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15 May 2013, Volume 32 Issue 3
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Reviewing Back the Past，Looking Forward to the Future--Reflection at the 25th Anniversary of Successful Application of ART in Mainland of China WANG Yi-fei 2013, 32 (3):  149-153.  Abstract ( 1598 )   PDF (520KB) ( 7483 )   On the happy occasion of the 25th anniversary of successful application of ART in mainland of China，it is advisable to review ART development history in China，to investigate challenges and opportunities，and to develop an overall plan for the future. One Standpoint: ART is a significant milestone in Biomedicine History. Two Reflections: ART is not necessary the best approach and /or the first choice for infertility management; ART needs strict and systematic safety review and evaluation. Three Challenges: How to improve successful rate of ART? How to reduce the potential risks of ART? How to develop an enabling bioethical environment for ART? Four Recommendations: Interdisciplinary Research on ART and its Safety; National ART Network and Database;Capacity Building of ART Staffs; International Communication and Collaboration. Related Articles | Metrics

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Effect of Metformine on the Expression of Insulin Receptor Substrates-1 and Extracellular Signal-Regulated Kinases-2 in Granulosa Cells REN Wen-chao;LIU Jian-xin;QI Xiu-juan;DING Yu;WANG Lin 2013, 32 (3):  154-156.  Abstract ( 1913 )   PDF (550KB) ( 7424 )   Objective： To study the effect of metformoin on the expression of insulin receptor substrate-1 （IRS-1） and extracellular signal-regulated kinase-2 （ERK-2） in ovarian granulosa cells of the patients with polycystic ovarian syndrome （PCOS）． Methods：Granulosa cells were collected from PCOS patients during IVF-ET. Those granulosa cells from non-PCOS patients during IVF-ET were used as control. After in vitro treated by metformin for 48 h, the cultured granulose cells were examined for IRS-1 and ERK-2 mRNA expression by real-time quantitative PCR. Results：The expression levels of IRS-1 and ERK-2 mRNAs in the granulosa cells of PCOS patients were higher than those in control group （Ｐ＜０．０５）. The level of IRS-1 mRNA was increased by metformoin treatment, while the level of ERK-2 mRNA was decreased（P＜0.05）. Conclusions：Metformoin may alleviate the pathological state of insulin resistance in ovarian of PCOS patients by decreasing the activity of MAPK insulin signaling pathway, which has a negative effect on PI3K pathway. Related Articles | Metrics

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Expression of Luteinizing Hormone/Choriogonadotropin Receptor mRNA in the Lymphocytes May Identify IVF Patients at Risk of Ovarian Hyperstimulation Syndrome WANG Shuang;QI Xiu-juan;YANG Kun;GUO Xiao-jing;SUN Yue-rong 2013, 32 (3):  157-161.  Abstract ( 1797 )   PDF (688KB) ( 7463 )   Objective：To investigate whether women with high risks of ovarian hyperstimulation syndrome （OHSS） undergoing controlled ovarian hyperstimulation have the altered levels of the luteinizing hormone/choriogonadotropin receptor （LHCGR） mRNA in the lymphocytes. Methods：In this single center prospective study，108 IVF-ET patients were divided into 3 groups according ovarian response. In 42 cases with high OHSS risks，those 19 cases diagnosed OHSS were group A，the others 23 cases were group B. Those 62 cases with normal ovarian response were group C. The levels of LHCGR mRNA in lymphocytes were detected by PCR technology in the days of hCG injection and ovum pick-up （OPU day）. Results：The level of basal serum FSH in group A was lower than that in group C （P=0.028）. The serum concentration of estradiol （E2） in both group A and group B was higher than that in group C on the days of hCG injection and OPU（P=0.000）. The median numbers of oocytes retrieved per patient in group A and group B were more than that in group C （P=0.000）. Group A had higher expression of LHCGR in lymphocytes mRNA on the hCG day and OPU day than group B and group C（P＜0.05）. The difference of the levels of LHCGR mRNA in lymphocytes between group B and group C was not significant（P＞0.05）. Conclusions：Expression of LHCGR mRNA in lymphocytes was related to ovarian response， which increased in OHSS patients. It could be used as a marker to predict OHSS. Related Articles | Metrics

