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de Oliveira ECF, Cruzeiro IKDC, de Souza CAA, Reis FM. Prevalence of karyotype alterations in couples with recurrent pregnancy loss in a tertiary center in Brazil. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo51. [PMID: 38994459 PMCID: PMC11239216 DOI: 10.61622/rbgo/2024rbgo51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/08/2024] [Indexed: 07/13/2024] Open
Abstract
Objective To assess the prevalence and type of chromosomal abnormalities in Brazilian couples with recurrent pregnancy loss (RPL) and compare the clinical characteristics of couples with and without chromosome abnormalities. Methods We assessed the medical records of 127 couples with a history of two or more miscarriages, referred to a tertiary academic hospital in Belo Horizonte, Brazil, from January 2014 to May 2023. Karyotype was generated from peripheral blood lymphocyte cultures, and cytogenetic analysis was performed according to standard protocols by heat-denatured Giemsa (RHG) banding. Results Abnormal karyotypes were detected in 10 couples (7.8%). The prevalence of chromosomal abnormalities was higher among females (6.3%) compared to males (2.0%), but this difference was not statistically significant (p=0.192). The mean number of miscarriages was. 3.3 ± 1.1 in couples with chromosome abnormalities and 3.1 ± 1.5 in couples without chromosome abnormalities (p=0.681). Numerical chromosomal anomalies (6 cases) were more frequent than structural anomalies. Four women presented low-grade Turner mosaicism. No differences were found between couples with and without karyotype alterations, except for maternal age, which was higher in the group with chromosome alterations. Conclusion The prevalence of parental chromosomal alterations in our study was higher than in most series described in the literature and was associated with increased maternal age. These findings suggest that karyotyping should be part of the investigation for Brazilian couples with RPL, as identifying the genetic etiology may have implications for subsequent pregnancies.
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Affiliation(s)
- Elaine Cristina Fontes de Oliveira
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrazilHospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Ines Katerina Damasceno Cavallo Cruzeiro
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrazilHospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Cezar Antônio Abreu de Souza
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrazilHospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Fernando Marcos Reis
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrazilHospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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de Assis V, Giugni CS, Ros ST. Evaluation of Recurrent Pregnancy Loss. Obstet Gynecol 2024; 143:645-659. [PMID: 38176012 DOI: 10.1097/aog.0000000000005498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/02/2023] [Indexed: 01/06/2024]
Abstract
Recurrent pregnancy loss (RPL) affects approximately 5% of couples. Although RPL definitions vary across professional societies, an evaluation after a second clinically recognized first-trimester pregnancy loss is recommended. Good quality evidence links parental chromosomal rearrangements, uterine anomalies, and antiphospholipid syndrome (APS) to RPL. In contrast, the relationship between RPL and other endocrine, hematologic, and immunologic disorders or environmental exposures is less clear. Anticoagulant therapy and low-dose aspirin are recommended for patients with RPL who have also been diagnosed with APS. Vaginal progesterone supplementation may be considered in patients experiencing vaginal bleeding during the first trimester. Surgical correction may be considered for patients with RPL in whom a uterine anomaly is identified. Evaluation and management of additional comorbidities should be guided by the patient's history rather than solely based on the diagnosis of RPL, with the goal of improving overall health to reduce complications in the event of pregnancy. Most people with RPL, including those without identifiable risk factors, are expected to achieve a live birth within 5 years from the initial evaluation. Nevertheless, clinicians should be sensitive to the psychological needs of individuals with this condition and provide compassionate and supportive care across all stages.
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Affiliation(s)
- Viviana de Assis
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida
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Recurrent pregnancy loss and incident arthritis in midlife: an exploratory longitudinal analysis of the Study of Women's Health Across the Nation. Ann Epidemiol 2022; 76:61-67. [DOI: 10.1016/j.annepidem.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 09/23/2022] [Accepted: 10/06/2022] [Indexed: 11/23/2022]
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Basso CG, de Araujo-Ramos AT, Martino-Andrade AJ. Exposure to phthalates and female reproductive health: a literature review. Reprod Toxicol 2022; 109:61-79. [DOI: 10.1016/j.reprotox.2022.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/10/2022] [Accepted: 02/28/2022] [Indexed: 12/11/2022]
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Deng W, Sun R, Du J, Wu X, Ma L, Wang M, Lv Q. Prediction of miscarriage in first trimester by serum estradiol, progesterone and β-human chorionic gonadotropin within 9 weeks of gestation. BMC Pregnancy Childbirth 2022; 22:112. [PMID: 35144584 PMCID: PMC8832762 DOI: 10.1186/s12884-021-04158-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/23/2021] [Indexed: 12/11/2022] Open
Abstract
Purpose To predict miscarriage outcome within 12 weeks of gestational age by evaluating values of serum estradiol, progesterone and β-human chorionic gonadotropin (β-HCG) within 9 weeks of gestation. Methods One hundred sixty-five women with singleton pregnancies were retrospectively studied. Estradiol, progesterone and β-HCG levels were measured at 5–6 weeks of gestation and the measurements were repeated at 7–9 weeks. According to pregnancy outcome at 12 weeks of gestation, 71 cases were categorized into miscarriage group, and 94 cases into group of normal pregnancy. Each group was further divided into 5–6 and 7–9 weeks of gestation sub-group. Predictive values of estradiol, progesterone and β- HCG levels at 5–6 weeks and 7–9 weeks of gestation were analyzed with receiver operating characteristic (ROC) curves and logistic regression. Results Serum levels of estradiol at 7–9 weeks identified miscarriage with an area under the ROC curve (AUC) of 0.866 (95% CI 0. 793 ~ 0.938, P = 0.000), diagnostic cutoff value of 576 pg/ml, sensitivity of 0.804, and specificity of 0.829 respectively at the optimal threshold, according to Youden index. Progesterone levels at 7–9 weeks were with AUC of 0.766 (95% CI 0. 672 ~ 0.861, P = 0.000), cutoff value of 15.27 ng/ml, sensitivity of 0.921, and specificity of 0.558, respectively; Estradiol at 5–6 weeks were with AUC of 0.709 (95% CI 0. 616 ~ 0.801, P < 0.001), the diagnostic cutoff value of 320 pg/ml, sensitivity of 0.800, and specificity of 0.574, respectively. The performance of the dual markers of estradiol and progesterone analysis (AUC 0.871, CI 0.793–0.950), three-markers analysis (AUC 0.869, CI 0.759–0.980)were slightly better than the single marker at 7-9 weeks. β-HCG or progesterone provide additional utility of estradiol prediction at 5–6 weeks with AUC 0.770 (0.672–0.869) for β-HCG and estradiol, AUC0.768(CI 0.670–0.866) for β-HCG, estradiol and progesterone and AUC 0.739 (CI 0.651–0.827) for progesterone and estradiol. Conclusions Low serum levels such as dual of estradiol and progesterone or estradiol alone at 7–9 weeks, β-HCG or progesterone combing estradiol at 5–6 weeks of gestation can be used better to predict miscarriage in first trimester.
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Affiliation(s)
- Wenhui Deng
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China.
| | - Rui Sun
- Department of Obstetrics and Gynecology, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing, 101100, P. R. China
| | - Jun Du
- Department of Pathology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Xue Wu
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Lijie Ma
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
| | - Min Wang
- Department of Obstetrics and Gynecology, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing, 101100, P. R. China
| | - Qiubo Lv
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China
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Li J, Luo L, Diao J, Li Y, Zhang S, Chen L, Yang T, Qin J. Male sperm quality and risk of recurrent spontaneous abortion in Chinese couples: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24828. [PMID: 33725837 PMCID: PMC7969329 DOI: 10.1097/md.0000000000024828] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 12/16/2020] [Accepted: 01/22/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To assess the association of conventional semen parameters and sperm DNA fragmentation with risk of recurrent spontaneous abortion (RSA). DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENTS Total 1,690 male partners of women with RSA, and 1,337 male partners of fertile control women. INTERVENTIONS Case-control or cohort studies were determined by searching PubMed, Google Scholar, Cochrane Libraries, China Biology Medicine disc, Chinese Scientific Journals Fulltext Database, China National Knowledge Infrastructure, and Wanfang Database. RSA was defined as two or more previous pregnancy losses. The fertile women refer to the reproductive women who have had at least a normal pregnancy history and no history of abortion. MAIN OUTCOME MEASURES This study included eight outcome measures: semen volume(ml), semen pH value, sperm density(106/ml), sperm viability (%), sperm progressive motility rate (%), normal sperm morphology rate (%), sperm deformity rate(%), sperm DNA fragmentation index (DFI) (%). The summary measures were reported as standardized mean difference (SMD) with 95% confidence interval (CI). RESULTS Finally, twenty-four studies were included for analysis. Overall, male partners of women with RSA had a significantly lower level of sperm density (SMD = -0.53, 95%CI: - 0.75 to -0.30), sperm viability (SMD = -1.03, 95%CI: - 1.52 to -0.54), sperm progressive motility rate (SMD = -0.76, 95%CI:-1.06 - -0.46), and normal sperm morphology rate (SMD = -0.56, 95%CI: - 0.99 to -0.12), and had a significantly higher rate of sperm deformity rate (SMD = 1.29, 95%CI: 0.60 - 1.97), and sperm DFI (SMD = 1.60, 95%CI: 1.04 to 2.17), when compared with the reference group. However, there were no statistically significant differences for semen volume (SMD = -0.03, 95%CI: -0.14 - 0.08) and semen pH value (SMD = -0.23, 95% CI: -0.50 to 0.05) among 2 groups. CONCLUSIONS The results of this analysis support an association of sperm density, sperm viability, sperm progressive motility rate, normal sperm morphology rate, sperm deformity rate, as well as sperm DFI with RSA. However, given the significant heterogeneity between studies and the lack of more detailed data on the subjects, further large-scale prospective studies are needed.
