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Wan JP, Wang ZJ, Sheng Y, Chen W, Guo QQ, Xu J, Fan HR, Sun M. Effect of HCG-Triggered Ovulation on Pregnancy Outcomes in Intrauterine Insemination: An Analysis of 5,610 First IUI Natural Cycles With Donor Sperm in China. Front Endocrinol (Lausanne) 2020; 11:423. [PMID: 32774325 PMCID: PMC7381339 DOI: 10.3389/fendo.2020.00423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/27/2020] [Indexed: 01/02/2023] Open
Abstract
Objective: To evaluate the effect of human chorionic gonadotropin (hCG) trigger ovulation on pregnancy outcomes in natural IUI cycles with donor sperm. Methods: This retrospective cohort study included 5,610 first-natural IUI cycles with donor sperm in infertile couples during the period from January 2012 to December 2017. To control for other confounding factors, our analysis was restricted to normo-ovulatory women without tubal infertility. The main outcome measure was live birth rate; the secondary outcomes included rates of clinical pregnancy and miscarriage. Results: In the crude analysis, both the clinical pregnancy (27.40 vs. 22.73%; P = 0.001) and live birth rates (24.52 vs. 20.13%; P = 0.007) were significantly higher for the hCG group than for the spontaneous LH group. After adjustment for a number of confounding factors, the reproductive outcomes were still significantly worse for the spontaneous ovulatory group. Conclusions: Among women undergoing natural cycle IUI with donor sperm, hCG triggered ovulation for timing insemination offers beneficial impacts on both clinical pregnancy rates and live birth rates.
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Affiliation(s)
- Ji-Peng Wan
- Department of Obstetrics and Gynecology, Cheeloo College of Medicine, Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Zhen-Jing Wang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Yan Sheng
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Wei Chen
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Qing-Qing Guo
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Jin Xu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Hua-Rui Fan
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
| | - Mei Sun
- Department of Obstetrics and Gynecology, Cheeloo College of Medicine, Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
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Rijsdijk OE, Cantineau AE, Bourdrez P, Gijsen TP, Gondrie ET, Sprengers O, Vrouenraets FP, Donners JJ, Evers JL, Smits LJ, den Hartog JE. Intrauterine insemination: simultaneous with or 36 h after HCG? A randomized clinical trial. Reprod Biomed Online 2019; 39:262-268. [PMID: 31182355 DOI: 10.1016/j.rbmo.2019.03.208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 02/28/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
RESEARCH QUESTION Does intrauterine insemination (IUI) carried out simultaneously with HCG triggering ('simultaneous IUI') increase the ongoing pregnancy rate compared with IUI 32-36 h after HCG triggering ('regular IUI')? STUDY DESIGN An open-label randomized clinical trial was conducted in seven Dutch fertility clinics. One hundred and sixty-six couples were randomized to receive simultaneous IUI and 208 couples to receive regular IUI. Treatment was allocated using a computer-based randomization algorithm using sealed opaque envelopes. Data were analysed according to the intention-to-treat principle. Couples with unexplained or mild-to-moderate male factor subfertility were eligible. Exclusion criteria were female age 42 years or older, female body mass index 35 kg/m2 or over, double-sided tubal pathology or severe male factor subfertility. Mild ovarian stimulation was carried out by subcutaneous FSH self-administration. 'Simultaneous IUI' was carried out at the point of HCG triggering for ovulation. 'Regular IUI' was carried out 32-36 h after HCG triggering. RESULTS The cumulative ongoing pregnancy rate after a maximum of four cycles was 26.2% for simultaneous IUI (43 ongoing pregnancies) and 33.7% for regular IUI (70 ongoing pregnancies) (RR 0.78 95% CI 0.57 to 1.07). Ongoing pregnancy rates per cycle in the simultaneous IUI group were 6.8%, 10.5%, 9.5% and 7.4% for the first, second, third and fourth IUI cycle. In the regular IUI group, ongoing pregnancy rates were 8.3%, 16.4%, 13.5% and 9.0% for the first, second, third and fourth IUI cycle. CONCLUSIONS This multicentre randomized controlled trial did not demonstrate that IUI carried out at the point of HCG triggering increases pregnancy rates compared with IUI carried out around the time of ovulation.
