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Kapetanios V, Lampraki M, Georgoulias G, Kasdaglis S, Kliafas S, Gkavra N, Xountasi M, Tsilivakos V, Leventopoulos M. Correlation between hysteroscopic features and specific microbial species in women with chronic endometritis. Heliyon 2024; 10:e30259. [PMID: 38711647 PMCID: PMC11070820 DOI: 10.1016/j.heliyon.2024.e30259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/08/2024] Open
Abstract
Objective and rationale Chronic endometritis (CE) has recently been associated with unexplained infertility and recurrent miscarriages. The current gold standard for CE detection is histopathological examination. However, office hysteroscopy and endometrial cultures are also significant, due to the possible link between CE and various microorganisms. Bacterial colonization of the endometrium has been associated with reduced success rates of in vitro fertilisation embryo transfer. Few studies have tried to correlate CE hysteroscopy findings with pathogenic microorganisms. This prospective cohort study sought to establish whether hysteroscopic diagnostic lesions correlate with specific microbial species. Methods The study encompassed women undergoing diagnostic tests for a range of subfertility health issues. 189 women completed the standard office diagnostic hysteroscopy (DH). 181 had also endometrial samples taken for microbial culture investigation. Correlation analysis (χ2 and Fisher's exact test) between hysteroscopic findings suggestive of CE and endometrial cultures was carried out. Logistic regression models were also fitted to measure whether a positive endometrial culture could affect CE conditions. Results A significant association of E. coli was observed between the hysteroscopically characterized CE + group with focal hyperplasia, when compared to the non-CE group. Logistic regression analysis revealed that women positive for E. coli were 4.423 times more likely to have focal endometrial hyperplasia. No other significant correlations were identified between DH and positive endometrial cultures. Conclusions The presence of E. coli in the endometrium was significantly correlated with focal hyperplasia findings from hysteroscopy, emphasizing the importance of microbial cultures in the diagnosis and targeted treatment of CE in women with subfertility.
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Affiliation(s)
| | - Maria Lampraki
- Department of Gynecology, Locus Medicus S.A., Athens, Greece
| | | | | | - Stylianos Kliafas
- School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Greece
| | - Nikolaos Gkavra
- School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Greece
| | - Maria Xountasi
- Department of Cellular Biology and Immunology, Locus Medicus S.A., Athens, Greece
| | - Vassilis Tsilivakos
- Department of Cellular Biology and Immunology, Locus Medicus S.A., Athens, Greece
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Takimoto K, Yamada H, Shimada S, Fukushi Y, Wada S. Chronic Endometritis and Uterine Endometrium Microbiota in Recurrent Implantation Failure and Recurrent Pregnancy Loss. Biomedicines 2023; 11:2391. [PMID: 37760832 PMCID: PMC10525987 DOI: 10.3390/biomedicines11092391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of this study was to evaluate whether chronic endometritis (CE) and uterine endometrium microbiota were associated with repeated implantation failures (RIFs) and recurrent pregnancy losses (RPLs). In this prospective study, uterine endometrial specimens were obtained from 24 women with RIF, 27 with RPL, and 29 fertile control women. Immunohistochemical staining of CD138 for CE and 16S ribosomal RNA (rRNA) sequencing analysis for uterine endometrium microbiota were performed simultaneously. To assess CE, Liu's method, McQueen scores and plasma cell count/10 mm2 were used. The frequency of CE (plasma cells > 5.15/10 mm2) was higher in women with RPL (29.6%) than in fertile controls (6.8%, p < 0.05). The plasma cell count/10 mm2 in women with RPL (median 1.53, range 0-252.6, p < 0.01) and women with RIF (median 0.6, range 0-6.98, p < 0.05) was higher than in fertile controls (median 0, range 0-29). The uterine endometrium microbiota in women with RPL or RIF was not significantly different from that in fertile controls. However, the relative dominance rate of Lactobacillus iners (median 4.7%, range 0-99.9 vs. median 0%, range 0-100, p < 0.001) and the positive rate of Ureaplasma species (36.3% vs. 8.6%, p < 0.05) were higher in 11 women with CE than in 69 women without CE. The results suggest that CE may be involved in the pathophysiology of RPL and RIF. Lactobacillus iners and Ureaplasma species may be associated with the etiology of CE.
