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15 July 2015, Volume 34 Issue 4
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Ethical Issues of Artificial Insemination by Donor WANG Ting;SHI Xiao;QUAN Song 2015, 34 (4):  269-272.  Abstract ( 1952 )   PDF (618KB) ( 7711 )   The advances in sperm frozen technologies along with the sperm bank promoted the artificial insemination by donor, which brought more opportunities for paternity for many infertile couples. However, the ethical issue related to the artificial insemination by donor has gradually been in a hot topic. Disputes are focused on the following six topics: the source of sperm, the limited number of donor offspring, the age of donator, cross-border service of the artificial insemination by donor; the right of recipients to choose donors, the right of anonymity, and the right of offsprings to be informed. We here summarized our standpoint and suggestion, based on the legislation at home and abroad and the present social phenomenon. The donor selection should be based on physical condition, beside the social status and position. The maximum number of donor offspring should be in a properly increased range, more than five. The donor age should be properly decreased. The cross-border service of artificial insemination by donor is not feasible at present. The anonymity should be kept on, while the right of recipient to choose donor should be prudently considered. Related Articles | Metrics

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Analysis of Blood Traceelements in Preschool Children Born from Assisted Reproductive Technology CHAI De-chun;ZHANG Yuan;HU You-fang;LI Jing;QIN Rui;GAO Li;CUI Yu-gui;LIU Jia-yin 2015, 34 (4):  273-277.  Abstract ( 1629 )   PDF (784KB) ( 7747 )   Objective: To analyze the levels of blood traceelements in those preschool children born from assisted reproductive technology （ＡＲＴ）, and to evaluate the developmental status, when compared with those children from natural pregnancy. Methods：Totally, 63 preschool children of ART aged 3 to 6 years （ＡＲＴ ｇｒｏｕｐ）, and 37 children of the same age and from natural pregnancy （ｃｏｎｔｒｏｌ ｇｒｏｕｐ）, from Jiangsu Province were included in this study. Those children with chromosome abnormity, overweight or obesity or other metabolic disorders, had been excluded. Levels of serum zinc, copper, ferrum, calcium, magnesium and lead were analyzed using the BH5100 and BH2100 atomic absorption spectrum instrument and meters. Results：There were not significant differences in body weight, height, bone age, serum biochemistry parameters between two groups. The mean levels of all traceelements in the ART children were in the normal ranges of the same age children. The mean level of zinc in the ART group was slightly lower, and the level of lead higher （P＜０．０1）, than those in the control group. Conclusions：The mean levels of blood traceelements in those preschool children born from ART are within the normal ranges, which suggested the ART safety in the absorption and metabolism of traceelements. It is necessary to study further in the large sample, and to track, whether the levels of zinc and lead are authentically discrepant in those ART children. Related Articles | Metrics

