The incidence of apoptotic bodies in membrana granulosa can predict prognosis of ova from patients participating in in vitro fertilization programs

Decreased oocyte-granulosa cell gap junction communication and connexin expression in a type 1 diabetic mouse model

In women, type 1 diabetes is associated with an increased risk of poor prenatal outcomes such as congenital anomalies and early miscarriage. In murine models of type 1 diabetes, impaired oocyte meiotic maturation, abnormal oocyte metabolism, and increased granulosa cell apoptosis have been noted. because gap junction communication is critical for the regulation of oocyte growth and meiotic maturation, we investigated the level of communication between the oocyte and surrounding cumulus cells in a streptozotocin-induced type 1 diabetic B6SJL/F1 mouse model and the expression of gap junction proteins known as connexins. Fluorescence recovery after photobleaching analyses of cumulus cell-enclosed oocytes (CEOs) from diabetic mice showed a 60% decrease in communication as compared with CEOs from nondiabetic mice. Real-time RT-PCR analyses confirmed the presence of Cx26, Cx37, and Cx57 mRNA and revealed a significant decrease in Cx37 mRNA expression in oocytes from diabetic mice compared with nondiabetic mice. Western analyses detected Cx26 expression in CEO but not denuded oocyte (DO) samples, and Cx37 in DO samples. Cx26 protein levels were decreased by 78% in CEOs from diabetic mice, and Cx37 protein levels were decreased 36% in DOs from diabetic mice. This decrease in connexin expression and gap junction communication in CEOs from diabetic mice may be responsible for the impaired oocyte meiotic maturation and poor pregnancy outcomes.

Effect of GnRH down-regulation on cumulus cell viability and apoptosis as measured by fluorescence-activated cell sorting

OBJECTIVE

To determine whether gonadotropin releasing hormone (GnRH)-agonist or -antagonist induces higher percentages of cumulus cell apoptosis and if the use of either is detrimental to ART outcomes.

PATIENTS

Women in a private facility under treatment for IVF had their cumulus cells isolated and analyzed by flow cytometry. Viable, apoptotic, and dead cumulus cell rates related to ovarian stimulation by GnRH-agonist or -antagonist were measured and compared with fertilization and implantation rates.

RESULTS

Treatment with GnRH-agonist produced a greater number of follicles than treatment with GnRH-antagonist. No differences in implantation and pregnancy rates were found. While cumulus cell (CC) apoptosis was positively correlated with estradiol on the day of hCG administration, no significant difference in the percentage of apoptotic cells between treatments was detectable. Additionally, implantation rate and the average follicular estradiol production on the day of hCG administration were no different between treatments.

CONCLUSIONS

GnRH-agonist or -antagonist treatment protocols induce similar levels of apoptosis in CCs and are not detrimental to ART outcomes.

Long-term effects of GnRH agonist, GnRH antagonist, and estrogen plus progesterone treatment on apoptosis related genes in rat ovary

OBJECTIVE

To define the long-term effects of GnRH antagonist, GnRH agonist, and estrogen plus progesterone treatments on apoptosis and apoptosis-related gene expressions, including bcl2, bax, and cyt c in rat ovary.

DESIGN

Prospective placebo-controlled experimental study.

SETTING

Obstetrics and Gynecology and Medical Biology and Genetics university departments.

ANIMAL(S)

Forty female wistar rats that were 3 to 4 months of age.

INTERVENTION(S)

Forty rats were randomly divided into 4 groups of 10 each. In group 1 (control) each rat received normal saline as placebo by gastric lavage. In group 2 (GnRH agonist) 1 mg/kg leuprolide acetate in depot form was given for 30 days. In group 3 (GnRH antagonist) each animal received 0.1 mg/kg cetrorelix every 2 days. In group 4 (estrogen plus progesterone) 0.5 mg/kg estradiol valerate and norethisterone enantate in depot form was given every 30 days. After 60 days, the animals were killed.

MAIN OUTCOME MEASURE(S)

Assessment of morphology, histology of ovaries, determination of the number of apoptotic cells, and analysis of apoptosis-related gene expression of bcl2, bax, and cyt c in the rat ovaries.

RESULT(S)

Long-term GnRH antagonist treatment significantly increased bax gene expression, but the ratio of bcl2:bax gene expression was constant compared with control group. The GnRH agonist treatment significantly increased cyt c gene expression, and estrogen plus progesterone treatment significantly decreased bcl 2 and significantly increased cyt c expressions. In the estrogen plus progesterone group, ovaries were cystic and larger than in the other groups. There was no significant morphologic change between the other groups.

CONCLUSION(S)

Long-term administration of GnRH agonist, GnRH antagonist, and estrogen plus progesterone can modulate the apoptosis-related genes in rat ovary. Although GnRH antagonist treatment does not influence apoptosis, GnRH antagonist and estrogen plus progesterone treatments seem to influence apoptosis in rat the ovary. Further clinical studies focusing on the effect of these agents on apoptosis-related genes could be performed.

Glucose metabolism in pregnancy and embryogenesis

PURPOSE OF REVIEW

It has been known for decades that diabetic women have somewhat decreased fertility and that their offspring have an increased risk of being born with developmental abnormalities. We review results from studies examining the impact of maternal hyperglycemia and diabetes on oocyte and early embryo development. We focus on the effects of the maternal milieu on metabolism, cell signaling and the regulation of glucose-transporter expression in the developing oocyte and embryo.

RECENT FINDINGS

Offspring of diabetic mothers have metabolic disease at higher rates than can be explained by genetic inheritance alone. Oocytes from hyperglycemic animals display several abnormalities and are of lower quality than oocytes from control animals. There appears to be a decrease in glucose transport in embryos exposed to a hyperglycemic environment, which may lead to programmed cell death.

SUMMARY

Maternal hyperglycemia and diabetes have detrimental effects on the developing embryo at several stages of development. Although the exact pathophysiology of the developmental defects seen in infants born to diabetic mothers remains unclear, the role of glucose transport and regulation seems to play a critical role in early growth and development.

Glutathione S-transferase theta 1 expressed in granulosa cells as a biomarker for oocyte quality in age-related infertility

OBJECTIVE

The goal of this study was to identify a reliable biomarker for age-related infertility.

DESIGN

Laboratory study.

SETTING

ART laboratory.

PATIENT(S)

Patients undergoing intracytoplasmic sperm injection or IVF cycles.

INTERVENTION(S)

Expression of Glutathione S-transferase (GST) mRNA and protein in mural and cumulus granulosa cells obtained from infertile patients were examined by reverse transcriptase-polymerase chain reaction and immunofluorescence.

MAIN OUTCOME MEASURE(S)

Correlation between the expression of GST theta 1 (GSTT1) in granulosa cells and oocyte quality was a main outcome measure.

