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Jiang C, Geng M, Zhang C, She H, Wang D, Wang J, Liu J, Diao F, Cai L, Hu Y. The synergy of morphokinetic parameters and sHLA-G in cleavage embryo enhancing implantation rates. Front Cell Dev Biol 2024; 12:1417375. [PMID: 39081861 PMCID: PMC11286472 DOI: 10.3389/fcell.2024.1417375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/28/2024] [Indexed: 08/02/2024] Open
Abstract
Objective: This study aimed to assess the relationship between implantation and soluble HLA-G (sHLA-G) expression in cleavage embryo culture medium (ECM) in conjunction with early developmental kinetics determined by time-lapse imaging (TLI). Methods: A retrospective, single-center study was conducted involving 238 embryos from 165 patients who underwent Frozen-thawed embryo transfer (FET) using autologous oocytes, with either single or double embryo transfer. TLI morphokinetic parameters (t2, t3, t4, t5, t6, t7, t8, cc2, s2, cc3, s3) of embryos were analyzed, and sHLA-G levels in D3 ECM were measured using an enzyme-linked immunosorbent assay (ELISA). A hierarchical classification model was developed to categorize embryos into five groups (A, B, C, D, E). The correlation between sHLA-G levels, TLI classification of embryos, and embryo implantation was investigated to establish a non-invasive method for evaluating implantation potential. Multivariate logistic regression analysis was performed to identify potential influencing factors, and receiver operating characteristic (ROC) curves were used to evaluate the predictive value for implantation. Results: Multivariate unconditional logistic regression analysis indicated that TLI parameters t5 and s3 and sHLA-G level in ECM were independent risk factors affecting embryo implantation. The implantation rate decreased from TLI classification A to E. The proposed classification model effectively assessed the implantation potential of embryos. The implantation rate was higher in the sHLA-G positive group compared to the sHLA-G negative group (p < 0.001). The expression of sHLA-G in D3 ECM, combined with the TLI classification model, accurately evaluated the implantation potential of embryos with an AUC of 0.876. Conclusion: The integration of cleavage kinetics and embryonic sHLA-G expression could reliably identify embryos with a high likelihood of successful implantation.
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Affiliation(s)
- Chunyan Jiang
- State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Menghui Geng
- Reproductive Medicine Center of Northern Jiangsu People’s Hospital, Yangzhou, China
- Department of Obstetrics and Gynecology, The 2 Affiliated Hospital and Yuying Chidren’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Can Zhang
- Department of Obstetrics and Gynecology, Tumor Hospital Affiliated to Nantong University, Nantong, China
| | - Hong She
- Reproductive Medicine Center of Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Dalin Wang
- Reproductive Medicine Center of Xu Zhou Maternity and Child Healthcare Hospital Affiliated to Xuzhou Medical University, Xuzhou, China
| | - Jing Wang
- State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiayin Liu
- State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Feiyang Diao
- State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lingbo Cai
- State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yanqiu Hu
- State Key Laboratory of Reproductive Medicine and Offspring Health, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Reproductive Medicine Center of Northern Jiangsu People’s Hospital, Yangzhou, China
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Zhuang BM, Cao DD, Liu XF, Wang L, Lin XL, Duan YG, Lee CL, Chiu PCN, Yeung WSB, Yao YQ. Application of a JEG-3 organoid model to study HLA-G function in the trophoblast. Front Immunol 2023; 14:1130308. [PMID: 37006248 PMCID: PMC10050466 DOI: 10.3389/fimmu.2023.1130308] [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: 12/29/2022] [Accepted: 02/28/2023] [Indexed: 03/17/2023] Open
Abstract
The human placenta is a unique temporary organ with a mysterious immune tolerance. The formation of trophoblast organoids has advanced the study of placental development. HLA-G is uniquely expressed in the extravillous trophoblast (EVT) and has been linked to placental disorders. With older experimental methodologies, the role of HLA-G in trophoblast function beyond immunomodulation is still contested, as is its role during trophoblast differentiation. Organoid models incorporating CRISPR/Cas9 technology were used to examine the role of HLA-G in trophoblast function and differentiation. JEG-3 trophoblast organoids (JEG-3-ORGs) were established that highly expressed trophoblast representative markers and had the capacity to differentiate into EVT. CRISPR/Cas9 based on HLA-G knockout (KO) significantly altered the trophoblast immunomodulatory effect on the cytotoxicity of natural killer cells, as well as the trophoblast regulatory effect on HUVEC angiogenesis, but had no effect on the proliferation and invasion of JEG-3 cells and the formation of TB-ORGs. RNA-sequencing analysis further demonstrated that JEG-3 KO cells followed similar biological pathways as their wild-type counterparts during the formation of TB-ORGs. In addition, neither HLA-G KO nor the exogenous addition of HLA-G protein during EVT differentiation from JEG-3-ORGs altered the temporal expression of the known EVT marker genes. Based on the JEG-3 KO (disruption of exons 2 and 3) cell line and the TB-ORGs model, it was determined that HLA-G has a negligible effect on trophoblast invasion and differentiation. Despite this, JEG-3-ORG remains a valuable model for studying trophoblast differentiation.
