1
|
McGlade EA, Mao J, Stephens KK, Kelleher AM, Maddison LA, Bernhardt ML, DeMayo FJ, Lydon JP, Winuthayanon W. Generation of Oviductal Glycoprotein 1 Cre Mouse Model for the Study of Secretory Epithelial Cells of the Oviduct. Endocrinology 2024; 165:bqae070. [PMID: 38916490 PMCID: PMC11210311 DOI: 10.1210/endocr/bqae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 06/26/2024]
Abstract
The epithelial cell lining of the oviduct plays an important role in oocyte pickup, sperm migration, preimplantation embryo development, and embryo transport. The oviduct epithelial cell layer comprises ciliated and nonciliated secretory cells. The ciliary function has been shown to support gamete and embryo movement in the oviduct, yet secretory cell function has not been well characterized. Therefore, our goal was to generate a secretory cell-specific Cre recombinase mouse model to study the role of the oviductal secretory cells. A knock-in mouse model, Ovgp1Cre:eGFP, was created by expressing Cre from the endogenous Ovgp1 (oviductal glycoprotein 1) locus, with enhanced green fluorescent protein (eGFP) as a reporter. EGFP signals were strongly detected in the secretory epithelial cells of the oviducts at estrus in adult Ovgp1Cre:eGFP mice. Signals were also detected in the ovarian stroma, uterine stroma, vaginal epithelial cells, epididymal epithelial cells, and elongated spermatids. To validate recombinase activity, progesterone receptor (PGR) expression was ablated using the Ovgp1Cre:eGFP; Pgrf/f mouse model. Surprisingly, the deletion was restricted to the epithelial cells of the uterotubal junction (UTJ) region of Ovgp1Cre:eGFP; Pgrf/f oviducts. Deletion of Pgr in the epithelial cells of the UTJ region had no effect on female fecundity. In summary, we found that eGFP signals were likely specific to secretory epithelial cells in all regions of the oviduct. However, due to a potential target-specific Cre activity, validation of appropriate recombination and expression of the gene(s) of interest is absolutely required to confirm efficient deletion when generating conditional knockout mice using the Ovgp1Cre:eGFP line.
Collapse
Affiliation(s)
- Emily A McGlade
- Obstetrics, Gynecology and Women's Health, University of Missouri–Columbia, Columbia, MO 65211, USA
- Reproductive and Developmental Biology Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC 27709, USA
| | - Jiude Mao
- Obstetrics, Gynecology and Women's Health, University of Missouri–Columbia, Columbia, MO 65211, USA
| | - Kalli K Stephens
- Obstetrics, Gynecology and Women's Health, University of Missouri–Columbia, Columbia, MO 65211, USA
| | - Andrew M Kelleher
- Obstetrics, Gynecology and Women's Health, University of Missouri–Columbia, Columbia, MO 65211, USA
| | - Lisette A Maddison
- Center for Reproductive Biology, College of Veterinary Medicine, Washington State University, Pullman, WA 99164, USA
| | - Miranda L Bernhardt
- Center for Reproductive Biology, College of Veterinary Medicine, Washington State University, Pullman, WA 99164, USA
| | - Francesco J DeMayo
- Reproductive and Developmental Biology Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC 27709, USA
| | - John P Lydon
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Wipawee Winuthayanon
- Obstetrics, Gynecology and Women's Health, University of Missouri–Columbia, Columbia, MO 65211, USA
- Center for Reproductive Biology, College of Veterinary Medicine, Washington State University, Pullman, WA 99164, USA
| |
Collapse
|
2
|
Progesterone and Inflammatory Response in the Oviduct during Physiological and Pathological Conditions. Cells 2022; 11:cells11071075. [PMID: 35406639 PMCID: PMC8997425 DOI: 10.3390/cells11071075] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
Progesterone has been shown to be a potent suppressor of several inflammatory pathways. During pregnancy, progesterone levels increase, allowing for normal pregnancy establishment and maintenance. The dysregulation of progesterone, as well as inflammation, leads to poor pregnancy outcomes. However, it is unclear how progesterone imbalance could impact inflammatory responses in the oviduct and subsequently result in early pregnancy loss. Therefore, in this review, we describe the role of progesterone signaling in regulating the inflammatory response, with a focus on the oviduct and pathological conditions in the Fallopian tubes.