RESULT(S)

Expression of GSTT1 in granulosa cells from male factor patients was positively correlated with age and negatively with cumulus-oocyte complex maturity. When samples with high and low GSTT1 in granulosa cells were extracted from the other infertility factors, cumulus-oocyte complex maturity in the high GSTT1 group was significantly lower than that in the low GSTT1 group (high: 27.2% vs. low: 51.3%). The developmental capacity of oocytes in the high GSTT1 group was likely to be lower (high: 26.4% vs. low: 43.9%). Up-regulation of GSTT1 during aging may be promoted by FSH and H(2)O(2), determined by an in vitro model.

CONCLUSION(S)

GSTT1 is a good indicator for age-related infertility.

Evaluation of oocyte quality: morphological, cellular and molecular predictors

Mounting evidence that oocyte quality profoundly affects fertilisation an d subsequent embryo development drives the continued search for reliable predictors of oocyte developmental competence. In the present review, we provide an overall summary and analysis of potential criteria that can be used to evaluate oocyte quality. These criteria are specifically classified as morphological and cellular/molecular predictors. Traditional methods for the evaluation of oocyte quality are based on morphological classification of thefollicle, cumulus-oocytecomplex, polar body and/or meiotic spindle. Although the use of morphological characteristics as predictors of oocyte quality is controversial, such a grading system can provide valuable information for the preselection of oocytes with higher developmental competence and, therefore, may maximise embryo developmental outcome. Several intrinsic markers (such as mitochondrial status and glucose-6-phosphate dehydrogenase 1 activity) and extrinsic markers (such as apoptosis of follicular cells and levels of the transforming growth factor-beta superfamily in follicular fluid or serum) have also been reported as useful indicators of oocyte competence and embryo quality. Compared with the morphological parameters, these cellular and molecular predictors of oocyte quality may prove to be more precise and objective, although further studies and refinement of techniques are needed.

Anti-Müllerian hormone concentrations in the follicular fluid of the preovulatory follicle are predictive of the implantation potential of the ensuing embryo obtained by in vitro fertilization

CONTEXT

The strong relationship between serum anti-Müllerian hormone (AMH) levels and the number of antral follicles supports the use of AMH measurements as a quantitative marker of the ovarian follicular status. Yet, it still is unclear whether the aptitude of an individual follicle to produce AMH reflects its reproductive competence.

OBJECTIVE

This study examined the possible relationship between serum or follicular fluid (FF) AMH concentrations and the fate of the ensuing oocytes and embryos obtained by in vitro fertilization-embryo transfer conducted in monodominant follicle cycles.

DESIGN AND SETTING

We conducted a prospective study at the University of Paris XI, Assistance Publique-Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale U782.

PATIENTS

Patients included 118 infertile in vitro fertilization-embryo transfer candidates.

INTERVENTIONS

Concentrations of AMH, progesterone, and estradiol were measured in the serum on cycle d 3 and on the day of oocyte pickup (dOPU), and in FF. Cycles were sorted into three sets of three distinct groups according to whether serum d 3, serum dOPU, and FF AMH concentrations were 30th centile or below (low AMH), between the 31st and the 70th centiles (average AMH), or above the 70th centile (high AMH) of measurements.

MAIN OUTCOME MEASURE

Clinical pregnancy and embryo implantation rates were assessed.

RESULTS

Clinical pregnancy rates (5.7, 20.0, and 39.5%, respectively; P < 0.002) and embryo implantation rates (11.8, 30.8, and 65.4, respectively; P <0.001) were markedly different among the low, moderate, and high FF AMH groups but not among the serum (d 3 or dOPU) AMH groups. Fertilization rates and embryo morphology remained similar irrespective of AMH concentrations in the serum or in FF. Incidentally, FF AMH concentrations were negatively correlated with FF progesterone (r = -0.27; P <0.003) and FF estradiol (r = -0.21; P <0.02) concentrations.

CONCLUSIONS

Concentrations of AMH in the FF, but not in the serum, constitute a useful follicular marker of embryo implantation and are negatively related to FF progesterone and estradiol concentrations.

Effect of apoptosis and reactive oxygen species production in human granulosa cells on oocyte fertilization and blastocyst development

PURPOSE

The aim was to establish the impact of human granulosa cell apoptosis and reactive oxygen species (ROS) production on fertilization competence of the oocyte, embryo developmental stage and implantation rate.

METHODS

Thirty women undergoing IVF-ET for tubal factor infertility were included; GnRH antagonists and gonadotrophins were used for ovarian stimulation. Granulosa cells were isolated from each aspirated follicle using gradient centrifugation. Apoptosis was studied by flow cytometry using annexin V and propidium iodide. ROS production was studied with hydroethidine staining and analyzed by flow cytometry.

RESULTS

There were no differences in characteristics of granulosa cells between the follicles with fertilized and non-fertilized oocytes. The analyzed characteristics of granulosa cells in corresponding follicles had no effect on embryo developmental stage on day 5. The percentage of ROS producing granulosa cells was lower in the follicles giving rise to blastocysts that resulted in implantation compared to those that did not (39.9% versus 69.9%, P = 0.031).

CONCLUSIONS

Apoptosis and ROS production in granulosa cells have no significant impact on fertilization and do not correlate with the development of blastocysts. An increased percentage of ROS producing granulosa cells results in fewer oocytes retrieved and diminishes implantation rate.

Regulated upon activation, normal T cell expressed and secreted (RANTES) and monocyte chemotactic protein 1 in follicular fluid accumulate differentially in patients with and without endometriosis undergoing in vitro fertilization

OBJECTIVE

To compare the amount of regulated upon activation, normal T cell expressed and secreted (RANTES) and monocyte chemotactic protein 1 (MCP-1) in follicular fluid (FF) of patients with and without endometriosis and to determine their oocyte fertilization and pregnancy rates.

DESIGN

Case-control study.

SETTING

Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Campus Luebeck, Germany.

PATIENT(S)

Thirty-two women with endometriosis stages I-IV and 28 women without endometriosis, both groups surgically and histologically confirmed.

INTERVENTION(S)

Diagnostic laparoscopy, IVF-ET.

MAIN OUTCOME MEASURE(S)

RANTES and MCP-1 levels in follicular fluid, measured by ELISA, and oocyte fertilization and pregnancy rates.

RESULT(S)

Follicular response and days of gonadotropin stimulation were similar between the two groups. The levels of RANTES in FF from patients with endometriosis were significantly higher (460.4 +/- 90.3 pg/mL) compared with concentrations in patients with tubal infertility (243.8 +/- 70.9 pg/mL; P<.05). In contrast, MCP-1 concentrations in FF from women with endometriosis (330.0 +/- 29.2 pg/mL) were lower than in women with tubal infertility (420.5 +/- 46.6 pg/mL; P<.05). Oocyte fertilization rates in the endometriosis group (54%) were significantly lower than those of the tubal infertility group (73%; P<.05), as were the pregnancy rates (19% vs. 35%, respectively; P<.01).

