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Agustí I, Méndez M, Borrás A, Goday A, Guimerà M, Peralta S, Ribera L, Rodriguez-Revenga L, Manau D. Prevalence of the FMR1 Gene Premutation in Young Women with a Diminished Ovarian Reserve Included in an IVF Program: Implications for Clinical Practice. Genes (Basel) 2024; 15:1008. [PMID: 39202368 PMCID: PMC11353426 DOI: 10.3390/genes15081008] [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: 07/07/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 09/03/2024] Open
Abstract
The relationship between premature ovarian insufficiency (FXPOI) and premutation in the FMR1 gene is well established. In recent years, though, a potential relationship between the latter and a low ovarian reserve has been suggested. To explore it, we conducted a retrospective study in an IVF program at a university tertiary referral center in Barcelona (Spain). Data were obtained retrospectively from a total of 385 women referred for FMR1 gene testing at our institution from January 2018 to December 2021. We compared the prevalence of FMR1 gene premutation between 93 of them, younger than 35 years, with a diminished ovarian reserve (DOR), characterized by levels of anti-Mullerian hormone < 1.1 ng/mL and antral follicle count < 5; and 132 egg donors screened by protocol that served as the controls. We found a higher prevalence of FMR1 premutation in the DOR group (seven patients (7.69%)) than in the control group (one patient (1.32%)), Fisher-exact test p-value = 0.012). We concluded that compared with the general population represented by young egg donors, the prevalence of FMR1 gene premutation is higher in young patients with a diminished ovarian reserve. Although these findings warrant further prospective validation in a larger cohort of patients within DOR, they suggest that, in clinical practice, FMR1 premutation should be determined in infertile young patients with DOR in order to give them adequate genetic counselling.
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Affiliation(s)
- Inés Agustí
- Assisted Human Reproduction Unit, Gynecology Service, Clinic Institute of Gynecology, Obstetrics, and Neonatology (ICGON), Hospital Clínic Barcelona, 08036 Barcelona, Spain; (I.A.); (M.M.); (A.B.); (A.G.); (M.G.); (S.P.); (L.R.)
| | - Marta Méndez
- Assisted Human Reproduction Unit, Gynecology Service, Clinic Institute of Gynecology, Obstetrics, and Neonatology (ICGON), Hospital Clínic Barcelona, 08036 Barcelona, Spain; (I.A.); (M.M.); (A.B.); (A.G.); (M.G.); (S.P.); (L.R.)
| | - Aina Borrás
- Assisted Human Reproduction Unit, Gynecology Service, Clinic Institute of Gynecology, Obstetrics, and Neonatology (ICGON), Hospital Clínic Barcelona, 08036 Barcelona, Spain; (I.A.); (M.M.); (A.B.); (A.G.); (M.G.); (S.P.); (L.R.)
- Fundacio Clinic de Recerca Biomedique-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Anna Goday
- Assisted Human Reproduction Unit, Gynecology Service, Clinic Institute of Gynecology, Obstetrics, and Neonatology (ICGON), Hospital Clínic Barcelona, 08036 Barcelona, Spain; (I.A.); (M.M.); (A.B.); (A.G.); (M.G.); (S.P.); (L.R.)
| | - Marta Guimerà
- Assisted Human Reproduction Unit, Gynecology Service, Clinic Institute of Gynecology, Obstetrics, and Neonatology (ICGON), Hospital Clínic Barcelona, 08036 Barcelona, Spain; (I.A.); (M.M.); (A.B.); (A.G.); (M.G.); (S.P.); (L.R.)
| | - Sara Peralta
- Assisted Human Reproduction Unit, Gynecology Service, Clinic Institute of Gynecology, Obstetrics, and Neonatology (ICGON), Hospital Clínic Barcelona, 08036 Barcelona, Spain; (I.A.); (M.M.); (A.B.); (A.G.); (M.G.); (S.P.); (L.R.)
| | - Laura Ribera
- Assisted Human Reproduction Unit, Gynecology Service, Clinic Institute of Gynecology, Obstetrics, and Neonatology (ICGON), Hospital Clínic Barcelona, 08036 Barcelona, Spain; (I.A.); (M.M.); (A.B.); (A.G.); (M.G.); (S.P.); (L.R.)
| | - Laia Rodriguez-Revenga
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona—Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain;
- CIBER of Rare Diseases (CIBERER), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Dolors Manau
- Assisted Human Reproduction Unit, Gynecology Service, Clinic Institute of Gynecology, Obstetrics, and Neonatology (ICGON), Hospital Clínic Barcelona, 08036 Barcelona, Spain; (I.A.); (M.M.); (A.B.); (A.G.); (M.G.); (S.P.); (L.R.)