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Affiliation(s)
- Bai-Mei Zhuang
- Medical School of Chinese People’s Liberation Army, Chinese People’s Liberation Army General Hospital, Beijing, China
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Shenzhen, Guangdong, China
| | - Dan-Dan Cao
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Shenzhen, Guangdong, China
| | - Xiao-Feng Liu
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Shenzhen, Guangdong, China
| | - Li Wang
- Department of Obstetrics and Gynecology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Xiao-Li Lin
- Department of Obstetrics and Gynecology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yong-Gang Duan
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Shenzhen, Guangdong, China
| | - Cheuk-Lun Lee
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Shenzhen, Guangdong, China
- Department of Obstetrics and Gynecology, HKU Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Philip C. N. Chiu
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Shenzhen, Guangdong, China
- Department of Obstetrics and Gynecology, HKU Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - William S. B. Yeung
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Shenzhen, Guangdong, China
- Department of Obstetrics and Gynecology, HKU Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- *Correspondence: William S. B. Yeung, ; Yuan-Qing Yao,
| | - Yuan-Qing Yao
- Medical School of Chinese People’s Liberation Army, Chinese People’s Liberation Army General Hospital, Beijing, China
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Shenzhen, Guangdong, China
- Department of Obstetrics and Gynecology, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing, China
- *Correspondence: William S. B. Yeung, ; Yuan-Qing Yao,
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Radwan P, Tarnowska A, Piekarska K, Wiśniewski A, Krasiński R, Radwan M, Nowak I. The impact of soluble HLA-G in IVF/ICSI embryo culture medium on implantation success. Front Immunol 2022; 13:982518. [PMID: 36505440 PMCID: PMC9730522 DOI: 10.3389/fimmu.2022.982518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
The HLA-G molecule is widely accepted as an important factor for pregnancy success. Its expression has been detected in the extravillous trophoblasts. Soluble HLA-G (sHLA-G) was found in the genital tract, pre-implanted embryos as well as in seminal fluid. In this study, we investigated the concentration of sHLA-G (sHLA-G1 and sHLA-G5) in media from 344 single cultured embryos following in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). The level of sHLA-G (U/ml) was tested with a sandwich enzyme-linked immunosorbent assay (ELISA) kit. We correlated sHLA-G secretion with ovarian stimulation protocols, the type of embryo transfer (fresh or frozen cycle) and the quality of the embryos. The ovarian stimulation protocol affects the secretion of sHLA-G by the embryo. Embryos obtained from the long agonist protocol secreted more sHLA-G than those originating from the short antagonist protocol (p = 0.0001). Embryos whose transfer resulted in a clinical pregnancy and/or live birth secreted more sHLA-G compared to those whose transfer ended without pregnancy. This was particularly observable in embryos following the long ovarian stimulation protocol and from a frozen embryo cycle. In conclusion, sHLA-G secreted by the embryo has an impact on implantation and live birth and could be a developmental potential marker of the embryo. Its concentration depends on the ovarian stimulation protocol used.