Collapse
|
3
|
Capmas P, Suarthana E, Tulandi T. Management of Hydrosalpinx in the Era of Assisted Reproductive Technology: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 28:418-441. [PMID: 32853797 DOI: 10.1016/j.jmig.2020.08.017] [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: 06/26/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis evaluating the effect of hydrosalpinx on pregnancy outcomes, to compare different types of management of hydrosalpinx and their impact on pregnancy rates as well as on the ovarian reserve. DATA SOURCES Electronic search using Pubmed, EMBASE, Ovid MEDLINE, Google Scholar, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials and including all published studies that examined tubal infertility and its management (assisted reproductive technology or surgery) as well as the effects on ovarian reserve. The following medical subject headings (Mesh) terms combinations were used: "fallopian tube disease," hydrosalpinx," "tubal or salpinx occlusion or obstruction," "in vitro fertilization," "fallopian tube surgery," "salpingectomy," "salpingostomy," "infertility," "subfertility," "sterility" and "ovarian reserve." METHODS OF STUDY SELECTION All randomized trials, cohort, and case controls studies were included. We excluded review articles, meeting abstracts, case series and case reports, and abstracts without access to full texts. The search was limited to trials in humans and published in English. TABULATION, INTEGRATION, AND RESULTS Our electronic search initially retrieved 6354 articles. Finally, 19 studies were included in the quantitative evaluation of the effects of hydrosalpinx: 23 in the qualitative evaluation and 5 in the quantitative evaluation of different types of hydrosalpinx treatments; and 17 in the quantitative evaluation of ovarian reserve. The presence of a hydrosalpinx was associated with decreased rates of implantation and clinical pregnancy, and increased rates of ectopic pregnancy and miscarriage. Management of hydrosalpinx with salpingectomy, tubal occlusion, or hydrosalpinx aspiration led to better in vitro fertilization pregnancy rates. We found no difference in ovarian response to stimulation after salpingectomy except a decrease in antimüllerian hormone compared to no surgery. CONCLUSIONS The presence of hydrosalpinx is associated with decreased pregnancy rate and increased rates of ectopic pregnancy and miscarriage. Management of hydrosalpinx, regardless of the type of treatment, leads to an increased chance of pregnancy.
Collapse
Affiliation(s)
- Perrine Capmas
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada (all authors); Inserm, Centre of Research in Epidemiology and Population Health, U1018, and Faculty of Medicine, University Paris Sud, Le Kremlin Bicêtre, France (Dr. Capmas)
| | - Eva Suarthana
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada (all authors)
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada (all authors).
| |
Collapse
|
4
|
Harb H, Al-Rshoud F, Karunakaran B, Gallos ID, Coomarasamy A. Hydrosalpinx and pregnancy loss: a systematic review and meta-analysis. Reprod Biomed Online 2019; 38:427-441. [DOI: 10.1016/j.rbmo.2018.12.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/07/2018] [Accepted: 12/10/2018] [Indexed: 11/24/2022]
|
5
|
Haggerty CL, Totten PA, Tang G, Astete SG, Ferris MJ, Norori J, Bass DC, Martin DH, Taylor BD, Ness RB. Identification of novel microbes associated with pelvic inflammatory disease and infertility. Sex Transm Infect 2016; 92:441-6. [PMID: 26825087 PMCID: PMC5013099 DOI: 10.1136/sextrans-2015-052285] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/30/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES As pelvic inflammatory disease (PID) aetiology is not completely understood, we examined the relationship between select novel bacteria, PID and long-term sequelae. METHODS Fastidious bacterial vaginosis (BV)-associated bacteria (Sneathia (Leptotrichia) sanguinegens, Sneathia amnionii, Atopobium vaginae and BV-associated bacteria 1 (BVAB1)), as well as Ureaplasma urealyticum and Ureaplasma parvum were identified in cervical and endometrial specimens using organism-specific PCR assays among 545 women enrolled in the PID Evaluation and Clinical Health study. Risk ratios and 95% CIs were constructed to determine associations between bacteria, histologically confirmed endometritis, recurrent PID and infertility, adjusting for age, race, gonorrhoea and chlamydia. Infertility models were additionally adjusted for baseline infertility. RESULTS Persistent detection of BV-associated bacteria was common (range 58% for A. vaginae to 82% for BVAB1) and elevated the risk for persistent endometritis (RRadj 8.5, 95% CI 1.6 to 44.6) 30 days post-cefoxitin/doxycycline treatment, independent of gonorrhoea and chlamydia. In models adjusted for gonorrhoea and chlamydia, endometrial BV-associated bacteria were associated with recurrent PID (RRadj 4.7, 95% CI 1.7 to 12.8), and women who tested positive in the cervix and/or endometrium were more likely to develop infertility (RRadj 3.4, 95% CI 1.1 to 10.4). Associations between ureaplasmas and PID sequelae were modest. CONCLUSIONS To our knowledge, this is the first prospective study to demonstrate that S. sanguinegens, S. amnionii, BVAB1 and A. vaginae are associated with PID, failure of the Centers for Disease Control and Prevention-recommended treatment to eliminate short-term endometritis, recurrent PID and infertility. Optimal antibiotic regimens for PID may require coverage of novel BV-associated microbes.
