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Luo X, Wen S, Zeng J, Liu J, Ye W, Wu J, Huang S, Xie W, Wen H, Sun Y, Cai J, Mo D, Lin Q, Chen M, Xia S, Song Y. AOPPs induces EMT and fibrosis by activating oxidative stress through ERK/p38 MAPK signaling pathway in endometriosis. Reprod Biol 2024; 24:100950. [PMID: 39241657 DOI: 10.1016/j.repbio.2024.100950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/28/2024] [Accepted: 08/29/2024] [Indexed: 09/09/2024]
Abstract
Epithelial-mesenchymal transition (EMT) is known to play a crucial role in the development of endometriosis (EMs). However, the exact mechanisms involved in EMT regulation in EMs are not well understood. In this study, we performed comprehensive research using clinical samples, single-cell sequencing, and in vivo/in vitro models to investigate the effects of advanced oxidation protein products (AOPPs) on EMT and the underlying mechanisms in EMs. Combining bioinformatics analysis with experimental validation, our results show that AOPPs accumulate in EMs tissues, and their levels positively correlate with the expression of EMT markers in fibrotic lesions of EMs patients. Stimulation with AOPPs leads to a concentration- and time-dependent alteration of EMT markers expression in both in vitro and in vivo models. These effects are mainly mediated by the generation of reactive oxygen species and nitrite, along with the activation of the ERK and P38 signaling pathways. In chronic administration studies using normal rats, AOPPs induce EMT and enhance collagen deposition. These findings significantly contribute to our understanding of the molecular mechanisms of EMs and provide a foundation for future research and therapeutic development in this field.
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Affiliation(s)
- Xiaoqing Luo
- Department of Reproductive Medicine, Dongguan Maternal and Child Health Care Hospital, Dongguan 523000, China
| | - Sixi Wen
- Department of Reproductive Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Junling Zeng
- Laboratory Animal Research Center of Nanfang Hospital Southern Medical University
| | - Jing Liu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Wenting Ye
- Department of Reproductive Medicine, Dongguan Maternal and Child Health Care Hospital, Dongguan 523000, China
| | - Jiangpeng Wu
- Department of Reproductive Medicine, Dongguan Maternal and Child Health Care Hospital, Dongguan 523000, China
| | - Songyu Huang
- Department of Reproductive Medicine, Dongguan Maternal and Child Health Care Hospital, Dongguan 523000, China
| | - Wuwei Xie
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Haiping Wen
- Department of Reproductive Medicine, Dongguan Maternal and Child Health Care Hospital, Dongguan 523000, China
| | - Yan Sun
- Department of Reproductive Medicine, Dongguan Maternal and Child Health Care Hospital, Dongguan 523000, China
| | - Jing Cai
- Department of Reproductive Medicine, Dongguan Maternal and Child Health Care Hospital, Dongguan 523000, China
| | - Daidi Mo
- Department of Reproductive Medicine, Dongguan Maternal and Child Health Care Hospital, Dongguan 523000, China
| | - Qianxia Lin
- Department of Reproductive Medicine, Dongguan Maternal and Child Health Care Hospital, Dongguan 523000, China
| | - Mingwei Chen
- Department of Reproductive Medicine, Dongguan Maternal and Child Health Care Hospital, Dongguan 523000, China
| | - Siyu Xia
- Department of Reproductive Medicine, Dongguan Maternal and Child Health Care Hospital, Dongguan 523000, China.
| | - Yali Song
- Department of Reproductive Medicine, Dongguan Maternal and Child Health Care Hospital, Dongguan 523000, China.
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Molina A, Carter A, Alexander L, Davé A, Riley K. Holistic approach to care for patients with endometriosis. Curr Opin Obstet Gynecol 2024; 36:266-272. [PMID: 38837362 DOI: 10.1097/gco.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Endometriosis is a chronic, often debilitating, disease which is typically managed with surgery and hormonal medications. However, many patients feel they lack agency when managing endometriosis symptoms. The purpose of this review is to discuss the mental and physical management strategies, the long-term health consequences, and the role of a multidisciplinary team in the treatment of endometriosis. RECENT FINDINGS Evidence is becoming more robust regarding the role of complementary care and physical activity in the management of endometriosis. Health risks such as infertility are well known and newer evidence is evolving regarding perinatal and cardiovascular health risks. There are also trends towards multiple specialist involvement in the care of endometriosis and the benefit of interdisciplinary collaboration. SUMMARY Endometriosis is a frequently recurrent condition requiring not only meticulous medical and surgical care, but also coordinated longitudinal disease management and impact mitigation. Gynecologists should be aware of the short-term and long-term implications of the disease to empower patients on the management of their overall health.
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Affiliation(s)
- Andrea Molina
- Department of Minimally Invasive Gynecologic Surgery, Penn State Health
| | - Ashlie Carter
- Department of Minimally Invasive Gynecologic Surgery, Penn State Health
| | - Lacy Alexander
- Department of Kinesiology, Penn State, College of Health and Human Development, Pennsylvania, USA
| | - Arpit Davé
- Department of Minimally Invasive Gynecologic Surgery, Penn State Health
| | - Kristin Riley
- Department of Minimally Invasive Gynecologic Surgery, Penn State Health
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Munshi H, Khan T, Khan S, DasMahapatra P, Balakrishnan S, Nirmala C, Das V, Kulkarni K, John BM, Majumdar A, Sowmini CV, Srivastava A, Khade K, Gajbhiye RK. Determinants of Conception and Adverse Pregnancy Outcomes in Women with Endometriosis: A Longitudinal Study. Reprod Sci 2024; 31:1757-1762. [PMID: 38653856 DOI: 10.1007/s43032-024-01569-w] [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: 12/14/2023] [Accepted: 04/18/2024] [Indexed: 04/25/2024]
Abstract
Endometriosis, affecting approximately 10% of reproductive-aged women globally, poses significant challenges, including chronic pelvic pain, dysmenorrhea, and infertility. In low- and middle-income countries like India, accessibility to affordable infertility care remains a concern. This multicenter prospective cohort study, conducted across six tertiary care hospitals in India from 2017 to 2022, aims to explore the natural progression of conception and pregnancy outcomes in women with endometriosis. Of the 257 participants, 19.1% conceived during the study, revealing significant geographic and income-based variations (p < 0.001, p = 0.01). Dysmenorrhea (p < 0.001) and dyspareunia (p=0.027) were correlated with conception, while no such associations were found with chronic pelvic pain or menstrual factors. Lesion type, number, and severity showed no conclusive link with conception. Natural conception occurred in 70% of cases, with an average post-surgery conception time of 282.1 days. Live birth rate was 85.7%, while complications included placenta previa (16.4%), preeclampsia (4.1%), and preterm births (4.1%). This study, one of the first in India on endometriosis-related fertility progression, emphasizes the need for comprehensive understanding and management of conception and pregnancy outcomes. Considering India's substantial endometriosis burden, the study recommends prioritizing larger multicenter investigations for a better understanding and effective strategies for infertility management.