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Affiliation(s)
- Paweł Radwan
- Gameta Hospital, Department of Reproductive Medicine, Rzgów, Poland
| | - Agnieszka Tarnowska
- Laboratory of Immunogenetics and Tissue Immunology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Department of Clinical Immunology, Wrocław, Poland
| | - Karolina Piekarska
- Laboratory of Immunogenetics and Tissue Immunology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Department of Clinical Immunology, Wrocław, Poland
| | - Andrzej Wiśniewski
- Laboratory of Immunogenetics and Tissue Immunology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Department of Clinical Immunology, Wrocław, Poland
| | - Rafał Krasiński
- Gameta Hospital, Department of Reproductive Medicine, Rzgów, Poland
| | - Michał Radwan
- Gameta Hospital, Department of Reproductive Medicine, Rzgów, Poland
| | - Izabela Nowak
- Laboratory of Immunogenetics and Tissue Immunology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Department of Clinical Immunology, Wrocław, Poland,*Correspondence: Izabela Nowak,
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Li J, Li C, Liu X, Yang J, Zhang Q, Han W, Huang G. GDF9 concentration in embryo culture medium is linked to human embryo quality and viability. J Assist Reprod Genet 2022; 39:117-125. [PMID: 34845575 PMCID: PMC8866627 DOI: 10.1007/s10815-021-02368-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/24/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE We aimed to evaluate the link between the GDF9 concentration in day 3 human embryo culture medium and embryo quality and viability. METHODS Two independent, prospective, observational studies were conducted. In study 1, a total of 280 embryos from 70 patients who obtained at least 4 embryos with 6-10 blastomeres (2 transferable and 2 non-transferable embryos) at day 3 were enrolled. In study 2, a total of 119 embryos from 61 patients (29 fully implanted and 32 non-implanted patients) were enrolled. The corresponding GDF9 concentrations in spent culture medium of embryos were quantified by ELISA assay. The expression pattern of GDF9 in human embryos was investigated using Q-PCR and immunofluorescence. RESULTS GDF9 mRNA and protein were detected from human oocytes to eight-cell embryos and displayed a slow decreasing trend. In study 1, GDF9 concentration in culture medium is lower for transferable embryos compared with non-transferable embryos (331 pg/mL (quartiles: 442, 664 pg/mL) vs. 518 pg/mL (quartiles: 328, 1086 pg/mL), P < 0.001), and increased commensurate with the diminution of the embryo quality (P < 0.001). In study 2, significantly lower GDF9 concentration was detected for implanted embryos than non-implanted embryos (331 pg/mL (quartiles: 156, 665 pg/mL) vs. 518 pg/mL (quartiles: 328, 1086 pg/mL), P < 0.001). The same trend was found between the embryos that led to live birth and those that failed. CONCLUSION The GDF9 concentration in culture medium is linked to embryo quality and viability, and exhibited the potential to be a non-invasive biomarker for embryo selection.
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Affiliation(s)
- Jingyu Li
- Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013 China ,Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, China
| | - Chong Li
- Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013 China ,Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, China
| | - Xuemei Liu
- Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013 China ,Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, China
| | - Jingwei Yang
- Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013 China ,Chongqing Clinical Research Center for Reproductive Medicine, Chongqing, China
| | - Qi Zhang
- Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013 China ,Chongqing Clinical Research Center for Reproductive Medicine, Chongqing, China
| | - Wei Han
- Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013 China ,Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, China
| | - Guoning Huang
- Chongqing Reproduction and Genetics Institute, Chongqing Health Center for Women and Children, No.64 Jin Tang Street, Yu Zhong District, Chongqing, 400013 China ,Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, China ,Chongqing Clinical Research Center for Reproductive Medicine, Chongqing, China
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Vani V, Vasan SS, Adiga SK, Varsha SR, Sachdeva G, Kumar P, Seshagiri PB. Soluble human leukocyte antigen-G is a potential embryo viability biomarker and a positive predictor of live-births in humans. Am J Reprod Immunol 2021; 86:e13499. [PMID: 34766406 DOI: 10.1111/aji.13499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/18/2021] [Accepted: 09/20/2021] [Indexed: 11/27/2022] Open
Abstract
PROBLEM Human infertility affects 15-20% of reproductive-age couples and it is mitigated by assisted reproductive technology (ART) approaches. Poor biological viability of embryos contributes to implantation failure and live birth rate (LBR). This study is aimed to examine whether or not embryo-secreted soluble human leukocyte antigen-G (sHLA-G) is (i) associated with developing embryos and (ii) able to predict successful pregnancy outcome. METHOD OF STUDY A retrospective, multicentric study using 539 human embryo spent medium samples (E-SMs), analysed for sHLA-G levels by ELISA. Correlation analysis was performed on sHLA-G levels with developing embryonic stages, their quality scores and pregnancy outcome in terms of LBR. RESULTS Of 539 E-SMs analysed, 445 had detectable sHLA-G (83%) with levels varying within and across clinics and, between stages of embryonic development. Levels of sHLA-G (ng/mL) were significantly (P < .05) different in E-SMs of cleavage-stage embryos versus blastocysts. There was an insignificant correlation between the sHLA-G levels and morphology scores of embryos. But, sHLA-G levels showed a positive correlation with grades of blastocysts and importantly, its levels were significantly (P < .05) higher in live-birth vis-a-vis no-birth cases. Also, levels were higher in live-births out of blastocysts-ETs versus cleavage-stage-embryo transfers. Altered levels were observed with embryos, which resulted in miscarriages. Overall, a significant (P < .0001) association of sHLA-G with live births was observed. CONCLUSION Embryo-derived sHLA-G can be a valuable embryo viability, independent, biomarker, which can predict live-birth outcome and it could be useful as an adjunct to existing criteria for elective single embryo transfer.
