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Halpern G, Braga DPDAF, Morishima C, Setti AS, Setti Jr. AI, Borges Jr. E. Beetroot, watermelon and ginger juice supplementation may increase the clinical outcomes of Intracytoplasmic Sperm Injection cycles. JBRA Assist Reprod 2023; 27:490-495. [PMID: 37459441 PMCID: PMC10712821 DOI: 10.5935/1518-0557.20230012] [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: 08/17/2022] [Accepted: 02/20/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVE To prove the hypothesis that beetroot, watermelon and ginger juice supplementation improves the endometrial receptivity and clinical outcomes of intracytoplasmic sperm injection (ICSI) cycles. METHODS This prospective randomized study enrolled 436 female patients undergoing ICSI cycles from January/2018 to June/2021, in a private university-affiliated IVF center. Female patients were randomized in a 1:3 ratio to either Control (n=109) or Supplementation Group (n=327). All patients received nutritional orientation before the beginning of the treatment. Participants in the Supplementation Group were instructed to intake a daily dose of homemade juice, prepared with fresh beetroot, watermelon and ginger, from the day of embryo transfer until the day of pregnancy test, while patients in Control Group did not follow the juice protocol. Generalized Linear Models, adjusted for potential confounders (female age, body mass index - BMI, endometrial thickness upon embryo transfer, and number of transferred embryos), followed by Bonferroni post hoc test for the comparison of means between groups, were used to investigate the impact of juice supplementation on the clinical outcomes of ICSI. RESULTS Patients and cycles characteristics were equally distributed among Supplementation and Control groups. Implantation rate (25.2% vs. 20.5%, p<0.001) and clinical pregnancy rate (41.0% vs. 22.0%, p=0.039) were significantly higher in the Supplementation compared to the Control group. CONCLUSIONS The use of beetroot, watermelon and ginger juice may be considered a promising strategy for improving clinical outcomes in assisted reproductive technology (ART), without any side effects.
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Affiliation(s)
- Gabriela Halpern
- Fertility Medical Group, Av. Brigadeiro Luiz Antônio, 4545.
São Paulo – SP, Brazil. Zip: 01401-002
| | - Daniela Paes de Almeida Ferreira Braga
- Fertility Medical Group, Av. Brigadeiro Luiz Antônio, 4545.
São Paulo – SP, Brazil. Zip: 01401-002
- Instituto Sapientiae – Centro de Estudos e Pesquisa em
Reprodução Assistida Rua Vieira Maciel, 62. São Paulo – SP,
Brazil. Zip: 04503-040
| | - Christina Morishima
- Instituto Sapientiae – Centro de Estudos e Pesquisa em
Reprodução Assistida Rua Vieira Maciel, 62. São Paulo – SP,
Brazil. Zip: 04503-040
| | - Amanda Souza Setti
- Fertility Medical Group, Av. Brigadeiro Luiz Antônio, 4545.
São Paulo – SP, Brazil. Zip: 01401-002
- Instituto Sapientiae – Centro de Estudos e Pesquisa em
Reprodução Assistida Rua Vieira Maciel, 62. São Paulo – SP,
Brazil. Zip: 04503-040
| | | | - Edson Borges Jr.
- Fertility Medical Group, Av. Brigadeiro Luiz Antônio, 4545.
