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15 January 2021, Volume 40 Issue 1
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Original Article

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Relationship between Preovulatory Dominant Follicle Size and the Outcome of Artificial Insemination with Donor Sperm NI Li-li, WANG Jing, DIAO Fei-yang, MA Xiang, MAO Yun-dong, LIU Jia-yin, LIU Jin-yong 2021, 40 (1):  1-5.  doi: 10.12280/gjszjk.20200513 Abstract ( 2376 )   HTML ( 191 )   PDF (1140KB) ( 10543 )   Objective: To investigate the relastionship between preovulatory dominant follicle size (PDFS) and the outcome of artificial insemination with donor sperm (AID) in natural cycle (NC) and the ovulation induction cycles using clomiphene citrate (CC) or letrozole (LE) respectively.Methods: The clinical data of 2 675 natural cycles (NC-AID), 547 CC-induced cycles (CC-AID) and 1 566 LE-induced cycles (LE-AID) in AID procedures performed between January 2012 and August 2019 were retrospectively analyzed. These AID cycles were respectively grouped according to preovulatory dominant follicle size(PDFS) to understand the variation characteristics of AID outcomes, and to group them respectively into two sub-groups: the dominant group and the control group. The relative advantages of the dominant group in terms of intrauterine pregnancy rate (IPR) and ongoing pregnancy rate (OPR) were analyzed by the univariate and multivariate logical regression.Results: In NC-AID, the IPR and OPR in PDFS 16.0-19.9 mm were significantly higher than those in PDFS ≥20.0 mm (23.01% vs. 19.13%, aOR=1.260, P=0.035; 20.57% vs. 16.88%, aOR=1.277, P=0.034). In CC-AID, the IPR in PDFS 18.0-21.9 mm was significantly higher than that in PDFS<18.0 mm or ≥22.0 mm (26.86% vs. 16.85%, aOR=1.898, P=0.036). In LE-AID, the IPR and OPR in PDFS 18.0-20.0 mm were significantly higher than those in PDFS<18.0 mm or≥20.0 mm (23.90% vs. 18.08%, aOR=1.405, P=0.013; 22.28% vs. 16.35%, aOR=1.449, P=0.009).Conclusions: In AID procedure, the optimal ranges of PDFS in the NC, CC or LE cycles were 16.0-19.9 mm, 18.0-21.9 mm and 18.0-20.0 mm, respectively. Figures and Tables | References | Related Articles | Metrics

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Study on the Relationship between the Number and Grade of Embryo Transfer and Pregnancy Outcome in Assisted Reproductive Technology SU Min, YOU Min, ZHANG Hong-mei, WANG Li-yuan, TU Zeng-rong, TIAN Xiu-zhu 2021, 40 (1):  6-10.  doi: 10.12280/gjszjk.20200311 Abstract ( 2161 )   HTML ( 49 )   PDF (924KB) ( 10479 )   Objective: To explore the relationship between the number and grade of transferred embryos in fresh cycle and the pregnancy outcome in assisted reproductive technology.Methods: The clinical data of 1 261 cases of fresh transfer cycles were analyzed retrospectively. According to the number of transferred embryos after age stratification were grouped. In women of <35 years, the group A is single embryo transfer and the group B double embryos transfer. In women of ≥35 years, the group a is single embryo transfer the group b double embryos transfer, and the group c three embryos transfer. In each group, patients were further divided into subgroups according to the number of grade Ⅰ embryos transferred. The group A was divided into the group A0 and the group A1 (the number of gradeⅠembryos transferred was 0 and 1). Similarly, the group B was divided into group B0, B1 and B2. With the same grouping method, patients aged ≥35 years were divided into subgroups (the group a as group a0 and a1; the group b as group b0, b1 and b2; the group c as group c0, c1 and c2). The differences of pregnancy outcome were compared.Results: ①In patients <35 years, the clinical pregnancy rate and implantation rate of group A1 were significantly higher than those of group A0 (both P<0.05). The implantation rate, clinical pregnancy rate, multiple pregnancy rate and live birth rate of group B2 were significantly higher than those of group B0 and B1 (all P<0.05). Meanwhile, the clinical pregnancy rate of group B0 was higher than that of group A0, the implantation rate of group A1 was higher than that of group B1, and the multiple pregnancy rate of group A1 was lower than that of group B1 (all P<0.05). There was no significant difference in other indexes among the groups (all P>0.05). ②In patients aged ≥35 years, the implantation rate, clinical pregnancy rate and live rate of group a1 were significantly higher than those of group a0 (all P<0.05). The clinical pregnancy rate and live birth rate of group b1 and b2 were higher than those of group b0, the implantation rate of group b2 was higher than that of group b0 (all P<0.05). The implantation rate and clinical pregnancy rate of group c2 were significantly higher than those of group c0 and c1. However, the multiple pregnancy rate and live birth rate of group c2 were higher than those in group c0 (P<0.05). Meanwhile, the multiple pregnancy rate of group c2 was significantly higher than that of group b2 (P<0.05). There was no significant difference in other indexes between the groups (P>0.05).Conclusions: In the fresh embryo transfer cycles, the individualized embryo transfer program should be implemented according to the number and grade of embryos. It is suggested that no more than 2 embryos and no more than 1 embryo of grade Ⅰ should be transferred in patients of any age. The single embryo transfer can not only ensure the clinical pregnancy rate, but also effectively reduce the multiple pregnancy rate for the patients with conditions. Figures and Tables | References | Related Articles | Metrics