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Affiliation(s)
- Venkatappa Vani
- Department of Molecular Reproduction, Development and Genetics, Indian Institute of Science, Sir C.V. Raman Road, Bangalore, India
| | - Satya S Vasan
- Manipal Ankur Andrology & Reproductive Services, Bangalore, India
| | - Satish K Adiga
- Department of Clinical Embryology, Kasturba Medical College, Manipal, India
| | | | | | - Pratap Kumar
- Department of Reproductive Medicine & Surgery, Kasturba Medical College, Manipal, India
| | - Polani B Seshagiri
- Department of Molecular Reproduction, Development and Genetics, Indian Institute of Science, Sir C.V. Raman Road, Bangalore, India
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Simpson S, Kaislasuo J, Peng G, Aldo P, Paidas M, Guller S, Mor G, Pal L. Peri-implantation cytokine profile differs between singleton and twin IVF pregnancies. Am J Reprod Immunol 2020; 85:e13348. [PMID: 32946159 DOI: 10.1111/aji.13348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/18/2020] [Accepted: 09/09/2020] [Indexed: 01/23/2023] Open
Abstract
PROBLEM It is unknown whether maternal cytokine production differs between twin and singleton gestations in the implantation phase. A difference in maternal serum cytokine concentrations in twins would imply a dose-response to the invading embryos, as opposed to a general immune reaction. METHOD OF STUDY A prospective longitudinal cohort of women aged 18-45 at an academic fertility center undergoing in vitro fertilization and embryo transfer (IVF-ET) underwent routine collection of serial serum samples starting 9 days after ET and then approximately every 48 hours thereafter. Cryopreserved aliquots of these samples were assayed for interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α), and C-X-C motif chemokine ligand 10 (CXCL10) using the SimplePlex immunoassay platform. Pregnancies were followed until delivery. Serial measures of serum concentrations of IL-10, CXCL10, and TNF-α in singleton or di-di twin pregnancies from 9 to 15 days after IVF-ET were compared. RESULTS Maternal serum levels of CXCL10 are significantly lower in women with di-di twin pregnancies in early implantation compared to those with singleton gestation (day 9-11, P = .02). Serum levels of TNF-α and IL-10 were comparable at all studied time points (P > .05). CONCLUSION Maternal serum levels of CXCL10 are significantly lower in the earliest implantation phase in di-di twins compared to singleton conceptions. Given the known anti-angiogenic role of CXCL10, we hypothesize that lower CXCL10 levels in twin implantations allow an environment that is conducive for the greater vascularization required for the establishment of dual placentation in di-di twins.
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Affiliation(s)
- Samantha Simpson
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Janina Kaislasuo
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.,Department of Obstetrics and Gynecology, University of Helsinki and the Helsinki University Hospital, Helsinki, Finland
| | - Gang Peng
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, USA
| | - Paulomi Aldo
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Michael Paidas
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Seth Guller
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Gil Mor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.,C.S. Mott Center for Human Growth and Development, Department of Obstetrics, Gynecology, Wayne State University, Detroit, MI, USA
| | - Lubna Pal
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
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Ferrick L, Lee YSL, Gardner DK. Reducing time to pregnancy and facilitating the birth of healthy children through functional analysis of embryo physiology†. Biol Reprod 2020; 101:1124-1139. [PMID: 30649216 DOI: 10.1093/biolre/ioz005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/21/2018] [Accepted: 01/09/2019] [Indexed: 12/12/2022] Open
Abstract
An ever-increasing number of couples rely on assisted reproductive technologies (ART) in order to conceive a child. Although advances in embryo culture have led to increases in the success rates of clinical ART, it often takes more than one treatment cycle to conceive a child. Ensuring patients conceive as soon as possible with a healthy embryo is a priority for reproductive medicine. Currently, selection of embryos for transfer relies predominantly on the morphological assessment of the preimplantation embryo; however, morphology is not an absolute link to embryo physiology, nor the health of the resulting child. Non-invasive quantitation of individual embryo physiology, a key regulator of both embryo viability and health, could provide valuable information to assist in the selection of the most viable embryo for transfer, hence reducing the time to pregnancy. Further, according to the Barker Hypothesis, the environment to which a fetus is exposed to during gestation affects subsequent offspring health. If the environment of the preimplantation period is capable of affecting metabolism, which in turn will affect gene expression through the metaboloepigenetic link, then assessment of embryo metabolism should represent an indirect measure of future offspring health. Previously, the term viable embryo has been used in association with the potential of an embryo to establish a pregnancy. Here, we propose the term healthy embryo to reflect the capacity of that embryo to lead to a healthy child and adult.
