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Joseph T, Karuppusami R, Kunjummen AT, Kamath MS. Impact of tubal patency test selection on the live birth rate following intrauterine insemination in couples with unexplained infertility: a retrospective cohort study. Arch Gynecol Obstet 2023; 308:621-629. [PMID: 37310451 DOI: 10.1007/s00404-023-07091-9] [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: 12/07/2022] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE We planned a study to evaluate the impact of selecting hysterosalpingography (HSG) over diagnostic laparoscopy during initial fertility evaluation on IUI treatment outcomes in couples diagnosed with unexplained infertility. METHODS The study comprised a retrospective cohort and included couples evaluated for infertility at our tertiary level hospital between January 2008 and December 2019. Couples diagnosed with unexplained infertility based on tubal patency tests (either HSG or diagnostic laparoscopy) were included. We compared outcomes following ovarian stimulation (OS) and intrauterine insemination (IUI) between women who underwent HSG versus laparoscopy for up to three treatment cycles. RESULTS A total of 7413 women were screened, out of which 1002 women were diagnosed with unexplained infertility. We did not find a significant statistical difference in the clinical pregnancy (16.7% vs. 11.7%; OR (odds ratio) 1.51; 95% CI (confidence interval) 0.90-2.5) or live birth rate per IUI cycle (15.1% vs. 10.7%; OR 1.51, 95% CI 0.9-2.6) in women who underwent HSG for tubal evaluation as compared to laparoscopy. After adjustment for potential confounders through multivariate analysis, we found that outcomes were comparable between the HSG and laparoscopy. CONCLUSION The current study did not find any significant difference in treatment outcomes following OS and IUI in women with unexplained infertility who underwent HSG compared to laparoscopy for the assessment of the tubal patency during the initial fertility workup. The finding suggests minimal or no impact of selecting HSG over diagnostic laparoscopy as a tubal patency test on the subsequent IUI outcomes.
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Affiliation(s)
- Treasa Joseph
- Department of Reproductive Medicine and Surgery, Christian Medical College Hospital, Vellore, 632004, India
| | - Reka Karuppusami
- Department of Biostatistics, Christian Medical College, Vellore, 632002, India
| | - Aleyamma T Kunjummen
- Department of Reproductive Medicine and Surgery, Christian Medical College Hospital, Vellore, 632004, India
| | - Mohan S Kamath
- Department of Reproductive Medicine and Surgery, Christian Medical College Hospital, Vellore, 632004, India.
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Vaigauskaitė-Mažeikienė B, Baušytė R, Valatkaitė E, Maželytė R, Kazėnaitė E, Ramašauskaitė D, Navakauskienė R. Assisted reproductive technology outcomes and gene expression in unexplained infertility patients. Front Cell Dev Biol 2023; 11:1217808. [PMID: 37576599 PMCID: PMC10416262 DOI: 10.3389/fcell.2023.1217808] [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: 05/05/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Background: Unexplained infertility (UI) can be a frustrating and challenging diagnosis for doctors and couples as it can be difficult to understand why they are unable to conceive despite increasing diagnostic tools. Assisted reproductive technology (ART) procedures have been successfully applied to many couples aiming to overcome UI. However, they can be not only expensive but also require multiple cycles to achieve a successful pregnancy. The endometrium and the follicular fluid have been investigated as target tissues not only to determine the cause of UI but also to increase conception rates. Results: In this study, we analyzed the outcomes of ART in 223 UI couples and gene expression associated with DNA modification, cell death, immune response and senescence (TET1, TET2, BCL2, BAK1, HMGA2, IL-6, IL-8) in infertile women's endometrium and follicular fluid. We found significant differences in women who successfully got pregnant compared to women unable to conceive depending on age, duration of infertility, number of retrieved oocytes, zygotes, transferred embryos. Further, the expression of genes BAK1 (pro-apoptotic), TET2 (associated with epigenetic DNA modification) and IL-6 (associated with immune responses) were significantly higher in the endometrium of women who successfully got pregnant. Conclusion: Younger parental age couples showed higher ART success rates, shorter duration of infertility, higher number of retrieved oocytes, zygotes and transferred embryos. The gene expression analysis revealed significant changes in the endometrium depending on genes associated with cell death and immune response which were upregulated in females with diagnosed unexplained infertility.
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Affiliation(s)
- Brigita Vaigauskaitė-Mažeikienė
- Department of Molecular Cell Biology, Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
- Centre of Obstetrics and Gynaecology of the Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Raminta Baušytė
- Department of Molecular Cell Biology, Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
- Centre of Obstetrics and Gynaecology of the Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Elvina Valatkaitė
- Department of Molecular Cell Biology, Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Rūta Maželytė
- Centre of Obstetrics and Gynaecology of the Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Edita Kazėnaitė
- Faculty of Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | - Diana Ramašauskaitė
- Centre of Obstetrics and Gynaecology of the Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rūta Navakauskienė
- Department of Molecular Cell Biology, Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
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Shingshetty L, Maheshwari A, McLernon DJ, Bhattacharya S. Should we adopt a prognosis-based approach to unexplained infertility? Hum Reprod Open 2022; 2022:hoac046. [PMID: 36382011 PMCID: PMC9662706 DOI: 10.1093/hropen/hoac046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/09/2022] [Indexed: 08/27/2023] Open
Abstract
The treatment of unexplained infertility is a contentious topic that continues to attract a great deal of interest amongst clinicians, patients and policy makers. The inability to identify an underlying pathology makes it difficult to devise effective treatments for this condition. Couples with unexplained infertility can conceive on their own and any proposed intervention needs to offer a better chance of having a baby. Over the years, several prognostic and prediction models based on routinely collected clinical data have been developed, but these are not widely used by clinicians and patients. In this opinion paper, we propose a prognosis-based approach such that a decision to access treatment is based on the estimated chances of natural and treatment-related conception, which, in the same couple, can change over time. This approach avoids treating all couples as a homogeneous group and minimizes unnecessary treatment whilst ensuring access to those who need it early.
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Affiliation(s)
- Laxmi Shingshetty
- Aberdeen Centre for Reproductive Medicine, NHS Grampian, Aberdeen, UK
| | - Abha Maheshwari
- Aberdeen Centre for Reproductive Medicine, NHS Grampian, Aberdeen, UK
| | - David J McLernon
- Medical Statistics Team, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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4
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Huang J, Xia L, Lin J, Liu B, Zhao Y, Xin C, Ai X, Cao W, Zhang X, Tian L, Wu Q. No Effect of Inactivated SARS-CoV-2 Vaccination on in vitro Fertilization Outcomes: A Propensity Score-Matched Study. J Inflamm Res 2022; 15:839-849. [PMID: 35177919 PMCID: PMC8843422 DOI: 10.2147/jir.s347729] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/15/2022] [Indexed: 12/17/2022] Open
Abstract
Purpose Patients and Methods Results Conclusion
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Affiliation(s)
- Jialyu Huang
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Nanchang, People’s Republic of China
| | - Leizhen Xia
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Nanchang, People’s Republic of China
| | - Jiaying Lin
- Department of Assisted Reproduction, Shanghai Ninth People’s Hospital, Shanghai, People’s Republic of China
| | - Bangdong Liu
- Department of Laboratory Medicine, Huanan Hospital of Shenzhen University, Shenzhen, People’s Republic of China
| | - Yan Zhao
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Nanchang, People’s Republic of China
| | - Cailin Xin
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Nanchang, People’s Republic of China
| | - Xiaoyan Ai
- Department of Gynecology, Jiangxi Maternal and Child Health Hospital, Nanchang, People’s Republic of China
| | - Wenting Cao
- Department of Otorhinolaryngology, The First Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Xiaocui Zhang
- Center for Reproductive Medicine, Shangrao Maternal and Child Health Hospital, Shangrao, People’s Republic of China
| | - Lifeng Tian
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Nanchang, People’s Republic of China
- Correspondence: Lifeng Tian; Qiongfang Wu, Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Nanchang, People’s Republic of China, Email ;
| | - Qiongfang Wu
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Nanchang, People’s Republic of China
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5
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Kunjummen A, Sarkar S, Joseph T, Yadav B, Kamath M. Comparison of treatment outcomes following ovarian stimulation with intrauterine insemination in minimal or mild endometriosis versus unexplained infertility: A retrospective cohort study. J Hum Reprod Sci 2022; 15:272-277. [DOI: 10.4103/jhrs.jhrs_102_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/10/2022] [Accepted: 09/11/2022] [Indexed: 11/04/2022] Open
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Orvieto R, Segev-Zahav A, Aizer A. Does COVID-19 infection influence patients' performance during IVF-ET cycle?: an observational study. Gynecol Endocrinol 2021; 37:895-897. [PMID: 33974475 DOI: 10.1080/09513590.2021.1918080] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE No information exists in the literature regarding the effect of coronavirus disease 19 (COVID-19) infection on subsequent in vitro fertilization (IVF) cycle attempt. We, therefore, aim to assess the influence of COVID-19 infection on IVF treatments. DESIGN An observational study. SETTING A tertiary, university-affiliated medical center. PATIENTS AND METHODS All consecutive couples undergoing ovarian stimulation (OS) for IVF, before and after recovering from COVID-19 infection, and reached the ovum pick-up (OPU) stage. The stimulation characteristics and embryological variables of couples undergoing IVF treatments after recovering from COVID-19 infection were assessed and compared to their IVF cycles prior to COVID-19 infection. MAIN OUTCOME MEASURES Stimulation characteristics and embryological variables. RESULTS Nine couples (seven with the female partner infection and two with the male partner) resumed IVF treatment 8-92 d after recovering from the COVID-19 infection (negative polymerase chain reaction [PCR]). No in-between cycles differences were observed in OS and embryological variables between the cycles before and after recovering from the COVID-19 infection, except for a significantly lower proportion of top-quality embryos. CONCLUSIONS COVID-19 infection did not affect patients' performance or ovarian reserve in their immediate subsequent IVF cycle, except for a reduced proportion of top-quality embryos (TQEs). We therefore suggest, to postpone IVF treatment for a least 3 months (duration of folliculogenesis and spermatogenesis) after recovering from COVID-19 infection, aiming to recruit healthy gametes that were not exposed to COVID-19 infection during their development.
