15 March 2026, Volume 27 Issue 2
    

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  • Fertility preservation in patients with gynecological malignancies: Life continuation and ethics after clinical treatment#br#
    TIAN LI, WANG Jianliu.
    Chinese Journal of Clinical Obstetrics and Gynecology. 2026, 27(2): 97-98. https://doi.org/10.13390/j.issn.1672-1861.2026.02.001
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  • Retrospective analysis of fertility-preserving treatment with POLE-mutated endometrial carcinoma/atypical hyperplasia
    REN Qian, ZHANG Lijuan, XUE Yu, LU Danhua, WANG Weina, LIU Chunhong, WANG Yifei, FU Yuanyuan, SUN Yuefang, JI Guo, HUANG Qiongyi, ZHENG Jiayi, ZHU Huiting, SHAN Weiwei, CHEN Xiaojun
    Chinese Journal of Clinical Obstetrics and Gynecology. 2026, 27(2): 99-104. https://doi.org/10.13390/j.issn.1672-1861.2026.02.002
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    Objective To explore the efficacy of fertility-preserving therapy (FST) in patients with POLE ultra-mutant (POLEmut) endometrial carcinoma (EC)/endometrial atypical hyperplasia (EAH), and to compare the therapeutic effects between theprogestogen/gonadotropin-releasing hormone agonist (GnRH-a) and immune checkpoint inhibitors (ICIs) regimens. Methods Clinical data of POLEmut EC/EAH patients who received FST were collected retrospectively at Obstetrics and Gynecology Hospital of Fudan University and Shanghai Tenth People's Hospital of Tongji University from April 2019 to November 2025. They were divided into progestogen/GnRH-a group (n=8) and ICIs group (n=5). Therapeutic, follow-up and pregnancy outcomes were compared between groups. Results Among the 13 patients, 7 cases underwent off-indication FST, and 5 cases in the ICIs group were off-indication. There was no significant difference in the complete response (CR) rate between the two groups (P=1.000). The median CR time in the ICIs group (28.2 weeks) was shorter than that in the progestogen/GnRH-a group (35.9 weeks, P=0.450). There were 4 refractory cases, including 3 in the progestogen/GnRH-a group and 1 case in the ICIs group, with no statistical difference (P=1.000). The median total follow-up time and post-CR follow-up time in the ICIs group were significantly shorter than those in the progestogen/GnRH-a group (median 21.1 months vs 44.6 months, 14.0 months vs 33.8 months, both P<0.05). No recurrence was observed in the ICIs group, while 2 cases of recurred were in the progestogen/GnRH-a group (P=0.467). Among the 8 CR patients, 7 achieved successful pregnancy, including 5 cases in the progesterone/GnRH-a group, all of which resulted in successful pregnancies with 4 live births; 2 cases in the ICIs group achieved successful pregnancy, both of which were in the third trimester. Conclusion Both progestogen/GnRH-a and ICIs regimens are effective for FST in POLEmut EC/EAH patients. With all ICIs patients undergoing off-indication FST, the ICIs regimen shows a trend of faster onset, better short-term disease control and favorable pregnancy outcomes, which may be a preferred FST option.
