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Keleş ID, Günel T, Özgör BY, Ülgen E, Gümüşoğlu E, Hosseini MK, Sezerman U, Buyru F, Yeh J, Baştu E. Gene pathway analysis of the endometrium at the start of the window of implantation in women with unexplained infertility and unexplained recurrent pregnancy loss: is unexplained recurrent pregnancy loss a subset of unexplained infertility? HUM FERTIL 2023; 26:1129-1141. [PMID: 36369952 DOI: 10.1080/14647273.2022.2143299] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 06/05/2022] [Indexed: 11/14/2022]
Abstract
This study aims to understand differences/similarities in the genetic profile of the endometrium at the start of window of implantation (WOI) in women with unexplained infertility (UI) and unexplained recurrent pregnancy loss (uRPL). Differentially expressed genes (DEGs) from the endometrium were evaluated using gene expression array and pathway enrichment analysis was performed to analyse gene expression pathways involved in both conditions. We found 2,171 genes arranged in 117 pathways and 730 genes arranged in 33 pathways differentially expressed in endometrium of patients in UI and uRPL, respectively. Complement-coagulation cascades, morphine addiction pathway, and PI3K-Akt signalling pathway were predominantly differentially expressed in UI. Cancer pathways, NF-κB signalling pathway, and actin cytoskeleton regulation pathway showed significant changes in uRPL. Forty-eight percent of DEGs and 84% of differentially expressed pathways in uRPL were found in the endometrium of UI patients. Unexpected close association in gene expression pathways between UI and uRPL is observed supporting the hypothesis 'uRPL is a clinical subset of UI'. Yet 100% DEGs overlap wasn't found suggesting the endometrium has still some different gene expression patterns at start of WOI in UI and uRPL. Lastly, diagnostic tools may be developed for uRPL because more specific genes-pathways are involved compared with UI, which shows broader genetic expression profile.
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Affiliation(s)
- Irem Demiral Keleş
- Department of Obstetrics and Gynecology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Tuba Günel
- Department of Molecular Biology and Genetics, Istanbul University, Istanbul, Turkey
| | - Bahar Yüksel Özgör
- Department of Obstetrics and Gynecology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ege Ülgen
- Department of Biostatistics and Medical Informatics, Acibadem University School of Medicine, Istanbul, Turkey
| | - Ece Gümüşoğlu
- Department of Molecular Biology and Genetics, Istanbul University, Istanbul, Turkey
| | | | - Uğur Sezerman
- Department of Biostatistics and Medical Informatics, Acibadem University School of Medicine, Istanbul, Turkey
| | - Faruk Buyru
- Department of Obstetrics and Gynecology, Acibadem University School of Medicine, Istanbul, Turkey
| | - John Yeh
- Department of Obstetrics and Gynecology, UMass Memorial Medical Center, Worcester, MA, USA
| | - Ercan Baştu
- Department of Obstetrics and Gynecology, Acibadem University School of Medicine, Istanbul, Turkey
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Protein-rich food intake and risk of spontaneous abortion: a prospective cohort study. Eur J Nutr 2022; 61:2737-2748. [DOI: 10.1007/s00394-022-02849-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/22/2022] [Indexed: 11/04/2022]
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Abstract
BACKGROUND Up to 30% of pregnancies end in spontaneous abortion, yet few risk factors have been identified. Examining seasonal patterns in risk of spontaneous abortion can generate new hypotheses regarding environmental and lifestyle determinants. METHODS We used data from Pregnancy Study Online (PRESTO), a preconception cohort study of pregnancy planners from the United States and Canada, to examine seasonal variation in spontaneous abortion risk. We enrolled 12,197 women during 2013-2020, 6,104 of whom reported a conception within 12 months of enrollment. On follow-up questionnaires, participants reported date of spontaneous abortion and weeks gestation at time of loss. We used periodic regression to estimate two aspects of seasonal occurrence: peak/low ratio-a measure of intensity of seasonal variation-and peak timing. We examined season at risk (from date of each gestational week) in relation to spontaneous abortion; in a secondary analysis, we examined season of conception in relation to spontaneous abortion. We controlled for seasonal patterns in attempt initiation via month the pregnancy attempt began. RESULTS Almost 20% of women experienced spontaneous abortion. Risk was highest in late August, with a peak/low ratio of 1.3 (95% confidence interval [CI]: 1.1, 1.6). This seasonal pattern was evident almost exclusively for spontaneous abortion at <8 weeks since last menstrual period date (peak/low ratio: 1.4, 95% CI: 1.2, 1.8), and associations were stronger among women living in the Southern and Midwestern United States. CONCLUSIONS Environmental or lifestyle factors more prevalent in late summer may be associated with increased risk of early spontaneous abortion.