CONCLUSION(S)

Women with endometriosis-associated infertility have a poor IVF outcome. Immune cell recruitment into the ovary might affect follicular function and lead to impaired oocyte quality.

The importance of folate, zinc and antioxidants in the pathogenesis and prevention of subfertility

Current treatments of subfertile couples are usually empiric, as the true cause of subfertility often remains unknown. Therefore, we outline the role of nutritional and biochemical factors in reproduction and subfertility. A literature search was performed using MEDLINE, Science Direct and bibliographies of published work with both positive and negative results. The studies showed that folate has a role in spermatogenesis. In female reproduction, folate is also important for oocyte quality and maturation, implantation, placentation, fetal growth and organ development. Zinc has also been implicated in testicular development, sperm maturation and testosterone synthesis. In females, zinc plays a role in sexual development, ovulation and the menstrual cycle. Both folate and zinc have antioxidant properties that counteract reactive oxygen species (ROS). Thiols, such as glutathione, balance the levels of ROS produced by spermatozoa and influence DNA compaction and the stability and motility of spermatozoa. Oocyte maturation, ovulation, luteolysis and follicle atresia are also affected by ROS. After fertilization, glutathione is important for sperm nucleus decondensation and pronucleus formation. Folate, zinc, ROS and thiols affect apoptosis, which is important for sperm release, regulation of follicle atresia, degeneration of the corpus luteum and endometrial shedding. Therefore, the concentrations of these nutrients may have substantial effects on reproduction. In conclusion, nutritional and biochemical factors affect biological processes in male and female reproduction. Further research should identify pathways that may lead to improvements in care and treatment of subfertility.

L'apoptose des cellules de la granulosa peut-elle être considérée comme un marqueur prédictif du succès de la fécondation in vitro ?

During in vitro fertilization (IVF) morphological criteria are the only means usable today to select embryos before their uterine transfer in order to obtain pregnancy with the best chances of success. Since several years many attempts have been made to find more functional means. Quantification of apoptosis of granulosa cells has been proposed for this purpose. The aim of this review is to take stock of our knowledge on apoptosis and its mechanisms in granulosa cells and to analyse how quantification of these apoptotic cells could be a reliable and predictive marker of success for an attempt of an IVF in terms of pregnancy.

Apoptosis of cultured granulosa-lutein cells is reduced by insulin-like growth factor I and may correlate with embryo fragmentation and pregnancy rate

OBJECTIVE

To correlate apoptosis of cultured human granulosa-lutein cells (GL cells) with the outcome of IVF (embryo fragmentation and pregnancy rate) and to study the effect of insulin and insulin-like growth factor I (IGF-I) on apoptosis.

DESIGN

In vitro assays.

SETTING

University laboratory and private IVF center.

PATIENT(S)

Eighty-one women undergoing IVF.

INTERVENTION(S)

Purified human GL cells from pooled follicles were cultured for 48 hours in serum-free media with or without insulin and IGF-I. Cumulus cells and mural GL cells were evaluated separately.

MAIN OUTCOME MEASURE(S)

Detection of apoptosis by using caspACE FITC-VAD-FMK, a fluorescent in situ marker for activated caspases; embryo fragmentation; and pregnancy.

RESULT(S)

Age younger than 38 years and successful pregnancy were associated with less apoptosis (33.0% +/- 17.2% vs. 43.2% +/- 18.0% and 30.2% +/- 14.0% vs. 40.4% +/- 19.5%, respectively). There was a linear correlation between embryo fragmentation and GL cell apoptosis. Insulin-like growth factor I decreased apoptosis in a dose-dependent fashion. A statistically significant effect (17% decrease) was reached at a dose of 10 nM. Insulin (10 nM) caused a small (8%) decrease in apoptosis, but this effect did not reach statistical significance. Cumulus cells consistently had <3% apoptosis.

CONCLUSION(S)

[1] Apoptosis of cultured GL cells may be associated with IVF outcome and ovarian reserve and [2] IGF-I decreases apoptosis of cultured GL cells.

Effects of Gonadotrophin-Releasing Hormone Agonists on Apoptosis of Granulosa Cells

Granulosa cells are known to contribute to maturation of oocytes, and most of the growth factors exert their action via granulosa cells. It has been established that granulosa cell death during follicular atresia and luteolysis results from apoptosis. However, the precise mechanistic pathways of granulosa cell apoptosis have not yet been defined. In this study, we determined the proportions of apoptosis in granulosa cells treated with two kinds of gonadotrophin-releasing hormone agonists (GnRHa): buserelin and leuprorelin depot. The incidences of DNA fragmentation of human granulosa cells treated with buserelin and leuprorelin were 54.33% and 39.02%, respectively. The proportions of apoptotic bodies were 6.04% and 4.29%, respectively. There was a significant difference in the proportions of DNA fragmentation between the two kinds of GnRHa-treated granulosa cells. The apoptosis pathway and associated protein expression in granulosa cells treated with GnRHa were also determined. The Bax molecule, a pro-apoptosis protein, was expressed in granulosa cells undergoing apoptosis. In contrast, Bcl-2, an anti-apoptosis protein, could not be detected in the same group of granulosa cells. The distribution of cytochrome c determined via immunostaining showed a diffuse pattern, which most likely indicated that cytochrome c was translocated from mitochondria into the cytoplasm. Western blotting showed the expressions of caspase-9 and caspase-3 in patients' granulosa cells. The GnRHa effects on granulosa cells indicated a higher incidence of DNA fragmentation and apoptotic bodies in the buserelin-treated than in the leuprorelin depot-treated group. The granulosa cells go through the mitochondria-dependent apoptosis pathway; the indicated pro-apoptosis protein Bax was expressed and induced cytochrome c release from mitochondria, which then activated caspase-9 and caspase-3 until cell death occurred.

Deleted Mitochondrial DNA in Human Luteinized Granulosa Cells

The rearrangement of mitochondrial DNA in luteinized granulosa cells was determined in order to evaluate the fertilization capacity of oocytes and the development of embryos. Multiple deletions of mtDNA were found in luteinized granulosa cells from in vitro fertilization (IVF) patients. The 4977-base pair (bp) deletion was the most frequent deletion found in human granulosa cells. No significant difference was noted between mtDNA deletions of granulosa cells based on the fertilization capacity of oocytes and the development of embryos. To determine the relationship of proportions of mtDNA rearrangements with the aging process, granulosa cells were grouped into three different cohorts according to maternal age: younger than 32 years, between 32 and 37 years, and older than 37 years. No statistical correlation was noted between patient age and the frequency of occurrence of multiple mtDNA deletions. However, an increase in granulosa cell apoptosis was associated with an increase in mtDNA deletions. Accumulation of mtDNA deletions may contribute to mitochondrial dysfunction and impaired ATP production. We concluded that the accumulation of rearranged mtDNA in granulosa cells might not interfere with fertilization of human oocytes and further embryonic development; it was, however, associated with apoptosis processes.

