輔酶Q10是提高精子濃度最有效的治療方法

左旋肉鹼( Carnitine)是增強精子活力的最佳治療方法

Effects of Carnitine and Coenzyme Q10 on Sperm Quality and Pregnancy Rates in Men with Unexplained Infertility: A Systematic Review and Network Meta-Analysis

Aims

To study and explore the effects of oral Carnitine and Coenzyme Q10 on the quality of sperm and the rate of pregnancy in males with unexplained infertility.

Background

Preventing and reducing oxidative stress is essential for male infertility treatment. Antioxidants can effectively improve sperm quality and maintain sperm motility, thereby improving male fertility. At present, the most commonly used antioxidants in the clinic are carnitine and coenzyme Q10.

Methods

In this study, the effects of carnitine and coenzyme Q10 antioxidants on sperm quality and the rate of pregnancy in men with unexplained infertility were explored using a network meta-analysis method. The Cochrane Library, EMBASE, Web of Science and PubMed databases were searched for relevant studies. The observed indicators included semen concentration, progressive sperm motility, the rate of morphologically normal sperm and pregnancy rate.

Results

16 pieces of literature were included after rigorous screening. L-carnitine, coenzyme Q10 and L-carnitine + acetyl-L-carnitine significantly improved sperm quality parameters compared with placebo. CoQ10 induced the highest increase in sperm concentration (SMD 2.98 [95% CI: 1.13 to 7.87]). Furthermore, L-Carnitine has the greatest improvement effect on progressive sperm motility (SMD 4.19 [95% CI: 1.60 to 10.95]).

Conclusions

CoQ10 was the most effective intervention measure for improving sperm concentration, and L-carnitine was regarded as the best treatment method for enhancing sperm motility. In the future, we need more high-quality and large-sample studies to verify the effectiveness of antioxidants in the treatment of male infertility.

AMH水平與胚胎blastomere多核胚胎(MLN)的發生率有關

AMH水平每增加一個單位，MLN胚胎形成的風險就會增加1.12倍。

懷孕MLN胚胎/總胚胎的平均比率為0.34±0.18，

未懷孕MLN胚胎/總胚胎的平均比率為0.47±0.3（p=0.010）

Do serum AMH levels affect the incidence rate of multinucleated embryos in ICSI cycles?

A blastomere containing more than one nucleus is defined as a multinucleated blastomere. In our study, we aimed to investigate the relationship between serum anti-Mullerian hormone (AMH) levels and multinucleated (MLN) embryos, one of the parameters indicating embryo quality, in intracytoplasmic sperm injection (ICSI) cycles. The results of 888 ICSI cycles of patients aged 19–45 years attending an ART (assisted reproductive technology) clinic were retrospectively analysed. Cycles with at least one MLN embryo were defined as the study group (n = 237) and cycles without MLN embryos as the control group (n = 651). Univariate and multivariate logistic regression analyses were used to determine the risk factors affecting the dependent qualitative variables. The effect of AMH levels on multinucleation was found to be a significant risk factor (p < 0.001). One unit increase in AMH levels increases the risk of the presence of MLN embryos by 1.12 times. The mean MLN embryos/total embryo ratio in the group with clinical pregnancy was 0.34 ± 0.18, while the mean MLN embryos/total embryo ratio in the group that did not achieve clinical pregnancy was 0.47 ± 0.3 (p = 0.010). The presence of an MLN embryo has been associated with poor embryo development and ART outcomes. Parameters that can predict the formation of MLN embryos before treatment are crucial for the determination of the pregnancy rate. According to our results, serum AMH levels can be used as a predictive marker for the formation of MLN embryos.

 抗苗勒氏管激素 (AMH) 臨界值以確定多囊性卵巢形態

l      評估 AMH 臨界值 3.2 ng/mL 在經陰道超音波 (TVUS) 確定 PCOM 狀態的有效性。

l     根據血清AMH或陰道超音波(TVUS)檢測結果，計算PCOM陽性病例（PCOS表型為A、C或D的參與者）和陰性對照的數量。

l     3.2 ng/mL為AMH截斷值，   AMH 3.2 ng/m用於檢測PCOM的高準確性。在所有PCOM陽性的PCOS表型和體質指數分類中，AMH與PCOM狀態也具有一致性       

Original ArticleVolume 124, Issue 3p543-552  2025/9/162025

Anti-Müllerian hormone cutoff to determine polycystic ovarian morphology: HARMONIA study