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Effect of Aspirin Combined with Prednisone on Pregnancy Outcome in People with Positive Anti-Phospholipid Antibody Undergoing IVF-ET ZHANG Yu;JI Jing-juan;LIU Yu-sheng;LUO Li-hua;TONG Xian-hong 2013, 32 (3):  162-165.  Abstract ( 1894 )   PDF (630KB) ( 7499 )   Objective：To investigate the effect of aspinrin combined with prednisone on pregnancy outcome in patients with positive anti-phospholipid antibody（APA） undergoing in vitro fertility-embryo transfer（IVF-ET）. Methods: Fifty-two patients underwent IVF-ET who had positive anticardiolipin（ACA） or/and anti-beta 2 glycoprotein 1 antibody（Aβ2GP1） were randomly divided into two groups，one group treated with aspirin and prednisone at low doses， another untreated as control. Oocyte retrieval number，fertilization rate，cleavage rate，useful embryo rate，high quality embryo rate，implantation rate，clinical pregnancy rate，abortion rate were analyzed. Results: Between two groups，there were not significant differences in the oocyte retrieval rate and abortion rate（8.52±4.34 vs. 9.67±4.02，P=0.312；9.09% vs. 50%，P=0.05）. The treated group had higher fertilization rate （80.43% vs. 72.41%，P=0.032），cleavage rate（98.67% vs. 94.64%，P=0.045）， useful embryo rate （89.24% vs. 76.73%，P=0.001），high quality embryo rate （72.65% vs. 42.77%， P＜0.001）， and clinical pregnancy rate （66.67% vs. 33.33%，P=0.013） than control. Conclusions: Those patients with positive ACA and Aβ2GP1 but without recurrent abortion undergoing IVF-ET can be treated with aspirin and prednisone in low dose，which could be helpful to improve fertility rate， embryo quality，clinical pregnance rate，and IVF-ET outcomes. Related Articles | Metrics

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Investigation the Association between Male Infertility and Microdeletions of AZF Genes ZHUO Sheng-nan;ZHANG Wei-wei;ZHANG Shuai;ZHANG Yin-feng;CUI Xian-feng;LUO Hai-ning;ZHANG Yun-shan 2013, 32 (3):  166-168.  Abstract ( 2151 )   PDF (595KB) ( 7430 )   Objective： To evaluate the clinical significance of Y chromosome microdeletion in male infertility. Methods：122 cases with male infertility were included in this study. Fifteen pairs of sequence-tagged site （include the six STSs site recommended by the EAA） based primers，spanning the AZFa，AZFb，AZFc，and AZFd regions in Y chromosome, were screened by the multiplex PCR. The basic levels of sexual hormones, and chromosome karyotype, were detected. Results：12 microdeletions were identified in all 122 cases, with the total rate of 9.8% (12/122). The rats of AZF microdeletions were 11.1%（5/45），10.9%（6/55）and 4.5%（1/22） in cases of azoospermia，severe oligozoospermia and oligozoospermia, respectively. The chromosome karyotype was abnormal，45，XY，-13-14+t（13；14）（q11；q11），in one case. The rates of AZF microdeletion in cases with azoospermia and severe oligozoospermia were significant higher than that in cases with oligozoospermia （χ2=7.810，P=0.005；χ2=7.700，P=0.006）. There was not significant difference in the hormonal levels of three groups （P＞0.05）. Conclusions：Microdeletion of AZF gene on Y chromosome is one of the major risks leading to idiopathic azoospermia，severe oligozoospermia or oligozoospermia. So it is important to test the AZF gene microdeletion before undergoing assisted reproductive technology （ART） for male infertility, which could reduce patients′ mental pain and economic pressure. Related Articles | Metrics

