The Effect Of Infectious Diseases On Clinical Outcomes Of Assisted Reproductive Technology And Safety Analysis

Part one The effect of female genital tract chlamydia trachomatis infections on pregnancy outcomes of fresh and frozen-thawed IVF-ET cyclesObjective To investigate the effect of female genital tract chlamydia trachomatis(CT)infections on pregnancy outcomes of fresh and frozen-thawed in vitro fertilization-embryo transfer(IVF-ET)cycles.Methods Female patients with CT detection before IVF-ET treatment from August 2016 to October 2017 were included.Among them,3654 cases underwent fresh embryo transfer while 2766 cases underwent frozen-thawed embryo transfer.Based on the results of CT infections,treatment and reexamination,they were divided into negative-conversion group,persistent positive group,untreated group and negative control group.The basic characteristics and pregnancy outcomes were compared among these groups.Results In fresh IVF-ET cycles,both fertilization rates and blastocyst formation rates were significantly different between negative-conversion group and negative control group(P<0.05).The MII oocyte rates between persistent positive group and negative control group,untreated group and negative control group were significantly different(P<0.05).There was no significant difference in pregnancy outcomes among these groups(P>0.05).In frozen-thawed cycles,there was no significant difference in pregnancy outcomes among these groups(P>0.05).Conclusion Female genital tract CT infections have no adverse effect on the pregnancy outcomes of either fresh IVF-ET or frozen-thawed cycles.Part two Risk of vertical transmission of hepatitis B virus in assisted reproductive technologyObjective To explore whether assisted reproductive technology(ART)can increase the risk of vertical mother-infant transmission of HBV compared with natural pregnancy,and to compare the risks of vertical transmission between HBV-positive women subject to IVF and ICSI.Materials and methods Serum HBs Ag positive parturients subject to natural pregnancies or ART(IVF or ICSI)were continuously included.The blood samples of parturients were collected at the time of admission and waiting for delivery,and the serum markers of HBV,HBV DNA and liver enzymes were detected quantitatively.Clinical data of obstetric complications were acquired.Umbilical cord blood of all neonates during delivery was kept to detect HBV serum markers(HBs Ag,HBe Ag,anti-HBs,anti-HBe,and anti-HBc).Neonates with HBs Ag positive in umbilical cord blood were re-examined 9-15 months after birth and followed up by telephone.Results No significant difference in the positive rate of HBs Ag in umbilical cord blood was found between natural pregnancy group and ART group(9.4% vs.6.8%,P>0.05).The positive rate of HBs Ag in umbilical cord blood of newborns with maternal HBVDNA ≥ 500IU/m L was significantly higher than that of newborns with HBVDNA < 500IU/m L(P < 0.05).The positive rate of HBs Ag in umbilical cord blood of newborns with HBe Ag positive maternal blood was significantly higher than that of newborns with HBe Ag negative maternal blood(P < 0.05).In the subgroup of HBV DNA < 500IU/m L,the positive rate of HBs Ag in umbilical cord blood of newborns in ICSI group was significantly higher than that in IVF group(10.5% vs.0%,P < 0.05).All follow-up newborns with HBs Ag positive cord blood at birth turned serum HBs Ag negative at 9-15 months.Higher incidence of obstetric complications in assisted reproduction group compared with natural pregnancy group was observed.Conclusion ART brings no increase in the risk of vertical transmission of HBV from mother to infant.High HBV DNA load and HBe Ag positive in maternal blood are risk factors for vertical transmission of HBV.Compared with IVF,ICSI plays a possible role in increasing the risk,which requires further research.The combination of hepatitis B vaccine and hepatitis B immunoglobulin can effectively block the vertical transmission between mother and infant.