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Qi R, Zhang T, Zhang Y, Chung JPW, Yang WJ, Wang CC. Association of angiotensin II and receptors in peri-implantation endometrium with microvessel density and pregnancy outcomes of women with recurrent implantation failure after embryo transfer. Front Endocrinol (Lausanne) 2023; 14:1206326. [PMID: 37711897 PMCID: PMC10497869 DOI: 10.3389/fendo.2023.1206326] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023] Open
Abstract
Purpose Investigate whether local angiotensin II (AngII) and its AngII type 1 and 2 receptors (AT1R, AT2R) in the endometrium are different and correlate with microvessel density in women with reproductive failure and pregnancy outcomes. Methods Endometrium during the window of implantation from 40 women with recurrent miscarriage (RM) and 40 with recurrent implantation failure (RIF) were compared with 27 fertile women. Peri-implantation endometrium from 54 women prior to euploid embryo transfer were collected and compared in women with successful pregnancy and unsuccessful pregnancy. Results Compared with fertile women, expression of AT2R was significantly lower, while AT1R/AT2R expression ratio was significantly higher in the stroma of the RIF group. Endometrium arteriole MVD was significantly lower and negatively correlated with the AT1R/AT2R expression ratio in the stroma of the RIF group. No significant differences and correlations were found in the RM group. Compared with the pregnancy group, expression of AT1R and AT2R were significantly lower in all compartments, but only AT1R/AT2R ratio was significantly higher in the stroma of the non-pregnancy group. Similarly, endometrium arteriole MVD was also significantly lower and negatively correlated with the AT1R/AT2R ratio in the stroma of the non-pregnancy group. Conclusion Local renin-angiotensin system is dysregulated in peri-implantation endometrium and associated with abnormal angiogenesis in RIF and poor implantation outcome after embryo transfer.
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Affiliation(s)
- Ruofan Qi
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tao Zhang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yingying Zhang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jacqueline Pui Wah Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wen-Jui Yang
- Department of Infertility and Reproductive Medicine, Taiwan IVF Group Center, Hsinchu, Taiwan
- Department of Fertility and Reproductive Medicine, Ton-Yen General Hospital, Hsinchu, Taiwan
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Reproduction and Development Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Chinese University of Hong Kong -Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Shen M, Liu Y, Ma X, Zhu Q. Erbu Zhuyu decoction improves endometrial angiogenesis via uterine natural killer cells and the PI3K/Akt/eNOS pathway a mouse model of embryo implantation dysfunction. Am J Reprod Immunol 2023; 89:e13634. [PMID: 36327113 PMCID: PMC10078112 DOI: 10.1111/aji.13634] [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: 02/20/2022] [Revised: 09/17/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND We investigated the effect of Erbu Zhuyu decoction (EBZY) on angiogenesis via uterine natural killer (uNK) cells and the PI3K/Akt/eNOS pathway in embryo implantation dysfunction (EID) mice. METHODS Pregnant mice were randomly divided into blank, model, EBZY, progynova, and aspirin groups. Uteri were excised on the 5th day of pregnancy for analysis. RESULTS Mice in the model group showed pale uteri, a reduced implantation rate, and lower expression levels of phosphatidylinositol-3-kinase (PI3K), protein kinase B (Akt), endothelial nitric oxide synthase (eNOS) and nitric oxide (NO). Compared to the model group, implantation rates in the medium-dose and high-dose groups of EBZY were significantly higher (P < .05), PI3K and Akt mRNA expression levels in the low-dose group were significantly higher (P < .05, P < .01), and the expression of p-PI3K, p-Akt, and p-eNOS proteins in all treatment groups were significantly increased (P < .01, P < .05). The expression of NO was significantly increased in the low-dose and high-dose groups (P < .01, P < .05, respectively). The level of p-Akt protein in the high-dose group was significantly higher than those in the other treatment groups (P < .01, P < .05). There was no significant difference in the density of uNK cells (P > .05). CONCLUSIONS EBZY facilitated embryo implantation in EID mice by enhancing endometrial angiogenesis via activation of the PI3K/Akt/eNOS pathway, at least in part. There was no evidence to indicate that EBZY could adjust the expression of uNK.