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Affiliation(s)
- Laura Ferrick
- School of BioSciences, University of Melbourne, VIC, Australia
| | | | - David K Gardner
- School of BioSciences, University of Melbourne, VIC, Australia.,Melbourne IVF, East Melbourne, VIC, Australia
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Xiong F, Yao Z, Chen P, Sun Q, Zhong H, Wan C, Zeng Y. Comparative secretome profile analysis of cultured immortalized human endometrial stromal cells supplemented with implanted versus nonimplanted blastocyst-conditioned medium: A preliminary analysis. J Obstet Gynaecol Res 2020; 46:1809-1818. [PMID: 32643241 DOI: 10.1111/jog.14359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/05/2020] [Accepted: 05/31/2020] [Indexed: 11/28/2022]
Abstract
AIM Human endometrial stromal cells (HESCs) were previously shown to be capable of discriminating embryos with different qualities. Here we aimed to compare the specific response of the HESC secretome to implanted blastocyst-conditioned medium (BCM) versus nonimplanted medium and identify cytokine candidates useful for the assessment of blastocyst implantation. METHODS Cleavage embryos were individually cultured in one microdrop of medium for blastocyst formation. The BCM was collected after fresh blastocyst transfer on day 5 and used to supplement HESC culture medium. A high-throughput antibody array covering 440 cytokines was used to detect the secretory proteins of HESCs supplemented with implanted or nonimplanted BCM. RESULTS A total of 22 differentially expressed proteins were found out of 440 cytokines in the supernatant of HESCs supplemented with BCM from the implanted group compared to the nonimplanted group, including seven upregulated and 15 downregulated proteins. Gene Ontology enrichment analysis showed that the differentially expressed proteins were mainly involved in cell chemotaxis and motility, and ERK1/2 cascade regulation. Kyoto Encyclopedia of Genes and Genomes analysis suggested that the mitogen-activated protein kinase and phosphatidylinositol 3 kinase/Akt pathways were mainly involved. CONCLUSION HESCs specifically responded to BCM from different quality blastocysts, a finding that can be used to develop a novel approach for blastocyst quality assessment.
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Affiliation(s)
- Feng Xiong
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - ZhiHong Yao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - PeiLin Chen
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Qing Sun
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - HuiXian Zhong
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - CaiYun Wan
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Yong Zeng
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
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Rødgaard T, Heegaard PM, Callesen H. Non-invasive assessment of in-vitro embryo quality to improve transfer success. Reprod Biomed Online 2015; 31:585-92. [DOI: 10.1016/j.rbmo.2015.08.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 08/05/2015] [Accepted: 08/06/2015] [Indexed: 12/12/2022]
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10
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Embryo culture and selection: morphological criteria. Methods Mol Biol 2014; 1154:501-32. [PMID: 24782025 DOI: 10.1007/978-1-4939-0659-8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
In this chapter, we have outlined the various morphological criteria for selection of the best embryo at each important milestone encountered in the progress from the oocyte to the blastocyst. As Gerris et al. stated, a combination of one, two, or even three selection points should lead to a more accurate selection of the best embryo, as no one criterion is better than the other. An embryo that fails to meet the entire set of selection criteria must be avoided as culture cannot correct an impaired embryo.
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11
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Rizzo R. HLA-G molecules in pregnancy and their possible role in assisted reproductive technology. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.09.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kotze D, Kruger TF, Lombard C, Padayachee T, Keskintepe L, Sher G. The effect of the biochemical marker soluble human leukocyte antigen G on pregnancy outcome in assisted reproductive technology--a multicenter study. Fertil Steril 2013; 100:1303-9. [PMID: 23993930 DOI: 10.1016/j.fertnstert.2013.07.1977] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 07/19/2013] [Accepted: 07/19/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether the presence of soluble human leukocyte antigen G (sHLA-G) affects implantation and pregnancy outcomes in vitro. DESIGN A multicenter retrospective study. SETTING Six certified in vitro fertilization (IVF) units. PATIENT(S) Embryos obtained from 2,040 patients from six different IVF clinics. INTERVENTION(S) Soluble HLA-G determination on day-2 embryos after intracytoplasmic sperm injection, with embryos transferred on day 3 using the sHLA-G data. MAIN OUTCOME MEASURE(S) Ongoing pregnancy rate (10- to 12-week ultrasound finding). RESULT(S) All embryos were individually cultured, and a chemiluminescence enzyme-linked immunosorbent assay was used to detect the presence of sHLA-G in the culture medium surrounding the embryos. Embryos were selected based on a positive sHLA-G result and a graduated embryo scoring (GES) score >70, or on embryo morphology if the test was negative. In all centers, a positive sHLA-G result was associated with an increase in the odds of an ongoing pregnancy. The incidence of an ongoing pregnancy was 2.52 times greater in embryos transferred on day 3 with a positive sHLA-G test result than the incidence of an ongoing pregnancy in embryos with a negative sHLA-G test result. CONCLUSION(S) Data from this multicenter study confirm that sHLA-G expression is a valuable noninvasive embryo marker to assist in improving pregnancy outcomes, with the theoretical potential to reduce multiple pregnancies.