Collapse
Affiliation(s)
- Catherine L Haggerty
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Patricia A Totten
- Department of Medicine, Division of Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Gong Tang
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Sabina G Astete
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Michael J Ferris
- Departments of Pediatrics and Microbiology, Louisiana State University, New Orleans, Louisiana, USA
| | - Johana Norori
- Departments of Pediatrics and Microbiology, Louisiana State University, New Orleans, Louisiana, USA
| | - Debra C Bass
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - David H Martin
- Department of Medicine, Louisiana State University, New Orleans, Louisiana, USA
| | - Brandie D Taylor
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Roberta B Ness
- The University of Texas School of Public Health, Houston, Texas, USA
| |
Collapse
|
6
|
Galen DI, Khan N, Richter KS. Essure Multicenter Off-Label Treatment for Hydrosalpinx Before In Vitro Fertilization. J Minim Invasive Gynecol 2011; 18:338-42. [DOI: 10.1016/j.jmig.2011.01.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 01/21/2011] [Accepted: 01/26/2011] [Indexed: 11/28/2022]
|
7
|
Luke B, Brown MB, Grainger DA, Cedars M, Klein N, Stern JE. Practice patterns and outcomes with the use of single embryo transfer in the United States. Fertil Steril 2010; 93:490-8. [DOI: 10.1016/j.fertnstert.2009.02.077] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Revised: 02/13/2009] [Accepted: 02/25/2009] [Indexed: 11/26/2022]
|
8
|
Agarwal A, Gupta S, Sekhon L, Shah R. Redox considerations in female reproductive function and assisted reproduction: from molecular mechanisms to health implications. Antioxid Redox Signal 2008; 10:1375-403. [PMID: 18402550 DOI: 10.1089/ars.2007.1964] [Citation(s) in RCA: 198] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Physiological levels of reactive oxygen species (ROS) play an important regulatory role through various signaling transduction pathways in folliculogenesis, oocyte maturation, endometrial cycle, luteolysis, implantation, embryogenesis, and pregnancy. Persistent and elevated generation of ROS leads to a disturbance of redox potential that in turn causes oxidative stress (OS). Our literature review captures the role of ROS in modulating a range of physiological functions and pathological processes affecting the female reproductive life span and even thereafter (i.e., menopause). The role of OS in female reproduction is becoming increasingly important, as recent evidence suggest that it plays a part in conditions such as polycystic ovarian disease, endometriosis, spontaneous abortions, preeclampsia, hydatidiform mole, embryopathies, preterm labor, and intrauterine growth retardation. OS has been implicated in different reproductive scenarios and is detrimental to both natural and assisted fertility. Many extrinsic and intrinsic conditions exist in assisted reproduction settings that can be tailored to reduce the toxic effects of ROS. Laboratory personnel should avoid procedures that are known to be deleterious, especially when safer procedures that can prevent OS are available. Although antioxidants such as folate, zinc, and thiols may help enhance fertility, the available data are contentious and must be evaluated in controlled studies with larger populations.
