| Part Ⅰ The effect of endometriosis on the outcome of in vitro fertilization-embryo transferObjective1.By analyzing the pregnancy process and outcomes of infertility patients with endometriosis and tubal factors after in vitro fertilization-embryo transfer,to investigate the effect of endometriosis on IVF-ET.2.To analyze the pregnancy process and outcome of infertility patients with endometriosis by adopting long protocol and Ultra-long downregulation protocol,and to explore two options for infertility patients with endometriosis.To provides a basis for the rational application of the two protocols in clinical practice.Methods1.Retrospective analysis of 266 cases of infertility patients who received IVF-ET treatment due to endometriosis in Qilu Hospital of Shandong University from January 2014 to May 2018.The research group was divided into two groups,group Ai:154 infertility patients with long protocol;group A2:112 infertility patients with Ultra-long downregulation protocol;The control group(group B):174 infertility patients due to a simple fallopian tube factor with long protocol.Collect medical records of the subjects,record and analyze the age,infertility years,body mass index,type of infertility,basic serum follicle stimulating hormone,basic antral follicle number,and the ovarian response to gonadotropin,the number of oocytes obtained,fertilization rate,cleavage rate,high quality embryo rate,average number of transplanted embryos,implantation rate,clinical pregnancy rate,and abortion rate.2.Statistical analysis was performed by SPSS 22.0 software.The measurement data were expressed as mean±standard deviation(X±S).The difference between groups were analyzed by independent sample T test.the results of rate was used percentage(%),the comparison of rate using χ2 test,the statistical results P<0.05 is considered to be statistically significant.Result1.There was no significant difference in age between group A1 and group B(31.31±3.71,31.70±3.95,P>0.05).The length of infertility in group A1 was longer than that in group B(3.78±2.60,3.18±2.25,P<0.05).BMI was lower than that of group B(22.13±2.87,23.76±3.21,P<0.05),and the proportion of primary infertility was higher than that of group B(60.50%,32.00%,P<0.05).The difference was statistically significant.significance.2.Compared with group B,the number of antral follicles in group A1 was less(10.96±4.87,15.41±6.32,P<0.05),and the baseline FSH was higher(7.28±2.84,6.60±1.43,P<0.05),the baseline LH value was lower(4.83±2.56,5.82±3.11,P<0.05),and the difference was statistically significant.3.Compared with group B,the total dose of Gn in the group Ai was higher(2088.27±724.18,1780.75±704.54,P<0.05),and the total number of Gn days was longer(9.03±2.48,8.16±2.16,P<0.05),the number of follicles above 1.4cm on HCG day was less(5.49±2.97,7.38±3.64,P<0.05),and the number of oocytes obtained was less(8.12±5.74,11.40±6.70,P<0.05).The differences were statistically significant.4.Compared with group B,group Ai had lower fertilization rate(63.60%vs 74.79%,P<0.05),lower quality embryo rate(65.80%vs 78.37%,P<0.05),and the implantation rate was significantly lower(26.0%vs 41.7%,P<0.05),the clinical pregnancy rate was significantly lower(28.82%vs 48.01%,P<0.05),the difference was statistically significant,and there was no significant difference in cleavage rate and abortion rate(96.34%vs 97.60%,P>0.05),(12.10%vs 11.30%.P>0.05).5.There was no significant difference in age,infertility,body mass index and infertility type between group Ai and group A2.(31.31±3.71,31.04±3.58,P>0.05),(3.78±2.60,3.45±2.23,P>0.05),(22.13±2.87,21.73±3.10,P>0.05),(60.50%vs 60.37%,P>0.05).6.There was no significant difference in the number of antral follicles,basic FSH and basic LH between group Ai and group A2.(10.96±4.87,10.73±4.10,P>0.05),(7.28±2.84,7.23±2.44,P>0.05),(4.83±2.56,4.79±2.53,P>0.05).7.Compared with Ai group,the total dose of Gn in the A2 group was higher than that in the A1 group(2088.27±724.18,2418±779.60,P<0.05),and the total number of Gn days in the A2 group was longer(9.03±2.48,10.60±2.22,P<0.05),there was no significant difference in the number of follicles at 1.4cm above in the day of HCG and the number of oocytes obtained between group Ai and group A2.