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Devranoğlu B, Yilmaz MB, Peker G, Emekçi Özay Ö, Özay AC, Güzel Aİ. Effects of obesity on clinical outcomes in diminished ovarian reserve patients undergoing intracytoplasmic sperm injection cycles. Medicine (Baltimore) 2024; 103:e38942. [PMID: 38996138 PMCID: PMC11245180 DOI: 10.1097/md.0000000000038942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
The aim of this study is to evaluate the effects of obesity on clinical outcomes in diminished ovarian reserve (DOR) patients undergoing intracytoplasmic sperm injection cycles. In this retrospective observational cross-sectional study, women admitted to current clinic with DOR undergoing intracytoplasmic sperm injection were divided into 2 groups according to the obesity. Patient age, body mass index, anti-mullerian hormone, baseline follicle stimulating hormone and baseline estradiol levels, antral follicle count, total gonadotropin dose, day of stimulation, number of mature (MII) oocytes, and clinical pregnancy were evaluated. There were no statistically significant differences between groups in terms of age, anti-mullerian hormone, baseline follicle stimulating hormone, baseline estradiol levels, antral follicle count, and clinical pregnancy (P > .05). Total gonadotropin dose, the days of ovarian stimulation were higher and number of MII oocyte were less in the obese group (P < .05). Logistic regression analyses also revealed that the days of ovarian stimulation and number of MII oocyte were significant factors in the study group. ROC curve analysis showed obesity is a negatively affecting factor in DOR patients. Obesity causes more gonadotropin dose longer days of stimulation, and less number of MII oocyte. However clinical pregnancy rate is not negatively affected by obesity according to the current study.
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Affiliation(s)
- Belgin Devranoğlu
- Health Sciences University, Zeynep Kamil Women and Children’s Diseases Training and Research Hospital, İstanbul, Turkey
| | - Müşerref Banu Yilmaz
- Health Sciences University, Zeynep Kamil Women and Children’s Diseases Training and Research Hospital, İstanbul, Turkey
| | - Gamze Peker
- Department of Obstetrics and Gynecology, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Özlen Emekçi Özay
- Department of Obstetrics and Gynecology, Cyprus International University, Nicosia, Cyprus
| | - Ali Cenk Özay
- Department of Obstetrics and Gynecology, Cyprus International University, Nicosia, Cyprus
| | - Ali İrfan Güzel
- Department of Obstetrics and Gynecology, Sanko University, Gaziantep, Turkey
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Chen Y, Ma G, Gai Y, Yang Q, Liu X, de Avila JM, Mao S, Zhu M, Du M. AMPK Suppression Due to Obesity Drives Oocyte mtDNA Heteroplasmy via ATF5-POLG Axis. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2307480. [PMID: 38499990 PMCID: PMC11132083 DOI: 10.1002/advs.202307480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/23/2024] [Indexed: 03/20/2024]
Abstract
Due to the exclusive maternal transmission, oocyte mitochondrial dysfunction reduces fertility rates, affects embryonic development, and programs offspring to metabolic diseases. However, mitochondrial DNA (mtDNA) are vulnerable to mutations during oocyte maturation, leading to mitochondrial nucleotide variations (mtSNVs) within a single oocyte, referring to mtDNA heteroplasmy. Obesity (OB) accounts for more than 40% of women at the reproductive age in the USA, but little is known about impacts of OB on mtSNVs in mature oocytes. It is found that OB reduces mtDNA content and increases mtSNVs in mature oocytes, which impairs mitochondrial energetic functions and oocyte quality. In mature oocytes, OB suppresses AMPK activity, aligned with an increased binding affinity of the ATF5-POLG protein complex to mutated mtDNA D-loop and protein-coding regions. Similarly, AMPK knockout increases the binding affinity of ATF5-POLG proteins to mutated mtDNA, leading to the replication of heteroplasmic mtDNA and impairing oocyte quality. Consistently, AMPK activation blocks the detrimental impacts of OB by preventing ATF5-POLG protein recruitment, improving oocyte maturation and mitochondrial energetics. Overall, the data uncover key features of AMPK activation in suppressing mtSNVs, and improving mitochondrial biogenesis and oocyte maturation in obese females.