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Affiliation(s)
- Mengmeng Shen
- Department of Gynecology, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Yanfeng Liu
- Department of Gynecology, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
| | - Xiaona Ma
- Department of Gynecology, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Qingwen Zhu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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Kim MK, Yoon JA, Yoon SY, Park M, Lee WS, Lyu SW, Song H. Human Platelet-Rich Plasma Facilitates Angiogenesis to Restore Impaired Uterine Environments with Asherman’s Syndrome for Embryo Implantation and Following Pregnancy in Mice. Cells 2022; 11:cells11091549. [PMID: 35563855 PMCID: PMC9101537 DOI: 10.3390/cells11091549] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 02/05/2023] Open
Abstract
Asherman’s syndrome (AS) is caused by intrauterine adhesions and inactive endometrium from repeated curettage of the uterine endometrium. AS is a major cause of recurrent implantation failure and miscarriage and is very difficult to treat because of the poor recovery of endometrial basal cells. Platelet-rich plasma (PRP) has abundant growth factors that may induce angiogenesis and cell proliferation. Here, we demonstrate that human PRP (hPRP) significantly enhances angiogenesis to restore embryo implantation, leading to successful pregnancy in mice with AS. In mice with AS, hPRP treatment considerably reduced the expression of fibrosis markers and alleviated oligo/amenorrhea phenotypes. Mice with AS did not produce any pups, but the hPRP therapy restored their infertility. AS-induced abnormalities, such as aberrantly delayed embryo implantation and intrauterine growth retardation, were considerably eliminated by hPRP. Furthermore, hPRP significantly promoted not only the elevation of various angiogenic factors, but also the migration of endometrial stromal cells. It also increased the phosphorylation of STAT3, a critical mediator of wound healing, and the expression of tissue remodeling genes in a fibrotic uterus. PRP could be a promising therapeutic strategy to promote angiogenesis and reduce fibrosis in impaired uterine environments, leading to successful embryo implantation for better clinical outcomes in patients with AS.
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Affiliation(s)
- Min Kyoung Kim
- Department of Obstetrics and Gynecology, CHA Fertility Center Gangnam, CHA University School of Medicine, 569 Nonhyun-ro, Gangnam-gu, Seoul 06125, Korea; (M.K.K.); (J.A.Y.); (S.Y.Y.); (W.S.L.); (S.W.L.)
| | - Jung Ah Yoon
- Department of Obstetrics and Gynecology, CHA Fertility Center Gangnam, CHA University School of Medicine, 569 Nonhyun-ro, Gangnam-gu, Seoul 06125, Korea; (M.K.K.); (J.A.Y.); (S.Y.Y.); (W.S.L.); (S.W.L.)
| | - Sook Young Yoon
- Department of Obstetrics and Gynecology, CHA Fertility Center Gangnam, CHA University School of Medicine, 569 Nonhyun-ro, Gangnam-gu, Seoul 06125, Korea; (M.K.K.); (J.A.Y.); (S.Y.Y.); (W.S.L.); (S.W.L.)
| | - Mira Park
- Department of Biomedical Science, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam 13488, Korea;
| | - Woo Sik Lee
- Department of Obstetrics and Gynecology, CHA Fertility Center Gangnam, CHA University School of Medicine, 569 Nonhyun-ro, Gangnam-gu, Seoul 06125, Korea; (M.K.K.); (J.A.Y.); (S.Y.Y.); (W.S.L.); (S.W.L.)
| | - Sang Woo Lyu
- Department of Obstetrics and Gynecology, CHA Fertility Center Gangnam, CHA University School of Medicine, 569 Nonhyun-ro, Gangnam-gu, Seoul 06125, Korea; (M.K.K.); (J.A.Y.); (S.Y.Y.); (W.S.L.); (S.W.L.)
| | - Haengseok Song
- Department of Biomedical Science, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam 13488, Korea;
- Correspondence: ; Tel.: +82-031-881-7150
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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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Metwally M, Walters S, Chatters R. The Current Role of Induced Endometrial Trauma (Endometrial Scratch) in Women Undergoing Infertility Treatment. Semin Reprod Med 2021; 39:e1-e4. [PMID: 34781399 DOI: 10.1055/s-0041-1739162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Induced endometrial trauma, otherwise known as endometrial scratch is a simple technique that has been rapidly adopted into clinical practice, mainly for women having IVF treatment, in an attempt to increase pregnancy rates. The introduction of endometrial scratch followed early reports of improved clinical pregnancy rates in women with repetitive implantation failure after having the procedure and follows on from evidence from animal models in the early 20th century suggesting that mechanical trauma to the endometrium can induce decidual changes. Due to the ease and low cost of the procedure, it has been rapidly adopted as an add-on to fertility treatments, in many cases where evidence is still lacking. Despite the initial publication of a large number of studies that demonstrated encouraging improvements in pregnancy rates in women who underwent this procedure, these studies were mainly limited by the small sample sizes and heterogeneity of their study populations, leading to limited validity of the evidence provided by these studies. More recently, three large randomized controlled studies have been published that paint a different picture regarding the value of this procedure. This article explores the evolution of the evidence and the current state of endometrial scratch as an adjuvant therapy for women undergoing IVF treatment.