Predictive value of cumulus cell apoptosis with regard to blastocyst development of corresponding gametes

OBJECTIVE

To test if a high degree of apoptosis in cumulus cells could indicate diminished oocyte quality and developmental competence.

DESIGN

Prospective analysis.

SETTING

Public hospital and university.

PATIENT(S)

Thirty seven women who gave written consent to participate in this study.

INTERVENTION(S)

Cumulus-oocyte complexes were denuded separately and the resulting cumulus cell suspensions were analyzed for presence of apoptosis using a terminal deoxynucleotidyl transferase-mediated digoxigenin-dUTP nick-end labeling (TUNEL) assay detection kit.

MAIN OUTCOME MEASURE(S)

Percentage of apoptotic cumulus cells and blastocyst formation rate.

RESULT(S)

Younger patients (< or = 35 years) showed significantly fewer apoptotic cumulus cells than older ones. In all patients gamete maturity was shown to be highly correlated to the rate of apoptosis in cumulus cells. At zygote and cleavage stages (days 1 to 4) no morphologic features were related to the degree of programmed cell death. However, blastocyst development was predictable taking into account the percentage of apoptosis in associated somatic cells. In addition, there was a trend toward better quality blastocysts from follicles with a lower rate of apoptotic cells. No influence on pregnancy and implantation rate was observed.

CONCLUSION(S)

Apoptotic processes within follicles seem to impair oocyte maturation. Though not manifested in the morphologic appearance, gametes and embryos derived from cumulus complexes with no or minor apoptosis have an increased chance of giving rise to optimal blastocysts.

Role of apoptosis controlled by cytochrome c released from mitochondria for luteal function in human granulosa cells

PROBLEM

The aim of this study was to investigate the relationship between apoptosis by the mitochondrial pathway and luteal function in human granulosa cells.

METHOD OF STUDY

Granulosa cells were obtained by ultrasound-guided follicular aspiration from patients undergoing in vitro fertilization and embryo transfer. After the addition of RU486, cells were stained with a mitochondria-specific fluorescent dye, MitoTracker Red CM x Ros. Using flow cytometry and National Institute of Health image, the mitochondrial fluorescent area was measured. After staining with Hoechst 33258 dye, the number of apoptotic bodies per 1000 cells were counted at random on photomicrographs. Homogenates were used for sodium dodecyl sulphate-polyacrylamide gel electrophoresis and Western blot analysis using antibodies against cytochrome c or caspase-3.

RESULTS

The incidence of apoptotic bodies increased and the mitochondrial membrane potential decreased time dependently. The opposite effect was observed dose dependently with RU486 treatment. Western blot analysis showed increased cytochrome c expression, after treatment with 1-2 microg/mL of RU486 which then decreased with 5-10 microg/mL of RU486. Caspase-3 expression increased dose dependently with RU486.

CONCLUSIONS

These results suggest that the activation of caspase-3 caused by cytochrome c released from mitochondria plays an important role in apoptosis-related luteal function in human granulosa cells.

Maternal diabetes adversely affects preovulatory oocyte maturation, development, and granulosa cell apoptosis

Maternal diabetes adversely affects preimplantation embryo development and pregnancy outcomes. The objective of this study was to determine whether diabetes has an impact at an earlier stage of development, the preovulatory oocyte. Models of both acute and chronic insulin-dependent diabetes were used. Acute hyperglycemia was induced by a single streptozotocin injection. Akita mice, which harbor an autosomal dominant mutation causing them to be chronically hypoinsulinemic and hyperglycemic, were used. In both models, preovulatory oocytes were markedly smaller when compared with control animals. A significantly greater number of control oocytes had progressed to meiotic maturation before diabetic oocytes. Both models were found to have smaller, less developed ovarian follicles with a greater number of apoptotic foci by histological evaluation as well as by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling staining. Immunohistochemistry displayed a greater amount of TNF-related apoptosis-inducing ligand (TRAIL) and KILLER, a key murine ligand and receptor involved in the extrinsic pathway, expressed in cumulus cells from hyperglycemic mice compared with controls, suggesting that this apoptotic pathway may be up-regulated under diabetic stress. Elevated KILLER expression was also confirmed through Western blotting. Connexin-43 expression was found to be lower by immunohistochemistry and Western blot analysis in the diabetic samples. Both models of maternal hyperglycemia and hypoinsulinemia may have a detrimental effect on oocyte maturation and development as detailed by the smaller sizes of oocytes and developing ovarian follicles, the lowered percentage reaching germinal vesicle breakdown, and the greater amount of apoptosis. In addition, there may be dysfunctional or decreased communication in diabetic oocytes, as demonstrated by lower expression of connexin-43.

Removal of endometriomas before in vitro fertilization does not improve fertility outcomes: a matched, case–control study

OBJECTIVE

To investigate whether conservative surgery on ovarian endometriomas before an IVF cycle improves fertility outcomes.

DESIGN

Retrospective, matched case-control study.

SETTING

Two academic IVF programs.

PATIENT(S)

One hundred eighty-nine women with endometriomas who underwent IVF treatment: 56 women proceeded directly to IVF, and 133 first underwent conservative ovarian surgery.

INTERVENTION(S)

Controlled ovarian hyperstimulation and IVF-ET.

MAIN OUTCOME MEASURE(S)

Response to gonadotropins, fertilization, implantation, and pregnancy rates.

RESULT(S)

Aside from lower peak E(2) levels on the day of hCG and a higher total FSH dose in women previously operated for an endometrioma, no significant differences were found between the two groups in the different IVF variables analyzed.

CONCLUSION(S)

Laparoscopic cystectomy for endometriomas before commencing an IVF cycle does not improve fertility outcomes. Proceeding directly to controlled ovarian hyperstimulation in women with asymptomatic ovarian endometriomas might reduce the time to pregnancy, the costs of treatment, and the hypothetical complications of laparoscopic surgery. Conversely, conservative surgical treatment of ovarian endometriomas in symptomatic women does not impair IVF or intracytoplasmic sperm injection success rates.

Does granulosa cell apoptosis have a role in the etiology of unexplained infertility?

OBJECTIVE(S)

To compare granulosa cell apoptosis in patients with unexplained infertility and tubal factor. Accelerated granulosa cell apoptosis may be the cause of unexplained infertility.

STUDY DESIGN

Setting was IVF-ET Unit of Cerrahpasa Medical Faculty, Istanbul University. GnRH analogs and gonadotropins were used for ovulation induction in patients with unexplained infertility (n=15) and tubal factor (n=15) undergoing in vitro fertilization and embryo transfer (IVF-ET) procedures. Following HCG injection and follicular aspiration, apoptosis of granulosa cells was assessed using the in situ DNA nick end labelling method and apoptosis rate was further determined by flow cytometry. Apoptosis rates were compared between two groups. Mann-Whitney's U-test and Student's t-test were used for statistics.

