Ultrasound Evaluation in Female Infertility

Ovarian function in patients with systemic lupus erythematosus: Pathogenesis, drug application and prospective therapies

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease in which multiple organs are damaged that prevails in fertile women. Currently, glucocorticoids and immunosuppressants are widely used to treat SLE patients. However, ovarian dysfunction occurs following the use of these drugs in women with SLE. Here, we summarize recent progress in terms of understanding ovarian injury, the effects of drug application and strategies to improve ovarian function in women with SLE. This review could be helpful to precisely cure SLE in women desiring to have offspring.

High-Resolution Single-Shot Fast Spin-Echo MR Imaging with Deep Learning Reconstruction Algorithm Can Improve Repeatability and Reproducibility of Follicle Counting

OBJECTIVE

To investigate the diagnostic performance of high-resolution single-shot fast spin-echo (SSFSE) imaging with deep learning (DL) reconstruction algorithm on follicle counting and compare it with original SSFSE images and conventional fast spin-echo (FSE) images.

METHODS

This study included 20 participants (40 ovaries) with clinically confirmed polycystic ovary syndrome (PCOS) who underwent high-resolution ovary MRI, including three-plane T2-weighted FSE sequences and slice-matched T2-weighted SSFSE sequences. A DL reconstruction algorithm was applied to the SSFSE sequences to generate SSFSE-DL images, and the original SSFSE images were also saved. Subjective evaluations such as the blurring artifacts, subjective noise, and clarity of the follicles on the SSFSE-DL, SSFSE, and conventional FSE images were independently conducted by two observers. Intra-class correlation coefficients and Bland-Altman plots were used to present the repeatability and reproducibility of the follicle number per ovary (FNPO) based on the three types of images.

RESULTS

SSFSE-DL images showed less blurring artifact, subjective noise, and better clarity of the follicles than SSFSE and FSE (p < 0.05). For the repeatability of the FNPO, SSFSE-DL showed the highest intra-observer (ICC = 0.930; 95% CI: 0.878-0.962) and inter-observer (ICC = 0.914; 95% CI: 0.843-0.953) agreements. The inter-observer 95% limits of agreement (LOA) for SSFSE-DL, SSFSE, and FSE ranged from -3.7 to 4.5, -4.4 to 7.0, and -7.1 to 7.6, respectively. The intra-observer 95% LOA for SSFSE-DL, SSFSE, and FSE ranged from -3.5 to 4.0, -5.1 to 6.1, and -5.7 to 4.2, respectively. The absolute values of intra-observer and inter-observer differences for SSFSE-DL were significantly lower than those for SSFSE and FSE (p < 0.05).

CONCLUSIONS

Compared with the original SSFSE images and the conventional FSE images, high-resolution SSFSE images with DL reconstruction algorithm can better display follicles, thus improving FNPO assessment.

Diagnostic values of MRI indexes for polycystic ovary syndrome

BACKGROUND

Magnetic resonance imaging (MRI) is a useful non-invasive modality for observation of ovarian morphologic characteristics. Few studies have focused on the value of MRI-derived indexes in reproductive-aged women with polycystic ovary syndrome (PCOS).

PURPOSE

To assess the diagnostic value of MRI in women with PCOS.

MATERIAL AND METHODS

This prospective case-control study included 85 women with PCOS and 50 controls who underwent pelvic MRI during 2017-2019. Ovarian volume (OV), follicle count (FC; counts of follicles sizing 2-3, 4-6, 7-9, 2-9 mm, respectively), follicular peripheral distribution, absence of a dominant follicle and stromal to total area ratio (S:A) were determined with MRI. The diagnostic value (sensitivity, specificity, area under the receiver operating characteristic curve [AUC]) of OV, FC2-9, and follicular peripheral distribution for PCOS were assessed.

RESULTS

The AUCs were 0.94 for OV, 0.96 for FC2-9, and 0.78 for follicular peripheral distribution. The optimal threshold to detect PCOS was 8.5 mL for OV (sensitivity 78%; specificity 96%) and 26 for FC2-9 (sensitivity 85%; specificity 98%). Sensitivity and specificity were 73% and 82% for follicular peripheral distribution, respectively. Reproducibility was perfect for OV (ICC = 0.96) and absence of a dominant follicle (k = 0.85), substantial for FC2-9 (ICC = 0.79) and S:A (ICC = 0.69), and moderate for follicular peripheral distribution (k = 0.56).

CONCLUSION

Detected by MRI, OV >8.5 mL or FC2-9 >26 are accurate for diagnosing PCOS.

Autologous transplantation of thecal stem cells restores ovarian function in nonhuman primates

Premature ovarian insufficiency (POI) is defined as the loss of ovarian activity under the age of 40. Theca cells (TCs) play a vital role during folliculogenesis and TCs dysfunction participate in the pathogenesis of POI. Therefore, transplantation of thecal stem cells (TSCs), which are capable of self-renewal and differentiation into mature TCs, may provide a new strategy for treating POI. To investigate the feasibility, safety, and efficacy of TSCs transplantation in clinically relevant non-human primate (NHP) models, we isolate TSCs from cynomolgus monkeys, and these cells are confirmed to expand continuously and show potential to differentiate into mature TCs. In addition, engraftment of autologous TSCs into POI monkeys significantly improves hormone levels, rescues the follicle development, promotes the quality of oocytes and boosts oocyte maturation/fertilization rate. Taken together, these results for the first time suggest that autologous TSCs can ameliorate POI symptoms in primate models and shed new light on developing stem cell therapy for POI.

Three-dimensional imaging and reconstruction of the whole ovary and testis: a new frontier for the reproductive scientist

The 3D functional reconstruction of a whole organ or organism down to the single cell level and to the subcellular components and molecules is a major future scientific challenge. The recent convergence of advanced imaging techniques with an impressively increased computing power allowed early attempts to translate and combine 2D images and functional data to obtain in-silico organ 3D models. This review first describes the experimental pipeline required for organ 3D reconstruction: from the collection of 2D serial images obtained with light, confocal, light-sheet microscopy or tomography, followed by their registration, segmentation and subsequent 3D rendering. Then, we summarise the results of investigations performed so far by applying these 3D image analyses to the study of the female and male mammalian gonads. These studies highlight the importance of working towards a 3D in-silico model of the ovary and testis as a tool to gain insights into their biology during the phases of differentiation or adulthood, in normal or pathological conditions. Furthermore, the use of 3D imaging approaches opens to key technical improvements, ranging from image acquisition to optimisation and development of new processing tools, and unfolds novel possibilities for multidisciplinary research.