São Paulo – SP, Brazil. Zip: 01401-002
- Instituto Sapientiae – Centro de Estudos e Pesquisa em
Reprodução Assistida Rua Vieira Maciel, 62. São Paulo – SP,
Brazil. Zip: 04503-040
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Rubin SC, Abdulkadir M, Lewis J, Harutyunyan A, Hirani R, Grimes CL. Review of Endometrial Receptivity Array: A Personalized Approach to Embryo Transfer and Its Clinical Applications. J Pers Med 2023; 13:jpm13050749. [PMID: 37240919 DOI: 10.3390/jpm13050749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Successful outcomes of in vitro fertilization (IVF) rely on both the formation of a chromosomally normal embryo and its implantation in a receptive endometrium. Pre-implantation genetic testing for aneuploidy (PGT-A) has been widely accepted as a tool to assess the viability of an embryo. In 2011, the endometrial receptivity array (ERA) was first published as a tool to determine when the endometrium is most receptive to an embryo, commonly referred to as the "window of implantation" (WOI). The ERA uses molecular arrays to assess proliferation and differentiation in the endometrium and screens for inflammatory markers. Unlike PGT-A, there has been dissent within the field concerning the efficacy of the ERA. Many studies that contest the success of the ERA found that it did not improve pregnancy outcomes in patients with an already-good prognosis. Alternatively, studies that utilized the ERA in patients with repeated implantation failure (RIF) and transfer of known euploid embryos demonstrated improved outcomes. This review aims to describe the ERA as a novel technique, review the various settings that the ERA may be used in, such as natural frozen embryo transfer (nFET) and hormone replacement therapy frozen embryo transfer (HRT-FET), and provide a summary of the recent clinical data for embryo transfers in patients with RIF utilizing the ERA.
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Affiliation(s)
- Sarah C Rubin
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA
| | - Mawerdi Abdulkadir
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA
| | - Joshua Lewis
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA
| | - Aleksandr Harutyunyan
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA
| | - Rahim Hirani
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA
| | - Cara L Grimes
- School of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA
- Department of Obstetrics and Gynecology and Urology, New York Medical College, Valhalla, NY 10595, USA
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An In Vivo Screening Model for Investigation of Pathophysiology of Human Implantation Failure. Biomolecules 2022; 13:biom13010079. [PMID: 36671464 PMCID: PMC9856033 DOI: 10.3390/biom13010079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/14/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
To improve current infertility treatments, it is important to understand the pathophysiology of implantation failure. However, many molecules are involved in the normal biological process of implantation and the roles of each molecule and the molecular mechanism are not fully understood. This review highlights the hemagglutinating virus of Japan (HVJ; Sendai virus) envelope (HVJ-E) vector, which uses inactivated viral particles as a local and transient gene transfer system to the murine uterus during the implantation period in order to investigate the molecular mechanism of implantation. In vivo screening in mice using the HVJ-E vector system suggests that signal transducer and activator of transcription-3 (Stat-3) could be a diagnostic and therapeutic target for women with a history of implantation failure. The HVJ-E vector system hardly induces complete defects in genes; however, it not only suppresses but also transiently overexpresses some genes in the murine uterus. These features may be useful in investigating the pathophysiology of implantation failure in women.
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Zhai J, Li S, Hu J, Gao M, Sun Y, Chen ZJ, Giudice LC, Du Y. In Silico, In Vitro, and In Vivo Analysis Identifies Endometrial Circadian Clock Genes in Recurrent Implantation Failure. J Clin Endocrinol Metab 2021; 106:2077-2091. [PMID: 33619544 PMCID: PMC8502449 DOI: 10.1210/clinem/dgab119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Previous work has demonstrated the role of the circadian clock in ovarian steroid hormone synthesis and attributed embryo implantation failure associated with arrhythmic circadian clock genes to insufficient ovarian-derived progesterone synthesis. Research on expression of core circadian clock genes in the endometrium itself and possible roles in compromised endometrial receptivity and recurrent implantation failure (RIF) are limited. OBJECTIVE We aimed to assess the core circadian clock gene profiling in human endometrium across the menstrual cycle and the possible gene interaction networks in the endometrial receptivity of window of implantation (WOI) as well as RIF. METHODS The study was initially an in silico study, with confirmatory lab-based data from primary human endometrial stromal cells (hESCs) as well as endometrial biopsies obtained from 60 women undergoing gynecological surgery in a clinical research center. The study included 30 RIF women and 30 age-matched and body mass index-matched controls. RESULTS Initial data mining and bioinformatics analysis of human endometrial microarray datasets across the menstrual cycle and between RIF women versus controls demonstrated the varied expression of core circadian clock genes across menstrual cycle, including the key role of PER2 in WOI and RIF. A PER2-centered network was investigated in the regulation of endometrial receptivity. We also confirmed the evidently increased mRNA expression of SHTN1, RXFP1, KLF5, and STEAP4 in the endometrium of RIF women, displaying the same trend as PER2 did, without any changes in MT1E and FKBP5. Treatment of PER2 siRNA in hESCs verified the positive regulation of PER2 to SHTN1, KLF5, and STEAP4. CONCLUSION Aberrant expression of endometrial PER2 might contribute to impaired endometrial receptivity and development of RIF via regulating SHTN1, KLF5, and STEAP4.