(5.49±2.97,5.78±2.64,P>0.05),(8.12±5.74,8.64±5.24,P>0.05).8.Compared with A1 group,A2 group had higher implantation rate(26.0%vs 38.90%,P<0.05)and higher pregnancy rate(28.82%vs 41.26%,P<0.05).The difference was statistically significant.Fertilization rate,cleavage rate,high quality embryo rate,average number of transplanted embryos,and abortion rate were not significantly different.(63.60%vs 69.96%,P>0.05),(96.34%vs 96.75%,P>0.05),(65.80%vs 65.47%,P>0.05),(1.46±0.67,1.43±0.56,P>0.05),(12.10%vs 11.96%,P>0.05)Conclusion1.Infertility patients with endometriosis have longer infertility years,lower body mass index,and a higher proportion of primary infertility.2.Endometriosis can lead to decreased ovarian reserve function in infertile patients,reduced responsiveness to Gn during ovulation induction,reduced number of oocytes obtained,and reduced fertilization rate of infertile patients in assisted reproductive technology and High quality embryo rate.3.The implantation rate and clinical pregnancy rate of the Infertility patients with endometriosis were significantly lower than the control group.Endometriosis adversely affected the pregnancy outcome of IVF-ET.4.The ultra-long downregulation protocol will increase the dose and time of Gn in patients with endometriosis to a certain extent,but it can improve the pregnancy success rate of patients with endometriosis,and to some extent improve the pregnancy outcome of patients with endometriosis.Part Ⅱ The expression of ADAM12 in endometriosis with infertilityObjectiveTo investigate the expression of ADAM12 in the eutopic endometrial tissue of patients with endometriosis combined with infertility and dicuss the clinical significance.Methods1.Collecting the eutopic endometrial tissue of patients undergoing hysteroscopy before IVF-ET in the Reproductive Center of Qilu Hospital of Shandong University from January 2018 to August 2018.The study group consisted of 60 infertility patients with endometriosis;the control group consisted of 60 women who were infertile only due to tubal factors.All patients in the study group and the control group were not received any hormone therapy,abortion,and in vitro fertilization treatment within 6 months.All patients had no history of sexual intercourse between the last menstrual period and the sample collection.Exclusion criteria included:history of autoimmune disease,pelvic inflammatory disease,genital tract infection,using intrauterine contraception within 6 months prior to surgery,endometrial hyperplasia or endometrial polyps,adenomyosis and myoma of uterus.The expression of ADAM12 mRNA in eutopic endometrial tissues was analyzed by real-time PCR;The expression of ADAM12 proteins was assessed by immunohistochemistry.2.Analyze the data by using GraphPad Prism 5.0 biological statistical analysis software,The results of qRT-PCR were analyzed by using t test.The correlation of immunohistochemistry results was compared by using χ2 test,P<0.05 was considered statistically significant.Result1.The results of qRT-PCR showed that the level of ADAM 12 mRNA expression in the eutopic endometrium of the study group was significantly higher than that of the control group,and the difference was statistically significant(P<0.05).2.The results of immunohistochemistry showed that the positive expression rate of ADAM 12 protein in 70 specimens was 70%(42/60).The positive expression rate of ADAM12 protein in the 60 control samples was 26.7%(16/60).The expression of ADAM 12 in the study group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).ConclusionADAM 12 is elevated whether in mRNA or protein levels in eutopic endometrial tissues of endometriosis with infertility,and the changes indicate that ADAM12 may have a great significance in the pathogenesis of endometriosis with infertility. |
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