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Affiliation(s)
- Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aliza Segev-Zahav
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adva Aizer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Santamaria X, Simón C. Endometrial Factor in Unexplained Infertility and Recurrent Implantation Failure. Semin Reprod Med 2021; 39:227-232. [PMID: 34425598 DOI: 10.1055/s-0041-1735199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Unexplained infertility (UI) and recurrent implantation failure (RIF) are diagnoses based on failed pregnancy attempts within current infertility treatment models. Both diagnoses are made when fertility is unexplained based on current diagnostic methods and has no clear cause; UI is diagnosed when testing is inconclusive, and RIF is diagnosed after three failed in vitro fertilization cycles. In both cases, interventions are often introduced without an understanding of the cause of the infertility, frequently leading to frustration for patients and caregivers. Here, we review evidence to support an influence of endometrial factor in patients given these poorly defined diagnoses and possible treatments targeting the endometrium to improve outcomes in these patients.
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Affiliation(s)
- Xavier Santamaria
- Igenomix Foundation, INCLIVA Health Research Institute, Valencia, Spain.,Vall Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Carlos Simón
- Igenomix Foundation, INCLIVA Health Research Institute, Valencia, Spain.,Department of Obstetrics and Gynecology, University of Valencia, Valencia, Spain.,Department of Obstetrics and Gynecology, BIDMC, Harvard University, Boston
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8
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Garg I, Shekhar R, Sheikh AB, Pal S. COVID-19 Vaccine in Pregnant and Lactating Women: A Review of Existing Evidence and Practice Guidelines. Infect Dis Rep 2021; 13:685-699. [PMID: 34449637 PMCID: PMC8395843 DOI: 10.3390/idr13030064] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 01/21/2023] Open
Abstract
Coronavirus 2019 (COVID-19) has created a global pandemic that is devastating human lives, public healthcare systems, and global economies. Multiple effective and safe COVID-19 vaccines have been developed at an unprecedented speed due to the efforts of the scientific community, and collaboration between the federal government and pharmaceutical companies. However, the continued exclusion of pregnant and lactating women from the COVID anti-viral and vaccine trials has created the paradox of a lack of empirical evidence in a high-risk population. Based on the experience of similar prior vaccines, animal developmental and reproductive toxicology studies, and preliminary findings from human studies, various healthcare professional advisory committees (Advisory Committee on Immunization Practices, American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, and Academy of Breastfeeding Medicine) have issued guidance supporting COVID-19 vaccination in pregnant and lactating women. In this article, we summarize the available data on the efficacy and safety profile of COVID-19 vaccination in pregnant and lactating women, review the challenges of vaccine hesitancy, and include recommendations for healthcare providers.
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Affiliation(s)
- Ishan Garg
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN 55902, USA;
| | - Rahul Shekhar
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA; (R.S.); (A.B.S.)
| | - Abu B. Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA; (R.S.); (A.B.S.)
| | - Suman Pal
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA; (R.S.); (A.B.S.)
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9
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Bosselut H, Paulmyer-Lacroix O, Gnisci A, Bretelle F, Perrin J, Courbiere B. [Prognostic factors of live-birth after in vitro fertilization for unexplained infertility: A cohort study]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:601-607. [PMID: 33434750 DOI: 10.1016/j.gofs.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES For 15 to 30% of infertile couples, no etiology can be found, leading to the diagnosis of "unexplained infertility". The aim of our study was to identify prognostic factors for live birth following in vitro fertilization (IVF) for these couples. METHODS A retrospective, monocentric study on a cohort of couples undergoing IVF for unexplained infertility with the woman aged≤40 years old. Primary analysis compared couples with a live birth following IVF versus childless couples following IVF. RESULTS Between January 2014 and December 2018, 104 couples were included, 196 transvaginal oocyte pickup were performed, followed by 234 embryo transfers (fresh or cryopreserved) which resulted in 43 deliveries. The cumulative live birth rate was 40.4% per couple. Before IVF attempts, no clinical or paraclinical prognostic factors between the two groups was observed. However, multivariate analysis showed several biological factors of good prognosis in course of treatment, such as a higher number of mature oocytes and better quality embryos in "live birth" group. CONCLUSIONS For a couple, the chances of having a child following IVF unexplained infertility are 40.4%. However, no clinical characteristic enabled us to identify favourable or unfavourable prognosis factors before starting ART. The prognostic factors identified during IVF cycle are interesting to advise or not to pursue IVF.
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Affiliation(s)
- H Bosselut
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - O Paulmyer-Lacroix
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, département d'histologie et embryologie, Marseille, France
| | - A Gnisci
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - F Bretelle
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, unité de recherche sur les maladies infectieuses tropicales et émergentes, UM 63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France
| | - J Perrin
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, CNRS, IRD, Avignon université, IMBE, Marseille, France
| | - B Courbiere
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, CNRS, IRD, Avignon université, IMBE, Marseille, France
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Orvieto R, Noach-Hirsh M, Segev-Zahav A, Haas J, Nahum R, Aizer A. Does mRNA SARS-CoV-2 vaccine influence patients' performance during IVF-ET cycle? Reprod Biol Endocrinol 2021; 19:69. [PMID: 33985514 PMCID: PMC8116639 DOI: 10.1186/s12958-021-00757-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE No information exists in the literature regarding the effect of mRNA SARS-CoV-2 vaccine on subsequent IVF cycle attempt. We therefore aim to assess the influence of mRNA SARS-CoV-2 vaccine on IVF treatments. DESIGN An observational study. SETTING A tertiary, university-affiliated medical center. PATIENTS AND METHODS All couples undergoing consecutive ovarian stimulation cycles for IVF before and after receiving mRNA SARS-CoV-2 vaccine, and reached the ovum pick-up (OPU) stage. The stimulation characteristics and embryological variables of couples undergoing IVF treatments after receiving mRNA SARS-CoV-2 vaccine were assessed and compared to their IVF cycles prior to vaccination. MAIN OUTCOME MEASURES Stimulation characteristics and embryological variables. RESULTS Thirty-six couples resumed IVF treatment 7-85 days after receiving mRNA SARS-CoV-2 vaccine. No in-between cycles differences were observed in ovarian stimulation and embryological variables before and after receiving mRNA SARS-CoV-2 vaccination. CONCLUSIONS mRNA SARS-CoV-2 vaccine did not affect patients' performance or ovarian reserve in their immediate subsequent IVF cycle. Future larger studies with longer follow-up will be needed to validate our observations.