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Affiliation(s)
- Junyu Zhai
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Shang Li
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Jingwen Hu
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Minzhi Gao
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Yun Sun
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
| | - Linda C Giudice
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Yanzhi Du
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
- Correspondence: Yanzhi Du, MD, PhD, 845 Lingshan Road, Shanghai 200135, China.
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5
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Braga DPDAF, Setti AS, Iaconelli A, Borges E. Predictive factors for successful pregnancy in an egg-sharing donation program. JBRA Assist Reprod 2020; 24:163-169. [PMID: 32157861 PMCID: PMC7169914 DOI: 10.5935/1518-0557.20190087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate the predictive factors for successful pregnancy in oocyte recipient ICSI cycles in an egg-sharing donation program. Methods Analysed data were obtained via chart review of 1505 vitrified oocytes donated from 268 patients to 225 oocyte recipients, undergoing 307 ICSI cycles. Patients were participating in an egg-sharing donation program between January 2015 and May 2017. Adjusted generalised linear models were used to investigate the impact of oocyte donor and recipient characteristics on recipients’ pregnancy achievement. Results Implantation rate in the oocyte donor was highly correlated with pregnancy achievement in the oocyte recipient’s cycles (ExpB: 1.181, CI: 1.138-1.226, p<0.001). The ROC curve analysis demonstrated that the implantation rate in the oocyte donor has a strong predictive value for pregnancy success in the oocyte recipient (area under the curve: 0.98, CI: 0.95-0.99, p<0.001). Pregnancy in oocyte donors and recipients were highly associated (ExpB: 54.6, CI: 28.1-105.8, p<0.001), regardless of the oocyte recipient’s age. In oocyte recipients, the high-quality embryos rates on days 2 (ExpB: 3.397, CI: 1.635-7.054, p=0.001) and 3 (ExpB: 6.629, CI: 1.185-37.092, p=0.031), and blastocyst development rates (ExpB: 2.331, CI: 1.086-5.001, p=0.030) were positively associated with pregnancy outcome. Conclusion The strong association in pregnancy success between donors and recipients, and the lack of correlation between donor characteristics and cycles’ outcomes, demonstrate the power of oocyte quality on the success of ICSI treatment.
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Affiliation(s)
| | - Amanda Souza Setti
- Fertility Medical Group, São Paulo, SP, Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Assistida, São Paulo, SP, Brazil
| | - Assumpto Iaconelli
- Fertility Medical Group, São Paulo, SP, Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Assistida, São Paulo, SP, Brazil
| | - Edson Borges
- Fertility Medical Group, São Paulo, SP, Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Assistida, São Paulo, SP, Brazil
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6
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Braga DPDAF, Borges E, Godoy AT, Montani DA, Setti AS, Zanetti BF, Figueira RDCS, Eberlin MN, Lo Turco EG. Lipidomic profile as a noninvasive tool to predict endometrial receptivity. Mol Reprod Dev 2018; 86:145-155. [PMID: 30418697 DOI: 10.1002/mrd.23088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/05/2018] [Indexed: 12/28/2022]
Abstract
For the present study we asked whether the endometrial fluid lipidomic may be a useful approach to predict endometrial receptivity in freeze-all cycles. For this case-control study, endometrial fluid samples were collected from 41 patients undergoing freeze-all cycles. Samples were split depending on the pregnancy outcome: positive group (n = 24) and negative group (n = 17). Data were acquired by the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) were applied. A list of potential biomarker ion ratios was obtained and the values were used to build a receiver operating characteristic (ROC) curve to predict pregnancy success. The lipid categories were attributed by LIPID MAPS database. Ion ratios were established according to their correlations and used for the analysis. The PCA showed a tendency of separation between the studied groups, whereas the PLS-DA was able to clearly distinguish them. Fifteen ratios (13 hyper-represented in the negative and two hyper-represented in the positive group) were selected according to their importance for model prediction. These ratios were used to build the ROC curve, which presented an area under curve of 84.0% (95%CI: 69.2-97.4%; p = 0.009). These findings suggest that lipidomic profiling of endometrial fluid may be a valuable tool for identifying the time interval comprising the window of implantation.