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Affiliation(s)
- Jinqi Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University
| | - Liu Luo
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University
| | - Jingyi Diao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University
| | - Yihuan Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University
| | - Senmao Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University
| | - Letao Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University
| | - Tubao Yang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University
| | - Jiabi Qin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University
- National Health Commission Key Laboratory for Birth Defect Research and Prevention, Changsha, Hunan
- Institute of Cardiovascular Research, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
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Dai Y, Liu J, Yuan E, Li Y, Shi Y, Zhang L. Relationship Among Traditional Semen Parameters, Sperm DNA Fragmentation, and Unexplained Recurrent Miscarriage: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:802632. [PMID: 35058886 PMCID: PMC8764458 DOI: 10.3389/fendo.2021.802632] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/13/2021] [Indexed: 01/10/2023] Open
Abstract
Several studies have explored the relationship among traditional semen parameters, sperm DNA fragmentation (SDF), and unexplained recurrent miscarriage (RM); however, the findings remain controversial. Hence, we conducted a meta-analysis to explore the relationship among traditional semen parameters, SDF, and unexplained RM. Multiple databases, including PubMed, Google Scholar, MEDLINE, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure (CNKI), were searched to identify relevant publications. From the eligible publications, data were extracted independently by two researchers. A total of 280 publications were identified using the search strategy. According to the inclusion/exclusion criteria, 19 publications were eligible. A total of 1182 couples with unexplained RM and 1231 couples without RM were included in this meta-analysis to assess the relationship among traditional semen parameters, SDF, and unexplained RM. Our results showed that couples with unexplained RM had significantly increased levels of SDF and significantly decreased levels of total motility and progressive motility compared with couples without RM, although significant differences were not observed in the semen volume, sperm concentration, and total sperm count between couples with and without RM. The SDF assay may be considered for inclusion in evaluations of couples with unexplained RM.
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Affiliation(s)
- Yanpeng Dai
- Department of Clinical Laboratory, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junjie Liu
- Henan Human Sperm Bank, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Enwu Yuan
- Department of Clinical Laboratory, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yushan Li
- Henan Human Sperm Bank, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Shi
- Department of Clinical Laboratory, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Linlin Zhang
- Department of Clinical Laboratory, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Ali S, Majid S, Niamat Ali M, Taing S, El-Serehy HA, Al-Misned FA. Evaluation of etiology and pregnancy outcome in recurrent miscarriage patients. Saudi J Biol Sci 2020; 27:2809-2817. [PMID: 32994741 PMCID: PMC7499272 DOI: 10.1016/j.sjbs.2020.06.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 01/28/2023] Open
Abstract
The purpose of this study was to evaluate etiology and pregnancy outcome of recurrent miscarriage women. The enrolled patients (280) were evaluated for Triiodothyronine, Thyroxine, Thyroid stimulating hormone, prolactin, chromosomal analysis, Haemoglobin A1C, blood sugar, Magnetic resonance imaging, 3D-ultrasound, auto-antibodies profile (antiphospholipid antibodies, anticardiolipin antibodies, lupus anticoagulant, antinuclear antibodies, anti-thyroid antibodies and β2 glycoprotein1), torch profile (Toxoplasmo gondii, rubella, cytomegalo virus and herpes simplex virus), blood vitamin D3 levels, psychological factors, Body mass index and thrombotic factors (protein S and C deficiency, Prothrombin G20210A mutation, anti-thrombin III, Factor V Leiden and Methylenetetrahydrofolate reductase mutation), uterosalpingography (hysteronsalpingography) and hysteroscopy. The therapeutic regimens either singly or combined were employed for the treatment of recurrent miscarriage patients on the basis of etiology (single or multiple) and include intravenous immunoglobulin, low molecular weight heparin, low dose aspirin, levothyroxine, progesterone, folic acid, human chorionic gonadotrophin, vitamin D3, psychotherapy, genetic counselling. However, patients with idiopathic recurrent miscarriage were treated with progesterone supplementation, anticoagulation and/or immune modulatory agents. The incidence of primary recurrent miscarriage was highest and most of the women experienced recurrent miscarriage during first trimester. Endocrinological disorders (39%) were found as the major pathological factor for recurrent miscarriage. Other factors include uterine abnormalities (5.7%), vitamin D3 deficiency (3.5%), psychological factors (3.2%) infection (3.6%), autoimmune abnormalities (1.8%) and protein S deficiency (1.8%). However, 40% cases were idiopathic. The overall live birth rate achieved after the management of recurrent miscarriage patients was 75.7%. Enocrinopathy was the major cause of recurrent miscarriage. The overall live birth rate achieved was 75.7% with highest pregnancy outcome in secondary recurrent miscarriage patients after the management.
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Affiliation(s)
- Shafat Ali
- Cytogenetics and Molecular Biology Laboratory, Centre of Research for Development, University of Kashmir, Srinagar, J&K 190006, India
- Department of Biochemistry, Government Medical College, Srinagar, J&K 190010, India
- Corresponding authors at: Cytogenetics and Molecular Biology Laboratory, Centre of Research for Development, University of Kashmir, Srinagar, J&K 190006, India.
| | - Sabhiya Majid
- Department of Biochemistry, Government Medical College, Srinagar, J&K 190010, India
| | - Md. Niamat Ali
- Cytogenetics and Molecular Biology Laboratory, Centre of Research for Development, University of Kashmir, Srinagar, J&K 190006, India
- Corresponding authors at: Cytogenetics and Molecular Biology Laboratory, Centre of Research for Development, University of Kashmir, Srinagar, J&K 190006, India.
| | - Shahnaz Taing
- Department of Obstetrics and Gynaecology, Government Medical College Associated Lalla Ded Hospital, Srinagar, J&K 190012, India
| | - Hamed A. El-Serehy
- Department of Zoology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Fahad A. Al-Misned
- Department of Zoology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
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Ay ME, İzci Ay Ö, Çevik K, Doğru G, Söylemez F, Çayan FE, Erdal ME. Tekrarlayan gebelik kayıplarında FAS ve FASLG polimorfizmlerinin TaqMan SNP genotiplendirme yöntemi ile belirlenmesi. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.523774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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10
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The relationship between sperm DNA fragmentation, free radicals and antioxidant capacity with idiopathic repeated pregnancy loss. Reprod Biol 2018; 18:330-335. [DOI: 10.1016/j.repbio.2018.11.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 01/02/2023]
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11
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Lower frequency of the HLA-G UTR-4 haplotype in women with unexplained recurrent miscarriage. J Reprod Immunol 2018; 126:46-52. [DOI: 10.1016/j.jri.2018.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/18/2018] [Accepted: 02/02/2018] [Indexed: 01/09/2023]
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Machin SJ, Mackie IJ, Cohen H, Jayakody Arachchillage DR. Diagnosis and management of non-criteria obstetric antiphospholipid syndrome. Thromb Haemost 2017; 113:13-9. [DOI: 10.1160/th14-05-0416] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 09/05/2014] [Indexed: 01/03/2023]
Abstract
SummaryAccurate diagnosis of obstetric antiphospholipid syndrome (APS) is a prerequisite for optimal clinical management. The international consensus (revised Sapporo) criteria for obstetric APS do not include low positive anticardiolipin (aCL) and anti β2 glycoprotein I (aβ2GPI) antibodies (> 99th centile) and/or certain clinical criteria such as two unexplained miscarriages, three non-consecutive miscarriages, late preeclampsia, placental abruption, late premature birth, or two or more unexplained in vitro fertilisation failures. In this review we examine the available evidence to address the question of whether patients who exhibit non-criteria clinical and/or laboratory manifestations should be included within the spectrum of obstetric APS. Prospective and retrospective cohort studies of women with pregnancy morbidity, particularly recurrent pregnancy loss, suggest that elimination of aCL and/or IgM aβ2GPI, or low positive positive aCL or aβ2GPI from APS laboratory diagnostic criteria may result in missing the diagnosis in a sizeable number of women who could be regarded to have obstetric APS. Such prospective and retrospective studies also suggest that women with non-criteria obstetric APS may benefit from standard treatment for obstetric APS with low-molecular-weight heparin plus low-dose aspirin, with good pregnancy outcomes. Thus, non-criteria manifestations of obstetric APS may be clinically relevant, and merit investigation of therapeutic approaches. Women with obstetric APS appear to be at a higher risk than other women of pre-eclampsia, placenta- mediated complications and neonatal mortality, and also at increased long-term risk of thrombotic events. The applicability of these observations to outcomes in women with non-criteria obstetric APS remains to be determined.
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Wagner MM, Visser J, Verburg H, Hukkelhoven CWPM, Van Lith JMM, Bloemenkamp KWM. Pregnancy before recurrent pregnancy loss more often complicated by post-term birth and perinatal death. Acta Obstet Gynecol Scand 2017; 97:82-88. [PMID: 29055052 DOI: 10.1111/aogs.13248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/15/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The cause of recurrent pregnancy loss often remains unknown. Possibly, pathophysiological pathways are shared with other pregnancy complications. MATERIAL AND METHODS All women with secondary recurrent pregnancy loss (SRPL) visiting Leiden University Medical Center (January 2000-2015) were included in this retrospective cohort to assess whether women with SRPL have a more complicated first pregnancy compared with control women. SRPL was defined as three or more consecutive pregnancy losses before 22 weeks of gestation, with a previous birth. The control group consisted of all Dutch nullipara delivering a singleton (January 2000-2015). Information was obtained from the Dutch Perinatal Registry. Outcomes were preeclampsia, preterm birth, post-term birth, intrauterine growth restriction, breach position, induction of labor, cesarean section, congenital abnormalities, perinatal death and severe hemorrhage in the first ongoing pregnancy. Subgroup analyses were performed for women with idiopathic SRPL and for women ≤35 years. RESULTS In all, 172 women with SRPL and 1 196 178 control women were included. Women with SRPL were older and had a higher body mass index; 29.7 years vs. 28.8 years and 25.1 kg/m2 vs. 24.1 kg/m2 , respectively. Women with SRPL more often had a post-term birth (OR 1.86, 95% CI 1.10-3.17) and more perinatal deaths occurred in women with SRPL compared with the control group (OR 5.03, 95% CI 2.48-10.2). Similar results were found in both subgroup analyses. CONCLUSIONS The first ongoing pregnancy of women with (idiopathic) SRPL is more often complicated by post-term birth and perinatal death. Revealing possible links between SRPL and these pregnancy complications might lead to a better understanding of underlying pathophysiology.