- Fundacio Clinic de Recerca Biomedique-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
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Le Poulennec T, Dubreuil S, Grynberg M, Chabbert-Buffet N, Sermondade N, Fourati S, Siffroi JP, Héron D, Bachelot A. Ovarian reserve in patients with FMR1 gene premutation and the role of fertility preservation. ANNALES D'ENDOCRINOLOGIE 2024; 85:269-275. [PMID: 38702011 DOI: 10.1016/j.ando.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Women with premutation (PM) of the FMR1 gene may suffer from reduced ovarian reserve or even premature ovarian insufficiency (POI). We studied hormonal and ultrasound ovarian reserve, fertility and fertility preservation outcomes in these patients. PATIENTS AND METHOD Retrospective cohort study of 63 female FMR1 premutation carriers. RESULTS Sixty-three female patients bearing an FMR1 premutation were included. Median age was 30 years [26.5-35]. Median number of CGG triplets was 83 [77.2-92]. Before diagnosis of PM, 19 women (30%) had had in all 35 pregnancies, resulting in 20 births, including 7 affected children. After diagnosis of PM, 17 women (26.1%) had in all 23 pregnancies, at a median age of 34.5 years [32.2-36.0]: 2 after pre-implantation genetic diagnosis, 3 after oocyte donation, 18 spontaneously, and 5 ending in medical termination for fragile X syndrome. Thirty-three patients (52.4%) had POI diagnosis (median age, 30 years [27-34]) with median FSH level 84 IU/L [50.5-110] and median AMH level 0.08ng/mL [0.01-0.19]. After POI diagnosis, 8 women had in all 9 pregnancies: 3 following oocyte donation, and 6 spontaneous in 5 women (15.1%). Eight of the 9 pregnancies resulted in a live birth (including 2 affected children) and 1 in medical termination for trisomy 13. The median age of the 30 patients without POI was 31 years [25.2-35.0]. Thirteen women (20.6%) underwent fertility preservation, at a median age of 29 years [24-33]: FSH 7.7 IU/L [6.8-9.9], AMH 1.1ng/mL [0.95-2.1], antral follicle count 9.5 [7.7-14.7]. A median 15 oocytes [10-26] were cryopreserved in a median 2 cycles [1-3]. At the time of writing, no oocytes had yet been thawed for in-vitro fertilization. CONCLUSIONS This study shows the importance of early fertility preservation after diagnosis of FMR1 premutation in women, due to early deterioration of ovarian reserve. Genetic counseling is essential in these patients, as spontaneous pregnancies are not uncommon, even in cases of impaired ovarian reserve, and can lead to birth of affected children.
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Affiliation(s)
- Tiphaine Le Poulennec
- Departement of Endocrinology and Reproductive Medicine, centre de référence des maladies endocriniennes rares de la croissance et du développement, centre de référence des pathologies gynécologiques rares, IE3M, hôpital Pitié-Salpêtrière, AP-HP, Paris, France; Sorbonne université médecine, Paris, France; Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Sophie Dubreuil
- Departement of Endocrinology and Reproductive Medicine, centre de référence des maladies endocriniennes rares de la croissance et du développement, centre de référence des pathologies gynécologiques rares, IE3M, hôpital Pitié-Salpêtrière, AP-HP, Paris, France; Sorbonne université médecine, Paris, France; Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Michael Grynberg
- Departement of Reproductive Medicine Clamart, hôpital Béclère, AP-HP, France; Hôpital Béclère, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - Nathalie Chabbert-Buffet
- Departement of Obstetrics Gynecology and Reproductive Medicine, hôpital Tenon, AP-HP, Sorbonne université médecine, Paris, France; Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Nathalie Sermondade
- Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Departement of Reproductive Biology, hôpital Tenon, AP-HP, Sorbonne université médecine, Paris, France
| | - Salma Fourati
- Sorbonne université médecine, Paris, France; Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Departement of Endocrine Biochemistry and oncology, hôpital Pitié-Salpêtrière-Charles-Foix, AP-HP, Paris, France
| | - Jean-Pierre Siffroi
- Genetics Departement, Inserm UMR_S_933, hôpital Armand-Trousseau, AP-HP, Paris, France; Hôpital Armand-Trousseau, 26, avenue du Dr Arnold-Netter, 75012 Paris, France
| | - Delphine Héron
- Genetics Department, hôpital Pitié-Salpêtrière, AP-HP, Paris, France; Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Anne Bachelot
- Departement of Endocrinology and Reproductive Medicine, centre de référence des maladies endocriniennes rares de la croissance et du développement, centre de référence des pathologies gynécologiques rares, IE3M, hôpital Pitié-Salpêtrière, AP-HP, Paris, France; Sorbonne université médecine, Paris, France; Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Jin X, Zeng W, Xu Y, Jin P, Dong M. Cytosine-guanine-guanine repeats of FMR1 gene negatively affect ovarian reserve and response in Chinese women. Reprod Biomed Online 2024; 49:103779. [PMID: 38678742 DOI: 10.1016/j.rbmo.2023.103779] [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: 10/13/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 05/01/2024]
Abstract
RESEARCH QUESTION Do cytosine-guanine-guanine (CGG) repeats of the FMR1 gene affect ovarian function, ovarian response and assisted reproductive technology (ART) outcomes in Chinese women? DESIGN A retrospective cohort study of 5869 women who underwent 8932 ART cycles at Women's Hospital, School of Medicine, Zhejiang University between January 2018 and June 2021. Basic hormone level, oocyte yield, embryo quality and the rate of live birth were considered as main outcome measures to evaluate the effects of CGG repeats on ovarian function, ovarian response and ART outcomes. RESULTS The CGG repeats were negatively related to serum anti-Müllerian hormone (AMH), oestradiol, antral follicle count (AFC) and oocyte yield. A significant association was found between serum AMH, oestradiol and AFC even after age was controlled for. No statistically significant association, however, was found between CGG repeats and embryo quality or live birth rate. Ovarian function mediated the association between CGG repeats and ovarian response. CONCLUSION Increased CGG repeats on the FMR1 gene were associated with diminished ovarian function and poor ovarian response, and ovarian function played an intermediary role in the relationship between CGG repeats and ovarian response.