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Affiliation(s)
- Daniela Paes de Almeida Ferreira Braga
- Departamento de Cirurgia, Disciplina de Urologia, Universidade Federal de São Paulo -UNIFESP, São Paulo, Brazil.,Fertility Medical Group, Av. Brigadeiro Luiz Antônio, 4545 São Paulo, Brazil
| | - Edson Borges
- Fertility Medical Group, Av. Brigadeiro Luiz Antônio, 4545 São Paulo, Brazil
| | - Adriana Teixeira Godoy
- Laboratorio ThoMSon de Espectrometria de Massas, Universidade de Campinas-UNICAMP, Rua Sérgio Buarque de Holanda, S/N - Cidade Universitária, Campinas, Brazil
| | - Daniela Antunes Montani
- Departamento de Cirurgia, Disciplina de Urologia, Universidade Federal de São Paulo -UNIFESP, São Paulo, Brazil
| | - Amanda Souza Setti
- Fertility Medical Group, Av. Brigadeiro Luiz Antônio, 4545 São Paulo, Brazil
| | | | | | - Marcos Nogueira Eberlin
- Laboratorio ThoMSon de Espectrometria de Massas, Universidade de Campinas-UNICAMP, Rua Sérgio Buarque de Holanda, S/N - Cidade Universitária, Campinas, Brazil
| | - Edson Guimarães Lo Turco
- Departamento de Cirurgia, Disciplina de Urologia, Universidade Federal de São Paulo -UNIFESP, São Paulo, Brazil
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7
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Herrera M, Herrera JM, Cantatore S, Aguilar J, Felipe A, Fumuso E. Comparative histomorphological study of endometrium in mares. Anat Histol Embryol 2018; 47:153-158. [PMID: 29314167 DOI: 10.1111/ahe.12335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/02/2017] [Indexed: 11/27/2022]
Abstract
Uterine acute post-breeding inflammation is a physiological tissue response to the entry of exogenous elements, with persistent endometritis being the main pathology responsible for subfertility in the mare (Equus ferus caballus; Linnaeus, 1758). Mares can be classified as susceptible or resistant to endometritis according to their ability to remove intrauterine fluid within 48 hr after experimental inoculation. Endometrial biopsy is a technique that is commonly used to establish the degree of lesions that can affect the fertility of the mare. Endometrial histomorphometry is an objective and highly precise diagnostic method. The aim of this study was to compare, during oestrus, the endometrial histomorphometry of mares previously classified as susceptible (SM) or resistant (RM) to endometritis. Endometrial biopsies from 24 mares at the oestrus phase of the cycle were obtained. For the histomorphometric analysis, samples were histologically processed and subjected to routine Haematoxylin-Eosin staining. For the evaluation, the variables were considered as follows: 1-Height of the lining and glandular epithelia (Lining SM = 15.9 μm vs. RM = 13.3 μm; Glandular SM = 15.0 μm vs. RM = 13.0 μm); 2-Perpendicular diameters of endometrial glands (SM = 51.3 μm vs. RM = 44.8 μm); 3-Number of endometrial glands per field (SM = 24.8 glands/field vs. RM = 20.5 glands/field). The results from this study suggest the existence of a relationship between the studied characteristics and the susceptibility/resistance to post-breeding endometritis in mares. Thus, increased epithelial height, greater glandular density and greater development of the glands during oestrus would be related to a higher susceptibility to endometritis.
