Background： After the two-child policy is frilly implemented, new challenges regarding pregnancy management and the treatment of pregnancy complications will arise. The aim of this study was to analyze the characteri...Background： After the two-child policy is frilly implemented, new challenges regarding pregnancy management and the treatment of pregnancy complications will arise. The aim of this study was to analyze the characteristics of pregnancy and delivery before and after the implementation of the two-child policy to make suggestions on the quality assurance of the new era of obstetrics. Methods： In total, 5895 cases of pregnant women who delivered from April 2016 to March 2017 in Peking University Third Hospital served as the study group and 5103 cases of pregnant women who delivered from January to December 2015 served as the control group. The characteristics of pregnancy and delivery were retrospectively analyzed. Results： In the study group, the percentage of pregnant women who were older （over 40 years） （3.6% vs. 2.2%）, were multipara （30.3% vs. 17.0%）, received irregular prenatal care （ 1.5% vs. 0.9%）, were transferred for treatment from a subordinate hospital （4.4% vs. 2.8%）, and were not residents of Beijing （3.8% vs. 2.2%）, were significantly increased compared with the control group （P 〈 0.05）. In the study group, the rate of a hypertensive disorder complicating pregnancy （6.4% vs. 5.0%）, gestational diabetes mellitus （25.3% vs. 23.1%）, dangerous placenta previa （3.0% vs. 2.3%）, placental implantation （2.4% vs. 1.8%）, and severe postpartum hemorrhage （2.8% vs. 1.9%） was significantly increased compared with the control group （P 〈 0.05）. In the study group, the cesarean section rate during primipara was significantly reduced compared with the control group （42.0% vs. 44.2%）. However, the rate during inultipara was significantly increased compared with the control group （P 〈 0.05）. Indications for cesarean section in the study group as well as the percentages of scared uterus and placenta previa were significantly increased compared with the control group （P 〈 0.05）. Conclusions： According to the current situation, better methods are展开更多
Background Endometriosis affects natural fertility through various approaches, and in vitro fertilization （IVF） is a good treatment. But the IVF result of endometriosis patients is still under debate. We investigate...Background Endometriosis affects natural fertility through various approaches, and in vitro fertilization （IVF） is a good treatment. But the IVF result of endometriosis patients is still under debate. We investigated the effect of endometriosis on IVF by analyzing the data from a single reproductive center. Methods A retrospective, database-searched cohort study was performed. Relevant information was collected from the electronic records of women who underwent IVF/intracytoplasmic sperm injection between January 2006 and December 2010 in the Assisted Reproductive Unit of Sir Run Run Shaw Hospital. Patients with endometriosis were enrolled the study group. The rest of the women formed the control group. The main outcome was the clinical pregnancy rate. Secondary outcomes were oocytes retrieved number, fertilization rate, high-quality embryo rate, number of high-quality embryo for embryo transplantation, and implantation embryo/high-quality embryo ratio （IE/HQE ratio）. Comparisons were performed by the z2-test and independent t-test. Results The endometriosis group （n=177） had a markedly lower oocytes retrieved number, fertilization rate, implantation rate, and clinical pregnancy rate （7.6_＋5.1, 63.6%, 27.7%, and 45.2%, respectively） compared with the non-endometriosis group （n=4267; 11.8＋7.3, 68.4%, 36.2%, and 55.2%, respectively）. Stratified analysis showed that this difference was found in the subgroup younger than 35-years old, while only fertilization rate and implantation rate were different in the elder subgroup. The ratio of high-quality embryos transferred is lower in endometriosis group （53.7% vs. 71.8%, P 〈0.05）, but there is no difference in IE/HQE ratio between two groups. There is no significant difference in fertilization rate, implantation rate, and clinical pregnancy rate between mild and severe endometriosis patients. Conclusions Endometriosis patients suffer a decreasing IVF pregnancy rates mainly caused by reducing oocytes number and fertilization rate, regardless 展开更多