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Affiliation(s)
- Xinyang Jin
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wenshan Zeng
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yanfei Xu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Pengzhen Jin
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Key Laboratory of Reproductive Genetics, Ministry of Education (Zhejiang University), Hangzhou, China
| | - Minyue Dong
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Key Laboratory of Reproductive Genetics, Ministry of Education (Zhejiang University), Hangzhou, China.
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Agusti I, Alvarez-Mora MI, Wijngaard R, Borras A, Barcos T, Peralta S, Guimera M, Goday A, Manau D, Rodriguez-Revenga L. Correlation of FMR4 expression levels to ovarian reserve markers in FMR1 premutation carriers. J Ovarian Res 2024; 17:103. [PMID: 38760837 PMCID: PMC11100203 DOI: 10.1186/s13048-024-01425-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/25/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Fragile X-associated primary ovarian insufficiency (FXPOI), characterized by amenorrhea before age 40 years, occurs in 20% of female FMR1 premutation carriers. Presently, there are no molecular or biomarkers that can help predicting which FMR1 premutation women will develop FXPOI. We previously demonstrated that high FMR4 levels can discriminate between FMR1 premutation carriers with and without FXPOI. In the present study the relationship between the expression levels of FMR4 and the ovarian reserve markers was assessed in female FMR1 premutation carriers under age of 35 years. METHODS We examined the association between FMR4 transcript levels and the measures of total antral follicle count (AFC) and serum anti-müllerian hormone (AMH) levels as markers of ovarian follicle reserve. RESULTS Results revealed a negative association between FMR4 levels and AMH (r = 0.45) and AFC (r = 0.64). Statistically significant higher FMR4 transcript levels were found among those FMR1 premutation women with both, low AFCs and AMH levels. CONCLUSIONS These findings reinforce previous studies supporting the association between high levels of FMR4 and the risk of developing FXPOI in FMR1 premutation carriers.
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Affiliation(s)
- Ines Agusti
- Clinical Institute of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona and FCRB-Institut de Investigacions Biomediques August Pi iSunyer (IDIBAPS), Barcelona, Spain
| | - Maria Isabel Alvarez-Mora
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona and FCRB- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/Villarroel, 170, Barcelona, 08036, Spain
- CIBER of Rare Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Robin Wijngaard
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
| | - Aina Borras
- Clinical Institute of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona and FCRB-Institut de Investigacions Biomediques August Pi iSunyer (IDIBAPS), Barcelona, Spain
| | - Tamara Barcos
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona and FCRB- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/Villarroel, 170, Barcelona, 08036, Spain
| | - Sara Peralta
- Clinical Institute of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona and FCRB-Institut de Investigacions Biomediques August Pi iSunyer (IDIBAPS), Barcelona, Spain
| | - Marta Guimera
- Clinical Institute of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona and FCRB-Institut de Investigacions Biomediques August Pi iSunyer (IDIBAPS), Barcelona, Spain
| | - Anna Goday
- Clinical Institute of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona and FCRB-Institut de Investigacions Biomediques August Pi iSunyer (IDIBAPS), Barcelona, Spain
| | - Dolors Manau
- Clinical Institute of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona and FCRB-Institut de Investigacions Biomediques August Pi iSunyer (IDIBAPS), Barcelona, Spain
| | - Laia Rodriguez-Revenga
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona and FCRB- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/Villarroel, 170, Barcelona, 08036, Spain.
- CIBER of Rare Diseases, Instituto de Salud Carlos III, Madrid, Spain.
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Persico T, Tranquillo ML, Seracchioli R, Zuccarello D, Sorrentino U. PGT-M for Premature Ovarian Failure Related to CGG Repeat Expansion of the FMR1 Gene. Genes (Basel) 2023; 15:6. [PMID: 38275588 PMCID: PMC10815814 DOI: 10.3390/genes15010006] [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: 10/25/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
Primary ovarian failure (POF) is caused by follicle exhaustion and is associated with menstrual irregularities and elevated gonadotropin levels, which lead to infertility before the age of 40 years. The etiology of POI is mostly unknown, but a heterogeneous genetic and familial background can be identified in a subset of cases. Abnormalities in the fragile X mental retardation 1 gene (FMR1) are among the most prevalent monogenic causes of POI. These abnormalities are caused by the expansion of an unstable CGG repeat in the 5' untranslated region of FMR1. Expansions over 200 repeats cause fragile X syndrome (FXS), whereas expansions between 55 and 200 CGG repeats, which are defined as a fragile X premutation, have been associated with premature ovarian failure type 1 (POF1) in heterozygous females. Preimplantation genetic testing for monogenic diseases (PGT-M) can be proposed when the female carries a premutation or a full mutation. In this narrative review, we aim to recapitulate the clinical and molecular features of POF1 and their implications in the context of PGT-M.