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Affiliation(s)
- Mostafa Metwally
- The Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield and Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Stephen Walters
- The Clinical Trials Research Unit, The University of Sheffield, Sheffield, United Kingdom
| | - Robin Chatters
- The Clinical Trials Research Unit, The University of Sheffield, Sheffield, United Kingdom
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Aghajanpour S, Hosseini E, Amirchaghmaghi E, Zandieh Z, Amjadi F, Yahyaei A, Zolfaghari Z, Aflatoonian K, Ashrafi M, Aflatoonian R. Differential expression of innate/adaptive immunity genes induced by endometrial scratching as a hopeful approach for implantation boosting in unexplained, repeated implantation failure: An RCT. J Reprod Immunol 2021; 148:103426. [PMID: 34653814 DOI: 10.1016/j.jri.2021.103426] [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: 03/15/2021] [Revised: 08/20/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Endometrial scratching (ES) has been proposed as a potential treatment for implantation improvement in unexplained repeated implantation failure (uRIF) patients, however, little is known about its exact molecular mechanisms. OBJECTIVE This randomized controlled trial (RCT) was conducted on twenty uRIF patients to investigate the expression of innate and adaptive immune signaling genes after ES. METHODS Ten uRIF patients in the intervention (twice endometrial sampling in follicular and luteal phases) and 10 uRIF patients in the control group (only luteal phase sampling) were randomly enrolled. Gene expression analysis with innate and adaptive immune response PCR-array kit between intervention and control groups were performed. RESULTS Among innate immune-associated genes, a significant decrease was observed in the expression of APCS, CPR, CCL2, NLRP3, HLA-A, TLR3 and TLR4 in the intervention group. In adaptive immune-related genes, the expression level of CD80, CD86, CXCR3, IFNγ, IFNα1, IFNβ, MBL2, CCR6, CCR8 and IL17A were decreased and CSF2, GATA3, and IL4 increased significantly in the intervention group (P < 0.05). Of 14 uRIF patients, five live birth (35.71 %) was achieved. CONCLUSION ES in uRIF patients may exert positive effects on the endometrial preparation which increases its receptivity for embryo implantation by modulating the expression of an array of immune signaling pathway genes.
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Affiliation(s)
- Samaneh Aghajanpour
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran; Department of Anatomical Sciences, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Hosseini
- Department of Obstetrics and Gynecology, IVF Clinic, Mousavi Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran; Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Elham Amirchaghmaghi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Zahra Zandieh
- Department of Anatomical Sciences, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Fatemehsadat Amjadi
- Department of Anatomical Sciences, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Azar Yahyaei
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Zahra Zolfaghari
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | | | - Mahnaz Ashrafi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran; Obstetrics and Gynecology Department, School of Medicine, Iran University of Medical Science, Tehran, Iran.
| | - Reza Aflatoonian
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
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Tu YA, Chou CH, Yang PK, Shun CT, Wen WF, Tsao PN, Chen SU, Yang JH. Intentional endometrial injury enhances angiogenesis through increased production and activation of MMP-9 by TNF-α and MMP-3 in a mouse model. Mol Hum Reprod 2021; 27:gaab055. [PMID: 34463765 DOI: 10.1093/molehr/gaab055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 08/08/2021] [Indexed: 11/12/2022] Open
Abstract
There have been reports of improved pregnancy rates after performing intentional endometrial injuries, also known as endometrial scratching, in patients with recurrent implantation failure. In our previous study on intentional endometrial injury, we found an increased expression of matrix metalloproteinase (MMP)-3 following induced injuries to the mice endometrium. In the current study, we further examine whether the rise in MMP-3 could contribute to increased angiogenesis. Female C57B1/6 mice were obtained at 12 weeks of age, and intentional endometrial injuries were induced mechanically in the left uterine horns. Using the appropriate media, uterine-washes were performed on the injured and uninjured (control) horns of the harvested uteri. The uterine tissues were further processed for tissue lysates, histopathology and immunohistochemistry. The results show that intentional endometrial injuries caused an increase in secreted LPA in the injured horns, which were detected in the uterine-washes. In addition, LPA induced increased production of TNF-α in human endometrial epithelial cells (hEEpCs). Furthermore, TNF-α appeared to induce differential and cell-specific upregulation of the MMPs: MMP-3 was upregulated in the epithelial (hEEpCs), while MMP-9 was upregulated in the endothelial cells (human endometrial endothelial cells; hEEnCs). The upregulation of MMP-3 appeared to be necessary for the activation of MMP-9, whose active form stimulated the formation of vessel-like structure by the hEEnCs. The results of this study suggest that there may be enhanced angiogenesis following intentional endometrial injuries, which is mediated in part by TNF-α-induced and MMP-3-activated MMP-9 production.
