Comparison of the number of oocytes obtained after ovarian stimulation between Chinese and Caucasian women undergoing in vitro fertilization using a standardized stimulation regime

Background In vitro fertilization (IVF) is a well-established method to treat various causes of infertility. Some previous retrospective studies suggested a lower ovarian response in Asian women compared to Caucasian women. However, the ovarian stimulation regimens were not standardized, potentially confounding the findings. The objective of this study is to compare the number of oocytes obtained after ovarian stimulation between Chinese and Caucasian women undergoing IVF using a standardized stimulation regimen. Methods This is a prospective cohort study conducted in two tertiary IVF units in Hong Kong, China and Sydney, Australia from October 2016 to August 2019. A total of 192 women aged 18–42 years with a body weight > 60 kg underwent IVF with a standard ovarian stimulation regimen of 150 micrograms corifollitropin alfa (Elonva®) followed by 200 IU follitropin beta (Puregon®) per day. The number of oocytes retrieved in Chinese women treated in the Hong Kong center was compared to that of Caucasian women treated in the Australian center. Results Serum AMH levels were similar between the two groups. Although women in the Chinese cohort were older and had a higher body mass index (BMI), longer duration of infertility and lower antral follicle count (AFC) than those in the Caucasian cohort in this study, no differences in the number of oocytes retrieved [11 (8–17) vs. 11 (6–17), p=0.29], total dosage and duration of stimulation and number of follicles aspirated were noted between the two ethnic cohorts. The peak estradiol level was greater in Chinese women than in Caucasian women. After controlling for age, BMI and AFC, ethnicity was a significant independent determinant of the number of oocytes obtained. Conclusions Chinese women had a higher number of oocytes after ovarian stimulation using a standardized stimulation regimen compared with Caucasian women undergoing IVF after controlling for age, BMI, AFC and AMH despite presenting later after a longer duration of infertility. Trial registration number: NCT02748278

An ultrasound-guided percutaneous nerve stimulation regimen based on finite element modeling for median nerve rupture

Object: In order to promote the functional recovery of median nerve rupture patients, this paper proposes an ultrasound-guided percutaneous nerve stimulation regimen based on finite element modeling. Method: First, according to anatomy feature, a multi-layer human forearm model is constructed. What’s more, taking current density and activate function as optimization indicators, the percutaneous nerve stimulation regimen is designed with finite element modeling, including electrical needle angel, distance and position. Finally, to test the performance of designed regimen, a total of 22 patients with median nerve rupture participate in the clinical randomized controlled trial. And the clinical treatment effect is evaluated with BMRC, grip strength, functional score of median nerve and DASH scores. Results: The designed percutaneous nerve stimulation regimen is that, parallel to each other, electrical needles are located at both ends of the injury nerve with a distance of 3 cm. Besides, clinical trial results show that, after treatment the difference in sensory function was statistically significant. In terms of motor function, the BMRC of motor and grip strength are improved in both groups after treatment and there are significant differences between groups. Besides the grip strength improvement of experimental group is 4 times higher than that of control group. On global function, the DASH scores are reduced by 29% with experimental group but only 8% with control group; functional score of median nerve improved by 24% in the experimental group and by 22% in the control group, but the difference between groups is statistically significant after treatment. Conclusion: Clinical trial results demonstrate that the designed percutaneous nerve stimulation regimen can significantly improve the sensory, motor and global function of median nerve rupture, which is a potential clinical treatment regimen. Trial registration: ChiCTR, ChiCTR2000030790. Registered14 march 2020, http://www.chictr.org.cn/ChiCTR2000030790

Comparative Effectiveness of Mild or Conventional GnRH-Antagonist Protocols for Ovarian Stimulation in Poor Responders (Poseidon Group 4)

Background and Aims: A panel of experts (the Poseidon Group) introduced a new and more detailed stratification for poor ovarian responders in order to predict the prognosis of IVF outcome according to the sensitivity to FSH. However, various arguments about the management strategy of these patients still remain, including the convenience and the cost. Therefore, this study was conducted to compare the efficacy of mild and conventional GnRH antagonist ovarian stimulation prescribed in patients classified in Poseidon Group 4.Methods: This retrospective cohort study included 359 poor responder patients (Poseidon Group 4) treated with mild or conventional GnRH antagonist stimulation regimens from 8/2017 to 7/2019 at Tam Anh Hospital ART Center. The main outcomes were the index of Follicular Output Rate (FORT) or Follicle to Oocyte Index (FOI), the number of day-2 embryos and top-quality embryos obtained. The t-test and Mann–Whitney U test in SPSS v25.0 was used to analyze the continuous data and Chi-squared/Exact test was used for binary variables. Multiple linear regression analysis was done by using Stata versions 15.0 to measure association between primary endpoints with stimulation regimen controlled for covariates and possible confounding factors.Results: In the overall group of poor responders, the conventional GnRH antagonist protocol performed better than the mild protocol. Subsequently, data were analyzed according to the AFC. In women with AFC < 3, no significant differences were observed between the 2 regimens regarding FORT (p = 0.71), FOI (p = 0.12), the number of day-2-embryos (p = 0.052) and the number of top-quality embryos (p = 0.26). In contrast, in women with AFC ≥ 3, mild stimulation regimen resulted in significantly poorer outcome compared to the conventional GnRH antagonist regimen, regarding FORT (p < 0.01), FOI (p < 0.01), the number of day-2-embryos (p < 0.01) and top-quality embryos (p = 0.01).Conclusions: Considering poor responders classified in Poseidon Group 4, both ovarian stimulation regimens resulted in similar outcome for patients with a very low ovarian reserve (AFC < 3). In contrast, the GnRH conventional antagonist protocol with maximum initial FSH dose (300–375 IU/day) and supplementary LH (75–150 IU/day) was more effective than the mild one for patients whose ovarian reserve was less reduced. The Clinical Trial was approved by the Ethnical Biomedical Research Committee Tam Anh General Hospital.