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Affiliation(s)
- Tiziana Persico
- Medically Assisted Procreation Center, Maternal and Child Department, Beauregard Hospital, Valle D’Aosta Local Public Health, 11100 Aoste, Italy
| | - Maria Lucrezia Tranquillo
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (M.L.T.); (R.S.)
| | - Renato Seracchioli
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (M.L.T.); (R.S.)
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero, University of Bologna, 40138 Bologna, Italy
| | - Daniela Zuccarello
- Clinical Genetics and Epidemiology Unit, University of Padova, 35128 Padova, Italy; (D.Z.); (U.S.)
| | - Ugo Sorrentino
- Clinical Genetics and Epidemiology Unit, University of Padova, 35128 Padova, Italy; (D.Z.); (U.S.)
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Boustanai I, Raanani H, Aizer A, Orvieto R, Elizur SE. Granulosa Cell Dysfunction Is Associated With Diminished Ovarian Response in FMR1 Premutation Carriers. J Clin Endocrinol Metab 2022; 107:3000-3009. [PMID: 36112470 DOI: 10.1210/clinem/dgac536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Indexed: 02/13/2023]
Abstract
CONTEXT FMR1 premutation (PM) carriers are at increased risk of ovarian impairment resulting in diminished ovarian response (DOR) to exogenous follicle-stimulating hormone (FSH) stimulation. Expanded CGG repeat transcript and RAN-associated protein (FMRpolyG) have been shown to accumulate in cellular aggregates and sequester proteins, thus impairing their function. Sam68 is a multifunctional RNA-binding protein highly expressed in the gonads involved in FSH receptor (FSHR) transcript maturation during FSH-dependent follicular development. OBJECTIVE The present study examined a possible pathophysiological explanation for DOR to exogenous FSH stimulation in FMR1 PM carriers. METHODS We used both a human granulosa cell (GC) line model and human GCs from FMR1 PM carriers to evaluate whether Sam68 is sequestered with expanded CGG repeat transcript. RESULTS We show that Sam68 is sequestered in GCs, most likely by interaction with the expanded CGG repeat transcript. The sequestration may lead to reduced levels of free Sam68 available for FHSR precursor transcript processing, causing dysregulation of FSHR transcript maturation, and a consequent decrease in FSHR protein levels. CONCLUSION Sam68 sequestration may underlie the diminished ovarian response to FSH stimulation in FMR1 PM carriers.
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Affiliation(s)
- Ilana Boustanai
- Sheba Medical Center Hospital-Tel Hashomer, Ramat-Gan 52621, Israel
| | - Hila Raanani
- Sheba Medical Center Hospital-Tel Hashomer, Ramat-Gan 52621, Israel
| | - Adva Aizer
- Sheba Medical Center Hospital-Tel Hashomer, Ramat-Gan 52621, Israel
| | - Raoul Orvieto
- Sheba Medical Center Hospital-Tel Hashomer, Ramat-Gan 52621, Israel
- Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Shai E Elizur
- Sheba Medical Center Hospital-Tel Hashomer, Ramat-Gan 52621, Israel
- Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv 6997801, Israel
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Shulman Y, Kalma Y, Malcov M, Kopel R, Fouks Y, Azem F, Almog B, Cohen Y. The impact of fragile X premutation carrier status on embryo morphokinetic development. Reprod Biomed Online 2022; 45:884-889. [DOI: 10.1016/j.rbmo.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/25/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
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High normal sized CGG repeat on the FMR1 gene reduces live birth rates after in vitro fertilization in Han Chinese. Gene 2022; 819:146204. [PMID: 35101584 DOI: 10.1016/j.gene.2022.146204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/08/2021] [Accepted: 01/13/2022] [Indexed: 11/22/2022]
Abstract
Substantial evidence now suggests an association between the FMR1 genotype and female fertility. The aim of this study was to determine whether a high normal FMR1 allele (35-54 repeats) affects in vitro fertilization (IVF) outcomes in Chinese women. A total of 120 women with 210 IVF cycles were retrospectively recruited in this study. The patients were divided into two groups based on the FMR1 repeat lengths at allele 2 (normal repeat group: <35 repeats; high repeat group: 35-54 repeats). The observed primary outcomes were the clinical pregnancy rate and live birth rate. No associations were observed between the high normal FMR1 allele and lower clinical pregnancy rate or live birth rate after adjusting for maternal age, education, work status, duration of infertility and number of embryos transferred (aOR 0.633, 95% CI 0.249-1.601, p = 0.337; aOR 0.325, 95% CI 0.094-1.118, p = 0.075; respectively). However, after additionally adjusting for anti-Müllerian hormone (AMH) level, there was a weak but significant association between high normal sized CGG repeats and a lower live birth rate (aOR 0.218, 95% CI 0.057-0.836, p = 0.026). The rate of available embryos showed a decreasing trend in patients with a high normal FMR1 allele, although the difference was not statistically significant after adjusting for maternal age, education, work status, duration of infertility and AMH level (aOR 0.905, 95% CI 0.810-1.011, p = 0.078). Furthermore, the number of CGG repeats in either allele was not associated with the live birth rate after adjusting for all confounding factors (aOR 0.832, 95% CI 0.677-1.023, p = 0.081; aOR 0.865, 95% CI 0.651-1.148, p = 0.315; respectively). In addition, no significant differences were found in the rates of good-quality embryos (p = 0.263), miscarriage (p = 0.861) or cycle cancellation (p = 0.295) between the groups. Taken together, in the Chinese population, individuals with high normal sized CGG repeats on the FMR1 gene have a higher risk of reduced live birth rates in childbearing age. Therefore, we recommend enhanced screening for fragile X syndrome in women of childbearing age in China. This study also suggests that the association between the FMR1 genotype and fertility in Chinese women merits further research.