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Affiliation(s)
- Yi-An Tu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Hung Chou
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Kai Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Tung Shun
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Fen Wen
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shee-Uan Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jehn-Hsiahn Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Metwally M, Chatters R, Dimairo M, Walters S, Pye C, White D, Bhide P, Chater T, Cheong Y, Choudhary M, Child T, Drakeley A, Evbuomwan I, Gelbaya T, Grace J, Harris P, Laird S, da Silva SM, Mohiyiddeen L, Pemberton K, Raine-Fenning N, Rajkhowa M, Young T, Cohen J. A randomised controlled trial to assess the clinical effectiveness and safety of the endometrial scratch procedure prior to first-time IVF, with or without ICSI. Hum Reprod 2021; 36:1841-1853. [PMID: 34050362 PMCID: PMC8213451 DOI: 10.1093/humrep/deab041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What is the clinical-effectiveness and safety of the endometrial scratch (ES) procedure compared to no ES, prior to usual first time in vitro fertilisation (IVF) treatment? SUMMARY ANSWER ES was safe but did not improve pregnancy outcomes when performed in the mid-luteal phase prior to the first IVF cycle, with or without intracytoplasmic sperm injection (ICSI). WHAT IS KNOWN ALREADY ES is an ‘add-on’ treatment that is available to women undergoing a first cycle of IVF, with or without ICSI, despite a lack of evidence to support its use. STUDY DESIGN, SIZE, DURATION This pragmatic, superiority, open-label, multi-centre, parallel-group randomised controlled trial involving 1048 women assessed the clinical effectiveness and safety of the ES procedure prior to first time IVF, with or without ICSI, between July 2016 and October 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants aged 18–37 years undergoing their first cycle of IVF, with or without ICSI, were recruited from 16 UK fertility clinics and randomised (1:1) by a web-based system with restricted access rights that concealed allocation. Stratified block randomisation was used to allocate participants to TAU or ES in the mid-luteal phase followed by usual IVF with or without ICSI treatment. The primary outcome was live birth after completing 24 weeks gestation within 10.5 months of egg collection. MAIN RESULTS AND THE ROLE OF CHANCE In total, 1048 women randomised to TAU (n = 525) and ES (n = 523) were available for intention to treat analysis. In the ES group, 453 (86.6%) received the ES procedure. IVF, with or without ICSI, was received in 494 (94.1%) and 497 (95.0%) of ES and TAU participants respectively. Live birth rate was 37.1% (195/525) in the TAU and 38.6% (202/523) in the ES: an unadjusted absolute difference of 1.5% (95% CI −4.4% to 7.4%, P = 0.621). There were no statistical differences in secondary outcomes. Adverse events were comparable across groups. LIMITATIONS, REASONS FOR CAUTION A sham ES procedure was not undertaken in the control group, however, we do not believe this would have influenced the results as objective fertility outcomes were used. WIDER IMPLICATIONS OF THE FINDINGS This is the largest trial that is adequately powered to assess the impact of ES on women undergoing their first cycle of IVF. ES was safe, but did not significantly improve pregnancy outcomes when performed in the mid-luteal phase prior to the first IVF or ICSI cycle. We recommend that ES is not undertaken in this population. STUDY FUNDING/COMPETING INTEREST(S) Funded by the National Institute of Health Research. Stephen Walters is an National Institute for Health Research (NIHR) Senior Investigator (2018 to present) and was a member of the following during the project: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Clinical Trials and Evaluation Committee (2011–2017), NIHR HTA Commissioning Strategy Group (2012 to 2017); NIHR Programme Grants for Applied Research Committee (2020 to present); NIHR Pre doctoral Fellowship Committee (2019 to present). Dr. Martins da Silva reports grants from AstraZeneca, during the conduct of the study; and is Associate editor of Human Reproduction and Editorial Board member of Reproduction and Fertility. Dr. Bhide reports grants from Bart's Charity and grants and non-financial support from Pharmasure Pharmaceuticals outside the submitted work. TRIAL REGISTRATION NUMBER ISRCTN number: ISRCTN23800982. TRIAL REGISTRATION DATE 31 May 2016 DATE OF FIRST PATIENT’S ENROLMENT 04 July 2016