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Analysis of the Heterotopic Pregnancy after in vitro Fertilization and Embryo Transfer DU Juan;HE Zhen;TAN Xin;YANG Dan;ZHU Ming-hui 2013, 32 (3):  169-171.  Abstract ( 1745 )   PDF (603KB) ( 7448 )   Objective：To investigate the clinical characteristics of heterotopic pregnancy （HP） after in vitro fertilization and embryo transfer （IVF-ET）. Methods：The clinical data of four patients with HP after IVF-ET was retrospectively analyzed, and then compared with literature. Results：The incidence of HP in ectopic pregnancy after IVF-ET was 15.38%. Four HP patients had tubal obstructions, did not have typical symptoms of ectopic pregnancy. They had higher levels of human chorionic gonadotrophin （β-hCG） than other patients with ectopic pregnancy after IVF-ET. Conclusions：HP is related to many factors, such as the history of surgical operation on oviducts，the number of transfer embryos. At the first stage of pregnancy, HP has the same clinical characteristics as normal uterine pregnancy. Related Articles | Metrics

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Clinical Application of Fertiloscopy in the Examination and Treatment of Tubal Infertility ZHANG Li;LIU Xiao-qun;LI Guo-zheng;DU Li-rong;ZHANG Yi-xin;LYV Li-hua;REN Li-juan 2013, 32 (3):  172-174.  Abstract ( 1775 )   PDF (720KB) ( 7464 )   Objective：To investigate the clinical application of fertiloscopy in diagnosis and treatment of tubal infertility. Methods：232 tubal infertile women who underwent fertiloscopy or hysteroscopy were selected, including 126 patients underwent fertiloscoｐｙ （ｆｅｒｔｉｌｏｓｃｏｐｙ ｇｒｏｕｐ）， ａｎｄ １０６ ｐａｔｉｅｎｔｓ ｕｎｄｅｒｗｅｎｔ ｈｙｓｔｅｒｏｓｃｏｐｙ （ｃｏｎｔｒｏｌ ｇｒｏｕｐ）． Ｐａｒａｍｅｔｅｒｓ ｗｅｒｅ ｉｎｃｌｕｄｅｄ ａｓ ｆｏｌｌｏｗ： ①Ｒａｔｅｓ ｏｆ ｔｕｂａｌ ｐａｔｅｎｃｙ. ② Ｆａｃｔｏｒｓ ｗｈｉｃｈ ｍｉｇｈｔ ａｆｆｅｃｔ ｆｅｔｉｌｉｔｙ， ｆｏｕｎｄ ｆｉｒｓｔｌｙ ｉｎ ＴＨＬ ｏｆ ｆｅｒｔｉｌｏｓｃｏｐｙ ｇｒｏｕｐ. ③Ｒａｔｅｓ ｏｆ ｃｏｍｐｌａｔｉｏｎｓ； ④Ｔｈｅ ａｃｃｕｍｕｌａｔｅｄ ｐｏｓｔｏｐｅｒａｔｉｖ ｐｒｅｇｎａｎｔ ｒａｔｅｓ ｉｎ ３，６，９ ｍｏｎｔｈ ｏｆ ｆｏｌｌｏｗｉｎｇ－ｕｐ． Ｒｅｓｕｌｔｓ： ①Ｔｈｅｒｅ ｗａｓ ｎｏ ｓｉｇｎｉｆｉｃａｎｔ ｄｉｆｆｅｒｅｎｃｅ ｉｎ ｒａｔｅｓ ｏｆ ｔｕｂａｌ ｐａｔｅｎｃｙ ｂｅｔｗｅｅｎ ｆｅｒｔｉｌｏｓｃｏｐｙ ｇｒｏｕｐ ａｎｄ ｃｏｎｔｒｏｌ， ８３．８％ ｖｓ. ８５．９％ （χ２＝０．２５，Ｐ＝０．６２）． ② The diagnosis rates by THL were, adhension 31.7%; pelvic edometriosis 5.6%; mesosalpinx cystic 18.3%; accessory fallopian tube 5.6%. ③Rates of complations in fertiloscopy group and control were 0.8% and 0%, respectively. ④ The accumulate postoperativ pregnace rates in fertiloscopy group in 3，6，9 month was higher than those in control group. Conclusions：Fertiloscopy combines the advantages of two minimally invasive operations, which can be used as a first-line procedure in diagnosis and treatment of tubal infertile. Related Articles | Metrics

