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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]

Purpose: To evaluate the effect of culture duration (embryo (day 3) transfer vs. blastocyst (day 5-6) transfer) on the birthweight of singletons from frozen embryo transfer (FET) cycles.Methods: A total of 1092 singletons were analyzed in this retrospective study. The distribution of large for gestational age (LGA) infants, the mean birthweight, and z scores of singletons were compared between the day 3 and day 5-6 transfer groups. Multiple linear regression analysis was performed to evaluate the relationships between confounding factors and singleton birthweight.Results: The proportion of LGA infants significantly increased with BMI (BMI < 20, 12.8%; 20 ≤ BMI ≤ 25, 23.2%; BMI > 25, 32.3%; P < 0.0001). However, the proportions of small for gestational age (SGA) and LGA infants were not significantly different between day 3 and day 5-6 transfers. The absolute mean birthweight of singletons was not significantly different between day 3 transfer (3422 ± 547 g) and day 5-6 transfer (3433 ± 559 g; P = 0.732). The z scores (calculated from a reference population) of singletons were also not significantly different between the two groups (0.499 vs. 0.533, P = 0.625). Multiple linear regression analysis showed that maternal BMI, gestational age, and infant gender had significant effects on singleton birthweight, while culture duration (P = 0.731) did not significantly affect singleton birthweight.Conclusions: In vitro culture duration did not affect the birthweight of newborns resulting from day 3 to day 5-6 transfers in FET cycles. [ABSTRACT FROM AUTHOR]

Cytochrome P450 enzymes are required for the synthesis of cholesterol and steroid hormones. Cytochrome P450 oxidoreductase (POR) donates electrons to microsomal cytochrome P450 enzymes. POR deficiency (PORD) is a rare autosomal recessive disease. In patients with PORD, steroid hormone synthesis is disrupted, which can cause infertility. The objective of this study was to report on a case of in vitro fertilization-frozen embryo transfer (IVF-FET) in a patient with PORD. The patient’s hormone (i.e. 17α-hydroxyprogesterone) and electrolyte levels were within normal ranges ordinarily. Upon controlled ovarian stimulation, follicle growth was normal, but serum estrogen and progesterone levels were low and high, respectively. The serum progesterone level was elevated after long-acting gonadotropin-releasing hormone agonist treatment, and an endometrial biopsy showed a change in the proliferative phase. Genetic tests detected homozygous mutations (c.976 T > G, p.Y326D) in exon 10 of the POR gene. The frozen embryo was transferred during the administration of hormone replacement therapy. No significant morphological or metabolic abnormalities were observed in the neonate. Our findings suggest that infertile women with normal hormone levels may have metabolic diseases such as PORD. Further studies are needed to determine the cause of these diseases and to assist pregnancy in such women. [ABSTRACT FROM AUTHOR]

Purpose: To study the association between the numbers of oocytes retrieved and the cumulative live birth rates (LBR) in women aged 35-40 years undergoing long GnRH agonist IVF/ICSI cycles.Methods: A total of 931 women aged 35-40 years who underwent their first cycle of IVF/ICSI treatment between January 2010 and December 2013 at Nanjing Drum Tower Hospital were identified and reviewed. The main endpoint of this study was the cumulative LBR after one complete oocyte retrieval, which included fresh and all subsequent frozen-thaw embryo transfer cycles. Odds ratios (OR) and 95% confidence interval (CI) for live birth were estimated by multivariate logistic regression analysis. Furthermore, all the women were divided into four groups based on the number of oocytes retrieved: 0-4, 5-9, 10-14 or ≥15 oocytes group. Variables were then compared among groups.Results: We found that 634 out of the 931 patients (68.1%) achieved at least one live birth. The number of oocytes retrieved was an independent predictive factor for live birth, with OR 1.20 (95% CI 1.15-1.26) when adjusted for age (years), duration of infertility and Gn (gonadotrophin) doses. The cumulative LBR in the four different oocyte groups was 35.6, 68.8, 83.4 and 89.2%, respectively. When the 1-4 oocytes group was issued as a reference, the ORs for cumulative LBR gradually increased to 3.66, 6.74 and 11.77 in other three oocytes groups, respectively. The moderate-severe ovarian hyperstimulation syndrome (OHSS) rate was dramatically increased in the ≥15 oocytes group (6.9%) when compared to that in the 10-14 oocytes group (0.8%), while the cumulative LBR only increased 5.8% (from 83.4 to 89.2%).Conclusions: The ideal number of oocytes retrieved in women aged 35-40 years is 10-14 oocytes, which achieves a high cumulative LBR while maintaining an acceptable low OHSS 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: 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 by in vitro fertilization 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 AUTHOR]

Background: It is still uncertain whether surgical evacuation adversely affects subsequent embryo transfer. The present study aims to assess the influence of surgical evacuation on the pregnancy outcomes of subsequent embryo transfer cycle following first trimester miscarriage in an initial in vitro fertilization and embryo transfer (IVF-ET) cycle.Methods: A total of 645 patients who underwent their first trimester miscarriage in an initial IVF cycle between January 2013 and May 2016 in Nanjing Drum Tower Hospital were enrolled. Surgical evacuation was performed when the products of conception were retained more than 8 h after medical evacuation. Characteristics and pregnancy outcomes were compared between surgical evacuation patients and no surgical evacuation patients. The pregnancy outcomes following surgical evacuation were further compared between patients with ≥ 8 mm or < 8 mm endometrial thickness (EMT), and with the different EMT changes.Results: The EMT in the subsequent embryo transfer cycle of surgical evacuation group was much thinner when compared with that in the no surgical evacuation group (9.0 ± 1.6 mm vs. 9.4 ± 1.9 mm, P = 0.01). There was no significant difference in implantation rate, clinical pregnancy rate, live birth rate or miscarriage rate between surgical evacuation group and no surgical evacuation group (P > 0.05). The live birth rate was higher in EMT ≥ 8 mm group when compared to < 8 mm group in surgical evacuation patients (43.0% vs. 17.4%, P < 0.05).Conclusions: There was no significant difference in the pregnancy outcomes of subsequent embryo transfer cycle between surgical evacuation patients and no surgical evacuation patients. Surgical evacuation led to the decrease of EMT, especially when the EMT < 8 mm was association with a lower live birth rate. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine if an association existed between serum human chorionic gonadotrophin (HCG) level at 12 h after trigger and IVF and intracytoplasmic sperm (ICSI) treatment outcomes. Women undergoing initial IVF–ICSI and embryo transfer treatment using the long luteal phase gonadotrophin-releasing hormone agonist protocol between April 2012 and March 2013 for tubal factor were included ( n = 699). In the clinical pregnancy group, HCG after trigger was significantly elevated (276.0 ± 5.1 versus 198.5 ± 6.1 mIU/mL; P < 0.001). The optimal cut-off value proposed by the receiver operating characteristic analysis (area under curve = 0.730) for HCG was 201.2 mIU/ml. Compared with the lower HCG group, the clinical pregnancy rate in the higher HCG group was increased in obese and non-obese patients (77.8% versus 57.3%, P < 0.05; 85.6% versus 53.0%, P < 0.01, respectively). Adjusted for age and body mass index, an increase of HCG was associated with a better IVF–ICSI treatment outcome (OR 4.39, 95% CI 2.99 to 6.45). Clinical pregnancy rate was significantly higher across increasing quartiles of HCG. An elevated level of serum HCG at 12 h after trigger was associated with a better IVF–ICSI outcome. [ABSTRACT FROM AUTHOR]