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Affiliation(s)
- Kanako Takimoto
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo 006-8555, Japan; (K.T.); (Y.F.); (S.W.)
| | - Hideto Yamada
- Center for Recurrent Pregnancy Loss, Teine Keijinkai Hospital, Sapporo 006-8555, Japan
| | - Shigeki Shimada
- Department of Obstetrics and Gynecology, Mommy’s Clinic Chitose, Chitose 066-0038, Japan;
| | - Yoshiyuki Fukushi
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo 006-8555, Japan; (K.T.); (Y.F.); (S.W.)
| | - Shinichiro Wada
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo 006-8555, Japan; (K.T.); (Y.F.); (S.W.)
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Marozio L, Nuzzo AM, Gullo E, Moretti L, Canuto EM, Tancredi A, Goia M, Cosma S, Revelli A, Rolfo A, Benedetto C. Immune Checkpoints in Recurrent Pregnancy Loss: New Insights into a Detrimental and Elusive Disorder. Int J Mol Sci 2023; 24:13071. [PMID: 37685876 PMCID: PMC10488095 DOI: 10.3390/ijms241713071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Recurrent pregnancy loss (RPL) refers to two or more miscarriages before 20 weeks gestation. Its prevalence is 1-2%; its pathogenesis remains unexplained in more than 50% of cases, in which the cause is thought to be abnormal immune activity during placentation leading to a lack of pregnancy-induced immune tolerance. It is unknown whether immune activity is deranged in the endometrium of women with RPL. We studied the gene expression and the quantitative tissue protein levels of three immune checkpoints (CD276, which enhances cytotoxic T-cell activity, cytotoxic T-lymphocyte-associated antigen-4 [CTL-4], which reduces Th1 cytokine production, and lymphocyte activation gene-3 [LAG-3], which shows suppressive activity on Tregs and CD4+ T-cells) in endometrial samples from 27 women with unexplained RPL and in 29 women with dysfunctional uterine bleeding and previous uneventful pregnancies as controls. RNA isolation, real-time PCR, protein isolation, and ELISA were performed. CD276 gene expression and protein tissue levels were significantly lower in the endometrium of the RPL group than in the controls, whereas both CTL-4 and LAG-3 were significantly higher. This difference suggests defective endometrial immune regulation and overactivation of immune response in women with a history of RPL, at least in relation to controls with dysfunctional uterine bleeding and previous normal reproductive history.
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Affiliation(s)
- Luca Marozio
- Department of Surgical Sciences, Obstetrics and Gynecology 1, University of Turin, Via Ventimiglia 1, 10126 Turin, Italy; (E.G.); (E.M.C.); (A.T.); (S.C.); (C.B.)
| | - Anna Maria Nuzzo
- Department of Surgical Sciences, University of Turin, Via Ventimiglia 1, 10126 Turin, Italy; (A.M.N.); (L.M.); (A.R.)
| | - Eugenio Gullo
- Department of Surgical Sciences, Obstetrics and Gynecology 1, University of Turin, Via Ventimiglia 1, 10126 Turin, Italy; (E.G.); (E.M.C.); (A.T.); (S.C.); (C.B.)
| | - Laura Moretti
- Department of Surgical Sciences, University of Turin, Via Ventimiglia 1, 10126 Turin, Italy; (A.M.N.); (L.M.); (A.R.)
| | - Emilie M. Canuto
- Department of Surgical Sciences, Obstetrics and Gynecology 1, University of Turin, Via Ventimiglia 1, 10126 Turin, Italy; (E.G.); (E.M.C.); (A.T.); (S.C.); (C.B.)
| | - Annalisa Tancredi
- Department of Surgical Sciences, Obstetrics and Gynecology 1, University of Turin, Via Ventimiglia 1, 10126 Turin, Italy; (E.G.); (E.M.C.); (A.T.); (S.C.); (C.B.)
| | - Margherita Goia
- Unit of Pathology, Department of Medical Sciences, University of Turin, Via Santena 7, 10126 Turin, Italy;
| | - Stefano Cosma
- Department of Surgical Sciences, Obstetrics and Gynecology 1, University of Turin, Via Ventimiglia 1, 10126 Turin, Italy; (E.G.); (E.M.C.); (A.T.); (S.C.); (C.B.)