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Affiliation(s)
- Hrishikesh Munshi
- Clinical Research Laboratory, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
| | - Tabassum Khan
- Clinical Research Laboratory, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
| | - Shagufta Khan
- Clinical Research Laboratory, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
| | | | - Sheila Balakrishnan
- Department of Reproductive Medicine, Sree Avittam Thirunal (SAT) Hospital, Thiruvananthapuram, India
| | - Chelana Nirmala
- Department of Obstetrics and Gynecology, Sree Avittam Thirunal (SAT) Hospital, Thiruvananthapuram, India
| | - Vinita Das
- Department of Obstetrics and Gynecology, King George's Medical University (KGMU), Lucknow, India
| | | | - Bimal M John
- Minimally Invasive Surgery Unit, Credence Hospital - Multispecialty Women's Hospital and IVF Center, Thiruvananthapuram, India
| | - Amiya Majumdar
- Spectrum Clinic and Endoscopy Research Institute, Kolkata, India
| | - C V Sowmini
- Department of Obstetrics and Gynecology, Sree Avittam Thirunal (SAT) Hospital, Thiruvananthapuram, India
| | - Aarti Srivastava
- Department of Obstetrics and Gynecology, King George's Medical University (KGMU), Lucknow, India
| | - Komal Khade
- Molecular Endocrinology Laboratory, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
| | - Rahul K Gajbhiye
- Clinical Research Laboratory, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India.
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Balasubramanian V, Saravanan R, Joseph LD, Dev B, Gouthaman S, Srinivasan B, Dharmarajan A, Rayala SK, Venkatraman G. Molecular dysregulations underlying the pathogenesis of endometriosis. Cell Signal 2021; 88:110139. [PMID: 34464692 DOI: 10.1016/j.cellsig.2021.110139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 01/07/2023]
Abstract
Endometriosis is a crippling disease characterized by the presence of endometrium-like tissue or scar outside the uterine cavity, commonly confined to the peritoneal and serosal surfaces of the pelvic organs. 10-15% of women in reproductive age are estimated to be affected by endometriosis. Most of these patients present with infertility and suffer from pelvic pain. The benign disease rarely progresses to malignancy. Regardless of its high prevalence, the pathogenesis of the disease is not fully understood. Treatment options for endometriosis are limited and are often based on a symptomatic approach. The unavailability of proper diagnostic approaches, fewer therapeutic options, and sparse understanding of molecular alterations are responsible for the continued disease burden. Exploring the molecular elements causing the pathogenesis of endometriosis may lead to a number of breakthroughs in the treatment of the illness, such as the discovery of new biomarkers for diagnosis and therapeutic targets that can be a guide to better prognosis and reduced recurrence. The goal of this review is to provide the reader a critical understanding of the disease by summarizing the genetic, immunological, hormonal, and epigenetic deregulations that support the molecular basis for development of endometriotic cyst, with a special focus on the study models needed to analyze these changes in the endometriotic microenvironment.
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Affiliation(s)
- Vaishnavi Balasubramanian
- Department of Human Genetics, Faculty of Biomedical Sciences, Technology and Research, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Roshni Saravanan
- Department of Human Genetics, Faculty of Biomedical Sciences, Technology and Research, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Leena Dennis Joseph
- Department of Pathology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Bhawna Dev
- Department of Radiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Shanmugasundaram Gouthaman
- Department of Surgical Oncology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Bhuvana Srinivasan
- Department of Obstetrics and Gynecology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Arun Dharmarajan
- Department of Biomedical Sciences, Faculty of Biomedical Sciences, Technology and Research, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Suresh Kumar Rayala
- Department of Biotechnology, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Ganesh Venkatraman
- Department of Human Genetics, Faculty of Biomedical Sciences, Technology and Research, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
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Zhao RH, Liu Y, Lu D, Wu Y, Wang XY, Li WL, Zeng C, Meng QW, Lian FM, Zhou J, Shi Y, Sun WW, Han Q, Tang Y, Shi G. Chinese Medicine Sequential Therapy Improves Pregnancy Outcomes after Surgery for Endometriosis-Associated Infertility: A Multicenter Randomized Double-blind Placebo Parallel Controlled Clinical Trial. Chin J Integr Med 2020; 26:92-99. [PMID: 31997236 DOI: 10.1007/s11655-019-3208-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of Chinese medicine (CM) improving pregnancy outcomes after surgery for endometriosis-associated infertility. METHODS A multicenter, randomized, double-blind placebo parallel controlled clinical trial was designed. A total of 202 patients who had laparoscopy for endometriosis-associated infertility with qi stagnation and blood stasis syndrome were included and randomly divided into the CM treatment group and placebo control group at a ratio of 1:1 using a central block randomization from May 2014 to September 2017, 101 patients in each group. The two groups received continuous intervention at 1-5 days after surgery, for 6 menstrual cycles. Before ovulation, the CM group was treated Huoxue Xiaoyi Granule (); after ovulation, Bushen Zhuyun Granule ( was involved. The control group was treated with placebo. Transvaginal ultrasonography was performed every menstrual cycle during the treatment, and female hormone levels in the follicular and luteal phases were measured during the 1st, 3rd and 6th menstrual cycles. The analysis was continued until pregnancy. The primary outcomes were clinical pregnancy rate and pregnancy outcome, and the secondary outcomes were follicular development and endometrial receptivity. Safety evaluations were performed before and after treatment. RESULTS (1) Clinical pregnancy and live birth rates: the clinical pregnancy and live birth rates of the CM group were significantly higher than those of the placebo group [44.6% (45/101) vs. 29.7% (30/101), 34.7% (35/101) vs. 20.8% (21/101), both P<0.05]. (2) Follicle development: the incidence of dominant follicles, rate of cumulative cycle ovulation, and rate of cumulative cycle mature follicle ovulation were significantly higher in the CM group than those in the placebo group [93.8% (350/373) vs. 89.5% (341/381), 80.4% (275/342) vs. 69.1% (253/366), 65.8% (181/275) vs 56.1% (142/253), P<0.05 or P<0.01]). The incidence of cumulative cycle luteinized unruptured follicle syndrome was significantly lower in the CM group than in the placebo group [11.7% (40/342) vs. 17.8% (65/366), P<0.05). (3) Endometrial receptivity: after treatment, both endometrial types and endometrial blood flow types in the CM group were mainly types A and B, while those in the placebo group were mainly types B and C, with a significant difference between the two groups (both P<0.05). (4) Adverse events: the incidence of adverse events between the two groups was not significantly different (P>0.05). CONCLUSION Strategies for activating blood circulation-regulating Gan (Liver)-tonifying Shen (Kidney) sequential therapy can effectively improve the clinical pregnancy rate and live birth rate of endometriosis-associated infertility with qi stagnation and blood stasis after laparoscopy, improve follicular development, promote ovulation, improve endometrial receptivity, while being a safe treatment option. (Trial registration No. NCT02676713).