• To verify the anti-Müllerian hormone (AMH) cutoff (3.2 ng/mL) for the determination of polycystic ovarian morphology (PCOM) as part of the latest polycystic ovary syndrome (PCOS) diagnosis in an independent prospective cohort of women of reproductive age.
• Assessment of the performance of the AMH cutoff of 3.2 ng/mL to identify PCOM status determined by transvaginal ultrasound (TVUS).
• The number of PCOM-positive cases (participants with PCOS phenotypes A, C, or D) and negative controls according to serum AMH or TVUS.
• Other measures included PCOM status within selected PCOS phenotypes and demographic/clinical factors including body mass index.
• Applying the AMH cutoff of 3.2 ng/mL, 118 of 128 cases and 639 of 820 controls were identified in accordance with TVUS (overall percent agreement, 79.9%).
• Agreement of AMH with PCOM status was also observed across all PCOM-positive PCOS phenotypes and body mass index categories.
• Conclusion
• The Elecsys AMH Plus immunoassay cutoff of 3.2 ng/mL was successfully verified, showing high accuracy to detect PCOM.
•  On the basis of current guideline recommendations for the detection of PCOM as part of PCOS diagnosis, these data support use of the AMH test as an easy-access diagnostic workup tool compared with TVUS.

 

 

 

Original ArticleVolume 124, Issue 3p468-477September 2025

Patients with a body mass index of ≥45 kg/m2 can safely undergo oocyte retrievals and anticipate similar assisted reproductive technology outcomes

比較體重指數 (BMI) 為 40-44.9 kg/m² 的患者與 BMI ≥45 kg/m² 的患者 的麻醉和輔助生殖技術 (ART) 結局。

l 本研究共納入 98 名 BMI ≥40 kg/m² 且接受取卵的患者：其中 BMI 在 40 至 44.9 kg/m² 之間的患者 56 名，BMI ≥45 kg/m² 的患者 42 名。

所有病人均成功接受靜脈鎮靜治療，無需更高程度的鎮靜或照護。

BMI ≥45 kg/m² 的患者平均手術時間比 BMI 40-44.9 kg/m² 的患者更長（26.8 分鐘 [標準差，13 分鐘] vs. 22.3 分鐘 [標準差，8.4 分鐘]）。

兩組在成熟卵母細胞獲獲數量、第 5/6 天囊胚數、整倍體胚胎數、臨床懷孕率、流產率或活產率均無差異。

使用靜脈鎮靜時，BMI ≥45 kg/m² 的患者與 BMI 40-44.9 kg/m² 的患者相比，其輔助生殖技術 (ART) 結局相似，且麻醉或輔助生殖技術併發症較少。

在適當的諮詢和術前準備下，BMI ≥45 kg/m² 的患者可以安全地進行取卵。

To compare anesthesia and assisted reproductive technology (ART) outcomes in patients with a body mass index (BMI) of 40–44.9 kg/m2 with those with a BMI of ≥45 kg/m2 because these patients are often excluded from care.

l           A total of 98 patients with a BMI of ≥40 kg/m2 undergoing oocyte retrieval were identified for the study: 56 patients with a BMI from 40 to 44.9 kg/m2 and 42 patients with a BMI of ≥45 kg/m2.

l           Demographics were not statistically significantly different between both groups, except that more patients with a BMI of 40–44.9 kg/m2 identified as White (73% vs. 60%) or Black (9% vs. 0).

l           All patients were successfully managed with intravenous sedation and did not require higher level of sedation or care.

l           The mean surgical duration was longer in patients with a BMI of ≥45 kg/m2 than in those with a BMI of 40–44.9 kg/m2 (26.8 minutes [standard deviation, 13 minutes] vs. 22.3 minutes [standard deviation, 8.4 minutes]).

l          There was no difference in the number of mature oocytes retrieved, day 5/6 blastocysts, the number of euploid embryos, or clinical pregnancy, miscarriage, or live birth rates.

l          When using intravenous sedation, patients with a BMI of ≥45 kg/m2 have similar ART outcomes with few anesthesia or ART complications compared with those with a BMI of 40–44.9 kg/m2.

l          With appropriate counseling and preoperative preparation, patients with a BMI of ≥45 kg/m2 can safely undergo oocyte retrieval.