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Analysis of the Factors Affecting Abnormal Fertilization after in Vitro Fertilization and Intracytoplasmic Sperm Injection LIU Bai-ling;SUN Ying-pu;DAI Wei;BU Zhi-qin 2015, 34 (4):  278-282.  Abstract ( 1660 )   PDF (824KB) ( 7681 )   Objective: To investigate the factors affecting monopronuclear and polypronuclear zygotes after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), so as to explore a feasible method to reduce the abnormal fertilization rate. Methods：A total of 2 229 treatment cycles, including 1 425 IVF cycles and 804 ICSI cycles, data from from 25 160 oocytes in our center from September 2013 to February 2014, were included in this retrospective study. Results：① There were not significant relationship between the incidence of monopronuclear zygotes and those factors, including the type of infertility, the Gn dosage and stimulation days, in IVF cycles. However, the incidence of monopronuclear zygotes in those women aged over 38 years was significantly increased, when compared with women aged 31 to 38 years. ② The incidence of polypronuclear zygotes in IVF group was significantly higher than that in ICSI group. In IVF cycles, the incidence of polypronuclear zygotes was significantly increased when the number of retrieved oocytes was more than 15, the serum estradiol level on the day of retrieved oocytes was more than 2 000 pg/mL, or when the difference of serum estradiol levels on the day of retrieved oocytes and the hCG day was more than 4 000 pg/mL. In ICSI cycles, the incidence of polypronuclear zygotes was significantly increased with the woman′s age, especially for those women aged more than 31 years. ③ Using the multiple linear regression analysis, the number of abnormal fertilized oocytes in ICSI group, was linearly related to the basic levels of E2 and LH （2-3 days during the menstrual cycle） and the total number of eggs, while this value in IVF group was linearly related to the basic level of FSH and the total number of eggs. However, the number of abnormal fertilized oocytes in both IVF and ICSI groups were negatively related with the P/E2×1 000 on the hCG day. Conclusions：The mechanism of abnormal fertilization and its factors are different in IVF treatment and ICSI treatment. It is helpful for reducing the incidence of monopronuclear zygotes and polypronuclear zygotes to use the appropriate fertilization for different infertile women, and to use individual stimulation protocol and adjustable dose of Gn according to their basic endocrine and the number of ovarian follicles. Related Articles | Metrics

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Level of Serum P/E2 on Day 6 after Embryo Transfer of COH and Clinical Outcomes of IVF/ICSI-ET XIANG Yun-gai;WAN Li-jing;SONG Yu-xia;CHU Xi-ying;TAN Li 2015, 34 (4):  283-285.  Abstract ( 1780 )   PDF (495KB) ( 7617 )   Objective: To explore the relationship between the level of serum P/E2 on the day 6 after embryo transfer of cotrolled ovarian hyperstimulation and the clinical outcomes of IVF/ICSI-ET. Methods：A total of 544 cycles of IVF-ET were divided into two groups by the level of P/E2 on the day 6 after ET: group A (P/E2＜114.5) and group B(P/E2≥114.5). The clinical data, implantation rate and clinical pregnancy rate were compared between two groups. Results：There were not significant differences between two groups in the endometrial thickness, total dose of gonadotropin, duration of gonadotropin and number of ET (P＞0.05). However, the implantation rate and clinical pregnancy rate in the group A were significantly higher than those in the group B (P＜0.05). Conclusions：The clinical outcomes will be better if the level of serum P/E2 on the day 6 after ET was lower than 114.5, suggesting that the level of serum P/E2 on the day 6 is a useful parameter predicting clinical outcomes of IVF. Related Articles | Metrics

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Effect of Laser-assisted Hatching on Clinical Outcomes of Frozen-thawed Embryo Transfer at Cleavage Stage and Blastocyst ZHAO Fang;LYU Yu-zhen;WANG Juan;TIAN Ke-ke 2015, 34 (4):  286-289.  Abstract ( 1676 )   PDF (678KB) ( 7739 )   Objective: To investigate the effects of laser-assisted hatching （LAH） on clinical outcomes of vitrified-warmed embryo transfer at the cleavage stage and blastocyst. Methods：565 vitrification-frozen embryo transfer（FET） cycles were retrospectively studied. According to whether the AH was performed, 426 cleavage stage embryo transfer cycles were divided into two groups: AH group and non-AH group; 139 blastocyst transfer cycles were divided into two groups: AH1 group and non-AH1 group. The general condition and pregnancy outcome were compared. Results：There were not significant differences in clinical pregnancy rate, implantation rate, multi-pregnancy rate, miscarriage rate and ectopic pregnancy rate between the AH group and the non-AH group （P＞0.05）. The implantation rate and multi-pregnancy rate in the AH1 group were significantly higher than those in the non-AH1 group （P＜0.05）. There were not significant differences in the rates of clinical pregnancy, miscarriage and ectopic pregnancy between the AH1 group and the non-AH1 group （P＞0.05）. Conclusions：LAH can increase the rates of implantation and multi-pregnancy in vitrified-warmed blastocyst transfer, but it does not increase the clinical pregnancy and implantation rates of vitrified-warmed embryos transfer at the cleavage stage. Related Articles | Metrics

