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Mehrafza M, Pourseify G, Zare Yousefi T, Azadeh R, Saghati Jalali S, Hosseinzadeh E, Samadnia S, Habibdoost M, Tamimi A, Hosseini A. The Efficiency of Introducing Intrauterine Infusion of Autologous Platelet-Rich Plasma versus Granulocyte Colony-Stimulating Factor in Repeated Implantation Failure Patients: An Unblinded Randomised Clinical Trial. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2024; 18:30-34. [PMID: 39033368 PMCID: PMC11263844 DOI: 10.22074/ijfs.2024.2013900.1557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Repeated implantation failure (RIF) refers to the condition where high quality embryos are unable to successfully implant after multiple cycles of in vitro fertilization (IVF) treatment. The aim of this study is to investigate the impact of intrauterine granulocyte colony-stimulating factor (G-CSF) and platelet-rich plasma (PRP) on pregnancy rate in patients with RIF. MATERIALS AND METHODS The present randomised clinical trial study was conducted at the IVF Centre of Mehr Medical Institute in Rasht, Iran, from 2020 to 2022. The research consisted of 200 individuals who had experienced multiple failed cycles. These patients were randomised into two groups: intrauterine infusion of 1 ml of G-CSF and intrauterine infusion of 1 ml autologous PRP at least 48 hours before embryo transfer (ET). The groups were compared in terms of implantation rate, and chemical, clinical, and ongoing pregnancy. RESULTS The implantation rate was significantly higher in patients who received PRP (P=0.016). Chemical pregnancy in the PRP group was significantly higher than G-CSF group (P=0.003). Both clinical pregnancy and ongoing pregnancy rates were significantly higher in the PRP group (P=0.001) compared to the G-CSF group (P=0.02). CONCLUSION The utilisation of PRP via intrauterine infusion is considerably more successful than G-CSF in enhancing pregnancy and live birth rates among patients with RIF.
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Affiliation(s)
- Marzieh Mehrafza
- Mehr Fertility Research Centre, Guilan University of Medical Sciences, Rasht, Iran.
| | - Gholamreza Pourseify
- Mehr Fertility Research Centre, Guilan University of Medical Sciences, Rasht, Iran
| | - Tahereh Zare Yousefi
- Mehr Fertility Research Centre, Guilan University of Medical Sciences, Rasht, Iran
| | - Raoufi Azadeh
- Mehr Fertility Research Centre, Guilan University of Medical Sciences, Rasht, Iran
| | - Sahar Saghati Jalali
- Mehr Fertility Research Centre, Guilan University of Medical Sciences, Rasht, Iran
| | - Elmira Hosseinzadeh
- Mehr Fertility Research Centre, Guilan University of Medical Sciences, Rasht, Iran
| | - Sajedeh Samadnia
- Mehr Fertility Research Centre, Guilan University of Medical Sciences, Rasht, Iran
| | - Maliheh Habibdoost
- Mehr Fertility Research Centre, Guilan University of Medical Sciences, Rasht, Iran
| | - Amirhossein Tamimi
- Mehr Fertility Research Centre, Guilan University of Medical Sciences, Rasht, Iran
| | - Ahmad Hosseini
- Mehr Fertility Research Centre, Guilan University of Medical Sciences, Rasht, Iran
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Peero EK, Banjar S, Khoudja R, Ton-Leclerc S, Beauchamp C, Benoit J, Beltempo M, Dahan MH, Gold P, Kadoch IJ, Jamal W, Laskin C, Mahutte N, Phillips S, Sylvestre C, Reinblatt S, Mazer BD, Buckett W, Genest G. Intravenous immunoglobulin for patients with unexplained recurrent implantation failure: a 6-year single center retrospective review of clinical outcomes. Sci Rep 2024; 14:3876. [PMID: 38365988 PMCID: PMC10873418 DOI: 10.1038/s41598-024-54423-z] [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: 11/14/2023] [Accepted: 02/13/2024] [Indexed: 02/18/2024] Open
Abstract
The effectiveness of intravenous immunoglobulin (IVIg) for patients with unexplained recurrent implantation failure (uRIF) remains debated. We retrospectively analysed outcomes of uRIF patients treated with IVIg compared to a separate control uRIF cohort within our center (01/2014-12/2021). Primary outcomes included live birth, miscarriage, or transfer failure. We documented IVIg side effects and maternal/fetal outcomes. Logistic regression analysis was used to assess for association of IVIg exposure with outcomes and adjust for confounders. The study included 143 patients, with a 2:1 ratio of controls to patients receiving IVIg treatment. Patient characteristics were similar between groups. There was higher live birth rate (LBR) in patients receiving IVIg (32/49; 65.3%) compared to controls (32/94; 34%); p < 0.001). When stratifying patients into moderate and severe uRIF (respectively 3-4 and [Formula: see text] 5 previous good quality blastocyst transfer failures), only patients with severe uRIF benefited from IVIg (LBR (20/29 (69%) versus 5/25 (20%) for controls, p = 0.0004). In the logistic regression analysis, IVIg was associated with higher odds of live birth (OR 3.64; 95% CI 1.78-7.67; p = 0.0004). There were no serious adverse events with IVIg. IVIg can be considered in well selected patients with [Formula: see text] 5 previous unexplained, high quality blastocyst transfer failures. A randomized controlled trial is needed to confirm these findings.
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Affiliation(s)
- Einav Kadour Peero
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Bnai-Zion Medical Center, Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Shorooq Banjar
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rabea Khoudja
- Division of Clinical Immunology and Allergy, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
| | | | - Coralie Beauchamp
- Ovo Clinic, 8000 Boulevard Decarie, Montréal, QC, H4P 2S4, Canada
- Obstetrics and Gynaecology Department, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Joanne Benoit
- Ovo Clinic, 8000 Boulevard Decarie, Montréal, QC, H4P 2S4, Canada
- Obstetrics and Gynaecology Department, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Marc Beltempo
- Division of Neonatology, Montreal Children's Hospital - McGill University Health Centre, Montreal, QC, Canada
| | - Michael H Dahan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montréal, QC, Canada
| | - Phil Gold
- Department of Allergy and Immunology, Montreal General Hospital, 1650 Cedar Ave. A6-123, Montreal, QC, H3G 1A4, Canada
| | - Isaac Jacques Kadoch
- Ovo Clinic, 8000 Boulevard Decarie, Montréal, QC, H4P 2S4, Canada
- Obstetrics and Gynaecology Department, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Wael Jamal
- Clinique OVO, 8000 boulevard Décarie, Montréal, QC, H4P 2S4, Canada
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Carl Laskin
- TRIO Fertility, 655 Bay St, Toronto, ON, M5G 2K4, Canada
- Deptartments of Medicine and Obstetrics & Gynecology University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada
| | - Neal Mahutte
- The Montreal Fertility Centre, 5252 de Maisonneuve Blvd West, Suite 220, Montreal, QC, H4A 3S5, Canada
| | - Simon Phillips
- Clinique OVO, 8000 boulevard Décarie, Montréal, QC, H4P 2S4, Canada
- Faculty of Medicine, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Camille Sylvestre
- Ovo Clinic, 8000 Boulevard Decarie, Montréal, QC, H4P 2S4, Canada
- Division of Reproductive Endocrinology and Infertility, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T1J4, Canada
| | - Shauna Reinblatt
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montréal, QC, Canada
- McGill University Health Care Reproductive Center, 888 Boul. De Maisonneuve E# 200, Montreal, QC, H2L 4S8, Canada
| | - Bruce D Mazer
- Department of Pediatrics, Division of Allergy Immunology and Clinical Dermatology, Montreal Children's Hospital, McGill University, Montréal, QC, Canada
- Program in Translational Research in Respiratory Diseases, Research Institute of the McGill, University Health Centre, Montréal, QC, Canada
| | - William Buckett
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montréal, QC, Canada
- McGill University Health Care Reproductive Center, 888 Boul. De Maisonneuve E# 200, Montreal, QC, H2L 4S8, Canada
| | - Genevieve Genest
- Division of Clinical Immunology and Allergy, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada.
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Almohammadi A, Choucair F, El Taha L, Burjaq H, Albader M, Cavanillas AB, Awwad JT. The reproductive potential of vitrified-warmed euploid embryos declines following repeated uterine transfers. Reprod Biol Endocrinol 2024; 22:23. [PMID: 38350949 PMCID: PMC10863213 DOI: 10.1186/s12958-024-01192-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/04/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Recurrent implantation failure (RIF) represents a vague clinical condition with an unclear diagnostic challenge that lacks solid scientific underpinning. Although euploid embryos have demonstrated consistent implantation capabilities across various age groups, a unanimous agreement regarding the advantages of preimplantation genetic testing for aneuploidy (PGT-A) in managing RIF is absent. The ongoing discussion about whether chromosomal aneuploidy in embryos significantly contributes to recurrent implantation failure remains unsettled. Despite active discussions in recent times, a universally accepted characterization of recurrent implantation failure remains elusive. We aimed in this study to measure the reproductive performance of vitrified-warmed euploid embryos transferred to the uterus in successive cycles. METHODS This observational cohort study included women (n = 387) with an anatomically normal uterus who underwent oocyte retrieval for PGT-A treatment with at least one biopsied blastocyst, between January 2017 and December 2021 at a university-affiliated public fertility center. The procedures involved in this study included ICSI, blastocyst culture, trophectoderm biopsy and comprehensive 24-chromosome analysis of preimplantation embryos using Next Generation Sequencing (NGS). Women, who failed a vitrified-warmed euploid embryo transfer, had successive blastocyst transfer cycles (FET) for a total of three using remaining cryopreserved euploid blastocysts from the same oocyte retrieval cycle. The primary endpoints were sustained implantation rate (SIR) and live birth rate (LBR) per vitrified-warmed single euploid embryo. The secondary endpoints were mean euploidy rate (m-ER) per cohort of biopsied blastocysts from each patient, as well as pregnancy and miscarriage rates. RESULTS The mean age of the patient population was 33.4 years (95% CI 32.8-33.9). A total of 1,641 embryos derived from the first oocyte retrieval cycle were biopsied and screened. We found no associations between the m-ER and the number of previous failed IVF cycles among different ranges of maternal age at oocyte retrieval (P = 0.45). Pairwise comparisons showed a significant decrease in the sustained implantation rate (44.7% vs. 30%; P = 0.01) and the livebirth rate per single euploid blastocyst (37.1% vs. 25%; P = 0.02) between the 1st and 3rd FET. The cumulative SIR and LBR after up to three successive single embryo transfers were 77.1% and 68.8%, respectively. We found that the live birth rate of the first vitrified-warmed euploid blastocyst transferred decreased significantly with the increasing number of previously failed IVF attempts by categories (45.3% vs. 35.8% vs. 27.6%; P = 0.04). A comparable decrease in sustained implantation rate was also observed but did not reach statistical significance (50% vs. 44.2 vs. 37.9%; P = NS). Using a logistic regression model, we confirmed the presence of a negative association between the number of previous IVF failed attempts and the live birth rate per embryo transfer cycle (OR = 0.76; 95% CI 0.62-0.94; P = 0.01). CONCLUSIONS These findings are vital for enhancing patient counseling and refining management strategies for individuals facing recurrent implantation failure. By tailoring interventions based on age and ovarian reserve, healthcare professionals can offer more personalized guidance, potentially improving the overall success rates and patient experiences in fertility treatments. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A Almohammadi
- Department of Preventive Medicine and Public Health, University of Granada, Granada, 18071, 11, Spain
- Division of Reproductive Medicine, Sidra Medicine, OPC Bldg. Level 3. Office 302. Al Luqta St. Education City North Campus. Qatar Foundation, Doha, PO BOX 26999, Qatar
| | - F Choucair
- Division of Reproductive Medicine, Sidra Medicine, OPC Bldg. Level 3. Office 302. Al Luqta St. Education City North Campus. Qatar Foundation, Doha, PO BOX 26999, Qatar
| | - L El Taha
- Division of Reproductive Medicine, Sidra Medicine, OPC Bldg. Level 3. Office 302. Al Luqta St. Education City North Campus. Qatar Foundation, Doha, PO BOX 26999, Qatar
| | - H Burjaq
- Department of Assisted Reproduction, Hamad Medical Corporation, Doha, 3050, Qatar
| | - M Albader
- Department of Assisted Reproduction, Hamad Medical Corporation, Doha, 3050, Qatar
| | - A B Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, 18071, 11, Spain
| | - Johnny T Awwad
- Division of Reproductive Medicine, Sidra Medicine, OPC Bldg. Level 3. Office 302. Al Luqta St. Education City North Campus. Qatar Foundation, Doha, PO BOX 26999, Qatar.
- Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital, Boston, MA, USA.
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Xiong Y, Wang Y, Wu M, Chen S, Lei H, Mu H, Yu H, Hou Y, Tang K, Chen X, Dong J, Wang X, Chen L. Aberrant NK cell profile in gestational diabetes mellitus with fetal growth restriction. Front Immunol 2024; 15:1346231. [PMID: 38375483 PMCID: PMC10875967 DOI: 10.3389/fimmu.2024.1346231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/17/2024] [Indexed: 02/21/2024] Open
Abstract
Gestational diabetes mellitus (GDM) is a gestational disorder characterized by hyperglycemia, that can lead to dysfunction of diverse cells in the body, especially the immune cells. It has been reported that immune cells, specifically natural killer (NK) cells, play a crucial role in normal pregnancy. However, it remains unknown how hyperglycemia affects NK cell dysfunction thus participates in the development of GDM. In this experiment, GDM mice were induced by an intraperitoneal injection of streptozotocin (STZ) after pregnancy and it has been found that the intrauterine growth restriction occurred in mice with STZ-induced GDM, accompanied by the changed proportion and function of NK cells. The percentage of cytotoxic CD27-CD11b+ NK cells was significantly increased, while the proportion of nourished CD27-CD11b- NK cells was significantly reduced in the decidua of GDM mice. Likewise, the same trend appeared in the peripheral blood NK cell subsets of GDM patients. What's more, after intrauterine reinfusion of NK cells to GDM mice, the fetal growth restriction was alleviated and the proportion of NK cells was restored. Our findings provide a theoretical and experimental basis for further exploring the pathogenesis of GDM.