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Value of ″See and Treat″ Method in the Diagnosis and Treatment of Cervical Intraepithelial Neoplasia GENG Xiao-hui;LI Hong-yan 2013, 32 (3):  175-177.  Abstract ( 1797 )   PDF (860KB) ( 7408 )   Objective：To evaluate the application of the "see and treat" approach of the loop electrosurgical excision procedure （LEEP） in women with cervical intraepithelial neoplasia（CIN）. Ｍｅｔｈｏｄｓ： Three hundred women having childbearing history with cervical intraepithelial neoplasia were included in this study. According to the test of cervical liquid-based cytology （TCT），cases were divided into two groups，group A（low lesions） and group B（high lesions）. Group A, included 162 cases with atypical squamous cells of undetermined significance（ASCUS）， atypical glandular cells of undetermined significance （AGUS）, low-grade squamous intraepithelial lesion （LSIL） patients. Group B included 138 cases with high-grade squamous intraepithelial neoplasia （ＨＳＩＬ）. All cases were scored by the electronic colposcope quantitative scoring system（RCI）. Cases of group A were treated by the cervical biopsy combined with colposcopy and electrosurgery（LEEP）. Cases of group B were treated by the "see and treat" approach of LEEP. Then pathological results were analyzed. Ｒｅｓｕｌｔｓ： There is not significant difference in the CIN Ⅱ detection rates between by cervical biopsy and by LEEP within group A（P＞0.05）. In group A, the pathologic diagnosis of CIN Ⅱ, or above, was 18.52%; while the over-treatment rate was 81.48%. In group B, the pathologic diagnosis of CIN Ⅱ or above was 80.43%, while the over-treatment rate was 19.57%. In group B, if combined with the RCI high score, the diagnosis sensitivity of CIN Ⅱ or above was 84.68%, specificity 81.48%, positive predictive value 94.94%，the omission diagnose rate 15.31%，and the over-treatment rate 5.05%. Ｃｏｎｃｌｕｓｉｏｎｓ： For those patients with HSIL by TCT and high scores by RCI，the "see and treat" approach can reduce the over-treatment rate and the omission diagnose rate. Related Articles | Metrics

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Structure and Function of Calretinin DAI Xiao-nan;LIU Shan;CUI Yu-gui 2013, 32 (3):  184-187.  Abstract ( 2089 )   PDF (675KB) ( 7389 )   Calretinin, also known as calcium retinal protein, is an important calcium-binding protein （CaBP）. CaBPs are important active substances in the nerve cells，which regulate the intracellular calcium ion concentration. Ca2+ is also the intracellular second messengers which in turn activates many physiological functions of enzymes or proteins in cells，such as the Ca2+-dependent protein kinase C and calcium calmodulin.Ca2+-CaBPs participate in a variety of cellular activities, including metabolism，skeletal muscle/cardiac contraction，nerve reaction impulse conduction. Calretinin predominantly expressed in the central nervous tissue，while it also expressed in some steroidogenic organs，such as testis （mainly in Leydig cell），ovary and adrenal. Function of calretinin in different tissues could be different，including regulation of hormonal production in cytoplasm，and regulatory effects on cell differentiation，development，proliferation and apoptosis. Effect of calretinin in reproductive endocrinology is a new area. Related Articles | Metrics

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Research Progress on Oocyte Apoptosis ZHU Li;XU Yan-wen 2013, 32 (3):  188-190.  Abstract ( 1962 )   PDF (679KB) ( 7491 )   To multicellular organisms, it is very necessary for cellular function coordination to control cell proliferation and death. Cell apoptosis is just the most important pattern to limit the proliferation of abnormal cells. The female germ cell apoptosis is an important way for follicle recuitment, selection and dominance. Recently，the research spots on oocyte apoptosis are the regulation mechanisms of Bcl-2 family, and its impact on embryo development. Related Articles | Metrics