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Affiliation(s)
- Mostafa Metwally
- Obstetrics, Gynaecology & Neonatology, Sheffield Teaching Hospitals NHS Foundation Trust and The University of Sheffield, Sheffield, S10 2JF, UK
| | - Robin Chatters
- Sheffield Clinical Trials Research Unit, The University of Sheffield, Sheffield, S1 4DA, UK
| | - Munya Dimairo
- Sheffield Clinical Trials Research Unit, The University of Sheffield, Sheffield, S1 4DA, UK
| | - Stephen Walters
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, S1 4DA, UK
| | - Clare Pye
- Obstetrics, Gynaecology & Neonatology, Sheffield Teaching Hospitals NHS Foundation Trust and The University of Sheffield, Sheffield, S10 2JF, UK
| | - David White
- Sheffield Clinical Trials Research Unit, The University of Sheffield, Sheffield, S1 4DA, UK
| | - Priya Bhide
- Fertility Centre, Homerton University Hospital NHS Foundation Trust, Clapton, E9 6SR, UK
| | - Tim Chater
- Sheffield Clinical Trials Research Unit, The University of Sheffield, Sheffield, S1 4DA, UK
| | - Ying Cheong
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Meenakshi Choudhary
- Oxford Fertility, The Fertility Partnership, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, OX4 2HW, UK
| | - Tim Child
- Newcastle Fertility Centre at Life, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, NE1 4EP, UK
| | - Andrew Drakeley
- The Hewitt Fertility Centre, Liverpool Women's NHS Foundation Trust, Liverpool, L8 7SS, UK
| | - Isaac Evbuomwan
- Gateshead Fertility Unit, Gateshead Health NHS Foundation Trust, Gateshead, NE9 6SX, UK
| | - Tarek Gelbaya
- Leicester Fertility Centre, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Jan Grace
- Assisted Conception Unit, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Philip Harris
- Fertility Fusion, Wrightington, Wigan & Leigh Teaching Hospitals NHS Foundation Trust, Appley Bridge, WB6 9EP, UK
| | - Susan Laird
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, S1 1WB, UK
| | | | - Lamiya Mohiyiddeen
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Kirsty Pemberton
- Sheffield Clinical Trials Research Unit, The University of Sheffield, Sheffield, S1 4DA, UK
| | | | | | - Tracey Young
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, S1 4DA, UK
| | - Judith Cohen
- Hull Health Trials Unit, The University of Hull, Hull, HU6 7RX, UK
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Makrigiannakis A, Makrygiannakis F, Vrekoussis T. Approaches to Improve Endometrial Receptivity in Case of Repeated Implantation Failures. Front Cell Dev Biol 2021; 9:613277. [PMID: 33796523 PMCID: PMC8007915 DOI: 10.3389/fcell.2021.613277] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/28/2021] [Indexed: 12/11/2022] Open
Abstract
Repeated implantation failures are a constant challenge in reproductive medicine with a significant impact both on health providers and on infertile couples. Several approaches have been proposed so far as effective; however, accumulative data have clarified that most of the treatment options do not have the evidence base for a generalized application to be suggested by the relevant societies. Implantation failures are attributed to either poor quality embryos or to defected endometrial receptivity. The current review aims to summarize in a systematic way all the new trends in managing RIF via interference with endometrial receptivity. The authors focus mainly, but not exclusively, on endometrial injury prior to embryo transfer and endometrial priming with autologous cells or biological agents. To this direction, a systematic search of the Pubmed database has been conducted taking into account the emerged evidence of the last two decades. All the suggested interventions are herein presented and analyzed in terms of reproductive outcomes. It is evident that properly powered and designed randomized trials are needed to support a new standard approach in RIF treatment that will safely be incorporated in national and international guidelines.