使用progestin(PPOS, duphaston 20mg/d) vs  GnRH antagonist 應用於試管誘導排卵之LH抑制 

PPOS 組和 GnRH antagonist的整倍體率相當（分別為 12.5% 和 16.0%，P > 0.05）。

兩組FET在每次移植的妊娠試驗陽性率、臨床懷孕率、流產率、子宮外孕率或活產率方面均無顯著差異。

Comparison of the euploidy rate  following progestin-primed vs GnRHantagonist protocol

• Euploidy rate was comparable between the PPOS and antagonist group (12.5% vs. 16.0% respectively, P > 0.05). 
• No significant differences were observed between the two groups in positive pregnancy test, clinical pregnancy, miscarriage, ectopic pregnancy, or live birth rates per transfer in the first frozen embryo transfer cycles.
• Both PPOS and antagonist protocols had similar euploidy rates in PGT-A cycles.

Variables	PPOS group (n = 120)	Antagonist group (n = 120)	P-value
Starting dose of FSH (IU)	225.0 (225.0-225.0)	225.0 (225.0-225.0)	0.134
Total dosage of FSH (IU)	1800.0 (1575.0-2025.0)	1800.0 (1575.0-2212.5)	0.010
Duration of stimulation (days)	8.0 (7.0-8.8)	8.0 (7.0–9.0)	0.053
Serum estradiol level on trigger day (pg/ml)	1870.5 (912.7-2940.1)	1061.3 (592.0-2614.1)	0.007
Serum LH level on trigger day (IU/l)	4.3 (2.7–5.9)	2.4 (1.6–3.6)	0.000
Serum progesterone level on trigger day (ng/ml)	0.9 (0.6–1.2)	0.8 (0.6–1.2)	0.588
Premature ovulation (%)	0.8 (1/120)	0.8 (1/120)	1
No. of retrieved oocytes (n)	6.0 (3.0–10.0)	5.0 (3.0–10.0)	0.914
No. of mature occytes (n)	4.5 (2.0–8.0)	4.0 (3.0–9.0)	0.980
No. of oocytes fertilized (n)	3.0 (2.0–7.0)	3.0 (2.0–6.0)	0.728
Fertilization rate (%)	94.4 (75.0-100)	92.9 (75.0-100)	0.746
Cleavage rate (%)	100 (100–100)	100 (100–100)	0.648
No. of blastocysts formation (n)	1.5 (0–3.0)	1.0 (0–3.0)	0.422
Blastocysts formation rate (%)	59.4 (33.3–100)	50.0 (33.3–80)	0.299
Total No. of euploid blastocysts	93	97
No. of euploid blastocysts (n)	0 (0–1.0)	0 (0–1.0)	0.995
Euploid blastocysts rate per injected oocyte (%)	12.5 (0–25.0)	16.0 (0-27.7)	0.477
Euploid blastocysts rate per woman (%)	33.3 (0-66.7)	50.0 (0-66.7)	0.459
No. of cycles with no blastocyst for biopsy (%)	27.5 (33/120)	30.0 (36/120)	0.669
No. of cycles with no euploid blastocysts for transfer (%)	52.5 (63/120)	55.0 (66/120)	0.698

PPOS group (n = 53)	Antagonist group (n = 47)	P-value
Endometrial preparation, n (%)			0.995
Natural cycles	1.9 (1/53)	2.0% (1/47)
Clomid-induced	11.5 (6/53)	10.0 (5/47)
Hormonal cycles	83.0 (44/53)	91.5 (43/47)
Endometrial thickness (day of trigger) (mm)	10.0 (8.6–11.0)	9.1 (8.5–10.4)	0.600
hCG test positive rate (%)	66.0 (35/53)	70.2 (33/47)	0.655
Clinical pregnancy rate (%)	58.5 (31/53)	59.6 (28/47)	0.912
Clinical miscarriage rate (%)	9.7 (3/31)	17.9 (5/28)	0.359
Ectopic pregnancy rate (%)	0 (0/35)	0 (0/33)	0
Live birth rate (%)	52.8 (28/53)	48.9 (23/47)	0.359

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使用progestin(PPOS, duphaston 20mg/d) vs  GnRH agonist vs GnRH antagonist 應用於試管誘導排卵之LH抑制 

本研究評估了黃體素促排卵方案 (PPOS)、促性腺激素釋放激素（GnRH）激動劑方案和促性腺激素釋放激素（GnRH）拮抗劑方案植入前非整倍體基因檢測 (PGT-A) 週期的整倍體率及懷孕結果。

整倍體囊胚率/MII卵母細胞比率 在三組間相當(14.60% vs. 14.09% vs. 13.94%) 