  • Analysis of outcomes and recurrence following assisted reproduction in patients with endometrial carcinoma or atypical hyperplasia after fertility‑sparing treatment
    XIAO Zerui, WANG Yiqin, SONG Ziyi, SONG Jingrong, WANG Jianliu, LU Qun, TIAN Li
    Chinese Journal of Clinical Obstetrics and Gynecology. 2026, 27(2): 105-109. https://doi.org/10.13390/j.issn.1672-1861.2026.02.003
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    Objective To investigate the disease recurrence risk, pregnancy outcomes, and influencing factors in patients with endometrial carcinoma (EC) or atypical endometrial hyperplasia (AEH) undergoing in vitro fertilization and embryo transfer (IVF-ET) after achieving complete response (CR) following fertility-sparing treatment (FST). Methods This multicenter retrospective cohort study included 109 patients with a history of EC or AEH who underwent IVF-ET at the reproductive centers of Peking University People's Hospital and Beijing Chaoyang Hospital from January 2009 to January 2024. Based on recurrence during follow-up, patients were divided into a recurrence group (n=28) and a non-recurrence group (n=81). A Cox regression model was used to analyze independent factors affecting recurrence. Pregnancy outcomes were also analyzed for patients who underwent embryo transfer. Results The proportion of EC patients was significantly higher in the recurrence group than in the non-recurrence group (53.6% vs. 32.1%, P=0.043). Multivariate analysis identified initial pathological type (EC), a longer interval from discontinuation of high-dose progestin to the start of controlled ovarian hyperstimulation (COH), and a higher cumulative estradiol (E2) level during COH cycles as independent risk factors for recurrence (all P<0.05). Among the 98 patients who underwent embryo transfer, the cumulative ongoing pregnancy rate was 55.1% (54/98), and the cumulative live birth rate was 43.9% (43/98). In 203 transfer cycles, the endometrial thickness was significantly greater in the cycles achieving ongoing pregnancy than in those that did not (P=0.012). Conclusions Initial pathological type EC, a prolonged interval to assisted reproduction, and high E2 exposure during COH may be associated with an increased recurrence risk in AEH/EC patients after FST. These patients can achieve certain pregnancy opportunities through assisted reproductive technology (ART), and endometrial thickness may be one of the factors influencing pregnancy outcomes. Clinical practice should involve a comprehensive assessment of recurrence risk and reproductive potential to aid in formulating more individualized fertility treatment strategies.
  • A retrospective clinical study on fertility-preserving treatment in patients with stageⅠ, grade 1 endometrial carcinoma and myometrial invasion
    WANG Na, WANG Yiqin, CHENG Jin, ZHANG Xiaobo, HE Yijiao, WANG Yi, SHEN Danhua, WANG Jianliu.
    Chinese Journal of Clinical Obstetrics and Gynecology. 2026, 27(2): 110-114. https://doi.org/10.13390/j.issn.1672-1861.2026.02.004
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    Objective To analyze the oncological and fertility outcomes of fertility-preserving treatment in stageⅠG1 endometrial cancer patients with and without myometrial invasion (MI). Methods This single-center retrospective study at Peking University People's Hospital included 63 patients from June 2010 to December 2022. Among them, 17 had superficial MI, 4 cases had deep MI, and 42 had no MI. MI depth was assessed by magnetic resonance imaging (MRI), and treatment response was evaluated via hysteroscopy directed biopsy combined with ultrasound and (or) MRI. Primary outcomes were complete response (CR) rate, recurrence rate, and disease-free survival (DFS). Results 59/63 patients (93.65%) achieved CR with a median time of 7 (3~14) months. Recurrence occurred in 13/59 patients (22.03%) within a median of 19 (10~43.5) months. Patients with MI had a larger tumor size (3.6 cm vs 2.6 cm, P=0.003) and a slightly higher rate of adenomyosis (28.57% vs 11.90%, P=0.100). There were no significant differences in treatment response and fertility outcomes (P＞0.05). Both MI depth and tumor size could moderately predicted recurrence. The recurrence rate seemed higher in MI patients (33.33% vs 15.79%, P=0.196). Patients with deep MI had significantly shorter DFS (P=0.036), while those with MI depth below 2.5 mm (P=0.106) and without adenomyosis (P=0.081) tended to have longer DFS. Conclusions While the depth of MI is associated with recurrence rate and DFS, fertility-sparing treatment remains a viable option for carefully selected patients with MI.
  • Clinical analysis of molecular classification-guided fertility-sparing treatment in patients with endometrial carcinoma
    HE Yijiao, LI He, MENG Meng, TANG Xiaoge, LIU Yuanyuan, WANG Jianliu, DONG Yangyang.