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Affiliation(s)
- M Herrera
- Facultad de Ciencias Veterinarias, Laboratorio de Clínica y Reproducción Equina, CIVETAN, UNICEN, Tandil, Argentina.,Facultad de Ciencias Veterinarias, Área de Ciencias Morfológicas, UNICEN, Tandil, Argentina
| | - J M Herrera
- Facultad de Ciencias Veterinarias, Área de Ciencias Morfológicas, UNICEN, Tandil, Argentina
| | - S Cantatore
- Facultad de Ciencias Veterinarias, Laboratorio de Clínica y Reproducción Equina, CIVETAN, UNICEN, Tandil, Argentina.,Facultad de Ciencias Veterinarias, CONICET, CIVETAN, UNICEN, Tandil, Argentina
| | - J Aguilar
- Facultad de Agronomía y Veterinaria, Laboratorio de Producción Equina, Universidad Nacional de Río Cuarto, Río Cuarto, Córdoba, Argentina
| | - A Felipe
- Facultad de Ciencias Veterinarias, Área de Ciencias Morfológicas, UNICEN, Tandil, Argentina
| | - E Fumuso
- Facultad de Ciencias Veterinarias, Laboratorio de Clínica y Reproducción Equina, CIVETAN, UNICEN, Tandil, Argentina
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Valdes CT, Schutt A, Simon C. Implantation failure of endometrial origin: it is not pathology, but our failure to synchronize the developing embryo with a receptive endometrium. Fertil Steril 2017; 108:15-18. [PMID: 28668151 DOI: 10.1016/j.fertnstert.2017.05.033] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 05/24/2017] [Indexed: 11/19/2022]
Abstract
Repeated implantation failure (RIF) is an intriguing, massive failure of reproductive treatment in otherwise healthy women leading to the introduction of empirical adjuvant interventions that are costly, inefficient, and frustrating for our patients. In this article, we will try to convince the readers that RIF is neither a stigma nor a mysterious pathology but rather our failure to diagnose and properly synchronize the euploid blastocyst with the patient's personalized window of implantation.
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Affiliation(s)
- Cecilia T Valdes
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Amy Schutt
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Carlos Simon
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; Department of Obstetrics and Gynecology, Valencia University and INCLIVA, Valencia, Spain; Igenomix, Parc Cientific Valencia University, Valencia, Spain; Department of Obstetrics and Gynecology, Stanford University, Stanford, California.
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9
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The endometrial receptivity array for diagnosis and personalized embryo transfer as a treatment for patients with repeated implantation failure. Fertil Steril 2013; 100:818-24. [DOI: 10.1016/j.fertnstert.2013.05.004] [Citation(s) in RCA: 296] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 05/02/2013] [Accepted: 05/02/2013] [Indexed: 01/25/2023]
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10
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Lindhard A, Ravn V, Bentin-Ley U, Horn T, Bangsboell S, Rex S, Toft B, Soerensen S. Ultrasound characteristics and histological dating of the endometrium in a natural cycle in infertile women compared with fertile controls. Fertil Steril 2006; 86:1344-55. [PMID: 16978615 DOI: 10.1016/j.fertnstert.2006.03.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2005] [Revised: 03/15/2006] [Accepted: 03/15/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare endometrial dating and ultrasound texture in a natural cycle before IVF and relate these to outcome and to fertile references. DESIGN Prospective study with a fertile reference group. SETTING Four university IVF clinics. PATIENT(S) Seventy-five IVF patients and 21 fertile women. INTERVENTION(S) Ultrasound, biopsy, blood sampling. In vitro fertilization-ET in the following cycle. MAIN OUTCOME MEASURE(S) Endometrial evaluation, P, IVF outcome. RESULT(S) At day LH+7, 42% infertile vs. 67% fertile women demonstrated endometria that were in phase (statistically nonsignificant difference). Nine percent had an accelerated endometrium, and 47% (infertile) vs. 24% (fertile) had a delayed endometrium (statistically nonsignificant difference). Statistically significantly fewer women with tubal factor and no hydrosalpinges had an endometrium in phase (20%) than was the case in fertile women (67%). Dating could not predict outcome. Statistically significantly more women in the hydrosalpinx group had a visible midline at day LH+7 compared with the case in other infertile groups. Forty-three percent conceived after IVF-ET. Plasma P was statistically significantly lower in nonpregnant women compared with in women with ongoing pregnancies and with fertile controls. A periovulatory hyperechogenic endometrium resulted in no ongoing pregnancies. CONCLUSION(S) In a natural cycle preceding IVF, a low midluteal P level predicts a low implantation rate. A periovulatory hyperechogenic endometrium or hydrosalpinges visible at ultrasound may have some predictive value. Endometrial dating was of no help.