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Affiliation(s)
- Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Meirav Noach-Hirsh
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aliza Segev-Zahav
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jigal Haas
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ravit Nahum
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adva Aizer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Satwik R, Kochhar M. Unexplained infertility categorization based on female laparoscopy and total motile sperm count, and its impact on cumulative live-births after one in-vitro fertilization cycle. A retrospective cohort study involving 721 cycles. Reprod Med Biol 2021; 20:190-198. [PMID: 33850452 PMCID: PMC8022093 DOI: 10.1002/rmb2.12368] [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: 09/22/2020] [Revised: 12/18/2020] [Accepted: 01/10/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine how subcategorizing unexplained infertility based on female laparoscopy and total-motile-sperm-count assessment would impact cumulative live-births after one in-vitro fertilization (IVF) cycle. METHODS Seven hundred twenty one IVF cycles from Jan 2014-April 2019 performed at a single-center were retrospectively analyzed. Couples with unexplained infertility having normal uterine and endometrial morphology were subcategorized into three cohorts, UI (1): those with no tuboperitoneal pathology on laparoscopy and total-motile-sperm-count (TMSC) ≧20 million: n = 103; UI (2): tuboperitoneal pathology on laparoscopy or TMSC <20 million, n = 86; and UI(3): tuboperitoneal status not known: n = 114. Controls were severe male factor, bilateral tubal block, and grade 3/4 endometriosis: n = 418. Primary Outcome was cumulative-live-birth-per-initiated-IVF cycle (CLBR). Odds ratio for live-births were adjusted for confounding factors. RESULTS The CLBR in UI1 cohort was significantly lower than controls (29.1% vs 39; OR = 0.62; 95%CI = 0.39-0.98; P = .04); but similar in UI2 and UI3 vs. controls. (37.2% vs 39.95%; OR = 0.89, 95%CI = 0.55-1.44; P = .89) and (38.6% vs 39.95%; OR = 0.98, 95%CI = 0.64-1.55; P = .98). After adjusting for age, infertility duration, past live-births, and AMH, the adjusted odds for CLBR in UI1 was 0.48 (95%CI = 0.28-0.82; P = .007). CONCLUSIONS Unexplained infertility when defined after a normal laparoscopy and TMSC significantly lowered cumulative-live-births-per-initiated-IVF cycle when compared with traditional diagnosis of tubal, endometriosis, or male factor infertility. In UI subcategory with abnormal laparoscopy or TMSC, CLBR remained unaffected. This information could be useful for counseling couples prior to IVF. Large-scale prospective studies are needed to confirm this observation.
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Affiliation(s)
- Ruma Satwik
- Centre of IVF and Human ReproductionInstitute of Obstetrics and GynaecologySir Ganga Ram HospitalNew DelhiIndia
| | - Mohinder Kochhar
- Centre of IVF and Human ReproductionInstitute of Obstetrics and GynaecologySir Ganga Ram HospitalNew DelhiIndia
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12
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Kamath MS, Rikken JFW, Bosteels J. Does Laparoscopy and Hysteroscopy Have a Place in the Diagnosis of Unexplained Infertility? Semin Reprod Med 2020; 38:29-35. [PMID: 33080633 DOI: 10.1055/s-0040-1718942] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The standard fertility workup includes assessment of ovulation, semen analysis, and evaluation of tubal patency. If the fertility workup is found to be normal, a diagnosis of unexplained infertility is made. The role of laparoscopy in fertility workup has been a matter of debate. The current review presents the evidence for and against laparoscopy and hysteroscopy during fertility workup and subsequently prior to fertility treatment. After appraising the literature, we found the role of diagnostic laparoscopy in fertility workup is limited and is dependent on factors like prevalence of pelvic infection, setting, and availability of expertise. Moreover, whenever a laparoscopy is planned as a part of the fertility workup, the preparation should include ability to carry out simultaneous therapeutic intervention to maximize the benefit. Similarly, the routine use of hysteroscopy in women with unexplained infertility cannot be recommended. There is a need to investigate the impact of choice of tubal test on chances of spontaneous conception and treatment outcomes in women with unexplained infertility. Our future research agenda should also include high-quality multicenter randomized trials assessing the cost-effectiveness of screening and operative hysteroscopy prior to intrauterine insemination or in vitro fertilization.
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Affiliation(s)
- Mohan S Kamath
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
| | - Judith F W Rikken
- Center for Reproductive Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jan Bosteels
- Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium.,Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Department of Development and Regeneration, Gent University, Gent, Belgium
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13
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Abdallah KS, Hunt S, Abdullah SA, Mol BWJ, Youssef MA. How and Why to Define Unexplained Infertility? Semin Reprod Med 2020; 38:55-60. [PMID: 33058088 DOI: 10.1055/s-0040-1718709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Unexplained infertility represents up to 30% of all cases of infertility. It is a diagnosis of exclusion, where no cause for infertility may be identified in the investigation of the couple, be it anovulation, fallopian tube blockage, or severe male factor. Unexplained infertility therefore cannot be considered a diagnosis to which a specific treatment is directed, rather that it indicates a failure to reach a diagnosis of the true cause of infertility. In this review, we explore the evidence base and potential limitations of the current routine infertility assessment. We also aim to highlight the importance of considering the prognosis of each individual couple through the process of assessment and propose a reconsidered approach to treatment, targeted to the prognosis rather than the diagnosis. Ultimately, a better understanding of the mechanisms of infertility will reduce the number of couples diagnosed with "unexplained" infertility.
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Affiliation(s)
- Karim S Abdallah
- Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Obstetrics and Gynecology, Monash University, Clayton, Australia
| | - Sarah Hunt
- Department of Obstetrics and Gynecology, Monash University, Clayton, Australia.,Department of Obstetrics and Gynecology, Monash Health, Clayton, Australia.,Monash IVF, Richmond, Australia
| | - Sayed A Abdullah
- Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ben W J Mol
- Department of Obstetrics and Gynecology, Monash University, Clayton, Australia.,Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, United Kingdom
| | - Mohamed A Youssef
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
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Siristatidis C, Pouliakis A, Sergentanis TN. Special characteristics, reproductive, and clinical profile of women with unexplained infertility versus other causes of infertility: a comparative study. J Assist Reprod Genet 2020; 37:1923-1930. [PMID: 32504303 DOI: 10.1007/s10815-020-01845-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/28/2020] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To investigate whether women with unexplained infertility (UI) demonstrate different demographic and IVF characteristics compared to those with other causes of infertility. METHODS Data on 245 couples that underwent a total of 413 IVF/ICSI cycles were analyzed (UI 114 cycles, 73 women; anovulation (PCO/PCOS) 83 cycles, 51 women; tubal factor 85 cycles, 47 women; male factor 131 cycles, 74 women). Features of UI were compared versus other infertility groups, after adjustment for multiple comparisons. Generalized least squares (GLS) and random-effects logistic regression analysis were also performed. RESULTS Live birth rates, consisting of the primary outcome, were similar in all compared infertility groups. Compared to male infertility, UI was associated with woman's older age at cycle, lower body mass index (BMI), and higher follicle-stimulating hormone (FSH). Compared to tubal infertility, UI was linked to lower endometrial thickness at oocyte retrieval and lower BMI; compared to anovulatory infertility related to PCO/PCOS, UI was linked to woman's older age, more frequent smoking, and poorer ovarian reserve tests (FSH and antral follicle count). After adjustment for other types of infertility, woman's age, age at menarche, and FSH levels, anovulatory infertility presented with higher odds of clinical pregnancy compared to UI (adjusted OR = 2.13, 95% C: 1.01-4.52). CONCLUSIONS Infertile women with UI undergoing assisted reproduction demonstrate different demographic and clinical characteristics compared to those of other causes of infertility, albeit live birth rates are similar.
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Affiliation(s)
- Charalampos Siristatidis
- Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini Street, Chaidari, 12642, Athens, Greece.
- Assisted Reproducton Unit, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Abraham Pouliakis
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital, 1 Rimini Street, Chaidari, 12642, Athens, Greece
| | - Theodoros N Sergentanis
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, 80 Vas. Sofias Ave, 11528, Athens, Greece
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Affiliation(s)
- Norbert Gleicher
- The Center for Human Reproduction, New York, NY 10021, USA; Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, NY, USA; Department of Obstetrics and Gynecology, Vienna University of Medicine, Vienna, Austria.
| | - Vitaly A Kuhnir
- The Center for Human Reproduction, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Wake Forest University, Winston Salem, NC, USA
| | - David H Barad
- Department of Obstetrics and Gynecology, Vienna University of Medicine, Vienna, Austria
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16
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Chen D, Zhang Z, Chen B, Ji D, Hao Y, Zhou P, Wei Z, Cao Y. Altered microRNA and Piwi-interacting RNA profiles in cumulus cells from patients with diminished ovarian reserve. Biol Reprod 2018. [PMID: 28651359 DOI: 10.1093/biolre/iox062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Diminished ovarian reserve (DOR) is defined as decreased number or quality of follicles and oocytes in a woman at childbearing age. It is estimated that up to 10% of women in the general population may suffer from DOR. This study aims to comprehensively characterize microRNA (miRNA) and Piwi-interacting RNA (piRNA) expression profiles in cumulus cells of DOR patients. Cumulus cells were collected from 20 women of similar chronological age who received assisted reproductive technology treatment: 10 with DOR and 10 with normal ovarian reserve (NOR). The small RNAs were extracted from each sample and reverse transcribed. Deep sequencing and bioinformatic analysis were performed to identify the small noncoding RNA profiles. The rRNAs were the most abundant small RNA class in cumulus cells derived from human MII oocytes, following were miRNAs and tRNAs. Twenty-six piRNAs, 79 annotated miRNAs, and 5 novel miRNAs were identified differentially expressed. In DOR group, the chromosomal strand bias patterns of piRNAs on chromosome 1, 3, 5, and X were distinct from its counterpart in NOR group. The involved biological pathways from the putative target genes of differentially expressed miRNAs were enriched by using GO analysis and KEGG pathway annotations, and mTOR pathway and meiosis-associated biological processes were enriched. This study provided additional information on the dysfunctions of cumulus cells in patients with diminished ovarian reserve. Future investigations will involve the characterization of specific functional roles of noncoding small RNA in ovarian reserve regulation.