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Meta-Analysis of Melatonin Supplementation during Controlled Ovarian Hyperstimulation for Women Undergoing Assisted Reproductive Technology ZHOU Li-yuan, WEN Yi, TANG Jun, KANG Ge-hua, MAO Zeng-hui 2021, 40 (1):  11-17.  doi: 10.12280/gjszjk.20200396 Abstract ( 3388 )   HTML ( 34 )   PDF (1607KB) ( 10930 )   Objective: To evaluate the effectiveness of melatonin supplementation during controlled ovarian hyperstimulation for women undergoing assisted reproductive technology.Methods: We searched PubMed, Embase, the Cochrane Library, the CNKI Database, VIP Database, Wanfang Database and the Chinese Biomedicine (CBM) Database for eligible studies published by the end of January 2020. Two independent evaluators screened the randomized controlled trials retrieved the effects of melatonin supplementation during controlled ovarian hyperstimulation in women undergoing assisted reproductive technology. The quality of the included studies was assessed, and the data were extracted for meta-analysis using RevMan 5.3.Results: A total of 6 RCTs involving 767 cycles were included. Among them, 419 cycles were in the melatonin group and 348 cycles in the control group. The meta-analysis showed that the numbers of MⅡ oocytes, high-quality embryos and the E2 levels on hCG day in the melatonin group was significantly higher than those in the control group (P<0.05). The melatonin supplementation during controlled ovarian hyperstimulation moderately elevated the clinical pregnancy rate, but the difference was not significant (WMD=1.34, P=0.08, 95%CI: 0.96-1.86). However, there were no significant differences in the number of oocytes retrieved and embryos transplanted, fertilization rate and abortion rate between the two groups (P>0.05).Conclusions: The currently available evidence suggests that melatonin supplementation during controlled ovarian hyperstimulation for women undergoing assisted reproductive technology can improve the numbers of MⅡ oocytes and high-quality embryos, and clinical pregnancy rate. Larger sample size and multicenter RCTs are needed to verify the above conclusions. Figures and Tables | References | Related Articles | Metrics