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Affiliation(s)
- Rui-Hua Zhao
- Department of Gynecology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
| | - Yong Liu
- Department of Gynecology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Dan Lu
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Ying Wu
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Xiao-Yun Wang
- Department of Gynecology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, 510120, China
| | - Wei-Li Li
- Department of Gynecology, First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, 230031, China
| | - Cheng Zeng
- Department of Gynecology, First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510405, China
| | - Qing-Wei Meng
- Department of Gynecology, Beijing Hospital, Beijing, 100730, China
| | - Feng-Mei Lian
- Department of Gynecology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Jun Zhou
- Department of Gynecology, First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, 230031, China
| | - Yun Shi
- Department of Gynecology, Dongzhimen Hospital Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Wei-Wei Sun
- Department of Gynecology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Qian Han
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Yi Tang
- Maternal and Child Health Service Center of Pidu District, Chengdu, 611730, China
| | - Guang Shi
- Department of Gynecology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
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Genario R, Morello E, Bueno AA, Santos HO. The usefulness of melatonin in the field of obstetrics and gynecology. Pharmacol Res 2019; 147:104337. [PMID: 31276773 DOI: 10.1016/j.phrs.2019.104337] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/28/2019] [Accepted: 06/28/2019] [Indexed: 01/24/2023]
Abstract
Disorders of the female reproductive system, including those associated with hormone regulation, fertility rate and fetal health, are issues of great concern worldwide. More recently, melatonin supplementation has been suggested as a therapeutic approach in gynecological practice. In both animal models and in women, melatonin supplementation suggests a therapeutic and preventative potential, effects attributed mainly to its antioxidant properties and action as hormone modulator. The aim of this literature review is to further investigate the evidence available on the effects of melatonin supplementation in animal and human studies, focusing on its potential application to gynecology. Melatonin-containing supplements are easily found in online and high street retailers, and despite its supplementation deemed to be relatively safe, no consensus has been reached on effective dosage and supplementation period. Short term supplementation studies, of up to six months, suggest that a daily posology of 2-18 mg of melatonin may have the potential to improve fertility rate, oocyte quality, maturation and number of embryos. However, the evidence available so far on the effects of melatonin supplementation covering gestational age and gestational outcomes is very scarce. Clinical trials and longer-term supplementation studies are required to assess any clinical outcome associated with melatonin supplementation in the field of gynecology.
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Affiliation(s)
- Rafael Genario
- Bioscience Institute, University of Passo Fundo (UPF), Passo Fundo, RS, Brazil.
| | | | - Allain Amador Bueno
- Department of Biological Sciences, University of Worcester, Henwick Grove, Worcester, WR2 6AJ, United Kingdom.
| | - Heitor Oliveira Santos
- School of Medicine, Federal University of Uberlandia (UFU), Av. Para, nº1720 Bloco 2U Campus Umuarama, Uberlandia, Minas Gerais, 38400-902, Brazil.
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Cai H, Zhu XX, Li ZF, Zhu YP, Lang JH. MicroRNA Dysregulation and Steroid Hormone Receptor Expression in Uterine Tissues of Rats with Endometriosis during the Implantation Window. Chin Med J (Engl) 2018; 131:2193-2204. [PMID: 30203794 PMCID: PMC6144856 DOI: 10.4103/0366-6999.240808] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Estrogen receptor (ER) and progesterone receptor (PR) are involved in endometriosis, but the involvement of microRNAs (miRNAs) is unknown. The aim of the study was to explore the correlation between miRNA and ER/PR in uterine tissues of rats with endometriosis during the implantation window. Methods: Twenty female Sprague-Dawley rats were randomized in three groups: endometriosis (n = 7), fat tissue control (n = 6), and normal (n = 7) groups. The female rats were mated and sacrificed on day 5 (implantation). Uterine tissues were obtained for hematoxylin-eosin staining, immunohistochemistry, and miRNA expression. Reverse transcription polymerase chain reaction (RT-PCR) was used to validate the expression of rno-miR-29c-3p, rno-miR-34c-5p, rno-miR-141-5p, rno-miR-24-1-5p, and rno-miR-490-5p. Results: The 475 miRNAs were found to differentially express between the endometriosis and normal control groups, with 127 being upregulated and 348 being downregulated. Expression of five miRNAs (rno-miR-29c-3p, rno-miR-34c-5p, rno-miR-141-5p, rno-miR-24-1-5p, and rno-miR-490-5p) were validated by RT-PCR and found to be differentially expressed among the three groups. Expression of ER and PR proteins (immunohistochemistry) in the glandular epithelium and endometrial stroma was significantly different among the three groups (all P < 0.05). Five miRNAs were involved in pathways probably taking part in implantation and fertility. Conclusions: The results suggested that miRNAs, ER, and PR could play important roles in the embryo implantation period of rats with endometriosis. These miRNAs might play a role in endometrial receptivity in endometriosis.