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Affiliation(s)
- Yujing Xiong
- Department of Immunology, Air Force Medical University, Xi’an, Shaanxi, China
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Yazhen Wang
- Department of Immunology, Air Force Medical University, Xi’an, Shaanxi, China
| | - Mengqi Wu
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China
| | - Shuqiang Chen
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Hui Lei
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Hui Mu
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Haikun Yu
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Yongli Hou
- Department of Immunology, Air Force Medical University, Xi’an, Shaanxi, China
| | - Kang Tang
- Department of Immunology, Air Force Medical University, Xi’an, Shaanxi, China
| | - Xutao Chen
- Department of Immunology, Air Force Medical University, Xi’an, Shaanxi, China
| | - Jie Dong
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Xiaohong Wang
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Lihua Chen
- Department of Immunology, Air Force Medical University, Xi’an, Shaanxi, China
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Saito S. Role of immune cells in the establishment of implantation and maintenance of pregnancy and immunomodulatory therapies for patients with repeated implantation failure and recurrent pregnancy loss. Reprod Med Biol 2024; 23:e12600. [PMID: 39091423 PMCID: PMC11292669 DOI: 10.1002/rmb2.12600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/10/2024] [Accepted: 07/16/2024] [Indexed: 08/04/2024] Open
Abstract
Background Immune cells play an important role in the establishment of pregnancy, and abnormalities in the immune system can cause implantation failure and miscarriage. Methods Previous papers have been summarized and the role of immune cells in reproduction is reviewed. Results The immune environment in the uterus changes drastically from before implantation to after pregnancy to maintain pregnancy. In allogeneic pregnancies, immature dendritic cells (DCs) that induce immune tolerance from outside the uterus flow into the uterus, and mature DCs that remain in the uterus express programmed cell death ligand 2, which suppresses the immune response. Macrophages are classified into M1-macrophages, which induce inflammation, and M2-macrophages, which suppress inflammation; M1-macrophages are required for luteinization, and M2-macrophages induce the differentiation of endometrial epithelial cells to enable implantation. Regulatory T cells, which suppress rejection, are essential for the implantation and maintenance of allogeneic pregnancies. Implantation failure and fetal loss are associated with decreased numbers or qualitative abnormalities of DCs, macrophages, and regulatory T cells. The clinical usefulness of immunomodulatory therapies in patients with repeated implantation failure and recurrent pregnancy loss has been reported. Conclusion The provision of individualized medical care in cases of implantation failure or miscarriage may improve clinical outcomes.
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Bhoi NR, Murdia N, Murdia K, Chandra V, Suwalka I, Mistari W, Aggrawal R, Shah N, Kumar D. Effect of Hyaluronic Acid-Containing Transfer Media (EmbryoGlue®) on the Live Birth Rate in Frozen Thawed Embryo Transfer Cycles. Cureus 2024; 16:e52713. [PMID: 38384631 PMCID: PMC10880135 DOI: 10.7759/cureus.52713] [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] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
This retrospective cohort study examines the impact of EmbryoGlue® - a culture medium comprising high-concentration hyaluronan and low-concentration recombinant human albumin (rHA) - on assisted reproductive technology (ART) outcomes in 1,298 cycles across 13 centers. The study focused on live birth rates, clinical pregnancy, and miscarriage rates between a standard treatment arm and an EmbryoGlue® arm in frozen embryo transfer (FET) cycles. Propensity score matching ensured comparable baseline variables. Findings showed higher live birth rates (60.6% vs. 47.5%) and clinical pregnancies (69.5% vs. 57.6%) in the EmbryoGlue® group, correlating with factors like patient age and blastocyst transfer. Specifically, EmbryoGlue® showed a significant association with higher live birth rates (OR 1.593; CI 1.170-2.168; P = 0.003). These findings underscore the impact of personalized approaches and highlight EmbryoGlue®'s potential in improving successful embryo implantation, thus enhancing pregnancy rates in ART procedures. Univariate and multivariate analyses identified EmbryoGlue®, female age, and blastocyst transfer as predictors of live birth. EmbryoGlue® exhibited significance in improving clinical outcomes, mirroring previous studies' findings. Limitations in the study's design warrant further prospective research for validation. In conclusion, EmbryoGlue® appears promising for enhancing live birth rates in FET cycles, presenting a potential advancement in ART protocols.
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Affiliation(s)
- Nihar R Bhoi
- Reproductive Medicine, Indira IVF Hospital Private Limited, Udaipur, IND
| | - Nitiz Murdia
- Embryology, Indira IVF Hospital Private Limited, Udaipur, IND
| | - Kshitiz Murdia
- Reproductive Medicine, Indira IVF Hospital Private Limited, Udaipur, IND
| | - Vipin Chandra
- Clinical Research and Operations, Indira IVF Hospital Private Limited, Udaipur, IND
| | - Isha Suwalka
- Research and Publication, Indira IVF Hospital Private Limited, Udaipur, IND
| | - Walmik Mistari
- Research and Publication, Indira IVF Hospital Private Limited, Udaipur, IND
| | - Ritesh Aggrawal
- Embryology, Indira IVF Hospital Private Limited, Udaipur, IND
| | - Naval Shah
- Embryology, Indira IVF Hospital Private Limited, Udaipur, IND
| | - Dayanidhi Kumar
- Reproductive Medicine, Indira IVF Hospital Private Limited, Patna, IND
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Wu S, Wu G, Li Y, Wu H. Mechanism of HCG regulating epithelial-mesenchymal transition progression in endometrial cells through the FoxO1/miR223-5p/Wnt5α pathway. Reprod Biomed Online 2024; 48:103246. [PMID: 37903673 DOI: 10.1016/j.rbmo.2023.05.016] [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: 02/06/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 11/01/2023]
Abstract
RESEARCH QUESTION Does human chorionic gonadotrophin (HCG) influence endometrial receptivity and epithelial-mesenchymal transition (EMT) via the FoxO1/miR223-5p/Wnt5α pathway? DESIGN This study aimed to establish the co-culture system of human embryonic trophoblast cell line (HTR-8-Svneo) cells and human endometrial epithelial cell line (HEEC) cells. The expression of Wnt5α protein and EMT-related proteins in HTR-8-Svneo and HEEC cells treated in a gradient-dependent manner using HCG and exosome inhibitor GW4869 were detected in the co-culture system. RESULTS In the HTR-8-Svneo/HEEC co-culture system, miR223-5p in HEEC cells increased significantly with induction of HTR-8-Svneo cells by 100 IU/ml HCG for 48 h (P = 0.046), and Wnt5α protein decreased significantly in HEEC cells (P = 0.021). Pretreatment of HTR-8-Svneo cells with GW4869, and knockdown of FoxO1 in HTR-8-Svneo cells, significantly inhibited the above effects of HCG on miR223-5p and Wnt5α expression in HEEC cells in the HTR-8-Svneo/HEEC co-culture system. HTR-8-Svneo cells induced with 100 IU/ml HCG for 48 h significantly enhanced the logarithmic phase proliferation activity of HEEC cells in the co-culture system (P < 0.001), while knockdown of FoxO1 in HTR-8-Svneo cells and inhibition of miR223-5p in HEEC cells suppressed proliferation of HEEC cells in the HTR-8-Svneo/HEEC co-culture system (P < 0.001). CONCLUSIONS HCG exposure induces HTR-8-Svneo cells to up-regulate miR223-5p expression, which enters HEEC cells in the co-culture system through the exosomal pathway, and inhibits Wnt5α expression and the progress of EMT.
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Affiliation(s)
- Shuxie Wu
- Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Gao Wu
- Department of Pharmacy, First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Yanping Li
- Reproductive Medicine Centre, Xiangya Hospital, Central South University, Hunan, China.
| | - Hanbin Wu
- Clinical Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Kaur H, Meenu M, Pandey S, Chauhan A, Mangla M. Role of Platelet-rich Plasma in Unexplained Recurrent Implantation Failure - A Systematic Review and Meta-analysis of Randomised Control Trials. J Hum Reprod Sci 2024; 17:2-15. [PMID: 38665609 PMCID: PMC11041320 DOI: 10.4103/jhrs.jhrs_166_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 04/28/2024] Open
Abstract
Background Recurrent implantation failure (RIF) is a challenging clinical situation and various strategies have been tried to improve the pregnancy rate in RIF. Platelet-rich plasma (PRP), which is obtained from the autologous blood samples of a person and is multiple times richer in platelets and other growth factors helps improve endometrial receptivity. Objective This study has been conducted to summarise the evidence and quality of evidence available so far regarding the role of PRP in cases of unexplained RIF. Materials and Methods An electronic database search for randomised clinical trials comparing PRP against routine care in women with unexplained RIF was performed on PubMed, EMBASE, SCOPUS and Cochrane Central. Two independent reviewers conducted a literature search and retrieved data using the predefined eligibility criteria. Bias assessment was done using the Cochrane Collaboration Network Risk of Bias Tool version 2. The quality of evidence was determined and a summary of the findings table was prepared for individual outcomes using GRADEpro software. Results We identified 1146 records, and after removing duplicates, 531 records were screened. Out of these, 22 studies reached full-text screening and nine studies were included in the final review. We are uncertain about the effect of PRP due to the very low quality of evidence and we have little confidence that the administration of PRP had any significant effect on improving the live birth rate in women with RIF (odds ratio [OR]: 7.32, 95% confidence interval [CI]: 4.54-11.81, I2 = 40%). Similarly, the quality of evidence was low for the clinical pregnancy rate, so we are uncertain if the administration of PRP had any significant effect on the clinical pregnancy rate (OR: 3.20, 95% CI: 2.38-4.28, I2 = 0%). Interpretation The current review suggests that there may be some beneficial effects of PRP in women with RIF, but the quality of evidence is very low and we are uncertain of the benefit and have little confidence in these findings. Limitations Limitations are the small sample size of most studies, a short follow-up period, non-uniformity in the definition of outcomes and very low quality of evidence. Registration The protocol was registered on PROSPERO (CRD42021292209).
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Affiliation(s)
- Harpreet Kaur
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
| | - Meenakshi Meenu
- Department of Pharmacology, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Anil Chauhan
- Department of Telemedicine, Regional Resource Centre, Evidence-Based Health Informatics Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mishu Mangla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
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Galati G, Reschini M, Mensi L, Di Dio C, Somigliana E, Muzii L. The impact of difficult embryo transfer on the success of IVF: a systematic review and meta-analysis. Sci Rep 2023; 13:22188. [PMID: 38092864 PMCID: PMC10719337 DOI: 10.1038/s41598-023-49141-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
The procedure of embryo transfer (ET) must be as gentle as possible since any traumatism may cause uterine contractility that interferes with the implantation. However, this ideal conduct is not always possible, and additional measures may be necessary (difficult ET). Different studies have evaluated the impact of difficult ET on the clinical pregnancy rate (CPR), but results were not univocal. The present systematic review and meta-analysis was aimed to provide a precise estimate of the possible detrimental effects of difficult ET on CPR. The study protocol was registered online (PROSPERO number: CRD42023387197). An electronic database search was performed to identify articles published until September 2022. The primary outcome was CPR. Fifteen studies fulfilled the inclusion criteria. Difficult ET significantly reduced the CPR (OR 0.70; 95%CI: 0.64-0.76; p < 0.0001. All pre-planned subgroup analyses according to study design (retrospective vs prospective studies), historical period (studies published before and after 2010), type of catheter, frequency of difficult cases (> or < 19%) and pregnancy rate (> or < 38%) confirmed the significant association. Difficult ET is associated with a significant reduction of CPR. Further studies are warranted to understand how to prevent or manage this common clinical situation.
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Affiliation(s)
- Giulia Galati
- Department of Maternal and Child Health and Urology, Sapienza University, 00161, Rome, Italy.
| | - Marco Reschini
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Mensi
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Camilla Di Dio
- Department of Maternal and Child Health and Urology, Sapienza University, 00161, Rome, Italy
| | - Edgardo Somigliana
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urology, Sapienza University, 00161, Rome, Italy
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10
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Deng H, Wang S, Li Z, Xiao L, Ma L. Effect of intrauterine infusion of platelet-rich plasma for women with recurrent implantation failure: a systematic review and meta-analysis. J OBSTET GYNAECOL 2023; 43:2144177. [PMID: 36397660 DOI: 10.1080/01443615.2022.2144177] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This study evaluated the effect of intrauterine perfusion of autologous platelet-rich plasma (PRP) on pregnancy outcomes in women with recurrent implantation failure (RIF). Key biomedical databases were searched to identify relevant clinical trials and observational studies. Outcomes included clinical pregnancy rate, chemical pregnancy rate, implantation rate, live birth rate, and abortion rate. Data was extracted from ten studies (six randomised controlled trials, four cohort studies) involving 1555 patients. Pregnancy outcomes were improved in women treated with PRP compared to controls: clinical pregnancy rate (RR = 1.96, 95% CI [1.67, 2.31], p < 0.00001, I2 = 46%), chemical pregnancy rate (RR = 1.79, 95% CI [1.54, 2.08], p < 0.00001, I2 = 29%), implantation rate (RR = 1.90, CI [1.50, 2.41], p < 0.00001, I2 = 0%), live birth rate (RR = 2.83, CI [1.45, 5.52], p = 0.0007, I2 = 83%), abortion rate (RR = 0.40, 95% CI [0.18, 0.90], p = 0.03, I2 = 59%). These data imply PRP has potential to improve pregnancy outcomes in women with RIF, suggesting a promising role in assisted reproductive technology.IMPACT STATEMENTWhat is already known on this subject? Platelet-rich plasma (PRP) is an autologous blood product that contains platelets, various growth factors, and cytokines at concentrations above the normal baseline level. Recent studies have shown that intrauterine infusion of autologous PRP can improve pregnancy outcomes in infertile women.What do the results of this study add? This systematic review and meta-analysis of data from ten studies (n = 1555; 775 cases and 780 controls) investigated the effect of intrauterine perfusion of autologous PRP on pregnancy outcomes in women with recurrent implantation failure (RIF). Findings suggest that pregnancy outcomes, including clinical pregnancy rate, chemical pregnancy rate, implantation rate, live birth rate and abortion rate were improved in women treated with PRP compared to controls.What are the implications of these findings for clinical practice and/or further research? RIF remains a challenge for researchers, clinicians, and patients. Our study identified PRP as a potential intervention in assisted reproduction. As an autologous blood preparation, PRP eliminates the risk of an immune response and transmission of disease. PRP is low cost and effective and may represent a new approach to the treatment of patients with RIF.