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Effect of Intrauterine Perfusion of Granulocyte Colony-Stimulating Factor on Treatment of Thin Endometrium During Frozen-Thawed Embryo Transfer Cycles ZHANG Li, GE Li-na, LIANG Jun-xia, ZHANG Yu, LIU Xiao-qun, YAN Meng, HAN Sheng-hua 2021, 40 (1):  18-22.  doi: 10.12280/gjszjk.20200359 Abstract ( 2739 )   HTML ( 31 )   PDF (915KB) ( 10512 )   Objective: To retrospectively analyze the effect of intrauterine perfusion of granulocyte colony-stimulating factor (G-CSF) on the outcome of frozen-thawed embryo transfer (FET) in patients with thin endometrium.Methods: From January 2018 to February 2020, patients with thin endometrium who were scheduled to undergo FET treatment in Hebei Research Institute for Family Planning and Hebei Reproductive Hospital were selected. 64 patients who met the inclusion criteria were treated with intrauterine perfusion of G-CSF. Endometrial thickness, morphology, endometrial blood flow, uterine artery blood flow parameters, and cancellation rate, clinical pregnancy rate and implantation rate in the post-/pre-perfusion cycle and the last cycle were compared with those in the previous hormone replacement therapy (HRT) cycle.Results: There was no difference in the endometrial thickness after intrauterine infusion of G-CSF between the before perfusion and the last cycles (P<0.05). The differences in the uterine PI value, RI value and S/D ratio after intrauterine infusion of G-CSF were not significant between the before perfusion and the last cycles (all P>0.05). The proportion of type A morphological endometrium after intrauterine perfusion was 25.0% (16/64), lower than that in the before perfusion [35.90% (23/64)] and the last cycles [34.4% (22/64)], although the difference was not statistically significant (P>0.05). The proportion of endometrium with type Ⅱ blood flow after intrauterine perfusion [75.00% (48/64)] was higher than that in the before perfusion [26.56% (17/64)] and the last cycles [18.75% (12/64)], and the difference was statistically significant (P<0.05). The abolition rate of perfusion cycle was lower than that of the last cycle (20.3% vs. 37.5%), and the clinical pregnancy rate (60.8% vs. 40.0%) and implantation rate (38.5% vs. 24.4%) were increased (both P<0.05).Conclusions: Intrauterine infusion of G-CSF can improve the endometrial thickness of patients with thin endometrium, reduce the cycle cancellation rate, and improve the pregnancy rate and implantation rate. Figures and Tables | References | Related Articles | Metrics

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Analysis of Factors Affecting the Clinical Outcomes after Hysteroscopy and Endometrial Biopsy in Patients with Repeated Implantation Failure ZHANG Yi-wen, LI Rong 2021, 40 (1):  23-28.  doi: 10.12280/gjszjk.20200367 Abstract ( 2593 )   HTML ( 89 )   PDF (975KB) ( 10579 )   Objective: To investigate the factors affecting the clinical outcomes of patients with repeated implantation failure (RIF) following hysteroscopy and endometrial biopsy, and to provide references for improving the clinical pregnancy rate of RIF patients.Methods: From September 2015 to September 2017, a total of 136 patients undergoing hysteroscopy and endometrial biopsy in our hospital were eligible for this study. All patients were diagnosed with RIF. Patients were divided into two groups (pregnancy group and non-pregnancy group) according to the presence of clinical pregnancy after the first embryo transplantation. Data of age, height, weight, infertility years, infertility types, hysteroscopy period (endometrial proliferation/secretion), transplant failure times, endometrial thickness, transfer cycle, time between transplantation and hysteroscopy, embryo type and number of embryos were collected by respectively reviewing patients′ medical records. Univariate analysis and multivariate logistic analysis were used to explore the influencing factors of clinical pregnancy following hysteroscopy and endometrial biopsy.Results: The incidence of clinical pregnancy following hysteroscopy and endometrial biopsy was 51.5% (70 of 136 cases). Univariate analysis showed the statistical differences in age and the type of embryo between the two groups (P<0.05). Multivariate Logistic regression analysis confirmed that the age (OR=1.160, 95%CI: 1.041-1.292) and type of embryo transplanted (OR=0.307, 95%CI: 0.108-0.873) were the influencing factors for the second pregnancy of patients with RIF after hysteroscopy.Conclusions: It is relatively easy for younger patients and those patients accepting blastocyst transplantation to obtain clinical pregnancy following the hysteroscopy and endometrial biopsy. The treatment timing of hysteroscopy and endometrial biopsy in the menstrual cycle is not a factor affecting the clinical pregnancy after the first postoperative embryo transfer. Figures and Tables | References | Related Articles | Metrics