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Research Progress of the Relationship between Human Cumulus Cells and Oocyte Developmental Potential YE Tian;SUN Ying-pu 2013, 32 (3):  191-193.  Abstract ( 1806 )   PDF (729KB) ( 7358 )   There is a close relationship between human cumulus granulosa cells and oocytes, because the former could influence the development and maturation of oocytes and therefore the embryos quality. In assisted reproductive technology, study on cumulus granulosa cells may offer us more objective， accurate and non-invasive criteria for embryo selection so that the pregnancy rates can be increased and the elective single embryo transfer protocol can be promoted. On the other hand， the high order multiple pregnancy rates and the poor outcomes can be also decreased considerably. Nowadays，it is a hot area to explore the relationship between cumulus cells and oocyte developmental potential at the genetic and transcriptional levels. It was reported that the up-regulation of oogenesis-related genes in cumulus cells can predict good quality embryos. Checkpoints and DNA repair-related genes are associated with oocyte quality. Cell apoptosis, glucogenesis, antioxidative stress-related genes and transcription factor NFIB are the biological parameters to predict the oocyte developmental potential and pregnancy outcome. Related Articles | Metrics

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Hyperandrogenism Involved in Pathogenesis of Polycystic Ovary Syndrome WANG Fang-fang;PAN Jie-xue;REN Jun;HUANG He-feng 2013, 32 (3):  194-197.  Abstract ( 2108 )   PDF (761KB) ( 7463 )   Polycystic ovary syndrome（PCOS） is the most common cause of hyperandrogenic anovulatory infertility，with the incidence of 10% among women of reproductive age. The main manifestations include ovulation，hyperandrogenism and polycystic ovary. Since its clinical manifestations are heterogeneous，the etiology of PCOS is still unclear. Nevertheless，the crucial role of hyperandrogenism in PCOS pathogenesis has been recognized in the world. Recently，scientists paid more attention on the early developmental origin hypothesis and epigenetics. We reviewed the role of androgen in ovarian function and its potential mechanism in PCOS pathogenesis. Related Articles | Metrics

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The Diagnosis Criteria and Treatment of Polycystic Ovary Syndrome in Adolescents ZHAO Nan-nan;CUI Yu-gui;LIU Jia-yin 2013, 32 (3):  198-202.  Abstract ( 1929 )   PDF (851KB) ( 7518 )   The diagnosis criteria of adolescent polycystic ovary syndrome（PCOS） remains controversial. There is growing support for the Rotterdam criteria，to fit all three criteria：oligoovulation or anovulation,hyperandrogenism and polycystic ovaries on pelvic ultrasonography. The adolescent PCOS may be over-diagnosed by the standard ′two of three′ criteria. The rates of metabolic syndrome and sleep disorders are higher in those patients with the adolescent PCOS，which likely have implications on long-term health. The lifestyle modification should be included in the comprehensive treatment for the adolescent PCOS, such as diet，exercise and behavioral changes. Medicines are used to treat insulin resistance and metabolic dysfunction, such as insulin sensitizers. Related Articles | Metrics

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Current Knowledge of the Aetiology and Risk Factors of Human Ectopic Pregnancy after Assisted Reproductive Technology WANG Jing;LIU Jia-yin;CUI Yu-gui 2013, 32 (3):  203-206.  Abstract ( 1820 )   PDF (741KB) ( 7482 )   The risk of ectopic pregnancy （EP） is higher in pregnancies resulting from assisted reproductive technology （ART） than in spontaneous pregnancies. Clinical studies showed that tubal factor infertility，different hormonal milieu，ART procedures，and embryo implantation potential were potential risk factors. At present, most reports were descriptive on the molecular mechanism of tubal ectopic pregnancy. Limited data revealed that some molecules may play roles in EP pathogenesis, which related to infection，hormonal abnormality and ART procedures. Those molecules may involve in the mechanism of embryo ectopic implantation through their impact on tubal transfer function，tubal environment and/or embryo factors. But, the changed expressions of those molecules could be simply the result of tubal implantation. Further understanding the aetiology and risk factors of tubal ectopic pregnancy is critical for us to improve ART procedures and prevent EP. Related Articles | Metrics