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Affiliation(s)
- Marise M Wagner
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jantien Visser
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Harjo Verburg
- Department of Reproductive Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Jan M M Van Lith
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.,Division Women and Baby, Department of Obstetrics, Birth Center, University Medical Center Utrecht, Utrecht, the Netherlands
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Santos TDS, Ieque AL, de Carvalho HC, Sell AM, Lonardoni MVC, Demarchi IG, de Lima Neto QA, Teixeira JJV. Antiphospholipid syndrome and recurrent miscarriage: A systematic review and meta-analysis. J Reprod Immunol 2017; 123:78-87. [PMID: 28985591 DOI: 10.1016/j.jri.2017.09.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Abstract
Antiphospholipid syndrome (APS) is an autoimmune condition that is associated with thrombosis and morbidity in pregnancy. The exact mechanisms by which these associations occur appear to be heterogeneous and are not yet well understood. The aim of this study was to identify and analyze publications in recent years to better understand the diagnosis and its contribution to monitoring APS among women with recurrent miscarriage (RM). This systematic review and meta-analysis was conducted using the PubMed and Web of Knowledge databases, with articles published between 2010 and 2014, according to the PRISMA statement. Of the 85 identified studies, nine were selected. Most of the studies reported an association between recurrent miscarriage and specific antiphospholipid antibodies, as anticardiolipin antibodies (aCL), lupus anticoagulant (LA), anti-β2-glycoprotein I antibodies (aβ2GPI) and antiphosphatidylserine (aPS), which showed a relationship with RM. The main result of the meta-analysis revealed association between antiphospholipid antibodies (aPLs) and/or APS compared to the patients with RM (OR: 0.279; 95% CI: 0.212-0.366) and APS cases compared to the patients with RM (OR: 0.083; 95% CI: 0.036-0.189). High heterogeneity among these studies (I2=100.0%, p <0.001) was observed. In addition, there was no significant publication bias across studies according to Begg's test (p=0.230), although Egger's test (p=0.037) suggests significant publication bias. The funnel plot was slightly asymmetrical. Systematic review and meta-analysis demonstrated a positive association between antiphospholipid antibodies and/or antiphospholipid syndrome in patients with recurrent miscarriage.
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Affiliation(s)
- Thaís da Silva Santos
- Postgraduate Program in Biosciences and Physiopathology, State University Maringa, 5790 Colombo Avenue, 87020-900, Maringa, Brazil
| | - Andressa Lorena Ieque
- Postgraduate Program in Health Sciences, State University Maringa, 5790 Colombo Avenue, 87020-900 Maringa, Brazil
| | - Hayalla Corrêa de Carvalho
- Postgraduate Program in Biosciences and Physiopathology, State University Maringa, 5790 Colombo Avenue, 87020-900, Maringa, Brazil
| | - Ana Maria Sell
- Department of Cell Biology and Genetics, Center of Biological Sciences, State University Maringa,5790 Colombo Avenue, 87020-900 Maringa, Brazil
| | | | - Izabel Galhardo Demarchi
- Department of Clinical Analyses and Biomedicine, State University Maringa, 5790 Colombo Avenue, 87020-900 Maringa, Brazil
| | - Quirino Alves de Lima Neto
- Department of Basic Health Sciences, State University Maringa,5790 Colombo Avenue, 87020-900 Maringa, Brazil
| | - Jorge Juarez Vieira Teixeira
- Postgraduate Program in Biosciences and Physiopathology, Department of Clinical Analyses and Biomedicine, State University Maringa, 5790 Colombo Avenue, 87020-900 Maringa, Brazil.
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Gao H, Zhang YW, Huang K, Yan SQ, Mao LJ, Ge X, Xu YQ, Xu YY, Sheng J, Jin ZX, Zhu P, Tao XG, Hao JH, Tao FB. Urinary concentrations of phthalate metabolites in early pregnancy associated with clinical pregnancy loss in Chinese women. Sci Rep 2017; 7:6800. [PMID: 28754983 PMCID: PMC5533765 DOI: 10.1038/s41598-017-06450-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/13/2017] [Indexed: 11/09/2022] Open
Abstract
Limited evidence revealed conflicting results on relationship between phthalate exposure and clinical pregnancy loss (gestational weeks >6). A prospective cohort study in Chinese pregnant women (n = 3220) was conducted to investigate the association between urinary phthalate metabolites and clinical pregnancy loss (gestational weeks 6 to 27; n = 109). Morning urine samples during gestational weeks 5 to 14 (mean 10.42) were collected to measure monomethyl phthalate (MMP), monoethyl phthalate (MEP), monobutyl phthalate (MBP), monobenzyl phthalate (MBzP), mono (2-ethylhexyl) phthalate (MEHP), mono (2-ethyl-5-oxohexyl) phthalate (MEOHP) and mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP). The concentrations of low- and high-molecular weight phthalate metabolites (ΣLMWP <250 Da and ΣHMWP >250 Da) were calculated. Adjusted logistic regression models showed increased risks of clinical pregnancy loss in women with higher creatinine- normalized concentrations of MEP, MBP, MEOHP, MEHHP, ΣLMWP and ΣHMWP. Stratified analysis by gestational weeks (10 weeks) of miscarriage indicated positive associations of MEP, MEOHP, MEHHP and ΣHMWP with embryonic loss (during gestational weeks 6 to 10). The only association of foetal loss (during gestational weeks 11 to 27) was observed with MEHHP. Our findings suggested that Chinese women who were exposed to phthalates during early pregnancy had an increased risk of clinical pregnancy loss, especially embryonic loss.
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Affiliation(s)
- Hui Gao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yun-Wei Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Shuang-Qin Yan
- Ma'anshan Maternal and Child Health (MCH) Center, Ma'anshan, Anhui, China
| | - Lei-Jing Mao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Xing Ge
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Ye-Qing Xu
- Ma'anshan Maternal and Child Health (MCH) Center, Ma'anshan, Anhui, China
| | - Yuan-Yuan Xu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui, China
| | - Jie Sheng
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui, China
| | - Zhong-Xiu Jin
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui, China
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui, China
| | - Xu-Guang Tao
- Johns Hopkins Medical Institution, Baltimore, USA
| | - Jia-Hu Hao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui, China
| | - Fang-Biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China. .,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui, China.
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Fournier A, Torre A, Delaroche L, Gala A, Mullet T, Ferrières A, Hamamah S. [Quality of oocytes and embryos from women with polycystic ovaries syndrome: State of the art]. ACTA ACUST UNITED AC 2017; 45:429-438. [PMID: 28757106 DOI: 10.1016/j.gofs.2017.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Indexed: 12/21/2022]
Abstract
The frequency of polycystic ovary syndrome (PCOS) and the consequent fertility disorders cause many difficulties in the management of the assisted reproductive technics. Some studies are focused on different additional treatments, stimulation protocols or techniques that could optimize the in vitro fertilization cycles. The quality of the oocytes and embryos of these patients is also an outstanding issue. They remain difficult to actually evaluate during management, and none of the few published studies on this subject demonstrated any inferiority, compared to control patients. However, many differences have been highlighted, studying intra- and extra-ovarian factors. The advent of new genetic techniques could allow a better understanding of the pathophysiological mechanisms of the syndrome, as well as refining the evaluation of oocytes and embryos, in order to better predict the results of in vitro fertilization attempts. Pregnancy and birth rates, however, appear to be comparable to those of the general population.
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Affiliation(s)
- A Fournier
- Département de biologie de la reproduction et du diagnostic pré-implantatoire, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - A Torre
- Département gynécologie-obstétrique, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - L Delaroche
- Clinique P. Cherest, centre de fécondation in vitro, 5, rue Pierre-Cherest, 92200 Neuilly-sur-Seine, France
| | - A Gala
- Département de biologie de la reproduction et du diagnostic pré-implantatoire, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France; Inserm U1203, institut de médecine régénérative et biothérapies (IRMB), hôpital Saint-Éloi, CHRU de Montpellier, 80, rue Augustin-Fliche, 34295 Montpellier, France
| | - T Mullet
- Département de biologie de la reproduction et du diagnostic pré-implantatoire, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France; Inserm U1203, institut de médecine régénérative et biothérapies (IRMB), hôpital Saint-Éloi, CHRU de Montpellier, 80, rue Augustin-Fliche, 34295 Montpellier, France
| | - A Ferrières
- Département de biologie de la reproduction et du diagnostic pré-implantatoire, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France; Inserm U1203, institut de médecine régénérative et biothérapies (IRMB), hôpital Saint-Éloi, CHRU de Montpellier, 80, rue Augustin-Fliche, 34295 Montpellier, France
| | - S Hamamah
- Département de biologie de la reproduction et du diagnostic pré-implantatoire, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France; Inserm U1203, institut de médecine régénérative et biothérapies (IRMB), hôpital Saint-Éloi, CHRU de Montpellier, 80, rue Augustin-Fliche, 34295 Montpellier, France.
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Ismail AM, Abbas AM, Bakry AK, Abu-Elhassan AM, Mohamed AO, Badr G, Youssef MA. Expression of ERK and Akt proteins in women with unexplained first-trimester recurrent miscarriage. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2016.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Carlini T, Paoli D, Pelloni M, Faja F, Dal Lago A, Lombardo F, Lenzi A, Gandini L. Sperm DNA fragmentation in Italian couples with recurrent pregnancy loss. Reprod Biomed Online 2017; 34:58-65. [DOI: 10.1016/j.rbmo.2016.09.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 09/21/2016] [Accepted: 09/27/2016] [Indexed: 01/11/2023]
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Grujičić D, Radović M, Arsenijević S, Milošević-Djordjević O. Cytogenetic biomarkers in detection of genotoxic effects of gestagens in peripheral blood lymphocytes in vitro and in vivo. Eur J Med Genet 2016; 59:624-633. [PMID: 27793715 DOI: 10.1016/j.ejmg.2016.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/28/2016] [Accepted: 10/24/2016] [Indexed: 01/02/2023]
Abstract
Gestagens are the most frequently used steroid hormones in hormone-replacement therapy in the treatment of threatened miscarriage during the first trimester of pregnancy. This therapy has been applied in a large number of women with threatened abortion, despite various degrees of success of its efficacy. Genetic factors play a key role in miscarriages, especially in the initial stages. Cytogenetic biomarkers such as micronucleus (MN) test, chromosomal aberrations (CAs), and sister chromatid exchanges (SCEs) provide information on DNA damage. Cytogenetic markers detecting DNA damage have become very popular and useful in analysing genetic risk associated with hormone-replacement therapy. Cytogenetic studies presented heterogenous information. In many in vitro studies synthetic gestagens have been shown to induce genotoxic effects, and it was evaluated using three cytogenetic biomarkers. Genotoxic effects of gestagens have also been confirmed in in vivo studies that were conducted involving patients who received gestagen therapy during pregnancy and their newborns. However, some studies have shown that hormone-replacement therapy does not have genotoxic effects. In this paper, we summarize the results from previous studies. We also describe the usefulness of these biomarkers in the detection of genotoxic effects of hormone-replacement therapy.