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Affiliation(s)
- Odette E Rijsdijk
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, PO Box 5800, AZ Maastricht 6202, the Netherlands.
| | - Astrid E Cantineau
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, the Netherlands
| | - Petra Bourdrez
- Department of Obstetrics and Gynaecology, VieCuri Medical Centre Venlo, the Netherlands
| | - Tanja P Gijsen
- Department of Obstetrics and Gynaecology, Elkerliek Hospital Helmond, the Netherlands
| | - Ed T Gondrie
- Department of Obstetrics and Gynaecology, Zuyderland Hospital Heerlen/Sittard, the Netherlands
| | - Odette Sprengers
- Department of Obstetrics and Gynaecology, Laurentius Hospital Roermond, the Netherlands
| | - Francis P Vrouenraets
- Department of Obstetrics and Gynaecology, Zuyderland Hospital Heerlen/Sittard, the Netherlands
| | - Judith J Donners
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, PO Box 5800, AZ Maastricht 6202, the Netherlands
| | - Johannes L Evers
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, PO Box 5800, AZ Maastricht 6202, the Netherlands
| | - Luc J Smits
- Department of Epidemiology, Maastricht University, the Netherlands
| | - Janneke E den Hartog
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, PO Box 5800, AZ Maastricht 6202, the Netherlands
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Lee J, Hwang S, Lee J, Yoo J, Jang D, Hwang K, Kim M. Effect of insemination timing on pregnancy outcome in association with female age, sperm motility, sperm morphology and sperm concentration in intrauterine insemination. J Obstet Gynaecol Res 2018; 44:1100-1106. [PMID: 29673000 DOI: 10.1111/jog.13625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 02/05/2018] [Indexed: 12/01/2022]
Abstract
AIM We investigated the effect of insemination timing on pregnancy outcomes in intrauterine insemination (IUI) cycles. METHODS This is a retrospective study of 411 IUI cycles performed with a diagnosis of unexplained infertility and male factor infertility. The cycles were divided according to the interval between insemination and ovulation: ≤36 h, 36-37 h, 37-38 h and >38 h. The overall pregnancy rate, chemical pregnancy rate and clinical pregnancy rate were compared. We also analyzed the association between pregnancy outcomes and clinical characteristics, including age, duration of infertility, sperm concentration, body mass index (BMI), anti-Müllerian hormone (AMH) and number of mature follicles at ovulation. RESULTS There were no differences regarding age, duration of infertility, BMI, AMH, sperm concentration and number of mature follicles between different IUI timing groups. Sperm morphology was significantly lower in ≤36 h group (5.3 ± 1.4) compared to 36-37 h, 37-38 h and >38 h (6.3 ± 2.5 vs 6.5 ± 2.7 vs 6.5 ± 3.5, P = 0.004) groups. The ≤36 h group showed lowest total pregnancy rate (5.0%) compared to other IUI timings (21.8% vs 24.8% vs 20.0%, P = 0.05). Multivariate analysis showed that sperm morphology was associated with pregnancy in 36-37 h (odd ratio 1.42, 95% confidence interval 1.03-1.95, P = 0.02). CONCLUSION Insemination at least 36 h after ovulation is associated with increased pregnancy rate compared to IUIs performed ≤36 h following ovulation.