Infertility is defined as the inability for a couple to have children without any contraceptive methods within 1 year.Tubal factors are responsible for 25％ to 35％ of female reasons,and these have been proven to be a...Infertility is defined as the inability for a couple to have children without any contraceptive methods within 1 year.Tubal factors are responsible for 25％ to 35％ of female reasons,and these have been proven to be a major cause of female infertility.Hydrosalpinx is a special type of tubal occlusion in which fluid accumulates inside the hymen of the tube.This adversely affects fallopian function,and hydrosalpinx fluids have a toxic effect on the quality of the embryos and endometrial receptivity.Currently,reconstructive surgery still plays a role in female infertility for tubal factors and has not been totally replaced by assisted reproductive technology in developing countries and districts.Keywords：infertility; hydrosalpinx; laparoscopy; pregnancy; ectopic pregnancy rate展开更多
目的:探讨宫腔镜下子宫中隔切除(transcervical resection of septum,TCRS)术后预防宫腔粘连形成及改善妊娠结局的最佳治疗方案。方法:TCRS术后患者116例随机分为4组:A组(n=30),术后行人工周期;B组(n=31),术后宫腔放置宫内节育器(IUD);C...目的:探讨宫腔镜下子宫中隔切除(transcervical resection of septum,TCRS)术后预防宫腔粘连形成及改善妊娠结局的最佳治疗方案。方法:TCRS术后患者116例随机分为4组:A组(n=30),术后行人工周期;B组(n=31),术后宫腔放置宫内节育器(IUD);C组(n=27),术后放置IUD+行人工周期;D组(n=28),术后不采取任何干预措施。术后3个月再次行宫腔镜检查,观察宫腔是否发生粘连及粘连分布,随访至术后24个月,记录月经恢复情况及妊娠结局。结果:A组排除9例(6例失访,3例漏服药物),B组排除6例(4例失访,2例IUD脱落),C组排除2例(1例失访,1例IUD下移),D组排除5例(均为失访)。4组术后3个月宫腔粘连发生率依次为:14.2%(1/7)、37.5%(3/8)、22.2%(2/9)、9.1%(1/11);随访至术后24个月,妊娠率分别为:33.3%(7/21)、32.0%(8/25)、36.0%(9/25)、47.8%(11/23);流产率分别为:4.8%(1/21)、12.0%(3/25)、8.0%(2/25)、4.3%(1/23),宫腔粘连发生率、妊娠率和流产率组间均无统计学差异(P>0.05)。结论:TCRS术后进行人工周期、IUD、IUD+人工周期3种治疗方法对防止宫腔粘连形成及提高妊娠率、改善妊娠结局方面无明显益处,且治疗效果差别不大,术后不必将其作为常规治疗方法。展开更多
Objective:To evaluate the efficacy and safety of Chinese medicine(CM)improving pregnancy outcomes after surgery for endometriosis-associated infertility.Methods:A multicenter,randomized,doubleblind placebo parallel co...Objective:To evaluate the efficacy and safety of Chinese medicine(CM)improving pregnancy outcomes after surgery for endometriosis-associated infertility.Methods:A multicenter,randomized,doubleblind placebo parallel controlled clinical trial was designed.A total of 202 patients who had laparoscopy for endometriosis-associated infertility with qi stagnation and blood stasis syndrome were included and randomly divided into the CM treatment group and placebo control group at a ratio of 1:1 using a central block randomization from May 2014 to September 2017,101 patients in each group.The two groups received continuous intervention at 1–5 days after surgery,for 6 menstrual cycles.Before ovulation,the CM group was treated Huoxue Xiaoyi Granule(活血消异颗粒);after ovulation,Bushen Zhuyun Granule(补肾助孕颗粒)was involved.The control group was treated with placebo.Transvaginal ultrasonography was performed every menstrual cycle during the treatment,and female hormone levels in the follicular and luteal phases were measured during the 1 st,3 rd and 6 th menstrual cycles.The analysis was continued until pregnancy.The primary outcomes were clinical pregnancy rate and pregnancy outcome,and the secondary outcomes were follicular development and endometrial receptivity.Safety evaluations were performed before and after treatment.Results:(1)Clinical pregnancy and live birth rates:the clinical pregnancy and live birth rates of the CM group were significantly higher than those of the placebo group[44.6%(45/101)vs.29.7%(30/101),34.7%(35/101)vs.20.8%(21/101),both P<0.05].(2)Follicle development:the incidence of dominant follicles,rate of cumulative cycle ovulation,and rate of cumulative cycle mature follicle ovulation were significantly higher in the CM group than those in the placebo group[93.8%(350/373)vs.89.5%(341/381),80.4%(275/342)vs.69.1%(253/366),65.8%(181/275)vs 56.1%(142/253),P<0.05 or P<0.01]).The incidence of cumulative cycle luteinized unruptured follicle syndrome was significantly lower in the CM group tha展开更多