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Retrospective Analysis of Azoospermia：A Report of 500 Cases CHE Yu-rui;CHEN Bin;WANG Yi-xin;WANG Hong-xiang;PING Ping;HAN Yin-fa;HUANG Yan-ping;HU Kai;JIN Yan 2015, 34 (4):  290-292.  Abstract ( 1690 )   PDF (518KB) ( 7699 )   Objective: To analyse retrospectively the clinical diagnosis and treatment of 500 cases with azoospermia, so as to act up to the normalized diagnosis and treatment of male infertility. Methods：Five hundreds cases with azoospermia infertility, from December 2012 to December 2013 in our center, were retrospectively analyzed. According to the 2013 Chinese Medical Guideline of Male Infertility, those patients were divided as: obstructive azoospermia, non-obstructive azoospermia and the mixed azoospermia. Mutiple treatments, such as the reconstructive surgery, medication, IVF/ICSI, AID and adoption, were advised to choose with a informed consent. Results：There were 254 cases with obstructed azoospermia, 187 cases with non-obstructed azoospermia and 40 cases with the mixed azoospermia in those 500 cases, and 19 cases were diagnosed as the microdeletion in AZFa or AZFb gene. In 44 cases underwent reconstructive surgery, there were 14 cases accepted the ejaculatory duct cyst incision by seminal vesicle mirror, 5 cases accepted the anastomosis of deferens and deferens, 25 cases accepted the anastomosis of deferens and epididymis. Sperms were found in 33 cases after 3-12 months of surgery, nature uxorial pregnancies were found in 2 cases. In 19 cases underwent medication, 7 patients with inflammatory obstruction were treated with antibiotics for 1-3 months. Sperms were found in 3 cases （3/7） after 3-6 months of treatment, one case had nature uxorial pregnancy, and 4 cases had significant improvement in their symptoms of reproductive system. Twelve cases with hypogonadism were treated with rFSH or hCG, including one case with Kallmann syndrome. Nine cases had the increased testicular volume （＞4-8 mL） and the increased testosterone concentration in their 3-12 months follow-up, while sperms were found in 5 cases in their 6-12 months follow-up. There were 196 pregnancies within 12 months in those 376 couples underwent IVF/ICSI. Sixty one cases （ｃｏｕｐｌｅｓ） accepted AID or adoption. Conclusions：The diagnosis and treatment of male azoospermia infertility should follow the Chinese Medical Guideline of Male Infertility, and the invasive methods should be prudently used. It should be proposed to make the medical decision under sufficient discussion between doctors and patients. It is important to diagnose and treat reasonably azoospermia infertility in clinical practice. Related Articles | Metrics

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Molecular Epidemiological Survey of Deafness Related Genes in 6 945 Newborns FENG Ji-zhen;LI Tian-jie;MO Zhong-fu;LI Li-xin;WANG Ya-fan 2015, 34 (4):  293-295.  Abstract ( 1974 )   PDF (637KB) ( 7689 )   Objective: To analyze the mutation rate of the deafness related genes in newborns, and to construct a database which provide reliable data for clinical diagnosis and genetic counseling. Methods：Blood samples of 6 945 newborns were collected from the heel on the Day 3 after birth in our center with the informed consent. Mutations of the deafness related genes were detected by the fluorescent PCR. 5 mutation sites in 3 genes, including GJB2 （235delC）, SLC26A４ （IVS7-2A＞G, 2168A＞G）, mitochondrial DNA12S rRNA （1494C＞T, 1555A＞G） were tested. Results：There were 239 neonates who carried mutations （239/6 945, 3.44%）. 114 （１．６４％） ｎｅwborns carried heterozygous mutations and １ （０．０１％） homogeneous mutation of GJB2 （235delC）; 97 （１．４０％） neonates carried heterozygous mutations and １（０.01%） homogeneous mutation of SLC26A4 （IVS7-2A＞G); and 14 (0.2%) newborns carried heterozygous mutations of SLC26A4 （２168A＞G）. There were 9 and 2 neonates who carried homogeneous and heterogeneous mutation of mitochondrial 12S rRNA gene （0.13% and 0.03％）． One newborn was found to carry 3 heterozygous mutations of 235delC, IVS7-2A＞G and 1555A＞G. Conclusions：The main mutational patterns of newborns were 235delC of GJB2 gene and IVS7-2A＞G of SLC26A4 gene in our center. The detection of deafness genes in newborns is helpful to investigate the carrier rate, which provides an academic guidance for local sound child rearing. Related Articles | Metrics