    Chinese Journal of Clinical Obstetrics and Gynecology. 2026, 27(2): 115-118. https://doi.org/10.13390/j.issn.1672-1861.2026.02.005
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    Objective To investigate the clinical efficacy of molecular classification-guided fertility-sparing treatment in patients with endometrial carcinoma (EC). Methods Clinical data of 88 EC patients who received fertility-sparing treatment at Peking University People's Hospital from January 2023 to June 2025 were retrospectively analyzed. Among them, 64 cases were of no specific molecular profile (NSMP) type, 10 cases mismatch repair deficient (MMRd) type, 8 cases p53 abnormal (p53abn) type, and 6 cases POLE type. Results ① All 6 patients with POLE-type EC achieved complete remission (CR), with a median CR time of 8.5 months (3 months, 20 months), but 2 cases relapsed. The CR rate of NSMP-type patients was 76.56% (49/64), with a median CR time of 9 months (3 months, 27 months). ② Among the 10 MMRd-type EC patients, 9 achieved CR, and 8 of them achieved CR through progesterone combined with immunotherapy. ③ Among the 8 patients with p53abn type EC who received individualized progesterone therapy±chemotherapy, the median CR time was 8 months (3 months, 22 months), and 1 case relapsed 3 months after treatment. Conclusions Molecular typing can precisely guide the treatment and prognosis of EC patients. The POLE type treatment for preserving fertility has a high rate of CR, but the recurrence rate is also high. The NSMP type patients exhibit significant heterogeneity and have a relatively low CR rate. It is imperative to further stratify NSMP for more precise treatment. Patients with MRRd type can benefit from combined immunotherapy. Although patients with p53abn type have a high risk of progression and recurrence, CR can still be achieved after careful assessment and individualized treatment.
  • Clinical study of niraparib combined with bevacizumab in the treatment of BRCA1/2 wild-type homologous recombination defect-negative advanced ovarian cancer
    LEI Jieyun, LI Jianfang, ZHANG Li, XU Yingying, WANG Yanzhou.
    Chinese Journal of Clinical Obstetrics and Gynecology. 2026, 27(2): 119-123. https://doi.org/10.13390/j.issn.1672-1861.2026.02.006
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    Objective To explore the clinical effect of niraparib combined with bevacizumab in the treatment of BRCA1/2 wild-type homologous recombination defect (HRD)-negative advanced ovarian cancer. Methods A retrospective analysis study design was used. The clinical data of 98 patients with BRCA1/2 wild-type and HRD-negative advanced ovarian cancer admitted to the First Affiliated Hospital of Army Medical University were collected from January 2022 to December 2024. 58 patients who received maintenance treatment with bevacizumab alone were set as control group, and 40 patients who received maintenance treatment with niraparib combined with bevacizumab were set as observation group. The progression-free survival (PFS), toxicity reactions and blood test indexes were analyzed. Results The median progression-free survival of patients in study group was 24 months and that in control group was 20 months, revealing a significant difference between two groups (P=0.002). After treatment, the levels of serum carbohydrate antigen 125 (CA125), human epididymis protein 4 (HE4), B-cell lymphoma-2 (Bcl-2) and Bcl-2 binding anti-apoptotic gene-1 (Bag-1), translocators protein (TSPO) and cell-free mitochondrial DNA (cf-mtDNA) and levels of nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3), interleukin-1β (IL-1β) and cysteine protease 1 (Caspase-1) in peripheral blood mononuclear cells in study group were lower than those in control group (P<0.05). The level of serum Bcl-2 related X protein (Bax) was higher in study group than that in control group (P<0.05). The toxicity reactions in both groups were mainly mild-to-moderate systemic reactions, digestive system toxicity and cardiovascular system toxicity, with no significant differences between groups (P>0.05). Conclusions Niraparib combined with bevacizumab for first-line maintenance treatment of BRCA1/2 wild-type HRD-negative advanced ovarian cancer can prolong the progression-free survival of patients. Its possible mechanism is to exert anti-tumor effects by improving the imbalance of cell apoptosis and relieving inflammatory responses, and its safety is controllable.