Background： The endometriosis fertility index （EFI） has a predictive value for pregnancy after surgery. In vitro fertilization and embryo transfer （IVF-ET） is a good treatment to infertility. This study aimed to ...Background： The endometriosis fertility index （EFI） has a predictive value for pregnancy after surgery. In vitro fertilization and embryo transfer （IVF-ET） is a good treatment to infertility. This study aimed to provide external validation of EFI, assess the factors affecting the ability of EFI to predict cumulative spontaneous pregnancy rates （PRs）, and propose reasonable advice for treatment by evaluating the effect of infertility management combining surgery and IVF-ET. Methods： This retrospective study enrolled 345 endometriosis-related infertile women after laparoscopic surgery from January 2012 to January 2016. Among them, 234 patients tried to conceive naturally and were divided into six groups according to their different EFI scores. Of the 345 patients, 307 with an EFI score 〉5 were divided into non-IVF-ET group （n = 209） and IVE-ET group （n = 98） to compare the cumulative PRs. Cumulative PRs＇ curves were calculated using the Kaplan-Meier product limit estimate and the differences were evaluated by log-rank test. Independent predictive factors for pregnancy were assessed using the Cox regression model. Results： Significant differences in spontaneous PRs among different EFI scores were identified （χ2 = 29.945, P 〈 0.05）. The least function score was proved to be the most important factor for EFI （χ2 = 6.931, P 〈 0.05） staging system. In patients with an EFI score ≥5 after 12 months from surgery, the cumulative PRs of those who received both surgery and IVF-ET were much higher than the spontaneous PRs of those who received surgery alone （χ2 =4.160, P = 0.041）. Conclusions： The EFI is a reliable staging system to predict the spontaneous PR of patients. The least function score was the most influential factor to predict the spontaneous PR. Patients with an EFI score ≥5 after 12 months from surgery are recommended to receive IVF-ET to achieve a higher PR.展开更多
文摘Background： After the two-child policy is frilly implemented, new challenges regarding pregnancy management and the treatment of pregnancy complications will arise. The aim of this study was to analyze the characteristics of pregnancy and delivery before and after the implementation of the two-child policy to make suggestions on the quality assurance of the new era of obstetrics. Methods： In total, 5895 cases of pregnant women who delivered from April 2016 to March 2017 in Peking University Third Hospital served as the study group and 5103 cases of pregnant women who delivered from January to December 2015 served as the control group. The characteristics of pregnancy and delivery were retrospectively analyzed. Results： In the study group, the percentage of pregnant women who were older （over 40 years） （3.6% vs. 2.2%）, were multipara （30.3% vs. 17.0%）, received irregular prenatal care （ 1.5% vs. 0.9%）, were transferred for treatment from a subordinate hospital （4.4% vs. 2.8%）, and were not residents of Beijing （3.8% vs. 2.2%）, were significantly increased compared with the control group （P 〈 0.05）. In the study group, the rate of a hypertensive disorder complicating pregnancy （6.4% vs. 5.0%）, gestational diabetes mellitus （25.3% vs. 23.1%）, dangerous placenta previa （3.0% vs. 2.3%）, placental implantation （2.4% vs. 1.8%）, and severe postpartum hemorrhage （2.8% vs. 1.9%） was significantly increased compared with the control group （P 〈 0.05）. In the study group, the cesarean section rate during primipara was significantly reduced compared with the control group （42.0% vs. 44.2%）. However, the rate during inultipara was significantly increased compared with the control group （P 〈 0.05）. Indications for cesarean section in the study group as well as the percentages of scared uterus and placenta previa were significantly increased compared with the control group （P 〈 0.05）. Conclusions： According to the current situation, better methods are
基金This study was supported by a grant from the Natural Science Foundation of Zhejiang(No.Y2080505).