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Affiliation(s)
- Darko Grujičić
- Faculty of Science, University of Kragujevac, 34 000, Kragujevac, Serbia.
| | - Marina Radović
- Faculty of Science, University of Kragujevac, 34 000, Kragujevac, Serbia
| | - Slobodan Arsenijević
- Faculty of Medical Sciences, University of Kragujevac, 34 000, Kragujevac, Serbia; Gynaecology Clinic, Clinical Centre Kragujevac, 34 000, Kragujevac, Serbia
| | - Olivera Milošević-Djordjević
- Faculty of Science, University of Kragujevac, 34 000, Kragujevac, Serbia; Faculty of Medical Sciences, University of Kragujevac, 34 000, Kragujevac, Serbia
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Etiologic characteristics and index pregnancy outcomes of recurrent pregnancy losses in Korean women. Obstet Gynecol Sci 2016; 59:379-87. [PMID: 27668201 PMCID: PMC5028645 DOI: 10.5468/ogs.2016.59.5.379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/29/2016] [Accepted: 05/02/2016] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE The goal of this study was to evaluate the etiologies and clinical outcomes of Korean recurrent pregnancy loss (RPL) patients. And also, we investigated the differences between primary and secondary RPL patients, between two and three or more pregnancy losses. METHODS One hundred seventy eight women diagnosed as RPL were enrolled. We performed chromosomal analysis, thyroid stimulating hormone, prolactin, blood glucose, plasminogen activator inhibitor-1, natural killer cell proportion, anticardiolipin antibodies, antiphospholipid antibodies, lupus anticoagulant, anti-β2glycoprotein-1 antibodies, antinuclear antibody, protein C, protein S, antithrombin III, homocysteine, MTFHR gene, factor V Leiden mutation, and hysterosalphingography/hysteroscopic evaluation. RESULTS The mean age was 34.03±4.30 years, and mean number of miscarriages was 2.69±1.11 (range, 2 to 11). Anatomical cause (13.5%), chromosomal abnormalities (5.6%), and endocrine disorders (34.3%) were observed in RPL women. Elevated natural killer cell and antiphospholipid antibodies were observed in 43.3% and 7.3% each. Among of 178 women, 77 women were pregnant. After management of those women, live birth rate was 84.4% and mean gestational weeks was 37.63±5.12. Women with three or more RPL compared with women with two RPL had more common anatomical cause such as intrauterine adhesions and lower rates of spontaneous pregnancy. Compare with secondary RPL women, immunological abnormalities were more common in primary RPL. However, miscarriage rates were not different. CONCLUSION Immunological factor including autoimmune and alloimmune disorders was most common etiology of RPL. Inherited thrombophilia showed different patterns with other ethnic countries. Miscarriage rates were not different between primary and secondary RPL, or between two and three or more miscarriages group.
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21
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Ticconi C, Giuliani E, Sorge R, Patrizi L, Piccione E, Pietropolli A. Gestational age of pregnancy loss in women with unexplained recurrent miscarriage. J Obstet Gynaecol Res 2015; 42:239-45. [DOI: 10.1111/jog.12903] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 08/02/2015] [Accepted: 10/01/2015] [Indexed: 01/28/2023]
Affiliation(s)
- Carlo Ticconi
- Academic Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics; Tor Vergata University; Rome Italy
- Clinical Department of Surgery, Division of Gynecology and Obstetrics; University Hospital Policlinico Tor Vergata; Rome Italy
| | - Emma Giuliani
- Department of Obstetrics and Gynecology, Grand Rapids Medical Education Partners; Michigan State University; Grand Rapids Michigan USA
| | - Roberto Sorge
- Laboratory of Biometry, Department of Systems Medicine; Tor Vergata University; Rome Italy
| | - Lodovico Patrizi
- Academic Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics; Tor Vergata University; Rome Italy
- Clinical Department of Surgery, Division of Gynecology and Obstetrics; University Hospital Policlinico Tor Vergata; Rome Italy
| | - Emilio Piccione
- Academic Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics; Tor Vergata University; Rome Italy
- Clinical Department of Surgery, Division of Gynecology and Obstetrics; University Hospital Policlinico Tor Vergata; Rome Italy
| | - Adalgisa Pietropolli
- Academic Department of Biomedicine and Prevention, Section of Gynecology and Obstetrics; Tor Vergata University; Rome Italy
- Clinical Department of Surgery, Division of Gynecology and Obstetrics; University Hospital Policlinico Tor Vergata; Rome Italy
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Mankee A, Petri M, Magder LS. Lupus anticoagulant, disease activity and low complement in the first trimester are predictive of pregnancy loss. Lupus Sci Med 2015; 2:e000095. [PMID: 26688740 PMCID: PMC4680586 DOI: 10.1136/lupus-2015-000095] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 08/05/2015] [Indexed: 11/12/2022]
Abstract
Introduction Multiple factors, including proteinuria, antiphospholipid syndrome, thrombocytopenia and hypertension, are predictive of pregnancy loss in systemic lupus erythematosus (SLE). In the PROMISSE study of predictors of pregnancy loss, only a battery of lupus anticoagulant tests was predictive of a composite of adverse pregnancy outcomes. We examined the predictive value of one baseline lupus anticoagulant test (dilute Russell viper venom time) with pregnancy loss in women with SLE. Methods From the Hopkins Lupus Cohort, there were 202 pregnancies from 175 different women after excluding twin pregnancies and pregnancies for which we did not have a first trimester assessment of lupus anticoagulant. We determined the percentage of women who had a pregnancy loss in groups defined by potential risk factors. The lupus anticoagulant was determined by dilute Russell viper venom time with appropriate mixing and confirmatory testing. Generalised estimating equations were used to calculate p values, accounting for repeated pregnancies in the same woman. Results The age at pregnancy was <20 years (2%), 20–29 (53%), 30–39 (41%) and >40 (3%). 55% were Caucasian and 34% African-American. Among those with lupus anticoagulant during the first trimester, 6/16 (38%) experienced a pregnancy loss compared with only 16/186 (9%) of other pregnancies (p=0.003). In addition, those with low complement or higher disease activity had a higher rate of pregnancy loss than those without (p=0.049 and 0.005, respectively). In contrast, there was no association between elevated anticardiolipin in the first trimester and pregnancy loss. Conclusions The strongest predictor of pregnancy loss in SLE in the first trimester is the lupus anticoagulant. In addition, moderate disease activity by the physician global assessment and low complement measured in the first trimester were predictive of pregnancy loss. These data suggest that treatment of the lupus anticoagulant could be considered, even in the absence of history of pregnancy loss.
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Affiliation(s)
- Anil Mankee
- Division of Rheumatology , Icahn School of Medicine at Mount Sinai , New York, New York , USA
| | - Michelle Petri
- Division of Rheumatology and Immunology , Johns Hopkins University School of Medicine , Baltimore, Maryland , USA
| | - Laurence S Magder
- Department of Epidemiology and Public Health , University of Maryland , Baltimore, Maryland , USA
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Chen X, Liang PY, Li GG, Diao LH, Liu CC, Huang CY, Wu TH, Xu J, Zeng Y. Association of HLA-DQ alleles with the presence of an anti-β2-glycoprotein I antibody in patients with recurrent miscarriage. HLA 2015; 87:19-24. [PMID: 26818121 DOI: 10.1111/tan.12713] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/15/2015] [Accepted: 10/31/2015] [Indexed: 11/27/2022]
Affiliation(s)
- X. Chen
- Fertility Center; Shenzhen Zhongshan Urology Hospital; Shenzhen China
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation; Shenzhen Zhongshan Urology Hospital; Shenzhen China
- Shenzhen Zhongshan Institute for Reproduction and Genetics; Shenzhen China
| | - P-Y. Liang
- Fertility Center; Shenzhen Zhongshan Urology Hospital; Shenzhen China
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation; Shenzhen Zhongshan Urology Hospital; Shenzhen China
- Shenzhen Zhongshan Institute for Reproduction and Genetics; Shenzhen China
| | - G-G. Li
- Fertility Center; Shenzhen Zhongshan Urology Hospital; Shenzhen China
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation; Shenzhen Zhongshan Urology Hospital; Shenzhen China
- Shenzhen Zhongshan Institute for Reproduction and Genetics; Shenzhen China
| | - L-H. Diao
- Fertility Center; Shenzhen Zhongshan Urology Hospital; Shenzhen China
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation; Shenzhen Zhongshan Urology Hospital; Shenzhen China
- Shenzhen Zhongshan Institute for Reproduction and Genetics; Shenzhen China
| | - C-C. Liu
- Fertility Center; Shenzhen Zhongshan Urology Hospital; Shenzhen China
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation; Shenzhen Zhongshan Urology Hospital; Shenzhen China
- Shenzhen Zhongshan Institute for Reproduction and Genetics; Shenzhen China
| | - C-Y. Huang
- Fertility Center; Shenzhen Zhongshan Urology Hospital; Shenzhen China
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation; Shenzhen Zhongshan Urology Hospital; Shenzhen China
- Shenzhen Zhongshan Institute for Reproduction and Genetics; Shenzhen China
| | - T-H. Wu
- Fertility Center; Shenzhen Zhongshan Urology Hospital; Shenzhen China
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation; Shenzhen Zhongshan Urology Hospital; Shenzhen China
- Shenzhen Zhongshan Institute for Reproduction and Genetics; Shenzhen China
| | - J. Xu
- Fertility Center; Shenzhen Zhongshan Urology Hospital; Shenzhen China
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation; Shenzhen Zhongshan Urology Hospital; Shenzhen China
- Shenzhen Zhongshan Institute for Reproduction and Genetics; Shenzhen China
| | - Y. Zeng
- Fertility Center; Shenzhen Zhongshan Urology Hospital; Shenzhen China
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation; Shenzhen Zhongshan Urology Hospital; Shenzhen China
- Shenzhen Zhongshan Institute for Reproduction and Genetics; Shenzhen China
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Neusser M, Rogenhofer N, Dürl S, Ochsenkühn R, Trottmann M, Jurinovic V, Steinlein O, von Schönfeldt V, Müller S, Thaler CJ. Increased chromosome 16 disomy rates in human spermatozoa and recurrent spontaneous abortions. Fertil Steril 2015; 104:1130-7.e1-10. [PMID: 26318886 DOI: 10.1016/j.fertnstert.2015.07.1160] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 07/25/2015] [Accepted: 07/27/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate if unexplained recurrent spontaneous abortions (RSA) are associated with increased rates of aneuploidy in spermatozoa of RSA partners ("RSA-men"). DESIGN Case-control study. SETTING Academic research center. PATIENT(S) Patients enrolled at the Hormone and Fertility Center and controls at the Department of Urology (LMU-Munich). INTERVENTION(S) Sperm samples of 11 partners of unexplained RSA cases evaluated for elevated diploidy and disomy levels of chromosomes 1-22, X, and Y by multicolor sperm fluorescence in situ hybridization (FISH). MAIN OUTCOME MEASURE(S) Aneuploidy rates obtained in RSA-men compared with controls from the literature and internally; an increase of the aneuploidy rate was considered statistically significant, when it differed ≥ 2 standard deviations from the mean baseline level in controls. RESULT(S) Our sperm FISH data on RSA men showed increased disomy rates for at least three chromosomes in more than 60% of patients but no statistically significant increase of the overall mean sperm disomy or diploidy rate. In particular, meiotic errors involving chromosome 16 contributed to increased sperm disomy in more than 60% of our patients. CONCLUSION(S) These data suggest that among paternal meiotic errors nondisjunction of chromosome 16 might have similar relative influence on fetal aneuploidy compared with maternal chromosome 16 disomy.