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Basirat Z, Kheirkhah F, Faramarzi M, Esmaelzadeh S, Khafri S, Tajali Z. Pharmacotherapy or Psychotherapy? Selective Treatment Depression in The Infertile Women with Recurrent Pregnancy Loss: A Triple-Arm Randomized Controlled Trial. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2022; 16:211-219. [PMID: 36029059 PMCID: PMC9395995 DOI: 10.22074/ijfs.2021.529258.1124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recurrent pregnancy loss (RPL) and infertility are associated with significant psychiatric complications.<br />The study aimed to investigate the effectiveness of cognitive behavioral therapy (CBT) and sertraline<br />in the treatment of in depression, anxiety, and infertility stress of depressed infertile women with RPL in comparison<br />with usual care.<br />Materials and Methods: A triple-arm randomized controlled trial was carried out on the 60 depressed infertile<br />women with RPL, a population of Infertility Center of Babol city, Iran, who were randomly assigned into three<br />groups: pharmacotherapy with sertraline (n=20), psychotherapy with CBT (n=20), and a usual care as control<br />group (n=20). The participants of psychotherapy received CBT sessions (90 minutes each) over 10 weeks. The<br />participants in the pharmacotherapy group took 50 mg/day sertraline daily for 22 weeks. Outcomes were assessed<br />using the Beck Depression Inventory (BDI-II), fertility problem inventory (FPI), and State-Trait Anxiety<br />Inventory Form Y (STAI-Y) at the beginning of the trial, 10-weeks post-trial, and three months of follow-up.<br />Using statistical package for the social sciences (SPSS) software, data were analyzed.<br />Results: CBT considerably reduced the depression symptoms more than sertraline with a moderate effect size<br />at the post-trial (g=0.11, 95% CI: -0.03 to -0.50). Sertraline showed reduced the scores of state-anxiety more<br />considerably in comparison with control group by a large effect size of post-trial (g=-1.04, 95% CI: -1.70 to<br />-0.38). CBT reduced the total scores of FPI more considerably than sertraline, with a large, small size at follow<br />up-trial [95% CI=-0.03(-0.65, -0.58)]. Both CBT and sertraline were superior to the control group in reducing<br />depression and infertility stress.<br />Conclusion: Depression and infertility stress diminished under CBT and sertraline in depressed infertile women with<br />RPL, with a significant advantage of CBT. Sertraline was superior to CBT in reduction of anxiety (registration number:<br />IRCT201304045931N3).