Collapse
Affiliation(s)
- Ashok Agarwal
- Reproductive Research Center, Department of Obstetrics and Gynecology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
| | | | | | | |
Collapse
|
9
|
Grace J, Bolton V, Braude P, Khalaf Y. Assisted hatching is more effective when embryo quality was optimal in previous failed IVF/ICSI cycles. J OBSTET GYNAECOL 2007; 27:56-60. [PMID: 17365461 DOI: 10.1080/01443610601056335] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Assisted hatching (AH) was developed as a possible solution to repeated implantation failure. The aim of this analysis was to examine the relationship between the morphology of embryos in a previous cycle on outcome in a subsequent cycle with AH. A total of 175 AH cycles performed after previous failed ART without hatching were divided into group A with optimal and group B with suboptimal embryos transferred previously. The groups were similar in terms of demographic and cycle characteristics. In group A, there was a significant improvement (p<0.001) in implantation (28.8 vs 5.1%), clinical pregnancy (41.9 vs 12.1%) and live birth rate (38.5 vs 8.6%) compared with group B. The data suggest that the prognosis for treatment is better if AH is performed after failure despite optimal embryos compared with failure associated with suboptimal embryos and embryo quality is the most significant factor affecting outcome.
Collapse
Affiliation(s)
- J Grace
- Assisted Conception Unit, King's College London, School of Medicine, Guy's and St Thomas' Hospital, London, UK.
| | | | | | | |
Collapse
|
10
|
Ozmen B, Diedrich K, Al-Hasani S. Hydrosalpinx and IVF: assessment of treatments implemented prior to IVF. Reprod Biomed Online 2007; 14:235-41. [PMID: 17298728 DOI: 10.1016/s1472-6483(10)60792-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
It is well known that the success of artificial reproductive techniques, especially IVF, for patients with tubal pathologies such as hydrosalpinx is reduced by half compared with patients without hydrosalpinx. Notably, there are also substantial increases in both early pregnancy loss and ectopic pregnancies. Alterations in the outcome of these patients generally reflect a detrimental effect of hydrosalpinx. However, although many theories have been published, a single explanation has not yet been found over a period of decades. Therefore, the negative effects of hydrosalpinx have generally been attributed largely to: (i) mechanical effects; (ii) embryo and gametotoxicity; (iii) alterations in endometrial receptivity markers; or dwindled cross talk between embryo-endometrium resulting in hindered implantation, and (iv) direct effect on endometrium, leading to intrauterine fluid formation. On the other hand, the most important question is selection of the preferred treatment option with either surgical or medical therapies. How should hydrosalpinx be managed? Does selection of the surgical method, either proximal obstruction or salpingectomy, depending on patients' clinical findings, differ in outcome, or is routine prophylactic salpingectomy needed? Additionally, the requirement for IVF or intracytoplasmic sperm injection is still controversial in patients with unilateral hydrosalpinx who have been treated with unilateral salpingectomy.
Collapse
Affiliation(s)
- B Ozmen
- University of Ankara, Department of Gynecology and Obstetrics, Centre of Artificial Reproduction, Campus of Cebeci, Mamak, Ankara, Turkey.
| | | | | |
Collapse
|
11
|
Garde RV, Jovanovic VP, Couchman GM, Walmer DK, Price TM. Ectopic pregnancy in a preexisting hydrosalpinx during a spontaneous pregnancy. Fertil Steril 2006; 86:1001.e11-3. [PMID: 16949588 DOI: 10.1016/j.fertnstert.2006.02.123] [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: 11/21/2005] [Revised: 02/13/2006] [Accepted: 02/13/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To discuss the possible role of abnormal embryo migration as a cause of ectopic pregnancy during IVF with hydrosalpinges. DESIGN Case report. SETTING University-based reproductive endocrinology and fertility clinic. PATIENT(S) A patient presenting with a tubal ectopic pregnancy after spontaneous conception in a preexisting hydrosalpinx. INTERVENTION(S) Laparoscopic salpingectomy. MAIN OUTCOME MEASURE(S) Ultrasound and operative findings. RESULT(S) Case demonstration of abnormal embryo migration into a surgically documented preexisting hydrosalpinx during a spontaneous conception. CONCLUSION(S) The mechanism of increased tubal ectopic pregnancy rates during IVF with hydrosalpinges remains unexplained. This case supports abnormal embryo migration due to the hydrosalpinx as a contributing factor.