Case Report

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A Case of Successful Pregnancy and Delivery after ICSI Derived from Zona-Free Oocyte ZHANG Hui, LU Jing, JING Li, CHAI Liang-ting 2021, 40 (1):  29-31.  doi: 10.12280/gjszjk.20200181 Abstract ( 2339 )   HTML ( 31 )   PDF (4197KB) ( 10604 )   Zona-free oocytes (ZFO) are frequently encountered in in-vitro fertilization (IVF) laboratories. The majority of these ZFO are due to the damage during manipulation, rather than abnormal zona production. We reported data case of a single live birth healthy baby after blastocyst transplantation following ICSI insemination of a naked egg after zona pellucida shedding. The biological function of zona pellucida and the clinical value of ZFOs were reviewed and discussed. We suggest that those mature and morphologically normal ZFO may be rescued, fertilized with ICSI and then cultured to the blastocyst stage for subsequent transfer or cryopreservation, so as to provide valuable embryo sources for infertile patients, especially for those patients with limited oocytes. Figures and Tables | References | Related Articles | Metrics

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Treatment of Primary Vaginal Adenocarcinoma by the Laparoscopic Surgery Combined with Vaginoplasty: a Case Report CHEN Yu-ying, LIU Zi-wei, LAN Xiao-hui, CUI Man-hua, JIA Yan 2021, 40 (1):  32-34.  doi: 10.12280/gjszjk.20200350 Abstract ( 2674 )   HTML ( 88 )   PDF (802KB) ( 10606 )   Most of vaginal cancer is transferred from other primary site, while primary vaginal cancer is rare in clinical practice. Primary vaginal cancer is often found in postmenopausal women. At present, the treatment standard of vaginal cancer has not been unified, and the individualized treatment is mainly based on the location of the lesion, tumor stage and pathological type. The radiotherapy is the main treatment. However, the radiotherapy has many long-term complications, such as vaginal sclerosis and stenosis, which seriously affect the quality of life of young patients. Due to the persistence of high-risk HPV infection, the incidence of primary vaginal cancer has increased in young women. We reported a case of young patients with primary vaginal adenocarcinoma who underwent radical surgery, vaginoplasty and postoperative adjuvant chemotherapy for 6 courses. Now, the treatment has been completed for 12 months, and there is no recurrence trace. The relevant literature was reviewed, so as to discuss the clinical diagnosis and treatment of young patients with vaginal cancer. References | Related Articles | Metrics

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A Case of Fetal Cerebral Tumor Diagnosed by MRI and Family Genetic Analysis LI Shan-shan, CHEN Xu, ZHANG Lei, YU Hong, ZHAO Xiao-min, SHEN Yong-mei, LI Wen, CHANG Ying 2021, 40 (1):  35-37.  doi: 10.12280/gjszjk.20200557 Abstract ( 3276 )   HTML ( 61 )   PDF (1646KB) ( 10633 )   We report a case of fetal cerebral tumor and family genetic analysis. In this case, the dimensional ultrasound showed the mixed intracranial echoes in the 24 weeks fetus. On the basis of that, the intracranial space-occupying lesion was considered. Ultrasound re-examination confirmed this consideration. The head magnetic resonance imaging (MRI) at 25 weeks of gestation age showed that the tumor were in the front of the fetal brainstem, and that the adjacent tissues were compressed and displaced. The second fetal MRI scan was done at 29 weeks of gestation age. This MRI showed that the tumor volume had increased. At 30+1 weeks, the mother of the fetus decided to have the option of labor induction. The postoperative pathological diagnosis was consistent with the MRI diagnosis. Whole exome sequencing did not find the pathogenic gene variation, but showed three gene variants with unclear significance. However, there was an interesting phenomenon. The ERBB2 gene variant c.3139C>T p.P1047Ss that originated from the father, was also detected in a cousin girl of the fetus in this family. Therfore, we considered that gliomas with ERBB2 gene mutation may be a family cluster. Figures and Tables | References | Related Articles | Metrics