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Affiliation(s)
- Michaela Neusser
- Institute of Human Genetics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Nina Rogenhofer
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Stephanie Dürl
- Institute of Human Genetics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | | | - Matthias Trottmann
- Department of Urology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Vindi Jurinovic
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Ortrud Steinlein
- Institute of Human Genetics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Viktoria von Schönfeldt
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Stefan Müller
- Institute of Human Genetics, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.
| | - Christian J Thaler
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Ludwig Maximilian University of Munich, Munich, Germany
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Pereza N, Peterlin B, Volk M, Kapović M, Ostojić S. A critical update on endothelial nitric oxide synthase gene variations in women with idiopathic recurrent spontaneous abortion: genetic association study, systematic review and meta-analyses. Mol Hum Reprod 2015; 21:466-78. [PMID: 25713339 DOI: 10.1093/molehr/gav008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 02/17/2015] [Indexed: 12/13/2022] Open
Abstract
A number of case-control studies investigated the association between idiopathic recurrent spontaneous abortion (IRSA) and variations in the gene encoding endothelial nitric oxide synthase (NOS3), but yielded contradictory results. Our aim was to test the association of the NOS3 variable number of tandem repeats (VNTR) in intron 4 and +894 G/T single-nucleotide polymorphism (SNP) with IRSA in Slovenian women (148 IRSA and 149 control women), conduct a systematic review of literature on the association between NOS3 gene variations and IRSA, and perform meta-analyses of studies that met the inclusion criteria, defined by virtue of the European Society for Human Reproduction and Embryology evidence-based guidelines for recurrent spontaneous abortion. Genotyping was performed using PCR and restriction fragment length polymorphism methods. The systematic review of literature (English language) was conducted using PubMed and Scopus databases, to 1 November 2014. We determined no association of IRSA with the VNTR in intron 4 and +894 G/T SNP in Slovenian women. Furthermore, 16 case-control studies were identified on the association between 15 NOS3 gene variations and IRSA. However, significant inconsistencies exist in the selection criteria of patients and controls between studies. The meta-analysis of VNTR in intron 4 was performed on five studies (894 patients, 944 controls), whereas the meta-analysis of +894 G/T SNP included six studies (1111 patients, 1121 controls). The association with IRSA was significant for the +894 G/T SNP under the dominant genetic model (GT+TT versus GG) based on fixed (odds ratio (OR) = 1.54, 95% confidence interval (CI) = 1.28-1.86, P = <0.01) and random effects models (OR = 1.54, 95% CI = 1.03-2.31, P = 0.03). In conclusion, the GT and TT genotypes of the +894 G/T SNP in women might contribute to a predisposition to IRSA. Additional genetic association and functional studies in different populations with larger numbers of participants and a uniformly defined IRSA are needed to clarify the contribution of NOS3 +894 G/T gene variation to IRSA.
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Affiliation(s)
- N Pereza
- Department of Biology and Medical Genetics, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - B Peterlin
- Clinical Institute of Medical Genetics, Department of Gynaecology and Obstetrics, UMC Ljubljana, 1000 Ljubljana, Slovenia
| | - M Volk
- Clinical Institute of Medical Genetics, Department of Gynaecology and Obstetrics, UMC Ljubljana, 1000 Ljubljana, Slovenia
| | - M Kapović
- Department of Biology and Medical Genetics, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - S Ostojić
- Department of Biology and Medical Genetics, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
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Gao H, Tao FB. Prothrombin G20210A mutation is associated with recurrent pregnancy loss: A systematic review and meta-analysis update. Thromb Res 2015; 135:339-46. [DOI: 10.1016/j.thromres.2014.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 11/30/2014] [Accepted: 12/01/2014] [Indexed: 11/30/2022]
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Shapiro D, Boostanfar R, Silverberg K, Yanushpolsky EH. Examining the evidence: progesterone supplementation during fresh and frozen embryo transfer. Reprod Biomed Online 2014; 29 Suppl 1:S1-14; quiz S15-6. [DOI: 10.1016/s1472-6483(14)50063-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Song G, Yan J, Zhang Q, Li G, Chen ZJ. Association of tissue inhibitor of metalloproteinase gene polymorphisms and unexplained recurrent spontaneous abortions in Han Chinese couples. Eur J Obstet Gynecol Reprod Biol 2014; 181:84-8. [PMID: 25128867 DOI: 10.1016/j.ejogrb.2014.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/08/2014] [Accepted: 07/20/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the association of tissue inhibitor of metalloproteinase (TIMP) gene polymorphisms with unexplained recurrent spontaneous abortions (URSA) in a well-defined group of Han Chinese couples. STUDY DESIGN This is a case-control association study. Genomic DNA was extracted from peripheral blood samples from 84 couples with histories of three or more pregnancy losses and 69 age-matched healthy couples with at least one live birth and no histories of pregnancy loss. Polymerase chain reactions (PCRs) and sequencing with the fluorescent dye dideoxy-termination method were used to detect the rs4898 in TIMP-1, rs2277698 in TIMP-2, rs2234921 and rs5749511 in TIMP-3 and rs17035945 in TIMP-4 genotypes and allele frequencies. RESULTS Neither the allele frequencies nor any of the genetic model of the five TIMP gene SNPs (i.e., TIMP-1-rs4898, TIMP-2-rs2277698, TIMP-3-rs5749511 and rs2234921, and TIMP-4-rs7035945) were significantly differences between the URSA couples and the control group. CONCLUSIONS No evidence was found for any associations between the TIMP-1,-2,-3, or -4 genes SNPs with URSA in this Han Chinese Han.
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Affiliation(s)
- Guihong Song
- Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University, Jinan, China; Shandong College of Traditional Chinese Medicine, Yantai, China
| | - Junhao Yan
- Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China; The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China
| | - Qian Zhang
- Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Guangyu Li
- Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China; The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University, Jinan, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China; The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China.
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Asadpor U, Totonchi M, Sabbaghian M, Hoseinifar H, Akhound MR, Zari Moradi S, Haratian K, Sadighi Gilani MA, Gourabi H, Mohseni Meybodi A. Ubiquitin-specific protease (USP26) gene alterations associated with male infertility and recurrent pregnancy loss (RPL) in Iranian infertile patients. J Assist Reprod Genet 2013; 30:923-31. [PMID: 23779098 DOI: 10.1007/s10815-013-0027-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 05/31/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND PURPOSE The human X chromosome is enriched with testis-specific genes that may be crucial for male fertility. Mutations in USP26 gene have been proposed to be associated with male infertility. Moreover, the importance of the ubiquitin pathway during different stages of mammalian fertilization and even embryo development has been addressed. Some mutations and haplotypes on this gene have been proposed to be associated with male infertility. In this study, five different mutations on USP26 were investigated: 1737 G > A, 1090 C > T, 370-371ins ACA, 494 T > C and 1423 C > T. METHODS The study included 166 infertile men with non-obstructive azoospermia, 72 male partners of couples who had previously experienced ≥3 clinical first trimester spontaneous abortions and 60 fertile men. Besides family history of reproduction, hormonal evaluation and semen analysis were performed. DNA was extracted from blood samples. PCR-SSCP, PCR-RFLP and PCR Product Cloning methods were used and resumed by sequencing to insure about the mutations. Moreover, USP26 gene expression was studied by Real-Time PCR after RNA extraction followed by cDNA synthesis from 24 testis biopsies in obstructive and non-obstructive azoospermia patients. RESULTS The results indicate that there is a haplotype between three observed mutations in Iranian population include: 370-371insACA, 1423C > T and 494 T > C. This haplotype was seen in control group as well. Surprisingly, total frequency of mutations in men with history of idiopathic RPL and azoospermic cases were significantly higher than that of in control groups (p < 0.05). Serum testosterone concentrations and testicular volume did not differ in the mutation positive group compared with the non-mutation group. About the USP26 gene expression, there is a significant difference between the expression levels of obstructive azoospermia, complete maturation arrest samples and SCO samples (P < 0.05). CONCLUSIONS According to our results, the USP26 gene may play an important role in male reproduction. The alterations of this gene may be involved in male infertility and RPL in Iranian population and may negatively affect testicular function.