  • A comparative study on the clinicopathological differences and molecular characteristics of ovarian endometrioid carcinoma and ovarian clear cell carcinoma based on the fifth edition WHO classification
    WANG Chen, LIU Yan, WANG Yuxiang, YANG Jing, ZHAO Xiaoya, SONG Zixiu, LIU Congrong.
    Chinese Journal of Clinical Obstetrics and Gynecology. 2026, 27(2): 129-133. https://doi.org/10.13390/j.issn.1672-1861.2026.02.008
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    Objective Based on the 2020 WHO classification of female genital tumors, this study aims to systematically compare the differences in clinicopathological and molecular characteristics between ovarian endometrioid carcinoma (OEC) and ovarian clear cell carcinoma (OCCC). Methods Clinicopathological data from 268 OEC cases and 120 OCCC cases were collected. Molecular subtyping data were obtained for 124 OEC and 41 OCCC cases. Targeted sequencing was performed on 91 OEC and 19 OCCC cases. Results ① Compared to OCCC patients, OEC patients were younger, had smaller tumors, and a higher rate of bilateral ovarian involvement. They underwent comprehensive staging surgery and chemotherapy at lower rates, and exhibited higher positive immunohistochemical expression rates of ER, PR, and WT1 (all P<0.001). ② The prognosis of OEC was significantly better than that of OCCC patients. Histological grade showed a significant negative correlation with progression free survival (PFS) of OEC patients (HR=3.9, P=0.032). ③ The WHO molecular classification had prognostic stratification significance for overall survival (OS) in OEC patients (P=0.041). ④ High-frequency mutations in OEC were concentrated in the RAF-MEK-ERK, PI3K-AKT-mTOR, and Wnt/β-catenin signaling pathways, whereas OCCC mutations were mainly found in the PI3K-AKT-mTOR and chromatin remodeling signaling pathways. Conclusions OEC and OCCC exhibit significant differences in clinicopathological characteristics and core molecular pathways. OCCC, grade 3 OEC, and the p53abn subtype of OEC should all be considered high-risk subtypes, and it is recommended that they receive heightened attention and intensified intervention in clinical management.
  • Clinical characteristics and prognostic analysis of patients with lung metastases from malignant tumors of the uterine
    ZHANG Yang, LI Shuangshuang, LI He, ZHANG Hui, WANG Yue, YANG Feng, LI Xiaoping
    Chinese Journal of Clinical Obstetrics and Gynecology. 2026, 27(2): 134-137. https://doi.org/10.13390/j.issn.1672-1861.2026.02.009
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    Objective To investigate the clinical characteristics, diagnostic and therapeutic approaches, and prognostic factors in patients with pulmonary metastases from Uterine malignant tumor. Methods A retrospective analysis was conducted of 35 patients with pulmonary metastases from Uterine malignant tumor admitted to Peking University People's Hospital between January 2010 and January 2024. Clinical features, diagnostic and therapeutic processes, follow-up, and prognostic factors were reviewed. Results The mean age of the 35 patients was (56.5±10.1) years, including 28 cases of endometrial carcinoma, 6 cases of uterine leiomyosarcoma, and 1 case of endometrial stromal sarcoma. Comparisons between the pulmonary metastasectomy group (11 cases) and the non-surgical group (24 cases) showed statistically significant differences in the number of pulmonary metastases (≤3 cm and >3 cm), presence of extrapulmonary metastases, and disease-free interval (P<0.05). Follow-up ranged from 5 to 107 months. The median post-lung-metastases overall survival (PLM-OS) was 32.4 months in the surgical group versus 28.5 months in the non-surgical group (P=0.812); the median post-lung-metastases progression-free survival (PLM-PFS) was 16.5 months and 14.1 months, respectively (P=0.740). Univariate Cox regression analysis identified histologic type as a prognostic factor for PLM-PFS (P=0.025); patients with endometrial carcinoma pulmonary metastases had better PLM-PFS than those with endometrial stromal sarcoma/leiomyosarcoma (HR=4.716, 95% CI: 0.151-0.941, P=0.037). Conclusions Prognosis of uterine malignancy patients with pulmonary metastases is associated with the primary tumor histologic type. For patients with ≤3 pulmonary metastases, no extrapulmonary disease, and a recurrence-free interval greater than 12 months, pulmonary metastasectomy may be considered under strict surgical indications, but larger studies are warranted.