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Affiliation(s)
- Antonis Makrigiannakis
- Department of Obstetrics and Gynecology, Medical School, University of Crete, Heraklion, Greece
| | | | - Thomas Vrekoussis
- Department of Obstetrics and Gynecology, Medical School, University of Crete, Heraklion, Greece
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Park HR, Choi HJ, Kim BS, Chung TW, Kim KJ, Joo JK, Ryu D, Bae SJ, Ha KT. Paeoniflorin Enhances Endometrial Receptivity through Leukemia Inhibitory Factor. Biomolecules 2021; 11:439. [PMID: 33809755 PMCID: PMC8002267 DOI: 10.3390/biom11030439] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 01/04/2023] Open
Abstract
Despite advances in assisted reproductive technology, treatment for deficient endometrial receptivity is a major clinical unmet need. In our previous study, the water extract of Paeonia lactiflora Pall. enhanced endometrial receptivity in vitro and in vivo via induction of leukemia inhibitory factor (LIF), an interleukin (IL)-6 family cytokine. In the present study, we found that paeoniflorin, a monoterpene glycoside, is the major active compound of P. lactiflora. Paeoniflorin significantly improved the embryo implantation rate in a murine model of mifepristone (RU486)-induced implantation failure. In addition, paeoniflorin increased the adhesion of human trophectoderm-derived JAr cells to endometrial Ishikawa cells through the expression of LIF in vitro. Moreover, using the National Center for Biotechnology Information (NCBI) Gene Expression Omnibus (GEO) database of the human endometrium, we confirmed that LIF signaling is a key regulator for improving human endometrial receptivity. Therefore, these results suggest that paeoniflorin might be a potent drug candidate for the treatment of endometrial implantation failure by enhancing endometrial receptivity.
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Affiliation(s)
- Hye-Rin Park
- Korean Medical Research Center for Healthy Aging, Pusan National University, Yangsan, Gyeongsangnam-do 50612, Korea; (H.-R.P.); (H.-J.C.); (B.-S.K.); (T.-W.C.); (S.-J.B.)
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Yangsan, Gyeongsangnam-do 50612, Korea
| | - Hee-Jung Choi
- Korean Medical Research Center for Healthy Aging, Pusan National University, Yangsan, Gyeongsangnam-do 50612, Korea; (H.-R.P.); (H.-J.C.); (B.-S.K.); (T.-W.C.); (S.-J.B.)
| | - Bo-Sung Kim
- Korean Medical Research Center for Healthy Aging, Pusan National University, Yangsan, Gyeongsangnam-do 50612, Korea; (H.-R.P.); (H.-J.C.); (B.-S.K.); (T.-W.C.); (S.-J.B.)
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Yangsan, Gyeongsangnam-do 50612, Korea
| | - Tae-Wook Chung
- Korean Medical Research Center for Healthy Aging, Pusan National University, Yangsan, Gyeongsangnam-do 50612, Korea; (H.-R.P.); (H.-J.C.); (B.-S.K.); (T.-W.C.); (S.-J.B.)
| | - Keuk-Jun Kim
- Department of Clinical Pathology, Daekyeung University, Gyeongsan, Gyeongsanabuk-do 38547, Korea;
| | - Jong-Kil Joo
- Department of Obstetrics and Gynecology, School of Medicine, Pusan National University Hospital, Busan 49241, Korea;
| | - Dongryeol Ryu
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon 16419, Korea;
| | - Sung-Jin Bae
- Korean Medical Research Center for Healthy Aging, Pusan National University, Yangsan, Gyeongsangnam-do 50612, Korea; (H.-R.P.); (H.-J.C.); (B.-S.K.); (T.-W.C.); (S.-J.B.)
| | - Ki-Tae Ha
- Korean Medical Research Center for Healthy Aging, Pusan National University, Yangsan, Gyeongsangnam-do 50612, Korea; (H.-R.P.); (H.-J.C.); (B.-S.K.); (T.-W.C.); (S.-J.B.)
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Yangsan, Gyeongsangnam-do 50612, Korea
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Huang P, Yao C, Wei L, Lin Z. The intrauterine perfusion of granulocyte-colony stimulating factor (G-CSF) before frozen-thawed embryo transfer in patients with two or more implantation failures. HUM FERTIL 2020; 25:1-5. [PMID: 32862740 DOI: 10.1080/14647273.2020.1811904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 03/22/2020] [Indexed: 12/14/2022]
Abstract
The objective of this study was to investigate the clinical benefits of intrauterine perfusion with G-CSF in patients undergoing a frozen-thawed embryo transfer (FET) after at least two previous implantation failures. This was a prospective, randomized, single-blind study. The intervention group received an intrauterine infusion of G-CSF whereas the placebo group was given an intrauterine infusion of physiological saline before embryo transfer. A third (control) group did not receive an intrauterine infusion prior to embryo transfer. The clinical pregnancy rates of both the intervention and placebo group were significantly higher than that in the control group (p < 0.05). But the miscarriage rates of the G-CSF were significantly lower than those of the other two groups (p < 0.05). The intrauterine infusion of G-CSF before frozen-thawed embryo transfer significantly reduced miscarriage rates and improve the live birth rates. While intrauterine perfusion with physiological saline did not reduce miscarriage rates.