在生化妊娠、臨床妊娠、持續妊娠、著床率、流產率、異位妊娠率以及首次FET週期每次移植的活產率等妊娠結局方面，三組間均無顯著差異 (p > 0.05)。

PPOS 方案對整倍體囊胚形成沒有負面影響，

POS 方案的 FET 週期的懷孕結果與GnRH agonist 和 GnRH antagonist 懷孕結果相似

PPOS 有倒排卵時間較短 排卵針劑量較低  取卵數略低於GnRH agonist 和 GnRH antagonist

Analysis of euploidy rates in preimplantation genetic testing for aneuploidy cycles with progestin-primed versus GnRH agonist/antagonist protocol

This study evaluate euploidy rates and pregnancy outcomes in preimplantation genetic testing for aneuploidy (PGT-A) cycles using progestin-primed ovarian stimulation (PPOS) vs  GnRH agonist vs GnRH antagonist protocol.

The euploid blastocyst rate per injected metaphase II(MII) oocytes (14.60% vs. 14.09% vs. 13.94%) was comparable among the three groups (p > 0.05). 

No significant differences were observed among the three groups regarding pregnancy outcomes, including biochemical pregnancy, clinical pregnancy, ongoing pregnancy, implantation, miscarriage, ectopic pregnancy, and live birth rates per transfer in the first FET cycles (p > 0.05).

The PPOS protocol had no negative effect on euploid blastocyst formation, and the pregnancy outcomes in FET cycles using the PPOS protocol were similar to those of the GnRH agonist and antagonist protocols.

Variables	Ovarian stimulation protocol			p value
	PPOS	GnRH agonist	GnRH antagonist
No. of PGT-A cycles	146	160	302
Total dosage of Gn (IU)	1800(1575–2025)	2550(2071.86–3150)	2025(1593.75–2400)	0.000a,b,c
Duration of stimulation (days)	8(7–9)	11.5(10–13)	9(8–9)	0.000a,b,c
Oestradiol level on triggering day (pg/ml)	2420.92(1290–3533.49)	2641(1973.32–3668.44)	2017.36(1268.5–3017)	0.003c
Serum LH level on trigger day (IU/l)	3(1.94–5)	0.86(0.59–1.68)	2(1–3.29)	0.000a,b,c
Progesterone level on trigger day (ng/ml)	1(0.77–1)	0.98(0.71–1.26)	1(0.73–1.32)	0.588
Total No. of retrieved oocytes	1280	1892	2999
No. of retrieved oocytes	7(4–12)	12(7–15)	8(5–13)	0.000a,c
Total No. of MII	1062	1483	2374
No. of MII (n)	6(3–10)	9(6–12)	6(4–11)	0.000a,c
MII rate (%)	82.97%(1062/1280)	78.38%(1483/1892)	79.16%(2374/2999)	0.004a,b
Total No. of oocytes fertilised (n)	815	1014	1716
No. of oocytes fertilised (n)	4.5(2–8)	6(3–9)	5(3–8)	0.014a,c
Oocytes fertilised rate (%)*	76.74%(815/1062)	68.37%(1014/1483)	72.28(1716/2374)	0.000a,b,c
Total No. of cleaving embryos (n)	793	975	1668
Cleavage rate (%)*	97.3%(793/815)	96.15%(975/1014)	97.2%(1668/1716)	0.24
Total No. of blastocyst culture	765	996	1625
Total No. of blastocysts formation	333	454	723
No. of blastocysts formation (n)	2(0–3)	2(1–4)	2(1–4)	0.036a,c
Blastocysts formation rate (%)*	43.53%(333/765)	45.58%(454/996)	44.49%(723/1625)	0.687
Total No. of euploid blastocysts	155	209	331
No. of euploid blastocysts (n)	0(0–2)	1(0–2)	1(0–2)	0.084
Euploid blastocysts rate per biopsy (%)*	46.54%(155/333)	46.04%(209/454)	45.78%(331/723)	0.973
Euploid blastocysts rate per injected MII (%)*	14.60%(155/1062)	14.09%(209/1483)	13.94%(331/2374)	0.878
No. of PGT cycle with no blastocyst (%)	28.1%(41/146)	14.38%(23/160)	21.52%(65/302)	0.013a
No. of PGT cycle with no transferable blastocysts (%)*	51.37%(75/146)	38.75%(62/160)	47.02%(142/302)	0.074