The Ovarian Sensitivity Index (OSI) Significantly Correlates with Ovarian Reserve Biomarkers, Is More Predictive of Clinical Pregnancy than the Total Number of Oocytes, and Is Consistent in Consecutive IVF Cycles

Background and Objectives: Some biomarkers of ovarian responsiveness to gonadotropins and the total number of retrieved oocytes are known to affect the success rate after controlled ovarian stimulation (COS) and in vitro fertilization (IVF). The aim of this study was to study another putative marker, the Ovarian Sensitivity Index (OSI: (number of retrieved oocytes/total gonadotropin dose) × 1000), assessing whether (a) it correlates with ovarian responsiveness biomarkers, (b) it is an independent predictor of clinical pregnancy, (c) it predicts clinical pregnancy comparably to the number of retrieved oocytes, and (d) it is consistent in the repeated COS cycles of the same woman. Design: retrospective analysis. Setting: public IVF Unit in University Hospital. Cases and Measurements: 1612 patients submitted to 3353 IVF cycles were included, their OSI was calculated and it was correlated with the ovarian responsiveness biomarkers (age, BMI, anti-Mullerian hormone, antral follicle count). The OSI and the total number of oocytes were compared for their value in predicting clinical pregnancy. The inter-cycle consistency of the OSI was estimated in 209 patients who underwent two consecutive cycles in which the ovarian stimulation regimen was changed from the Gonadotropin-releasing Hormone (GnRH)-agonist long protocol to the GnRH-antagonist protocol or vice-versa. Results: The OSI turned out to be significantly related to age and BMI (inversely), the anti-Mullerian hormone (AMH) and the antral follicle count (AFC) (directly), to be an independent predictor of clinical pregnancy, and to correlate with clinical pregnancy better than the total number of oocytes (p < 0.0001 vs. <0.002). In patients who underwent two consecutive COS cycles changing stimulation regimen, the OSI showed 82% consistency. Conclusion(s): The OSI significantly correlates to the currently used biomarkers of ovarian responsiveness; it is an independent predictor of clinical pregnancy; it is more predictive of clinical pregnancy than the total number of oocytes, and is highly consistent in repeated IVF cycles even when the COS protocol changes. These characteristics make the OSI quite suitable to be incorporated into more complex prediction models of IVF outcome.

Medical advantages of controlled ovarian stimulation in poor responders patients with corifolitropin-alpha and antagonists of gonadotropine-rilising-hormon s in ART clinic

The objective: study of the effectiveness of coriophyllotropin alpha in controlled ovarian stimulation regimens with gonadotropin-rilising hormone antagonists in poor responders. Materials and methods. The study of the effectiveness of the controlled ovarian stimulation regimen using long acting FSH in the protocol with GnRH antagonists was compared with the daily administration of recombinant FSH by the number of oocytes received, embryo digestion, pregnancy and implantation. Results. It has been shown that ovarian stimulation with the use of coriophyllotropin alfa is as effective as a daily injection of recombinant FSH for the treatment of patients with a poor response to stimulation. In addition, the perception of patients with protocols with corifolithopropin alfa results in better tolerability than traditional protocols due to fewer injections, which reduces the likelihood of early termination of treatment. Conclusion. The presented results of the study prove the effectiveness of using corifolotropin alpha in combination with additional FSH daly doses and gonadotropin-rilising hormone antagonists. The effectiveness of this regimen is comparable with standard daily FSH injections for poor responders patients. The study regimen simplify the design of the stimulation scheme, minimize the number of injections, and shorten the duration of the cycle. Key words: controlled ovarian stimulation, poor responders, coriophyllotropin alpha.

Clinical functional results of the continuous electromagnetic stimulation in patients with optic nerve partial atrophy

In this article, a treatment analysis is given of 81 patients (98 eyes) with optic nerve pathologic conditions using author-developed method of continuous optic nerve electromagnetic stimulation (neuromodulation), in comparison to traditional in-patient therapy. Authors present an original method of electrode implantation; show a dynamics of visual function changes in groups as a result of treatment: those of visual acuity, of electrophysiology testing results, and of visual fields. It is demonstrated that neuromodulation method allows performing stimulation therapy in out-patients; continuous stimulation regimen use causes an important and longstanding therapeutic effect without any negative impact on surrounding tissues.