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Affiliation(s)
- Han Cai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing 100005, China
| | - Xin-Xin Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing 100005, China
| | - Zhan-Fei Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing 100005, China
| | - Ya-Pei Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing 100005, China
| | - Jing-He Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing 100005, China
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8
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Bansal P, Khoiwal K, Malhotra N, Dadhwal V, Sharma A, Deka D. The Role of GnRH Analogues in Improving Outcome in Women Undergoing Superovulation and Intrauterine Insemination after Surgical Correction of Mild Endometriosis: A Randomized Controlled Trial. Eurasian J Med 2018; 50:105-110. [PMID: 30002577 DOI: 10.5152/eurasianjmed.2018.17379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/25/2017] [Indexed: 11/22/2022] Open
Abstract
Objective Treatment with laparoscopic surgery, gonadotropin-releasing hormone analog (GnRHa) therapy, superovulation (SO), and intrauterine insemination (IUI) have individual benefits in improving fertility outcomes in women with endometriosis. The aim of the study was to evaluate the role of GnRHa in improving outcome in women undergoing SO and IUI after surgical correction of mild endometriosis. Materials and Methods This was a randomized controlled trial conducted in the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India, over a period of 2 years and 6 months. Ninety women who were diagnosed with mild endometriosis on laparoscopy using the revised American Society for Reproductive Medicine criteria were included in the study. The patients in the study group (n=45) received a single dose of 3.75 mg GnRHa subcutaneously within 48 h of the surgery, and those in the control group (n=45) did not receive GnRHa. Thereafter, patients in both arms received SO and IUI from the next menstrual cycle. Four patients in the study group and three patients in the control group were lost to follow-up before the first cycle of ovulation induction. Primary outcomes measured in our study were live birth rates and clinical pregnancy rate. Secondary outcome measures were number of follicles >18 mm, endometrial thickness, dose and days of gonadotropin stimulation. Results Baseline characteristics, such as age and body mass index, were comparable in both groups. The SO and IUI cycles were comparable between the two groups with regard to the secondary outcome parameters. Pregnancy rate in the first cycle was 17.1% in the study group and 19.1% in the control group (p=0.81). The overall pregnancy rate was similar in both groups (study group=21.9%, control group=23.8%; p=1). As no patient had miscarriage or any other complication during pregnancy, live birth rate was similar to the clinical pregnancy rate. Conclusion Adding GnRHa for the suppression of mild endometriosis has shown no significant improvement in the surgical management of women undergoing SO and IUI.
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Affiliation(s)
- Piyush Bansal
- All India Institute of Medical Sciences, New Delhi, India
| | - Kavita Khoiwal
- All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| | - Neena Malhotra
- All India Institute of Medical Sciences, New Delhi, India
| | - Vatsla Dadhwal
- All India Institute of Medical Sciences, New Delhi, India
| | - Aparna Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - Dipika Deka
- All India Institute of Medical Sciences, New Delhi, India
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Strategies for Activating Blood Circulation-Regulating Gan (Liver)-Tonifying Shen (Kidney) Sequential Therapy of Endometriosis-Associated Infertility. Chin J Integr Med 2018; 25:243-245. [PMID: 29594941 DOI: 10.1007/s11655-018-2931-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Indexed: 10/17/2022]
Abstract
Endometriosis (EM) is a major cause of infertility and has a complex pathogenesis, which brings severe challenges in both clinical treatment and scientific research. Current clinical research focuses on the difficult problem of improving the pregnancy rate of EM patients. Our studies found that Chinese medicine has significant advantages in terms of improving the pregnancy rate of EM patients.
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Wang M, Hao C, Huang X, Bao H, Qu Q, Liu Z, Dai H, He S, Yan W. Aberrant Expression of lncRNA ( HOXA11-AS1) and Homeobox A ( HOXA9, HOXA10, HOXA11, and HOXA13) Genes in Infertile Women With Endometriosis. Reprod Sci 2017; 25:654-661. [PMID: 29017417 DOI: 10.1177/1933719117734320] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study aimed to study the expression of homeobox (HOX)A11-AS1 ( HOXA11 antisense RNA) long noncoding RNA (lncRNA) and the expression of homeobox A ( HOXA9, HOXA10, HOXA11, and HOXA13) genes in the eutopic (EU) and ectopic (EC) endometria of women with peritoneal endometriosis. A total of 30 women undergoing laparoscopic surgery for peritoneal endometriosis and 15 infertile women without endometriosis were enrolled in this study. Peritoneal EC tissue samples were obtained through surgery. The EU tissues were obtained by curettage. The EC and EU lncRNA and messenger RNA (mRNA) expression levels were measured using real-time reverse transcriptase-polymerase chain reaction. The HOXA11-AS1 lncRNA and HOXA9, HOXA10, HOXA11, and HOXA13 mRNA were expressed at significantly lower levels in the EU than in the EC, that is, in women with peritoneal endometriosis ( P < .05). The expression levels of HOXA10 and HOXA11 in the EU were significantly lower in women with peritoneal endometriosis compared to the control group participants ( P < .05), whereas the levels of lncRNA ( HOXA11-AS1), HOXA9, and HOXA13 did not differ significantly between the 2 patient groups ( P > .05). In conclusion, the study findings suggest that HOXA11-AS1 lncRNA may play a role in the development of peritoneal endometriosis, but HOXA11-AS1 may not influence endometrial receptivity in endometriosis-associated infertility.