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Application of HPV Screening Plus ws Classification in Cervical Lesions of High-risk Pattern PENG Min;ZHANG Jian-lan;MO Ju-ling;ZHOU Dong-hua;LIU Xiao-yan 2015, 34 (4):  296-298.  Abstract ( 1686 )   PDF (516KB) ( 7790 )   Objective: To explore the application of the HPV screening combined with ThinPrep cytology （ＴＣＴ） and loop electrosurgical excision proceduｒｅ （ＬＥＥＰ） ｉｎ diagnosis treatment of the cervical lesions of high-risk viral infections. Methods：From January 2013 to January 2014, 1 126 women were tested by HPV testing combined with ThinPrep cytology （ＴＣＴ） in our hospital. Those patients with positive resulｔ（ｓ） （ｏne or two tests) underwent the colposcopic biopsy and pathological exam. Those patients with high-risk HPV were divided into 3 groups, A9, A7 and A5/A6, while those patients with high-risk HPV and cervical lesions of high-risk pattern were treated by LEEP knife resection under electronic colposcope. The incidence of high-risk HPV cervical infection, the results of follow-up and treatment and the incidence of different types of cervical lesions in those patients with different high-risk HPV ws classification were compared. Results：Fourteen types of high-risk type HPV were detected in 1 126 women. The incidence of high-risk HPV was 8.5% （96/1 126）. There was not significant difference in the incidences of different types of cervical lesions in those patients with different high-risk HPV ws classification the three groups （Ｐ＞０．０５）. After three to six months of treatment, the overall rate of the inverted HPV negative infection was 74.0% （71/96）． There was not significant difference in this rate in 3 groups differencｅ （ｔhe A9 group, 78.9% （30/38）; the A7 group, 67.7% （21/31）; the A5/A6 group, 74.1% （２0/27;χ2=3.272, P＞0.0５）. Conclusions：LEEP is a effective method to treat those patients with different high-risk HPV ws classification infection. Related Articles | Metrics

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Adverse Exposure during Pregnancy and Fetal Origins of Adult Diseases MENG Ye;LYU Ping-ping;HUANG He-feng 2015, 34 (4):  304-308.  Abstract ( 1905 )   PDF (679KB) ( 7697 )   Fetal origins of adult diseases, as well as mechanisms, are the research hot topics in recent years. These diseases are involved to the cardiovascular system, respiratory system, urinary system, immune system and neuropsychiatric system, covering all major tissues and organs, which cause serious harm to human health. The maternal adverse exposure is also extended from simple malnutrition to hormone abnormalities, chemical exposure, mental condition and other factors during pregnancy. Both the developmental plasticity theory and epigenetic abnormality theory are introduced to explain the mechanisms of the early fetal origins of adult diseases from the organ development to molecular level. This paper reviewed the types of fetal original adult diseases, types of adverse exposure and the underlying mechanisms, as well as the research history of related diseases. Related Articles | Metrics