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Affiliation(s)
- Pinxiu Huang
- Reproductive Medicine Center, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China
- Liuzhou Institute of Reproduction and Genetics, Liuzhou, China
- Affiliated Maternity Hospital and Affiliated Children's Hospital of Guangxi, University of Science and Technology, Liuzhou, China
| | - Chunling Yao
- Reproductive Medicine Center, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China
- Liuzhou Institute of Reproduction and Genetics, Liuzhou, China
- Affiliated Maternity Hospital and Affiliated Children's Hospital of Guangxi, University of Science and Technology, Liuzhou, China
| | - Lihong Wei
- Reproductive Medicine Center, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, China
- Liuzhou Institute of Reproduction and Genetics, Liuzhou, China
- Affiliated Maternity Hospital and Affiliated Children's Hospital of Guangxi, University of Science and Technology, Liuzhou, China
| | - Zhong Lin
- Guangxi Zhuang Autonomous Region Reproductive Hospital, Nanning, China
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Wang D, Cheng X, Fang H, Ren Y, Li X, Ren W, Xue B, Yang C. Effect of cold stress on ovarian & uterine microcirculation in rats and the role of endothelin system. Reprod Biol Endocrinol 2020; 18:29. [PMID: 32290862 PMCID: PMC7155299 DOI: 10.1186/s12958-020-00584-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 03/27/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cold, an environmental factor, induces many reproductive diseases. It is known that endothelin (ET) is a potent vasoconstrictor, and cold stress can increase the expression of ET and its receptors. The cold stress rat model was developed to examine two parameters: (1) the effects of cold stress on ovarian and uterine morphology, function, and microvascular circulation and (2) possible mechanisms of ET and its receptors involved in cold stress-induced menstruation disorders. METHODS The rat cold stress model was prepared with an ice water bath. The estrous cycle was observed by methylene blue and hematoxylin and eosin (H&E) staining. Serum estradiol 2 (E2), testosterone (T), progesterone (P) were detected by radioimmunoassay. Hemorheology indices were measured. The real-time blood flow of auricle and uterine surfaces was measured. Expressions of CD34 and α-SMA in ovarian and uterine tissues were detected by immunohistochemistry. ET-1 contents in serum were tested, and expressions of ET-receptor types A and B (ET-AR and ET-BR) in ovarian tissues were detected via Western blotting. RESULTS Cold stress extended the estrous cycle, thereby causing reproductive hormone disorder, imbalance of local endothelin/nitric oxide expression, and microcirculation disturbance. Cold-stress led to up-regulation of ET-AR expression and protein and down-regulation of ET-BR expression in rats. CONCLUSIONS This study suggests that the reason for cold stress-induced dysfunction in reproductive organs may be closely related to the imbalance of ET-1 and its receptor expressions, leading to microvascular circulation disorders in local tissues.
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Affiliation(s)
- Di Wang
- grid.488206.00000 0004 4912 1751Hebei University of Chinese Medicine, No.326, Xinshi South Road, Qiaoxi District, Shijiazhuang, 050091 Hebei Province China
| | - Xiumei Cheng
- grid.488206.00000 0004 4912 1751Hebei University of Chinese Medicine, No.326, Xinshi South Road, Qiaoxi District, Shijiazhuang, 050091 Hebei Province China
| | - Huimin Fang
- grid.488206.00000 0004 4912 1751Hebei University of Chinese Medicine, No.326, Xinshi South Road, Qiaoxi District, Shijiazhuang, 050091 Hebei Province China
| | - Yanqing Ren
- grid.488206.00000 0004 4912 1751Hebei University of Chinese Medicine, No.326, Xinshi South Road, Qiaoxi District, Shijiazhuang, 050091 Hebei Province China
| | - Xinhua Li
- grid.488206.00000 0004 4912 1751Hebei University of Chinese Medicine, No.326, Xinshi South Road, Qiaoxi District, Shijiazhuang, 050091 Hebei Province China
| | - Weiwei Ren
- grid.488206.00000 0004 4912 1751Hebei University of Chinese Medicine, No.326, Xinshi South Road, Qiaoxi District, Shijiazhuang, 050091 Hebei Province China
| | - Bing Xue
- grid.488206.00000 0004 4912 1751Hebei University of Chinese Medicine, No.326, Xinshi South Road, Qiaoxi District, Shijiazhuang, 050091 Hebei Province China
| | - Cairui Yang
- grid.488206.00000 0004 4912 1751Hebei University of Chinese Medicine, No.326, Xinshi South Road, Qiaoxi District, Shijiazhuang, 050091 Hebei Province China
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Jiao Y, Xue N, Shui X, Yu C, Hu C. Application of ultrasound multimodal score in the assessment of endometrial receptivity in patients with artificial abortion. Insights Imaging 2020; 11:29. [PMID: 32115671 PMCID: PMC7049539 DOI: 10.1186/s13244-020-0840-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the value and feasibility of ultrasound multimodal score in the evaluation of endometrial receptivity in patients with artificial abortion (AA). METHODS Sixty-eight patients with AA (AA group) and 70 women of the childbearing age without any history of abortion (control group) were recruited between January 2018 and December 2018. All subjects received the examination of endometrium in the middle luteum phase (7-9 days after ovulation) with two-dimensional gray-scale ultrasound, two-dimensional color Doppler ultrasound, and three-dimensional ultrasound, and the quantitative scores were obtained and compared between two groups. RESULTS The quantitative score of endometrial receptivity was 10.46 ± 2.99 in the AA group and 13.49 ± 2.21 in the control group showing significant difference (p < 0.05). CONCLUSIONS Ultrasound multimodal quantitative scores can be used to evaluate the endometrial receptivity of patients with AA.