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Affiliation(s)
- Haiyu Deng
- School of Basic Medical Sciences, Wuhan University, Wuhan, P. R. China
| | - Suqing Wang
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Wuhan, P. R. China
| | - Zhijie Li
- School of Basic Medical Sciences, Wuhan University, Wuhan, P. R. China
| | - Lingfei Xiao
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital, Wuhan University, Wuhan, P. R. China
| | - Ling Ma
- Reproductive Medicine Center, Zhongnan Hospital, Wuhan University, Wuhan, P. R. China
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Ferreira Aderaldo J, da Silva Maranhão K, Ferreira Lanza DC. Does microfluidic sperm selection improve clinical pregnancy and miscarriage outcomes in assisted reproductive treatments? A systematic review and meta-analysis. PLoS One 2023; 18:e0292891. [PMID: 37983267 PMCID: PMC10659219 DOI: 10.1371/journal.pone.0292891] [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: 04/03/2023] [Accepted: 10/01/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The microfluidic sperm selection (MFSS) device has emerged as a promising adjunct in assisted reproduction treatments (ART). It employs mechanisms of biomimicry based on the microanatomy of the female reproductive tract through strategies like chemotaxis and rheotaxis. Numerous studies assert improvements in ART outcomes with the use of MFSS, often attributed to the theoretical reduction in sperm DNA damage compared to other techniques. However, these attributed benefits lack validation through large-scale clinical trials, and there is no significant evidence of enhanced assisted reproductive treatments (ART) outcomes. OBJECTIVE To evaluate whether the utilization of MFSS enhances clinical pregnancy results and abortion outcomes in couples undergoing ART compared to standard sperm selection techniques for Intracytoplasmic Sperm Injection (ICSI). We also assessed laboratory outcomes as a supplementary analysis. SEARCH METHODS We conducted searches across databases including PubMed, NIH, LILACS, CENTRAL, Crossref, Scopus, and OpenAlex. A total of 1,255 records were identified. From these, 284 duplicate records were eliminated, and an additional 895 records were excluded due to their association with patent applications, diagnostic tests, forensic analyses, or irrelevance to the research focus. Among the initially eligible 76 studies, 63 were excluded, encompassing abstracts, studies lacking adequate control groups, and ongoing clinical trials. Ultimately, 13 studies were selected for inclusion in the ensuing meta-analysis. RESULTS Regarding clinical pregnancy, we assessed a total of 868 instances of clinical pregnancies out of 1,646 embryo transfers. Regarding miscarriage, we examined 95 cases of pregnancy loss among the 598 confirmed clinical pregnancies in these studies. CONCLUSION The utilization of MFSS demonstrates marginal positive outcomes compared to standard sperm selection techniques, without statistical significance in any of the analyses. BROADER IMPLICATIONS This study conducted the first meta-analysis to evaluate clinical pregnancy rates, miscarriage rates, and laboratory results associated with the use of MFSS compared to standard sperm selection techniques. We have also listed potentially eligible studies for future inclusion. It's important to emphasize the need for multicenter studies with standardized parameters to attain a more robust clarification of this issue.
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Affiliation(s)
- Janaina Ferreira Aderaldo
- Januário Cicco Maternity School of Brazilian Company of Hospital Services (MEJC/UFRN-Ebserh), Natal, Brazil
- Biochemistry Department, Federal University of Rio Grande do Norte–UFRN, Natal, Brazil
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Curfs MHJM, Cohlen BJ, Slappendel EJ, Schoot DC, Derhaag JG, van Golde RJT, van der Heijden GW, Baart EB, Smeenk JMJ, Ritfeld VEEG, Brohet RM, van Bavel CCAW. A multicentre double-blinded randomized controlled trial on the efficacy of laser-assisted hatching in patients with repeated implantation failure undergoing IVF or ICSI. Hum Reprod 2023; 38:1952-1960. [PMID: 37646072 PMCID: PMC10546076 DOI: 10.1093/humrep/dead173] [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: 03/03/2023] [Revised: 07/24/2023] [Indexed: 09/01/2023] Open
Abstract
STUDY QUESTION Does assisted hatching increase the cumulative live birth rate in subfertile couples with repeated implantation failure? SUMMARY ANSWER This study showed no evidence of effect for assisted hatching as an add-on in subfertile couples with repeated implantation failure. WHAT IS KNOWN ALREADY The efficacy of assisted hatching, with regard to the live birth rate has not been convincingly demonstrated in randomized trials nor meta-analyses. It is suggested though that especially poor prognosis women, e.g. women with repeated implantation failure, might benefit most from assisted hatching. STUDY DESIGN, SIZE, DURATION The study was designed as a double-blinded, multicentre randomized controlled superiority trial. In order to demonstrate a statistically significant absolute increase in live birth rate of 10% after assisted hatching, 294 participants needed to be included per treatment arm, being a total of 588 subfertile couples. Participants were included and randomized from November 2012 until November 2017, 297 were allocated to the assisted hatching arm of the study and 295 to the control arm. Block randomization in blocks of 20 participants was applied and randomization was concealed from participants, treating physicians, and laboratory staff involved in the embryo transfer procedure. Ovarian hyperstimulation, oocyte retrieval, laboratory procedures, embryo selection for transfer and cryopreservation, the transfer itself, and luteal support were performed according to local protocols and were identical in both the intervention and control arm of the study with the exception of the assisted hatching procedure which was only performed in the intervention group. The laboratory staff performing the assisted hatching procedure was not involved in the embryo transfer itself. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were eligible for inclusion in the study after having had either at least two consecutive fresh IVF or ICSI embryo transfers, including the transfer of frozen and thawed embryos originating from those fresh cycles, and which did not result in a pregnancy or as having had at least one fresh IVF or ICSI transfer and at least two frozen embryo transfers with embryos originating from that fresh cycle which did not result in a pregnancy. The study was performed at the laboratory sites of three tertiary referral hospitals and two university medical centres in the Netherlands. MAIN RESULTS AND THE ROLE OF CHANCE The cumulative live birth rate per started cycle, including the transfer of fresh and subsequent frozen/thawed embryos if applicable, resulted in 77 live births in the assisted hatching group (n = 297, 25.9%) and 68 live births in the control group (n = 295, 23.1%). This proved to be statistically not significantly different (relative risk: 1.125, 95% CI: 0.847 to 1.494, P = 0.416). LIMITATIONS, REASONS FOR CAUTION There was a small cohort of subfertile couples that after not achieving an ongoing pregnancy, still had cryopreserved embryos in storage at the endpoint of the trial, i.e. 1 year after the last randomization. It cannot be excluded that the future transfer of these frozen/thawed embryos increases the cumulative live birth rate in either or both study arms. Next, at the start of this study, there was no international consensus on the definition of repeated implantation failure. Therefore, it cannot be excluded that assisted hatching might be effective in higher order repeated implantation failures. WIDER IMPLICATIONS OF THE FINDINGS This study demonstrated no evidence of a statistically significant effect for assisted hatching by increasing live birth rates in subfertile couples with repeated implantation failure, i.e. the couples which, based on meta-analyses, are suggested to benefit most from assisted hatching. It is therefore suggested that assisted hatching should only be offered if information on the absence of evidence of effect is provided, at no extra costs and preferably only in the setting of a clinical trial taking cost-effectiveness into account. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER Netherlands Trial Register (NTR 3387, NL 3235, https://www.clinicaltrialregister.nl/nl/trial/26138). TRIAL REGISTRATION DATE 6 April 2012. DATE OF FIRST PATIENT’S ENROLMENT 28 November 2012.
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Affiliation(s)
| | - Ben J Cohlen
- Isala Fertility Center, Isala, Zwolle, The Netherlands
| | | | - Dick C Schoot
- Department of Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Josien G Derhaag
- Center for Reproductive Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ron J T van Golde
- Center for Reproductive Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Esther B Baart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Jesper M J Smeenk
- Center for Reproductive Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | | | - Richard M Brohet
- Department of Innovation and Science, Isala, Zwolle, The Netherlands
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Scarpellini F, Sbracia M. Modification of peripheric Treg and CD56 brightNK levels in RIF women after egg donation, treated with GM-CSF or placebo. J Reprod Immunol 2023; 158:103983. [PMID: 37419075 DOI: 10.1016/j.jri.2023.103983] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 07/09/2023]
Abstract
Recurrent implantation failure (RIF) is defined as when implantation repeatedly failed to reach a stage recognizable by pelvic ultrasound in IVF cycle and it may be due to several causes. The GM-CSF is a cytokine promoting leukocyte growth and trophoblast development: we tested it to treat these patients in a pilot-controlled trial evaluating the modification of peripheric Treg and CD56brightNK levels after the treatment with this cytokine and in control patients affected by RIF after egg donation cycles. This study was performed on 24 RIF women after egg donation cycles. Single good quality blastocyst transfer was performed in the cycle object of this study. Patients were randomly assigned to two groups: 12 women treated with subcutaneous GM-CSF 0.3 mg/kg/daily from the day before embryo transfer to the β-hCG day, and 12 women treated with subcutaneous saline solution infusion as control. All patients were tested for Treg and CD56brightNK cell levels in blood circulation before and after treatment using flow-cytometry with specific antibodies. The two groups of patients were similar for epidemiologic characteristics, the ongoing pregnancy rate in the GM-CSF group was 83.3% whereas in the control group was 25.0% (P = 0.0123). In the study group there was a significative increase of Treg cells (P < 0.001) with respect to the levels before treatment and to control group. Instead, the levels of CD56brightNK did not show any significative variation. Our study showed that the treatment with GM-CSF increases the Treg cells in the peripheric blood.
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Muhandiram S, Dissanayake K, Orro T, Godakumara K, Kodithuwakku S, Fazeli A. Secretory Proteomic Responses of Endometrial Epithelial Cells to Trophoblast-Derived Extracellular Vesicles. Int J Mol Sci 2023; 24:11924. [PMID: 37569298 PMCID: PMC10418763 DOI: 10.3390/ijms241511924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
Synchronized crosstalk between the embryo and endometrium during the periconception period is integral to pregnancy establishment. Increasing evidence suggests that the exchange of extracellular vesicles (EVs) of both embryonic and endometrial origin is a critical component of embryo-maternal communication during peri-implantation. Here, we investigated whether embryonic signals in the form of EVs can modulate the endometrial epithelial cell secretome. Receptive endometrial analog RL95-2 cells were supplemented with trophoblast analog JAr cell-derived EVs, and the secretory protein changes occurring in the RL95-2 cells were analyzed using mass spectrometry. EVs of non-trophoblastic origin (HEK 293 cells) were used as the control EV source to supplement endometrial cells. Trophoblast cell-derived EVs enriched endometrial epithelial cell secretions with proteins that support embryo development, attachment, or implantation, whereas control EVs were unable to induce the same effect. The present study suggests that embryonic signals in the form of EVs may prime receptive endometrial epithelial cells to enrich their secretory proteome with critical proteomic molecules with functional importance for periconception milieu formation.
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Affiliation(s)
- Subhashini Muhandiram
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Kreutzwaldi 62, 51006 Tartu, Estonia; (S.M.); (K.D.); (T.O.); (K.G.); (S.K.)
| | - Keerthie Dissanayake
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Kreutzwaldi 62, 51006 Tartu, Estonia; (S.M.); (K.D.); (T.O.); (K.G.); (S.K.)
- Department of Pathophysiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Ravila St. 14B, 50411 Tartu, Estonia
- Department of Anatomy, Faculty of Medicine, University of Peradeniya, Kandy 20400, Sri Lanka
| | - Toomos Orro
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Kreutzwaldi 62, 51006 Tartu, Estonia; (S.M.); (K.D.); (T.O.); (K.G.); (S.K.)
| | - Kasun Godakumara
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Kreutzwaldi 62, 51006 Tartu, Estonia; (S.M.); (K.D.); (T.O.); (K.G.); (S.K.)
| | - Suranga Kodithuwakku
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Kreutzwaldi 62, 51006 Tartu, Estonia; (S.M.); (K.D.); (T.O.); (K.G.); (S.K.)
- Department of Animal Science, Faculty of Agriculture, University of Peradeniya, Kandy 20400, Sri Lanka
| | - Alireza Fazeli
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Kreutzwaldi 62, 51006 Tartu, Estonia; (S.M.); (K.D.); (T.O.); (K.G.); (S.K.)
- Department of Pathophysiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Ravila St. 14B, 50411 Tartu, Estonia
- Academic Unit of Reproductive and Developmental Medicine, Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield S10 2TN, UK
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Yan Q, Zhao M, Hao F, Zhao R, Teng X, He B, Zhu C, Chen Z, Li K. Effect of hyaluronic acid-enriched transfer medium on frozen-thawed embryo transfer outcomes in RIF patients: a single-centre retrospective study. Front Endocrinol (Lausanne) 2023; 14:1170727. [PMID: 37465128 PMCID: PMC10350524 DOI: 10.3389/fendo.2023.1170727] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/12/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction Many patients who undergo assisted reproductive technology (ART) suffer from recurrent implantation failure (RIF). The addition of hyaluronic acid (HA) to the transfer medium is one of several methods to improve pregnancy outcomes. We investigated whether HA could improve the live birth and clinical pregnancy rates of RIF patients. Methods This study included 248 RIF patients, who were divided into two groups: the control (CTL) group (n=137), which received transfer medium without HA, and the HA group (n=111), which received transfer medium with HA. The two groups were compared according to the ART outcome. Results The primary outcomes were the clinical pregnancy and live birth rates. Secondary outcomes include a positive urine pregnancy test, the implantation, ongoing pregnancy, multiple pregnancy, clinical miscarriage, and ectopic pregnancy rates, foetal or congenital defects, obstetric complications, infant birth weight and any related adverse events. Regarding the primary outcomes, the clinical pregnancy rate was significantly higher in the HA group than in the control group, and there was no significant difference in the live birth rate (LBR) between the HA and control groups. Regarding the secondary outcomes, the implantation, multiple pregnancy and ectopic pregnancy rates were similar between the two groups. Discussion Our findings supported the conclusion that HA can improve the clinical pregnancy rate of patients with RIF undergoing FET cycles, but the live birth rate was not significantly improved with the addition of HA to the traditional transfer medium.