| | - Alberto Revelli
- Department of Surgical Sciences, Obstetrics and Gynecology 2, University of Turin, Via Ventimiglia 1, 10126 Turin, Italy;
| | - Alessandro Rolfo
- Department of Surgical Sciences, University of Turin, Via Ventimiglia 1, 10126 Turin, Italy; (A.M.N.); (L.M.); (A.R.)
| | - Chiara Benedetto
- Department of Surgical Sciences, Obstetrics and Gynecology 1, University of Turin, Via Ventimiglia 1, 10126 Turin, Italy; (E.G.); (E.M.C.); (A.T.); (S.C.); (C.B.)
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Oshina K, Kuroda K, Nakabayashi K, Tomikawa J, Kitade M, Sugiyama R, Hata K, Itakura A. Gene expression signatures associated with chronic endometritis revealed by RNA sequencing. Front Med (Lausanne) 2023; 10:1185284. [PMID: 37547609 PMCID: PMC10400718 DOI: 10.3389/fmed.2023.1185284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Chronic endometritis (CE) is a persistent inflammatory condition of the endometrium characterized by the infiltration of plasma cells in the endometrial stroma. CD138 immunohistochemistry is considered to improve the CE diagnosis rate. Methods Using the number of CD138-positive cells equal or greater than five as a diagnostic criterion for CE, we identified 24 CE and 33 non-CE cases among women with infertility. We conducted RNA-sequencing analysis for these 57 cases in total as an attempt to elucidate the molecular pathogenesis of CE and to search for new biomarkers for CE. Results and Discussion By comparing CE and non-CE groups, we identified 20 genes upregulated in the endometria of CE patients, including 12 immunoglobulin-related genes and eight non-immunoglobulin genes as differentially expressed genes. The eight genes were MUC5AC, LTF, CAPN9, MESP1, ACSM1, TVP23A, ALOX15, and MZB1. By analyzing samples in the proliferative and secretory phases of the menstrual cycle separately, we also identified four additional non-immunoglobulin genes upregulated in CE endometria: CCDC13 by comparing the samples in the proliferative phase, and OVGP1, MTUS2, and CLIC6 by comparing the samples in the secretory phase. Although the genes upregulated in CE may serve as novel diagnostic markers of CE, many of them were upregulated only in a limited number of CE cases showing an extremely high number of CD138-positive cells near or over one hundred. Exceptionally, TVP23A was upregulated in the majority of CE cases regardless of the number of CD138-positive cells. The upregulation of TVP23A in the endometria of CE cases may reflect the pathophysiology of a cell-type or cell-types intrinsic to the endometrium rather than the accumulation of plasma cells. Our data, consisting of clinical and transcriptomic information for CE and non-CE cases, helped us identify gene expression signatures associated with CE.
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Affiliation(s)
- Kyoko Oshina
- Department of Maternal-Fetal Biology, National Center for Child Health and Development, Setagaya, Tokyo, Japan
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Bunkyo, Tokyo, Japan
| | - Keiji Kuroda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Bunkyo, Tokyo, Japan
- Center for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi, Chiyoda, Tokyo, Japan
| | - Kazuhiko Nakabayashi
- Department of Maternal-Fetal Biology, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Junko Tomikawa
- Department of Maternal-Fetal Biology, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Mari Kitade
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Bunkyo, Tokyo, Japan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Shinjuku, Tokyo, Japan
| | - Kenichiro Hata
- Department of Maternal-Fetal Biology, National Center for Child Health and Development, Setagaya, Tokyo, Japan
- Department of Human Molecular Genetics, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Bunkyo, Tokyo, Japan
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Li J, Xu D, Ma L, Li L, Yang L. Adverse impact of CD138+ cells in proliferative-phase endometrium on pregnancy outcomes in fresh IVF/ICSI cycles. Medicine (Baltimore) 2023; 102:e33106. [PMID: 36897723 PMCID: PMC9997799 DOI: 10.1097/md.0000000000033106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/07/2023] [Indexed: 03/11/2023] Open