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Affiliation(s)
- Meimei Wang
- 1 Shandong University School of Medicine, Jinan, People's Republic of China.,2 Reproductive Medicine Centre, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
| | - Cuifang Hao
- 2 Reproductive Medicine Centre, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
| | - Xin Huang
- 2 Reproductive Medicine Centre, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
| | - Hongchu Bao
- 2 Reproductive Medicine Centre, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
| | - Qinglan Qu
- 2 Reproductive Medicine Centre, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
| | - Zhenteng Liu
- 2 Reproductive Medicine Centre, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
| | - Huangguan Dai
- 2 Reproductive Medicine Centre, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
| | - Shunzhi He
- 2 Reproductive Medicine Centre, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
| | - Wei Yan
- 2 Reproductive Medicine Centre, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
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Abstract
The incidence and prevalence of inflammatory bowel disease (IBD) continues to rise with time, signifying its emergence as a global disease. Clinical onset of IBD, comprising Crohn's disease and ulcerative colitis, typically occurs before or at peak reproductive age. Although active disease in female patients is associated with reduced fertility and adverse obstetric outcomes in pregnancy, the molecular mechanisms underlying this altered reproductive course, and its impact on IBD transmission to offspring, remain poorly understood. Clinical and experimental studies have now begun to elucidate the hormonal, environmental, and microbial factors that modulate immune-reproductive cross talk in IBD and define their impact on maternal health, fetal development, and heritability of disease risk. Evolving insight into maternal-fetal imprinting in IBD has important implications for patient counseling and disease management during pregnancy and may help predict clinical outcomes for both mother and child.
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Predicting suitable timing for artificial reproductive technology treatment in aged infertile women. Reprod Med Biol 2016; 15:253-259. [PMID: 29259442 DOI: 10.1007/s12522-016-0241-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/14/2016] [Indexed: 10/22/2022] Open
Abstract
It has been widely accepted that the age of women plays a fundamental role in fecundity, and age-related fertility decline has one of the most significant and detrimental effects on the success rate of infertility treatment. Therefore, treatment cycles of non-in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment for infertile women of advanced aged have been limited due to their lack of efficacy, and they are often optimized, compared to IVF/ICSI treatment. Recent trends in infertility treatment apparently indicate that IVF/ICSI treatment, including egg donation, is frequently offered to aged women for first-line management, despite its heavy burden, but hasty IVF/ICSI treatment should be avoided, considering its socioeconomic problems. It is important to distinguish women who could conceive by non-IVF/ICSI treatment, although the optimization of non-IVF/ICSI treatment protocols remains poorly understood. This review focuses on extracting aged patients who have higher chance of conceiving with non-IVF/ICSI treatment and providing necessary and sufficient infertility treatment. After initial evaluation for fertility, including tubal factor, male factor, the presence of endometriosis and/or adenomyosis, and ovarian reserve, the outcomes of fertility treatment can be predicted to some extent in aged infertile women.
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Shaeib F, Khan SN, Thakur M, Kohan-Ghadr HR, Drewlo S, Saed GM, Pennathur S, Abu-Soud HM. The Impact of Myeloperoxidase and Activated Macrophages on Metaphase II Mouse Oocyte Quality. PLoS One 2016; 11:e0151160. [PMID: 26982351 PMCID: PMC4794194 DOI: 10.1371/journal.pone.0151160] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/24/2016] [Indexed: 01/26/2023] Open
Abstract
Myeloperoxidase (MPO), an abundant heme-containing enzyme present in neutrophils, monocytes, and macrophages, is produced in high levels during inflammation, and associated with poor reproductive outcomes. MPO is known to generate hypochlorous acid (HOCl), a damaging reactive oxygen species (ROS) utilizing hydrogen peroxide (H2O2) and chloride (Cl-). Here we investigate the effect of activated immune cells and MPO on oocyte quality. Mouse metaphase II oocytes were divided into the following groups: 1) Incubation with a catalytic amount of MPO (40 nM) for different incubation periods in the presence of 100 mM Cl- with and without H2O2 and with and without melatonin (100 μM), at 37°C (n = 648/648 total number of oocytes in each group for oocytes with and without cumulus cells); 2) Co-cultured with activated mouse peritoneal macrophage and neutrophils cells (1.0 x 106 cells/ml) in the absence and presence of melatonin (200 μM), an MPO inhibitor/ROS scavenger, for different incubation periods in HTF media, at 37°C (n = 200/200); 3) Untreated oocytes incubated for 4 hrs as controls (n = 73/64). Oocytes were then fixed, stained and scored based on the microtubule morphology and chromosomal alignment. All treatments were found to negatively affect oocyte quality in a time dependent fashion as compared to controls. In all cases the presence of cumulus cells offered no protection; however significant protection was offered by melatonin. Similar results were obtained with oocytes treated with neutrophils. This work provides a direct link between MPO and decreased oocyte quality. Therefore, strategies to decrease MPO mediated inflammation may influence reproductive outcomes.