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Affiliation(s)
- Yan Jiao
- Department of Radiology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, China.,Obstetrics and Gynecology Ultrasonic Department, Wenzhou Peoples' Hospital, Wenzhou, 325000, China
| | - Nianyu Xue
- Department of Diagnostic Ultrasonography, Ningbo First Hospital, Ningbo, 315010, China
| | - Xujuan Shui
- Obstetrics and Gynecology Ultrasonic Department, Wenzhou Peoples' Hospital, Wenzhou, 325000, China
| | - Caicha Yu
- Obstetrics and Gynecology Ultrasonic Department, Wenzhou Peoples' Hospital, Wenzhou, 325000, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, China.
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Gu X, Yang Y, Li T, Chen Z, Fu T, Pan J, Ou J, Yang Z. ATP mediates the interaction between human blastocyst and endometrium. Cell Prolif 2020; 53:e12737. [PMID: 31821660 PMCID: PMC7046473 DOI: 10.1111/cpr.12737] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/14/2019] [Accepted: 11/13/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Embryo implantation needs a reciprocal interaction between competent embryo and receptive endometrium. Adenosine triphosphate (ATP) produced by stressed or injured cells acts as an important signalling molecule. This study aims to investigate whether adenosine triphosphate (ATP) plays an important role in the dialogue of human blastocyst-endometrium. MATERIALS AND METHODS The concentration of lactate was analysed in culture medium from human embryos collected from in vitro fertilization patients. Extracellular ATP was measured by ATP Bioluminescent Assay Kit. Ishikawa cells and T-HESCs were treated with ATP, ATP receptor antagonist, ATP hydrolysis enzyme or inhibitors of ATP metabolic enzymes. The levels of gene expression were evaluated by real-time PCR and immunoassay. RESULTS We showed that injured human endometrial epithelial cells could rapidly release ATP into the extracellular environment as an important signalling molecule. In addition, blastocyst-derived lactate induces the release of non-lytic ATP from human endometrial receptive epithelial cells via connexins. Extracellular ATP stimulates the secretion of IL8 from epithelial cells to promote the process of in vitro decidualization. Extracellular ATP could also directly promote the decidualization of human endometrial stromal cells via P2Y-purinoceptors. More importantly, the supernatants of injured epithelial cells clearly induce the decidualization of stromal cells in time-dependent manner. CONCLUSION Our results suggest that ATP should play an important role in human blastocyst-endometrium dialogue for the initiation of decidualization.
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Affiliation(s)
- Xiao‐Wei Gu
- College of Veterinary MedicineSouth China Agricultural UniversityGuangzhouChina
| | - Yan Yang
- College of Veterinary MedicineSouth China Agricultural UniversityGuangzhouChina
| | - Tao Li
- Center for Reproductive MedicineThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Zi‐Cong Chen
- College of Veterinary MedicineSouth China Agricultural UniversityGuangzhouChina
| | - Tao Fu
- College of Veterinary MedicineSouth China Agricultural UniversityGuangzhouChina
| | - Ji‐Min Pan
- College of Veterinary MedicineSouth China Agricultural UniversityGuangzhouChina
| | - Jian‐Ping Ou
- Center for Reproductive MedicineThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Zeng‐Ming Yang
- College of Veterinary MedicineSouth China Agricultural UniversityGuangzhouChina
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15
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Should we stop offering endometrial scratching prior to in vitro fertilization? Fertil Steril 2019; 111:1094-1101. [PMID: 31155116 DOI: 10.1016/j.fertnstert.2019.04.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 12/12/2022]
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