  • The burden and prediction of polycystic ovary syndrome in Asia from 1990 to 2021
    WU Chan, LI Huiling, ZHOU Ling, YANG Sihui, LI Rong, ZHOU Huaijun
    Chinese Journal of Clinical Obstetrics and Gynecology. 2026, 27(2): 138-142. https://doi.org/10.13390/j.issn.1672-1861.2026.02.010
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    Objective To comprehensively assess the burden of polycystic ovary syndrome (PCOS) in Asia. Methods Data from the Global Burden of Disease (GBD) database were used to evaluate trends in PCOS incidence, prevalence, and years lived with disability (YLDs) in Asia from 1990 to 2021. Health inequality analyses were conducted to examine differences in PCOS burden across socioeconomic settings and the association between the sociodemographic index (SDI) and PCOS burden. The future burden of PCOS in the Asian region was predicted using the Bayesian age-period-cohort (BAPC) model for the next 15 years. Results The disease burden of PCOS in Asia increased significantly from 1990 to 2021 (P<0.05). The estimated annual percentage change (EAPC) of the age-standardized incidence rate (ASIR) was 1.42 (95% CI: 1.38~1.46), and the EAPC of the age-standardized prevalence was 1.44 (95% CI: 1.39~1.48). Incidence and prevalence showed sustained upward trends in multiple countries, particularly in China and India. In 2021, the highest incidence was observed in the 15~19-year age group (357.54 per 100 000), and the highest prevalence occurred among women aged 30~34 years (3 537.21 per 100 000). Socioeconomic development was closely associated with PCOS burden (P<0.001). Countries with high SDI had a higher incidence burden (ASIR: 144.89 per 100 000), whereas countries with middle SDI experienced a faster increase in incidence burden (ASIR EAPC: 1.58; 95% CI: 1.54~1.62). In addition, from 1990 to 2021, absolute inequality in PCOS prevalence increased in Asia [slope index of inequality (SII) from 1 037.18 to 1 918.42 per 100 000], while relative inequality decreased (concentration index from 0.29 decreased 0.12). BAPC projections indicated that the PCOS burden in Asia will continue to increase over the next 15 years. Conclusions The burden of PCOS in Asia has continued to rise, with particularly pronounced impacts among adolescents and young-to-middle-aged women. Prevention and control strategies should be tailored to different socioeconomic contexts and age groups.
  • Clinical characteristics of 522 patients with polycystic ovary syndrome based on cluster analysis
    WEI Shiyao, PENG Shuyi, AN Xiaofei.