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Affiliation(s)
- Faten Shaeib
- Department of Obstetrics and Gynecology, the C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, United States of America
| | - Sana N. Khan
- Department of Obstetrics and Gynecology, the C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, United States of America
| | - Mili Thakur
- Department of Obstetrics and Gynecology, the C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, United States of America
| | - Hamid-Reza Kohan-Ghadr
- Department of Obstetrics and Gynecology, the C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, United States of America
| | - Sascha Drewlo
- Department of Obstetrics and Gynecology, the C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, United States of America
| | - Ghassan M. Saed
- Department of Obstetrics and Gynecology, the C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, United States of America
| | - Subramaniam Pennathur
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Husam M. Abu-Soud
- Department of Obstetrics and Gynecology, the C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, United States of America
- Department of Biochemistry and Molecular Biology, Wayne State University School of Medicine, Detroit, MI 48201, United States of America
- * E-mail:
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14
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Saraswat L, Ayansina DT, Cooper KG, Bhattacharya S, Miligkos D, Horne AW, Bhattacharya S. Pregnancy outcomes in women with endometriosis: a national record linkage study. BJOG 2016; 124:444-452. [DOI: 10.1111/1471-0528.13920] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2016] [Indexed: 01/08/2023]
Affiliation(s)
- L Saraswat
- Ward 315 Department of Gynaecology Aberdeen Royal Infirmary Aberdeen UK
| | - DT Ayansina
- Medical Statistics Team Division of Applied Health Sciences University of Aberdeen Aberdeen UK
| | - KG Cooper
- Ward 315 Department of Gynaecology Aberdeen Royal Infirmary Aberdeen UK
| | - S Bhattacharya
- Dugald Baird Centre Aberdeen Maternity Hospital Aberdeen UK
| | - D Miligkos
- Department of Obstetrics and Gynaecology University Hospitals of Southampton Southampton UK
| | - AW Horne
- MRC Centre for Reproductive Health University of Edinburgh Edinburgh UK
| | - S Bhattacharya
- Head of Division of Applied Health Sciences School of Medicine and Dentistry University of Aberdeen Aberdeen UK
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15
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Kahyaoglu I, Kahyaoglu S, Moraloglu O, Zergeroglu S, Sut N, Batioglu S. Comparison of Ki-67 proliferative index between eutopic and ectopic endometrium: a case control study. Taiwan J Obstet Gynecol 2013; 51:393-6. [PMID: 23040923 DOI: 10.1016/j.tjog.2012.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2011] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE In this study, the Ki-67 proliferative indices among the stages of the endometriosis were compared to clarify whether the proliferation was increased with increasing disease stage. MATERIALS AND METHODS Thirty-eight patients who underwent surgery either by laparotomy or by laparoscopy with the diagnosis of endometriosis and 21 patients, as controls, who underwent hysterectomy with the diagnosis of myoma uteri and without any endometrial pathology at our hospital between 2005 and 2007 were studied. Biopsy specimens of endometriotic foci and endometriomas in study group, and eutopic endometrium of hysterectomy specimens of control group were studied. RESULTS Fifty-nine patients were divided into Group 1 (21 patients in control), Group 2 (19 patients in stage I and II of endometriosis), and Group 3 (19 patients in stage III and IV). A moderate correlation between the stage of endometriosis and the degree of Ki-67 staining was found. When Ki-67 immunohistochemical staining was considered according to the threshold value for CA-125 (35 U/mL), Ki-67 positivity was increased with the increase in CA-125 value, but this increase was not statistically significant. CONCLUSION Endometriosis shows some characteristics of tumors such as high rate of invasion, getting autonomy, and proliferation as the disease progresses with subsequent damage to target organs. When the stage of the disease increases, environment becomes more suitable for increased proliferation and invasion. In this study, the increase in proliferative activity as the severity increases is shown by the increase in Ki-67 index. As more studies are being conducted in this field, pathogenesis will be clarified, which could help in the development of new treatment modalities.
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Affiliation(s)
- Inci Kahyaoglu
- Department of Infertility and Reproductive Medicine, Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey.
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16
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Abstract
Infertility is defined as a couple's failure to achieve pregnancy after one year of regular, unprotected intercourse. The etiology of infertility can be due to female factors, male factors, combined male and female factors, or have an unknown etiology. This review focuses on the role of female pelvic anatomy in infertility. Normal anatomy and the physiology of reproduction will be discussed, as well as the anatomic and pathophysiologic processes that cause infertility including ovulatory disorders, endometriosis, pelvic adhesions, tubal blockage, mullerian anomalies, and abnormalities affecting the uterine cavity such as leiomyomata and endometrial polyps.
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Affiliation(s)
- Miranda Harris-Glocker
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Alabama, Birmingham, Alabama, USA.
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17
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Lu H, Yang X, Zhang Y, Lu R, Wang X. Epigenetic disorder may cause downregulation of HOXA10 in the eutopic endometrium of fertile women with endometriosis. Reprod Sci 2012; 20:78-84. [PMID: 22915150 DOI: 10.1177/1933719112451146] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
HOXA10 is an important gene for endometrial receptivity and plays a regulatory role in the adult female reproductive tract. It is regulated by epigenetic modulation in the CpG clusters of promoter in some cases. The aim of this study was to investigate HOXA10 expression and the epigenetic regulation in the eutopic endometrium of fertile women with endometriosis by quantitative real-time polymerase chain reaction (RT-PCR) and Western blot. The effect of 5-azacytidine (5-ac), a demethylation agent on HOXA10 expression was determined on endometrium stromal cells (ESCs) from these women with endometriosis. Results revealed that in normal endometrium (NE), HOXA10 messenger RNA (mRNA) and protein expression at the secretory phase were significantly higher than that at the proliferative phase. The HOXA10 mRNA and protein expression in the eutopic endometrium of endometriosis were significantly lower than in NE. The HOXA10 mRNA and protein levels in cultured stromal cells from endometriosis in vitro were significantly increased in a 5-ac treatment group compared with a nontreatment group. Our results indicated that the level of HOXA10 decrease in the eutopic endometrium of patients with endometriosis. Upregulation of HOXA10 in ESCs after treatment with 5-ac suggests that HOXA10 expression is controlled by methylation of the promoter. An epigenetic aberration is likely the main cause of endometriosis.
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Affiliation(s)
- Hong Lu
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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18
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Hackethal A, Luck C, von Hobe AK, Eskef K, Oehmke F, Konrad L. A structured questionnaire improves preoperative assessment of endometriosis patients: a retrospective analysis and prospective trial. Arch Gynecol Obstet 2011; 284:1179-88. [PMID: 21197594 DOI: 10.1007/s00404-010-1819-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 12/13/2010] [Indexed: 01/07/2023]
Abstract
PURPOSE To determine whether a structured questionnaire can improve preoperative assessment of patients with endometriosis. METHODS Hospital records for patients with endometriosis were evaluated retrospectively to determine the completeness of information. A structured electronic questionnaire was developed and used to assess preoperatively patients with suspected or proved endometriosis. Data from both assessments were compared. RESULTS Data analysed retrospectively showed that there were valid answers for 89.2% of questions on a standard patient history template, but information was available for only 46.3% of parameters considered specific to endometriosis. Data from 69 patients investigated by structured electronic questionnaire gave improved rates of 90.3% for standard patient history items and 88.5% for endometriosis-specific parameters. Significant improvement in valid answers was achieved in 66.7%. CONCLUSIONS A structured questionnaire improved the documentation of endometriosis-specific parameters. Further studies are needed to ensure that it enhances the effectiveness of preoperative counselling and decisions about surgery.