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13
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Wang YA, Costello M, Chapman M, Black D, Sullivan EA. Transfers of fresh blastocysts and blastocysts cultured from thawed cleavage embryos are associated with fewer miscarriages. Reprod Biomed Online 2011; 23:777-88. [DOI: 10.1016/j.rbmo.2011.07.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 07/21/2011] [Accepted: 07/21/2011] [Indexed: 10/17/2022]
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14
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Should there be a limit of one single embryo implanted during an IVF cycle? MCN Am J Matern Child Nurs 2011; 36:152-3. [PMID: 24736709 DOI: 10.1097/nmc.0b013e3182109272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Rizzo R, Vercammen M, van de Velde H, Horn PA, Rebmann V. The importance of HLA-G expression in embryos, trophoblast cells, and embryonic stem cells. Cell Mol Life Sci 2011; 68:341-52. [PMID: 21080028 PMCID: PMC11114702 DOI: 10.1007/s00018-010-0578-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 10/22/2010] [Indexed: 10/18/2022]
Abstract
The nonclassical HLA-G molecule is a trophoblast-specific molecule present in almost every pregnancy. It differs from classical HLA class I molecules by the low degree of allelic variants and the high diversity of protein structures. HLA-G is reported to be a tolerogenic molecule that acts on cells of both innate and adaptive immunity. At the maternal-fetal interface HLA-G seems to be responsible largely for the reprogramming of local maternal immune response. This review will focus on the HLA-G gene expression profile in pregnancy, in preimplantation embryos, and in human embryonic stem cells with emphasis on the structural diversity of the HLA-G protein and its potential functional and diagnostic implications.
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Affiliation(s)
- Roberta Rizzo
- Department of Experimental and Diagnostic Medicine, Section of Medical Genetics, University of Ferrara, Ferrara, Italy
| | - Martine Vercammen
- Department of Hematology, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium
| | - Hilde van de Velde
- Centre for Reproductive Medicine, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium
- Department of Reproduction and Genetics, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium
| | - Peter A. Horn
- Institute for Transfusion Medicine, University Hospital of Essen, Virchowstr. 179, 45122 Essen, Germany
| | - Vera Rebmann
- Institute for Transfusion Medicine, University Hospital of Essen, Virchowstr. 179, 45122 Essen, Germany
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16
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Kotze DJ, Hansen P, Keskintepe L, Snowden E, Sher G, Kruger T. Embryo selection criteria based on morphology VERSUS the expression of a biochemical marker (sHLA-G) and a graduated embryo score: prediction of pregnancy outcome. J Assist Reprod Genet 2010; 27:309-16. [PMID: 20358276 DOI: 10.1007/s10815-010-9403-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 02/23/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To compare pregnancy and implantation rates when embryos are selected based on a single Day 3 (D 3) morphology score vs. a GES score plus sHLA-G expression. METHODS A prospective randomized study (n = 214) undergoing fresh ICSI cycles. Embryos were selected for transfer based on either Day 3 morphology score (Group A) or GES-scoring plus sHLA-G expression (Group B). RESULTS Clinical [35/107 (33%) vs. 52/107 (49%)] and ongoing pregnancy [20/107 (19%) vs. 52/107 (49%)] rates were significantly different between Group A and Group B (p < 0.05). Implantation rates were not significantly different between Group A [52/353 (15%)] and Group B [73/417 (18%)] (p < 0.05). The number of pregnancies lost during the first trimester was nearly 12 times higher in Group A [25/52 (48%)]. CONCLUSION The miscarriage rate was significantly lower in Group B than Group A and the pregnancy results were superior when embryos were selected based on GES plus sHLA-G expression.
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Affiliation(s)
- Dirk J Kotze
- Sher Institute for Reproductive Medicine, Sacramento, CA, USA.