文摘Background Endometriosis affects natural fertility through various approaches, and in vitro fertilization （IVF） is a good treatment. But the IVF result of endometriosis patients is still under debate. We investigated the effect of endometriosis on IVF by analyzing the data from a single reproductive center. Methods A retrospective, database-searched cohort study was performed. Relevant information was collected from the electronic records of women who underwent IVF/intracytoplasmic sperm injection between January 2006 and December 2010 in the Assisted Reproductive Unit of Sir Run Run Shaw Hospital. Patients with endometriosis were enrolled the study group. The rest of the women formed the control group. The main outcome was the clinical pregnancy rate. Secondary outcomes were oocytes retrieved number, fertilization rate, high-quality embryo rate, number of high-quality embryo for embryo transplantation, and implantation embryo/high-quality embryo ratio （IE/HQE ratio）. Comparisons were performed by the z2-test and independent t-test. Results The endometriosis group （n=177） had a markedly lower oocytes retrieved number, fertilization rate, implantation rate, and clinical pregnancy rate （7.6_＋5.1, 63.6%, 27.7%, and 45.2%, respectively） compared with the non-endometriosis group （n=4267; 11.8＋7.3, 68.4%, 36.2%, and 55.2%, respectively）. Stratified analysis showed that this difference was found in the subgroup younger than 35-years old, while only fertilization rate and implantation rate were different in the elder subgroup. The ratio of high-quality embryos transferred is lower in endometriosis group （53.7% vs. 71.8%, P 〈0.05）, but there is no difference in IE/HQE ratio between two groups. There is no significant difference in fertilization rate, implantation rate, and clinical pregnancy rate between mild and severe endometriosis patients. Conclusions Endometriosis patients suffer a decreasing IVF pregnancy rates mainly caused by reducing oocytes number and fertilization rate, regardless
文摘Infertility is defined as the inability for a couple to have children without any contraceptive methods within 1 year.Tubal factors are responsible for 25％ to 35％ of female reasons,and these have been proven to be a major cause of female infertility.Hydrosalpinx is a special type of tubal occlusion in which fluid accumulates inside the hymen of the tube.This adversely affects fallopian function,and hydrosalpinx fluids have a toxic effect on the quality of the embryos and endometrial receptivity.Currently,reconstructive surgery still plays a role in female infertility for tubal factors and has not been totally replaced by assisted reproductive technology in developing countries and districts.Keywords：infertility; hydrosalpinx; laparoscopy; pregnancy; ectopic pregnancy rate
文摘目的:探讨宫腔镜下子宫中隔切除(transcervical resection of septum,TCRS)术后预防宫腔粘连形成及改善妊娠结局的最佳治疗方案。方法:TCRS术后患者116例随机分为4组:A组(n=30),术后行人工周期;B组(n=31),术后宫腔放置宫内节育器(IUD);C组(n=27),术后放置IUD+行人工周期;D组(n=28),术后不采取任何干预措施。术后3个月再次行宫腔镜检查,观察宫腔是否发生粘连及粘连分布,随访至术后24个月,记录月经恢复情况及妊娠结局。结果:A组排除9例(6例失访,3例漏服药物),B组排除6例(4例失访,2例IUD脱落),C组排除2例(1例失访,1例IUD下移),D组排除5例(均为失访)。4组术后3个月宫腔粘连发生率依次为:14.2%(1/7)、37.5%(3/8)、22.2%(2/9)、9.1%(1/11);随访至术后24个月,妊娠率分别为:33.3%(7/21)、32.0%(8/25)、36.0%(9/25)、47.8%(11/23);流产率分别为:4.8%(1/21)、12.0%(3/25)、8.0%(2/25)、4.3%(1/23),宫腔粘连发生率、妊娠率和流产率组间均无统计学差异(P>0.05)。结论:TCRS术后进行人工周期、IUD、IUD+人工周期3种治疗方法对防止宫腔粘连形成及提高妊娠率、改善妊娠结局方面无明显益处,且治疗效果差别不大,术后不必将其作为常规治疗方法。
基金Supported by the Key Projects of the National Science and Technology Pillar Program during the 12th Five-Year Plan Period(No.2014BAI10B08)