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Affiliation(s)
- Andreas Hackethal
- Department of Obstetrics and Gynaecology, Justus-Liebig-University of Giessen, Klinikstrasse 32, 35385 Giessen, Germany.
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Endometriosis e infertilidad. REVISTA MÉDICA CLÍNICA LAS CONDES 2010. [DOI: 10.1016/s0716-8640(10)70551-4] [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] Open
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20
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Chadha HK, Armstrong JE, Mower GD, Hubscher CH. Effects of surgical induction of endometriosis on response properties of preoptic area neurons in rats. Brain Res 2008; 1246:101-10. [PMID: 18955036 DOI: 10.1016/j.brainres.2008.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 09/22/2008] [Accepted: 10/02/2008] [Indexed: 10/24/2022]
Abstract
Subfertility and severe pelvic pains are symptoms associated with endometriosis (ENDO), a common condition among women that is characterized by the growth of the uterine endometrium on the surface of organs within the pelvic region and abdominal cavity. The contribution of the CNS to symptoms associated with ENDO is not known. In the present study, the preoptic area (POA) of the hypothalamus was investigated, as this region of the forebrain is known to play an important role in the neuroendocrine control of the reproductive cycle, mating behavior, and antinociception. Female rats were either induced for ENDO by autotransplantation of uterine tissue (n=20) or uterine fat for surgical sham controls (n=11). Terminal extracellular electrophysiological recordings (urethane anesthesia) were conducted in the POA six weeks post-ENDO induction when the rats were in either the proestrus or metestrus stages of their estrous cycle. Significant differences were found between the ENDO versus SHAM groups of animals for the proportion of inhibitory responses as well as the percentage of neurons responding to stimulation of the abdominal branches of the vagus, which innervates portions of the female reproductive tract, including the ovaries. The endometriotic cysts were found to be significantly larger in proestrus rats (stage when hormones are elevated). These data demonstrate that the responses of POA neurons are influenced by the presence of endometriotic cysts in the abdominal cavity. Since the POA is known to be part of the neural circuitries that mediate nociception and fertility, any deviation from its normal activity under ENDO conditions could contribute to the constellation of symptoms that ensue.
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Affiliation(s)
- Harpreet K Chadha
- Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY 40292, USA
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21
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Ozkan S, Murk W, Arici A. Endometriosis and infertility: epidemiology and evidence-based treatments. Ann N Y Acad Sci 2008; 1127:92-100. [PMID: 18443335 DOI: 10.1196/annals.1434.007] [Citation(s) in RCA: 196] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Endometriosis is an estrogen-dependent disorder defined as the presence of endometrial tissue outside of the uterine cavity. A leading cause of infertility, endometriosis has a prevalence of 0.5-5% in fertile and 25-40% in infertile women. The optimal choice of management for endometriosis-associated infertility remains obscure. Removal or suppression of endometrial deposits by medical or surgical means constitutes the basis of endometriosis management. Current evidence indicates that suppressive medical treatment of endometriosis does not benefit fertility and should not be used for this indication alone. Surgery is probably efficacious for all stages of the disease. Controlled ovarian hyperstimulation with intrauterine insemination is recommended in early-stage and surgically corrected endometriosis when pelvic anatomy is normal. In advanced cases, in vitro fertilization is a treatment of choice, and its success may be augmented with prolonged gonadotropin-releasing hormone analog treatment. Further randomized clinical trials focusing on diverse etiopathogenic mechanisms and therapeutic innovation are necessary to find more conclusive, evidence-based answers regarding this enigmatic disease.
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Affiliation(s)
- Sebiha Ozkan
- Department of Obstetrics and Gynecology, Kocaeli University School of Mediine, Kocaeli, Turkey
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22
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Mansour G, Abdelrazik H, Sharma RK, Radwan E, Falcone T, Agarwal A. L-carnitine supplementation reduces oocyte cytoskeleton damage and embryo apoptosis induced by incubation in peritoneal fluid from patients with endometriosis. Fertil Steril 2008; 91:2079-86. [PMID: 18394615 DOI: 10.1016/j.fertnstert.2008.02.097] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 02/07/2008] [Accepted: 02/07/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the protective effect of L-carnitine (LC) against deleterious substances present in the peritoneal fluid (PF) of patients with endometriosis, which may affect the oocyte cytoskeleton and embryogenesis. DESIGN Experimental study. SETTING Research embryology laboratory at an academic hospital. PATIENT(S) Frozen metaphase II mouse oocytes and embryos. INTERVENTION(S) One hundred metaphase II mouse oocytes were divided into five groups and incubated: PF from endometriosis patients; PF from endometriosis patients + LC; PF from tubal ligation patients (patient control); LC only; and human tubal fluid (HTF) alone. A total of 180 eight-cell mouse embryos were divided into: endometriosis only; tubal ligation only; endometriosis + LC; LC alone; and HTF alone. MAIN OUTCOME MEASURE(S) Protective effect of LC on oocytes and embryos. RESULT(S) Incubation of the oocytes and the embryos with PF from patients with endometriosis statistically significantly damaged the oocyte microtubules and chromosomes and increased embryo apoptosis compared with controls. Incubation with LC (0.6 mg/mL) statistically significantly improved microtubule and chromosome structure and decreased the level of embryo apoptosis. CONCLUSION(S) We propose the use of LC as a supplement in patients with endometriosis, a novel approach that may help improve in vitro fertilization outcome in these patients.