RESULTS

Apoptosis rate was significantly higher in the unexplained infertility group (33.20 +/- 35.62% versus 10.10 +/- 17.23%).

CONCLUSION(S)

Granulosa cell apoptosis seems to have a role in the etiology of unexplained infertility.

Significance of mRNA levels of connexin37, connexin43, and connexin45 in luteinized granulosa cells of controlled hyperstimulated follicles

OBJECTIVE

To evaluate the mRNA levels of connexins in different sizes of luteinized follicles.

DESIGN

Semiquantitative reverse transcriptase-polymerase chain reaction (RT-PCR) to determine the connexin mRNA levels in the granulosa cells of 91 luteinized follicles.

SETTING

Academic tertiary care medical center and research unit of university.

PATIENT(S)

Ninety-one female patients on controlled ovarian hyperstimulation (COH).

INTERVENTION(S)

Sonoguided aspiration to collect the oocytes and the granulosa cells simultaneously.

MAIN OUTCOME MEASURE(S)

The RT-PCR data are normalized by comparing the intensity of the connexins to the intensity of internal controls (beta-actin). The follicles are grouped according to the size and the mRNA levels of the connexins. The correlations among the size of the follicles, the outcome of oocytes, and the mRNA levels of the connexins are compared by Fisher's exact test and Mann-Whitney test.

RESULT(S)

The mRNA levels of the connexins are low in the follicles equal or larger than 5.5 mL. High cx43 levels are linked to good prognosis of oocytes.

CONCLUSION(S)

The luteinized granulosa cells from the large follicles are relatively quiescent in the connexin mRNA expression. In addition to the volume, the mRNA levels of cx43 may serve as a marker to predict the outcome of oocytes.

Apoptosis in human granulosa cells after induction of ovulation in women participating in an intracytoplasmic sperm injection program

OBJECTIVES

To investigate whether analysis of granulosa cell apoptosis can be useful in assessing follicular and oocyte maturation and the regulation of granulosa cell apoptosis by follicular fluid steroids in preovulatory follicles of stimulated women.

STUDY DESIGN

Apoptosis in aspirated granulosa cells (n=64) was measured using the Annexin V-affinity assay by flow cytometry. Follicular fluid steroids were determined by ELISA and RIA. Statistics were evaluated using the Levenne test, Student t-test and simple linear regression analysis.

RESULTS

No significant differences in the number and percentage of apoptotic granulosa cells per follicle were observed according to the maturity and fertilizability of the oocytes by intracytoplasmic sperm injection within these follicles. No correlations were found between levels of steroid hormones in follicular fluid and the number and proportion of granulosa cells undergoing apoptosis.

CONCLUSIONS

The percentage of apoptosis in granulosa cells is not related to oocyte maturity and fertilizability by ICSI or to follicular quality in stimulated cycles of normal women. However, the possibility cannot be discarded that this parameter may be of importance at other phases of follicular development or in natural cycles when no treatment that influences follicular physiology is being applied.

Effects of a Gonadotropin-Releasing Hormone agonist and Follicle Stimulating Hormone on the incidence of apoptosis in human luteinized granulosa cells

OBJECTIVE

Previous studies have shown the importance of apoptosis in follicular atresia occurring especially in granulosa cells (GC) and its relation to the outcome of in vitro fertilization (IVF). The aim of this study was to evaluate the effects of a Gonadotropin-Releasing Hormone agonist (GnRHa) and of Follicle-Stimulating Hormone (FSH) on the apoptosis rate of human luteinized GC.

STUDY DESIGN

GC were isolated from follicular fluids of 15 women undergoing IVF cycles, cultured for 1 day and then treated for 1 day in serum-free medium with triptorelin at 100 or 1000pg/ml or with FSH at 100 or 500ng/ml. GC cultured without any hormone addition were used as controls. Treatment of cultured GC with triptorelin 100pg/ml and FSH 100ng/ml was performed five times each. GC were analysed by flow cytometry after propidium iodide staining to measure the percentage of apoptotic GC. Some triptorelin-treated GC were also examined by electron microscopy.

RESULTS

Percentages of GC apoptosis were after hormone treatment respectively: FSH: 100ng/ml, 2.9+/-0.6%; 500ng/ml, 2.9%; triptorelin: 100pg/ml, 18.6+/-2.8%; 1000pg/ml, 86.5% versus 9.8+/-1.8% in GC controls (FSH 100ng/ml versus control; triptorelin 100pg/ml versus control: P<10(-6)). Electron microscopy confirmed apoptosis of GC incubated with triptorelin.

CONCLUSIONS

This study demonstrated that FSH decreased apoptosis in human luteinized GC. In contrast, triptorelin was possibly implicated in a dose-dependent increase in the incidence of apoptotic GC. This last result suggests that clinical use of GnRHa should perhaps be reconsidered in the context of its apoptosis-inducing effect.

Time interval between FSH priming and aspiration of immature human oocytes for in-vitro maturation: a prospective randomized study

This prospective randomized controlled study was performed to examine the influence of coasting for 2 days versus 3 days following a fixed daily dose of FSH for 3 days. The outcome was 2-fold. In the first experiment (n = 50 cycles), the incidence of apoptosis in granulosa cells was compared. In the second experiment (n = 28 cycles), the rates of maturation, fertilization, cleavage, pregnancy and implantation were compared. In addition, clinical pregnancy rate per aspiration was registered. Granulosa cells were collected from follicular aspirates and pooled for each patient. The APOPTAG Detection Kit was used for staining of the granulosa cells and detection of apoptosis. Oocytes were matured in vitro for 28-30 h before intracytoplasmic sperm injection. The incidence of apoptosis in granulosa cells did not differ between granulosa cells obtained after 2 days coasting (n = 25 cycles) compared with granulosa cells obtained after 3 days coasting (n = 25 cycles) (26.2 versus 26.2%). When oocytes obtained after coasting for 2 days (n = 12 cycles) were compared with oocytes obtained after coasting for 3 days (n = 16 cycles), no significant difference was found between rates of maturation (63 versus 65%), fertilization (60 versus 68%), cleavage (86 versus 92%) or implantation [5/12; 42 versus 1/12 (8%)]. A higher clinical pregnancy rate per aspiration [5/16 (31%) versus 1/12 (8%)] was obtained after coasting for 3 days compared with coasting for 2 days. The difference was not significant. This randomized study showed no difference in apoptosis of granulosa cells and no difference in developmental competence of oocytes obtained after coasting for 3 days compared with 2 days coasting.

How does endometriosis affect infertility?

Prospective and retrospective clinical trials suggest a decreased oocyte and embryo quality in women with endometriosis. Based on these observations, the authors described an altered intrafollicular milieu in endometriosis, which explains the bad quality oocytes and the resulting embryos with lower capacity to implant. Whether these changes affect the oocytes or are the consequence of genomic alterations manifested by biochemical and chromosomal differences in healthy women is an unresolved issue. If the effects of endometriosis on follicular development are nongenomic in origin, modulation of the process of folliculogenesis may be sufficient to treat the disease and cure infertility associated with endometriosis. A genomic defect needs specific genetic therapy, which currently is not available.