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Affiliation(s)
- Dawei Chen
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China.,Anhui Provincial Engineering Technology Research Center for Bio-preservation and Artificial Organs, Hefei, China
| | - Zhiguo Zhang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China.,Anhui Provincial Engineering Technology Research Center for Bio-preservation and Artificial Organs, Hefei, China
| | - Beili Chen
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China.,Anhui Provincial Engineering Technology Research Center for Bio-preservation and Artificial Organs, Hefei, China
| | - Dongmei Ji
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China.,Anhui Provincial Engineering Technology Research Center for Bio-preservation and Artificial Organs, Hefei, China
| | - Yan Hao
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China.,Anhui Provincial Engineering Technology Research Center for Bio-preservation and Artificial Organs, Hefei, China
| | - Ping Zhou
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China.,Anhui Provincial Engineering Technology Research Center for Bio-preservation and Artificial Organs, Hefei, China
| | - Zhaolian Wei
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China.,Anhui Provincial Engineering Technology Research Center for Bio-preservation and Artificial Organs, Hefei, China
| | - Yunxia Cao
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China.,Anhui Provincial Engineering Technology Research Center for Bio-preservation and Artificial Organs, Hefei, China
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17
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Hosseini S, Shokri F, Pour SA, Khoshnoodi J, Jeddi-Tehrani M, Zarnani AH. Diminished Frequency of Menstrual and Peripheral Blood NKT-Like Cells in Patients With Unexplained Recurrent Spontaneous Abortion and Infertile Women. Reprod Sci 2018; 26:97-108. [PMID: 29576002 DOI: 10.1177/1933719118766261] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Systemic monitoring of immune system may not precisely outline the local immune status in the uterus. This survey is a continuation of our previous studies on potential usefulness of menstrual blood (MB) immunophenotyping as a tool for investigation of immunological disturbances in pregnancy-related disorders. Peripheral blood (PB) and MB from healthy fertile (n = 15), unexplained recurrent spontaneous abortion (URSA; n = 15), and unexplained infertile women (n = 8) were collected simultaneously in the second day of their menstrual cycle and frequency of natural killer T (NKT)-like cell subpopulations were assessed by flow cytometry. Menstrual blood of all experimental groups contained higher percentage of TCRαβ+, CD45RO+, and CD16- NKT-like cells compared to corresponding PB. Frequency of MB NKT-like cells in unexplained infertile participants was lower than fertile and URSA groups. Compared to normal participants, patients with URSA had lower frequency of PB TCRαβ+ and higher CD16+, while in infertile woman frequencies of PB CD45RO+, CD45RO-, CD16-, IL17+, and MB CD45RO+ NKT-like cells were lower. Although, PB and MB seemingly have the same histological nature, our results showed that MB contained different composition of NKT-like subsets with different cytokine profiles and could be viewed as one potential biological sample for evaluation of patients with infertility and URSA.
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Affiliation(s)
- Samira Hosseini
- 1 Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fazel Shokri
- 1 Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheila Ansari Pour
- 2 Reproductive Immunology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Jalal Khoshnoodi
- 1 Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Jeddi-Tehrani
- 3 Monoclonal Antibody Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Amir-Hassan Zarnani
- 1 Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,2 Reproductive Immunology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran.,4 Immunology Research Center, Iran University of Medical Sciences, Tehran, Iran
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Yücel B, Demirel E, Kelekci S, Shawki O. Hysteroscopic evaluation of tubal peristaltic dysfunction in unexplained infertility. J OBSTET GYNAECOL 2018; 38:511-515. [PMID: 29557219 DOI: 10.1080/01443615.2017.1303469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
It has been realised that rhythmic peristalsis of the ostia and tubes can be observed during hysteroscopy. The aim of this study was to examine the presence of tubal peristaltic dysfunction in unexplained infertility (UI). Hysteroscopy was performed in 35 women with UI and in 37 healthy fertile women. Bilateral tubal peristalses were assessed hysteroscopically by the observation of methylene blue injection and its transport to the Fallopian tubes. Tubal patency was evaluated with laparoscopic chromopertubation. Two women in control group (6.67%) and eight women in UI group (30.77%) had no tubal peristalsis, at least one tube with normal tubal patency. The difference was statistically significant (p = .019). Tubal peristaltic dysfunction may be a hidden cause of subfertility in women with bilateral patent Fallopian tubes. There is a definite need for larger trials to identify tubal peristaltic dysfunction as a cause of UI. Impact statement What is already known on this subject? Unexplained infertility has no identified pathophysiologic basis. It has been realised that rhythmic peristalsis of the ostia and tubes can be observed during hysteroscopy. What do the results of this study add? Tubal peristaltic dysfunction was detected in two tubes (3.70%) in a control group and nine tubes (19.57%) in women with unexplained infertility, when the tubes were patent. The difference was statistically significant (p = .012). What are the implications of these findings for clinical practice and/or further research? In cases of bilateral patent Fallopian tubes such as in unexplained infertility, tubal peristaltic dysfunction may be a hidden additional cause of subfertility.
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Affiliation(s)
- Burak Yücel
- a Clinic of Obstetrics and Gynaecology , Kanuni Sultan Suleyman Research and Training Hospital , Istanbul , Turkey
| | - Emine Demirel
- b Department of Obstetrics and Gynaecology , School of Medicine, Katip Celebi University , Izmir , Turkey
| | - Sefa Kelekci
- b Department of Obstetrics and Gynaecology , School of Medicine, Katip Celebi University , Izmir , Turkey
| | - Osama Shawki
- c Department of Obstetrics and Gyneacology , School of Medicine, Cairo University , Cairo , Egypt
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Brazdova A, Senechal H, Peltre G, Poncet P. Immune Aspects of Female Infertility. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 10:1-10. [PMID: 27123194 PMCID: PMC4845518 DOI: 10.22074/ijfs.2016.4762] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 12/31/2014] [Indexed: 12/24/2022]
Abstract
Immune infertility, in terms of reproductive failure, has become a serious health issue involving approximately 1 out of 5 couples at reproductive age. Semen that is defined as a complex fluid containing sperm, cellular vesicles and other cells and components, could sensitize the female genital tract. The immune rejection of male semen in the female reproductive tract is explained as the failure of natural tolerance leading to local and/or systemic immune response. Present active immune mechanism may induce high levels of anti-seminal/sperm antibodies. It has already been proven that iso-immunization is associated with infertility. Comprehensive studies with regards to the identification of antibody-targets and the determination of specific antibody class contribute to the development of effective immuno-therapy and, on the other hand, potential immuno-contraception, and then of course to complex patient diagnosis. This review summarizes the aspects of female immune infertility.
