers. [ABSTRACT FROM AUTHOR]

Objective: To investigate the application of intracytoplasmic sperm injection (ICSI) combined with immature oocyte in vitro maturation (IVM) in those ageing women with poor ovarian response(POR) who underwent different ovarian stimulation. Methods: A total of 81 cycles of ICSI were evaluated retrospectively from January 2016 to September 2018 at the First Affiliated Hospital of Zhengzhou University. The inclusion criteria were age 多 35 years, the number of oocytes 矣3, and the oocytes immature. These cycles were grouped according to the protocols of ovulation stimulation: the micro-stimulation group (n=37) and the antagonist group (n=44). The basal levels of reproductive hormones and the pregnancy outcome were compared between the two gruops. Results: There were no significant differences in age, infertility years, basal levels of hormones (including AMH) and basal antral follicles between the two groups (P>0.05). The amount of Gn in the antagonist group was significantly higher than that in the micro-stimulation group (P<0.05). There were no significant differences in the in vitro culture maturation rate, 2PN rate, cleavage rate, embryonic rate and excellent embryo rate between the two groups (P<0.05). Meanwhile, there were no significant differences in the implantation rate and the clinical pregnancy rate (P> 0.05). Conclusions: The ICSI combined with IVM in ageing women with POR is beneficial to improve the oocyte maturation rate and embryo utilization, and to increase the pregnancy chance. The micro-stimulation protocol is a cost-effective option for those women with POR. [ABSTRACT FROM AUTHOR]

Objective：To evaluate the effect of GnRHa ultra long protocol on clinical outcomes of IVF/ ICSI-ET in patients with different stages of endometriosis. Methods：PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, Wanfang Data, VIP database, CBM and Google Scholar were searched to identify those studies involving human subjects published before August 1st, 2018. Those clinical trials that compared the effects of the GnRHa ultra long protocol and the GnRHa long protocol on clinical outcomes of IVF/ICSI-ET in patients with endometriosis were included. The meta-analysis was performed by two investigators. Results：Nine studies were included in the meta-analysis. Comparing with the GnRHa long protocol, the GnRHa ultral long protocol in those endometriosis patients at stage Ⅰ-Ⅱ had significantly higher Gn doses (SMD=0.36, 95%CI：0.01-0.70) and higher implantation rate (RR=1.19, 95%CI: 1.04-1.37), and lower number of oocytes retrieved (SMD=-0.26, 95%CI: -0.48- -0.04), although there were no significant differences in basal FSH, Gn days and clinical pregnancy rate (all P＞0.05). In those endometriosis patients at stage Ⅲ-Ⅳ, the GnRHa ultra long protocol had significantly higher clinical pregnancy rate (RR=1.38, 95%CI: 1.06 -1.80) when compared with the GnRHa long protocol, although there were no significantly differences in basal FSH, Gn doses, Gn days, the number of oocytes retrieved and implantation rate (all P＞0.05). Conclusions：For those endometriosis patients at stage Ⅰ-Ⅱ, the GnRHa ultra long protocol could not improve the pregnancy rate, but cost more Gn and retrieve fewer oocytes. For those endometriosis patients at stage Ⅲ-Ⅳ, the GnRHa ultra long protocol could significantly improve the pregnancy rate. [ABSTRACT FROM AUTHOR]

Objective：To investigate the correlation between serum vitamin D and the pregnancy outcome of in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in women with polycystic ovary syndrome (PCOS). Methods: A total of 286 infertility women with PCOS underwent IVF/ICSI from November 2016 to June 2018 were included，including 114 women received fresh embryo transfer (ET). According to the level of 25-hydroxyvitamin D(25OHD), those patients were divided into three groups: vitamin D deficiency group (≤10 ng/mL), insufficiency group (10-30 ng/mL) and sufficiency group (≥30 ng/mL).The pregnancy rate of IVF/ICSI was analyzed. Furthermore, the patients with fresh ET were further divided into two groups: clinical pregnancy group and non -pregnancy group. After adjusting for baselines of luteinizing hormone (LH), testosterone and endometrial thickness on the ET day, logistic regression analysis on the vitamin D level and clinical pregnancy outcome of IVF/ICSI -ET was performed. Results: (1)There were significant differences in BMI, baseline testosterone, the ratio of baseline LH/ FSH among three groups (P＜0.05). There were no significant differences in the indicators of ovulation induction (P＞0.05). (2)In those fresh ET patients, there were significant differences in BMI, the rate of fertilization and the rate of embryo implantation among three subgroups (P＜0.05). (3) The baselines of LH and testosterone in the pregnancy group were lower than those in the non-pregnancy group (P＜0.05), while the endometrial thickness on the ET day and the rate of fertilization in the pregnancy group were significantly higher than those in the nonpregnancy group (P＜0.05). After adjusting for age, baseline LH, baseline testosterone, the endometrial thickness on the ET day and the ratio of baseline LH/FSH, the logistic regression analysis showed that the pregnancy rates in the vitamin D insufficiency group and the sufficiency group were significantly higher than this rate in the vitamin D deficiency group （aOR=5.559，95%CI：1.463-21.124，P=0.012；aOR=11.192，95%CI：1.674 -74.822，P =0.013）. Conclusions: The level of serum vitamin D≥10 ng/mL is a protective factor of IVF/ICSI-ET in women with PCOS. [ABSTRACT FROM AUTHOR]

