Objective: To identify the prevalence and risk factors for chronic endometritis (CE) with tubal factors and the correlation between chronic endometritis and tubal factors among infertile populations. Method: A total of 52 patients with chronic endometritis (CE group) who underwent laparoscopy and hysteroscopic surgery were recruited between July 2020 and December 2021. A total of 38 patients without chronic endometritis (non-CE group) were included as a control. Patients with endometriosis and intra-uterine abnormalities were excluded. Endometrial samples were collected during surgery for CD138 immunohistochemistry staining for the diagnosis of CE. Preoperative information (including age, reproductive health characteristics, previous medical and surgical history), intra-operative information (including the patency of the fallopian tube, the presence of hydrosalpinx, score and the grade of tubal lesion condition) and post-operative information (counts of CD138-positive HPF in the endometrial specimen) were collected. Result: A multivariate analysis revealed that tubal factors with unilateral or bilateral occlusion were significantly higher in the CE group (OR 3.066, 95% CI 1.020–9.213, p = 0.046). The bilateral occlusion of fallopian tubes (OR 8.785, 95% CI 1.408–54.818, p = 0.020) rather than unilateral occlusion (OR 2.860, 95% CI 0.893–9.162, p = 0.077) was significantly associated with chronic endometritis. The presence of a hydrosalpinx on one side (OR 7.842, 95% CI 1.279–48.086, p = 0.026) or both sides (OR 9.450, 95% CI 1.037–86.148, p = 0.046) was significantly associated with chronic endometritis. The comparison of CD138-positive HPF counts among the tubal occlusion patients without hydrosalpinx, patients with unilateral hydrosalpinx and patients with bilateral hydrosalpinx were as follows: 1 HPF (50.00% vs. 12.50% vs. 11.11%, p = 0.051), 2 HPF (38.89% vs. 25.00% vs. 22.22%, p = 0.615), ≥3 HPF (11.11% vs. 62.50% vs. 66.67%, p = 0.005). The stage of tubal condition was positively correlated with CD138-positive HPF counts in women with chronic endometritis (r = 0.460, p = 0.001). Conclusion: CE was closely related to the blockage of fallopian tubes and hydrosalpinx. The severity degree of the fallopian lesion condition was associated with inflammation of the endometrium.

Does luteinizing hormone (LH) levels on human chorionic gonadotropin (HCG) trigger day (LHHCG) affect the clinical outcomes of patients with diminished ovarian reserve (DOR) undergoing gonadotropin-releasing hormone antagonist (GnRH-ant) protocol? Retrospective analysis fresh embryo transfer cycles of DOR patients who underwent GnRH-ant protocol from August 2019 to June 2023. The participants were divided into different groups according to LHHCG level and age. The clinical data and outcomes were compared between groups. In patients with DOR, the HCG positive rate (59.3% versus 39.8%, P = 0.005), embryo implantation rate (34.5% versus 19.7%, P = 0.002), clinical pregnancy rate (49.2% versus 28.4%, P = 0.003), live birth rate (41.5% versus 22.7%, P = 0.005) in LHHCG < 2.58 IU/L group were significantly higher than LHHCG ≥ 2.58 IU/L group. There was no significant correlation between LHHCG level and clinical pregnancy in POSEIDON group 3. In POSEIDON group 4, the HCG positive rate (52.8% versus 27.0%, P = 0.015), embryo implantation rate (29.2% versus 13.3%, P = 0.023), clinical pregnancy rate (45.3% versus 18.9%, P = 0.010) in LHHCG < 3.14 IU/L group were significantly higher than LHHCG ≥ 3.14 IU/L group. Logistic regression analysis indicated that LHHCG level was an independent influencing factor for clinical pregnancy in POSEIDON group 4 patients (OR = 3.831, 95% CI: 1.379–10.643, P < 0.05). LHHCG level is an independent factor affecting pregnancy outcome of fresh embryo transfer in DOR patients undergoing GnRH-ant protocol, especially for advanced-aged women. LHHCG had a high predictive value for POSEIDON group 4 patients, and LHHCG ≥ 3.14 IU/L predicts poor pregnancy outcomes.