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Affiliation(s)
- U Asadpor
- Department of Genetics at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Bonney EA. Demystifying animal models of adverse pregnancy outcomes: touching bench and bedside. Am J Reprod Immunol 2013; 69:567-84. [PMID: 23448345 DOI: 10.1111/aji.12102] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 01/28/2013] [Indexed: 01/21/2023] Open
Abstract
This represents an overview of the use of animal models to study the adverse pregnancy outcomes seen in humans. The purpose is to entice clinicians to utilize some of this information to seek out the literature and have more meaningful and profitable discussions with their academic colleagues and enhance transdisciplinary research in reproductive health.
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Affiliation(s)
- Elizabeth A Bonney
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, Burlington, VT, USA.
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Shahin S, Singh VP, Shukla RK, Dhawan A, Gangwar RK, Singh SP, Chaturvedi CM. 2.45 GHz microwave irradiation-induced oxidative stress affects implantation or pregnancy in mice, Mus musculus. Appl Biochem Biotechnol 2013; 169:1727-51. [PMID: 23334843 DOI: 10.1007/s12010-012-0079-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 12/27/2012] [Indexed: 12/17/2022]
Abstract
The present experiment was designed to study the 2.45 GHz low-level microwave (MW) irradiation-induced stress response and its effect on implantation or pregnancy in female mice. Twelve-week-old mice were exposed to MW radiation (continuous wave for 2 h/day for 45 days, frequency 2.45 GHz, power density=0.033549 mW/cm(2), and specific absorption rate=0.023023 W/kg). At the end of a total of 45 days of exposure, mice were sacrificed, implantation sites were monitored, blood was processed to study stress parameters (hemoglobin, RBC and WBC count, and neutrophil/lymphocyte (N/L) ratio), the brain was processed for comet assay, and plasma was used for nitric oxide (NO), progesterone and estradiol estimation. Reactive oxygen species (ROS) and the activities of ROS-scavenging enzymes- superoxide dismutase, catalase, and glutathione peroxidase-were determined in the liver, kidney and ovary. We observed that implantation sites were affected significantly in MW-irradiated mice as compared to control. Further, in addition to a significant increase in ROS, hemoglobin (p<0.001), RBC and WBC counts (p<0.001), N/L ratio (p<0.01), DNA damage (p<0.001) in brain cells, and plasma estradiol concentration (p<0.05), a significant decrease was observed in NO level (p<0.05) and antioxidant enzyme activities of MW-exposed mice. Our findings led us to conclude that a low level of MW irradiation-induced oxidative stress not only suppresses implantation, but it may also lead to deformity of the embryo in case pregnancy continues. We also suggest that MW radiation-induced oxidative stress by increasing ROS production in the body may lead to DNA strand breakage in the brain cells and implantation failure/resorption or abnormal pregnancy in mice.
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Affiliation(s)
- Saba Shahin
- Department of Zoology, Banaras Hindu University, Varanasi, 221005, India,
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Midluteal serum progesterone concentration does not predict the outcome of pregnancy in women with unexplained recurrent miscarriage. Reprod Biomed Online 2013; 26:138-41. [PMID: 23273755 DOI: 10.1016/j.rbmo.2012.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 10/15/2012] [Accepted: 10/25/2012] [Indexed: 11/21/2022]
Abstract
This retrospective observational study was performed to determine the predictive value of midluteal serum progesterone measurement on the subsequent pregnancy outcome in women with unexplained recurrent miscarriage after referral. This study involved women with unexplained recurrent miscarriage attending the recurrent miscarriage clinic between January 1992 and March 2011. A total of 132 women with unexplained recurrent miscarriage who conceived again within 12 months of midluteal serum progesterone measurement were analysed. Midluteal serum progesterone concentrations were compared between miscarriage and live birth groups. Also live birth rates were compared between higher and lower progesterone groups. Among 132 women studied, the serum progesterone concentrations (mean ± SE) in the live birth group (n=86) and miscarriage group (n=46) were 42.3 ± 2.4 nmol/l and 42.5 ± 3.2 nmol/l, respectively. In addition, using three different progesterone cut-off values (20, 30 and 40 nmol/l), the live birth and miscarriage rates were also not significantly different. The conclusion is that midluteal serum progesterone measurement does not predict the outcome of a subsequent pregnancy in women with unexplained recurrent miscarriage. This retrospective observational study was performed to determine the predictive value of midluteal serum progesterone measurement on the subsequent pregnancy outcome in women with unexplained recurrent miscarriage after referral. This study involved women with unexplained recurrent miscarriage attending the recurrent miscarriage clinic between January 1992 and March 2011. A total of 132 women with unexplained recurrent miscarriage who conceived again within 12 months of midluteal serum progesterone measurement were analysed. Midluteal serum progesterone values were compared between miscarriage and live birth groups. Also live birth rates were compared between higher and lower progesterone groups. Among 132 women studied, the serum progesterone concentration in the live birth group (n=86) and miscarriage group (n=46) were (mean ± SE) 42.3 ± 2.4 nmol/l and 42.5 ± 3.2 nmol/l, respectively. In addition, using three different progesterone cut-off values (20, 30 and 40 nmol/l), the live birth and miscarriage rates were also not significantly different. The conclusion is that midluteal serum progesterone measurement does not predict the outcome of a subsequent pregnancy in women with unexplained recurrent miscarriage.
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Ribas-Maynou J, García-Peiró A, Fernandez-Encinas A, Amengual MJ, Prada E, Cortés P, Navarro J, Benet J. Double stranded sperm DNA breaks, measured by Comet assay, are associated with unexplained recurrent miscarriage in couples without a female factor. PLoS One 2012; 7:e44679. [PMID: 23028579 PMCID: PMC3444447 DOI: 10.1371/journal.pone.0044679] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 08/07/2012] [Indexed: 12/23/2022] Open
Abstract
It is known that sperm samples from recurrent pregnancy loss (RPL) couples have an increase in their sperm DNA fragmentation (SDF), but no studies have been performed in order to identify differences between single stranded SDF (ssSDF) and double stranded SDF (dsSDF) in these patients. This could be relevant because the type of DNA damage could have different effects. Semen samples were classified attending their clinical status: 25 fertile donors and 20 RPL patients with at least two unexplained first trimester miscarriages. SDF was analysed using alkaline and neutral Comet assay, SCD test and pulsed-field gel electrophoresis (PFGE), and ROC analysis including data from 105 more infertile patients (n = 150) was performed to establish predictive threshold values. SDF for alkaline and neutral Comet, and the SCD test was analysed in these categories of individuals. Data revealed the presence of two subgroups within fertile donors. The values obtained were 21.10±9.13, 23.35±10.45 and 12.31±4.31, respectively, for fertile donors with low values for both ssSDF and dsSDF; 27.86±12.64, 80.69±12.67 and 12.43±5.22, for fertile donors with low ssSDF and high dsSDF; and 33.61±15.50, 84.64±11.28 and 19.28±6.05, for unexplained RPL patients, also showing a low ssSDF and high dsSDF profile. This latter profile was seen in 85% of unexplained RPL and 33% of fertile donors, suggesting that it may be associated to a male risk factor for undergoing RPL. ROC analysis regarding recurrent miscarriage set the cut-off value at 77.50% of dsDNA SDF. PFGE for low ssSDF and high dsSDF profile samples and positive controls treated with DNase, to induce dsDNA breaks, showed a more intense band of about 48 kb, which fits the toroid model of DNA compaction in sperm, pointing out that some nuclease activity may be affecting their sperm DNA in RPL patients. This work identifies a very specific SDF profile related to the paternal risk of having RPL.
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Affiliation(s)
- Jordi Ribas-Maynou
- Càtedra de Recerca Eugin-UAB, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Departament de Biologia Cel lular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Agustín García-Peiró
- Càtedra de Recerca Eugin-UAB, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Departament de Biologia Cel lular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Alba Fernandez-Encinas
- Càtedra de Recerca Eugin-UAB, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Departament de Biologia Cel lular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Maria José Amengual
- UDIAT, Centre Diagnòstic. Corporació Sanitària Parc Taulí. Sabadell. Institut Universitari Parc Taulí – UAB, Sabadell, Spain
| | - Elena Prada
- Servei de Ginecologia, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Pilar Cortés
- Departament de Genética i Microbiologia, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Joaquima Navarro
- Càtedra de Recerca Eugin-UAB, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Departament de Biologia Cel lular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jordi Benet
- Càtedra de Recerca Eugin-UAB, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Departament de Biologia Cel lular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Sater MS, Finan RR, Abu-Hijleh FM, Abu-Hijleh TM, Almawi WY. Anti-phosphatidylserine, anti-cardiolipin, anti-β2 glycoprotein I and anti-prothrombin antibodies in recurrent miscarriage at 8–12 gestational weeks. Eur J Obstet Gynecol Reprod Biol 2012; 163:170-4. [DOI: 10.1016/j.ejogrb.2012.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 03/22/2012] [Accepted: 04/02/2012] [Indexed: 10/28/2022]
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Zhang L, Wang L, Zhang X, Xu G, Zhang W, Wang K, Wang Q, Qiu Y, Li J, Gai L. Sperm chromatin integrity may predict future fertility for unexplained recurrent spontaneous abortion patients. ACTA ACUST UNITED AC 2012; 35:752-7. [PMID: 22519675 DOI: 10.1111/j.1365-2605.2012.01276.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The pathogenesis of recurrent spontaneous abortion (RSA) is multi-factorial, complex and poorly understood. In the present study, semen parameters, including sperm chromatin integrity, sperm concentration, sperm motility and sperm morphology, were compared between 111 men whose partners had a history of unexplained RSA (RSA group) and 30 healthy fertile men (control group). The RSA group was further separated into three subgroups, depending on their reproductive outcome during the 12 months after they were enrolled in the study: the pregnancy subgroup consisted of 43 men whose partners achieved a successful pregnancy up to at least the 24th week of gestation; the abortion subgroup included 31 men whose partners experienced further abortions; and the infertile subgroup had 37 men whose partners did not have any positive pregnancy test after regular, unprotected intercourse. Significantly lower proportion of sperm with normal morphology was found in the abortion subgroup (14.7 ± 4.3%) than in the control group (17.5 ± 5.0%). Sperm concentrations were significantly lower in the infertile subgroup (55.7 ± 24.1%) than in the controls (68.6 ± 27.8%). The rates of abnormal sperm chromatin integrity were significantly higher in the abortion (16.7 ± 7.7%) and infertile (16.3 ± 6.6%) subgroups, compared to the control group (13.0 ± 4.4%). Logistic regression analysis showed that the subsequent reproductive outcome of the 111 RSA patients was negatively correlated to the rates of abnormal sperm chromatin integrity. In conclusion, sperm chromatin integrity, sperm morphology, and sperm concentration were associated with future reproductive outcome of RSA patients. The sperm chromatin integrity was a significant predictor for future abortion and infertility.