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Affiliation(s)
- Qiang Yan
- Reproductive Medicine Center, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Mei Zhao
- Reproductive Medicine Center, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fan Hao
- Reproductive Medicine Center, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ruru Zhao
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaoming Teng
- Reproductive Medicine Center, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bin He
- Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chong Zhu
- Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhiqin Chen
- Reproductive Medicine Center, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Kunming Li
- Reproductive Medicine Center, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
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Cimadomo D, de los Santos MJ, Griesinger G, Lainas G, Le Clef N, McLernon DJ, Montjean D, Toth B, Vermeulen N, Macklon N. ESHRE good practice recommendations on recurrent implantation failure. Hum Reprod Open 2023; 2023:hoad023. [PMID: 37332387 PMCID: PMC10270320 DOI: 10.1093/hropen/hoad023] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Indexed: 06/20/2023] Open
Abstract
STUDY QUESTION How should recurrent implantation failure (RIF) in patients undergoing ART be defined and managed? SUMMARY ANSWER This is the first ESHRE good practice recommendations paper providing a definition for RIF together with recommendations on how to investigate causes and contributing factors, and how to improve the chances of a pregnancy. WHAT IS KNOWN ALREADY RIF is a challenge in the ART clinic, with a multitude of investigations and interventions offered and applied in clinical practice, often without biological rationale or with unequivocal evidence of benefit. STUDY DESIGN SIZE DURATION This document was developed according to a predefined methodology for ESHRE good practice recommendations. Recommendations are supported by data from the literature, if available, and the results of a previously published survey on clinical practice in RIF and the expertise of the working group. A literature search was performed in PubMed and Cochrane focussing on 'recurrent reproductive failure', 'recurrent implantation failure', and 'repeated implantation failure'. PARTICIPANTS/MATERIALS SETTING METHODS The ESHRE Working Group on Recurrent Implantation Failure included eight members representing the ESHRE Special Interest Groups for Implantation and Early Pregnancy, Reproductive Endocrinology, and Embryology, with an independent chair and an expert in statistics. The recommendations for clinical practice were formulated based on the expert opinion of the working group, while taking into consideration the published data and results of the survey on uptake in clinical practice. The draft document was then open to ESHRE members for online peer review and was revised in light of the comments received. MAIN RESULTS AND THE ROLE OF CHANCE The working group recommends considering RIF as a secondary phenomenon of ART, as it can only be observed in patients undergoing IVF, and that the following description of RIF be adopted: 'RIF describes the scenario in which the transfer of embryos considered to be viable has failed to result in a positive pregnancy test sufficiently often in a specific patient to warrant consideration of further investigations and/or interventions'. It was agreed that the recommended threshold for the cumulative predicted chance of implantation to identify RIF for the purposes of initiating further investigation is 60%. When a couple have not had a successful implantation by a certain number of embryo transfers and the cumulative predicted chance of implantation associated with that number is greater than 60%, then they should be counselled on further investigation and/or treatment options. This term defines clinical RIF for which further actions should be considered. Nineteen recommendations were formulated on investigations when RIF is suspected, and 13 on interventions. Recommendations were colour-coded based on whether the investigations/interventions were recommended (green), to be considered (orange), or not recommended, i.e. not to be offered routinely (red). LIMITATIONS REASONS FOR CAUTION While awaiting the results of further studies and trials, the ESHRE Working Group on Recurrent Implantation Failure recommends identifying RIF based on the chance of successful implantation for the individual patient or couple and to restrict investigations and treatments to those supported by a clear rationale and data indicating their likely benefit. WIDER IMPLICATIONS OF THE FINDINGS This article provides not only good practice advice but also highlights the investigations and interventions that need further research. This research, when well-conducted, will be key to making progress in the clinical management of RIF. STUDY FUNDING/COMPETING INTERESTS The meetings and technical support for this project were funded by ESHRE. N.M. declared consulting fees from ArtPRED (The Netherlands) and Freya Biosciences (Denmark); Honoraria for lectures from Gedeon Richter, Merck, Abbott, and IBSA; being co-founder of Verso Biosense. He is Co-Chief Editor of Reproductive Biomedicine Online (RBMO). D.C. declared being an Associate Editor of Human Reproduction Update, and declared honoraria for lectures from Merck, Organon, IBSA, and Fairtility; support for attending meetings from Cooper Surgical, Fujifilm Irvine Scientific. G.G. declared that he or his institution received financial or non-financial support for research, lectures, workshops, advisory roles, or travelling from Ferring, Merck, Gedeon-Richter, PregLem, Abbott, Vifor, Organon, MSD, Coopersurgical, ObsEVA, and ReprodWissen. He is an Editor of the journals Archives of Obstetrics and Gynecology and Reproductive Biomedicine Online, and Editor in Chief of Journal Gynäkologische Endokrinologie. He is involved in guideline developments and quality control on national and international level. G.L. declared he or his institution received honoraria for lectures from Merck, Ferring, Vianex/Organon, and MSD. He is an Associate Editor of Human Reproduction Update, immediate past Coordinator of Special Interest Group for Reproductive Endocrinology of ESHRE and has been involved in Guideline Development Groups of ESHRE and national fertility authorities. D.J.M. declared being an Associate Editor for Human Reproduction Open and statistical Advisor for Reproductive Biomedicine Online. B.T. declared being shareholder of Reprognostics and she or her institution received financial or non-financial support for research, clinical trials, lectures, workshops, advisory roles or travelling from support for attending meetings from Ferring, MSD, Exeltis, Merck Serono, Bayer, Teva, Theramex and Novartis, Astropharm, Ferring. The other authors had nothing to disclose. DISCLAIMER This Good Practice Recommendations (GPR) document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and are based on the scientific evidence available at the time of preparation. ESHRE GPRs should be used for information and educational purposes. They should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care, or be exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, or variations based on locality and facility type. Furthermore, ESHRE GPRs do not constitute or imply the endorsement, or favouring, of any of the included technologies by ESHRE.
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Affiliation(s)
| | - D Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | | | - G Griesinger
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
- University of Luebeck, Luebeck, Germany
| | - G Lainas
- Eugonia IVF, Unit of Human Reproduction, Athens, Greece
| | - N Le Clef
- ESHRE Central Office, Strombeek-Bever, Belgium
| | - D J McLernon
- School of Medicine Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - D Montjean
- Fertilys Fertility Centers, Laval & Brossard, Canada
| | - B Toth
- Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - N Vermeulen
- ESHRE Central Office, Strombeek-Bever, Belgium
| | - N Macklon
- Correspondence address. ESHRE Central Office, BXL7—Building 1, Nijverheidslaan 3, B-1853 Strombeek-Bever, Belgium. E-mail:
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Li X, Du Y, Han X, Wang H, Sheng Y, Lian F, Lian Q. Efficacy of atosiban for repeated implantation failure in frozen embryo transfer cycles. Sci Rep 2023; 13:9277. [PMID: 37286752 DOI: 10.1038/s41598-023-36286-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023] Open
Abstract
Atosiban was commonly added to improve pregnancy outcomes of patients with repeated embryo implantation failure (RIF). In this study, we aimed to investigate the effect of atosiban before transferring the frozen-thawed embryo to RIF patients. This retrospective study was conducted in the Hospital for Reproductive Medicine affiliated to Shandong University from August 2017 to June 2021. A total of 1774 women with a history of RIF undergoing frozen embryo transfer (FET) were included in this study. All the participants were classified into atosiban or control group: Group A included 677 patients who were administered atosiban intravenously 30 min prior to FET with a dose of 37.5 mg; Group B included 1097 patients who received no atosiban before the transfer. There were no significant differences observed in the live birth rate (LBR) (39.73% vs. 39.02%, P = 0.928) between the two groups. Other secondary outcomes including biochemical pregnancy rate, clinical pregnancy rate, implantation rate, clinical miscarriage rate and preterm birth rate were similar between the two groups (all P > 0.05). However, subgroup analysis demonstrated significantly higher preterm birth rates in the control group compared with the atosiban group (0 versus 3.0%, P = 0.024) in the natural FET cycles. Atosiban may not improve pregnancy outcomes of RIF patients in FET cycles. However, the effects of Atosiban on pregnancy outcomes should be assessed in clinical trials with larger sample sizes.
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Affiliation(s)
- Xiufang Li
- Center for Reproductive Medicine, Shandong University, Jinan, 250021, China
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Yanbo Du
- Center for Reproductive Medicine, Shandong University, Jinan, 250021, China
| | - Xu Han
- Center for Reproductive Medicine, Shandong University, Jinan, 250021, China
| | - Huidan Wang
- Center for Reproductive Medicine, Shandong University, Jinan, 250021, China
| | - Yan Sheng
- Center for Reproductive Medicine, Shandong University, Jinan, 250021, China
| | - Fang Lian
- Reproductive and Genetic Center of Integtated Traditional and Western Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, China.
| | - Qingfeng Lian
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
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Liu L, Zhuo Y, Zhang H, Li J, Jiang X, Han X, Chao J, Feng B, Che L, Xu S, Lin Y, Li J, Fang Z, Sun M, Luo T, Wu D, Hua L. Time-restricted feeding ameliorates uterine epithelial estrogen receptor α transcriptional activity at the time of embryo implantation in mice fed a high-fat diet. J Nutr 2023:S0022-3166(23)37555-2. [PMID: 37062485 DOI: 10.1016/j.tjnut.2023.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND More than 30% of reproductive-age women are obese or overweight. Obesity and exposure to a high-fat diet (HFD) detrimentally affect endometrial development and embryo implantation. We previously reported that time-restricted feeding (TRF) improved ovarian follicular development, but whether and how TRF modulates embryo implantation are poorly understood. OBJECTIVE We investigated the effect of TRF on embryo implantation. METHODS In TRF group, mice had 10 hours of food free access from 9 pm to 7 am, and fed a normal diet or a HFD. Tail vein injection of Chicago blue dye was used to examine embryo implantation sites at day 5.5 (D5.5) of pregnancy. Serum collected at D0.5 and D4.5 of pregnancy was used to examine the level of estradiol (E2) and progesterone. Uterine estrogen receptor (ER) and progesterone receptor levels and their targeted aquaporins (AQPs) were measured. LC-MS was used to analyze bile acid (BA) composition, and primary hepatocytes were used to test the effects of BA on the expression level of SULT1E1, a key enzyme in estrogen inactivation and elimination. RESULTS We found that TRF prevented HFD-induced embryo loss and alleviated the defect in luminal closure on D4.5 of pregnancy. The cyclic changes of E2 level were lost in mice fed ad libitum but not in TRF mice on the HFD. The HFD increased ERα expression and transcriptional activity, which induced AQP3 and AQP5 expression on D4.5 of pregnancy. TRF prevented the negative effect of the HFD on uterine luminal closure. Furthermore, in vitro and in vivo results showed that BA suppressed estrogen degradation by activating liver SULT1E1 expression. CONCLUSIONS Our findings demonstrated that TRF prevented HFD-induced defects in luminal closure, thereby improving embryonic implantation, and provide novel insights into the effects of dietary intervention on obesity and associated infertility.
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Affiliation(s)
- Luting Liu
- Animal Nutrition Institute, Chengdu, PR China, 611130; Key Laboratory for Animal Disease-Resistant Nutrition of the Ministry of Education of China, Chengdu, PR China, 611130; Key Laboratory of Animal Disease-Resistant Nutrition of Sichuan Province, Sichuan Agricultural University, Chengdu, PR China, 611130
| | - Yong Zhuo
- Animal Nutrition Institute, Chengdu, PR China, 611130; Key Laboratory for Animal Disease-Resistant Nutrition of the Ministry of Education of China, Chengdu, PR China, 611130; Key Laboratory of Animal Disease-Resistant Nutrition of Sichuan Province, Sichuan Agricultural University, Chengdu, PR China, 611130
| | - Haoqi Zhang
- Animal Nutrition Institute, Chengdu, PR China, 611130; Key Laboratory for Animal Disease-Resistant Nutrition of the Ministry of Education of China, Chengdu, PR China, 611130; Key Laboratory of Animal Disease-Resistant Nutrition of Sichuan Province, Sichuan Agricultural University, Chengdu, PR China, 611130
| | - Jing Li
- Animal Nutrition Institute, Chengdu, PR China, 611130; Key Laboratory for Animal Disease-Resistant Nutrition of the Ministry of Education of China, Chengdu, PR China, 611130; Key Laboratory of Animal Disease-Resistant Nutrition of Sichuan Province, Sichuan Agricultural University, Chengdu, PR China, 611130
| | - Xuemei Jiang
- Animal Nutrition Institute, Chengdu, PR China, 611130; Key Laboratory for Animal Disease-Resistant Nutrition of the Ministry of Education of China, Chengdu, PR China, 611130; Key Laboratory of Animal Disease-Resistant Nutrition of Sichuan Province, Sichuan Agricultural University, Chengdu, PR China, 611130
| | - Xingfa Han
- School of Life Sciences, Sichuan Agricultural University, Chengdu, P. R. China
| | - Jin Chao
- Animal Nutrition Institute, Chengdu, PR China, 611130; Key Laboratory for Animal Disease-Resistant Nutrition of the Ministry of Education of China, Chengdu, PR China, 611130; Key Laboratory of Animal Disease-Resistant Nutrition of Sichuan Province, Sichuan Agricultural University, Chengdu, PR China, 611130
| | - Bin Feng
- Animal Nutrition Institute, Chengdu, PR China, 611130; Key Laboratory for Animal Disease-Resistant Nutrition of the Ministry of Education of China, Chengdu, PR China, 611130; Key Laboratory of Animal Disease-Resistant Nutrition of Sichuan Province, Sichuan Agricultural University, Chengdu, PR China, 611130
| | - Lianqiang Che
- Animal Nutrition Institute, Chengdu, PR China, 611130; Key Laboratory for Animal Disease-Resistant Nutrition of the Ministry of Education of China, Chengdu, PR China, 611130; Key Laboratory of Animal Disease-Resistant Nutrition of Sichuan Province, Sichuan Agricultural University, Chengdu, PR China, 611130
| | - Shengyu Xu
- Animal Nutrition Institute, Chengdu, PR China, 611130; Key Laboratory for Animal Disease-Resistant Nutrition of the Ministry of Education of China, Chengdu, PR China, 611130; Key Laboratory of Animal Disease-Resistant Nutrition of Sichuan Province, Sichuan Agricultural University, Chengdu, PR China, 611130
| | - Yan Lin
- Animal Nutrition Institute, Chengdu, PR China, 611130; Key Laboratory for Animal Disease-Resistant Nutrition of the Ministry of Education of China, Chengdu, PR China, 611130; Key Laboratory of Animal Disease-Resistant Nutrition of Sichuan Province, Sichuan Agricultural University, Chengdu, PR China, 611130
| | - Jian Li
- Animal Nutrition Institute, Chengdu, PR China, 611130; Key Laboratory for Animal Disease-Resistant Nutrition of the Ministry of Education of China, Chengdu, PR China, 611130; Key Laboratory of Animal Disease-Resistant Nutrition of Sichuan Province, Sichuan Agricultural University, Chengdu, PR China, 611130
| | - Zhengfeng Fang
- Animal Nutrition Institute, Chengdu, PR China, 611130; Key Laboratory for Animal Disease-Resistant Nutrition of the Ministry of Education of China, Chengdu, PR China, 611130; Key Laboratory of Animal Disease-Resistant Nutrition of Sichuan Province, Sichuan Agricultural University, Chengdu, PR China, 611130
| | - Mengmeng Sun
- College of Science, Sichuan Agricultural University, Xin Kang Road, Yucheng District, Ya'an 625014, P.R. China
| | - Ting Luo
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, Jiangxi 330047, China
| | - De Wu
- Animal Nutrition Institute, Chengdu, PR China, 611130; Key Laboratory for Animal Disease-Resistant Nutrition of the Ministry of Education of China, Chengdu, PR China, 611130; Key Laboratory of Animal Disease-Resistant Nutrition of Sichuan Province, Sichuan Agricultural University, Chengdu, PR China, 611130.
| | - Lun Hua
- Animal Nutrition Institute, Chengdu, PR China, 611130; Key Laboratory for Animal Disease-Resistant Nutrition of the Ministry of Education of China, Chengdu, PR China, 611130; Key Laboratory of Animal Disease-Resistant Nutrition of Sichuan Province, Sichuan Agricultural University, Chengdu, PR China, 611130.