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Affiliation(s)
- Yanting Chen
- National Center for Internatinal Research on Animal Gut NutritionJingsu Key Laboratory of Gastrointestinal Nutrition and Animal HealthCollege of Animal Science and TechnologyNanjing Agricultural UniversityNanjing210095China
- Nutrigenomics and Growth Biology LaboratoryDepartment of Animal SciencesWashington State UniversityPullmanWA99164USA
| | - Guiling Ma
- National Center for Internatinal Research on Animal Gut NutritionJingsu Key Laboratory of Gastrointestinal Nutrition and Animal HealthCollege of Animal Science and TechnologyNanjing Agricultural UniversityNanjing210095China
- Nutrigenomics and Growth Biology LaboratoryDepartment of Animal SciencesWashington State UniversityPullmanWA99164USA
| | - Yang Gai
- National Center for Internatinal Research on Animal Gut NutritionJingsu Key Laboratory of Gastrointestinal Nutrition and Animal HealthCollege of Animal Science and TechnologyNanjing Agricultural UniversityNanjing210095China
| | - Qiyuan Yang
- Department of MolecularCell and Cancer BiologyUniversity of Massachusetts Chan Medical SchoolWorcesterMA01655USA
| | - Xiangdong Liu
- Nutrigenomics and Growth Biology LaboratoryDepartment of Animal SciencesWashington State UniversityPullmanWA99164USA
- Department of Cancer biologyDana‐Farber Cancer InstituteHarvard Medical SchoolBostonMA02215USA
| | - Jeanene M. de Avila
- Nutrigenomics and Growth Biology LaboratoryDepartment of Animal SciencesWashington State UniversityPullmanWA99164USA
| | - Shengyong Mao
- National Center for Internatinal Research on Animal Gut NutritionJingsu Key Laboratory of Gastrointestinal Nutrition and Animal HealthCollege of Animal Science and TechnologyNanjing Agricultural UniversityNanjing210095China
| | - Mei‐Jun Zhu
- School of Food SciencesWashington State UniversityPullmanWA99164USA
| | - Min Du
- Nutrigenomics and Growth Biology LaboratoryDepartment of Animal SciencesWashington State UniversityPullmanWA99164USA
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Shang J, Wang S, Wang A, Li F, Zhang J, Wang J, Lv R, Chen H, Mu X, Zhang K, Bai X, Tian Y. Intra-ovarian inflammatory states and their associations with embryo quality in normal-BMI PCOS patients undergoing IVF treatment. Reprod Biol Endocrinol 2024; 22:11. [PMID: 38212789 PMCID: PMC10782707 DOI: 10.1186/s12958-023-01183-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/28/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the main cause of anovulatory infertility in women of reproductive age, and low-grade chronic inflammation plays a key role in the occurrence and development of PCOS. However, obesity, as a likely confounding factor, can affect the inflammatory state of PCOS patients. OBJECTIVE The aim of this study was to comprehensively investigate intra-ovarian inflammatory states and their impact on embryo quality in PCOS patients with a normal BMI undergoing IVF treatment. METHODS DIA-mass spectrometry-based proteomics and bioinformatic analysis were combined to comprehensively profile the protein expression of granulosa cells (GCs) from 5 normal-BMI PCOS patients and 5 controls. Thirty-four cytokines were further systematically detected in follicular fluid (FF) from 32 age- and BMI-matched normal-BMI patients using Luminex liquid chip suspension technology. Next, the differentially expressed cytokines were evaluated by enzyme-linked immunosorbent assay (ELISA) in 24 newly recruited subjects, and the relationship between these cytokines and embryo quality in PCOS patients was analysed. Finally, these cytokine levels were compared and evaluated in PCOS patients with different androgen levels. RESULTS Proteomic analysis showed that the suppression of substance metabolism and steroid biosynthesis, more interestingly, resulted in an enhanced immune and inflammatory response in the GCs of normal-BMI PCOS patients and prompted the involvement of cytokines in this process. Luminex analysis further showed that FF macrophage inflammatory protein-1 beta (MIP-1β) and stromal cell-derived factor-1 alpha (SDF-1α) levels were significantly increased in normal-BMI PCOS patients compared to controls (P = 0.005; P = 0.035, respectively), and the ELISA results were consistent with these findings. Besides, FF MIP-1β showed an inverse correlation with the number of D3 good-quality embryos and the good-quality blastocyst rate in patients with PCOS (P = 0.006; P = 0.003, respectively), which remained significant after correction for multiple comparisons. Moreover, SDF-1α levels had no relationship with embryo development in PCOS patients. Additionally, SDF-1α levels were significantly lower in PCOS patients with high androgen levels than in controls (P = 0.031). CONCLUSIONS Local ovarian inflammation was present in normal-BMI PCOS patients, affecting follicular development, and FF MIP-1β may be a potential biomarker associated with embryo quality in normal-BMI PCOS patients.
