Xiaojing Chen

Background: Hepatitis B virus (HBV) infection is highly prevalent among women of reproductive age in China, yet whether maternal HBV carrier status affects the outcomes of assisted reproduction remains unclear. Published studies have yielded conflicting results, most were underpowered or inadequately controlled for confounders, and few have tracked outcomes beyond early pregnancy. This study used propensity score matching to evaluate the impact of maternal HBV infection on laboratory, clinical pregnancy, obstetric, and neonatal outcomes in women undergoing their first fresh IVF/ICSI embryo transfer cycle. Methods: This retrospective study analyzed clinical data of 3,455 cycles involving couples who underwent fresh IVF/ICSI embryo transfer for the first time at the Reproductive Center of Fujian Maternal and Child Health Hospital from January 2018 to December 2020. Patients were divided into the HBV group ( n = 811) and non-HBV group ( n = 2,644). Propensity score matching was used to perform 1:1 nearest-neighbor matching on baseline covariates, yielding 810 pairs with balanced covariates. Results: After propensity score matching, baseline characteristics were well balanced. No significant differences were observed in oocyte maturation rate (52.84% vs. 52.38%), normal fertilization rate (81.73% vs. 82.01%), high-quality embryo rate (57.82% vs. 58.66%), blastocyst formation rate (63.49% vs. 64.45%), implantation rate (30.99% vs. 32.76%), clinical pregnancy rate (44.44% vs. 45.43%), multiple pregnancy rate, miscarriage rate (12.78% vs. 9.24%), stillbirth rate (1.39% vs. 1.09%), ectopic pregnancy rate, or live birth rate (32.59% vs. 32.96%) (all P > 0.05). Rates of gestational hypertension, gestational diabetes, premature rupture of membranes, cesarean delivery, and neonatal outcomes were also comparable. However, the preterm birth rate was higher in the HBV group both before (15.73% vs. 11.10%, P = 0.041) and after matching (15.73% vs. 7.78%, P = 0.004). Conclusions: In this propensity score-matched cohort, maternal HBV infection was not associated with impaired laboratory, clinical pregnancy, or live birth outcomes following IVF/ICSI with fresh embryo transfer. Apart from an increased preterm birth rate, no significant differences were observed in obstetric complications or neonatal outcomes. The association with preterm birth warrants further investigation in prospective studies incorporating detailed virologic data.

Background Poor ovarian response (POR) is associated with decreased clinical pregnancy rates, emphasizing the need for developing clinical prediction models. Such models can improve prognostic accuracy, personalize medical interventions, and ultimately enhance live birth rates among patients with POR. Objective This study aims to develop and validate a prognostic model for predicting clinical pregnancy outcomes in individuals with POR undergoing in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) cycles. Methods A retrospective cohort of 969 patients with POR undergoing fresh embryo transfer cycles at the Reproductive Center of Fujian Maternal and Child Health Center from January 2018 to January 2022 was included. The cohort was randomly divided into model (n = 678) and validation (n = 291) groups in a 7:3 ratio. A single-factor analysis was performed on the model group to identify variables influencing clinical pregnancy. Optimal variables were selected using LASSO regression, and a clinical prediction model was constructed using multivariate logistic regression analysis. The model's calibration and discrimination were assessed using receiver operating characteristic (ROC) and calibration curves, while the clinical utility was evaluated using decision curve analysis. Results Multivariate logistic regression analysis revealed that the age of the women (odds ratio [OR] 0.936, 95% confidence interval [CI] 0.898–0.976, P = 0.002), body mass index (BMI) ≤ 24 (OR 2.748, 95% CI 1.724–4.492, P < 0.001), antral follicle count (AFC) (OR 1.232, 95% CI 1.073–1.416, P = 0.003), anti-Müllerian hormone (AMH) (OR 1.67, 95% CI 1.178–2.376, P = 0.004), number of mature oocytes (OR 1.227, 95% CI 1.075–1.403, P = 0.003), number of embryos transferred (OR 1.692, 95% CI 1.132–2.545, P = 0.011), and transfer of high-quality embryos (OR 3.452, 95% CI 1.548–8.842, P = 0.005) were independent predictors of clinical pregnancy in patients with POR. According to the receiver operating characteristic (ROC) analysis, the prediction model exhibited an area under the curve (AUC) of 0.752 (0.714, 0.789) in the model group and 0.765 (0.708, 0.821) in the validation group. The clinical decision curve demonstrated that the model held maximum clinical utility in both cohorts when the threshold probability of clinical pregnancy ranged from 6–81% to 12–82%, respectively. Conclusion Clinical pregnancy outcomes in patients with POR who underwent IVF/ICSI treatment were influenced by several independent factors, including the age of the women, BMI, AFC, AMH, number of mature oocytes, number of embryos transferred, and transfer of high-quality embryos. A clinical prediction model based on these factors exhibited favorable clinical predictive and applicative value. Therefore, this model can serve as a valuable tool for clinical prognosis, intervention, and facilitating personalized medical treatment.