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Is Air Pollution Associated with Gestational Hypertension and Diabetes? ZHANG Yan-yan;HOU Hai-yan;CHEN Ya-qiong 2015, 34 (4):  309-311.  Abstract ( 1653 )   PDF (435KB) ( 7663 )   Along with the rapid development of industrialization, the environmental air pollution is increasingly serious. Investigation shows that air pollution may lead to respiratory disease, cardiovascular disease and cerebrovascular disease. In recent years, studies showed that air pollution also affected women health, especially the effect of air pollution on pregnancy complications has received extensive attention in the world. The gestational hypertensive disorder and gestational diabetes mellitus are the most common two pregnancy complications. The physiological characteristics of pregnant women，such as the increased blood volume, the increased cardiac load, leukocytosis, the accelerated slightly breathing frequency and the increased fat deposition, make pregnant women and fetus to be susceptible to pollutants and to increase exposure to air pollutants. In this paper, the relationship between air pollution and gestational hypertensive disorder and gestational diabetes was discussed. Related Articles | Metrics

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GABA and its Receptor and Female Reproduction DAI Huang-guan;HAO Cui-fang 2015, 34 (4):  312-314.  Abstract ( 2476 )   PDF (538KB) ( 7699 )   GABA is a principal inhibitory neurotransmitter in the central nervous system of mammalian. However, GABA and its receptor are present not only in peripheral neuronal tissue, but also in many peripheral non-neuronal tissues, suggesting that GABA plays important roles in regulating signal transduction and endocrine function. Recently, many studies showed that GABA and its receptors also play some special roles in the female reproduction and reproductive disorders. GABA signaling is involved in follicular development and maturation by regulating estrogen and progesterone production. Meanwhile, GABA through various GABA receptors can regulate embryo implantation and placentation. In addition, GABA and its receptors are related to many reproductive diseases by some specific signaling pathways, including tumor proliferation and metastasis. This review discussed the research progress of GABA and its receptors in the female reproductive processing and related diseases. Related Articles | Metrics

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Roles of let-7c in Regulating Ovarian Function HONG Li-ming;YANG Xiao-kui 2015, 34 (4):  315-318.  Abstract ( 1715 )   PDF (474KB) ( 7693 )   Normal ovarian functions are not only controlled by the hypothalamic-pituitary-ovarian axis, but also regulated by autocine and paracrine systerms in the ovary. The coordinating roles among endocrine hormones, cytokines, growth factors and many other factors are essential for normal ovarian functions. Any dysregulation of these factors may result in ovarian dysfunction and ovarian diseases. MicroRNAs（miRNAs） are a class of non-coding single-stranded RNA molecules, which negatively regulated gene expression at post-transcriptional level and involved in a variety of physiological and pathological processes. Let-7c is one of the most widely studied miRNAs at present. Recent studies suggested that let-7c was related to the occurrence and development of tumor. In addition, let-7c regulates proliferation, differentiation and apoptosis of ovarian granulosa cells through various signal pathways, showing its important roles in follicular development, ovarian hormone synthesis and function, premature ovarian failure and ovarian cancer. Related Articles | Metrics

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Human Pre-implantation Embryo Development LI Min;ZHANG Wen-ke;CHEN Li;XU Xiao-fei;YAO Yuan-qing 2015, 34 (4):  319-323.  Abstract ( 1695 )   PDF (679KB) ( 7632 )   With recent advances in the non-invasive imaging techniques and molecular and genomic technologies，study on the development of human pre-implantation embryo has been progressed. Time-lapse imaging of human embryos was used to observe the first three mitotic divisions, which can predict the success or failure of development of blastocyst. The embryo scope is currently used by a number of IVF clinics throughout the world. Time-lapse technology was used to assess the rate of cleavage divisions and the spatial pattern of embryonic development. The development of human pre-implantation embryo is characterized by reprogramming, including the fusion of egg and sperm pronuclei, epigenetic reprogramming and modification，an extensive wave of degradation of maternal transcripts, and the activation of nascent human embryonic genome. It is generally considered that a major wave of the activation of embryonic genome is between the 4- and 8-cell stages. The lineage commitment study showed that each cell of human embryo at the 8-cell stage can autonomously develop, suggesting that the different cell at this stage was not differentiated to the trophectoderm（TE） or inner cell mass（ICM）. Genomic analyses of single human oocytes and single-cell RNA sequencing of human oocytes and embryos had been reported. Related Articles | Metrics