Abstract
To evaluate the impact of Syndecan-1 (CD138) in proliferative-phase endometrium on pregnancy outcomes in fresh in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) cycles. This retrospective cohort study contained 273 patients who underwent IVF/ICSI with fresh embryo transfer following an endometrial curettage from January 2020 to May 2022. Endometrial curettage was performed on all patients within 3 to 5 days following menstruation and endometrial tissue was acquired for detection of plasma cells by immunohistochemistry. Subsequent pregnancy outcomes of all cycles were traced and analyzed. A total of 149 patients became pregnant (i.e., pregnant group) in the fresh transfer IVF/ICSI cycles and 124 did not become pregnant (i.e., nonpregnant group). The number of CD138 + cells/ high-power field (HPF) of the nonpregnant group was significantly higher than the pregnant group (2.36 ± 4.24 vs 1.31 ± 3.41, P = .008). The cut off value of CD138 + cells/HPF was 2 by receiver operating characteristic curve analysis, with an area under the receiver operating characteristic curve of 0.572. Compared with the negative group (i.e., CD138 + cells/HPF < 2, n = 204), the positive group (i.e., CD138 + cells/HPF ≥ 2, n = 69) had a significantly lower clinical pregnancy rate (71.8% vs 40.6%, P < .001). The clinical pregnancy rate revealed a gradually decreasing trend with the increase in CD138 + cells. Proliferative-phase endometrial CD138 + cells may be an adverse indicator for pregnancy outcomes in fresh IVF/ICSI cycles, with a certain value in predicting non-pregnancy. Pregnancy outcome was poor when CD138 + cells/HPF ≥ 2 in the endometrium and may worsen with the increase in CD138 + cells.
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Affiliation(s)
- Jie Li
- The Reproductive Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Dujuan Xu
- The Reproductive Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Ling Ma
- The Reproductive Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Lin Li
- The Reproductive Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Lijuan Yang
- The Reproductive Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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Canella PRBC, Vinces SS, Silva ÁAR, Sanches PHG, Barini R, Porcari ADM, Razolli DS, Carvalho PDO. Altered profile of plasma phospholipids in woman with recurrent pregnancy loss and recurrent implantation failure treated with lipid emulsion therapy. Am J Reprod Immunol 2023; 89:e13673. [PMID: 36585861 DOI: 10.1111/aji.13673] [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: 05/09/2022] [Revised: 11/22/2022] [Accepted: 12/20/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Recurrent Pregnancy Loss (RPL) and Recurrent Implantation Failure (RIF) are highly heterogeneous condition and many of the mechanisms involved still require elucidation. The aim was to analyze the lipidomic profile in plasma of women with RPL and RIF before and after receiving the Lipid Emulsion Therapy (LET) containing 10% fish oil (SMOFlipid® 20%). METHODS This study included twenty-six women with RPL or RIF from immunological or inflammatory causes, with elevated natural killer cell levels and divided into a Pregnancy Loss or a Live Birth group according to the outcome. The women received intravenous LET and sample collecting was done before the first, third and fifth dose of LET in the pregnant women. Ultra-performance liquid chromatography quadrupole time of flight mass spectrometry (UPLC-QTOF MS) and multivariate statistical methods were performed to evaluate the profile of phospholipids present in the women's plasma. RESULTS An increase of phosphatidylcholines (PC) 40:8 and 36:5 levels with predominance of n6 polyunsaturated fatty acids (PUFA) was observed in plasma lipids of the Pregnancy Loss Group compared to Live Birth Group. We also observed an increase in the relative abundance of n3 PUFA-PC species (42:10 and 36:6) and LysoPC 15:0 with the long term use of LET. CONCLUSION The greater availability of n3 PUFA in plasma of the pregnant women stemming from LET use can be considered advantageous regarding the alteration of the phospholipid profile and its postulated anti-inflammatory and immunomodulatory role.