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Affiliation(s)
- Lihong Zhang
- Shandong Provincial Key Laboratory for Improving Birth Outcome Technique, Shandong Provincial Research Institute for Family Planning, Jinan 250002, China.
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Matthiesen L, Kalkunte S, Sharma S. Multiple pregnancy failures: an immunological paradigm. Am J Reprod Immunol 2012; 67:334-40. [PMID: 22380628 DOI: 10.1111/j.1600-0897.2012.01121.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 02/06/2012] [Indexed: 01/08/2023] Open
Abstract
Recurrent spontaneous abortion (RSA), three or more pregnancy losses prior to 20 weeks, occurs in about 1% of all pregnancies, 50% of RSA cases remain unexplained and unresolved. Recently, immune pathways have been implicated in the pathophysiology of RSA. Immune tolerance of the fetal-placental unit and placental angiogenesis are mandatory for a successful pregnancy outcome. Unscheduled dysregulation of the placental vasculature is thought to be the pathophysiologic mechanisms underlying an array of pregnancy complications like infertility, miscarriage, pre-eclampsia, and fetal growth restriction and death. Investigations on mechanisms and management of RSA are mired by substandard design and lack of optimal randomized clinical trials and have resulted in disagreement on guidelines for evaluation and treatments for patients with multiple pregnancy losses of unknown etiology. The present review focuses on evidence-based research discussion with immunologic causes, and immune-regulatory therapies recommended for helping patients with a history of RSA. We highlight data that might support revalidation of low molecular weight heparin as a protective therapy in RSA. Newly launched growth factors, GM-CSF, and potentially novel agents to suppress inflammatory rejection, including regulatory T cells, human chorionic gonadotropin, and M-CSF/IL-10, may work in concert with tender-loving-care therapy and give hope to couples with multiple pregnancy losses.
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Affiliation(s)
- Leif Matthiesen
- Department Obstetrics and Gynecology, Helsingborg Hospital, Affiliated Lunds University, Sweden.
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AlShaikh FS, Finan RR, Almawi AW, Mustafa FE, Almawi WY. Association of the R67X and W303X non-sense polymorphisms in the protein Z-dependent protease inhibitor gene with idiopathic recurrent miscarriage. Mol Hum Reprod 2011; 18:156-60. [PMID: 22039093 DOI: 10.1093/molehr/gar069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Protein Z-dependent protease inhibitor (ZPI) is a 72 kDa single-chain serpin which inhibits the activated coagulation factors X and XI. Two non-sense polymorphisms of ZPI, R67X and W303X, were recently identified, and were linked with a prothrombotic state. Here, we investigated the association of the R67X (728C>T) and W303X (1438G>A) variants in the ZPI gene with recurrent spontaneous miscarriage (RSM). This was a case-control study involving a total of 288 women with a history of two consecutive or ≥3 non-consecutive pregnancy losses between 8 and 12th week of gestation, along with 304 age-matched and ethnically matched multiparous control women, with no personal or family history of pregnancy complications. The minor allele frequency of R67X (P = 0.003) and W303X (P = 0.014) were higher in RSM cases than in control women. Both single-nucleotide polymorphisms were significantly associated with RSM under the dominant genetic association model, and were in moderate linkage disequilibrium (D' = 0.412; P < 0.001). Taking the common (728)C/(1438)G haplotype as reference, multivariate analysis confirmed the positive association of (728)T/(1438)G [P = 0.043; odds ratio (OR) = 2.25; 95% confidence interval (CI) = 1.03-4.90], and (728)T/(1438)A (P = 0.022; OR = 3.93; 95% CI = 1.23-12.59) haplotypes with increased RSM risk. These differences remained significant after controlling for some covariates. These results demonstrate that both ZPI R67X and W303X non-sense variants and specific ZPI haplotypes are significantly associated with RSM.
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Affiliation(s)
- F S AlShaikh
- Department of Medical Biochemistry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
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Brahem S, Mehdi M, Landolsi H, Mougou S, Elghezal H, Saad A. Semen parameters and sperm DNA fragmentation as causes of recurrent pregnancy loss. Urology 2011; 78:792-6. [PMID: 21813165 DOI: 10.1016/j.urology.2011.05.049] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 05/20/2011] [Accepted: 05/28/2011] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To evaluate and compare standard sperm parameters, and sperm DNA fragmentation in seminal ejaculates from men whose partners had a history of recurrent pregnancy loss (RPL) and in a control group of men who had recently established their fertility. METHODS Semen samples from 31 patients with a history of recurrent pregnancy loss and 20 men with proven fertility were analyzed according to World Health Organization guidelines. Sperm DNA fragmentation was detected by the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assay. RESULTS When sperm quality of the control group was compared with that of the RPL group, a significant difference was observed in sperm motility, but not in other parameters. The mean number of sperm cells with fragmented DNA was significantly increased in the RPL group (32.22 ± 6.14%) compared with control donors (10.20 ± 2.1%). CONCLUSIONS Our data indicate that sperm from men with a history of RPL have a higher incidence of DNA damage and poor motility than sperm from a control group, and this can explain in part the pregnancy loss in these patients.
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Affiliation(s)
- Sonia Brahem
- Department of Cytogenetic and Reproductive Biology, Farhat Hached, University Teaching Hospital, Sousse, Tunisia.
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Cohn DM, Goddijn M, Middeldorp S, Korevaar JC, Dawood F, Farquharson RG. Recurrent miscarriage and antiphospholipid antibodies: prognosis of subsequent pregnancy. J Thromb Haemost 2010; 8:2208-13. [PMID: 20704646 PMCID: PMC2965809 DOI: 10.1111/j.1538-7836.2010.04015.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although women with antiphospholipid antibodies (APLAs) are at increased risk of recurrent miscarriage, the outcome of a subsequent pregnancy is not clearly elucidated. OBJECTIVES To assess the pregnancy outcome of a subsequent pregnancy in women with APLAs and compare this outcome with women with unexplained recurrent miscarriage. METHODS We performed a cohort study among all women who attended the Miscarriage Clinic at Liverpool Women's Hospital between 1987 and 2006 after being referred due to recurrent miscarriage (≥2 consecutive pregnancy losses). All women underwent a standardized investigation sequence. Women with other reasons for recurrent miscarriage were excluded. RESULTS A total of 693 women fulfilled the selection criteria, of whom 176 (25%) had APLAs. One hundred and twenty-two (69%) women with APLAs had a subsequent live birth compared with 324 (63%) women with unexplained recurrent miscarriage (OR 1.3, 95% CI 0.9-1.9). No differences were found for birth weight, gestational age, and intra-uterine growth restriction. When treatment was analyzed, 53/67 (79%) of women with APLAs who had received aspirin and heparin during their pregnancy had a live birth, compared with 64/104 (62%) of women with APLAs who received aspirin only (adjusted OR 2.7, 95% CI 1.3-5.8). In unexplained recurrent miscarriage, stratification for treatment showed no differences in outcome. CONCLUSION The prognosis of a subsequent pregnancy in women with APLAs is good. Although this was not a randomized clinical trial, combined treatment of aspirin and heparin seemed associated with a better outcome in women with APLAs, but not in women with unexplained recurrent miscarriage.
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Affiliation(s)
- D M Cohn
- Department of Internal Medicine, Academic Medical Center Center, University of Amsterdam, the Netherlands.
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The roles of cellular reactive oxygen species, oxidative stress and antioxidants in pregnancy outcomes. Int J Biochem Cell Biol 2010; 42:1634-50. [DOI: 10.1016/j.biocel.2010.06.001] [Citation(s) in RCA: 441] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 05/13/2010] [Accepted: 06/01/2010] [Indexed: 12/18/2022]
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Abstract
Defective reaction toward fetal alloantigens could result in both recurrent spontaneous abortions (RSAs) and recurrent early pregnancy failures (REPFs), the latter existing in couples with unexplained infertility and multiple failures of implantation after in vitro fertilization embryo transfer. Immunological mechanisms leading to RSA and REPF seem to be different, although both syndromes probably have a genetic background that has not been identified so far. Despite the fact that antiphospholipid syndrome is a well-established cause of repeated pregnancy loss, the role of different autoantibodies existing in RSA and REPF patients needs to be elucidated. Immunotherapy is believed to correct the detrimental immune reactions; however, its real effectiveness and safety for the treatment of distinct forms of pregnancy loss need to be reconsidered.
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Affiliation(s)
- Jacek R Wilczynski
- Polish Mother's Health Center Research Institute, Department of Gynecological Surgery, 281/289 Rzgowska Street, 93-338 Lódz, Poland.