Objective：To investigate the high-accuracy predictive factors of ovarian response to ovulation induction. Methods：The basic information, medication and outcome of 5 859 IVF/ICSI cycles were respectively analyzed in our center from June 2014 to December 2016. The Logistic regression model was developed to predict the ovarian response. There were a total of 517 cycles in the low-response group, 1 281 cycles in the high - response group and 4 061 cycles in the normal-response group. The clinical data of 1 143 cycles in 2017 were used to test the diagnostic value of those factors. Results：The differences in the age, AFC, basal hormone levels, medication and clinical outcomes were significant among the three groups (P＜0.001). The level of serum AMH was the important predictor of ovarian response, with the cut-off values of 2.76 ng/mL for high ovarian response and 1.50 ng/mL for low ovarian response. AMH if combining with age could predict high ovarian response, while AMH combining with AFC also predict low ovarian response. Conclusions：The level of serum AMH was a good predictor of ovarian response before Gn initiation. AMH if combining with AFC and age was of great significance in obtaining an appropriate number of oocytes, ensuring a good pregnancy outcome and preventing ovarian hyperstimulation syndrome. [ABSTRACT FROM AUTHOR]

Objective：To evaluate whether the index of sperm DNA fragmentation index (DFI) can be used as a parameter of male fertility. Methods：A total of 460 infertile men were enrolled in the observation group, and 107 fertile men in the control group. Semen parameters were calculated by the computer assisted semen analysis system (CASA). Sperm DNA fragmentation index (DFI) was detected by the sperm chromatin structure assay (SCSA). The results of routine semen analysis were divided into the normal, oligospermia, asthenospermia and oligoasthenospermia subgroups. Objects were also grouped into 3 subgroups according to the age, ＜30 years, 30-39 years, and over 40 years. Specially, those objects were further divided into three subgroups according to DFI, ≤15, 15 -30 and ≥30. DFI was compared between the control group and the observation group. The correlations between sperm DFI and age, IVF/ICSI embryonic development and reproductive outcome were successively analyzed. Results：There were significant differences in the proportions of normal, oligospermia, asthenospermia and oligoasthenospermia between the observation group and the control group (22.17% vs. 60.96%, 13.26% vs. 34.59%, 52.62% vs. 1.75% and 11.95% vs. 2.70%, all P＜0.05). In the observation group, the proportion of sperm DFI ≤15% was decreased while the proportion of DFI ≥30% increased (both P＜0.05). The level of sperm DFI was increased with age (P＜0.05). The early abortion rates of those IVF or ICSI embryos derived from sperms with DFI≥30 were significantly increased (31% and 25%, P＜0.05). However, there were no significant differences in the fertilization rate, cleavage rate, biochemical pregnancy rate, clinical pregnancy rate, implantation rate among those subgroups (all P＞0.05). Conclusions： The sperm DFI in infertile men is at a higher level, and increased with age. The early abortion rate of IVF or ICSI embryos will be increased when sperm DFI≥30, suggesting that sperm DFI is a practical reference for the evaluation of the potential fertility in those infertile men. [ABSTRACT FROM AUTHOR]

Objective：To explore the relationship between chromosomal polymorphism of the infertile couples and the outcomes of IVF/ICSI -ET. Methods: The chromosome karyotype analysis of 1 318 infertile couples received IVF/ICSI-ET was performed in our center from September 2015 to November 2016. The couples with either male or female chromosome polymorphism were enrolled as the study group，while the couples with normal chromosome karyotypes were served as the control group. The outcomes of IVF/ICSI-ET of two groups were compared. Results: The occurrence of miscarriage history in the study group was significantly higher than that in the control group (24.64% vs. 15.65%, P=0.007). The rate of high-grade blastocysts in the male polymorphic couple was significantly lower than that in the woman′s chromosomal polymorphism (18.11% vs. 29.03%, P=0.016) or the control group (18.11% vs. 23.81% , P =0.017). Conclusions: The infertile couples with chromosomal polymorphism have higher rate of previous miscarriage history, and the embryos from male chromosomal polymorphism might have relatively low development potential. However, their outcomes of IVF/ICSI -ET are similar to those with normal chromosome karyotypes. [ABSTRACT FROM AUTHOR]