Collapse
Affiliation(s)
- Rachana V Garde
- Division of Reproductive Endocrinology and Fertility, Duke University, Durham, North Carolina, USA
| | | | | | | | | |
Collapse
|
12
|
Zolghadri J, Momtahan M, Alborzi S, Mohammadinejad A, Khosravi D. Pregnancy outcome in patients with early recurrent abortion following laparoscopic tubal corneal interruption of a fallopian tube with hydrosalpinx. Fertil Steril 2006; 86:149-51. [PMID: 16716315 DOI: 10.1016/j.fertnstert.2005.12.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2005] [Revised: 12/02/2005] [Accepted: 12/02/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the outcome of pregnancy following laparoscopic unilateral tubal fulguration of hydrosalpinges in patients with recurrent spontaneous early abortion. DESIGN Prospective randomized controlled trial. SETTING University tertiary center. PATIENT(S) Thirteen patients with history of unexplained recurrent early spontaneous abortion and a unilateral hydrosalpinx diagnosed by sonography and hysterosalpingography in whom other causes of abortion were excluded. INTERVENTION(S) The treatment group (group I) consisted of seven women who underwent laparoscopic unilateral tubal fulguration. The control group (group II) consisted of six patients for whom no surgical intervention was performed. MAIN OUTCOME MEASURE(S) Continuation of pregnancy over first trimester. RESULT(S) Six patients in the treatment group and five in the control group conceived. Five patients in the treatment group and none in the control group had pregnancy beyond the first trimester and finally reached 36-40 weeks gestational age (P=.02). CONCLUSION(S) Laparoscopic tubal fulguration improves pregnancy outcome in selected patients with previous recurrent early abortion and a unilateral hydrosalpinx.
Collapse
Affiliation(s)
- Jaleh Zolghadri
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | | | | | | |
Collapse
|
13
|
Feinberg EC, Larsen FW, Catherino WH, Zhang J, Armstrong AY. Comparison of assisted reproductive technology utilization and outcomes between Caucasian and African American patients in an equal-access-to-care setting. Fertil Steril 2006; 85:888-94. [PMID: 16580370 DOI: 10.1016/j.fertnstert.2005.10.028] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Revised: 10/16/2005] [Accepted: 10/16/2005] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Racial disparity in assisted reproductive technology (ART) outcomes has been reported but remains controversial. Reasons for the disparity are unclear, and access to care has been suggested as a causative factor. In this study, we sought to examine minority utilization of ART in the Department of Defense (DoD) compared with minority utilization in the U.S. ART population. Outcomes from ART were compared between Caucasian (Cau) and African American (AA) patients, and etiologies of disparity were examined. DESIGN Retrospective cohort study. SETTING University-based ART program. PATIENT(S) A total of 1,457 patients undergoing first-cycle fresh, nondonor ART. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate, live birth rate, implantation rate, spontaneous abortion rate. RESULT(S) Within the DoD population, AA women had a fourfold increase in utilization of ART services relative to the U.S. ART population. In this equal-access-to-care setting, AA women experienced a clinically significant decrease in live birth rate that did not reach statistical significance (29.6% vs. 35.8%, risk ratio [RR] 0.83, 95% confidence interval [CI] 0.67-1.02) and a statistically significant increase in spontaneous abortions compared with Cau women (25% vs. 15.9%, RR 1.57, 95% CI 1.05-2.36). This might be explained, in part, by a higher prevalence of uterine leiomyomas in AA women (30.8% AA vs. 10.7% Cau, RR 2.85, 95% CI 2.06-3.95). For both AA and Cau women, the presence of fibroids at baseline ultrasound was associated with reductions in clinical pregnancy rates (35% with leiomyomas vs. 43.2% without leiomyomas, RR 0.74, 95% CI 0.51-0.98), live birth rates (26.2% vs. 36.0%, RR 0.63, 95% CI 0.44-0.90), and implantation rates (25.6% vs. 31.1% RR 0.82, 95% CI 0.69-0.98). CONCLUSION(S) Utilization of ART services among AA women increased when access to care was improved. A clinically significant reduction in live birth rate and statistically significant increase in spontaneous abortion rate was observed in AA women compared with Cau women. Leiomyomas were three times more prevalent in AA women and reduced ART success, regardless of race. The persistence of racial differences in an equal-access-to-care environment might be explained, in part, by the increased prevalence of leiomyomas in AA women.