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Bellver J, Meseguer M, Muriel L, García-Herrero S, Barreto MAM, Garda AL, Remohí J, Pellicer A, Garrido N. Y chromosome microdeletions, sperm DNA fragmentation and sperm oxidative stress as causes of recurrent spontaneous abortion of unknown etiology. Hum Reprod 2010; 25:1713-21. [PMID: 20501469 DOI: 10.1093/humrep/deq098] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The aim of the present study was to evaluate the implication of male factor, in terms of sperm DNA oxidation and fragmentation, and Y chromosome microdeletions in recurrent spontaneous abortion (RSA) of unknown origin in a strictly selected cohort. METHODS A prospective cohort study was carried out in a private university-affiliated setting. Three groups, each comprised of 30 males, were compared. The first was formed by healthy and fertile sperm donors (SD) with normal sperm parameters (control group), the second by men presenting severe oligozoospermia (SO) without RSA history, and the third by men from couples who had experienced idiopathic RSA. Frequency of Y chromosome microdeletions and mean sperm DNA fragmentation and oxidation were determined. RESULTS Y chromosome microdeletions were not detected in any of the males enrolled in the study. Moreover, sperm DNA oxidation measurements were not demonstrated to be relevant to RSA. Interestingly, sperm DNA fragmentation was higher in the SO group than in the RSA and the SD groups, and also higher in the RSA group compared with the SD group, but lacked an adequate predictive power to be employed as a discriminative test of RSA condition. CONCLUSIONS Sperm DNA features and Y chromosome microdeletions do not seem to be related to RSA of unknown origin. Other molecular features of sperm should be studied to determine their possible influence on RSA. Clinicaltrials.gov reference: NCT00447395.
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Affiliation(s)
- J Bellver
- Instituto Valenciano de Infertilidad (IVI), University of Valencia, Plaza de la Policía Local, 3, 46015 Valencia, Spain.
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Kohan K, Carvajal R, Gabler F, Vantman D, Romero C, Vega M. Role of the transcriptional factors FOXO1 and PPARG on gene expression of SLC2A4 in endometrial tissue from women with polycystic ovary syndrome. Reproduction 2010; 140:123-31. [PMID: 20406953 DOI: 10.1530/rep-10-0056] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Fifty to seventy percent of patients with polycystic ovary syndrome (PCOS) present hyperinsulinemia. On the other hand, reports indicate that forkhead box class O 1 (FOXO1) and peroxisome proliferator-activated receptor-gamma (PPARG) are involved in the insulin signaling pathway, regulating the gene expression of SLC2A4 (GLUT4). The negative effect of FOXO1 over PPARG transcription disappears when FOXO1 is phosphorylated (p-FOXO1) and excluded from the nucleus, whereas PPARG can suppress gene expression of SLC2A4. Scarce knowledge is available in endometrium of women with PCOS and hyperinsulinemia (PCOSE h-Ins) about the role of these factors. We aimed to evaluate whether the endocrine and metabolic status of PCOS modify the levels of gene and protein expression of FOXO1, PPARG, and SLC2A4 in the endometria from hyperinsulinemic PCOS women compared with controls. In endometria from control (CE, n=7) or PCOSE h-Ins (n=7), we determined the subcellular location and protein levels of p-FOXO1Ser319 and FOXO1/FOXO4 by immunohistochemistry and western blot respectively; gene and/or protein levels of PPARG and SLC2A4 were evaluated by RT-PCR and/or western blot. Cytoplasm location for FOXO1 and p-FOXO1Ser319 was immunodetected in both groups of endometria, showing significantly higher staining in PCOSE h-Ins for these proteins (P<0.05). In PCOSE h-Ins, gene and protein levels of PPARG were significantly higher than in CE, whereas SLC2A4 mRNA was decreased (P<0.05). In conclusion, the derepression of PPARG transcription by the high levels of p-FOXO1Ser319 could partially account for the lower levels of SLC2A4 found in PCOSE h-Ins, suggesting an alteration of the endometrial function in these patients.
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Affiliation(s)
- Karla Kohan
- Laboratory of Endocrinology and Reproductive Biology, University of Chile Clinical Hospital, Santos Dumont # 999, Independencia, Santiago 838-0456, Chile
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44
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Cochran-Black DL. Recurrent Pregnancy Loss and Infertility in an Apparently Healthy 23-Year-Old Woman. Lab Med 2010. [DOI: 10.1309/lm2ph47cupebkpem] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Association of inherited thrombophilia with embryonic and postembryonic recurrent pregnancy loss. Blood Coagul Fibrinolysis 2009; 20:134-40. [DOI: 10.1097/mbc.0b013e32832545f3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Low levels of serum asymmetric antibodies as a marker of threatened pregnancy. J Reprod Immunol 2009; 79:201-10. [DOI: 10.1016/j.jri.2008.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 11/18/2008] [Accepted: 11/19/2008] [Indexed: 11/20/2022]
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Abstract
Inherited thrombophilia can be defined as a genetically determined predisposition to the development of thromboembolic complications. Since the discovery of activated protein C resistance in 1993, several additional disorders have been described and, at present, it is possible to identify an inherited predisposition in about 60 to 70% of patients with such complications. These inherited prothrombotic risk factors include qualitative or quantitative defects of coagulation factor inhibitors, increased levels or function of coagulation factors, defects of the fibrinolytic system, altered platelet function, and hyperhomocysteinemia. In this review, the main inherited prothrombotic risk factors are analyzed from epidemiological, laboratory, clinical, and therapeutic points of view. Finally, we discuss the synergism between genetic and acquired prothrombotic risk factors in particular conditions such as childhood and pregnancy.
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Affiliation(s)
- Massimo Franchini
- Servizio di Immunoematologia e Trasfusione, Azienda Ospedaliera di Verona, Verona, Italy.
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Walch KT, Huber JC. Progesterone for recurrent miscarriage: truth and deceptions. Best Pract Res Clin Obstet Gynaecol 2008; 22:375-89. [DOI: 10.1016/j.bpobgyn.2007.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Glueck CJ, Gogenini S, Munjal J, Tracy T, Pranikoff J, Wang P. Factor V Leiden mutation: a treatable etiology for sporadic and recurrent pregnancy loss. Fertil Steril 2008; 89:410-6. [PMID: 17582408 DOI: 10.1016/j.fertnstert.2007.03.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 03/05/2007] [Accepted: 03/05/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We hypothesized that the thrombophilic G1691A factor V Leiden (FVL) gene mutation was a common, significant, and treatable cause of sporadic and recurrent pregnancy loss (RPL). DESIGN We compared the frequency of the FVL mutation in 141 women with >or=1 pregnancy and 1 sporadic pregnancy loss (308 live births, 141 pregnancy losses), 44 women with >or=1 pregnancy and >or=3 pregnancy losses (105 live births, 180 pregnancy losses), and 638 women with >or=1 live birth pregnancy and 0 pregnancy loss (1553 live births). SETTING Outpatient Clinical Research Center. PATIENT(S) A total of 823 caucasian women with consecutive measures of the FVL mutation. MAIN OUTCOME MEASURE(S) We used polymerase chain reaction techniques to characterize the thrombophilic FVL G1691A gene mutation. RESULT(S) Of the 638 controls, 47 (7.4%) had FVL heterozygosity versus 16 heterozygous and 2 homozygous FVL cases (18/141, 12.8%) in 141 women with 1 sporadic pregnancy loss versus 9/44 RPL cases (20.5%, 8 heterozygous and 1 homozygous FVL). The FVL frequency in cases with 1 sporadic pregnancy loss (18/141, 12.8%) did not differ from RPL cases (9/44, 20.45%). CONCLUSION(S) After unexplained sporadic pregnancy loss, as well as after RPL, to provide the option to prospectively optimize subsequent live birth outcomes with low-molecular-weight heparin thromboprophylaxis, we suggest that measurements be done of the FVL mutation, a treatable etiology for sporadic pregnancy loss as well as for RPL.
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Affiliation(s)
- Charles J Glueck
- Cholesterol Center, Jewish Hospital, Cincinnati, Ohio 45229, USA.
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Leon L, Bacallao K, Gabler F, Romero C, Valladares L, Vega M. Activities of steroid metabolic enzymes in secretory endometria from untreated women with Polycystic Ovary Syndrome. Steroids 2008; 73:88-95. [PMID: 17953976 DOI: 10.1016/j.steroids.2007.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 09/10/2007] [Accepted: 09/11/2007] [Indexed: 10/22/2022]
Abstract
Polycystic Ovary Syndrome (PCOS) is an endocrine-metabolic pathology related with infertility and recurrent miscarriage. We have previously shown that the endometrium of these patients can exhibit a potentially higher sensitivity to estrogen action, being estrogens important regulators of the cell cycle and tissue homeostasis. The effect of estrogens on tissues depends on their in situ availability, which is in part regulated by the activity of steroid metabolic enzymes within the tissues. Therefore, the objective of the present study was to analyze if the activity and/or expression of steroid metabolic enzymes in endometria from women with PCOS differ from controls. For this purpose, the activity of the enzymes was determined by using radiometric assays and the mRNA levels measured by semi-quantitative RT-PCR. Both assays were assessed in endometria obtained during mid secretory phase from control (CE, n=12) and PCOS women (PCOSE, n=11). For the statistical analyses, Mann-Whitney and Student's t-tests were used to compare CE and PCOSE, considering a p value <0.05 significantly different. The results showed an increase in the sulfatase activity in PCOS respect to control endometria (200+/-28pmol/mg vs. 115+/-13pmol/mgproth; p<0.05), in agreement with the higher mRNA levels found for the enzyme in PCOSE. In addition, a PCOSE exhibited lower activity of sulfotransferase respect to the control group (50+/-21pmol/mg vs. 124+/-10pmol/mgproth; p<0.05), whereas a higher level of 17beta-hydroxysteroid dehydrogenase type 1mRNA was found in PCOSE compared with the control tissues (p<0.05). The activity of 17beta-hydroxysteroid dehydrogenase type 2 and the mRNA levels of sulfotransferase were similar in both groups; meanwhile, the expression of aromatase was undetectable. These data indicate that the sulfatase pathway could play an important role in the local production of estrogens in PCOSE from secretory phase. This potentially higher bioavailability of estrogens in endometria from PCOS women could influence the deregulation of tissue homeostasis that we have previously reported, and could partially explain the poor reproductive performance observed in this group of patients.
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Affiliation(s)
- Luis Leon
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Chile
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