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Affiliation(s)
- Andrea Brazdova
- Department of Biochemistry, Allergy and Environment, Armand-Trousseau Hospital, Paris, France
| | - Helene Senechal
- Department of Biochemistry, Allergy and Environment, Armand-Trousseau Hospital, Paris, France
| | - Gabriel Peltre
- Department of Biochemistry, Allergy and Environment, Armand-Trousseau Hospital, Paris, France
| | - Pascal Poncet
- Department of Biochemistry, Allergy and Environment, Armand-Trousseau Hospital, Paris, France
- Department of Infection and Epidemiology, Pasteur Institute, Paris, France
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20
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Hosseini S, Shokri F, Ansari Pour S, Jeddi-Tehrani M, Nikoo S, Yousefi M, Zarnani AH. A shift in the balance of T17 and Treg cells in menstrual blood of women with unexplained recurrent spontaneous abortion. J Reprod Immunol 2016; 116:13-22. [PMID: 27128988 DOI: 10.1016/j.jri.2016.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 02/15/2016] [Accepted: 03/10/2016] [Indexed: 12/22/2022]
Abstract
To determine usefulness of menstrual blood for assessment of differential frequency of T cell subsets, peripheral blood (PB) and menstrual blood (MB) from healthy fertile (n=15), unexplained recurrent spontaneous abortion (URSA) women (n=15) and unexplained infertile women (n=8) were collected in the second day of menstrual bleeding. Frequency of T cell subsets was measured by flow cytometry. URSA and unexplained infertile patients had higher frequency of TCRαβ(+)CD3(+)CD56(-) and CD45RO(+) T cells as well as CD45RO(+)/CD45RO(-) ratio in PB as compared to MB. Frequency of CD3(+)TCRγδ(+) cells in PB of unexplained infertile and MB of URSA patients were significantly lower than that in fertile group. In all groups MB contained higher percentage of CD4(+)CD25(+)Foxp3(+) regulatory and lower percentages of CD16(+) T cells compared to PB. T17 cells (CD3(+)CD56(-)IL-17(+)) was found to be significantly higher in MB of only fertile and unexplained infertile subjects and not URSA patients in comparison with PB. Compared to PB, only fertile women had higher T17:Treg ratio in their MB. URSA women had significantly lower MB T17 cells and T17:Treg ratio compared to those in fertile and unexplained infertile women. Based on the findings presented here, we speculate that MB has its own unique immune milieu which is not solely continuation of the immune environment of secretory endometrium. Indeed, immunophenotyping of MB immune cells could potentially be a useful tool for investigation of immunological disturbances in pregnancy-related disorders.
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Affiliation(s)
- Samira Hosseini
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fazel Shokri
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Soheila Ansari Pour
- Avicenna Infertility Clinic, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Mahmood Jeddi-Tehrani
- Monoclonal Antibody Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Shohreh Nikoo
- Reproductive Immunology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Mehdi Yousefi
- Immunology Research Center, Tabriz University of Medical Science, Tehran, Iran
| | - Amir-Hassan Zarnani
- Reproductive Immunology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran; Immunology Research Center, Iran University of Medical Sciences, Tehran, Iran.
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22
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Gupta S, Ghulmiyyah J, Sharma R, Halabi J, Agarwal A. Power of proteomics in linking oxidative stress and female infertility. BIOMED RESEARCH INTERNATIONAL 2014; 2014:916212. [PMID: 24900998 PMCID: PMC4036646 DOI: 10.1155/2014/916212] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/30/2014] [Accepted: 04/07/2014] [Indexed: 01/11/2023]
Abstract
Endometriosis, PCOS, and unexplained infertility are currently the most common diseases rendering large numbers of women infertile worldwide. Oxidative stress, due to its deleterious effects on proteins and nucleic acids, is postulated to be the one of the important mechanistic pathways in differential expression of proteins and in these diseases. The emerging field of proteomics has allowed identification of proteins involved in cell cycle, as antioxidants, extracellular matrix (ECM), cytoskeleton, and their linkage to oxidative stress in female infertility related diseases. The aim of this paper is to assess the association of oxidative stress and protein expression in the reproductive microenvironments such as endometrial fluid, peritoneal fluid, and follicular fluid, as well as reproductive tissues and serum. The review also highlights the literature that proposes the use of the fertility related proteins as potential biomarkers for noninvasive and early diagnosis of the aforementioned diseases rather than utilizing the more invasive methods used currently. The review will highlight the power of proteomic profiles identified in infertility related disease conditions and their linkage with underlying oxidative stress. The power of proteomics will be reviewed with regard to eliciting molecular mechanisms for early detection and management of these infertility related conditions.
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Affiliation(s)
- Sajal Gupta
- Center for Reproductive Medicine, Cleveland Clinic Foundation, 10681 Carnegie Avenue, Desk X11, Cleveland, OH 44195, USA
| | - Jana Ghulmiyyah
- Center for Reproductive Medicine, Cleveland Clinic Foundation, 10681 Carnegie Avenue, Desk X11, Cleveland, OH 44195, USA
| | - Rakesh Sharma
- Center for Reproductive Medicine, Cleveland Clinic Foundation, 10681 Carnegie Avenue, Desk X11, Cleveland, OH 44195, USA
| | - Jacques Halabi
- Center for Reproductive Medicine, Cleveland Clinic Foundation, 10681 Carnegie Avenue, Desk X11, Cleveland, OH 44195, USA
| | - Ashok Agarwal
- Center for Reproductive Medicine, Cleveland Clinic Foundation, 10681 Carnegie Avenue, Desk X11, Cleveland, OH 44195, USA
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24
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Gleicher N, Weghofer A, Barad D. Female infertility due to abnormal autoimmunity: frequently overlooked and greatly underappreciated. Part I. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2.4.453] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Younis JS, Ben-Ami M, Izhaki I, Jadaon J, Brenner B, Sarig G. The association between poor ovarian response and thrombophilia in assisted reproduction. Eur J Obstet Gynecol Reprod Biol 2013; 166:65-9. [DOI: 10.1016/j.ejogrb.2012.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 08/26/2012] [Accepted: 09/21/2012] [Indexed: 11/24/2022]
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26
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Kamath MS, Bhattacharya S. Demographics of infertility and management of unexplained infertility. Best Pract Res Clin Obstet Gynaecol 2012; 26:729-38. [DOI: 10.1016/j.bpobgyn.2012.08.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 08/08/2012] [Indexed: 11/30/2022]
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27
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Ray A, Shah A, Gudi A, Homburg R. Unexplained infertility: an update and review of practice. Reprod Biomed Online 2012; 24:591-602. [DOI: 10.1016/j.rbmo.2012.02.021] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 02/20/2012] [Accepted: 02/23/2012] [Indexed: 12/15/2022]
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28
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Altmäe S, Salumets A, Bjuresten K, Kallak TK, Wånggren K, Landgren BM, Hovatta O, Stavreus-Evers A. Tissue Factor and Tissue Factor Pathway Inhibitors TFPI and TFPI2 in Human Secretory Endometrium—Possible Link to Female Infertility. Reprod Sci 2011; 18:666-78. [DOI: 10.1177/1933719111400633] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Signe Altmäe
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynaecology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Competence Centre on Reproductive Medicine and Biology, Tartu, Estonia
| | - Andres Salumets
- Competence Centre on Reproductive Medicine and Biology, Tartu, Estonia
- Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia
| | - Kerstin Bjuresten
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynaecology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Theodora Kunovac Kallak
- Department of Women’s and Children’s Health, Uppsala University, Akademiska Sjukhuset, Uppsala, Sweden
| | - Kjell Wånggren
- Department of Women’s and Children’s Health, Uppsala University, Akademiska Sjukhuset, Uppsala, Sweden
| | - Britt-Marie Landgren
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynaecology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Outi Hovatta
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynaecology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Anneli Stavreus-Evers
- Department of Women’s and Children’s Health, Uppsala University, Akademiska Sjukhuset, Uppsala, Sweden
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Barad DH, Weghofer A, Gleicher N. Utility of age-specific serum anti-Müllerian hormone concentrations. Reprod Biomed Online 2011; 22:284-91. [PMID: 21269880 DOI: 10.1016/j.rbmo.2010.12.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 11/30/2010] [Accepted: 12/01/2010] [Indexed: 10/18/2022]
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30
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Gleicher N, Weghofer A, Barad DH. Defining ovarian reserve to better understand ovarian aging. Reprod Biol Endocrinol 2011; 9:23. [PMID: 21299886 PMCID: PMC3042920 DOI: 10.1186/1477-7827-9-23] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 02/07/2011] [Indexed: 11/10/2022] Open
Abstract
Though a widely utilized term and clinical concept, ovarian reserve (OR) has been only inadequately defined. Based on Medline and PubMed searches we here define OR in its various components, review genetic control of OR, with special emphasis on the FMR1 gene, and discuss whether diminished OR (DOR) is treatable. What is generally referred to as OR reflects only a small portion of total OR (TOR), a pool of growing (recruited) follicles (GFs) at different stages of maturation. Functional OR (FOR) depends on size of the follicle pool at menarche and the follicle recruitment rate. Both vary between individuals and, at least partially, are under genetic control. The FMR1 gene plays a role in defining FOR at all ages. Infertility treatments have in the past almost exclusively only centered on the last two weeks of folliculogenesis, the gonadotropin-sensitive phase. Expansions of treatments into earlier stages of maturation will offer opportunity to significantly improve ovarian stimulation protocols, especially in women with DOR. Dehydroepiandrosterone (DHEA) may represent a first such intervention. Data generated in DHEA-supplemented women, indeed, suggest a new ovarian aging concept, based on aging of ovarian environments and not, as currently is believed, aging oocytes.