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Affiliation(s)
- Jisun Lee
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Suna Hwang
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Jaehun Lee
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Junghyun Yoo
- Department of Obstetrics and Gynecology, Bundang Jesaeng General Hospital, Bungdang-gu, Korea
| | - Dongmin Jang
- Department of Biological Science, Graduate School of Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Kyungjoo Hwang
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Miran Kim
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
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Ostermeier GC, Cardona C, Moody MA, Simpson AJ, Mendoza R, Seaman E, Travis AJ. Timing of sperm capacitation varies reproducibly among men. Mol Reprod Dev 2018. [PMID: 29521463 PMCID: PMC6001750 DOI: 10.1002/mrd.22972] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sperm must mature functionally in the process of capacitation to become able to fertilize. Capacitation depends on membrane lipid changes, and can be quantitatively assessed by redistribution of the ganglioside GM1, the basis of the Cap‐Score™ sperm function test. Here, differences in Cap‐Score were compared among and within men at two time points. Ejaculates were liquefied, washed, and incubated for 3 hr under capacitating (Cap) conditions, then fixed and analyzed immediately (Day0); after being incubated 3 hr under Cap conditions then maintained 22–24 hr in fix (Day1‐fix); or after 22–24 hr incubation under Cap conditions prior to fixation (Day1). In all cases, a light fixative previously shown to allow membrane lipid movements was used. Day1‐fix and Day1 Cap‐Scores were greater than Day0 (p < 0.001; n = 25), whereas Day1‐fix and Day1 Cap‐Scores were equivalent (p = 0.43; n = 25). In 123 samples from 52 fertile men, Cap‐Score increased more than 1SD (7.7; calculated previously from a fertile cohort) from Day0 to Day1‐fix in 44% (54/123) of the samples. To test whether timing of capacitation was consistent within an individual, 52 samples from 11 fertile men were classified into either “early” or “late” capacitation groups. The average capacitation group concordance within a donor was 81%. Median absolute deviation (MAD; in Cap‐Score units) was used to assess the tightness of clustering of the difference from Day0 to Day1‐fix within individuals. The average (2.21) and median (1.98) MAD confirmed consistency within individuals. Together, these data show that the timing of capacitation differed among men and was consistent within men.
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Affiliation(s)
| | | | | | | | | | | | - Alexander J. Travis
- Androvia LifeSciencesMountainsideNew Jersey
- Baker Institute for Animal Health, College of Veterinary MedicineCornell UniversityIthacaNew York
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Vichinsartvichai P, Traipak K, Manolertthewan C. Performing IUI Simultaneously with hCG Administration Does Not Compromise Pregnancy Rate: A Retrospective Cohort Study. J Reprod Infertil 2018; 19:26-31. [PMID: 29850444 PMCID: PMC5960048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The probability of conception occurs before ovulation in natural cycle, thus performing IUI before ovulation should not compromise the pregnancy outcomes. METHODS A retrospective cohort study was conducted at a university hospital during 2007 to 2015. The ovarian stimulation and monitoring were performed as usual. The total of 29 preovulatory IUI, and 221 postovulatory IUI couples were recruited. In postovulatory IUI, 5,000 IU of hCG was injected when dominant follicle reached 17 mm. The IUI was performed 36 to 40 hr afterward. In preovulatory IUI, hCG was injected and IUI was performed simultaneously when the dominant follicle reached the size. Data were compared using independent sample t test and Fisher's exact test. A p-value of <0.05 was considered statistically significant. RESULTS The characteristics of both groups were comparable. The cumulative biochemical, clinical, and live birth rates were not different between prevulatory and postovulatory IUI groups (10.3% vs. 16.3%; p=0.407, 10.3% vs. 12.2%; p=0.77 and 10.3% vs. 11.3%; p=0.877, respectively). CONCLUSION Performing IUI simultaneously with hCG administration does not compromise pregnancy rate.
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Affiliation(s)
- Patsama Vichinsartvichai
- Corresponding Author: Patsama Vichinsartvichai, Infertility Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen rd., Dusit, Bangkok 10300, Thailand, E-mail:
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Effect of time interval between human chorionic gonadotropin injection and intrauterine insemination on pregnancy rate. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2016.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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The effect of delaying intrauterine insemination till 48 h after hCG injection on pregnancy rate. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2015.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Rao CV. Potential Therapy for Rheumatoid Arthritis and Sjögren Syndrome With Human Chorionic Gonadotropin. Reprod Sci 2015; 23:566-71. [PMID: 26239386 DOI: 10.1177/1933719115597765] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Autoimmune diseases such as rheumatoid arthritis (RA) and Sjögren syndrome (SS) ameliorate during pregnancy, through dampening (immunotolerance) of the maternal immune system which protects the fetus from rejection. A large number of studies have shown that human chorionic gonadotropin (hCG) contributes to this tolerance. Studies on animal models have reaffirmed that hCG treatment mimics the benefits of pregnancy. Based on the scientific evidence, randomized clinical trials comparing hCG with current therapies and/or placebo are recommended for RA, SS, and for other autoimmune diseases such as, type 1 diabetes and ankylosing spondylitis, which also get better during pregnancy and hCG treatment seems to help.