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Affiliation(s)
| | - Salvador Sánchez Vinces
- Post Graduate Program in Health Sciences, São Francisco University, USF, Bragança Paulista, Brazil
| | | | | | - Ricardo Barini
- Department of Obstetrics and Gynecology, Campinas University (UNICAMP), São Paulo, Campinas, Brazil
| | - Andréia de Melo Porcari
- Post Graduate Program in Health Sciences, São Francisco University, USF, Bragança Paulista, Brazil
| | - Daniela Soares Razolli
- Post Graduate Program in Health Sciences, São Francisco University, USF, Bragança Paulista, Brazil
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He Y, Zhou M, Li S, Gong Z, Yan F, Liu H. Ultrasound Molecular Imaging of Neovascularization for Evaluation of Endometrial Receptivity Using Magnetic iRGD-Modified Lipid-Polymer Hybrid Microbubbles. Int J Nanomedicine 2022; 17:5869-5881. [PMID: 36483520 PMCID: PMC9726466 DOI: 10.2147/ijn.s359065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 06/01/2022] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Angiogenesis plays an important role in endometrial receptivity, determining the response of the endometrium to the blastocyst at the early stage of embryo implantation. During the application of assisted reproduction technologies, it is very important to evaluate the status of uterine angiogenesis before deciding on embryo implantation. Targeted microbubbles (MBs)-based ultrasound molecular imaging (UMI) can noninvasively detect the expression status of biomarkers at the molecular level, thereby being a potential diagnosis strategy for various diseases and their therapeutic evaluation. METHODS The iRGD-lipopeptide (DSPE-PEG2000-iRGD) conjugate was prepared with iRGD peptides and DSPE-PEG2000-maleimide through the Michael-type addition reaction. Then, the magnetic iRGD-modified lipid-polymer hybrid MBs (Mag-iLPMs) were prepared with the double-emulsification-solvent-evaporation method. Magnetic targeting of Mag-iLPMs was confirmed under the microscope, followed by a rectangular magnet. Next, the in vitro targeted binding of MBs to murine brain-derived endothelial cells.3 (bEnd.3) and human umbilical vein endothelial cells (HUVEC) were evaluated. The ratio of MBs binding to bEnd.3 and HUVEC at the same field was also compared. For in vivo studies, bolus injections of targeted or control MBs were randomly administrated to non-pregnant or pregnant rats on day 5. Then, the uteri were imaged using a VisualSonics Vevo 2100 ultrasound system (Fujifilm VisualSonics Inc., Ontario, Canada) equipped with a high-frequency transducer. Ultrasonic imaging signals were acquired from Mag-iLPMs, and compared with Mag-LPMs, iLPMs, and LPMs. RESULTS The Mag-iLPMs showed excellent performance in ultrasound contrast imaging and binding affinity to target cells. Using the magnetic field, 10.5- and 12.47-fold higher binding efficiency to bEnd.3 and HUVEC were achieved compared to non-magnetic iLPMs, respectively. Significantly enhanced UMI signals were also observed in the uteri of rats intravenously injected pregnant rats (6.58-fold higher than rats injected with iLPMs). CONCLUSION We provided a powerful ultrasonic molecular functional imaging tool for uterine angiogenesis evaluation before embryonic implantation.
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Affiliation(s)
- Yanni He
- Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, People’s Republic of China
| | - Meijun Zhou
- Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, People’s Republic of China
| | - Sushu Li
- Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, People’s Republic of China
| | - Zheli Gong
- Department of Ultrasound, The People’s Hospital of Hunan Province, Changsha, 410061, People’s Republic of China
| | - Fei Yan
- CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, People’s Republic of China
| | - Hongmei Liu
- Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, People’s Republic of China
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Liu FT, Yang S, Yang Z, Zhou P, Peng T, Yin J, Ye Z, Shan H, Yu Y, Li R. An Altered Microbiota in the Lower and Upper Female Reproductive Tract of Women with Recurrent Spontaneous Abortion. Microbiol Spectr 2022; 10:e0046222. [PMID: 35604131 PMCID: PMC9241707 DOI: 10.1128/spectrum.00462-22] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/28/2022] [Indexed: 11/24/2022] Open
Abstract