Background: For the poor ovarian response (POR) population, the relationship between medroxyprogesterone acetate (MPA) dose in progestin-primed ovarian stimulation (PPOS) and clinical outcome is still unclear. This study aims to explore the effect of MPA dose in PPOS on clinical outcomes in POSEIDON group 3 and 4 patients with different body mass index (BMI) levels, hoping to provide clinical doctors with better options for controlled ovarian hyperstimulation (COH) programs.Methods: This is a retrospective analysis of 253 oocyte retrieval cycles of POSEIDON group 3 and 4 patients who underwent PPOS protocol in IVF/ICSI treatment at the Reproductive Medical Center of Renmin Hospital of Wuhan University from March 2019 to April 2022. The effects of different MPA doses (8 mg/d or 10 mg/d) on pregnancy outcomes were compared in normal BMI (18.5–24 kg/m²) and high BMI (≥24 kg/m²) patients, and multivariate logistic regression analysis was performed to analyze the factors affecting pregnancy outcomes.Results: For normal BMI patients, the 8-mg/d MPA group had a higher embryo implantation rate (33.78% vs. 18.97%, P = 0.012). For high BMI patients, the 10-mg/d MPA group had a higher HCG positive rate (55.00% vs. 25.00%, P = 0.028), clinical pregnancy rate (50.00% vs. 20.00%, P = 0.025), and cumulative pregnancy rate (37.74% vs. 13.79%, P = 0.023) compared with the 8-mg/d MPA group. There was no significant difference in cumulative live birth rate between the 8-mg/d and 10-mg/d MPA groups in patients with normal or high BMI. The results of multivariate logistic regression showed a significant correlation between MPA dose and cumulative pregnancy in the high BMI population (OR = 0.199, 95% CI: 0.046~0.861, P = 0.031).Conclusions: For POR patients with high BMI, 10 mg/d of MPA in the PPOS protocol had a higher cumulative pregnancy rate than 8 mg/d of MPA, but it had no significant effect on the cumulative live birth rate.

Background: There is limited research about the pregnancy outcomes of POSEIDON group 2 patients. This study aims to evaluate the factors related to the clinical outcomes of in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI) in POSEIDON group 2 patients, so as to provide clinical guidance to improve clinical outcomes.Methods: A total of 1,249 IVF/ICSI cycles of POSEIDON group 2 patients were retrospectively analyzed from July 2019 to September 2024. The patients were divided into different groups according to live birth, maternal age, and endometrial thickness (EMT). The clinical outcomes were compared between groups.Results: Compared with the non-live birth group, maternal age, gonadotropin (Gn) dosage, and Gn total dosage were significantly lower, while EMT was significantly higher in the live birth group (p < 0.05). The type of infertility showed statistically significant differences (p = 0.013). Multivariate logistic regression analysis indicated that maternal age (OR = 1.195, 95% CI: 1.077–1.327; p = 0.001) and EMT on transfer day (OR = 0.887, 95% CI: 0.820–0.959; p = 0.003) were independent influencing factors for live birth in POSEIDON group 2 patients. According to the receiver operating characteristic (ROC) curve predictive cutoff value, the patients were divided into group A (age < 38 years, n = 249) and group B (age ≥ 38 years, n = 155). Group A had a higher human chorionic gonadotropin (hCG)-positive rate (55.8% vs. 34.2%, p < 0.001), embryo implantation rate (35.2% vs. 19.2%, p < 0.001), clinical pregnancy rate (47.8% vs. 29.7%, p < 0.001), and live birth rate (37.3% vs. 20.0%, p < 0.001) and a lower early miscarriage rate (12.6% vs. 28.3%, p = 0.016) than group B. According to the ROC predictive cutoff value of EMT, group A patients were further divided into group A1 (EMT < 11.65 mm, n = 136) and group A2 (EMT ≥ 11.65 mm, n = 113). Group B patients were divided into group B1 (EMT < 11.65 mm, n = 93) and group B2 (EMT ≥ 11.65 mm, n = 62). Compared with group A1 and group A2, group B1 had a lower hCG-positive rate (28.0% vs. 49.3%, p = 0.001; 28.0% vs. 63.7%, p < 0.001), embryo implantation rate (14.7% vs. 32.2%, p < 0.001; 14.7% vs. 40.2%, p < 0.001), clinical pregnancy rate (23.7% vs. 41.2%, p = 0.006; 23.7% vs. 55.8%, p < 0.001), and live birth rate (16.1% vs. 33.8%, p = 0.003; 16.1% vs. 41.6%, p < 0.001).Conclusions: Maternal age and EMT on transfer day are independent factors affecting IVF/ICSI clinical outcomes in POSEIDON group 2 patients. Among these, maternal age <38 years or EMT ≥ 11.65 mm indicated better clinical outcomes. Further stratification by age and EMT on transfer day may optimize clinical outcomes in POSEIDON group 2 patients.

Diminished ovarian reserve (DOR) represents a critical clinical challenge in assisted reproductive technology (ART), and the gonadotropin-releasing hormone