Lactate dehydrogenase estimation in follicular fluid: correlation with patient age, follicle size and super ovulation in ART cycles

OBJECTIVE

To quantify the lactate dehydrogenase (LDH) level in human follicular fluids, and to define its relationship with follicle size, patient age, serum estradiol (E(2)) level, and the amount of gonadotropins administered during superovulation in ART cycles.

STUDY DESIGN

In this prospective study, 21 women undergoing ART treatment were selected. Follicular fluid from the largest follicle of both ovaries was collected from each patient on the day of oocyte aspiration and analyzed for LDH. Serum oestradiol was estimated on the day of hCG administration. Relationship between LDH level and (1) patient age, (2) follicle size, (3) follicle stimulating hormone administered during superovulation period and (4) serum oestradiol was studied.

RESULT(S)

LDH activity increased with chronological age of the patient. As follicular size (diameter) increased, increase in the LDH concentration in follicular fluid was observed. Serum estradiol level did not show any relationship with LDH activity. Similarly, administration of various doses of follicle stimulating hormone during superovulation did not show any correlation with LDH level.

CONCLUSION(S)

Follicular fluid LDH level has shown association with patient age and the follicle size, however, no significant association was found with other parameters studied.

Effects of hepatitis C virus on the apoptosis percentage of granulosa cells in vivo in women undergoing IVF: preliminary results

BACKGROUND

The aim of this study was to investigate the relationship between the apoptosis percentage of human luteinized granulosa cells (GC) and the presence of hepatitis C virus (HCV) in follicular fluid (FF).

METHODS

GC were isolated from FF of 12 women undergoing 12 IVF cycles: six were HCV+ with active viral replication and six HCV- serving as controls. No male partner was HCV+. HCV detection and quantification were assessed by reverse transcriptase-polymerase chain reaction in serum, FF and embryo-incubation medium. GC were analysed by flow cytometry after propidium iodide staining to measure the percentages of apoptotic GC. Routine IVF parameters were tabulated.

RESULTS

Mean +/- standard deviation (SD) serum and FF HCV viral loads were 3.58 +/- 4.25 x 10(6) and 0.14 +/- 0.10 x 10(6) IU/ml respectively. Mean percentages of apoptotic GC from HCV+ and HCV- women were 3.08 +/- 1.14 and 3.14 +/- 1.40% respectively. No statistically significant difference was found between these two groups concerning GC apoptosis and when we compared all IVF parameters. No HCV RNA was detected in embryo incubation media after 2 days of culture.

CONCLUSIONS

Comparing GC apoptosis percentages and usual IVF parameters in the HCV+ group versus the HCV- group, our preliminary study shows that active chronic HCV infection does not affect follicle development and IVF outcome in HCV+ women undergoing IVF. Furthermore, the risk of newborns becoming HCV-infected might not be increased by assisted reproductive technologies when performed in couples in which women are HCV+ and men HCV-.

Prognostic implication of apoptosis in human luteinized granulosa cells during IVF-ET

PURPOSE

To investigate the prognostic significance of apoptosis in granulosa cells recovered from patients participating in IVF-ET.

METHODS

Seventy-three women underwent ovarian hyperstimulation for IVF and embryo transfer. After follicle aspiration, recovered granulosa cells were stained by BCL2 monoclonal antibody with FITC and propidium iodide (PI). Fluorescence was detected by flowcytometry, then the apoptotic index (Al) and BCL2 positivity were assessed.

RESULTS

The pregnant group showed a significantly lower apoptotic index in granulosa cells compared with the nonpregnant group (p < 0.0001). Patient's age, basal serum FSH concentration, serum E2 concentrations at hCG day, number of retrieved oocytes, fertilization rates. number of embryos transferred, and BCL2 positivity were not different between the two groups. Linear regression analysis of AI to serum basal FSH showed a positive correlation. Al in granulosa cells of 6.14% or below could predict a successful pregnancy with a sensitivity of 87.5% and a specificity of 73.7%.

CONCLUSION

Our results indicate that apoptotic analysis within granulosa cells can be used as a prognostic indicator for IVF success.

New advances in the understanding of endometriosis related infertility

The association between endometriosis and infertility is complex. Nevertheless, in the absence of tubal distortion considerable evidence suggests four principle factors likely to contribute to subfertility. These include impaired folliculogenesis, decreased fertilization, inflammatory factors in follicular, peritoneal and reproductive tract fluid, and implantation defects. The potential impact of each of these is critically examined. The role of endometriomas, prior surgeries and donor oocytes is also discussed.

Cumulus cells apoptosis as an indicator to predict the quality of oocytes and the outcome of IVF-ET

PURPOSE

Our purpose was to establish an evaluation system for oocyte quality based on the incidence of cumulus cells apoptosis and to examine the effect of coculture, using autologous cumulus cells, on the outcome of IVF-ET according to proliferative activities of helper cells and the incidence of cumulus cells apoptosis.

METHODS

Cumulus cell masses were collected from 91 mature oocytes among 330 oocytes retrieved from a total of 34 IVF-ET cycles with tubal infertility and unexplained infertility. The incidence of apoptosis in cumulus cells was assessed by apoptosis detection kit fluorescein. On ovum pick up, 2nd day embryos were cocultured with autologous cumulus cells. Prior to coculture, in vitro proliferative activity of cumulus cells was evaluated.

RESULTS

Cumulus cells from patient groups over 40 years old had a significantly increased apoptosis incidence, a lower fertilization rate, and the decreased number of oocytes retrieved compared to the other age groups (P < .05). The incidence of cumulus cells apoptosis was significantly lower when the number of oocytes retrieved was 5 or less (P < .05). Cumulus cells from fertilized oocytes (0.43 +/- 0.07%) and those from patients who became pregnant (0.44 +/- 0.11%) following IVF-ET showed a significantly lower incidence of apoptosis compared to those of unfertilized oocytes (1.80 +/- 0.35%; P < .001) and the nonpregnant group (0.81 +/- 0.10%; P < .05). Embryo quality also had a negative correlation with the incidence of cumulus cells apoptosis. Coculture of fertilized oocytes with cumulus cells with high proliferative activity resulted in improved rates of implantation and pregnancy compared to that with poor active cumulus cells. No significant difference was found between the in vitro proliferative activity of cumulus cells and the incidence of cumulus cells apoptosis (P < .063).

CONCLUSIONS

The age of women might influence the incidence of apoptosis in cumulus cells, and the increased incidence of apoptosis is associated with the number of oocytes retrieved, the fertilization rate, and the pregnancy outcome following IVF-ET. These results suggest that the incidence of cumulus cells apoptosis can be used in predicting oocyte quality, outcome of IVF-ET, and age-related decline in fertility.