Recurrent spontaneous abortion (RSA) is a complex multifactorial disease. Recently, the microbiota of the female reproductive tract, as an emerging factor in RSA, has gradually attracted the attention of many clinical researchers. Here, we reported that the microbiota of the lower and upper female reproductive tracts from patients with RSA showed no significant differences in alpha diversity compared to that of controls. Beta diversity was significantly higher in the RSA group than in the control group in the vaginal microbiota (P = 0.036), cervical microbiota (P = 0.010) and microbiota from uterine lavage fluid (P = 0.001). In addition, dramatic decreases in gamma interferon and interleukin-6 cytokine levels were observed in the RSA group. In conclusion, our data suggested altered microbial biodiversity in the vagina, cervix and uterine lavage fluid in the RSA group. Alterations in the microbiota in the uterine cavity could be associated with altered cytokine levels, which might be a risk factor for RSA pathogenesis. Moreover, the microbiota composition differed markedly from the lower genital tract to the uterine cavity, and the microbiota in the uterine cavity also distinctly varied between endometrial tissue and uterine lavage fluid in the RSA group. Hence, sampling with these two methods simultaneously allowed a more comprehensive perspective of microbial colonization in the uterine cavity. IMPORTANCE As an obstacle to pregnancy, recurrent spontaneous abortion (RSA) can be caused by a variety of factors, and a current understanding of the etiology of RSA is still lacking; half of cases have an unknown cause. A substantial fraction of patients show no improvement after treatment. Since the microbiota of the female reproductive tract has been proposed as an emerging factor in RSA patients, further investigation is needed to provide guidance for clinical therapy. In general, this is the first report describing the distinct alterations of the vaginal, cervical, and uterine microbiota in RSA, not just that in the vagina. Furthermore, another major strength of this study derived from the further in-depth investigation and analysis of the characteristics of the microbiota colonizing the upper female genital tract in RSA, which provided a more comprehensive view for investigating the uterine microbiota.
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Affiliation(s)
- Fen-Ting Liu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital, Beijing, China
| | - Shuo Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital, Beijing, China
| | - Zi Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital, Beijing, China
| | - Ping Zhou
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital, Beijing, China
| | - Tianliu Peng
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital, Beijing, China
| | - Jingwen Yin
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital, Beijing, China
| | - Zhenhong Ye
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital, Beijing, China
| | - Hongying Shan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital, Beijing, China
| | - Yang Yu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital, Beijing, China
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital, Beijing, China
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Rimmer MP, Howie RA, Subramanian V, Anderson RA, Bertolla RP, Beebeejaun Y, Bortoletto P, Sunkara SK, Mitchell RT, Pacey A, van Wely M, Farquhar CM, Duffy JMN, Niederberger C. Outcome reporting across randomized controlled trials evaluating potential treatments for male infertility: a systematic review. Hum Reprod Open 2022; 2022:hoac010. [PMID: 35386119 PMCID: PMC8982407 DOI: 10.1093/hropen/hoac010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/18/2022] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What are the primary outcomes and outcome measures used in randomized controlled trials (RCTs) evaluating potential treatments for male infertility in the last 10 years? SUMMARY ANSWER Outcome reporting across male infertility trials is heterogeneous with numerous definitions and measures used to define similar outcomes. WHAT IS KNOWN ALREADY No core outcome set for male infertility trials has been developed. Male infertility trials are unique in that they have potentially three participants, a man, a female partner and their offspring and this will likely lead to significant variation in outcome reporting in randomized trials. STUDY DESIGN SIZE DURATION A systematic review of RCTs mapping outcomes and outcome measures evaluating potential treatments for men with infertility registered in the Cochrane Register of Controlled Trials (CENTRAL) between January 2010 and July 2021. PARTICIPANTS/MATERIALS SETTING METHODS Abstract screening and study selection was undertaken in duplicate using a review protocol that was developed prior to commencing the review. No risk of bias assessment was undertaken as this review aims to report on outcome reporting only. MAIN RESULTS AND THE ROLE OF CHANCE One hundred and seventy-five RCTs were identified, and given the large number of studies we limited our review to the 100 largest trials. Seventy-nine different treatments were reported across the 100 largest RCTs including vitamin and dietary supplements (18 trials), surgical treatments (18 trials) and sperm selection techniques (22 trials). When considering the largest 100 trials (range: 80-2772 participants), 36 primary and 89 secondary outcomes were reported. Forty-seven trials reported a primary outcome and 36 trials clearly defined their primary outcome. Pregnancy outcomes were inconsistently reported and included pregnancy rate (51 trials), pregnancy loss including miscarriage, ectopic pregnancy, stillbirth (9 trials) and live birth (13 