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Affiliation(s)
- Gihan Mansour
- Reproductive Research Center, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio, USA
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23
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Ovarian suppression treatment prior to in-vitro fertilization and embryo transfer in Chinese women with stage III or IV endometriosis. Int J Gynaecol Obstet 2007; 100:167-70. [PMID: 18029283 DOI: 10.1016/j.ijgo.2007.08.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Revised: 07/31/2007] [Accepted: 08/02/2007] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a 2-month treatment with a gonadotropin-releasing hormone (GnRH) agonist prior to in-vitro fertilization in Chinese women with moderate or severe endometriosis. METHODS A study of 162 women surgically diagnosed as having moderate or severe endometriosis. Pituitary down-regulation was achieved with injections of a GnRH agonist prior to the IVF procedures either for 7 to 10 days in the mid-luteal phase (group 1 [standard protocol], 97 cycles in total), or for 2 months (group 2, 55 cycles), or 3 months (group 3, 75 cycles). RESULTS Women pretreated with a GnRH agonist for 2 or 3 months required significantly higher doses of gonadotropin for ovarian stimulation (P<0.001), and for a longer time, than those treated with the standard long protocol (P<0.05). The number of oocytes and good embryos was lower in group 3 than in groups 1 or 2 (P<0.05). The implantation rate was significantly higher in group 2 than in group 1 (P<0.02). CONCLUSION A 2-month treatment with a GnRH agonist prior to IVF produced a trend toward an increase in the implantation rate in a group of Chinese women with stages III and IV endometriosis.
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24
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Chavez-Badiola A, Drakeley A. Optimising in vitro fertilisation (IVF) outcome in women with endometriosis. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.rigapp.2006.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Karaer O, Vatansever HS, Oruç S, Ozbilgin K, Cilaker S, Koyuncu MF. The aromatase inhibitor anastrozole is associated with favorable embryo development and implantation markers in mice ovarian stimulation cycles. Fertil Steril 2005; 83:1797-806. [PMID: 15950653 DOI: 10.1016/j.fertnstert.2005.01.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2004] [Revised: 01/29/2005] [Accepted: 01/29/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the embryonic and endometrial effects of anastrozole in preimplantation and implantation phases in FSH-induced cycles in mice. DESIGN Blind randomized study. SETTING University research laboratory. ANIMAL(S) Twenty-seven mature female mice. INTERVENTION(S) Single-dose anastrozole (25 mg/kg [0.75 mg]), recombinant FSH (5 IU/mL), and hCG (5 IU/mL) (n = 9); recombinant FSH (5 IU/mL) and hCG (5 IU/mL) (n = 9); or sterile saline (1 mL) (n = 9). The morning of finding the vaginal plug was designated as day 1 of embryonic development (E1). Three mice from each group were sacrificed on E1 and embryos aspirated from uterine tubes. The rest of the mice were sacrificed on E2.5-3 and uteruses removed. MAIN OUTCOME MEASURE(S) Embryo quality, endometrial histologic evaluation, and immunohistochemical analysis of tumor necrosis factor-alpha, leukemia inhibitory factor, laminin, and collagen IV staining. RESULT(S) Anastrozole use in FSH-induced cycles not only caused an increase in preimplantation receptivity and implantation but also supported release of implantation markers. The enhanced embryo development seen in this study would explain the higher implantation because embryo development is synchronized with endometrial development. CONCLUSION(S) In mice, the use of anastrozole in FSH-induced cycles has a positive effect on embryo quality and implantation. This effect might be species dependent, and human studies are needed.
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Pritts EA, Taylor RN. An evidence-based evaluation of endometriosis-associated infertility. Endocrinol Metab Clin North Am 2003; 32:653-67. [PMID: 14560892 DOI: 10.1016/s0889-8529(03)00045-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although endometriosis is associated with infertility, a clear causal relationship has yet to be established, unless adhesive disease is found. Despite this indirect association, multiple theories have been promulgated and studies are currently underway to investigate theoretic pathogenetic mechanisms. The data regarding the treatment of endometriosis-associated infertility are limited and conflicting; however, some general preliminary conclusions can be drawn. It seems that, with early-stage disease, surgical treatment increases pregnancy rates. Using the US Preventive Services Task Force classification scheme, the evidence in support of this finding is of the highest quality, or level I. Surgical treatment for moderate and severe disease also confers benefit, although the evidence in support of this treatment is of lesser quality, level II-3 by the scheme. Medical treatment, particularly if it induces an anovulatory state, has no benefit and may delay fertility. This evidence is again of the highest quality, with a classification of level I. Although assisted reproductive technologies are of benefit regarding fertility for women with endometriosis, the IVF evidence is inconclusive, with both treatments being evaluated by at least one randomized, controlled trial conferring a level I classification to the evidence. It is unclear at this time whether endometriomas have an impact on IVF outcome. The evidence consists of only a few lower-quality studies, with a classification level of II-2. Despite the haziness of current insight into the treatment of endometriosis-associated infertility, well-designed clinical trials and basic mechanistic investigations are underway in many reproductive medicine centers. As the data from these scientific inquiries emerge, clinicians will have a clearer view of effective treatment regimens for endometriosis.
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Affiliation(s)
- Elizabeth A Pritts
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Wisconsin, H4/630 CSC, 600 Highland Avenue, Madison, WI 53792-6188, USA.
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27
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Scott L. Embryological strategies for overcoming recurrent assisted reproductive technology treatment failure. HUM FERTIL 2002; 5:206-14. [PMID: 12477965 DOI: 10.1080/1464727022000199142] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In every assisted reproductive technology (ART) programme there are patients who experience repeated failure. If all laboratory and stimulation parameters are controlled, it is assumed that the underlying cause of failure is physiological, and is attributable to either of the gametes or the embryo. Within the laboratory, few tools are available, other than careful observation and embryo selection, to aid in selecting the right embryo to overcome this failure. The morphology of the zygote, the state of the cleaving embryos on day 2 and day 3 of development, and the blastocyst can influence implantation rates. However, without functional gametes it is unlikely that success can be achieved. An early indicator of this functionality is the morphology of the zygote, which can be influenced by either the oocyte or the spermatozoon, and can be altered by either improving oocyte quality during stimulation or by using donor sperm if the failure to conceive is attributable to the male gamete. Subsequently, selecting embryos for transfer on the basis of the morphology of zygotes and embryos at day 3 or day 5 of development with the addition of fragmentation scoring and assisted hatching has been found to overcome many cases of repetitive failure to conceive after ART.
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Affiliation(s)
- Lynette Scott
- ART Institute of Washington, Inc., Walter Reed Army Medical Center, 6900 Georgia Ave, NW, Washington, DC 20307, USA
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