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19
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Fu LL, Xu Y, Yan J, Zhang XY, Li DD, Zheng LW. Efficacy of granulocyte colony-stimulating factor for infertility undergoing IVF: a systematic review and meta-analysis. Reprod Biol Endocrinol 2023; 21:34. [PMID: 37013570 PMCID: PMC10069139 DOI: 10.1186/s12958-023-01063-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 01/19/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of granulocyte colony-stimulating factor (G-CSF) for infertility and recurrent spontaneous abortion. METHODS Existing research was searched in PubMed, Embase and Cochrane Library till Dec 2021. Randomized control trials (RCTs) that compared G-CSF administration with the control group in infertility women undergoing IVF were included. The primary outcomes included clinical pregnancy rate; the secondary outcomes included live birth rate, abortion ratebiochemical pregnancy rate, embryo implantation rate, as well as endometrial thickness. RESULT(S) 20 RCTs were included in this study. G-CSF increased the clinical pregnancy rate (RR = 1.85; 95% CI: 1.07, 3.18) and the endometrial thickness (MD = 2.25; 95% CI: 1.58,2.92;) in patients with thin endometrium undergoing IVF. G-CSF increased the biochemical pregnancy rate (RR = 2.12; 95% CI: 1.54, 2.93), the embryo implantation rate (RR = 2.51; 95% CI: 1.82, 3.47) and the clinical pregnancy rate (RR = 1.93; 95% CI: 1.63, 2.29) in patients with a history of repeated implantation failure undergoing IVF. No differences were found in pregnancy outcomes of general IVF patients. CONCLUSIONS Granulocyte colony-stimulating factor is likely to be a potential option for infertility women undergoing IVF with thin endometrium or recurrent implantation failure . TRIAL REGISTRATION Retrospectively registered (The PROSPERO registration number: CRD42022360161).
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Affiliation(s)
- Lu-Lu Fu
- Reproductive Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Ying Xu
- Reproductive Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Jing Yan
- Reproductive Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Xue-Ying Zhang
- Reproductive Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Dan-Dan Li
- Reproductive Medical Center, The Second Hospital of Jilin University, Changchun, China.
| | - Lian-Wen Zheng
- Reproductive Medical Center, The Second Hospital of Jilin University, Changchun, China.
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20
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Duan Y, Liu Y, Xu Y, Zhou C. Bioinformatics Analysis Identifies Key Genes in Recurrent Implantation Failure Based on Immune Infiltration. Reprod Sci 2023; 30:952-965. [PMID: 36045247 DOI: 10.1007/s43032-022-01060-4] [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: 01/25/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022]
Abstract
Recurrent implantation failure (RIF) is a thorny problem often encountered in the field of assisted reproduction. Existing evidences suggest that immune dysregulation may be involved in the pathogenesis of RIF. The purpose of this study is to explore immune-related genes contributing to RIF through data mining. The endometrial expression profiles of 24 RIF and 24 controls were obtained from the GEO database. The immune infiltration in bulk tissue was estimated by single sample gene set enrichment analysis (ssGSEA) method based on marker gene sets for immune cells generated from endometrial single-cell RNA sequencing data. The results showed that the infiltration levels of B cells and regulatory T cells (Tregs) were significantly reduced in the RIF group. Four hub genes (GJA1, PRKAG2, CPT1A, and ICA1) were identified by integrated analysis of weighted gene co-expression network analysis (WGCNA), random forest and LASSO regression. Moreover, these hub genes were significantly correlated with certain immune-related factors, especially CXCL12, CEACAM1, and XCR1. Single-gene GSEA indicated that the pathways associated with hub genes included the regulation of cell cycle, the process of epithelial-mesenchymal transition and transplant rejection, etc. A predictive model for RIF was constructed based on hub genes and performed well in the training dataset and the other two external datasets. Thus, this study identified immune-related key genes in RIF and provided new biomarkers for early diagnosis.
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Affiliation(s)
- Yuwei Duan
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, 510080, Guangdong, China
| | - Yongxiang Liu
- Department of Reproductive Medicine, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Yanwen Xu
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, 510080, Guangdong, China
| | - Canquan Zhou
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.
- Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, 510080, Guangdong, China.
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21
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Mrozikiewicz AE, Kurzawińska G, Ożarowski M, Walczak M, Ożegowska K, Jędrzejczak P. Polymorphic Variants of Genes Encoding Angiogenesis-Related Factors in Infertile Women with Recurrent Implantation Failure. Int J Mol Sci 2023; 24:ijms24054267. [PMID: 36901702 PMCID: PMC10001634 DOI: 10.3390/ijms24054267] [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: 01/17/2023] [Revised: 02/14/2023] [Accepted: 02/18/2023] [Indexed: 02/24/2023] Open
Abstract
Recurrent implantation failure (RIF) is a global health issue affecting a significant number of infertile women who undergo in vitro fertilization (IVF) cycles. Extensive vasculogenesis and angiogenesis occur in both maternal and fetal placental tissues, and vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF) family molecules and their receptors are potent angiogenic mediators in the placenta. Five single nucleotide polymorphisms (SNPs) in the genes encoding angiogenesis-related factors were selected and genotyped in 247 women who had undergone the ART procedure and 120 healthy controls. Genotyping was conducted by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). A variant of the kinase insertion domain receptor (KDR) gene (rs2071559) was associated with an increased risk of infertility after adjusting for age and BMI (OR = 0.64; 95% CI: 0.45-0.91, p = 0.013 in a log-additive model). Vascular endothelial growth factor A (VEGFA) rs699947 was associated with an increased risk of recurrent implantation failures under a dominant (OR = 2.34; 95% CI: 1.11-4.94, padj. = 0.022) and a log-additive model (OR = 0.65; 95% CI 0.43-0.99, padj. = 0.038). Variants of the KDR gene (rs1870377, rs2071559) in the whole group were in linkage equilibrium (D' = 0.25, r2 = 0.025). Gene-gene interaction analysis showed the strongest interactions between the KDR gene SNPs rs2071559-rs1870377 (p = 0.004) and KDR rs1870377-VEGFA rs699947 (p = 0.030). Our study revealed that the KDR gene rs2071559 variant may be associated with infertility and rs699947 VEGFA with an increased risk of recurrent implantation failures in infertile ART treated Polish women.
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Affiliation(s)
- Aleksandra E. Mrozikiewicz
- Department of Obstetrics and Women’s Diseases, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland
- Chair and Department of Cell Biology, Poznan University of Medical Sciences, Rokietnicka 5D, 60-806 Poznan, Poland
| | - Grażyna Kurzawińska
- Division of Perinatology and Womens Diseases, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland
| | - Marcin Ożarowski
- Department of Biotechnology, Institute of Natural Fibres and Medicinal Plants—National Research Institute, Wojska Polskiego 71B, 60-630 Poznan, Poland
- Correspondence:
| | - Michał Walczak
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszyńska 32, 60-479 Poznan, Poland
| | - Katarzyna Ożegowska
- Department of Infertility and Reproductive Endocrinology, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland
| | - Piotr Jędrzejczak
- Chair and Department of Cell Biology, Poznan University of Medical Sciences, Rokietnicka 5D, 60-806 Poznan, Poland
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22
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Nauber R, Goudu SR, Goeckenjan M, Bornhäuser M, Ribeiro C, Medina-Sánchez M. Medical microrobots in reproductive medicine from the bench to the clinic. Nat Commun 2023; 14:728. [PMID: 36759511 PMCID: PMC9911761 DOI: 10.1038/s41467-023-36215-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Medical microrobotics is an emerging field that aims at non-invasive diagnosis and therapy inside the human body through miniaturized sensors and actuators. Such microrobots can be tethered (e.g., smart microcatheters, microendoscopes) or untethered (e.g., cell-based drug delivery systems). Active motion and multiple functionalities, distinguishing microrobots from mere passive carriers and conventional nanomedicines, can be achieved through external control with physical fields such as magnetism or ultrasound. Here we give an overview of the key challenges in the field of assisted reproduction and how these new technologies could, in the future, enable assisted fertilization in vivo and enhance embryo implantation. As a case study, we describe a potential intervention in the case of recurrent embryo implantation failure, which involves the non-invasive delivery of an early embryo back to the fertilization site using magnetically-controlled microrobots. As the embryo will be in contact with the secretory oviduct fluid, it can develop under natural conditions and in synchrony with the endometrium preparation. We discuss the potential microrobot designs, including a proper selection of materials and processes, envisioning their translation from bench to animal studies and human medicine. Finally, we highlight regulatory and ethical considerations for bringing this technology to the clinic.
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Affiliation(s)
- Richard Nauber
- Micro- and NanoBiomedical Engineering Group (MNBE) Institute for Integrative Nanosciences, Leibniz Institute for Solid State and Materials Research (IFW), 01069, Dresden, Germany
| | - Sandhya R Goudu
- Micro- and NanoBiomedical Engineering Group (MNBE) Institute for Integrative Nanosciences, Leibniz Institute for Solid State and Materials Research (IFW), 01069, Dresden, Germany
| | - Maren Goeckenjan
- Medical Clinic I, University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Martin Bornhäuser
- Medical Clinic I, University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Carla Ribeiro
- Micro- and NanoBiomedical Engineering Group (MNBE) Institute for Integrative Nanosciences, Leibniz Institute for Solid State and Materials Research (IFW), 01069, Dresden, Germany
| | - Mariana Medina-Sánchez
- Micro- and NanoBiomedical Engineering Group (MNBE) Institute for Integrative Nanosciences, Leibniz Institute for Solid State and Materials Research (IFW), 01069, Dresden, Germany. .,Chair of Micro- and NanoSystems, Center for Molecular Bioengineering (B CUBE), Dresden University of Technology, 01062, Dresden, Germany.
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23
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Zou Y, Liu X, Chen P, Wang Y, Li W, Huang R. The endometrial microbiota profile influenced pregnancy outcomes in patients with repeated implantation failure: a retrospective study. J Reprod Immunol 2023; 155:103782. [PMID: 36502684 DOI: 10.1016/j.jri.2022.103782] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/03/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES To investigate the association between the pregnancy outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) patients with repeated implantation failure (RIF) and their endometrial microbiota profiles. METHODS One hundred and forty-one RIF patients were recruited in this retrospective study. Endometrial tissues were sampled using a disposable sterile endometrium sampler. Comprehensive next-generation sequencing techniques were used to detect the endometrial bacteria status, and the pregnancy outcomes were analyzed. RESULTS Endometrial pathogenic bacteria were detected in 125 patients (88.70%, the pathogenic group) while no relevant pathogen was found in the remaining 16 (11.30%, the no-pathogen group). All the 125 patients received the treatment of oral antibiotics for 14 days. Clinical pregnancy rates and ongoing pregnancy rates were higher in the pathogenic group than in the no-pathogen group without statistical significance (50.40% vs. 37.50%, P>0.05; 42.40% vs. 25%, P>0.05). CONCLUSION In the endometrium of most RIF patients existed pathogenic bacteria, among which Streptococcus, Staphylococcus, Neisseria, and Klebsiella were most frequently observed, and the sensitive antibiotic therapy might improve clinical outcomes of the RIF patients in subsequent embryo transfer cycles.
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Affiliation(s)
- Yixuan Zou
- Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Xiaoping Liu
- Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Peigen Chen
- Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Yanfang Wang
- Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Wei Li
- Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Rui Huang
- Reproductive Medicine Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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24
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Mukherjee N, Sharma R, Modi D. Immune alterations in recurrent implantation failure. Am J Reprod Immunol 2023; 89:e13563. [PMID: 35587052 DOI: 10.1111/aji.13563] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/01/2022] [Accepted: 04/26/2022] [Indexed: 02/01/2023] Open
Abstract
A failure to achieve pregnancy after three or more embryo transfer cycles with high-quality blastocysts is referred to as recurrent implantation failure (RIF). RIF can be due to altered uterine factors or male factors or embryo factors. Disrupted endometrial receptivity, altered expression of genes in several pathways, immunologic disturbances in the peripheral blood and/or the endometrium, and epigenetic alterations are associated with RIF. Amongst the immunologic disturbances, altered Th1/Th2 ratio, altered NK cell and macrophage numbers are observed in women with RIF. However, not all women with RIF have the same kind of immune dysfunction suggesting that RIF is a heterogeneous condition associated with varied immune responses and one size may not fit all. Thus, personalized therapies based on the immune status of the patient are being tested in women with RIF. In general, women with a high Th1/Th2 ratio are offered Tacrolimus, while intravenous IgG is recommended in women with high NK cell numbers/HLA mismatch. Women with hyperactivated immune status in the uterus are offered progesterone support, prednisolone, vitamin E, and intralipid treatment to suppress inflammation and oxidative stress, while endometrial scratching and intrauterine hCG administration are offered to women with hypo-active immune status. There is a need for standardized tests for evaluation of immune status in patients and sufficiently powered randomized controlled trials for personalized therapies to determine which of these will be beneficial in women with RIF. Till then, the ART community should limit the use of such add-on interventions in women with RIF.
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Affiliation(s)
- Nupur Mukherjee
- Molecular and Cellular Biology Laboratory, ICMR-National Institute for Research in Reproductive and Child Health, Indian Council of Medical Research (ICMR), Parel, Mumbai, Maharashtra, India
| | - Richa Sharma
- Molecular and Cellular Biology Laboratory, ICMR-National Institute for Research in Reproductive and Child Health, Indian Council of Medical Research (ICMR), Parel, Mumbai, Maharashtra, India
| | - Deepak Modi
- Molecular and Cellular Biology Laboratory, ICMR-National Institute for Research in Reproductive and Child Health, Indian Council of Medical Research (ICMR), Parel, Mumbai, Maharashtra, India
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25
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Lapides L, Klein M, Belušáková V, Csöbönyeiová M, Varga I, Babál P. Uterine Natural Killer Cells in the Context of Implantation: Immunohistochemical Analysis of Endometrial Samples from Women with Habitual Abortion and Recurrent Implantation Failure. Physiol Res 2022. [DOI: 10.33549/physiolres.935012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Infertility affects approximately 48 million couples globally. Despite the enormous progress of the methods of reproductive medicine that has been made since the first test-tube baby was born in 1978, the implantation rate of day-3 embryos is only around 15-20 % and 30 % of day-5 embryos. Numerous strategies aim to improve implantation rates and prevent repeated implantation failure. However, there is no specific general recommendation leading to satisfying results. One of the many risk factors relevant in this regard is the uterine immunological make-up, mainly the uterine Natural Killer (uNK) cells. They orchestrate the overall immune response during implantation by influencing trophoblast invasion and vascular remodeling and throughout pregnancy, uNK cells are also the main immune cells at the maternal–fetal interface. Previously, uNK count has been correlated with various fertility issues including idiopathic recurrent miscarriage. The present study used endometrial samples collected from 256 patients with recurrent implantation failure (RIF), habitual abortion (HA) and idiopathic sterility. Samples were collected between day 19 and 21 of the menstrual cycle mainly by Pipelle endometrial sampling. The samples were fixed in formalin for 24 hours and further processed for immunohistochemistry using anti-CD56 to visualize this antigen marker of uNK cells. Immunohistochemical counting was performed to assess the low, normal, or elevated count of uNK cells. According to the one-way ANOVA test, the age of our patients did not have any influence on the count of uNK cells. With Spearman correlation analysis, we found statistically significant correlation (p-value 0.05) of -0.133 between prior miscarriage and lower uNK cell count. Using the same analysis we found statistically significant correlation (correlation 0.233 with p value 0.01) between number of uNK cells and activation status. Patients with higher uNK cells were more frequenty diagnosed with endometriosis (p-value 0.05, correlation 0.130). Patients with an immunological factor of sterility (defined by a clinical immunologist) had a lower chance of gravidity (-0.203 with p-value 0.01). Based on our results, we can confirm that there is a correlation between RIF, HA, idiopathic sterility, endometriosis, and immunological factor of sterility (uNK cell count). The true predictive value with regard to fertility outcomes needs to be addressed in future research.