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Affiliation(s)
- Jie Shang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No.154, Anshan Road, Heping District, Tianjin, 300052, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin, China
| | - Siyu Wang
- Key Laboratory of Immune Microenvironment and Disease (Ministry of Education), Tianjin Key Laboratory of Medical Epigenetics, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, The Province and Ministry Co-sponsored Collaborative Innovation Center for Medical Epigenetics, Tianjin Medical University, Tianjin, China
| | - Aiyuan Wang
- Key Laboratory of Immune Microenvironment and Disease (Ministry of Education), Tianjin Key Laboratory of Medical Epigenetics, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, The Province and Ministry Co-sponsored Collaborative Innovation Center for Medical Epigenetics, Tianjin Medical University, Tianjin, China
| | - Fang Li
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No.154, Anshan Road, Heping District, Tianjin, 300052, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin, China
| | - Jing Zhang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No.154, Anshan Road, Heping District, Tianjin, 300052, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin, China
| | - Jin Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No.154, Anshan Road, Heping District, Tianjin, 300052, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin, China
| | - Rui Lv
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No.154, Anshan Road, Heping District, Tianjin, 300052, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin, China
| | - Haixia Chen
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No.154, Anshan Road, Heping District, Tianjin, 300052, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaohuan Mu
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No.154, Anshan Road, Heping District, Tianjin, 300052, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin, China
| | - Kai Zhang
- Key Laboratory of Immune Microenvironment and Disease (Ministry of Education), Tianjin Key Laboratory of Medical Epigenetics, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, The Province and Ministry Co-sponsored Collaborative Innovation Center for Medical Epigenetics, Tianjin Medical University, Tianjin, China
| | - Xiaohong Bai
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No.154, Anshan Road, Heping District, Tianjin, 300052, China.
- Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin, China.
| | - Ye Tian
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No.154, Anshan Road, Heping District, Tianjin, 300052, China.
- Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin, China.
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Petkar S, Chakole V, Nayak A. Comprehensive Review of Anesthetic Evaluation and Management in Obese Female Patients Undergoing In Vitro Fertilization. Cureus 2023; 15:e47521. [PMID: 38021482 PMCID: PMC10664690 DOI: 10.7759/cureus.47521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Obesity has become a global health epidemic with profound implications for various medical specialties, including reproductive medicine. This comprehensive review focuses on the anesthetic evaluation and management of obese patients undergoing in vitro fertilization (IVF) procedures. Obesity, as defined by BMI, is associated with infertility and poses unique challenges for anesthetic care. The review also addresses the timing of anesthesia concerning IVF procedures, the impact of obesity on IVF success rates, and the importance of emotional and psychological support for obese patients undergoing IVF. Challenges and future directions in the field are highlighted, focusing on ongoing research, emerging technologies, and the role of multidisciplinary teams in managing these complex cases. In conclusion, this review underscores the critical role of tailored anesthesia and perioperative care in optimizing outcomes for obese patients undergoing IVF. It provides valuable insights for anesthetic providers, reproductive specialists, and healthcare teams, emphasizing the need for a patient-centered approach to address the unique challenges posed by obesity in the context of assisted reproductive technology.
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Affiliation(s)
- Shubham Petkar
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vivek Chakole
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aishwarya Nayak
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Abstract
PURPOSE OF REVIEW The objective of this review is to highlight the recent literature on how obesity affects reproductive capacity in men and women. RECENT FINDINGS The relationship between fertility and obesity is complex and involves the hypothalamic-pituitary-ovarian axis, neuroendocrine systems and adipose tissue. The exact pathophysiology of how obesity lowers fertility rates is unknown, but is likely multifactorial involving anovulation, insulin resistance and alterations in gonadotropins. In addition, there is controversy on whether oocyte quality or endometrial receptivity plays a larger role in obese infertile women. Data on effects of bariatric surgery and weight loss on obese infertile men and women are mixed. SUMMARY Obesity alters the hormonal profile, gonadotropin secretion, embryo development and in-vitro fertilization outcomes in both men and women.
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Affiliation(s)
- Abigail Armstrong
- Department of Obstetrics & Gynecology, University of California Los Angeles, Los Angeles, California, USA
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Abstract
Increasing evidence has demonstrated that obesity impairs female fertility and negatively affects human reproductive outcome following medically assisted reproduction (MAR) treatment. In the United States, 36.5% of women of reproductive age are obese. Obesity results not only in metabolic disorders including type II diabetes and cardiovascular disease, but might also be responsible for chronic inflammation and oxidative stress. Several studies have demonstrated that inflammation and reactive oxygen species (ROS) in the ovary modify steroidogenesis and might induce anovulation, as well as affecting oocyte meiotic maturation, leading to impaired oocyte quality and embryo developmental competence. Although the adverse effect of female obesity on human reproduction has been an object of debate in the past, there is growing evidence showing a link between female obesity and increased risk of infertility. However, further studies need to clarify some gaps in knowledge. We reviewed the recent evidence on the association between female obesity and infertility. In particular, we highlight the association between fat distribution and reproductive outcome, and how the inflammation and oxidative stress mechanisms might reduce ovarian function and oocyte quality. Finally, we evaluate the connection between female obesity and endometrial receptivity.