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Oocyte vitrification for elective fertility preservation: a SWOT analysis. Reprod Biomed Online 2022; 44:1005-1014. [DOI: 10.1016/j.rbmo.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/19/2022] [Accepted: 02/01/2022] [Indexed: 11/17/2022]
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Sonigo C, Mayeur A, Sadoun M, Pinto M, Benguigui J, Frydman N, Monnot S, Benachi A, Steffann J, Grynberg M. What is the threshold of mature oocytes to obtain at least one healthy transferable cleavage-stage embryo after preimplantation genetic testing for fragile X syndrome? Hum Reprod 2021; 36:3003-3013. [PMID: 34568938 DOI: 10.1093/humrep/deab214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/25/2021] [Indexed: 01/07/2023] Open
Abstract
STUDY QUESTION What are the chances of obtaining a healthy transferable cleavage-stage embryo according to the number of mature oocytes in fragile X mental retardation 1 (FMR1)-mutated or premutated females undergoing preimplantation genetic testing (PGT)? SUMMARY ANSWER In our population, a cycle with seven or more mature oocytes has an 83% chance of obtaining one or more healthy embryos. WHAT IS KNOWN ALREADY PGT may be an option to achieve a pregnancy with a healthy baby for FMR1 mutation carriers. In addition, FMR1 premutation is associated with a higher risk of diminished ovarian reserve and premature ovarian failure. The number of metaphase II (MII) oocytes needed to allow the transfer of a healthy embryo following PGT has never been investigated. STUDY DESIGN, SIZE, DURATION The study is a monocentric retrospective observational study carried out from January 2006 to January 2020 that is associated with a case-control study and that analyzes 38 FMR1 mutation female carriers who are candidates for PGT; 16 carried the FMR1 premutation and 22 had the full FMR1 mutation. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 95 controlled ovarian stimulation (COS) cycles for PGT for fragile X syndrome were analyzed, 49 in premutated patients and 46 in fully mutated women. Only patients aged ≤38 years with anti-Müllerian hormone (AMH) >1 ng/ml and antral follicle count (AFC) >10 follicles were eligible for the PGT procedure. Each COS cycle of the FMR1-PGT group was matched with the COS cycles of partners of males carrying any type of translocation (ratio 1:3). Conditional logistic regression was performed to compare the COS outcomes. We then estimated the number of mature oocytes needed to obtain at least one healthy embryo after PGT using receiver operating characteristic curve analysis. MAIN RESULTS AND THE ROLE OF CHANCE Overall, in the FMR1-PGT group, the median number of retrieved and mature oocytes per cycle was 11 (interquartile range 7-15) and 9 (6-12), respectively. The COS outcomes of FMR1 premutation or full mutation female carriers were not altered compared with the matched COS cycles in partners of males carrying a balanced translocation in their karyotype. Among the 6 (4-10) Day 3 embryos obtained in the FMR1-PGT group, a median number of 3 (1-6) embryos were morphologically eligible for biopsy, leading to 1 (1-3) healthy embryo. A cutoff value of seven MII oocytes yielded a sensitivity of 82% and a specificity of 61% of having at least one healthy embryo, whereas a cutoff value of 10 MII oocytes led to a specificity of 85% and improved positive predictive value. LIMITATIONS, REASONS FOR CAUTION This study is retrospective, analyzing a limited number of cycles. Moreover, the patients who were included in a fresh PGT cycle were selected on ovarian reserve parameters and show high values in ovarian reserve tests. This information could influence our conclusion. WIDER IMPLICATIONS OF THE FINDINGS The results relate only to the target population of this study, with a correct ovarian reserve of AMH >1 and AFC >10. However, the information provided herein extends knowledge about the current state of COS for FMR1 mutation carriers in order to provide patients with proper counseling regarding the optimal number of oocytes needed to have a chance of transferring an unaffected embryo following PGT. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- C Sonigo
- Assistance Publique Hopitaux de Paris, Hopital Béclère, Service de Médecine de la Reproduction et Préservation de la Fertilité, Université Paris-Saclay, Clamart, France.,Inserm, Physiologie et Physiopathologie Endocrinienne, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - A Mayeur
- Laboratoire d'Histologie-Embryologie-Cytogenetique CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, Cedex, Clamart, France
| | - M Sadoun
- Assistance Publique Hopitaux de Paris, Hopital Béclère, Service de Médecine de la Reproduction et Préservation de la Fertilité, Université Paris-Saclay, Clamart, France
| | - M Pinto
- Assistance Publique Hopitaux de Paris, Hopital Béclère, Service de Médecine de la Reproduction et Préservation de la Fertilité, Université Paris-Saclay, Clamart, France
| | - J Benguigui
- Assistance Publique Hopitaux de Paris, Hopital Béclère, Service de Médecine de la Reproduction et Préservation de la Fertilité, Université Paris-Saclay, Clamart, France
| | - N Frydman
- Laboratoire d'Histologie-Embryologie-Cytogenetique CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, Cedex, Clamart, France
| | - S Monnot
- Service de Génétique Moléculaire, Groupe Hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - A Benachi
- Assistance Publique Hopitaux de Paris, Hopital Béclère, Service de Gynécologie Obstétrique, Université Paris-Saclay, Clamart, France
| | - J Steffann
- Imagine Institute, Université de Paris-Sorbonne Paris Cité, INSERM UMR1163, Paris, France
| | - M Grynberg