Review

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Leptin and Male Reproduction JIN Ming-hao, HUANG Wen-yi, ZHANG Meng-yi, ZHANG Yi-wei, LIU Yue, DING Zhi-de 2021, 40 (1):  38-43.  doi: 10.12280/gjszjk.20200499 Abstract ( 2537 )   HTML ( 30 )   PDF (1013KB) ( 10541 )   The downward trend in male fertility has become increasingly obvious in the world. To clarify the etiology and pathogenesis of this trend is very helpful for the precision treatment of male infertility. Leptin, a hormone produced mainly by adipose tissue, plays an important role in regulating energy metabolism, responding to inflammation, promoting the development of reproductive system and maintaining reproductive function. Leptin and its receptor can widely express in mammals′ HPG axis, testicular tissue, genital tract, accessory glands and sperm. The abnormal expression of leptin is related to the delayed development or dysfunction of the male reproductive system. To verify the leptin expression in male reproductive system and to elucidate its molecular mechanism may provide critical theoretical evidences for the clinical treatment of reproductive diseases such as male infertility. References | Related Articles | Metrics

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Research Progress of Mesenchymal-Epithelial Transition in Female Reproductive System WANG Bin, GAO Ming-xia, SHEN Hao-fei, WANG Yi-qing, ZHANG Xue-hong 2021, 40 (1):  44-48.  doi: 10.12280/gjszjk.20200339 Abstract ( 2891 )   HTML ( 35 )   PDF (849KB) ( 10680 )   Mesenchymal epithelial transition (MET) is a biological characteristic of the transformation between mesenchymal cells and epithelial cells. It is the basis of many biological processes in the human body. It also plays a key role in the formation and development of the female reproductive system. MET begins at the early stage of embryo development, which is involved in the formation of multiple organs and tissues. In addition, MET not only helps the physiological regeneration of endometrial epithelial cells and the decidualization to regulate the adhesion and implantation of embryos, but also plays an important role in the pathological process of reproductive diseases such as endometriosis and tumors. This article reviews the research progress related to MET in order to provide ideas and directions for the research on the structure and function of female reproductive system and the prevention and treatment of reproduction-related diseases. References | Related Articles | Metrics

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Application of High-Throughput Transcriptome Sequencing in Evaluation of Endometrial Receptivity BAI Ta-ji, HE Jin-ying, MA Yu-zhen 2021, 40 (1):  49-52.  doi: 10.12280/gjszjk.20200190 Abstract ( 2090 )   HTML ( 89 )   PDF (905KB) ( 10588 )   The good endometrial receptivity is a key factor for embryo implantation. The gene expression profile of endometrial tissue cells in the receptive period is closely related to the endometrial receptivity. High-throughput transcriptome sequencing technology can obtain gene expression profiles of the endometrium at different periods of menstruation, as well as microRNA (miRNA) and long non-coding RNA (lncRNA) sequences that regulate gene expression. Combined with bioinformatics analysis, these profiles are very helpful for us to understand the expression of specific genes in the endometrium during the receptivity period, and provide technical support for the mechanism study. This high-throughput method may be used for the diagnosis and treatment of patients with infertility and repeated implantation failure. This review summarized the research progress of high-throughput transcriptome sequencing in the evaluation of endometrial receptivity and embryo implantation. References | Related Articles | Metrics