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Affiliation(s)
- Norbert Gleicher
- Center for Human Reproduction - New York, New York, NY, USA
- Foundation for Reproductive Medicine, New York, NY, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Andrea Weghofer
- Center for Human Reproduction - New York, New York, NY, USA
- Department of Obstetrics and Gynecology, University of Vienna School of Medicine, Vienna, Austria
| | - David H Barad
- Center for Human Reproduction - New York, New York, NY, USA
- Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Obstetrics Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Altmäe S, Kallak TK, Fridén B, Stavreus-Evers A. Variation in hyaluronan-binding protein 2 (HABP2) promoter region is associated with unexplained female infertility. Reprod Sci 2010; 18:485-92. [PMID: 21098215 DOI: 10.1177/1933719110388849] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We set up to analyze polymorphisms in hyaluronan-binding protein 2 (HABP2) gene in healthy fertile women (n = 158) and in women with unexplained infertility (n = 116) and to investigate the potential role of HABP2 in receptive endometrium. Minor rs1157916 A and the major rs2240879 A alleles together with AA genotypes were significantly less frequent in infertile women than in controls. Immunohistochemistry analysis of endometrial HABP2 expression at the time of implantation identified significantly lower HABP2 protein level in infertile women in stroma and vessels than in fertile women. Migration assay analysis of cultured trophoblast and endothelial cells toward HABP2 protein referred to the function of HABP2 in endometrial endothelial cells. In conclusion, our results indicate that polymorphisms in the regulatory region of HABP2 gene could influence gene expression levels in the receptive endometrium and could thereby be one reason for infertility complications in women with unexplained infertility. Additionally, HABP2 protein involvement in endometrial angiogenesis is proposed.
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Affiliation(s)
- Signe Altmäe
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
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The role of hyaluronic acid binding assay in choosing the fertilization method for patients undergoing IVF for unexplained infertility. J Assist Reprod Genet 2010; 28:49-54. [PMID: 20842418 DOI: 10.1007/s10815-010-9479-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 09/03/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Patients with unexplained infertility may have fertilization problems. Split fertilization (ICSI and conventional IVF on sibling oocytes) is often used to avoid poor fertilization. Our aim was to assess the ability of hyaluronic acid binding (HA-binding) assay to predict spontaneous fertilization during IVF. METHODS Prospective, blinded, controlled trial. Patients undergoing their first IVF cycle for unexplained infertility were eligible. Split fertilization was used. IVF and ICSI fertilization rates and embryo development based on 3 HA-binding cut-offs (< 60%; 60-80%; >80%) were compared. RESULTS ICSI fertilization was higher than IVF, but none of the HA-binding cut-off levels predicted those cases where IVF was less effective, therefore ICSI only would have lead to improved outcome. Embryo development and morphology were similar in all cut-off groups. CONCLUSIONS HA-binding did not predict spontaneous fertilization in patients with unexplained infertility undergoing IVF treatment. When it was used for "screening" it did not help to select the method of fertilization.
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Jaques AM, Amor DJ, Baker HWG, Healy DL, Ukoumunne OC, Breheny S, Garrett C, Halliday JL. Adverse obstetric and perinatal outcomes in subfertile women conceiving without assisted reproductive technologies. Fertil Steril 2010; 94:2674-9. [PMID: 20381039 DOI: 10.1016/j.fertnstert.2010.02.043] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 02/17/2010] [Accepted: 02/18/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether adverse perinatal outcomes are increased in subfertile women. DESIGN Cohort study. SETTING Two tertiary assisted reproductive technologies (ART) centers; Victorian births register. PATIENT(S) Records of women who registered with the clinics (1991-2000), but did not have an infant using ART, were linked to the birth register (1991-2004) to identify singleton non-ART births within 5 years of registration (N = 2171). Controls, matched by maternal age and year of infant's birth, were selected randomly from birth records (N = 4363). INTERVENTIONS None. MAIN OUTCOME MEASURE(S) Adverse obstetric and perinatal outcomes. RESULT(S) After adjusting for confounders, compared with controls, subfertile women had increased odds of hypertension or preeclampsia (adjusted odds ratio [OR] 1.29, 1.02-1.61), antepartum hemorrhage (adjusted OR 1.41, 1.05-1.89), perinatal death (adjusted OR 2.19, 1.10-4.36), low birth weight (adjusted OR 1.44, 1.11-1.85), preterm birth <37 weeks (adjusted OR 1.32, 1.05-1.67) or <31 weeks (adjusted OR 2.37, 1.35-4.13), and cesarean delivery (adjusted OR 1.56, 1.37-1.77). There was weak evidence for increased birth defects (adjusted OR 1.30, 0.98-1.72) and gestational diabetes (adjusted OR 1.25, 0.96-1.63). No increased risk was found for prelabor rupture of membranes, small for gestational age, or postpartum hemorrhage. CONCLUSION(S) Subfertile women with singleton births are at increased risk of several adverse outcomes. These risks should be considered during their antenatal care and when analyzing adverse effects of ART.
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Affiliation(s)
- Alice M Jaques
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
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Lee TH, Liu CH, Shih YT, Tsao HM, Huang CC, Chen HH, Lee MS. Magnetic-activated cell sorting for sperm preparation reduces spermatozoa with apoptotic markers and improves the acrosome reaction in couples with unexplained infertility. Hum Reprod 2010; 25:839-46. [DOI: 10.1093/humrep/deq009] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Oktay K, Kim JY, Barad D, Babayev SN. Association of BRCA1 mutations with occult primary ovarian insufficiency: a possible explanation for the link between infertility and breast/ovarian cancer risks. J Clin Oncol 2009; 28:240-4. [PMID: 19996028 DOI: 10.1200/jco.2009.24.2057] [Citation(s) in RCA: 269] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Germline mutations in BRCA genes are associated with breast and ovarian cancer susceptibility. Because infertility is associated with breast and ovarian cancer risks, we hypothesized that the mutations in the BRCA gene may be associated with low response to fertility treatments. METHODS We performed ovarian stimulation in 126 women with breast cancer by using letrozole and gonadotropins for the purpose of fertility preservation by embryo or oocyte cryopreservation. As surrogates of ovarian reserve, the oocyte yield and the incidence of low response were compared with ovarian stimulation according to BRCA mutation status. RESULTS Of the 82 women who met the inclusion criteria, 47 women (57%) had undergone BRCA testing, and 14 had a mutation in BRCA genes, of which two were of clinically undetermined significance. In BRCA mutation-positive patients, low ovarian response rate was significantly higher compared with BRCA mutation-negative patients (33.3 v 3.3%; P = .014) and with BRCA-untested women (2.9%; P = .012). All BRCA mutation-positive low responders had BRCA1 mutations, but low response was not encountered in women who were only BRCA2 mutation positive. Compared with controls, BRCA1 mutation- but not BRCA2 mutation-positive women produced lower numbers of eggs (7.4 [95% CI, 3.1 to 17.7] v 12.4 [95% CI, 10.8 to 14.2]; P = .025) and had as many as 38.3 times the odds ratio of low response (95% CI, 4.1 to 353.4; P = .001). CONCLUSION BRCA1 mutations are associated with occult primary ovarian insufficiency. This finding may, at least in part, explain the link between infertility and breast/ovarian cancer risks.
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Affiliation(s)
- Kutluk Oktay
- Institute for Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College-Westchester Medical Center, Valhalla, NY 10595, USA.
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Brovko AA, Tavokina LV, Sopko YA. Genetic factors of male infertility. The role of complex examination in the case of spermatogenesis disturbances. CYTOL GENET+ 2009. [DOI: 10.3103/s0095452709050119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Is the immunological noise of abnormal autoimmunity an independent risk factor for premature ovarian aging? Menopause 2009; 16:760-4. [PMID: 19197218 DOI: 10.1097/gme.0b013e318193c48b] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The risk for premature ovarian failure increases in association with two principal known etiologies: in the presence of excessive triple CGG expansions on the FMR1 (fragile X) gene (genetic etiology) and in association with a variety of autoimmune conditions (autoimmune etiology). To what degree milder forms of premature ovarian aging are also associated with these two etiologies is, however, unknown. METHODS We, therefore, investigated 119 consecutive, so identified, infertile women and statistically correlated by linear and logistic regression analyses ovarian function parameters to markers of a possible genetic etiology (number of CGG triple repeats on the FMR1 gene) and to markers of possible abnormal immune function (immune panel). RESULTS Sixty (50.4%) of 119 participants demonstrated at least one immune abnormality. Both groups did not differ statistically in age, mean follicle-stimulating hormone, estradiol, and antimüllerian hormone levels, although antimüllerian hormone suggested a trend toward higher levels in autoimmune participants (P = 0.19). Autoimmune participants also demonstrated lower mean triple CGG expansion sizes (P < 0.05) and included fewer women with greater than or equal to 35 triple repeats (relative risk, 4.0; 95% CI, 1.3-11.9; P < 0.01), previously reported to demarcate increased risk for premature ovarian aging. CONCLUSIONS Even minimal evidence of abnormal autoimmune function ("immunological noise") seems to increase risk toward premature ovarian aging, often manifesting as infertility. Evidence of abnormal autoimmune function, such as increased CGG triple expansion sizes, in young women, therefore, warrants vigilance for development of prematurely diminished ovarian reserve and infertility.