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Affiliation(s)
- Zahra Basirat
- Department of General Courses, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of
Medical Sciences, Babol, Iran
| | - Farzan Kheirkhah
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mahbobeh Faramarzi
- Department of General Courses, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of
Medical Sciences, Babol, Iran ,P.O.Box: 4717647745Department of General
CoursesInfertility and Reproductive Health Research CenterHealth Research InstituteBabol University of Medical SciencesBabolIran
| | - Seddigheh Esmaelzadeh
- Department of General Courses, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of
Medical Sciences, Babol, Iran
| | - Soraya Khafri
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Tajali
- Department of General Courses, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of
Medical Sciences, Babol, Iran
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Rahim MN, Theocharidou E, Yen Lau KG, Ahmed R, Marattukalam F, Long L, Cannon MD, Heneghan MA. Safety and efficacy of in vitro fertilisation in patients with chronic liver disease and liver transplantation recipients. J Hepatol 2021; 74:1407-1415. [PMID: 33460690 DOI: 10.1016/j.jhep.2020.12.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/24/2020] [Accepted: 12/16/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Chronic liver disease and liver transplantation (LT) can delay both timing and ability of women to conceive. With increased awareness and availability of in vitro fertilisation (IVF), the need for accurate counselling is paramount. To date, minimal data exist on outcomes of IVF in patients with chronic liver disease, cirrhosis, or post-LT. We report the largest experience of IVF in women with liver-related subfertility (LRSF). METHODS A retrospective analysis was performed on 42 women with LRSF who had undergone 57 IVF cycles between 1990 and 2019. RESULTS Forty-two women with LRSF received IVF; 9 cycles in 6 women with cirrhosis, 14 cycles in 11 women post-LT, and 34 cycles in 25 women without cirrhosis. The main aetiologies of liver disease included HBV, HCV, and autoimmune hepatitis (AIH). Of 57 IVF cycles evaluated, 43 (75%) resulted in successful implantation. Eight (2 post-LT, 3 with cirrhosis, 4 without cirrhosis) resulted in miscarriage. The live birth rate (LBR) was 74% (32/43). Two of 9 (22%) patients with cirrhosis, 4/14 (29%) patients who were post-LT, and 6/34 (18%) patients without cirrhosis had unsuccessful IVF attempts. Nine of 57 (16%) IVF cycles resulted in new liver enzyme derangement during therapy, which improved after treatment completion. Six pregnancies (2 in patients who were post-LT, 4 without cirrhosis) were complicated by obstetric cholestasis (OC). Ovarian hyperstimulation syndrome (OHSS) was rare (n = 3, 7%). One patient with AIH-related cirrhosis decompensated after initiating IVF, warranting discontinuation of therapy. There were no maternal deaths. Three women developed a hypertensive disorder of pregnancy. Half the pregnancies resulted in premature deliveries (range 27-36 weeks). CONCLUSIONS In selected cases, IVF in women with LRSF can be successful. However, patients should be counselled on the potential increased risks of OHSS, OC, and prematurity. LAY SUMMARY Women with liver disease or those who have had a liver transplant can experience difficulties getting pregnant. In this study, we look at whether alternative approaches to achieve pregnancy are harmful in these women. Overall, there were no significant issues with the use of in vitro fertilisation in women with liver disease, but they need to be aware of potential risks, such as early delivery of the baby.
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Affiliation(s)
- Mussarat N Rahim
- Institute of Liver Studies, King's College Hospital, London, UK; King's Liver Pregnancy Research Group, King's College Hospital, London, UK
| | | | - Katherine Gar Yen Lau
- King's Liver Pregnancy Research Group, King's College Hospital, London, UK; Foetal Medicine Research Unit, King's College Hospital, London, UK
| | - Refah Ahmed
- Institute of Liver Studies, King's College Hospital, London, UK; King's Liver Pregnancy Research Group, King's College Hospital, London, UK
| | | | - Lisa Long
- King's Liver Pregnancy Research Group, King's College Hospital, London, UK; Foetal Medicine Research Unit, King's College Hospital, London, UK
| | - Mary D Cannon
- Institute of Liver Studies, King's College Hospital, London, UK; King's Liver Pregnancy Research Group, King's College Hospital, London, UK
| | - Michael A Heneghan
- Institute of Liver Studies, King's College Hospital, London, UK; King's Liver Pregnancy Research Group, King's College Hospital, London, UK; EASL European Registry for Liver Diseases in Pregnancy, Geneva, Switzerland; European Reference Network - Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany.