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Affiliation(s)
- L Lapides
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Slovakia.
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Granulocyte colony stimulating factor versus human chorionic gonadotropin for recurrent implantation failure in intra cytoplasmic sperm injection: a randomized clinical trial. BMC Pregnancy Childbirth 2022; 22:881. [PMID: 36447142 PMCID: PMC9706918 DOI: 10.1186/s12884-022-05098-9] [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: 05/01/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Repeated implantation failure (RIF) is defined as the case whereby the transferred embryos fail to implant after several attempts of In vitro fertilization (IVF) which causes a profound impact on the quality of life and financial burden. Some clinical studies have confirmed that Granulocyte colony-stimulating factor (G-CSF) and human chorionic gonadotropin (HCG) can improve pregnancy outcomes and implantation rates. Hence, our study aims to compare the efficacy of G-CSF and HCG on pregnancy outcomes in RIF women who undergo intra-cytoplasmic sperm injection (ICSI). METHODS This randomized, single-blinded study was conducted et al.-Azhar University Hospitals, Cairo, Egypt, between 10th October 2020 and 20th December 2020. The study included 100 women aged 20-43 years old undergoing ICSI cycles, with a history of RIF. Patients were divided randomly into two groups: group (1): included 50 patients injected with 500 IU of intrauterine HCG on embryo transfer day, and group (2): Included 50 patients injected with G-CSF on the embryo transfer day. RESULTS In 100 RIF women, we found a significant improvement in pregnancy outcomes favoring G-CSF over HCG including implantation rate, chemical pregnancy, and clinical pregnancy (P < 0.0001, P = 0.0003, and P = 0.0006, respectively). CONCLUSION For the first time, we demonstrated a significant improvement in pregnancy outcomes favoring G-CSF over HCG in terms of implantation rate, chemical pregnancy, and clinical pregnancy. TRIAL REGISTRATION The study was registered on Pan African Clinical Trials Registry with the following number: PACTR202010482774275 and was approved on 2nd October 2020.
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LAPIDES L, KLEIN M, BELUŠÁKOVÁ V, CSÖBÖNYEIOVÁ M, VARGA I, BABÁL P. Uterine Natural Killer Cells in the Context of Implantation: Immunohistochemical Analysis of Endometrial Samples from Women with Habitual Abortion and Recurrent Implantation Failure. Physiol Res 2022; 71:S99-S105. [PMID: 36592445 PMCID: PMC9853996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Infertility affects approximately 48 million couples globally. Despite the enormous progress of the methods of reproductive medicine that has been made since the first test-tube baby was born in 1978, the implantation rate of day-3 embryos is only around 15-20 % and 30 % of day-5 embryos. Numerous strategies aim to improve implantation rates and prevent repeated implantation failure, however there is no specific general recommendation leading to satisfying results. One of the many risk factors relevant in this regard is the uterine immunological make-up, mainly the uterine Natural Killer (uNK) cells. They orchestrate the overall immune response during implantation by influencing trophoblast invasion and vascular remodeling and throughout pregnancy, uNK cells are also the main immune cells at the maternal-foetal interface. Previously, uNK count has been correlated with various fertility issues including idiopathic reccurent miscarriage. The present study used endometrial samples collected from 256 patients with recurrent implantation failure (RIF), habitual abortion (HA) and idiopathic sterility. Samples were collected between day 19 and 21 of the menstrual cycle mainly by Pipelle endometrial sampling. The samples were fixed in formalin for 24 hours and further processed for immunohistochemistry using anti-CD56 to visualize this antigen marker of uNK cells. Immunohistochemical counting was performed to assess the low, normal, or elevated count of uNK cells. According to the one-way ANOVA test, the age of our patients did not have any influence on the count of uNK cells. With Spearman correlation analysis, we found statistically significant correlation (p-value 0.05) of -0.133 between prior miscarriage and lower uNK cell count. Using the same analysis we found statistically significant correlation (correlation 0.233 with p-value 0.01) between number of uNK cells and activation status. Patients with higher uNK cells were more frequenty diagnosed with endometriosis (p-value 0.05, correlation 0.130). Patients with an immunological factor of sterility (defined by a clinical immunologist) had a lower chance of gravidity (-0.203 with p-value 0.01). Based on our results, we can confirm that there is a correlation between RIF, HA, idiopathic sterility, endometriosis, and immunological factor of sterility (uNK cell count). The true predictive value with regard to fertility outcomes needs to be addressed in future research.
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Affiliation(s)
- Lenka LAPIDES
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University, Bratislava, Slovakia,ISCARE, Reproduction Clinic, Gynaecology & Urology, Bratislava, Slovakia
| | - Martin KLEIN
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Viera BELUŠÁKOVÁ
- ISCARE, Reproduction Clinic, Gynaecology & Urology, Bratislava, Slovakia
| | - Mária CSÖBÖNYEIOVÁ
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Ivan VARGA
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Pavel BABÁL
- Institute of Pathology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
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Bulletti C, Bulletti FM, Sciorio R, Guido M. Progesterone: The Key Factor of the Beginning of Life. Int J Mol Sci 2022; 23:ijms232214138. [PMID: 36430614 PMCID: PMC9692968 DOI: 10.3390/ijms232214138] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 11/17/2022] Open
Abstract
Progesterone is the ovarian steroid produced by the granulosa cells of follicles after the LH peak at mid-cycle. Its role is to sustain embryo endometrial implantation and ongoing pregnancy. Other biological effects of progesterone may exert a protective function in supporting pregnancy up to birth. Luteal phase support (LPS) with progesterone is the standard of care for assisted reproductive technology. Progesterone vaginal administration is currently the most widely used treatment for LPS. Physicians and patients have been reluctant to change an administration route that has proven to be effective. However, some questions remain open, namely the need for LPS in fresh and frozen embryo transfer, the route of administration, the optimal duration of LPS, dosage, and the benefit of combination therapies. The aim of this review is to provide an overview of the uterine and extra-uterine effects of progesterone that may play a role in embryo implantation and pregnancy, and to discuss the advantages of the use of progesterone for LPS in the context of Good Medical Practice.
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Affiliation(s)
- Carlo Bulletti
- Extra Omnes, Assisted Reproductive Technology, ART Center, Via Gallinelli, 8, 47841 Cattolica, Italy
- Department of Obstetrics, Gynecology, and Reproductive Science, Yale University, New Haven, CT 06510, USA
- Correspondence:
| | | | - Romualdo Sciorio
- Edinburgh Assisted Conception Programme, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Maurizio Guido
- Obstetrics and Gynecology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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Liu M, Yuan Y, Qiao Y, Tang Y, Sui X, Yin P, Yang D. The effectiveness of immunomodulatory therapies for patients with repeated implantation failure: a systematic review and network meta-analysis. Sci Rep 2022; 12:18434. [PMID: 36319652 PMCID: PMC9626579 DOI: 10.1038/s41598-022-21014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 09/21/2022] [Indexed: 11/23/2022] Open
Abstract
This meta-analysis analyzed the clinical pregnancy outcomes of repeated implantation failure (RIF) patients treated with immunomodulatory therapies. Publications (published by August 16, 2021) were identified by searching the PubMed, Embase, and Web of Science databases. The quality of the studies was evaluated with the Cochrane bias risk assessment tool, and a network meta-analysis was performed with Stata 14.0. The outcomes were clinical pregnancy rate (CPR), live birth rate (LBR), and implantation rate (IR). The results of our network meta-analysis of 16 RCTs (including 2,008 participants) show that PBMCs, PRP, and SC-GCSF can significantly improve the CPR compared with LMWH (PBMCs: OR 2.15; 95% CI 1.21-3.83; PRP: OR 2.38; 95% CI 1.08-5.24; SC-GCSF: OR 2.46; 95% CI 1.05-5.72). The LBR of PRP was significantly higher than those of IU-GCSF (OR 3.81; 95% CI 1.22-11.86), LMWH (OR 4.38; 95% CI 1.50-12.90), and intralipid (OR 3.85; 95% CI 1.03-14.29), and the LBR of PBMCs was also significantly better than that of LMWH (OR 2.35; 95% CI 1.14-4.85). Furthermore, PRP treatment significantly improved the IR compared with LMWH treatment (OR 2.81; 95% CI 1.07-7.4). The limited evidence from existing RCTs suggests that PBMCs and PRP are the best therapeutic options for RIF patients. However, owing to the quantity limitation, more top-quality research is required to obtain additional high-level evidence.
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Affiliation(s)
- Mengqi Liu
- Kapok Zhucheng Medical Clinic, No. 302, No. 9, Huaqiang Road, Tianhe District, Guangzhou, 510623 China
| | - Yuan Yuan
- Kapok Zhucheng Medical Clinic, No. 302, No. 9, Huaqiang Road, Tianhe District, Guangzhou, 510623 China
| | - Yan Qiao
- Kapok Zhucheng Medical Clinic, No. 302, No. 9, Huaqiang Road, Tianhe District, Guangzhou, 510623 China
| | - Yuzhu Tang
- Shanghai Kapok Integrated Traditional Chinese and Western Medicine Clinic Co., Ltd., 3rd Floor, No. 21 Pudong South Road, Pudong New Area, Shanghai, 200126 China
| | - Xi Sui
- Shenzhen Kapok Health Medical Co., Ltd. Kapok Clinic, L2-12, Shenye Tairan Building, Tairan 8th Road, Shatou Street, Futian District, Shenzhen, 518042 China
| | - Ping Yin
- Guangzhou Kapok Medical Investment Co., Ltd., Room 116 and 117, No. 173, South 2nd Road, Yuncheng, Baiyun District, Guangzhou, 510405 China
| | - Dongzi Yang
- grid.12981.330000 0001 2360 039XDepartment of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou City, 528406 Guangdong Province China
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Benkhalifa M, Joao F, Duval C, Montjean D, Bouricha M, Cabry R, Bélanger MC, Bahri H, Miron P, Benkhalifa M. Endometrium Immunomodulation to Prevent Recurrent Implantation Failure in Assisted Reproductive Technology. Int J Mol Sci 2022; 23:ijms232112787. [PMID: 36361577 PMCID: PMC9654171 DOI: 10.3390/ijms232112787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 12/02/2022] Open
Abstract
After more than four decades of assisted reproductive technology (ART) practice worldwide, today more than 60% of women undergoing in vitro fertilization (IVF) treatments fail to become pregnant after the first embryo transfer and nearly 20% of patients are suffering from unexplained recurrent implantation failures (RIFs) and repeated pregnancy loss (RPL). The literature reported different causes of RIF–RPL, mainly multifactorial, endometrial and idiopathic. RIF remains a black box because of the complicated categorization and causes of this physio-pathological dysregulation of implantation and pregnancy process after ovarian stimulation. Many options were suggested as solutions to treat RIF–RPL with controversial results on their usefulness. In this article, we reviewed different possible therapeutic options to improve implantation rates and clinical outcomes. Based on our experience we believe that endometrium immunomodulation after intrauterine insemination of activated autologous peripheral blood mononuclear cells (PBMCs) or platelet-rich plasma (PRP) can be a promising therapeutic solution. On the other hand, peripheral lymphocyte balance typing, specific cytokines and interleukins profiling can be proposed as predictive biomarkers of implantation before embryo transfer.
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Affiliation(s)
- Mustapha Benkhalifa
- HB Laboratory, Tunis TN 1007, Tunisia
- Faculty of Sciences of Bizerte, University of Carthage, Bizerte TN 7021, Tunisia
| | - Fabien Joao
- Fertilys Reproductive Center, Laval, QC H7S 1Z5, Canada
| | - Cynthia Duval
- Fertilys Reproductive Center, Laval, QC H7S 1Z5, Canada
| | | | - Molka Bouricha
- Department of Reproductive Medicine, Reproductive Biology & Genetics, University Hospital and School of Medicine Picardie University Jules Verne, 80054 Amiens, France
| | - Rosalie Cabry
- Department of Reproductive Medicine, Reproductive Biology & Genetics, University Hospital and School of Medicine Picardie University Jules Verne, 80054 Amiens, France
| | | | | | - Pierre Miron
- Fertilys Reproductive Center, Laval, QC H7S 1Z5, Canada
| | - Moncef Benkhalifa
- Department of Reproductive Medicine, Reproductive Biology & Genetics, University Hospital and School of Medicine Picardie University Jules Verne, 80054 Amiens, France
- PeriTox Laboratory, CURS, Amiens Sud, 80480 Salouël, France
- Correspondence: ; Tel.: +33-677-867-390
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Yuan B, Luo S, Mao J, Luo B, Wang J. Effects of intrauterine infusion of platelet-rich plasma on hormone levels and endometrial receptivity in patients with repeated embryo implantation failure. Am J Transl Res 2022; 14:5651-5659. [PMID: 36105023 PMCID: PMC9452326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To analyze the effect of intrauterine infusion on platelet-rich plasma on hormone levels and endometrial receptivity of patients with repeated embryo implantation failure (RIF). METHODS A total of 64 patients with repeated implantation failure and re-fertilization-embryo transfer who were admitted to our hospital from January 2019 to December 2021 were analyzed retrospectively. Among them were 30 patients who did not receive the platelet-rich plasma perfusion therapy. This became the control group (CG). The 34 patients who received the therapy were regarded as the research group (RG). The changes of hormone levels before and after the treatment and endometrial receptivity after the treatment were evaluated. The outcomes of IVF assisted pregnancy, including rates of embryo implantation, clinical pregnancy, and early miscarriage, were compared after the treatment. Risk factors for clinical pregnancy were analyzed by logistic regression. RESULTS After treatment, the estradiol (E2) level increased and the follicle stimulating hormone (FSH) level decreased (P<0.05), but there was no marked difference in luteinizing hormone (LH) before or after the treatment (P>0.05). The E2 level in the RG was higher than that in the CG, and FSH in the RG was lower (P<0.05). In comparison to CG, the endometrial thickness on the day of human chorionic gonadotropin (hCG) injection and embryo transfer in the RG increased dramatically (P<0.05). The uterine artery pulsation index (PI) and uterine artery resistance index (RI) decreased (P<0.05). The embryo implantation and clinical pregnancy rates in the RG increased markedly (P<0.01), and the early abortion rate decreased significantly (P<0.05). The logistic regression analysis identified that age, number of transplant failures, treatment regimens, and FSH were risk factors for clinical pregnancy outcomes in patients. CONCLUSION Intrauterine infusion of platelet-rich plasma can improve the hormone levels in RIF patients, increase endometrial thickness, and enhance endometrial blood flow, increasing the pregnancy rate of patients and improving clinical pregnancy.