trials). Trials consistently reporting the same outcome frequently used different definitions. For example, semen quality was reported by 75 trials and was defined in 7 different ways, including; the World Health Organization (WHO) 2010 criteria (32 trials), WHO 1999 criteria (18 trials), WHO 1992 criteria (3 trials), WHO 1999 and 1992 criteria (1 trial) and the Kruger strict morphology criteria (1 trial). LIMITATIONS REASONS FOR CAUTION We only evaluated the 100 largest trials published in the last 10 years and did not report outcomes on the remaining 75. An outcome was included as a primary outcome only if clearly stated in the manuscript and we did not contact authors to clarify this. As our review mapped outcomes and outcome measures, we did not undertake an integrity assessment of the trials included in our review. WIDER IMPLICATIONS OF THE FINDINGS Most randomized trials evaluating treatments for male infertility report different outcomes. Only half of the RCTs reported pregnancy rate and even fewer reported live birth; furthermore, the definitions of these outcomes varies across trials. Developing, disseminating and implementing a minimum data set, known as a core outcome set, for male infertility research could help to improve outcome selection, collection and reporting. STUDY FUNDING/COMPETING INTERESTS A.P.-chairman of external scientific advisory committee of Cryos International Denmark ApS, member of the scientific advisory board for Cytoswim LDT and ExSeed Health. Guest lecture at the 'Insights for Fertility Conference', funded by MERK SERONO Limited. M.v.W.-holds a ZON-MW research grant. No external funding was obtained for this study.
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Affiliation(s)
| | | | - Venkatesh Subramanian
- King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK
| | - Richard A Anderson
- MRC Centre for Reproductive Health, Queens Medical research Institute, University of Edinburgh, Edinburgh, UK,Edinburgh Fertility Centre, Simpsons Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ricardo Pimenta Bertolla
- Division of Urology, Department of Surgery, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Yusuf Beebeejaun
- King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK
| | - Pietro Bortoletto
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sesh K Sunkara
- Division of Women’s Health, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, Queens Medical research Institute, University of Edinburgh, Edinburgh, UK
| | - Allan Pacey
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Madelon van Wely
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Cindy M Farquhar
- Cochrane Gynaecology and Fertility Group, Auckland, New Zealand,Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - James M N Duffy
- Correspondence address. King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK. Tel: +44-7949-066806; E-mail:
| | - Craig Niederberger
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA,Department of Bioengineering, University of Illinois at Chicago College of Engineering, Chicago, IL, USA
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Kumar P, Marron K, Harrity C. Intralipid therapy and adverse reproductive outcome: is there any evidence? REPRODUCTION AND FERTILITY 2022; 2:173-186. [PMID: 35118388 PMCID: PMC8788620 DOI: 10.1530/raf-20-0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 12/21/2022] Open
Abstract
Controversy exists regarding the benefits of intravenous intralipid therapy in patients with a poor reproductive history. It is frequently reported that there is no evidence to support the effectiveness, utility or safety for this treatment. While individual studies may be perceived as weak, a systematic review and meta-analysis were performed to determine if there is any advantage to patients. PubMed, Embase and Scopus searches were performed with the target populations being either recurrent pregnancy loss (RPL), or recurrent implantation failure (RIF) undergoing assisted reproductive technology (ART) and receiving intralipid infusions. These cohorts were compared with either placebo, no intervention or alternative treatments. The most relevant outcome measures were considered to be clinical pregnancy rate (CPR), live birth rate (LBR), implantation rate (IR) and miscarriage rate (MR). Twelve studies encompassing 2676 participants met the criteria for selection and were included and reviewed. Treatment of the target population with intralipid led to an improvement in IR (Odds Ratio (OR): 2.97, 2.05–4.29), pregnancy rate (OR: 1.64, 1.31–2.04), and LBR (OR: 2.36, 1.75–3.17), with a reduction in MR (OR: 0.2, 0.14–0.30). Although intravenous intralipid is not recommended as a routine treatment for recurrent miscarriage or implantation failure, there is enough data to suggest consideration in selected patients where routine testing is unremarkable, standard treatments have failed and immunological risk factors are present. The presence of abnormal uterine natural killer (uNK) cells needs more study as a target marker to determine those who could benefit.