Objective: This study aims to investigate the effect of diminished ovarian reserve (DOR) on the clinical outcomes and maternal and infant safety of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) procedures in young women aged ≤ 35 years. Methods: A retrospective cohort study was performed to analyze the clinical data of 4,203 infertile women aged ≤ 35 years who underwent fresh embryo transfer (ET) in IVF/ICSI cycles. The data were collected from their initial visits to Fujian Maternity and Child Health Hospital between January 2015 and January 2022. Based on their ovarian reserve, the participants were categorized into two groups: DOR group (n = 1,027) and non-DOR group (n = 3,176). A propensity score matching (PSM) method was employed to ensure a relatively balanced distribution of covariates. The primary outcome assessed in this study was the live birth rate, while the secondary observation indicators included rates of high-quality embryo development, blastocyst formation, clinical pregnancy, and miscarriage, along with perinatal complications, neonatal birth weight, and the incidence of low birth weight (LBW). Results: The DOR group showed notably lowered rates of blastocyst formation (59.8% vs. 64.1%), embryo implantation (29.8% vs.33.3%), clinical pregnancy (47.9% vs. 53.6%), and live birth (40.6% vs. 45.7%) compared to the non-DOR group (all P < 0.05). However, no statistically significant differences were observed in the high-quality embryo rate, miscarriage rate, perinatal complications, neonatal birth weight, or LBW incidence in infants between both groups (all P > 0.05). Conclusion: DOR has been found to reduce both clinical pregnancy and live birth rates in young females undergoing fresh ET in IVF/ICSI cycles. However, this reduction does not increase the risk of perinatal complications or LBW of infants through live birth cycles.

This study aimed to investigate the effects of male hepatitis B virus (HBV) infection on male fertility, embryonic development, and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes. We performed a retrospective cohort study that included 3965 infertile couples who received fresh embryo transfer cycles for the first time at the Fujian Maternity and Child Health Hospital (Fuzhou, China) from January 2018 to January 2021. Infertile couples were categorized based on their HBV infection status into the HBV group (HBV-positive men and HBV-negative women) and the control group (HBV-negative couples). A 1:1 propensity score matching was performed with relatively balanced covariates. Baseline characteristics, semen parameters, laboratory outcomes, clinical outcomes, and obstetric and neonatal outcomes were compared between groups. After propensity score matching, 821 couples were included in each group. Both groups had similar semen parameters and obstetric and neonatal outcomes. The HBV group showed a significantly lower live birth rate than the control group (P < 0.05). The HBV group had a significantly higher abortion rate than the control group (P < 0.05). The rates of high-quality embryos and blastocyst formation were significantly lower in the HBV group than those in the control group (both P < 0.05). In conclusion, in couples who undergo IVF/ICSI, male HBV infection reduces the live birth rate and increases the risk of miscarriage. However, the incidence of low birth weight in women with IVF/ICSI does not increase with male HBV infection.

Purpose: To construct and validate a nomogram model for predicting clinical pregnancy in individuals with endometriosis undergoing fersh embryo transfer (ET). Methods: A retrospective analysis was conducted on 1630 individuals with endometriosis who underwent in vitro fertilization (IVF) with fresh embryo transfer at the Reproductive Medicine Center of Fujian Maternity and Child Health Hospital from January 2018 to January 2022. The research population was sorted into two groups through random sampling, namely, the model group (n = 1141) and the validation group (n = 489), with a ratio of 7:3. Univariate analysis was utilized to determine the influencing factors for clinical pregnancy in the model group. The LASSO algorithm was utilized to select the optimal matching factors, which were then included in a multifactorial forward stepwise logistic regression to determine independent influencing factors and develop a nomogram. The discrimination, accuracy, and clinical efficacy of the prediction model were analyzed utilizing the receiver operating characteristic (ROC) curve, calibration curve, and clinical decision curve. Results: Through multivariate-logistic-regression analysis, these factors were identified as independent influencing factors for the clinical pregnancy in endometriosis patients undergoing fresh embryo transfer: female age (OR = 0.933, 95% CI = 0.902–0.965, P < 0.001), ASRM stage (OR = 0.384, 95% CI = 0.276–0.532, P < 0.001), postoperative to IVF duration (OR = 0.496, 95% CI = 0.356–0.688, P < 0.001), antral follicle count (AFC) (OR = 1.076, 95% CI = 1.013–1.161, P = 0.045), anti-Müllerian hormone (AMH) (OR = 1.202, 95% CI = 1.073–1.35, P = 0.002), Gonadotrophin-releasing hormone (GnRH) agonist protocol (OR = 1.536, 95% CI = 1.109–2.131, P = 0.01), number of oocytes retrieved (OR = 1.154, 95% CI = 1.067–1.249, P < 0.001), number of high-quality cleavage embryos (OR = 1.261, 95% CI = 1.164–1.369, P < 0.001), and number of embryos transferred (OR = 1.957, 95% CI = 1.435–2.679, P < 0.001). A prediction model for estimating the clinical pregnancy probability in individuals with endometriosis was constructed per these identified independent factors. The ROC showed an area under the curve (AUC) of 0.807 (95% CI = 0.782–0.832) in the model group and 0.800 (95% CI = 0.761–0.84) in the validation group. The Hosmer-Lemeshow test demonstrated no statistically significant difference between predicted and actual clinical pregnancy probabilities (P > 0.05). The clinical decision curve demonstrated that both the model and the validation groups achieved maximum net benefit at threshold probability values of 0.08–0.96 and 0.16–0.96, indicating good clinical efficacy within this range of threshold probabilities. Conclusion: Female age, ASRM stage, postoperative to IVF duration, stimulation protocol, AFC, AMH, number of oocytes retrieved, number of high-quality cleavage embryos and number of transferred embryos are independent influencing factors for the clinical pregnancy rate in individuals with endometriosis receiving fresh embryo transfer. The nomogram model based on these factors demonstrates good clinical predictive value and efficacy, providing a basis for clinical prognosis, intervention, and individualized medical treatment planning.