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Affiliation(s)
- C V Rao
- Department of Cellular Biology and Pharmacology, Molecular and Human Genetics and Obstetrics and Gynecology, Reproduction and Development Program, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
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Aaleyasin A, Aghahosseini M, Rashidi M, Safdarian L, Sarvi F, Najmi Z, Mobasseri A, Amoozgar B. In vitro fertilization outcome following embryo transfer with or without preinstillation of human chorionic gonadotropin into the uterine cavity: a randomized controlled trial. Gynecol Obstet Invest 2014; 79:201-5. [PMID: 25531413 DOI: 10.1159/000363235] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 04/24/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intrauterine injection of human chorionic gonadotropin (hCG) at embryo transfer (ET) has been shown to improve the outcome of assisted reproductive techniques. The aim of this study was to confirm previous findings. METHODS In this randomized controlled trial, 483 infertile women who were candidates for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) for the first time were randomly assigned to receive an intrauterine injection of 500 IU hCG or placebo (tissue culture media) before ET. The main outcome measures were implantation and clinical pregnancy rates. RESULTS Both the hCG-treated group (n = 240) and control group (n = 243) were similar at baseline in terms of demographic and obstetrical characteristics. There were significant differences between the two groups regarding the implantation rate (23.6 vs. 12.2%, p < 0.001), pregnancy rate (54.6 vs. 35.8%, p < 0.001), clinical pregnancy rate (50 vs. 32.1%, p < 0.001), ongoing pregnancy rate (15.3 vs. 9.2%, p < 0.001) and live delivery rate (14.3 vs. 8.4%, p < 0.001). The rate of fertilization and abortion rates were not statistically different. CONCLUSION Intrauterine injection of hCG before ET improves implantation and pregnancy rates and may be considered an adjuvant in IVF/ICSI.
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Affiliation(s)
- Ashraf Aaleyasin
- Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Arsenic-induced toxicity in the endometrium of adult albino rat and the possible role of human chorionic gonadotropin hormone. ACTA ACUST UNITED AC 2014. [DOI: 10.1097/01.ehx.0000446582.73701.1b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kleppe M, van Hooff MH, Rhemrev JP. Effect of total motile sperm count in intra-uterine insemination on ongoing pregnancy rate. Andrologia 2014; 46:1183-8. [DOI: 10.1111/and.12212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- M. Kleppe
- Department of Obstetrics and Gynaecology; Maastricht University Medical Centre; Maastricht The Netherlands
- Department of Obstetrics and Gynaecology; Bronovo Hospital; Den Haag The Netherlands
| | - M. H. van Hooff
- Department of Obstetrics and Gynaecology; Sint Franciscus Gasthuis; Rotterdam The Netherlands
| | - J. P. Rhemrev
- Department of Obstetrics and Gynaecology; Bronovo Hospital; Den Haag The Netherlands
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Cao S, Zhao C, Zhang J, Wu X, Zhou L, Guo X, Shen R, Ling X. A minimum number of motile spermatozoa are required for successful fertilisation through artificial intrauterine insemination with husband's spermatozoa. Andrologia 2013; 46:529-34. [PMID: 23701485 DOI: 10.1111/and.12109] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2013] [Indexed: 11/27/2022] Open
Affiliation(s)
- S. Cao
- State Key Laboratory of Reproductive Medicine; Department of Reproduction; Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University; Nanjing China
| | - C. Zhao
- State Key Laboratory of Reproductive Medicine; Department of Reproduction; Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University; Nanjing China
| | - J. Zhang
- State Key Laboratory of Reproductive Medicine; Department of Reproduction; Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University; Nanjing China
| | - X. Wu
- State Key Laboratory of Reproductive Medicine; Department of Reproduction; Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University; Nanjing China
| | - L. Zhou
- State Key Laboratory of Reproductive Medicine; Department of Reproduction; Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University; Nanjing China
| | - X. Guo
- State Key Laboratory of Reproductive Medicine; Department of Reproduction; Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University; Nanjing China
| | - R. Shen
- State Key Laboratory of Reproductive Medicine; Department of Reproduction; Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University; Nanjing China
| | - X. Ling
- State Key Laboratory of Reproductive Medicine; Department of Reproduction; Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University; Nanjing China
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