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Gleicher N, Weghofer A, Barad DH. A pilot study of premature ovarian senescence: I. Correlation of triple CGG repeats on the FMR1 gene to ovarian reserve parameters FSH and anti-Müllerian hormone. Fertil Steril 2009; 91:1700-6. [DOI: 10.1016/j.fertnstert.2008.01.098] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 01/30/2008] [Accepted: 01/30/2008] [Indexed: 10/22/2022]
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Do stimulation characteristics of the first in vitro fertilization cycle predict pregnancy in women of 40 years old and over? Fertil Steril 2009; 91:1311-3. [DOI: 10.1016/j.fertnstert.2008.01.094] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 01/24/2008] [Accepted: 01/24/2008] [Indexed: 11/27/2022]
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40
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Altmäe S, Stavreus-Evers A, Ruiz JR, Laanpere M, Syvänen T, Yngve A, Salumets A, Nilsson TK. Variations in folate pathway genes are associated with unexplained female infertility. Fertil Steril 2009; 94:130-7. [PMID: 19324355 DOI: 10.1016/j.fertnstert.2009.02.025] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 01/29/2009] [Accepted: 02/09/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate associations between folate-metabolizing gene variations, folate status, and unexplained female infertility. DESIGN An association study. SETTING Hospital-based IVF unit and university-affiliated reproductive research laboratories. PATIENT(S) Seventy-one female patients with unexplained infertility. INTERVENTION(S) Blood samples for polymorphism genotyping and homocysteine, vitamin B12, and folate measurements. MAIN OUTCOME MEASURE(S) Allele and genotype frequencies of the following polymorphisms: 5,10-methylenetetrahydrofolate reductase (MTHFR) 677C/T, 1298A/C, and 1793G/A, folate receptor 1 (FOLR1) 1314G/A, 1816delC, 1841G/A, and 1928C/T, transcobalamin II (TCN2) 776C/G, cystathionase (CTH) 1208G/T and solute carrier family 19, member 1 (SLC19A1) 80G/A, and concentrations of plasma homocysteine, vitamin B12, and serum folate. RESULT(S) MTHFR genotypes 677CT and 1793GA, as well as 1793 allele A were significantly more frequent among controls than in patients. The common MTHFR wild-type haplotype (677, 1298, 1793) CAG was less prevalent, whereas the rare haplotype CCA was more frequent in the general population than among infertility patients. The frequency of SLC19A1 80G/A genotypes differed significantly between controls and patients and the A allele was more common in the general population than in infertile women. Plasma homocysteine concentrations were influenced by CTH 1208G/T polymorphism among infertile women. CONCLUSION(S) Polymorphisms in folate pathway genes could be one reason for fertility complications in some women with unexplained infertility.
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Affiliation(s)
- Signe Altmäe
- Department of Clinical Science, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
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Patounakis G, Treff N, Tao X, Lonczak A, Scott RT, Frattarelli JL. The p53 codon 72 single nucleotide polymorphism lacks a significant effect on implantation rate in fresh in vitro fertilization cycles: an analysis of 1,056 patients. Fertil Steril 2008; 92:1290-1296. [PMID: 18930193 DOI: 10.1016/j.fertnstert.2008.07.1783] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2008] [Revised: 07/29/2008] [Accepted: 07/31/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether the p53 codon 72 single nucleotide polymorphism, a change of the amino acid arginine (Arg) to proline (Pro) resulting from a single nucleotide mutation of guanine (G) to cytosine (C), has a clinically significant effect on implantation rate in fresh IVF cycles. DESIGN Prospective cohort analysis. SETTING University-affiliated private IVF center. PATIENT(S) One thousand fifty-six female patients undergoing fresh nondonor IVF cycles. MAIN OUTCOME MEASURE(S) Embryo implantation rate. RESULT(S) Of the 1,056 patients (2,600 total embryos transferred) undergoing their first IVF cycle, 289 had no implantation events and attempted a second cycle. Of the 289 patients in their second cycle, 72 had no implantation events and attempted a third cycle. The p53 codon 72 single nucleotide polymorphism frequencies in the first cycle (homozygous major allele Arg/Arg [G_G] = 45%, heterozygous allele Arg/Pro [G_C] = 44%, and homozygous minor allele Pro/Pro [C_C] = 11%) did not differ significantly across subsequent IVF cycles. There was no statistically significant difference in embryo implantation rate with respect to the single nucleotide polymorphism. CONCLUSION(S) The p53 codon 72 single nucleotide polymorphism lacks a clinically significant effect on embryo implantation rate in patients undergoing fresh nondonor IVF cycles.
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Affiliation(s)
- George Patounakis
- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Nathan Treff
- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, New Jersey; Reproductive Medicine Associates of New Jersey, Morristown, New Jersey
| | - Xin Tao
- Reproductive Medicine Associates of New Jersey, Morristown, New Jersey
| | - Agnieszka Lonczak
- Reproductive Medicine Associates of New Jersey, Morristown, New Jersey
| | - Richard T Scott
- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, New Jersey; Reproductive Medicine Associates of New Jersey, Morristown, New Jersey
| | - John L Frattarelli
- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, New Jersey; Reproductive Medicine Associates of New Jersey, Morristown, New Jersey.
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Aghajanova L, Bjuresten K, Altmäe S, Landgren BM, Stavreus-Evers A. HB-EGF but not amphiregulin or their receptors HER1 and HER4 is altered in endometrium of women with unexplained infertility. Reprod Sci 2008; 15:484-92. [PMID: 18579857 DOI: 10.1177/1933719108314624] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Heparin-binding epidermal growth factor-like growth factor (HB-EGF) and its receptors (HER1 and HER4) play a role in the human implantation process. Amphiregulin is a member of the EGF family but with unknown function in human fertility. It has been suggested that some women with unexplained infertility have defective endometrial development. The aim of this study is to determine the presence of amphiregulin and the receptors HER1 and HER4 in normal human endometrium throughout the menstrual cycle. In addition, the present study aims to compare endometrium from women with unexplained infertility with endometrium from women with male factor infertility and healthy fertile controls. Immunohistochemistry and real-time polymerase chain reaction were used to determine the expression of HB-EGF, HER1, HER4, and amphiregulin. The stromal staining of HER1 and the epithelial staining of HER4 were most intense in the mid- and late-secretory-phase endometrium. Amphiregulin did not vary during the menstrual cycle. In the mid-secretory phase, the protein expression of HB-EGF was lower in endometrium from women with unexplained infertility versus normal endometrium and endometrium from women with male factor infertility. HB-EGF and HER4 mRNA expression in mid-secretory endometrium of women with unexplained and male factor infertility were increased compared with normal controls. Impaired endometrial expression of certain members of the EGF family may contribute to infertility in some women with unexplained infertility.
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Affiliation(s)
- Lusine Aghajanova
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynaecology, Karolinska Institutet, Stockholm, Sweden
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Bhattacharya S, Harrild K, Mollison J, Wordsworth S, Tay C, Harrold A, McQueen D, Lyall H, Johnston L, Burrage J, Grossett S, Walton H, Lynch J, Johnstone A, Kini S, Raja A, Templeton A. Clomifene citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial. BMJ 2008; 337:a716. [PMID: 18687718 PMCID: PMC2505091 DOI: 10.1136/bmj.a716] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the effectiveness of clomifene citrate and unstimulated intrauterine insemination with expectant management for the treatment of unexplained infertility. DESIGN Three arm parallel group, pragmatic randomised controlled trial. SETTING Four teaching hospitals and a district general hospital in Scotland. PARTICIPANTS Couples with infertility for over two years, confirmed ovulation, patent fallopian tubes, and motile sperm. INTERVENTION Expectant management, oral clomifene citrate, and unstimulated intrauterine insemination. MAIN OUTCOME MEASURES The primary outcome was live birth. Secondary outcome measures included clinical pregnancy, multiple pregnancy, miscarriage, and acceptability. RESULTS 580 women were randomised to expectant management (n=193), oral clomifene citrate (n=194), or unstimulated intrauterine insemination (n=193) for six months. The three randomised groups were comparable in terms of age, body mass index, duration of infertility, sperm concentration, and motility. Live birth rates were 32/193 (17%), 26/192 (14%), and 43/191 (23%), respectively. Compared with expectant management, the odds ratio for a live birth was 0.79 (95% confidence interval 0.45 to 1.38) after clomifene citrate and 1.46 (0.88 to 2.43) after unstimulated intrauterine insemination. More women randomised to clomifene citrate (159/170, 94%) and unstimulated intrauterine insemination (155/162, 96%) found the process of treatment acceptable than those randomised to expectant management (123/153, 80%) (P=0.001 and P<0.001, respectively). CONCLUSION In couples with unexplained infertility existing treatments such as empirical clomifene and unstimulated intrauterine insemination are unlikely to offer superior live birth rates compared with expectant management. TRIAL REGISTRATION ISRCT No: 71762042.