- Assistance Publique Hopitaux de Paris, Hopital Béclère, Service de Médecine de la Reproduction et Préservation de la Fertilité, Université Paris-Saclay, Clamart, France.,BFA- Unité de Biologie Fonctionnelle et Adaptative, UMR 8251, CNRS, ERL U1133, Inserm, Université de Paris, Paris, France
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11
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Cohen Y, Nattiv N, Avrham S, Fouks Y, Friedman MR, Hasson J, Kalma Y, Azem F, Malcov M, Almog B. A decision tree model for predicting live birth in FMR1 premutation carriers undergoing preimplantation genetic testing for monogenic/single gene defects. Reprod Biomed Online 2021; 43:680-686. [PMID: 34412974 DOI: 10.1016/j.rbmo.2021.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
RESEARCH QUESTION Can patient selection for successful preimplantation genetic testing for women who are fragile X (FMR1) premutation carriers be optimized using a decision tree analysis? This decision support tool enables a comprehensive study of a set of clinical parameters and the expected outcomes. DESIGN A retrospective case-control study analysing the results of 264 fresh and 21 frozen preimplantation genetic testing for monogenic disorders/single gene defects (PGT-M) cycles in 64 FMR1 premutation carriers. Primary outcome was live birth per cycle start. Live birth rate was calculated for the start of the ovarian stimulation cycle. Fresh and frozen embryo transfers from the same cycle were included. RESULTS The decision tree model showed that the number of cytosine guanine (CGG) repeats was only a moderate predictor for live birth, whereas an age younger than 36 years was the best predictor for live birth, followed by a collection of 14 or more oocytes. These findings were supported by the results of the logistic regression, which found that only age and oocyte number were significantly associated with live birth (P = 0.005 and 0.017, respectively). CONCLUSIONS The number of CGG repeats is a relatively poor predictor for live birth in PGT-M cycles. FMR1 premutation carriers are no different from non-carriers. Age is the best identifier of live birth, followed by the number of retrieved oocytes.
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Affiliation(s)
- Yoni Cohen
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel.
| | - Noga Nattiv
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - Sarit Avrham
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - Yuval Fouks
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - Michal Rosenberg Friedman
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - Joseph Hasson
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - Yael Kalma
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - Foad Azem
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - Mira Malcov
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - Benny Almog
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
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12
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La Marca A, Mastellari E. Fertility preservation for genetic diseases leading to premature ovarian insufficiency (POI). J Assist Reprod Genet 2021; 38:759-777. [PMID: 33495935 DOI: 10.1007/s10815-021-02067-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/07/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The current review aims to summarize the data available concerning the applicability of fertility preservation techniques to genetic conditions at risk of premature ovarian insufficiency (POI). METHODS A literature review through the PubMed Database was carried out. RESULTS About 10% of cases of POI is related to genetic diseases. The most frequent conditions associated with POI are Turner syndrome and fragile X pre-mutation; mutation of BRCA 1-2 genes and several other mutations and genetic syndromes have recently been highlighted, although they rarely occur. If a diagnosis is issued before POI onset, counseling on currently available fertility preservation techniques is advisable. In case of spontaneous menarche (this can occur variably depending on the mutation) established techniques like embryo or oocyte cryopreservation can be proposed, even if, in some cases, their effectiveness may be reduced by ovarian alterations connected to the mutation. Ovarian tissue cryopreservation has recently been defined as an established medical procedure for fertility preservation in young cancer patients and may be an option for prepubertal patients. However, it is still experimental in special populations with genetic diseases causing POI. New innovative experimental techniques, like in vitro maturation of immature oocytes (IVM) and vitro activation (IVA) of immature follicles on ovarian tissue, have shown limited but encouraging data and they will be probably available in the near future. For a correct risk-benefit evaluation, the following aspects should be considered: actual knowledge about the pathology-specific efficacy of the various techniques, the average age of onset of POI, the possible risks associated with the procedure in relation to the underlying pathology, the probability of spontaneous conception, as well as the health implications of a possible future pregnancy.. CONCLUSIONS Fertility preservation techniques represent a crucial opportunity for patients with genetic risk of POI. Early diagnosis increases the chances to apply these techniques. No specific recommendations concerning fertility preservation for each genetic pathology are available, and clinicians should first counsel the patient and her relatives about known risks and benefits of the available techniques, both those established and those considered as experimental.
