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Objective: To minimize twin birth rate by establishing an elective single cleavage embryo transfer strategy based on a twin live birth prediction model from fresh double cleavage embryos transfer (cleavage DET) patients.Methods: A total of 2478 patients underwent fresh cleavage DET in Nanjing Tower Hospital were enrolled to establish the twin live birth prediction model by logistic regression analysis and the cutoff value was calculated by ROC curve. Another 300 fresh cleavage DET patients and 550 cleavage single-embryo transfer (SET) patients were selected to testify the sensitivity, specificity and usefulness of this model.Results: The twin live birth probability (TLBP) = eX/(eX + 1), e is a natural logarithm, X = -1.763 - (0.319 × female age) + (0.329 × endometrial thickness) + (0.282 × the number of transferred top embryos) - (0.314 × previous transfer times), and the cutoff value of TLBP was 24.2%. The sensitivity of this model for predicting twin live birth was 75.6%, while the specificity was 52.5% in the external validation of 300 DET patients. Furthermore, the validation of 550 SET patients showed that the live birth rate of TLBP value positive patients was significantly higher than that in negative patients (54.3% vs. 35.5%, p < .001). When adopted an elective single cleavage embryo transfer strategy, the patients with a positive TLBP value choose SET, while still undergo DET who with a negative TLBP value, the live birth rate would maintain as 56.7%; however, the twin birth rate would significantly decline to 7.4%.Conclusion: Female age, endometrial thickness, the number of transferred top embryos and previous embryo transfer times were critical variables for the twin live birth prediction model. An elective single cleavage embryo transfer strategy according to this model can maintain the relatively high live birth rate, meanwhile get the acceptable low twin birth rate. [ABSTRACT FROM AUTHOR]

Objective: Myeloid-derived suppressor cells (MDSCs) have been described as important immunosuppressive cells for maternal immune tolerance. The aim of this study was to detect whether there was any association between the peripheral blood MDSCs level and in vitro fertilization (IVF) treatment outcomes. Methods: This prospective observational study randomly recruited 85 women who underwent IVF treatment from May 2016 to June 2016. The levels of peripheral blood granulocytic MDSC (G-MDSC), monocytic MDSC (M-MDSC) and their relations to IVF treatment outcomes were analyzed. Results: The circulating G-MDSC level was significantly increased in the clinical pregnant group when compared to that in the nonclinical pregnant group (p = .014), while M-MDSC had no significant difference. The G-MDSC level was an independent predictive factor for clinical pregnancy with odds ratios 12.7 (95% CI: 1.53-105.4, p = .018) when using multiple logistic regression analysis. A receiver operating characteristic analysis (area under curve = 0.634) found the clinical pregnancy rate in women with G-MDSC >2.38% was higher than that in women below this level (96 versus 66.7%, p = .004). The high G-MDSC level in the peripheral blood was associated with clinical pregnancy, with a sensitivity of 37.5%, specificity of 95.2%. Conclusion: High circulating G-MDSC level was associated with elevated clinical pregnancy rate. G-MDSC might be a new therapeutic target for better IVF treatment outcome. [ABSTRACT FROM AUTHOR]

Objective: Myeloid-derived suppressor cells (MDSCs) have been described as important immunosuppressive cells for maternal immune tolerance. The aim of this study was to detect whether there was any association between the peripheral blood MDSCs level and in vitro fertilization (IVF) treatment outcomes. Methods: This prospective observational study randomly recruited 85 women who underwent IVF treatment from May 2016 to June 2016. The levels of peripheral blood granulocytic MDSC (G-MDSC), monocytic MDSC (M-MDSC) and their relations to IVF treatment outcomes were analyzed. Results: The circulating G-MDSC level was significantly increased in the clinical pregnant group when compared to that in the nonclinical pregnant group (p = .014), while M-MDSC had no significant difference. The G-MDSC level was an independent predictive factor for clinical pregnancy with odds ratios 12.7 (95% CI: 1.53-105.4, p = .018) when using multiple logistic regression analysis. A receiver operating characteristic analysis (area under curve = 0.634) found the clinical pregnancy rate in women with G-MDSC >2.38% was higher than that in women below this level (96 versus 66.7%, p = .004). The high G-MDSC level in the peripheral blood was associated with clinical pregnancy, with a sensitivity of 37.5%, specificity of 95.2%. Conclusion: High circulating G-MDSC level was associated with elevated clinical pregnancy rate. G-MDSC might be a new therapeutic target for better IVF treatment outcome. [ABSTRACT FROM AUTHOR]

Objective: The aim of this retrospective cohort study was to assess the effect of subchorionic hematoma (SCH) on pregnancy outcomes in IVF/ICSI patients. Methods: We retrospectively analyzed 1097 pregnancies achieved byin vitrofertilization and embryo transfer (IVF-ET) or frozen-thawed embryo transfers (FETs) between January 2013 and June 2013 at the IVF center of Nanjing Drum Tower Hospital. The prevalence of SCH was 12.1% in this group (133/1097). We compared the pregnancy outcomes between the SCH group and non-SCH group, while the risk factors for SCH were also evaluated. Results: There was no significant difference between SCH group and non-SCH group with regard to patients’ age, spouse’s age, endometrial thickness, miscarriage rate (5.6% versus 6.2%,p > 0.05), second trimester fetus loss rate (5.6% versus 7.7%,p > 0.05) or live birth rate (89.5% versus 86.1%,p > 0.05). While the birth weight in singleton pregnancy in SCH group was significant lower (3207.8 ± 595.7 g versus 3349.2 ± 59.7 g,p= 0.03). SCH was more common in fresh embryo transfer patients than that in FET patients (16.6% versus 5.1%,p < 0.01), fresh embryo transfer was a high risk for SCH with OR 3.67, 95% CI: 2.28–5.90. Conclusion: We concluded that SCH was associated with lower birth weight in singleton pregnancy, but SCH did not increase pregnancy loss rate in IVF/ICSI patients, and fresh embryo transfer may contribute to SCH onset. [ABSTRACT FROM PUBLISHER]

Objective: The objective of this study was to evaluate the predictive values of lipids and uric acid in mid-second trimester for adverse pregnancy outcome. Methods: Lipids and uric acid concentrations were measured in 1000 healthy nulliparous women at 20 weeks of gestation. Pregnancy outcomes were followed-up. The odds ratios (OR) and 95% CI were estimated with unconditional logistic regression adjusting for maternal age and body mass index (BMI). Results: Women who had elevated triglyceride (TG) in the mid-second trimester experienced a 2.91-fold risk (95% CI 1.58-5.34) for preeclampsia and a 2.03-fold risk (95% CI 1.29-3.19) for gestation diabetes mellitus (GDM). Hyperuricemic women experienced a 1.99-fold risk (95% CI 1.16-3.40) for preeclampsia and a 2.34-fold risk (95% CI 1.44-3.83) for GDM, while women who had decreased high-density lipoprotein cholesterol (HDLc) experienced a 2.32-fold risk (95% CI 1.18-4.58) for preeclampsia, a 2.11-fold risk (95% CI 1.37-3.25) for GDM, and a 1.63-fold risk (95% CI 1.02-2.60) for delivering macrosomic newborns. These effects were concentration dependent, as risks increased with increasing TG quartiles and with decreasing HDLc quartiles. The result of the ROC analysis revealed that the sensitivity and specificity values for one marker alone was relatively low. But when combined TG, HDLc, uric acid, age and BMI together, the area under ROC curve increased to 0.71-0.77, sensitivity and specificity increased to 80-92% and 50-53%. Conclusion: The combination of these metabolic markers in mid-second trimester can be used to predict adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]