    Chinese Journal of Clinical Obstetrics and Gynecology. 2026, 27(2): 143-146. https://doi.org/10.13390/j.issn.1672-1861.2026.02.011
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     To identify clinical subtype characteristics of polycystic ovary syndrome (PCOS) via cluster analysis, and provide novel evidence for individualized diagnosis and treatment. Methods This retrospective study enrolled 522 reproductive-aged (20-45 years old) PCOS patients from the Endocrinology Clinic of the Affiliated Hospital of Nanjing University of Chinese Medicine from March 2022 to September 2025, collecting their clinical characteristics, sex hormone levels and metabolic indicators. Patients were divided by oligomenorrhea severity and blood sampling time into mild (menstrual cycle 36-90 d, n=229) and severe oligomenorrhea groups (91-180 d, n=293). K-means cluster analysis was performed for body mass index, homeostasis model assessment of insulin resistance, free androgen index and luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio. Intergroup differences in clinical indicators were analyzed. Results Four distinct subtypes were identified in two groups. In the mild group: Subtype A (21.8%, 50/229) featured oligomenorrhea and polycystic ovarian morphology without obesity, insulin resistance (IR) or hyperandrogenemia (HA); Subtype B (29.7%, 68/229) had LH/FSH≥2 (mild HA optional) without obesity or IR; Subtypes C (27.5%, 63/229) and D (21.0%, 48/229) both had obesity, IR and HA, but the LH/FSH ratio of Subtype C approached 1, and Subtype D LH/FSH≥2. The core clinical features of each subtype in the severe oligomenorrhea group were basically consistent with those in the mild oligomenorrhea group. Conclusions PCOS patients can be classified into four distinct subtypes. This novel classification guides investigations into PCOS pathophysiological mechanisms and promotes individualized clinical treatment.
  • The effect of increasing exogenous gonadotropins doses on IVF-ET outcomes in poor ovarian response patients of POSEIDON group 3 and 4
    XU Xiaoyan, WU Zhijuan, WANG Xiaoxuan.
    Chinese Journal of Clinical Obstetrics and Gynecology. 2026, 27(2): 147-150. https://doi.org/10.13390/j.issn.1672-1861.2026.02.012
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    Objective To investigate the impact of increasing the dose of exogenous gonadotropins (Gn) on the outcomes of in vitro fertilization-embryo transfer (IVF-ET) in patients with poor ovarian response (POR) in POSEIDON group 3 and 4. Methods A retrospective analysis was conducted on the data of POR patients who met the diagnostic criteria for the POSEIDON 3 and 4 groups from January 2016 to December 2023, including a total of 1089 IVF cycles. Patients were divided into two groups based on the total Gn dosage, the Gn<3 000 IU group (635 cycles) and the Gn≥3 000 IU group (454 cycles). The number of oocytes retrieved per cycle and cumulative live birth rate were observed. Multivariate logistic regression analysis was performed to control for confounding factors. Results The number of oocytes retrieved in the Gn<3 000 IU group [(2.25±1.54)] was not statistically significantly different from that in the Gn ≥3 000 IU group [(2.26±1.54)] (P=0.955). The cumulative live birth rate was statistically significantly higher in the Gn≥3 000 IU group (10.7% vs. 16.8%, P=0.022). Logistic regression analysis showed that the odds ratio (OR) between cumulative live birth rate and different group was 1.61, and the difference was not statistically significant (P>0.05). Conclusions For POR patients in the 3 and 4 subgroup of POSEIDON criteria, increasing exogenous Gn dosage did not increase the number of retrieved oocytes and the cumulative live birth rate.
  • Analysis of risk factors and clinical pathological characteristics of postmenopausal uterine bleeding
    LI Donghan, ZHOU Meinan, FU Yanxia, HUANG Liuxuan, CHENG Liqin, ZENG Liqin.