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Affiliation(s)
- Antonio La Marca
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy. .,Clinica Eugin Modena, Modena, Italy.
| | - Elisa Mastellari
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
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13
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Abstract
Fertility represents a biological and psychological requirement for women. Some genetic diseases represent a rare cause of infertility, being responsible for 10% of cases of premature ovarian insufficiency. Among these, the most frequent and also those most studied by researchers are Turner Syndrome - due to a karyotype abnormality of the X chromosome pair - and the presence of fragile X premutation (FMR1). To exclude these conditions the diagnostic workup for non-iatrogenic premature ovarian insufficiency (POI) involves the performance of a karyotype analysis and the search for the FMR1 gene mutation, as well as the search for the presence of Y-chromosomal material. However, several other mutations and genetic syndromes associated with POI development have recently been highlighted, although they occur rarely, such as the GALT gene mutation in galactosemia or the FOXL2 gene mutation in BPES and many others, and further autosomal genetic testing are indicated if clinical suspicion is present. Mutations of BRCA 1 and 2 genes, make patients at genetically determined high risk of developing early ovarian or breast cancer and of getting POIs for the treatments they must undergo to prevent it (prophylactic bilateral oophorectomy) or treat it (chemotherapy). The management of impaired fertility is not less important than that of other syndromic manifestations for the quality of life of patients. Few data are available regarding the efficiency of cryopreservation of reproductive material (oocytes, embryos or ovarian tissue) in order to preserve fertility in this particular subgroup of patients, but certainly it represents a promising chance and a hope for the future.
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Affiliation(s)
- Elisa Mastellari
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio La Marca
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy -
- Clinica Eugin Modena, Modena, Italy
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14
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Batiha O, Shaaban ST, Al-Smadi M, Jarun Y, Maswadeh A, Alahmad NA, Al-Talib MM. A study on the role of FMR1 CGG trinucleotide repeats in Jordanian poor ovarian responders. Gene 2020; 767:145174. [PMID: 33007370 DOI: 10.1016/j.gene.2020.145174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/04/2020] [Accepted: 09/23/2020] [Indexed: 11/25/2022]
Abstract
The expansion of trinucleotide CGG repeats in the promoter of fragile X mental retardation 1 (FMR1) gene is associated with fragile X and fragile X associated tremor/ataxia syndromes. While the expansion of CGG repeats has been associated with such neuro/psychiatric diseases, the contraction of CGG repeats has been recently suggested as an indication of ovarian dysfunction. This study aimed to evaluate a possible association of the short CGG repeats with poor ovarian responders (POR) and to test for a possible correlation between the CGG size and different known markers of the ovarian reserve, namely FSH, AMH, and the number of retrieved oocytes from Jordanian females. We found a significant difference between the CGG median allele size between the cases and the controls (p < 0.001), where poor ovarian responders had shorter CGG repeats compared to the healthy controls. Also, females with alleles <26 had twice the odds to be presented in the POR compared to the controls. However, we did not find a significant correlation between CGG sizes and the markers of ovarian reserve. We conclude that although low CGG repeats appear to be linked to POR, the clinical utility of FMR1 for predicting ovarian response needs further investigation.
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Affiliation(s)
- Osamah Batiha
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan.
| | - Sherin T Shaaban
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Al-Smadi
- Reproductive Endocrinology and IVF Unit, King Hussein Medical Center, Amman, Jordan
| | - Yousef Jarun
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmad Maswadeh
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Nour Alhoda Alahmad
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan
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15
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Are ovarian response and pregnancy rates similar in selected FMR1 premutated and mutated patients undergoing preimplantation genetic testing? J Assist Reprod Genet 2020; 37:1675-1683. [PMID: 32483686 DOI: 10.1007/s10815-020-01809-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To assess if the ovarian response of FMR1 premutated women undergoing preimplantation genetic testing (PGT) for Fragile X syndrome is lower compared with fully mutated patients, due to their frequent premature ovarian failure. METHODS In a retrospective cohort study from January 2009 to March 2019, we compared PGT outcomes in 18 FMR1 premutated women and 12 fully mutated women and aimed to identify predictive factors of stimulation outcomes. RESULTS Eighty-six IVF/PGT-M cycles for FMR1 PGT were analyzed. Premutation and full mutation patients were comparable in terms of age, body mass index (BMI), basal FSH, antral follicular count, and cycle length. However, premutation carriers had significantly lower AMH (1.9 versus 4.0 ng/mL, p = 0.0167). Premutated patients required higher doses of FSH (2740 versus 1944 IU, p = 0.0069) but had similar numbers of metaphase II oocytes (7.1 versus 6.6, p = 0.871) and embryos (5.6 versus 4.9, p = 0. 554). Pregnancy rates (37.1% versus 13.3%, p = 0.1076) were not statistically different in both groups. CONCLUSION In spite of lower ovarian reserve and thanks to an increased total dose of FSH, FMR1 premutated selected patients seem to have similar ovarian response as fully mutated patients. Neither the number of CGG repeats in FMR1 gene nor FMR1 mutation status was good predictors of the number of retrieved oocytes.