文摘Objective:To evaluate the efficacy and safety of Chinese medicine(CM)improving pregnancy outcomes after surgery for endometriosis-associated infertility.Methods:A multicenter,randomized,doubleblind placebo parallel controlled clinical trial was designed.A total of 202 patients who had laparoscopy for endometriosis-associated infertility with qi stagnation and blood stasis syndrome were included and randomly divided into the CM treatment group and placebo control group at a ratio of 1:1 using a central block randomization from May 2014 to September 2017,101 patients in each group.The two groups received continuous intervention at 1–5 days after surgery,for 6 menstrual cycles.Before ovulation,the CM group was treated Huoxue Xiaoyi Granule(活血消异颗粒);after ovulation,Bushen Zhuyun Granule(补肾助孕颗粒)was involved.The control group was treated with placebo.Transvaginal ultrasonography was performed every menstrual cycle during the treatment,and female hormone levels in the follicular and luteal phases were measured during the 1 st,3 rd and 6 th menstrual cycles.The analysis was continued until pregnancy.The primary outcomes were clinical pregnancy rate and pregnancy outcome,and the secondary outcomes were follicular development and endometrial receptivity.Safety evaluations were performed before and after treatment.Results:(1)Clinical pregnancy and live birth rates:the clinical pregnancy and live birth rates of the CM group were significantly higher than those of the placebo group[44.6%(45/101)vs.29.7%(30/101),34.7%(35/101)vs.20.8%(21/101),both P<0.05].(2)Follicle development:the incidence of dominant follicles,rate of cumulative cycle ovulation,and rate of cumulative cycle mature follicle ovulation were significantly higher in the CM group than those in the placebo group[93.8%(350/373)vs.89.5%(341/381),80.4%(275/342)vs.69.1%(253/366),65.8%(181/275)vs 56.1%(142/253),P<0.05 or P<0.01]).The incidence of cumulative cycle luteinized unruptured follicle syndrome was significantly lower in the CM group tha
基金This work was supported by a grant from the National Natural Science Foundation of China （No. 81671427）.
文摘Background： The endometriosis fertility index （EFI） has a predictive value for pregnancy after surgery. In vitro fertilization and embryo transfer （IVF-ET） is a good treatment to infertility. This study aimed to provide external validation of EFI, assess the factors affecting the ability of EFI to predict cumulative spontaneous pregnancy rates （PRs）, and propose reasonable advice for treatment by evaluating the effect of infertility management combining surgery and IVF-ET. Methods： This retrospective study enrolled 345 endometriosis-related infertile women after laparoscopic surgery from January 2012 to January 2016. Among them, 234 patients tried to conceive naturally and were divided into six groups according to their different EFI scores. Of the 345 patients, 307 with an EFI score 〉5 were divided into non-IVF-ET group （n = 209） and IVE-ET group （n = 98） to compare the cumulative PRs. Cumulative PRs＇ curves were calculated using the Kaplan-Meier product limit estimate and the differences were evaluated by log-rank test. Independent predictive factors for pregnancy were assessed using the Cox regression model. Results： Significant differences in spontaneous PRs among different EFI scores were identified （χ2 = 29.945, P 〈 0.05）. The least function score was proved to be the most important factor for EFI （χ2 = 6.931, P 〈 0.05） staging system. In patients with an EFI score ≥5 after 12 months from surgery, the cumulative PRs of those who received both surgery and IVF-ET were much higher than the spontaneous PRs of those who received surgery alone （χ2 =4.160, P = 0.041）. Conclusions： The EFI is a reliable staging system to predict the spontaneous PR of patients. The least function score was the most influential factor to predict the spontaneous PR. Patients with an EFI score ≥5 after 12 months from surgery are recommended to receive IVF-ET to achieve a higher PR.