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17
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Possible role of human leukocyte antigen–G molecules in human oocyte/embryo secretome. Hum Immunol 2009; 70:970-5. [DOI: 10.1016/j.humimm.2009.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 07/28/2009] [Accepted: 07/29/2009] [Indexed: 11/21/2022]
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18
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Can soluble human leucocyte antigen-G predict successful pregnancy in assisted reproductive technology? Curr Opin Obstet Gynecol 2009; 21:285-90. [DOI: 10.1097/gco.0b013e32832924cd] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Tabiasco J, Perrier d'Hauterive S, Thonon F, Parinaud J, Léandri R, Foidart JM, Chaouat G, Munaut C, Lombroso R, Selva J, Bergère M, Hammoud I, Kozma N, Aguerre-Girr M, Swales AKE, Sargent IL, Le Bouteiller P, Lédée N. Soluble HLA-G in IVF/ICSI embryo culture supernatants does not always predict implantation success: a multicentre study. Reprod Biomed Online 2009; 18:374-81. [PMID: 19298737 DOI: 10.1016/s1472-6483(10)60096-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Several reports have described an association between the presence of soluble human leukocyte antigen G (sHLA-G) in human embryo culture supernatants (ES) and implantation success. However, not all studies agree with these findings. To further document this debate, a multicentre blinded study was performed to investigate, on a large number of IVF ES and ICSI ES, whether sHLA-G is a useful criterion for embryo selection before transfer. A total of 1405 ES from 355 patients were collected from three assisted reproductive technique (ART) centres and evaluated for their sHLA-G content in a single laboratory, using a chemiluminescence enzyme-linked immunosorbent assay. In only one centre was a significant association between sHLA-G-positive ES and successful implantation established (P = 0.0379), whereas no such association was observed in the other centres. It was found that the percentages and concentrations of sHLA-G-positive ES varied between centres, depending on culture media and ART conditions. The percentage of sHLA-G-positive ES was significantly higher in IVF ES than ICSI ES (P < 0.001 and P < 0.01 for two centres). These data demonstrate that substantial variations of sHLA-G content in ES occur between different ART centres, highlighting the influence of several technical parameters that differ from one centre to another.
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Affiliation(s)
- Julie Tabiasco
- INSERM, U563, Centre de Physiopathologie de Toulouse Purpan, Toulouse, F-31300 France
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20
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Kapoor M, Pal L. Epidemic of plurality and contributions of assisted reproductive technology therein. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2009; 151C:128-135. [PMID: 19378330 DOI: 10.1002/ajmg.c.30205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A commentary on contributions of ART to the pandemic of multiple gestations is presented and mechanistic aspects therein are explored.
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Affiliation(s)
- Monica Kapoor
- Department of Obstetrics & Gynecology, Danbury Hospital, Danbury, Connecticut, USA
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21
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Symposium: innovative techniques in human embryo viability assessment. Soluble human leukocyte antigen-G and pregnancy success. Reprod Biomed Online 2009; 17:470-85. [PMID: 18854100 DOI: 10.1016/s1472-6483(10)60233-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Non-invasive methods of assessing embryo quality are critical for pregnancy success following IVF or intracytoplasmic sperm injection (ICSI). The addition of new non-invasive morphological and biochemical analyses may further improve pregnancy success, allowing the transfer of a single embryo, thereby reducing the risks involved in multiple births following IVF/ICSI. The presence of a protein, soluble human leukocyte antigen-G (sHLA-G), in embryo cultures has been suggested as a way to non-invasively predict embryo quality and pregnancy success, especially when used in conjunction with current embryo quality assessment methods. Detection of sHLA-G in embryo culture medium has been correlated with pregnancy success in 12 studies, but three studies were not able to detect sHLA-G. This is a review of the literature on sHLA-G detection in IVF/ICSI, and reasons are proposed for the reported discrepancies, as well as guidelines for reporting of data in future studies. Furthermore, it is suggested that the use of an HLA-G transgenic mouse model would advance understanding of the mechanism of action of sHLA-G in preimplantation embryos and its correlation to embryo health and viability. Research on a mouse model, combined with clinical studies, should enable the development of a fast and reliable method for utilizing sHLA-G detection to improve pregnancy success after IVF/ICSI.
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22
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Cutting R, Morroll D, Roberts SA, Pickering S, Rutherford A. Elective single embryo transfer: guidelines for practice British Fertility Society and Association of Clinical Embryologists. HUM FERTIL 2009; 11:131-46. [PMID: 18766953 DOI: 10.1080/14647270802302629] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Assisted conception treatment is the single most important cause in the increase in multiple pregnancy and births over the last 25 years. Multiple births are associated with significant peri natal morbidity and mortality. Europe has led the way in reducing multiple births by widespread adoption of an elective single embryo policy, which in Belgium is linked to an increase in state funding. Randomized controlled trials suggest that an eSET policy must include the ability to cryopreserve and transfer any remaining quality embryos to obtain parity with a double embryo transfer. This document provides a review of the available evidence with guidelines for practice, to help facilitate the introduction of an eSET policy in the UK.