Oocyte activation deficiency (OAD) refers to the failure of the evoking calcium oscillations which orchestrates a series of key events, such as the resumption of meiosis, extrusion of polar body, exocytosis of cortical granules and the formation of pronuclei after the spermatozoon is engulfed by the oocyte cytoplasm. These events are essential for the following embryogenesis. Both the defect of sperm and oocyte may cause OAD. Assisted oocyte activation (AOA) and the recombinant protein recombinant human phospholipases C zeta (rhPLCζ) injected into oocyte can significantly improve the fertilization outcome of OAD oocyte undergoing intracytoplasmic sperm injection (ICSI). In this paper, the causes and countermeasures of OAD were discussed. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the pregnancy outcomes of those patients with balanced reciprocal translocations after conventional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), and to provide valuable reference for genetic counseling and assisted reproductive technology (ART) treatment. Methods: Forty- one patients with balanced reciprocal translocation (the study group) and 751 couples with normal karyotypes (the control group) were included. Clinical pregnancy outcomes were compared between the two groups. Results: In the study group, 24 patients were treated with IVF, while other patients treated with ICSI. Additionally, 28 patients were diagnosed as primary infertility, and 11 patients had a history of adverse pregnancy or childbearing. There were not significant differences in the maternal age, number of retrieved oocytes, number of M II oocytes, number of transferred embryo, clinical pregnancy rate, late abortion rate, ectopic pregnancy rate, fetal malformation rate, stillbirth rate, live birth rate, live birth rate per ovum pick-up (OPU) cycle between the two groups (P>0.05). However, there was significant differences in the embryo implantation rate and early miscarriage rate (P<0.05). Nineteen patients in the study group delivered a total of 22 babies in 27 pregnancy cycles. Conclusions: Those balanced reciprocal translocation carrier could achieve an ideal pregnancy outcome when treated with conventional IVF/ICSI and prenatal diagnosis which is an economical and effective treatment for those patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of the collected oocytes by controlled ovarian stimulation (COS, long GnRHa protocol) on the clinical outcomes of intracytoplasmic sperm injection (ICSI). Methods: All couples (1 042 cycles) who underwent ICSI because of male factor were involved in this retrospective study, from January 2007 to June 2013 in our center. Those cycles were divided into 4 groups according to the number of collected oocytes: G1 as ≤4 oocytes(90 cycles), G2 as 5-10(368 cycles), G3 as 11-20 oocytes(449 cycles) and G4 as ≥21 oocytes (135 cycles). Results: In the ICSI treatment cycle, the mean age in G1 was highest among 4 groups (P<0.01), while 57.8% women were aged <35. The total fertilization failure(TFF) rate in G1, the ovarian hyperstimulation syndrome (OHSS) rate in G4 and the rates of cancelled transfer cycles in G1 and G4 were significantly higher than those in G2 and G3 (P<0.01). The rate of clinical pregnancy in G1 was the lowest in 4 groups (31.3%, P<0.05). The rate of clinical pregnancy, the implant rate and the live birth rate in G3 were the highest in 4 groups (P<0.05). Conclusions: In the ICSI treatment cycle, the number of collected oocytes lower than 4 has negative effect on fertilization; the collected oocytes between 11 to 20 have good clinical outcomes. [ABSTRACT FROM AUTHOR]

The motile sperm organelle morphology examination (MSOME), a morphological analysis of isolated motile spermatozoa in real-time at more than 6 000 times magnification, can help embryologist to select those sperms with normal morphology for intracytoplasmic sperm injection (ICSI). MOSME is a very special method to identify sperm head vacuoles. What are sperm vacuoles? Whether may sperm vacuoles influence the outcome of ART? This article reviewed those characteristics of sperm vacuoles as follows: (1)Vacuoles were commonly found in sperm head; (2)Vacuoles were distributed more frequently in the anteromedian region of sperm head; (3)There were different types of vacuoles; (4)The origin of sperm vacuoles was still unsure; (4)There were correlation in a certain extent between sperm vacuoles and routine semen parameters. It was found, although unasserted, that sperm vacuoles were positively correlated with abnormal chromatin condensation, DNA fragmentation rate, and aneuploid rate; (6)Spern vacuoles could lead to the lowed fertilization rate, the lowed rate of high-qualified embryo, and the lowed rate of clinical pregnancy specially. [ABSTRACT FROM AUTHOR]