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16
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An explanation of the mechanisms underlying fragile X-associated premature ovarian insufficiency. J Assist Reprod Genet 2020; 37:1313-1322. [PMID: 32377997 PMCID: PMC7311620 DOI: 10.1007/s10815-020-01774-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/01/2020] [Indexed: 12/22/2022] Open
Abstract
Fragile X and fragile X-associated tremor-ataxia syndrome (FXTAS) are caused by mutations of the FMR1 gene. The mutations causing FXTAS can expand in a generation to a "full mutation" causing fragile X syndrome. The mutations causing FXTAS and the phenotype, fragile X-associated premature ovarian insufficiency (FXPOI), are referred to as the FMR1 premutation (PM). The objective of this paper was to formulate a theory to explain the Mechanism for FXPOI.Recent research on fragile X syndrome and FXTAS has led to sophisticated theories about the mechanisms underlying these diseases. It has been proposed that similar mechanisms underlie FXPOI. Utilizing recent research on FXTAS, but a more detailed application of ovarian physiology, we present a more ovarian specific theory as to the primary mechanism explaining the development of FXPOI.The FXPOI phenotype may best be viewed as derivative of the observation that fragile X PM carriers experience menopause an average of 5 years earlier than non-carriers. Women carrying the PM experience an earlier menopause because of an accelerated activation of their primordial follicle pool. This acceleration of primordial follicle activation occurs, in part, because of diminished AMH production. AMH production is diminished because of accelerated atresia of early antral follicles. This accelerated atresia likely occurs because the fragile X PM leads to a slowing of the rate of granulosa cell mitosis in some follicles.
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17
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Friedman-Gohas M, Kirshenbaum M, Michaeli A, Domniz N, Elizur S, Raanani H, Orvieto R, Cohen Y. Does the presence of AGG interruptions within the CGG repeat tract have a protective effect on the fertility phenotype of female FMR1 premutation carriers? J Assist Reprod Genet 2020; 37:849-854. [PMID: 32096109 DOI: 10.1007/s10815-020-01701-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/12/2019] [Indexed: 10/24/2022] Open
Abstract
PURPOSE While FMR1 premutation carriers (CGG 55-200) were shown to have reduced success with IVF treatment (lower oocyte yield), studies reporting on the association between the number of CGG repeats and patients' response to controlled ovarian hyperstimulation (COH) are inconsistent. In the present study, we aim to explore whether the number of CGG repeats in women with premutation in FMR1 gene, undergoing COH for IVF, correlates with COH variables and whether the number of AGG interruptions may function as a "protective factor" by improving the ovarian response to COH. METHODS Retrospective study, in an academic IVF-PGD unit. Fifty-seven consecutive FMR1 premutation carriers who underwent 285 IVF treatment cycles were included. The numbers of CGG repeats and AGG interruptions were retrieved and correlated to the demographics and COH variables. RESULTS There were no significant association between the numbers of CGG or the AGG interruptions and the number of oocyte retrieved or the peak estradiol levels. The lack of association was also observed when including all the IVF treatment cycles or only the first or last IVF treatment cycle. Moreover, no associations were found between the number of CGG repeats or AGG interruptions and other COH variables, i.e., duration of stimulation, the total dose of gonadotropin used, or the number of top-quality embryos. CONCLUSIONS No associations were observed between the number of CGG repeats or AGG interruptions and any of the COH variables. Further studies are required to identify early biomarkers of POI to empower FMR1 premutation carriers with risk assessment tools to consider procedures such as fertility preservation.
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Affiliation(s)
- M Friedman-Gohas
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - M Kirshenbaum
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - A Michaeli
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - N Domniz
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel
| | - S Elizur
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - H Raanani
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - R Orvieto
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, 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
| | - Y Cohen
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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18
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Pastore LM, Christianson MS, McGuinness B, Vaught KC, Maher JY, Kearns WG. Does theFMR1 gene affect IVF success? Reprod Biomed Online 2018; 38:560-569. [PMID: 30711457 DOI: 10.1016/j.rbmo.2018.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/13/2018] [Accepted: 11/29/2018] [Indexed: 12/14/2022]
Abstract
FMR1 CGG trinucleotide repeat expansions are associated with Fragile X syndrome (full mutations) and primary ovarian insufficiency (premutation range); the effect of FMR1 on the success of fertility treatment is unclear. The effect of FMR1 CGG repeat lengths on IVF outcomes after ovarian stimulation was reviewed. PubMed was searched for studies on IVF-related outcomes reported by FMR1 trinucleotide repeat length published between 2002 and December 2017. For women with CGG repeats in the normal (<45 CGG), intermediate range (45-54 CGG), or both, research supports a minimal effect on IVF outcomes, including pregnancy rates; although one study reported lower oocyte yields after IVF stimulation in women with lower CGG repeat lengths and normal ovarian reserve. Meta-analysis revealed no association within subcategories of normal repeat length (<45 CGG) and IVF pregnancy rates (summary OR 1.0, 95% CI 0.87 to 1.15). Premutation carriers (CGG 55-200) may have reduced success with IVF treatment (lower oocyte yield) than women with a normal CGG repeat length or a full mutation, although findings are inconsistent. Direct implications of the repeat length on inheritance and the risk of Fragile X syndrome have been observed. Patients may require clinical and psychological counselling, and further preimplantation genetic testing options should be considered. Thus, there are clinical and psychological counseling implications for patients and potential further patient decisions regarding preimplantation genetic testing options.
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Affiliation(s)
- Lisa M Pastore
- OB/GYN and Reproductive Medicine Department, Stony Brook Medicine, Stony Brook, New York USA
| | - Mindy S Christianson
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | | | - Kamaria Cayton Vaught
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Jacqueline Y Maher
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore MD, USA
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