    Chinese Journal of Clinical Obstetrics and Gynecology. 2026, 27(2): 151-153. https://doi.org/10.13390/j.issn.1672-1861.2026.02.013
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    Objective To explore the related risk factors and clinical pathological characteristics of postmenopausal uterine bleeding. Methods A retrospective study was conducted on 219 postmenopausal patients admitted to the Eighth Affiliated Hospital of Sun Yat-sen University from May 2023 to May 2025. Postmenopausal patients with uterine bleeding were selected as the study group (52.5%, 115/219), and the control group (47.5%, 104/219) based on whether they had postmenopausal uterine bleeding. Univariate and multivariate logistic regression analyses were used to investigate the risk factors for postmenopausal uterine bleeding, and the pathological characteristics of the endometrium in two groups were analyzed. Results The number of pregnancies and deliveries in the study group was significantly higher than that in the control group (P<0.05). There were no statistically significant differences in age, BMI, and time of menopause between the two groups (P>0.05). The proportion of patients with uterine fibroids in the study group (17.4%, 20/115) was significantly higher than that in the control group (6.7%, 7/104, P<0.05). Multivariate regression analysis showed a significant positive correlation between BMI and the risk of postmenopausal bleeding (adjusted OR=1.10, 95% CI: 1.00-1.20, P<0.05), indicating that for every 
    1 kg/m2 increase in BMI, the risk of bleeding increases by 10%. Patients with uterine fibroids had a significantly higher risk of postmenopausal bleeding than those without (P<0.05). Endometrial polyps and atrophic endometrium were the most common pathological changes in postmenopausal patients. Conclusions Postmenopausal endometrial lesions are primarily benign. BMI can serve as an independent risk factor for postmenopausal bleeding, possessing great predictive value.
  • Study on the application of time-lapse imaging monitoring of second polar body extrusion combined with early rescue oocyte activation in preventing ICSI fertilization failure
    WANG Gongfa, DI Chunguang, WANG Yi, WANG Hui, DING Jie, HUA Ke, MAO Shanshan, FU Weiping.
    Chinese Journal of Clinical Obstetrics and Gynecology. 2026, 27(2): 154-158. https://doi.org/10.13390/j.issn.1672-1861.2026.02.014
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    Objective To evaluate the clinical efficacy of time-lapse imaging (TLI)-based dynamic monitoring of the second polar body (Pb2) extrusion timing after intracytoplasmic sperm injection (ICSI) in guiding early rescue artificial oocyte activation (AOA) for preventing fertilization failure. Methods A total of 162 patients undergoing ICSI treatment at our hospital between July 2023 and July 2025 were enrolled. First, TLI was used to characterize Pb2 extrusion timing in 102 patients with normal fertilization (normal fertilization group) to establish the optimal intervention window for early rescue AOA. Subsequently, early rescue AOA using calcium ionophore A23187 was performed at the determined timepoint on unfertilized oocytes from 60 patients with low fertilization (fertilization disorder group). Fertilization and embryonic development outcomes before and after activation were compared, and results were benchmarked against the normal fertilization group. Results Multivariate analysis indicated that the number of retrieved oocytes was an independent risk factor for low fertilization after ICSI (OR=0.863, 95% CI: 0.780~0.955, P=0.004). In the normal fertilization group, the mean Pb2 extrusion time was 2.85±0.88 hours, with 98.79% of extrusions occurring within 5 hours post-ICSI. Therefore, 5 hours post-ICSI was defined as the optimal time for early rescue AOA intervention. Among 295 oocytes without Pb2 extrusion in the low fertilization group, both fertilization rate and normal fertilization rate increased significantly after early rescue AOA (81.36% vs 26.62%, 73.56% vs 20.65%, P<0.05). The high-quality embryo rate also improved significantly (57.07% vs 43.37%, P<0.05). Although the fertilization rate and normal fertilization rate in the activation group remained lower than those in the normal fertilization group (81.36% vs 86.40%, 73.56% vs 83.55%, P<0.05), no statistically significant differences were observed in normal cleavage rate, high-quality embryo rate and blastocyst formation rate between the two groups (P>0.05). Conclusions Dynamic TLI monitoring of Pb2 extrusion after ICSI enables early identification of low fertilization risk. Performing early rescue AOA at 5 hours post-ICSI significantly improves fertilization outcomes and embryo quality in patients with low fertilization. Furthermore, the number of retrieved oocytes serves as a key predictor for low fertilization after ICSI.
ISSN 1672-1861　CN 11-4967/R
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Ministry of Education People's Republic of China
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Editorial Board of CCOG
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WEI Lihui
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