Collapse
Affiliation(s)
- Eve C Feinberg
- Reproductive Biology and Medicine Branch, National Institute of Child Health and Human Development, NIH, Bethesda, Maryland 20892, USA
| | | | | | | | | |
Collapse
|
14
|
Abstract
This article discusses the endocrinology of ectopic pregnancy.
Collapse
Affiliation(s)
- Erkut Attar
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Istanbul University, Istanbul Medical School, Capa, Istanbul, 34093, Turkey.
| |
Collapse
|
15
|
Jastrow N, Chardonnens D, Araman M, Meisser A, Campana A, Bischof P. Effect of hydrosalpinx fluid on secretion of trophoblastic matrix metalloproteinases. Fertil Steril 2002; 77:588-94. [PMID: 11872217 DOI: 10.1016/s0015-0282(01)03011-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine if hydrosalpinx fluid affects trophoblastic metalloproteinases (MMPs) secretion. DESIGN Measurement of the effect of hydrosalpinx and peritoneal fluids (as controls) added to the medium on the MMPs secreted by cytotrophoblastic cells. SETTING Academic research center. PATIENT(S) Five samples of hydrosalpinx fluid were obtained at the time of ovocyte retrieval. Three samples of peritoneal fluids were collected at laparoscopic sterilization. MAIN OUTCOME MEASURE(S) The concentration and activity of MMP-2 and MMP-9, the concentration of the tissue inhibitor of metalloproteinases (TIMP-1), and the total gelatinolytic activity of the cytotrophoblastic cells were measured in the culture medium. RESULT(S) Hydrosalpinx significantly stimulated MMP-2, MMP-9, and TIMP-1. The net result was a significant stimulation of the total gelatinolytic activity. Peritoneal fluids increased MMP-2, MMP-9, and TIMP-1 concentrations, but the total gelatinolytic activity was not modified. CONCLUSION(S) In contrast to peritoneal fluids, hydrosalpinx stimulates the total gelatinolytic activity of cytotrophoblastic cells. This might indicate that the effect of hydrosalpinx on implantation rates may not be due to an inhibition of the capacity of an embryo to invade the endometrium. However, the stimulatory effect of hydrosalpinx on the net gelatinolytic activity could partly explain the increased incidence of ectopic pregnancies that have been described in the presence of hydrosalpinx.
Collapse
Affiliation(s)
- Nicole Jastrow
- Infertility and Gynaecological Endocrinology Clinic, WHO Collaborating Centre, University Hospital of Geneva, Geneva, Switzerland
| | | | | | | | | | | |
Collapse
|
16
|
Abstract
Salpingoscopy during laparoscopy yields the best prognosis in patients with hydrosalpinx. It has been demonstrated that in-vitro fertilization (IVF) patients with hydrosalpinx have decreased pregnancy rates as compared with control individuals. If a patient with hydrosalpinx is to be treated with IVF, then the communication between the uterine tube and the uterine cavity should be blocked via salpingectomy or proximal tubal ligation, with or without distal tubal fenestration. This is because there is evidence that hydrosalpinx, especially when it is bilateral and visible by ultrasonography, impacts negatively on pregnancy and implantation rates after IVF cycles.
Collapse
Affiliation(s)
- H B Zeyneloglu
- Department of Obstetrics and Gynecology, Baskent University, Ankara, Turkey.
| |
Collapse
|
17
|
Mansour R, Aboulghar M, Serour GI. Controversies in the surgical management of hydrosalpinx. Curr Opin Obstet Gynecol 2000; 12:297-301. [PMID: 10954150 DOI: 10.1097/00001703-200008000-00006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The surgical management of hydrosalpinges is a controversial subject. Chronic pathology of the fallopian tube with distal obstruction leads to the formation of a hydrosalpinx, and is associated with very poor pregnancy rates after surgery. In these cases, in-vitro fertilization has proved to be a much better alternative. However, several studies have shown that patients with hydrosalpinges have significantly lower pregnancy and implantation rates after in-vitro fertilization compared with patients with other forms of tubal damage. The exact mechanism by which the hydrosalpinx adversely affects in-vitro fertilization results is not yet fully understood. The value of performing a salpingectomy before in-vitro fertilization has been studied extensively. Currently, a clear benefit in salpingectomies has been proved for patients with ultrasonically visible hydrosalpinges.
Collapse
|