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New Progress in Drug Pretreatment in Patients with Premature Ovarian Insufficiency SHUAI Ling, DIAO Rui-ying, WU Sha, ZHONG Mei, WANG Li-ping 2021, 40 (1):  53-59.  doi: 10.12280/gjszjk.20200315 Abstract ( 2243 )   HTML ( 33 )   PDF (1122KB) ( 11057 )   Premature ovarian insufficiency (POI) is a heterogeneous disease that seriously affects the physical and mental health of women during childbearing period. However, the pathogenesis of POI is still unknown. For patients with POI, there is no effective means to prevent and/or restore their normal ovarian reserve. For those POI patients with fertility needs, the timely assisted reproductive treatment can improve their pregnancy rate and live birth rate. Individual fertility assessment of POI patients before assisted reproductive therapy, using a variety of pretreatment regimens, can effectively improve the poor ovarian response (POR), increase the success rate of assisted reproduction and improve pregnancy outcome. This article reviewed the progress in the pretreatment with assisted reproductive drugs in POI patients, including hormonal drugs, antioxidant stress agents, immunomodulators, anticoagulants and metabolic regulators, in order to provide reference for the selection of individual treatment protocols. It is true that the pretreatment with assisted reproductive drugs in patients with POI is very important for improving the pregnancy outcome. Figures and Tables | References | Related Articles | Metrics

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The Application Progress of Steroid Hormone Pretreatment in Assisted Reproductive Technology GUO Jing, LI Yuan 2021, 40 (1):  60-63.  doi: 10.12280/gjszjk.20200159 Abstract ( 2251 )   HTML ( 50 )   PDF (852KB) ( 10527 )   Adequate availability and FSH sensitivity of ovarian antral follicles, and coordination of their growth during controlled ovarian stimulation (COS), are two important factors that play a decisive role in pregnancy outcome. Growing evidence indicates that steroid hormone pretreatments may positively improve both factors by inhibiting or weakening the early rise of FSH at luteal phase. However, there is a lack of consensus on whether the conventional pretreatment with combined oral contraceptive pills (COCP), estrogen or progestin alone before COS will increase the IVF pregnancy rate and live birth rate. This article summarizes the clinical research progress of related topics in recent years, including the application of COCP, estrogen and progesterone pretreatment in different types of patients and different ovarian stimulation protocols, and the impact of hormonal pretreatment on the outcomes of assisted reproduction technology. References | Related Articles | Metrics

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FMR1 Gene Mutations and Female Fertility and Pregnancy Outcome WANG Mei-yun, ZHOU Jian-zheng 2021, 40 (1):  64-68.  doi: 10.12280/gjszjk.20200251 Abstract ( 2790 )   HTML ( 23 )   PDF (994KB) ( 10566 )   In recent years, there are more and more diseases of low fertility and repeated fertility failure, such as primary ovarian insufficiency (POI), unexplained early spontaneous abortion, recurrent abortion, embryo termination and so on. Fragile X mental retardation 1 (FMR1) gene is involved in the gene regulation of embryonic development. The mutations of FMR1 gene can cause a variety of female reproductive health diseases. The mutations of FMR1 gene are also related to menopausal age. Therefore, the screening of FMR1 gene has important clinical value in the diagnosis and treatment of female reproductive diseases, and also provides new ideas for the early prevention, diagnosis and treatment of the disease. References | Related Articles | Metrics

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Research Progress of Epigenetics in Recurrent Spontaneous Abortion ZHU Jing-xi, LI Hong 2021, 40 (1):  69-73.  doi: 10.12280/gjszjk.20200493 Abstract ( 2198 )   HTML ( 29 )   PDF (884KB) ( 10594 )   Recurrent spontaneous abortion (RSA) is a kind of common pathological pregnancy. The pathogenesis of RSA is complex, involving in many factors such as heredity, endocrine, immune system, abnormal reproductive structure, environment, and so on. Although the incidence of RSA is about 2%-5%, the etiology and pathogenesis of about 50% cases remain unclear. A growing number of studies have shown that epigenetics plays a subtle role in the occurrence and development of RSA through activating or inhibiting the expression of key genes that determine cell differentiation, proliferation and apoptosis. These genes are expected to become potential biomarkers for the diagnosis of RSA, but also new targets for the treatment of RSA. From the perspective of epigenetics, we review the research progress of DNA methylation, histone modification and noncoding RNA regulation in RSA, so as to provide a new perspective for the diagnosis and treatment of RSA. References | Related Articles | Metrics