Objective:To explore the effects of two criteria of hCG administration on the clinical outcomes of IVF/ICSI -ET. These criteria were individually based on the follicle diameter and the follicle symmetry. Methods: It's a prospective randomized study in our hospital reproductive center. IVF/ICSI-ET patients were randomly divided into two groups from Jan 2013 to Mar 2013. The criterion of hCG administration in Group A was based on the follicle diameter, while Group B on the follicle symmetry. Clinical and laboratory outcomes were then compared. Results: The average days of Gn, serum levels of progesterone and estradiol on the hCG day, the average number of matured eggs, and the rate of matured oocytes of group B were significantly higher than those of group A(P<0.05). There was not significant difference in the numbers of frozen embryos and good quality embryos between the two groups. However, the clinical pregnancy rate of group B was significantly lower than that of group A (42.19% vs. 54.22%, χ²=4.18, P=0.04), and the incidence of OHSS in group B significantly higher than that of group A(10.77% vs. 5.86%, χ²=4.07,P=0.04). Conclusions: The criterion based on the uniform size of follicular is not superior to the traditional criterion focused on the dominant follicle size in the efficacy and safety of IVF/ICSI-ET treatment. [ABSTRACT FROM AUTHOR]

Sperm morphology is closely related to male fertility. Abnormal sperm morphology is one of main causes of male infertility. Since the intracytoplasmic sperm injection (ICSI) was successfully developed in 1992, it has helped so many infertile couples with abnormal sperm parameters to obtain their children. Under a magnification of x400, the only major defects in sperm morphology could be found. Those sperms with many abnormities in subcellular organelles might not be identified, which could affect the success rate of ICSI. The motile sperm organelle morphology examination (MSOME) established by Bartoov in 2001 allowed to assess the subcellular organelles of sperm under high magnification, which is helpful to pick out sperm with normal morphology. The intracytoplasmic morphologically selected sperm injection (IMSI), combined MS0ME with ICSI, provided a new technique for the clinical ICSI practice. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of conventional in vitro fertilization (IVF)and intracytoplasmic sperm injection (ICSI)in older patients with poor ovarian response. Methods:The data of 381 in vitro fertilization-embryo transfer (IVF-ET) cycles of older patients (≥ 40 years old)with poor ovarian response were analyzed retrospectively. Those cycles were divided into two groups, IVF group (conventional IVF, 200 cycles) and ICSI group (181 cycles). Fertilization rate and clinical pregnancy rate were compared between two groups. Results: The fertilization rate and clinical pregnancy rate in the IVF group were insignificantly higher than those in the ICSI group, while the rate of effective cycles and high quality embryos in the ICSI group were very limitedly higher than those in the IVF group. However, there were not statistically differences in those rats between two groups (P>0.05). Conclusions: ICSI treatment did not increase fertilization rate and clinical pregnancy rate in IVF-ET cycles in those patients at ≥ 40 years with poor ovaian response. [ABSTRACT FROM AUTHOR]

Objective: To explore the effect of days of the elevated serum progesterone before hCG administration on the outcomes of IVF/ICSI-ET treatment. Methods: 2 905 cases of IVF/ICSI -ET treatment, from June 2012 to June 2013, were divided into two groups according to whether finding the follicle (s) of diameter ≥ 20 mm (Group A 2 725 cases, and Group B 180 cases) on the hCG day. Two groups were respectively divided into 3 subgroups according to days of the elevated level of progesterone (>1 ng/mL). Group A1 (1 788 cases) and B1 (83 cases) had 0 day of the elevated level of progesterone. Group A2 (717 cases) and B2 (67 cases) had 1-2 days of the elevated level of progesterone. Groups A3 (220 cases) and B3 (30 cases) had ≥3 days of the elevated level of progesterone. The clinical pregnancy rates of groups were meticulously compared. Results: There was significant difference in the clinical pregnancy rates among the Group A1 (55.42%), A2 (44.21%) and A3 (41.81%, P<0.01). Interestingly, there was no significant difference in those rates among the Group B1 (48.19%), B2 (47.76%) and B3 (46.66%, P>0.05). Conclusions: The clinical pregnancy rate could decrease following days of the elevated level of serum progesterone (>1 ng/mL) in those IVF/ICSI-ET patients with the follicle(s) of diameter ≥20 mm on the hCG day. [ABSTRACT FROM AUTHOR]

Following the development of intracytoplasmic sperm and haploid spermatid injection techniques, the cryopreservation technology of male germ cell, as important part of assisted reproductive technology (ART), has played a key role in the ART treatment for the couples with male infertility. Freezing methods of male germ cells include the programmed cryopreservation and vitrification freezing. Cryoprotectant, usually classified as permeable and impermeable cryoprotective agents,could minimize the cell injuries during the freeze-thaw. Various frozen carriers such as cryoloop and cryoleaf are widely used in cell cryopreservation. In this paper, the freezing method,carrier,cryoprotectants and frozen effect of male germ cell were reviewed. [ABSTRACT FROM AUTHOR]