The effect of hyperstimulation on transforming growth factor beta(1) and beta(2) in the rat uterus: possible consequences for embryo implantation

OBJECTIVE

To investigate the effect of exogenous gonadotropins on the expression of transforming growth factor (TGF) beta(1) and beta(2) in the rat uterus and its consequences for successful embryo implantation.

DESIGN

Controlled experimental research study.

SETTING

School of Anatomical Sciences, University of the Witwatersrand.

PATIENT(S)

Thirty-six adult, virgin, female Sprague-Dawley rats and two fertile males.

INTERVENTION(S)

Follicle-stimulating hormone (FSH) and human chorionic gonadotropin (hCG) were superimposed upon the normal hormonal milieu of normal, cycling female rats before mating. Uterine tissue was collected at peri-implantation stages (i.e., at 4.5, 5.5, and 6.5 days) after mating. Enzyme-linked immunosorbent assay (ELISA) was performed to estimate the blood estrogen and progesterone levels, and immunohistochemistry was performed to localize the TGF-beta(1) and TGF-beta(2) in the uterus.

MAIN OUTCOME MEASURE(S)

Hyperstimulation affecting the expression of both TGF-beta(1) and TGF-beta(2) during the peri-implantation period.

RESULT(S)

The release of ovarian steroids was altered, causing a change in the endogenous hormonal environment. A marked increase in the expression of TGF-beta(2) was distinct in the glandular epithelium. Expression of both TGF-beta(1) and TGF-beta(2) was weaker in the subluminal stroma when compared with the deeper stromal region.

CONCLUSION(S)

Hyperstimulation with exogenous hormones affects the expression of both TGF-beta(1) and TGF-beta(2), which may contribute to the disruption of the endometrial environment required for successful embryo implantation.

The role of aromatase inhibitors in ameliorating deleterious effects of ovarian stimulation on outcome of infertility treatment

Clinical utilization of ovulation stimulation to facilitate the ability of a couple to conceive has not only provided a valuable therapeutic approach, but has also yielded extensive information on the physiology of ovarian follicular recruitment, endometrial receptivity and early embryo competency. One of the consequences of the use of fertility enhancing agents for ovarian stimulation has been the creation of a hyperestrogenic state, which may influence each of these parameters. Use of aromatase inhibitors reduces hyperestrogenism inevitably attained during ovarian stimulation. In addition, the adjunct use of aromatase inhibitors during ovarian stimulation reduces amount of gonadotropins required for optimum stimulation. The unique approach of reducing hyperestrogenism, as well as lowering amount of gonadotropins without affecting the number of mature ovarian follicles is an exciting strategy that could result in improvement in the treatment outcome by ameliorating the deleterious effects of the ovarian stimulation on follicular development, endometrial receptivity, as well as oocyte and embryo quality.