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Affiliation(s)
- Ben Yuan
- Department of Reproductive Medicine, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group No. 141 Tianjin Road, Huangshigang District, Huangshi 435000, Hubei, China
| | - Shuhong Luo
- Department of Reproductive Medicine, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group No. 141 Tianjin Road, Huangshigang District, Huangshi 435000, Hubei, China
| | - Junbiao Mao
- Department of Reproductive Medicine, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group No. 141 Tianjin Road, Huangshigang District, Huangshi 435000, Hubei, China
| | - Bingbing Luo
- Department of Reproductive Medicine, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group No. 141 Tianjin Road, Huangshigang District, Huangshi 435000, Hubei, China
| | - Junling Wang
- Department of Reproductive Medicine, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group No. 141 Tianjin Road, Huangshigang District, Huangshi 435000, Hubei, China
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Ji M, Zhang L, Fu X, Xie W, Wu X, Shu J. The outcomes of sequential embryo transfer in patients undergoing in vitro fertilization with frozen-thawed embryos: A retrospective study. J Obstet Gynaecol Res 2022; 48:2563-2570. [PMID: 35868635 DOI: 10.1111/jog.15369] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/12/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
AIM To explore whether sequential embryo transfer benefits patients with repeated implantation failure (RIF) undergoing frozen-thawed embryo transfer (FET) cycles. METHODS We included 311 patients with a history of RIF in this retrospective study. We did sequential transfers with a cleavage embryo on day 3 and a blastocyst on day 5 in 77 patients; blastocyst transfers with two blastocysts on day 5 in 80 patients; and cleavage embryo transfers with two cleavage embryos on day 3 in 154 patients. We compared clinical outcomes between the three groups. RESULTS The clinical pregnancy rate was comparable between the blastocyst transfer group (48.8%), the sequential transfer group(48.1%) and the cleavage embryo transfer group (48.1%). There was no statistically significant difference found (p > 0.05). The ongoing pregnancy and multipregnancy rates were also comparable between the three groups (p > 0.05). The early miscarriage rate was significantly higher in the sequential transfer group (32.4%) compared with the blastocyst group (12.8%) and the cleavage embryo group (12.2%) (p < 0.05). However, after adjusting for confounders, there was no significant difference in early miscarriage rates in the sequential transfer group compared with the blastocyst group (odds ratio [OR], 2.97; 95% confidence interval [CI], 0.85-9.24; p = 0.07) and the cleavage embryo group (OR, 3.03; 95% CI, 0.94-8.06; p = 0.08). CONCLUSIONS Sequential embryo transfer failed to improve clinical outcomes for patients with RIF.
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Affiliation(s)
- Mengxia Ji
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Ling Zhang
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Xiaohua Fu
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Wenjie Xie
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Xiangli Wu
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Jing Shu
- Center for Reproductive Medicine, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
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Naghshineh E, Dehghani Mohammadabadi R, Mehrabian F, Ghasemi Tehrani H, Tarrahi MJ. Intrauterine Instillation of Human Chorionic Gonadotropin with Intrauterine Insemination Catheter Around the Golden Time of Embryo Transfer Does Not Improve In Vitro Fertilization /Intracytoplasmic Sperm Injection Outcomes in Infertile Women: A Randomized Controlled Trial. Rep Biochem Mol Biol 2022; 11:358-366. [PMID: 36164621 PMCID: PMC9455184 DOI: 10.52547/rbmb.11.2.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND We set out to explore the effect of intrauterine human chorionic gonadotropin (hCG) instillation by intrauterine insemination (IUI) catheter before embryo transfer (ET) on assisted reproductive technologies (ART) outcomes of infertile women. METHODS One hundred women with infertility who were scheduled for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles were included in the study. They were randomly devoted to two groups: experimental (n= 50) and control (n= 50). In the experimental group, 500 IU hCG passed into the internal cervical orifice via IUI catheter within 15 minutes before the transfer of fresh or vitrified cleavage-stage embryos. The control group underwent the same ET procedure without prior injection of hCG. RESULTS None of the outcomes showed a statistically significant difference between the two groups. In the intervention and control groups, respectively, biochemical pregnancies rates were 26% and 18%, implantation rates were 13.5% and 8.6%, clinical pregnancies rates were 22% and 14%, ongoing pregnancies rates were 18% and 14%, and live birth rates were 14% and 12%. CONCLUSION Intrauterine injection of hCG via IUI catheter is not recommended in a clinical routine setting at this stage. Future efforts are warranted to further refine the applicability of this modality.
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Affiliation(s)
- Elham Naghshineh
- Department of Obstetrics & Gynecology, School of Medicine, Shahid Beheshti Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Reihaneh Dehghani Mohammadabadi
- Department of Obstetrics & Gynecology, School of Medicine, Shahid Beheshti Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Ferdous Mehrabian
- Department of Obstetrics & Gynecology, School of Medicine, Shahid Beheshti Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Hatav Ghasemi Tehrani
- Department of Obstetrics & Gynecology, School of Medicine, Shahid Beheshti Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mohammad Javad Tarrahi
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
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Microbiome as a predictor of implantation. Curr Opin Obstet Gynecol 2022; 34:122-132. [PMID: 35645010 DOI: 10.1097/gco.0000000000000782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Review the latest research on the female urogenital microbiome as a predictor of successful implantation. RECENT FINDINGS Lactobacillus crispatus seems to be beneficial species in a healthy female genital tract, although the presence of anaerobic bacteria and their impact has yet to be determined. The vaginal microbiome is associated with assisted reproductive technology (ART) outcome in terms of successful implantation and pregnancy. Approaches restoring a dysbiotic vaginal microbiome seem promising. It is questionable if a unique endometrial microbiome exists, given the low bacterial biomass, the invasiveness of endometrial sampling, and its associated high contamination risk. Future studies should focus on the whole microbiome using proteomics and metabolomics, as well as the virome to get a more holistic understanding of its role in reproduction. SUMMARY The vaginal and endometrial compartments are being studied to determine a healthy and unhealthy microbiome composition. Defining a healthy composition could provide insight into physiological processes related to the success of embryo implantation. The vaginal microbiome is easily accessible and its composition can be reliably assessed and can be associated with ART outcome. The existence of an endometrial or uterine microbiome is still debated, due to the combination of low biomass and unavoidable high risk of contamination during sampling.
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The Role of Endometrial Stem/Progenitor Cells in Recurrent Reproductive Failure. J Pers Med 2022; 12:jpm12050775. [PMID: 35629197 PMCID: PMC9143189 DOI: 10.3390/jpm12050775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 02/06/2023] Open
Abstract
Recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL), collectively referred to as recurrent reproductive failure (RRF), are both challenging conditions with many unanswered questions relating to causes and management options. Both conditions are proposed to be related to an aberrant endometrial microenvironment, with different proposed aetiologies related to a restrictive or permissive endometrium for an invading embryo. The impressive regenerative capacity of the human endometrium has been well-established and has led to the isolation and characterisation of several subtypes of endometrial stem/progenitor cells (eSPCs). eSPCs are known to be involved in the pathogenesis of endometrium-related disorders (such as endometriosis) and have been proposed to be implicated in the pathogenesis of RRF. This review appraises the current knowledge of eSPCs, and their involvement in RRF, highlighting the considerable unknown aspects in this field, and providing avenues for future research to facilitate much-needed advances in the diagnosis and management of millions of women suffering with RRF.
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Wang C, Guan D, Li Z, Yang Y, Yang K. Emerging trends and frontier research on recurrent implantation failure: a bibliometric analysis. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:307. [PMID: 35433979 PMCID: PMC9011299 DOI: 10.21037/atm-22-703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/18/2022] [Indexed: 12/29/2022]
Abstract
Background Recurrent implantation failure (RIF) has been recognized to be a major obstacle to the successful application of artificial reproduction technologies. In this study, the trends in RIF research were examined through a bibliometric analysis evaluating relevant literature quantitatively and qualitatively. Methods A total of 1,764 publications from 2000 to 2020 were downloaded from the Web of Science Core Collection (WoSCC). Relevant articles were searched using the term "recurrent implantation failure" and other synonyms of this term. Using Excel 2013, CiteSpace V, and VOSviewer 1.6.10 software, data extracted from the literature, including countries/regions, institutions, journals, keywords, and trends, were analyzed. Next, a clustered network was constructed based on 46,718 references cited by the 1,764 publications to determine the top 10 cocited articles. Results The annual number of publications on RIF progressively increased over time. The highest number of publications were from the United States. Analysis of the cocited reference cluster showed that "endometrial injury", "platelet-rich plasma", "chronic endometritis" and "extracellular vesicles" were the hotspots in RIF research. Burst detection analysis of the top keywords showed that "hysteroscopy" and "improvement" are emerging research foci. Conclusions This study clarifies the current research status and evolution of research in the field of RIF. New therapeutic interventions designed to improve pregnancy outcomes are the focus of current research and are expected to dominate future research in the field of RIF.
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Affiliation(s)
- Caiyun Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
- Department of Obstetrics and Gynecology, The First Hospital of Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Defeng Guan
- Reproductive Medicine Center of The First Hospital of Lanzhou University, Lanzhou, China
| | - Zhihong Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yongxiu Yang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
- Department of Obstetrics and Gynecology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Kehu Yang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
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Sallam HN, Gelbaya TA, Rosas IM, Anagnostopoulou C, Sallam N, Agarwal A. Clinical aspects of oocyte retrieval and embryo transfer. Tips and tricks for the novice and experts. Panminerva Med 2022; 64:185-199. [PMID: 35179015 DOI: 10.23736/s0031-0808.22.04679-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oocyte retrieval (ovum pick-up) and embryo transfer (ET) are essential steps in IVF and ICSI and over the years, the two procedures were developed in order to improve the clinical outcome. Many suggestions were proposed and applied before, during and after oocyte retrieval such as timing of HCG trigger, pre-operative pelvic scan, vaginal cleansing, type of anesthesia, type and gauge of aspiration needles, aspiration pressure, follicle flushing, and the need for prophylactic antibiotics. Similarly, many steps were suggested and implemented before, during and after ET including patient's position, type of anesthesia/analgesia, dummy (mock) ET, ultrasound-guidance, HCG injection in the uterine cavity, use of relaxing agents, full bladder, removal of the cervical mucus, flushing the cervix with culture medium, type of ET catheter, embryo loading techniques, site of embryo deposition, the use of adherence compounds, as well as bed rest after ET. Complications were also reported with oocyte retrieval and ET. The aim of this review is to evaluate the current practice of these two procedures in the light of available evidence.
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Affiliation(s)
- Hassan N Sallam
- Department of Obsterics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt -
| | - Tarek A Gelbaya
- Department of Obstetrics and Gynaecology, University Hospitals of Leicester, Leicester, UK
| | - Israel M Rosas
- Citmer Reproductive Medicine, IVF LAB, Mexico City, Mexico
| | | | - Nooman Sallam
- Department of Obstetrics and Gynaecology, Guy's and St Thomas' NHS Trust, London, UK
| | - Ashok Agarwal
- Andrology Center and American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
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38
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Sadeghi MR. Health Problems and Financial Burdens in Mislabeling IVF Failures as RIF. J Reprod Infertil 2022; 23:229-230. [PMID: 36452186 PMCID: PMC9674457 DOI: 10.18502/jri.v23i4.10807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The Article Abstract is not Available.
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39
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Somigliana E, Busnelli A, Kalafat E, Viganò P, Ata B. Recurrent Implantation Failure: A plea for a widely adopted rational definition. Reprod Biomed Online 2022; 45:183-185. [DOI: 10.1016/j.rbmo.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
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40
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Ohara Y, Matsubayashi H, Suzuki Y, Takaya Y, Yamaguchi K, Doshida M, Takeuchi T, Ishikawa T, Handa M, Miyake T, Takiuchi T, Kimura T. Clinical relevance of a newly developed endometrial receptivity test for patients with recurrent implantation failure in Japan. Reprod Med Biol 2022; 21:e12444. [PMID: 35386362 PMCID: PMC8967283 DOI: 10.1002/rmb2.12444] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/07/2022] [Accepted: 01/19/2022] [Indexed: 01/10/2023] Open
Abstract
Purpose To assess the clinical efficacy of personalized embryo transfer (pET) guided by a new endometrial receptivity test, ERPeakSM, in patients with recurrent implantation failure (RIF). Methods Recurrent implantation failure patients of all ages at two private Japanese clinics from April 2019 to June 2020 were retrospectively analyzed. The intervention group (n = 244) received pET in accordance with endometrial receptivity testing results and was compared to control group (n = 306) receiving standardized timing, non-personalized embryo transfer (npET). In propensity score matching analysis, the clinical pregnancy rate (CPR) and live birth rate (LBR) were compared between groups, and a subanalysis of advanced maternal age (AMA) (≥38 years old) versus non-AMA (<38 years old) patients was also conducted. Results The CPR and LBR of the pET group were significantly higher than those of the npET group (37.7% vs. 20.0%, adjusted OR: 2.64; 95%CI, 1.70-4.11, p < 0.001 and 29.9% vs. 9.7%, adjusted OR: 4.13; 95%CI, 2.40-7.13, p < 0.001, respectively). Furthermore, in the subanalyses, the CPR and LBR of the pET group were significantly higher than those of the npET group in both the AMA non-AMA patients. Conclusions The new ERPeakSM endometrial receptivity test is a useful alternative diagnostic tool for poor-prognosis patients, regardless of age.