Endometriosis and assisted reproductive technologies: are outcomes affected?

The preponderance of recent data suggests that endometriosis does not adversely affect in-vitro fertilization pregnancy rates. However, many studies demonstrate impaired oocyte quality, decreased fertilization, and compromised implantation rates. Such findings give insight into the mechanisms by which endometriosis may impact on fertility, and provide clues as how to focus assisted reproductive technologies in order to overcome these deficiencies. Specifically, extended downregulation protocols, ample use of gonadotropins for ovarian stimulation, and conservative management of endometriomas have all been suggested as means to optimize in-vitro fertilization outcomes for women with endometriosis.

Comet assay of cumulus cell DNA status and the relationship to oocyte fertilization via intracytoplasmic sperm injection

This paper postulates that in the ovary, the close association between the cumulus cells and the oocytes permits the fertilizing ability of the oocytes to be determined indirectly through cumulus cell DNA status. The objective was to use a modified comet assay to analyse cumulus cell DNA and relate the data to oocyte fertilization after intracytoplasmic sperm injection (ICSI) procedures. Oocytes were retrieved (n = 15 cases) and free-floating cumulus cells were pooled and smeared on clear glass slides to dry. Meanwhile, the denuded oocytes were injected with spermatozoa and fertilization was assessed, followed by embryo transfer. The fixed cumulus cells were stained in acridine orange, coated with a mini-gel agarose layer, lysed in alkaline buffer and electrophoresis performed. Analyses of fluorescent cell images (n = 449) showed that the tail moment was positively correlated to the percentage of fertilization after ICSI (r = 0.567, P < 0.05). In contrast, there was no correlation between tail moment and number of oocytes retrieved, total ampoules used, endometrial thickness and age of patient. The results suggested that the competence of the oocytes was associated with the cumulus cell DNA status. A unique feature here was the comet assay for archived material with obvious advantages.

Hyaluronan in follicular fluids and fertilization of oocytes

OBJECTIVE

To determine the concentrations of hyaluronan, E(2), and progesterone in follicular fluids (FFs) and the incidence of apoptotic granulosa cells. Also, to examine the relationship between the concentration of hyaluronan and follicular steroids, the incidence of apoptotic cells, and the fertilizability of the oocyte in the same follicle.

DESIGN

Samples of 130 follicles were retrospectively analyzed for hyaluronan and steroids and the incidence of apoptotic cells.

SETTING

The reproductive center in Yamagata University Hospital.

PATIENT(S)

Forty women infertile because of tubal damage or unknown causes undergoing IVF treatment were selected.

INTERVENTION(S)

The samples were collected from follicle aspirations.

MAIN OUTCOME MEASUREMENT(S)

The concentrations of hyaluronan and steroids in FFs, the incidence of apoptotic granulosa cells, and oocyte fertilizability.

RESULT(S)

The levels of hyaluronan in FF were found to correlate positively with P (r=0.444, P<0.0001) and the incidence of apoptotic cumulus granulosa cells (r=0.387, P=0.002) and inversely with E(2) (r = -0.601, P<0.0001) and free T (r = -0.344, P=0.001). The concentration of hyaluronan in FFs containing a subsequently fertilized oocyte after insemination was significantly lower than that in FFs containing a subsequently unfertilized oocyte (P=0.0005) (fertilized, 50.0 +/- 2.6 ng/mL; triploidy, 59.1 +/- 6.8; and unfertilized, 66.9 +/- 5.9).

CONCLUSION(S)

The concentration of hyaluronan in FF is an indicator for estimation of oocyte viability for fertilization.

Clinical correlation of cyclin D2 mRNA expression in human luteinized granulosa cells

PURPOSE

The aim was to evaluate whether the expression of cyclin D2 mRNA in human luteinized granulosa cells correlates with the clinical parameters of women undergoing in vitro fertilization-embryo transfer (IVF-ET) programs.

METHODS

Using reverse transcriptase-polymerase chain reaction (RT-PCR) techniques, the cyclin D2 mRNA in human luteinized granulosa cells of large follicles was measured. Correlation analysis between cyclin D2 mRNA expression and clinical parameters [age; day 3 follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2); E2 and P4 at the day of human chorionic gonadotropin (hCG); total amount of gonadotropin and the number of days of gonadotropin administration; pregnancy outcome] were performed.

RESULT(S)

Cyclin D2 mRNA expression showed negative correlation with patient's age (R = -0.60, P < 0.005) and total amount of gonadotropins (R = -0.45, P < 0.03), and also showed positive correlation with serum E2 levels at the day of hCG administration (R = 0.55, P < 0.02). Other clinical parameters showed no statistical significance. Cyclin D2 mRNA expression of pregnant group was higher than that of nonpregnant group (P < 0.03).

CONCLUSIONS

Cyclin D2 mRNA expression in human luteinized granulosa cells positively correlates with clinical parameters of ovarian function and may be a novel marker for the health of human ovarian follicle.

Effects of controlled ovarian hyperstimulation on oocyte quality in terms of the incidence of apoptotic granulosa cells

PURPOSE

The aim was to investigate which ovarian hyperstimulation protocol performed in the same patients causes development of oocytes of good quality.

METHODS

Twenty normo-ovulatory women underwent three different controlled ovarian hyperstimulation protocols for in vitro fertilization-embryo transfer. Patients underwent follicle aspiration after administration of human chorionic gonadotropin (hCG). The total number of retrieved oocytes, the number of mature oocytes, and the rate of mature oocytes were examined. Recovered granulosa cells were stained with Hoechst 33258 and examined by fluorescence microscopy to estimate the incidence of apoptotic cells.

RESULTS

The total number of oocytes and the number of mature oocytes in gonadotropin-releasing hormone agonist (GnRHa) + human menopausal gonadotropin (hMG) + hCG and hMG + hCG cycles were higher than those in the natural cycle (P < 0.0001). The rate of mature oocytes in hMG + hCG cycle was the highest among the three protocols (P < 0.04). In the mural granulosa cells, the incidence of apoptotic cells in the GnRHa + hMG + hCG cycle was significantly higher than those of the natural (P < 0.002) and hMG + hCG cycles (P = 0.0002). The incidence of apoptotic cumulus granulosa cells in the GnRHa + hMG + hCG cycle was significantly higher than those of natural and hMG + hCG cycles (P < 0.002). Moreover, the incidence of apoptotic cumulus granulosa cells in the hMG + hCG cycle was significantly lower than that in the natural cycle (P < 0.01).

CONCLUSIONS

These results indicated that hMG + hCG is the most appropriate controlled ovarian hyperstimulation protocol among the three examined with regard to oocyte quality.

Effects of aging on ovarian fecundity in terms of the incidence of apoptotic granulosa cells

PURPOSE

The objective was to determine the effects of women's age on the ovarian fecundity as assessed by the incidence of apoptotic granulosa cells.