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Pre-implantation Genetic Diagnosis in Embryos of Translocation Carriers ZHANG Wen-ke;XU Xiao-fei;LI Min;CHEN Li;YAO Yuan-qing 2015, 34 (4):  324-327.  Abstract ( 1691 )   PDF (623KB) ( 7804 )   Translocation carriers usually had normal phenotype, but they generally had abnormal pregnancy history, such as abortion, dead-birth, fetal anomaly and hypophrenia mainly due to those embryos with the unbalanced translocation and the deletion or repetition of chromosome fragment（ｓ） which generated during the fertilization. Normal and/or balanced embryos can be selected for transfer by ART and PGD for those translocation carriers to prevent the abnormal pregnancy. This review introduced the conception, classification and indication of PGD, the probability of reciprocal translocation carriers and Robertsonian translocation carriers to get a normal baby. The principles, advantages and disadvantages, and practical issues and value of common PGD techniques for those translocation carriers were also discussed, including FISH, SKY, CGH, aCGH, SNP and NGS. Related Articles | Metrics

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LH-inducing Pathways in Androgen Biosynthesis of Ovarian Theca-cells XU Si-liang;CUI Yu-gui;LIU Jia-yin 2015, 34 (4):  328-332.  Abstract ( 1753 )   PDF (644KB) ( 7745 )   LH is postulated to regulate exactly the androgen biosynthesis in ovarian theca-cells. LH plays its roles by numerous downstream pathways, including conventional pathways like cAMP-PKA-CREB, PKA-ERK, Ras-Raf-MEK-ERK and PI3K-Akt. LH can stimulate adenylate cyclase（AC）-independed phospholipase C-inositol phosphate （PLC-IP） signaling in ovulatory-size follicles, by which LH induces the differentiation response of granulosa cells. Those classical pathways like Wnt and mTORC1 are related to the androgen biosynthesis in ovaries. The conventional pathways and above classical pathways such as Wnt signaling could act in concert to regulate the ovarian steroidogenesis though the complicated crosstalk. SET protein as a transcriptional regulating factor is widely expressed in various tissues and mediates diverse biological processes. It was recently found that a specific, SET-initiated and PP2A-mediated pathway would lead to the increased lyase activity of P450c17 and the increased testosterone production in ovarian theca cells, which maybe contribute to clarify the hyperandrogenism of polycystic ovarian syndrome（PCOS）. It is important to clarify the pathways involved in the androgen biosynthesis in ovarian theca cells and the hyperandrogenism of PCOS for the treatment of those androgen-related diseases. This review focused on the LH-inducing pathways in regulating steroidogenesis in ovarian theca-cells. Related Articles | Metrics

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Molecular Mechanisms of Oocyte Maturation Induced by LH Surge in Natural Cycle MA Wen-hong;WEI Ji-hong 2015, 34 (4):  333-338.  Abstract ( 1582 )   PDF (872KB) ( 7701 )   During a spontaneous menstrual cycle, a preovulatory luteinizing hormone （LH） surge initiates the complex ovulatory process whereby an oocyte is released from the ovarian follicle. As the result of LH surge, the oocytes complete meiosis I and enter meiosis II, the cumulus-oocyte complex separates from the follicle wall, and the process resulting in the release of the oocyte-cumulus complex is started. Human chorionic gonadotrophin （ｈＣＧ） was usually used as a surrogate ＬＨ surge to induce the final ovarian maturation in assisted reproductive technology （ＡＲＴ）, because hCG induces the necessary changes through the LH receptor. But the molecular mechanisms of oocyte maturation induced by LH surge in natural cycle are still unclear. The content of LH receptor on granulosa cell increases with the growth of follicles, and reaches a peak before the maturity of follicles, which make the growing follicles to be ready for the response to LH surge. High LH surge acts on GCs by its receptors, stimulating type G protein/adenosine cyclase/cAMP/cAMP-dependent protein kinase （Gs/AC/cAMP/PKA） pathway to increase intracellular cAMP concentration. The activated transcription factors, including cAMP response element binding protein 1 （ＣＲＥＢ１） ａnd cAMP-response element modulator （ＣＲＥＭ）, causes the activation or inhibition of some gene expressions which related on oocytes maturation and ovulation. All these result in the ovulation and the formation of corpus luteum. Related Articles | Metrics