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Zhang F, Ying L, Zhang Q, Wang F, Qu F. Association between maternal polycystic ovary syndrome and early childhood growth: a continuous observation from 3 months to 6 years of age. J Assist Reprod Genet 2022; 39:461-471. [PMID: 35048272 PMCID: PMC8956758 DOI: 10.1007/s10815-021-02378-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To investigate whether maternal PCOS could impact growth and development in offspring at an early age through continuous observation from age 3 months to 6 years. METHODS This prospective study was conducted in 198 children born to mothers with PCOS and 227 children born to healthy mothers in Ningbo (Zhejiang Province, China) between October 2012 and July 2015. Measurements of offspring height, weight, head circumference, and teething were examined by trained professionals through age 6 years. Height, weight, and body mass index (BMI) were analysed using repeated measures analysis of variance between the PCOS and control groups. RESULTS Offspring born to women with PCOS showed significantly higher BMI at age 12, 18, and 30 months and 5 years (P = 0.040, P = 0.000, P = 0.000, and P = 0.023, respectively). Female offspring born to women with PCOS showed significantly increased body weight at 3, 8, 12, 18, and 30 months, and 3 and 6 years (P = 0.027, P = 0.008, P = 0.010, P = 0.034, P = 0.047, P = 0.040, and P = 0.035, respectively) and significantly higher BMI at 3, 8, 12, 18, and 30 months (P = 0.009, P = 0.016, P = 0.029, P = 0.000, and P = 0.000, respectively). After adjusting for maternal, paternal, and pregnancy confounders, PCOS status presented significant associations with weight at age 3, 8, and 12 months and 3 years (P = 0.005, P = 0.004, P = 0.021, P = 0.035 respectively), and with BMI at age 3 and 8 months (P = 0.011 and P = 0.014) in female offspring. CONCLUSIONS Maternal PCOS is associated with an increased risk of developing obesity in female offspring.
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Affiliation(s)
- Fangfang Zhang
- grid.13402.340000 0004 1759 700XWomen’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006 People’s Republic of China
| | - Liying Ying
- grid.13402.340000 0004 1759 700XWomen’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006 People’s Republic of China ,Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang 315100 People’s Republic of China
| | - Qing Zhang
- grid.13402.340000 0004 1759 700XWomen’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006 People’s Republic of China
| | - Fangfang Wang
- grid.13402.340000 0004 1759 700XWomen’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006 People’s Republic of China
| | - Fan Qu
- grid.13402.340000 0004 1759 700XWomen’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006 People’s Republic of China
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Song H, Yu Z, Li P, Wang Y, Shi Y. HOMA-IR for predicting clinical pregnancy rate during IVF. Gynecol Endocrinol 2022; 38:33-38. [PMID: 34263713 DOI: 10.1080/09513590.2021.1952976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To determine the cutoff values of HOMA-IR for predicting clinical pregnancy rate in normal weight patients during their first IVF. MATERIALS AND METHODS The data was retrospectively analyzed from 329 normal-weight women aged 21-40 years with BMI <25 kg/m2 who received first IVF-ET during the period from December 2018 to June 2019.We assessed the associations between HOMA-IR and clinical pregnancy rates during IVF in the women with or without PCOS according to different BMI ranges. RESULTS In non PCOS,clinical pregnancy rate was significantly decreased at the HOMA-IR values ranging from 2.2 to 3.15 (OR, 0.188, 95% CI, 0.084-0.42; p < .05) and at those >3.15 (OR, 0.018, 95% CI, 0.004-0.081; p < .05).In PCOS, clinical pregnancy rate significantly decreased at the HOMA-IR >3.15 (OR, 0.15, 95% CI, 0.044-0.507; p < .05). In non PCOS with BMI <21.45 kg/m2, clinical pregnancy rate was decreased with HOMA-IR >2.2, and a significant cutoff point at HOMA-IR >3.15; with 21.45 ≤ BMI <25 kg/m2, clinical pregnancy rate was declined significantly at the HOMA-IR >1.56 (OR, 0.196, 95% CI, 0.055-0.704).In PCOS with BMI <21.45 kg/m2, clinical pregnancy rate was decreased as the HOMA-IR increased, but there was no significant cutoff point; with 21.45 ≤ BMI < 25 kg/m2, clinical pregnancy rate was declined significantly at the HOMA-IR > 3.15 (OR, 0.186; 95% CI, 0.04-0.872). CONCLUSION HOMA-IR and BMI had adverse effects on the IVF outcome of infertility women. Moreover, obesity can increase the degree of insulin resistance in infertility women. These findings suggested that only better HOMA-IR and BMI will lead to better IVF results.
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Affiliation(s)
- Haixia Song
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Reproductive Medicine, Shanxi Provincial People's Hospital, Taiyuan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
| | - Zhenqing Yu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
| | - Ping Li
- Women and Children's Hospital Affiliated to Xiamen University, Xiamen, China
| | - Ying Wang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
| | - Yuhua Shi
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China
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