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Affiliation(s)
- S Bhattacharya
- Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen AB25 2ZD.
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Gleicher N, Weghofer A, Barad DH. A pilot study of premature ovarian senescence: II. Different genotype and phenotype for genetic and autoimmune etiologies. Fertil Steril 2008; 91:1707-11. [PMID: 18384784 DOI: 10.1016/j.fertnstert.2008.01.099] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 01/30/2008] [Accepted: 01/30/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess whether abnormal autoimmune function and number of triple CGG repeats on the FMR1 (fragile X) gene, both historically associated with risk toward premature ovarian senescence, represent independent risk factors. DESIGN Retrospective cohort study. SETTING Academically affiliated, private fertility center. PATIENT(S) Forty consecutive, new infertility patients, of which 11 presented with a primary diagnosis of repeat pregnancy loss, 23 with prematurely elevated, age-specific baseline follicle stimulating hormone (FSH) levels (i.e., premature ovarian aging) and 6 with premature ovarian failure. INTERVENTION(S) Determination of triple CGG repeats on both alleles of the FMR1 gene, assessment of ovarian reserve via FSH and anti-Müllerian hormone levels, and evaluation of autoimmune status by antiphospholipid antibody panel, antinuclear antibody panel, total immunoglobulin levels (IgG, IgM, IgA), thyroid antibodies (antiglobulin and antimicrosomal), antiovarian, and antiadrenal antibodies. RESULT(S) Twenty-two of 40 patients (55%) demonstrated autoimmune abnormalities. Women with and without autoimmune abnormalities did not differ in age. Patients with autoimmune abnormalities, however, demonstrated significantly lower FSH levels and higher anti-Mullerian hormone levels. Although triple repeats on the lower count allele (allele-1) of the FMR1 gene did not differ statistically, autoimmune patients demonstrated in the higher count allele (allele-2) significantly fewer triple repeats, significantly fewer triple repeats >or=30, and, in contrast to nonautoimmune patients, a normal mean level of triple repeats. CONCLUSION(S) Abnormal autoimmune function and expansions in triple CGG repeats on the FMR1 gene represent distinctively different etiologies for premature ovarian senescence in infertile patients and may, indeed, constitute its two principal causes.
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Affiliation(s)
- Norbert Gleicher
- Department of Obstetrics, Gynecology and Reproductive Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
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Nawroth F, Ludwig M. What can we expect if we measure hormones in eumenorrhoeic infertile patients? Reprod Biomed Online 2008; 16:621-6. [DOI: 10.1016/s1472-6483(10)60474-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gleicher N, Weghofer A, Barad D. Too old for IVF: are we discriminating against older women? J Assist Reprod Genet 2007; 24:639-44. [PMID: 18064561 DOI: 10.1007/s10815-007-9182-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 11/05/2007] [Indexed: 11/25/2022] Open
Abstract
In vitro fertilization (IVF) in women of advanced age (>42 years) represents only 5%, a comparatively minute part, of the national IVF experience in the United States (US). In view of evolving population dynamics, it, however, also represents proportionally a rather quickly expanding patient need. Because of access restrictions at many IVF programs, this market does not live up to its potential. As best demonstrated by the 2004 US National Summary and Fertility Clinic Report, which for the first time reported pregnancies and births above age 45 year, IVF in women of advanced reproductive age represents a cutting edge area of interest for improving current IVF outcomes. Access to IVF should, therefore, not be withheld based on female age and/or baseline FSH levels. Instead, a definition of acceptable minimal pregnancy and life birth rates could be used to define the limits of offered access to IVF, independent of age and/or baseline FSH levels.
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Affiliation(s)
- Norbert Gleicher
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
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Orvieto R, Kruchkovich J, Zohav E, Rabinson J, Anteby EY, Meltcer S. Does methotrexate treatment for ectopic pregnancy influence the patient's performance during a subsequent in vitro fertilization/embryo transfer cycle? Fertil Steril 2007; 88:1685-6. [PMID: 17493622 DOI: 10.1016/j.fertnstert.2007.01.064] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2006] [Revised: 01/18/2007] [Accepted: 01/18/2007] [Indexed: 11/17/2022]
Abstract
In a study on the influence of methotrexate (MTX) treatment on ovarian stimulation characteristics during the subsequent IVF cycle, 14 patients admitted to our department with the diagnosis of ectopic pregnancy and successfully treated with MTX were evaluated. No differences were observed in ovarian stimulation characteristics between the IVF cycle that had resulted in the ectopic pregnancy and the IVF cycle that followed MTX treatment. Treating ectopic pregnancy with MTX has no influence on patients' performance in the following IVF cycle.
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Affiliation(s)
- Raoul Orvieto
- Department of Obstetrics and Gynecology, Barzilai Medical Center, Ashkelon, Israel.
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Barad DH, Weghofer A, Gleicher N. Age-specific levels for basal follicle-stimulating hormone assessment of ovarian function. Obstet Gynecol 2007; 109:1404-10. [PMID: 17540814 DOI: 10.1097/01.aog.0000264065.37661.a0] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Traditionally, the most important measurement in the assessment of ovarian function has been age-independent baseline follicle-stimulating hormone (FSH) levels. The objective of this study was to characterize the continuum of ovarian function based on age-specific categories of baseline FSH. METHODS In a cross-sectional historical cohort study we evaluated records of 434 patients with baseline FSH levels of less than 12 milli international units/mL that underwent ovulation induction for in vitro fertilization (IVF) with long gonadotropin-releasing hormone (GnRH) antagonist or GnRH agonist suppression and modal gonadotropin stimulation of 300 units of gonadotropins per day. In these patients with apparent normal ovarian function by current baseline FSH criteria and with routine ovarian stimulation, we assessed IVF cycle outcomes, including oocyte yields, based on age-specific baseline FSH levels, defined as levels less than or equal to the 95% confidence interval for each age group. RESULTS Age-specific baseline FSH levels predicted the retrieval of fewer than or equal to four oocytes, with a positive predictive value of 19.5% and a negative predictive value of 88%. The Mantel-Haenszel common odds ratio for fewer than or equal to 4 oocyte production in the presence of premature ovarian aging was 2.8 (95% confidence interval 1.52-5.17; P<.001). CONCLUSION These results suggest that, within generally accepted normal baseline FSH values, women with baseline FSH above the 95% confidence limits for age produce fewer oocytes in response to normal ovulation induction protocols compared with other women their age.
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Affiliation(s)
- David H Barad
- Center for Human Reproduction, New York and the Foundation for Reproductive Medicine, Chicago, Illinois, USA.
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Siristatidis C, Bhattacharya S. Unexplained infertility: does it really exist? Does it matter? Hum Reprod 2007; 22:2084-7. [PMID: 17562677 DOI: 10.1093/humrep/dem117] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Unexplained infertility (UI) refers to a diagnosis made in couples in whom standard investigations including semen analysis, tests of ovulation and tubal patency are normal. It has been suggested that the term UI is unsustainable, as conditions such as endometriosis, tubal infertility, premature ovarian ageing and immunological infertility tend to be misdiagnosed as UI. In this debate, we present the view that, although scientifically unsatisfying, the diagnosis of UI is sustainable from a clinical and practical perspective. Given our present treatment options, further investigations leading to a more 'accurate' diagnosis is unlikely to change our management in these cases. Scientific curiosity must take second place to a more pragmatic approach, which takes into account the clinical and financial costs of making a more 'accurate' diagnosis.
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Affiliation(s)
- Charalambos Siristatidis
- Assisted Reproduction Unit, Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Foresterhill, Aberdeen, UK.
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