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Affiliation(s)
- Anette Lindhard
- The Fertility Clinic, The Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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11
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Nakamura H, Kimura T, Koyama S, Ogita K, Tsutsui T, Shimoya K, Taniguchi T, Koyama M, Kaneda Y, Murata Y. Mouse model of human infertility: transient and local inhibition of endometrial STAT-3 activation results in implantation failure. FEBS Lett 2006; 580:2717-22. [PMID: 16647058 DOI: 10.1016/j.febslet.2006.04.029] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 04/06/2006] [Accepted: 04/07/2006] [Indexed: 11/29/2022]
Abstract
Embryo implantation involves a series of biochemical reactions and its failure is an important therapeutic target of infertility treatment. We established an infertile mouse model using transient and local suppression of signal transducer and activator of transcription-3 (STAT-3) activity by STAT-3 decoy transfer into the uterine cavity during implantation, resulting in <30% implantation. This infertility is caused by suppression of decidualization, which is indispensable for implantation, and independent of progesterone. These conditions may mimic clinically unexplained infertility. Our results suggest that STAT-3 could be a useful target for diagnosis and therapy of human implantation failure.
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Affiliation(s)
- Hitomi Nakamura
- Division of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka 5650871, Japan
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12
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Makker A, Singh MM. Endometrial receptivity: Clinical assessment in relation to fertility, infertility, and antifertility. Med Res Rev 2006; 26:699-746. [PMID: 16710862 DOI: 10.1002/med.20061] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Fertility in humans and other mammalian species depends absolutely on synchronous events that render the developing blastocyst and the receiving uterus competent for implantation. Endometrial receptivity is defined as the period during which the endometrial epithelium acquires functional, but transient, ovarian steroid-dependent status supportive to blastocyst acceptance and implantation. Once inside the uterus, the blastocyst is surrounded by an intact luminal epithelium, which is considered to act as barrier to its attachment, except for this short period of high endometrial receptivity to blastocyst signal(s). Its transport and permeability properties, in conjunction with cellular action of the endometrium and the embryo, have been suggested to influence creation and maintenance of informational and nutritional status of uterine luminal milieu. This period, also termed as the 'window of implantation,' is limited to days 20-24 of menstrual cycle in humans. However, establishment of endometrial receptivity is still a biological mystery that remains unsolved despite marked advances in our understanding of endometrial physiology following extensive research associated with its development and function. This review deals with various structural, biochemical, and molecular events in the endometrium coordinated within the implantation window that constitute essential elements in the repertoire that signifies endometrial receptivity and is aimed to achieve a better understanding of its relationship to fertility, infertility, and for the development of targeted antifertility agents for human use and welfare.
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Affiliation(s)
- Annu Makker
- Endocrinology Division, Central Drug Research Institute, Lucknow-226 001, India
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Nakamura H, Kimura T, Ogita K, Koyama S, Tsujie T, Tsutsui T, Shimoya K, Koyama M, Kaneda Y, Murata Y. Alteration of the timing of implantation by in vivo gene transfer: delay of implantation by suppression of nuclear factor kappaB activity and partial rescue by leukemia inhibitory factor. Biochem Biophys Res Commun 2004; 321:886-92. [PMID: 15358109 DOI: 10.1016/j.bbrc.2004.07.045] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2004] [Indexed: 11/15/2022]
Abstract
Nuclear factor kappaB (NF-kappaB) is activated in the murine endometrium during implantation period [Am. J. Reprod. Immunol. 51 (2004) 16]. Transient transfection of IkappaBalpha mutant (IkappaBalphaM) cDNA into the mouse uterine cavity using hemagglutinating virus of Japan envelope vector suppressed uterine NF-kappaB activity less than half of that observed in control on days 3.5 and 4.5 p.c. IkappaBalphaM cDNA transfection led to significant delay of implantation. After IkappaBalphaM cDNA transfection, LIF mRNA expression in the uterus was significantly suppressed on days 3.5 and 4.5 p.c. Co-transfection of LIF cDNA with IkappaBalphaM cDNA in the uterus partially rescued the delay of implantation induced by suppression of NF-kappaB activity. Taken together, these findings indicate that NF-kappaB activation determines the timing of the implantation, at least in part, via control of LIF expression.