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Luteal Phase Support in Cycles of Frozen-thawed Embryo Transfer LUO Yi-qun;QUAN Song 2015, 34 (4):  339-343.  Abstract ( 1640 )   PDF (779KB) ( 7743 )   In the cycle of frozen-thawed embryo transfer （ＦＥＴ）, natural cycle and hormone replacement cycle are the most commonly used for endometrial preparation. There is no disagreement on the necessity of luteal phase support in hormone replacement cycles. However, there are still no consensus on the necessity of luteal phase support in natural cycles, as well as the suitable drugs, dosage form and dose in natural cycles and hormone replacement cycles. There was not a conclusion on the effects of luteal phase support on the outcomes of FET. This review stated the luteal phase support in the cycles of FET, so as to improve clinical application of the luteal phase support. Related Articles | Metrics

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Treatment Strategy of Adenomyosis Combined with Infertility before Assisted Reproduction LI Dong-ju;MAO Yun-dong 2015, 34 (4):  344-348.  Abstract ( 1630 )   PDF (838KB) ( 7649 )   It is clear that assisted reproductive technology（ART） can improve the pregnancy outcome in those patients with adenomyosis and infertility. However, there is not consensus on what kind of treatment to be taken before ART. In this review, we discussed the treatment strategy of adenomyosis as so to improve the pregnancy outcome of ART as follows: hormone treatment，conservative surgery treatment and some new technologies such as uterine artery embolism and high intensity focused ultrasound（HIFU）. The hormone treatment included gonadotropin releasing hormone agonist（GnRHa），mifepristone and gestrinone. And the article described many controversies，such as the detailed drug treatment，the laparoscopic surgery and its indications and limitations before ART, the uterine artery embolism and HIFU and its effects on the pregnancy and newborns，and the type and the timing of ART after drug treatment or surgery. Related Articles | Metrics

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Diagnosis and Treatment for Perimenopausal Depressive Disorder CUI Li-li;WANG Dong-na;MAO Pei-xian;REN Yan-ping;TANG Yi-lang 2015, 34 (4):  349-352.  Abstract ( 1611 )   PDF (593KB) ( 7644 )   Perimenopause period is a high risk period of new and recurrent depression. Perimenopausal depressive disorder (PDD) is a common disorder related to the physical and mental health, as well as life quality, of middle aged women. The initial factor of PDD is the degradation of ovarian function, which lead to the decreased estrogen and the weaken negative feedback to hypothalamus and pituitary. The fluctuating hormonal level during the menopausal transition may increase vulnerability to depression. Perimenopausal depression may not only accelerate the primary course of depression, but also increase the risk of physical disorders including cardiovascular disease, diabetes and osteoporosis. Studies on the treatment of perimenopausal disorder showed that the main treatment was antidepressant, and antidepressant combined with hormone replacement for those refractory PDD patients. Because long term of estrogen therapy could increase the risk of breast canscer and endometrial carcinoma, it is usual that progesterone was combined with estrogen in clinical practice. This review introduced the combined therapy with estrogen and antidepressant for PDD. Related Articles | Metrics