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Affiliation(s)
- Parijot Kumar
- Beaumont Hospital, Dublin, Ireland.,RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kevin Marron
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Conor Harrity
- Beaumont Hospital, Dublin, Ireland.,RCSI University of Medicine and Health Sciences, Dublin, Ireland.,ReproMed, Dublin, Ireland
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La Marca A, Gaia G, Mignini Renzini M, Alboni C, Mastellari E. Hysteroscopic findings in chronic endometritis. Minerva Obstet Gynecol 2021; 73:790-805. [PMID: 34905882 DOI: 10.23736/s2724-606x.21.04970-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic endometritis (CE) is a subtle pathology. Despite being difficult to detect and probably underdiagnosed, it has great clinical relevance, representing as it does a reversible cause of infertility. Nowadays, histological examination with identification of endometrial stromal plasma cells is considered the gold standard for diagnosis. Diagnostic difficulties persist, however, as a result of the technical limitations of this method and the lack of standardized histological diagnostic criteria. Hysteroscopy has been proposed as an aid for CE diagnosis. The method works by detecting signs of inflammation (focal or diffuse hyperemia, stromal edema, presence of micropolyps and the typical strawberry aspect) on the endometrial surface. Yet, the jury is still out on how reliable this technique is. Hysteroscopy displays a high sensitivity (over 86% and up to 100%) and high negative predictive value (over 92% and up to 100%) in the diagnosis of CE, and it should probably be performed routinely in the assessment of patients with unexplained infertility, repeated implantation failure and repeated pregnancy loss; however, since values in the literature regarding specificity are conflicting, in cases of suspected CE, hysteroscopy may be combined with histological examination, which remains the gold standard to confirm CE. Considering that histopathological evaluation probably underdiagnoses CE, and that hysteroscopy tends to overdiagnose, further studies are needed to determine which technique (or combination of techniques) has greater value for patients.
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Affiliation(s)
- Antonio La Marca
- Department of Medical and Surgical Sciences for Children and Adults, Institute of Obstetrics and Gynecology Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy -
- Clinica Eugin Modena, Modena, Italy -
| | - Giorgia Gaia
- Department of Medical and Surgical Sciences for Children and Adults, Institute of Obstetrics and Gynecology Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Mario Mignini Renzini
- Clinica Eugin Modena, Modena, Italy
- Biogenesi Reproductive Medicine Center, Istituti Clinici Zucchi, Monza, Monza e Brianza, Italy
| | - Carlo Alboni
- Department of Medical and Surgical Sciences for Children and Adults, Institute of Obstetrics and Gynecology Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Mastellari
- Department of Medical and Surgical Sciences for Children and Adults, Institute of Obstetrics and Gynecology Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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Ticconi C, Di Simone N, Campagnolo L, Fazleabas A. Clinical consequences of defective decidualization. Tissue Cell 2021; 72:101586. [PMID: 34217128 DOI: 10.1016/j.tice.2021.101586] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023]
Abstract
Decidualization is characterized by a series of genetic, metabolic, morphological, biochemical, vascular and immune changes occurring in the endometrial stroma in response to the implanting embryo or even before conception and involves the stromal cells of the endometrium. It is a fundamental reproductive event occurring in mammalian species with hemochorial placentation. A growing body of experimental and clinical evidence strongly suggests that defective or disrupted decidualization contributes to the establishment of an inappropriate maternal-fetal interface. This has relevant clinical consequences, ranging from recurrent implantation failure and recurrent pregnancy loss in early pregnancy to several significant complications of advanced gestation. Moreover, recent evidence indicates that selected diseases of the endometrium, such as chronic endometritis and endometriosis, can have a detrimental impact on the decidualization response in the endometrium and may help explain some aspects of the reduced reproductive outcome associated with these conditions. Further research efforts are needed to fully understand the biomolecular mechanisms ans events underlying an abnormal decidualization response. This will permit the development of new diagnostic and therapeutic strategies aimed to improve the likelihood of achieveing a successful pregnancy.
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Affiliation(s)
- Carlo Ticconi
- Department of Surgical Sciences, Section of Gynecology and Obstetrics, University Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; IRCCS, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Luisa Campagnolo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
| | - Asgerally Fazleabas
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, MI, 49503, USA.
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