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Totonchi M, Babaabasi B, Najafi H, Rezazadeh Valojerdi M, Eftekhari-Yazdi P, Karimian L, Almadani N, Mohseni Meybodi A, Kimiai M, Mashayekhi M, Madani T, Gourabi H. Preimplantation Genetic Screening and The Success Rate of In Vitro Fertilization: A Three-Years Study on Iranian Population. CELL JOURNAL 2020; 22:467-475. [PMID: 32347040 DOI: 10.22074/cellj.2021.6784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 07/21/2019] [Indexed: 12/18/2022]
Abstract
Objective In vitro fertilization (IVF) is one of the most efficient approaches within the context of assisted reproductive technology (ART) to treat infertility. High pregnancy rates have become the major index of successful IVF in clinical studies. It is not clear yet which factors are certainly responsible for IVF success, as various outcomes were obtained in different IVF centers with different settings. In this study, we aimed to address controversies in the interpretation of promising results of IVF with respect to preimplantation genetic screening (PGS). Materials and Methods In this retrospective case series study, we built a dataset containing data from 213 IVF patient candidates for PGS (654 embryos) with blastomere biopsy at day 3 and trophectoderm biopsy in day 5, referred to Royan Institute, Tehran, Iran from 2015 to 2018. Next, the data were analyzed to find influential factors affecting success rate of ART cycles. Results Data analyses showed that regardless of PGS indications (ART failures, recurrent miscarriage, chromosomal abnormalities, etc.), the pregnancy rate is influenced by maternal and embryonic factors such as the age of mother as well as quantity and quality of transferred embryos. Furthermore, genotyping of embryos using array comparative genomic hybridization (aCGH) depicted the highest rate of chromosomal aberrations for chromosomes 1, 16 and 19 while the lowest frequency for chromosomes 11 and 17. Similarly, we detected 463 genetically abnormal embryos by aCGH, among which only 41.9% could be detected by classical fluorescent in situ hybridization (FISH) method. Conclusion This study not only highlighted the advantages of aCGH over the FISH method in detection of chromosomal abnormalities, but also emphasized the importance of genetic abnormality as an indication for determination of IVF success rate.
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Affiliation(s)
- Mehdi Totonchi
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Babak Babaabasi
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Hadi Najafi
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Departments of Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mojtaba Rezazadeh Valojerdi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Poopak Eftekhari-Yazdi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Lila Karimian
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Navid Almadani
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Anahita Mohseni Meybodi
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Morteza Kimiai
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mehri Mashayekhi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Tahereh Madani
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Hamid Gourabi
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran. Electronic Address:.,Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
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Miscarriage history association with euploid embryo transfer outcomes. Reprod Biomed Online 2019; 39:617-623. [DOI: 10.1016/j.rbmo.2019.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 11/24/2022]
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Mumtaz A, Khalid A, Jamil Z, Fatima SS, Arif S, Rehman R. Kisspeptin: A Potential Factor for Unexplained Infertility and Impaired Embryo Implantation. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2017; 11:99-104. [PMID: 28670427 PMCID: PMC5347457 DOI: 10.22074/ijfs.2017.4957] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/27/2016] [Indexed: 11/30/2022]
Abstract
Background Kisspeptin (KP) is a neuropeptide that causes the release of the gonadotropin releasing hormone, which controls hypothalamo pituitary ovarian axis and exerts
a number of peripheral effects on reproductive organs. The primary objective of this
study was to compare baseline KP levels in females with different types of infertility and
identify possible correlations with risk of failure to conceive, preclinical abortion and
pregnancy after intracytoplasmic sperm injection (ICSI). Materials and Methods A longitudinal cohort study was carried out from August 2014
until May 2015 by recruiting 124 female patients undergoing ICSI, after obtaining ethical
approval from the Australian Concept Infertility Medical Center. Cause of infertility due
to male, female and unexplained factors was at a frequency of 32 (24%), 33 (31%) and 59
(45%) among the individuals respectively. KP levels were measured by ELISA assay before the initiation of the ICSI treatment protocol. Outcome of ICSI was categorized into
three groups of non-pregnant with beta-human chorionic gonadotropin (β-hCG)<5-25
mIU/ml, preclinical abortion with β-hCG>25 mIU/ml and no cardiac activity, and clinical pregnancy declared upon confirmation of cardiac activity. Results based on cause of
infertility and outcome groups were analyzed by one-way ANOVA. Results Females with unexplained infertility had significantly lower levels of KP
when compared with those with male factor infertility (176.69 ± 5.03 vs. 397.6 ± 58.2,
P=0.001). Clinical pregnancy was observed in 28 (23%) females of which 17 (71%) had
a female cause of infertility. In the non-pregnant group of 66 (53%) females, common
cause of infertility was unexplained 56(85%). A weak positive correlation of KP levels
with fertilized oocytes and endometrial thickness was observed (P=0.04 and 0.01 respectively). Conclusion Deficiency of KP in females with unexplained infertility was associated with
reduced chances of implantation after ICSI.
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Affiliation(s)
- Aaida Mumtaz
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Aqsa Khalid
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Zehra Jamil
- Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Syeda Sadia Fatima
- Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Rehana Rehman
- Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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