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Mitochondrial Metabolism and Sperm Motility FAN Yong;DING Zhi-de 2013, 32 (3):  207-210.  Abstract ( 1905 )   PDF (784KB) ( 7441 )   Asthenospermia is one kind of male infertility, about 19% in total cases, which caused by defects in sperm motility. Generally, the energy for sperm motility fundamentally comes from the oxidative phosphorylation of mitochondrial respiratory chain. Thus, any factors related mitochondrial metabolism, such as oxidative stress, cell apoptosis as well as Ca2+ cycle, will have significant influences on sperm motility. Herein, we reviewed the research advances on mitochondrial metabolism and sperm motility. Related Articles | Metrics

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Tumor Necrosis Factor-like Weak Inducer of Apoptosis and Gynecologic Neoplasms MA Ning;QIU Li-hua 2013, 32 (3):  211-213.  Abstract ( 1836 )   PDF (703KB) ( 7425 )   Tumor necrosis factor-like weak inducer of apoptosis （TWEAK） is a new member of the TNF family, which widely expressed in human tissues. TWEAK plays biological roles by combining specifically its receptor, fibroblast growth factor-inducible 14 （Ｆｎ１４）. TWEAK -Fn14 system is important in regulating tumor development and prognosis, including cell apoptosis, tumor hyperplasia, differentiation, angiopoiesis, invasion and inflammation. It was demonstated that the TWEAK -Fn14 signaling was related to gynecologic tumors, and that TWEAK -Fn14 maybe a potential candidate target for treatment of gynecologic neoplasms. Related Articles | Metrics

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Therapy of Thin Endometrium TIAN Tian;ZHAO Jing;LI Yan-ping 2013, 32 (3):  214-217.  Abstract ( 1843 )   PDF (787KB) ( 7497 )   With the development of assisted reproductive technology（ART），clinician faced another challenge, thin endometrium. The reached agreement is that thin endometrium may affect endometrial receptivity. Thin endometrium is one of the reasons of cycle cancellation and implantation failure in ART，which caused economic and psychologycal pressure on patients. At present，there are many reports on therapy of thin endometrium，but those therapy protocols were mainly based on case reports or small scale study. So, the effectiveness need to be further confirmed. Now，we classified therapy protocols of thin endometrium as: improving cell regeneration, improving blood flow of endometrium，enhancing expression of growth factors，and discussed potential mechanisms, so as to explore a better therapy in future. Related Articles | Metrics

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Quality of Life for Patients with Recurrent Ovarian Cancer SHAO Zhu-yan;ZHANG Ping 2013, 32 (3):  218-221.  Abstract ( 1882 )   PDF (735KB) ( 7454 )   Most patients with ovarian cancer were diagnosed at the advanced stages， and would eventually recur. The quality of life（QOL）of these patients will be diminished while experiencing recurrence. Generally, the QOL of patients with recurrent ovarian cancer is affected by disease itself and treatment. Many physiological functions are changed owing to the recurrent symptoms, such as bowel obstruction, ascites and pleural effusion, the postoperative complications of cytoreductive surgery, and the side-effects of chemotherapy. Besides, the psychological distress caused by bad endings of treatment, such as alopecia, and sexual dysfunction, and fear of poor prognosis, will result in lower QOL. The therapeutic goals for patients with recurrent ovarian cancer should be aimed to improve their both survivals and QOL. Related Articles | Metrics

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Consensus on the Women′s Health of PCOS: the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group（Ⅰ） DU Shang-ming;MA Meng-jun;LIN Dan-yu;SUN Hong-lin;CUI Fei-huan;ZHAO Xiao-miao;YANG Dong-zi 2013, 32 (3):  222-224.  Abstract ( 1994 )   PDF (857KB) ( 7461 )   Polycystic ovary syndrome （PCOS） is the most common endocrine disorder in females，with a high prevalence. The etiology of this heterogeneous condition remains obscure，and its phenotype expression varies. Two consensus workshops focused on diagnosis （published in 2004） and infertility management（published in 2008）, which previously sponsored by ESHRE/ASRM. Those consensuses are widely cited now. In the present third PCOS consensus report, all current knowledge was summarized, and some blind area on understanding the women′s health of PCOS were clarified. The topics were addressed in a systematic fashion, including adolescence， hirsutism and acne， contraception， menstrual cycle abnormalities， life quality， ethnicity， pregnancy complications， long-term metabolic and cardiovascular health, and the risk of cancer. Related Articles | Metrics