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Affiliation(s)
- Hitomi Nakamura
- Division of Obstetrics and Gynecology, Department of Specific Organ Regulation, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka 5650871, Japan
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Crum CP, Hornstein MD, Nucci MR, Mutter GL. Hertig and beyond: a systematic and practical approach to the endometrial biopsy. Adv Anat Pathol 2003; 10:301-18. [PMID: 14581820 DOI: 10.1097/00125480-200311000-00001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Evaluation of the endometrial biopsy is a challenge to practicing pathologists, largely due to the wide range of morphologic patterns resulting from both normal and abnormal cyclic changes, exogenous hormones, infections, and intrauterine tumors. Successfully addressing these challenges requires that the practitioner (i) understand the clinical questions being asked, (ii) have a realistic expectation for answering these questions, and (iii) have a systematic approach to resolving these questions in the context of these expectations. The approach outlined begins with the subdividing of women with endometrial alterations into three general categories: (i) women in their fourth decade undergoing evaluation for infertility, (ii) women in their fifth decade who experience abnormal uterine bleeding, and (iii) women in their sixth decade and beyond who experience postmenopausal bleeding. The clinical expectations for each group are unique, as are the morphologic patterns most commonly encountered. Algorithms for the laboratory management of cyclic changes, dysfunctional bleeding, and mixed-pattern endometria are provided, as are pitfalls in interpretation and exclusion of neoplasia.
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Affiliation(s)
- Christopher P Crum
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Adams SM, Gayer N, Terry V, Murphy CR. Manipulation of the follicular phase: Uterodomes and pregnancy - is there a correlation? BMC Pregnancy Childbirth 2001; 1:2. [PMID: 11495634 PMCID: PMC37312 DOI: 10.1186/1471-2393-1-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2001] [Accepted: 07/17/2001] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND: Manipulation of the follicular phase uterine epithelium in women undergoing infertility treatment, has not generally shown differing morphological effects on uterine epithelial characteristics using Scanning Electron Microscopy (SEM) and resultant pregnancy rates have remained suboptimal utilising these manipulations. The present study observed manipulation of the proliferative epithelium, with either 7 or 14 days of sequential oestrogen (E) therapy followed by progesterone (P) and assessed the appearance of pinopods (now called uterodomes) for their usefulness as potential implantation markers in seven women who subsequently became pregnant. Three endometrial biopsies per patient were taken during consecutive cycles: day 19 of a natural cycle - (group 1), days 11/12 of a second cycle after 7 days E then P - (group 2), and days 19/22 of a third cycle after 14 days E then P - (group 3). Embryo transfer (ET) was performed in a subsequent long treatment cycle (as per Group 3). RESULTS: Seven pregnancies resulted in seven viable births including one twins and one miscarriage. Analysis of the individual regimes showed 5 days of P treatment to have a higher correlation for uterodomes in all 3 cycles observed individually. It was also observed that all 7 women demonstrated the appearance of uterodomes in at least one of their cycles. CONCLUSIONS: We conclude that manipulation of the follicular phase by shortening the period of E exposure to 7 days, does not compromise uterine epithelial morphology and we add weight to the conclusion that uterodomes indicate a receptive endometrium for implantation.
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Affiliation(s)
- Susan M Adams
- Departments of Anatomy & Histology, and Obstetrics and Gynaecology, University of Sydney, Sydney, NSW 2006, Australia
| | - Nalini Gayer
- Departments of Anatomy & Histology, and Obstetrics and Gynaecology, University of Sydney, Sydney, NSW 2006, Australia
| | - Vera Terry
- Departments of Anatomy & Histology, and Obstetrics and Gynaecology, University of Sydney, Sydney, NSW 2006, Australia
| | - Christopher R Murphy
- Departments of Anatomy & Histology, and Obstetrics and Gynaecology, University of Sydney, Sydney, NSW 2006, Australia
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