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Affiliation(s)
- Yasuhiro Ohara
- Department of Reproductive MedicineReproduction Clinic TokyoTokyoJapan
- Department of Obstetrics and GynecologyGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Hidehiko Matsubayashi
- Department of Reproductive MedicineReproduction Clinic TokyoTokyoJapan
- Department of Reproductive MedicineReproduction Clinic OsakaOsakaJapan
| | - Yosuke Suzuki
- Department of Reproductive MedicineReproduction Clinic OsakaOsakaJapan
| | - Yukiko Takaya
- Department of Reproductive MedicineReproduction Clinic OsakaOsakaJapan
| | - Kohei Yamaguchi
- Department of Reproductive MedicineReproduction Clinic TokyoTokyoJapan
- Department of Reproductive MedicineReproduction Clinic OsakaOsakaJapan
| | - Masakazu Doshida
- Department of Reproductive MedicineReproduction Clinic TokyoTokyoJapan
| | - Takumi Takeuchi
- Department of Reproductive MedicineReproduction Clinic TokyoTokyoJapan
| | - Tomomoto Ishikawa
- Department of Reproductive MedicineReproduction Clinic TokyoTokyoJapan
- Department of Reproductive MedicineReproduction Clinic OsakaOsakaJapan
| | - Mika Handa
- Department of Obstetrics and GynecologyGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Tatsuya Miyake
- Department of Obstetrics and GynecologyGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Tsuyoshi Takiuchi
- Department of Clinical GenomicsGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Tadashi Kimura
- Department of Obstetrics and GynecologyGraduate School of MedicineOsaka UniversitySuitaJapan
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41
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Autophagy as a Therapeutic Target of Natural Products Enhancing Embryo Implantation. Pharmaceuticals (Basel) 2021; 15:ph15010053. [PMID: 35056110 PMCID: PMC8779555 DOI: 10.3390/ph15010053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 12/13/2022] Open
Abstract
Infertility is an emerging health issue worldwide, and female infertility is intimately associated with embryo implantation failure. Embryo implantation is an essential process during the initiation of prenatal development. Recent studies have strongly suggested that autophagy in the endometrium is the most important factor for successful embryo implantation. In addition, several studies have reported the effects of various natural products on infertility improvement via the regulation of embryo implantation, embryo quality, and endometrial receptivity. However, it is unclear whether natural products can improve embryo implantation ability by regulating endometrial autophagy. Therefore, we performed a literature review of studies on endometrial autophagy, embryo implantation, natural products, and female infertility. Based on the information from these studies, this review suggests a new treatment strategy for female infertility by proposing natural products that have been proven to be safe and effective as endometrial autophagy regulators; additionally, we provide a comprehensive understanding of the relationship between the regulation of endometrial autophagy by natural products and female infertility, with an emphasis on embryo implantation.
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Kieu V, Lantsberg D, Mizrachi Y, Stern C, Polyakov A, Teh WT. A survey study of endometrial receptivity tests and immunological treatments in in vitro fertilisation (IVF). Aust N Z J Obstet Gynaecol 2021; 62:306-311. [PMID: 34862795 DOI: 10.1111/ajo.13466] [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: 06/19/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Suboptimal endometrial receptivity is a key factor behind in vitro fertilisation (IVF) implantation failure. Direct clinical tests of the endometrium of natural killer (NK) cells and endometrial receptivity analysis (ERA) are controversial. AIMS To examine the current practice of endometrial receptivity tests (NK cells and ERA) and immunological treatments (corticosteroids, anticoagulants, antiplatelets, intravenous immunoglobulin, Intralipid, other) among fertility specialists in Australia and New Zealand. METHODS A prospective 23-item web-based survey was distributed by email via the Fertility Society of Australia and New Zealand, between August and October 2020. Data were collected and analysed using Qualtrics. RESULTS Of 238 fertility specialists, 90 completed the survey (response rate 37.8%). ERA (48/90, 53.3%) was most commonly ordered, followed by uterine NK (uNK) (36/90, 40.0%) and peripheral blood NK (pNK) (12/90, 13.3%). For all tests, the most common indication was recurrent implantation failure (RIF) (41/48, 22/36, 6/12; 85.4%, 61.1%, and 50.0%, respectively for ERA, uNK and pNK). Of those that did not offer these tests, the main reason cited was insufficient evidence (30/42, 47/54, 68/78; 71.4%, 87.0%, and 87.0%). A third of specialists offered empirical immunological treatment for RIF (30/90, 33.3%): anticoagulants (28/30, 93.3%), antiplatelets (27/30, 90.0%), and corticosteroids (25/30; 83.3%). The majority of specialists (56/90, 62.2%) stated they had refused a patient request for endometrial testing or treatment. CONCLUSIONS Tests for presumed endometrial receptivity pathology are often used in Australia and New Zealand. Immunological treatments for RIF are commonly employed empirically, without strong evidence of their effectiveness or safety. Further studies should focus on education and clinical adherence to evidence-based guidelines.
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Affiliation(s)
- Violet Kieu
- Reproductive Services Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics & Gynaecology, School of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,Melbourne IVF, East Melbourne, Victoria, Australia
| | - Daniel Lantsberg
- Reproductive Services Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics & Gynaecology, School of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,Melbourne IVF, East Melbourne, Victoria, Australia
| | - Yossi Mizrachi
- Reproductive Services Unit, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Catharyn Stern
- Reproductive Services Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics & Gynaecology, School of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,Melbourne IVF, East Melbourne, Victoria, Australia
| | - Alex Polyakov
- Reproductive Services Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics & Gynaecology, School of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,Melbourne IVF, East Melbourne, Victoria, Australia
| | - Wan Tinn Teh
- Reproductive Services Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics & Gynaecology, School of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,Melbourne IVF, East Melbourne, Victoria, Australia
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43
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Turocy J, Williams Z. Novel therapeutic options for treatment of recurrent implantation failure. Fertil Steril 2021; 116:1449-1454. [PMID: 34836580 DOI: 10.1016/j.fertnstert.2021.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 12/12/2022]
Abstract
Despite the challenges in studying recurrent implantation failure, progress is currently being made in therapeutic options to help those who suffer from recurrent implantation failure. Three of the most promising therapeutic options for recurrent implantation failure include immune therapies such as peripheral blood mononuclear cells, platelet rich plasma and subcutaneous granulocyte-colony stimulating factor.
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Affiliation(s)
- Jenna Turocy
- Columbia University Fertility Center, New York, New York
| | - Zev Williams
- Columbia University Fertility Center, New York, New York.
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44
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Keskin M, Pabuçcu EG, Arslanca T, Demirkıran ÖD, Pabuçcu R. Does Microfluidic Sperm Sorting Affect Embryo Euploidy Rates in Couples with High Sperm DNA Fragmentation? Reprod Sci 2021; 29:1801-1808. [PMID: 34731459 DOI: 10.1007/s43032-021-00784-z] [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: 05/03/2021] [Accepted: 10/23/2021] [Indexed: 02/06/2023]
Abstract
Male infertility contributes as the main factor in 30-50% of infertility cases. Conventional methods for sperm preparation have induced questioning of sperm recovery rates. The microfluidic sperm sorting (MSS) technique selects highly motile sperm with lower levels of SDF (sperm DNA fragmentation) compared to conventional sperm sorting techniques. This study aimed to determine whether utilizing this technique will reveal better embryo quality and euploidy rates in couples with repeated implantation failure (RIF) and high SDF in a new PGT-A (preimplantation genetic testing for aneuploidies) cycle. This retrospective study included couples referred to PGT-A for previous repeated ART (assisted reproductive techniques) cycle failures and with high SDF. In their new cycles, couples who accepted the technique were assigned to the MSS group, and the rest were managed with DGC (density-gradient centrifugation). Two groups were compared in terms of fertilization and euploidy rates, clinical miscarriage and live birth rates, the total number of blastocysts, and top quality blastocysts. There was no difference between the groups regarding fertilization rates, euploidy rates, clinical miscarriage, and live birth rates. The total number of blastocysts and top quality blastocysts were significantly higher in the MSS group. The MSS technique provides a higher number of top-quality blastocysts than DGC; however, neither euploidy nor live birth rates improved. Studies focusing on confounding factors to embryonic genomic status in the presence of high SDF are needed.
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Affiliation(s)
- Müge Keskin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ufuk University, Mevlana Bulvarı No 86-88, Konya Yolu, Balgat, Ankara, 06520, Turkey.
| | - Emre Göksan Pabuçcu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ufuk University, Mevlana Bulvarı No 86-88, Konya Yolu, Balgat, Ankara, 06520, Turkey
| | - Tufan Arslanca
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ufuk University, Mevlana Bulvarı No 86-88, Konya Yolu, Balgat, Ankara, 06520, Turkey
| | | | - Recai Pabuçcu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ufuk University, Mevlana Bulvarı No 86-88, Konya Yolu, Balgat, Ankara, 06520, Turkey
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45
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Chowdhury D, Zhou X, Li B, Zhang Y, Cheung WK, Lu A, Zhang L. Editorial: Predicting High-Risk Individuals for Common Diseases Using Multi-Omics and Epidemiological Data. Front Genet 2021; 12:737598. [PMID: 34484310 PMCID: PMC8416410 DOI: 10.3389/fgene.2021.737598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/26/2021] [Indexed: 01/16/2023] Open
Affiliation(s)
- Debajyoti Chowdhury
- Computational Medicine Lab, Hong Kong Baptist University, Kowloon Tong, Hong Kong.,School of Chinese Medicine, Institute of Integrated Bioinformedicine and Translational Sciences, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Xin Zhou
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, United States
| | - Bailiang Li
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, United States
| | - Yuanwei Zhang
- The Chinese Academy of Sciences Key Laboratory of Innate Immunity and Chronic Diseases, Hefei National Laboratory for Physical Sciences at the Microscale, Chinese Academy of Sciences Center for Excellence in Molecular Cell Science, Collaborative Innovation Center of Genetics and Development, School of Life Sciences, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - William K Cheung
- Department of Computer Science, Faculty of Science, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Aiping Lu
- Computational Medicine Lab, Hong Kong Baptist University, Kowloon Tong, Hong Kong.,School of Chinese Medicine, Institute of Integrated Bioinformedicine and Translational Sciences, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Lu Zhang
- Computational Medicine Lab, Hong Kong Baptist University, Kowloon Tong, Hong Kong.,Department of Computer Science, Faculty of Science, Hong Kong Baptist University, Kowloon Tong, Hong Kong
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A Brief Analysis of Tissue-Resident NK Cells in Pregnancy and Endometrial Diseases: The Importance of Pharmacologic Modulation. IMMUNO 2021. [DOI: 10.3390/immuno1030011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
NK cells are lymphocytes involved in the innate and adaptative immune response. These cells are located in peripheral blood and tissues with ample functions, from immune vigilant to tolerogenic reactions. In the endometrium, NK cell populations vary depending on age, hormones, and inflammation. When pregnancy occurs, tissue-resident NK cells and conventional NK cells are recruited to protect the fetus, a tolerogenic response. On the contrary, in the inflamed endometrium, various inflammatory cells down-regulate NK tolerance and impair embryo implantation. Therefore, NK cells’ pharmacological modulation is difficult to achieve. Several strategies have been used, from progesterone, lipid emulsions to steroids; the success has not been as expected. However, new therapeutic approaches have been proposed to decrease the endometrial inflammatory burden and increase pregnancy success based on understanding NK cell physiology.
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Tempest N, Batchelor E, Hill CJ, Al-Lamee H, Drury J, Drakeley AJ, Hapangama DK. Anterior Gradient Protein 3 and S100 Calcium-Binding Protein P Levels in Different Endometrial Epithelial Compartments May Play an Important Role in Recurrent Pregnancy Failure. Int J Mol Sci 2021; 22:ijms22083835. [PMID: 33917163 PMCID: PMC8067849 DOI: 10.3390/ijms22083835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 01/31/2023] Open
Abstract
Recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL) are distressing conditions without effective treatments. The luminal epithelium (LE) is integral in determining receptivity of the endometrium, whereas functionalis glands and stroma aid in nurturing early embryo development. Calcium signalling pathways are known to be of vital importance to embryo implantation and pregnancy establishment, and anterior gradient protein 3 (AGR3) and S100 calcium-binding protein P (S100P) are involved with these pathways. We initially examined 20 full-thickness endometrial biopsies from premenopausal women across the menstrual cycle to characterize levels of AGR3 protein in each endometrial sub-region at the cellular level. A further 53 endometrial pipelle biopsies collected in the window of implantation were subsequently assessed to determine differential endometrial AGR3 and S100P levels relevant to RIF (n = 13) and RPL (n = 10) in comparison with parous women (n = 30) using immunohistochemistry. Significantly higher AGR3 and S100P immunostaining was observed in ciliated cells of the LE of women with recurrent reproductive failure compared with parous women, suggesting aberrant subcellular location-associated pathophysiology for these conditions. The nuclear localisation of S100P may allow transcriptional regulatory function, which is necessary for implantation of a viable pregnancy. Further work is thus warranted to assess their utility as diagnostic/therapeutic targets.
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Affiliation(s)
- Nicola Tempest
- Centre for Women’s Health Research, Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool L8 7SS, UK; (E.B.); (C.J.H.); (H.A.-L.); (J.D.); (D.K.H.)
- Liverpool Women’s NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool L8 7SS, UK
- Hewitt Centre for Reproductive Medicine, Liverpool Women’s NHS Foundation Trust, Liverpool L8 7SS, UK;
- Correspondence:
| | - Elizabeth Batchelor
- Centre for Women’s Health Research, Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool L8 7SS, UK; (E.B.); (C.J.H.); (H.A.-L.); (J.D.); (D.K.H.)
| | - Christopher J. Hill
- Centre for Women’s Health Research, Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool L8 7SS, UK; (E.B.); (C.J.H.); (H.A.-L.); (J.D.); (D.K.H.)
| | - Hannan Al-Lamee
- Centre for Women’s Health Research, Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool L8 7SS, UK; (E.B.); (C.J.H.); (H.A.-L.); (J.D.); (D.K.H.)
- Hewitt Centre for Reproductive Medicine, Liverpool Women’s NHS Foundation Trust, Liverpool L8 7SS, UK;
| | - Josephine Drury
- Centre for Women’s Health Research, Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool L8 7SS, UK; (E.B.); (C.J.H.); (H.A.-L.); (J.D.); (D.K.H.)
| | - Andrew J. Drakeley
- Hewitt Centre for Reproductive Medicine, Liverpool Women’s NHS Foundation Trust, Liverpool L8 7SS, UK;
| | - Dharani K. Hapangama
- Centre for Women’s Health Research, Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool L8 7SS, UK; (E.B.); (C.J.H.); (H.A.-L.); (J.D.); (D.K.H.)
- Liverpool Women’s NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool L8 7SS, UK
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