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Affiliation(s)
- Rachel Cutting
- Centre for Reproductive Medicine and Fertility, Jessops Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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23
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Vercammen MJ, Verloes A, Van de Velde H, Haentjens P. Accuracy of soluble human leukocyte antigen-G for predicting pregnancy among women undergoing infertility treatment: meta-analysis. Hum Reprod Update 2008; 14:209-18. [PMID: 18390888 DOI: 10.1093/humupd/dmn007] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There have been concerns about validity and accuracy of the measurement of sHLA-G in embryo culture supernatants. In this systematic review, we quantified the diagnostic accuracy of sHLA-G for predicting the ability to achieve clinical pregnancy in women who are undergoing infertility treatment. METHODS Medline and Embase were searched up to 7 September 2007, for full English and non-English articles concerning cohort studies evaluating sHLA-G in embryo culture for predicting clinical pregnancy in women undergoing IVF and ICSI. RESULTS Eleven studies including 1813 patients met our inclusion criteria. In the individual studies, sensitivity ranged from 0.01 to 0.97, specificity from 0.18 to 0.98, the positive likelihood ratio from 0.34 to 3.21 and the negative likelihood ratio from 0.08 to 1.01. These values were highly heterogeneous with, in each case, I(2) values of >75%, and P-values for the Q statistic of <0.001, arguing against generating a pooled estimate for these diagnostic test properties. The diagnostic odds ratios (DORs) ranged from 0.92 to 24.82 in the individual studies with an I(2) value of 49% indicating moderate heterogeneity. Therefore, the meta-analysis combined the logs of the DORs, which are derived from sensitivity and specificity. A random-effects model yielded a summary DOR of 4.38 (95% CI, 2.93-6.55), consistent with modest diagnostic accuracy. Interestingly, an a priori defined subgroup analysis restricted to six studies with good quality embryos showed a better diagnostic performance with a DOR of 12.67 (95% CI, 3.66-43.80) to predict the ability to achieve clinical pregnancy in women undergoing infertility treatment. CONCLUSIONS Further research is needed with single-embryo culture, single-embryo transfer and highly sensitive detection techniques to determine the potential application of measuring sHLA-G in culture supernatant.
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Affiliation(s)
- M J Vercammen
- Laboratory of Haematology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
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Sher G, Keskintepe L, Mukaida T, Keskintepe M, Ginsburg M, Agca Y, Maassarani G, Bayrak A. Selective vitrification of euploid oocytes markedly improves survival, fertilization and pregnancy-generating potential. Reprod Biomed Online 2008; 17:524-9. [DOI: 10.1016/s1472-6483(10)60240-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sargent I, Swales A, Ledee N, Kozma N, Tabiasco J, Le Bouteiller P. sHLA-G production by human IVF embryos: Can it be measured reliably? J Reprod Immunol 2007; 75:128-32. [PMID: 17482269 DOI: 10.1016/j.jri.2007.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 03/12/2007] [Accepted: 03/14/2007] [Indexed: 11/18/2022]
Abstract
A number of reports have demonstrated that sHLA-G can be detected in the culture medium of human IVF embryos and that levels correlate with the potential of an embryo to implant. This has aroused considerable interest in the IVF field. If sHLA-G can be used as a non-invasive marker of embryo quality, it will facilitate selection of the best embryos to transfer to the mother and thereby increase IVF pregnancy rates. However, there have been concerns about some aspects of these studies, including the sensitivity of the sHLA-G ELISAs used, the IVF culture conditions and the levels of sHLA-G which have been reported. A recent study by Sageshima et al. [J. Reprod. Immunol. 75, 11-22, 2007] attempts to address some of these concerns. However, despite using a sensitive ELISA, they were unable to detect sHLA-G in 111 embryo culture supernatants, or sHLA-G secretion by less than 10,000 sHLA-G transfected cells. They concluded that it is not possible to measure sHLA-G production by human embryos. This study has highlighted technical differences between IVF culture techniques and sHLA-G ELISAs that are currently confounding the system. Further collaboration between the research groups involved is required to establish robust reproducible systems that function identically in all laboratories.
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Affiliation(s)
- Ian Sargent
- Oxford Fertility Unit, Nuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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Chaouat G, Mas AE, Petitbarat M, Dubanchet S, Ledée N. [Physiology of implantation]. ACTA ACUST UNITED AC 2007; 35:861-6. [PMID: 17765593 DOI: 10.1016/j.gyobfe.2007.07.023] [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: 07/12/2007] [Accepted: 07/17/2007] [Indexed: 10/22/2022]
Abstract
This article explains why we have had to come to a central role for innate immunity rather than the threat of maternal rejection of the foetal allograft. We encompass briefly the role of inflammation in implantation, not only for invasion adhesion, but also to prepare future "tolerance". In this context, we envisage the role of TWEAK and complement.
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Affiliation(s)
- G Chaouat
- Inserm U 782, 32, rue des Carnets, 92141 Clamart,
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