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Research Progress of Apelin in Polycystic Ovary Syndrome YAN Qi, ZHANG Hui-xia, ZHANG Hui-ying 2021, 40 (1):  74-78.  doi: 10.12280/gjszjk.20200309 Abstract ( 2036 )   HTML ( 27 )   PDF (873KB) ( 10518 )   Polycystic ovary syndrome (PCOS) is the most common female endocrine disease, which is characterized by chronic anovulation and hyperandrogenemia, with complex etiology and highly heterogeneous clinical manifestations. PCOS not only affects female reproduction and endocrine system, but also is often accompanied with a variety of metabolic abnormalities, including insulin resistance (IR), hyperinsulinemia, obesity and so on. Apelin, a new member of adipokines family, is a kind of active peptide hormone secreted by adiposity. Apelin is mainly involved in many physiological processes, such as fluid balance, food intake, insulin secretion and energy metabolism. It can reverse IR and enhance insulin sensitivity. In recent years, it has been observed that the elevated level of serum Apelin in PCOS patients, especially in those patients with obesity and IR, may be related to the abnormal proliferation of granulosa cells and the related metabolic disorders. Therefore, Apelin as a novel biological indicator may be involved in the pathogenesis of PCOS and its metabolic disorders, so it is expected to become a potential target for the treatment of PCOS. References | Related Articles | Metrics

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Advances in Neuroendocrine Mechanism of Polycystic Ovary Syndrome QIAN Zi-wei, YAO Qi, ZHOU Ge, REN Qing-ling, HU Rong-kui 2021, 40 (1):  79-83.  doi: 10.12280/gjszjk.20200249 Abstract ( 1813 )   HTML ( 26 )   PDF (886KB) ( 10732 )   Polycystic ovary syndrome (PCOS) is a highly prevalent reproductive endocrine disorder in women. PCOS is characterized by three clinical features of hyperandrogenism, ovulatory dysfunction and the polycystic appearance of the ovaries. Hyperandrogenemia is driven by the increased luteinizing hormone (LH) pulse secretion from the pituitary. Indeed, PCOS women display both the elevated mean level of LH and the elevated frequency of LH pulses. The abnormally high frequency of LH pulses reflects a hyperactive circuit of gonadotropin-releasing hormone (GnRH) neurons, which suggests a neuroendocrine basis to either the etiology or phenotype of PCOS. Several studies in preclinical animal models of PCOS have demonstrated the alterations in GnRH neurons and their upstream afferent neuronal circuits. The PCOS model of excessive androgen or Mulller′s hormone exposure during development confirmed the increased activity of GnRH neurons that is related to the stimulation of Kisspeptinergic and GABAergic neurons to control GnRH neurons. In this paper, we review the pathology of PCOS associated with high frequency GnRH/LH pulses and highlight about the involved neural networks, and then discuss the neuroendocrine origins of PCOS. References | Related Articles | Metrics

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Progress in Diagnosis and Treatment of Heterotopic Pregnancy WU Dan, ZHANG Yao, ZHANG Hui-jie, LI Xin-hui, ZHANG Shu-lan 2021, 40 (1):  84-88.  doi: 10.12280/gjszjk.20200139 Abstract ( 2259 )   HTML ( 25 )   PDF (889KB) ( 10384 )   Heterotopic pregnancy is a kind of pathological pregnancy of the intrauterine pregnancy with simultaneous ectopic pregnancy. The incidence of heterotopic pregnancy is rare in natural condition, about 1/30 000. However, with the application of assisted reproduction, the incidence of complex pregnancy has increased year by year. The intrauterine fetus is precious for those patients with heterotopic pregnancy. How to diagnose and treat the intrauterine fetus accurately is of great significance. However, due to the interference of intrauterine pregnancy, the difficulty of the diagnosis of simultaneous ectopic pregnancy is increased. The misdiagnosis or missed diagnosis of heterotopic pregnancy is common, which seriously threatens the health of mother and child. There is no consensus on the diagnosis and treatment of heterotopic pregnancy. The clinical characteristics, diagnosis and treatment of heterotopic pregnancy, as well as the research progress, were summarized in this review. References | Related Articles | Metrics