METHODS

Twenty-eight normo-ovulatory women underwent ovulation induction for standard IVF. The husbands of these women showed severe male infertility factors. The women were divided into four groups according to their ages. Women underwent follicle aspiration after the administration of human menopausal gonadotropin plus human chorionic gonadotropin. The nuclei of granulosa cells were examined by using fluorescence microscopy, and the incidence of apoptotic granulosa cells was tabulated.

RESULTS

Granulosa cells in the older women revealed a significant increase in the number of apoptotic cells. The number of total oocytes and the number of mature oocytes obtained significantly decreased with age. However, endometrial thickness and follicular estradiol, progesterone, and free testosterone levels were not significantly different among four different age groups.

CONCLUSIONS

Age increases apoptotic changes in granulosa cells and consequently decreases the ovarian fecundity.

Relatively poor oocyte quality is an indication for intracytoplasmic sperm injection

OBJECTIVE

To determine the relation between the insemination method used and the quality of oocytes and embryos.

DESIGN

Prospective study.

SETTING

Assisted reproductive centers at Yamagata University Hospital and Kuramoto Women's Clinic in Yamagata, Japan.

PATIENT(S)

Forty patients undergoing IVF and 40 patients undergoing intracytoplasmic sperm injection (ICSI).

INTERVENTION(S)

To estimate oocyte quality, the granulosa cells surrounding the oocyte were fixed and stained with a commercial dye in both groups of patients. One thousand granulosa cells were examined under a fluorescence microscope.

MAIN OUTCOME MEASURE(S)

The incidence of apoptotic granulosa cells surrounding each oocyte.

RESULT(S)

The incidence of apoptosis in the granulosa cells enclosing the oocytes that were fertilized by IVF was significantly lower than that in the oocytes that were fertilized by ICSI. Moreover, the incidence of apoptosis in the granulosa cells enclosing the oocytes that grew into good-quality or fair-quality embryos was significantly lower after conventional IVF than after ICSI. With ICSI, the incidence of apoptosis was not significantly different among the granulosa cells surrounding the oocytes that were inseminated, were fertilized, or developed into good-quality or fair-quality embryos. With IVF, the incidence of apoptosis was highest in the granulosa cells surrounding the oocytes that were inseminated and lowest in the granulosa cells surrounding the oocytes that developed into good-quality and fair-quality embryos.

CONCLUSION(S)

A good-quality oocyte is necessary for the development of a good-quality embryo with IVF but not with ICSI. Thus, relatively poor oocyte quality is a good indication for the use of ICSI.

Moderate and severe endometriosis is associated with alterations in the cell cycle of granulosa cells in patients undergoing in vitro fertilization and embryo transfer

OBJECTIVE

To determine whether folliculogenesis is impaired in patients with endometriosis.

DESIGN

Prospective study.

SETTING

Yamagata University School of Medicine, Yamagata, Japan.

PATIENT(S)

Thirty women participating in an IVF program.

INTERVENTION(S)

The patients were divided into four groups according to the cause of their infertility: tubal factor (T), n = 7; male factor (M), n = 7; idiopathic (I), n = 7; and endometriosis (E), n = 9. Granulosa cells were obtained from the follicular fluid of each patient and analyzed by flow cytometry.

MAIN OUTCOME MEASURE(S)

The percentage of granulosa cells in each cell-cycle stage.

RESULT(S)

The mean (+/- SD) rate of apoptosis in the granulosa cells obtained from the patients with endometriosis was the highest among the four groups (T = 11.7% +/- 3.3%; M = 5.6% +/- 3.8%; I = 9.6% +/- 5.1%; and E = 18.6% +/- 9.6%). The percentage of S-phase granulosa cells was significantly higher in the patients with endometriosis than in all the other patients combined (E = 12.5% +/- 6%; T + M + I = 9.3% +/- 2.9%). The percentage of G2/M-phase granulosa cells was significantly lower in the endometriosis group than in the other three groups combined (E = 2.3% +/- 2.5%; T + M + I = 4.6% +/- 2.1%).

CONCLUSION(S)

Endometriosis impairs the cell cycle in granulosa cells. This phenomenon may have a detrimental effect on folliculogenesis.

Apoptotic cell death in human granulosa-lutein cells: a possible indicator of in vitro fertilization outcome

OBJECTIVE

To determine whether women who do not conceive during an IVF treatment despite normal FSH levels have a higher rate of apoptosis in their granulosa-lutein cells than women who do conceive.

DESIGN

Prospective.

SETTING

Large teaching hospital and fertility center.

PATIENT(S)

Patients with normal FSH levels undergoing an IVF treatment.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Outcome of the IVF treatment and percentage of apoptotic granulosa-lutein cells.

RESULT(S)

A significantly lower percentage of granulosa-lutein cells were apoptotic in patients who became pregnant compared with those who did not become pregnant. A higher basal FSH level was significantly correlated with the duration of the stimulation, and the number of follicles was significantly inversely correlated with the number of ampules of FSH used and the duration of the treatment. The number of embryos was significantly correlated with the number of oocytes, and significantly inversely correlated with the number of apoptotic granulosa-lutein cells.

CONCLUSION(S)

Fewer granulosa-lutein cells are apoptotic in women who have an ongoing pregnancy after IVF treatment than in women who do not conceive.

Ovarian fecundity in patients with endometriosis can be estimated by the incidence of apoptotic bodies

OBJECTIVE

To investigate the incidence of apoptotic bodies in membrana granulosa in patients with endometriosis.

DESIGN

Retrospective analysis.

SETTING

Yamagata University Hospital.

PATIENT(S)

Fifty-eight normoovulatory women with endometriosis and 45 patients with male factor infertility underwent ovulation induction for IVF-ET with GnRH analogues and gonadotropins.

INTERVENTION(S)

Patients underwent follicle aspiration after the administration of hCG.

MAIN OUTCOME MEASURE(S)

Recovered granulosa cells (GCs) were examined by fluorescence microscopy, and the incidence of apoptotic bodies was tabulated. These data and the other parameters associated with IVF results were analyzed on the basis of both the revised American Fertility Society (AFS) classification of endometriosis and the existence of chocolate cysts.

RESULT(S)

The incidence of apoptotic bodies in membrana granulosa of patients with endometriosis was significantly higher than that of the control (male factor infertility) group and increased as the stage of the revised AFS classification advanced. The incidence of apoptotic bodies in membrana granulosa was significantly higher in patients with chocolate cysts than in those without chocolate cysts. The patients with endometriosis had smaller numbers of developed follicles (> or = 15 mm), harvested oocytes, and mature oocytes than the male factor infertility patients. The existence of chocolate cysts corresponded with a reduced number of both harvested oocytes and mature oocytes.

CONCLUSION(S)

Through the apoptosis of GCs, the existence of endometriosis may have negatively affected the follicle development and oocyte quality.