The impact of luteal phase support on endometrial estrogen and progesterone receptor expression: a randomized control trial

The damage effect of heat stress and psychological stress combined exposure on uterus in female rats

AIMS

Explore the effects of heat stress and psychological stress combined exposure on the uterus and its underlying mechanisms.

MAIN METHODS

Sixty female Sprague-Dawley rats were randomly assigned to four groups: control group, psychological stress group, high ambient temperature group, and high ambient temperature combined with psychological stress group. All treatments were administered for two weeks. During this period, the estrous cycle, body weights and rectal temperature were measured regularly. Then, ovarian weight coefficient, serum estradiol (E₂) and progesterone (P) concentration, uterine histomorphological alterations, levels of tumor necrosis factor alpha (TNF-α), malondialdehyde (MDA) and superoxide dismutase (SOD), and the expressions of ovarian hormone receptors, leukemia inhibitory factor (LIF) and its receptor, homeobox gene A10 (HoxA10), Wnt5a, Wnt7a, β-catenin, and P-β-catenin^Y142 in the uterus and endometrium were detected.

KEY FINDINGS

High temperature combined with psychological stress lead to body weight, body temperature, ovarian hormones and estrus cycle disorder, uterine gland ducts expansion and endometrial thickness reduction, and the decreased expression of endometrial receptivity markers (LIF and HoxA10). Further, disturbed expression of E₂ and P receptors in endometrium, elevated MDA and TNF-α levels, and decreased Wnt5a, Wnt7a and P-β-catenin^Y142 content were found. Our data suggested that co-exposure to high temperature and psychological stress could aggravate uterine damage probably by inducing ovarian hormonal disorder and the subsequent oxidative stress and inflammation, and reduce the endometrial function through suppressing Wnt signaling.

SIGNIFICANCE

This will provide the scientific basis for improving female reproductive health, and preventing and treating reproductive disorders.

Effects of hormone replacement therapy on endometrial hormone concentrations and progesterone receptor expression in recurrent pregnancy loss: a self-controlled study

AIM

To investigate the differential effects of endometrial preparation approaches, natural cycle (NC) and hormone replacement therapy (HRT), on the endometrial hormone conditions in patients with recurrent pregnancy loss (RPL).

METHODS

42 RPL patients were recruited, and a self-controlled trial was conducted to compare the effectiveness of NC to HRT on the same patient. The estradiol (E2) and progesterone (P) levels in both serum and endometrial tissue were measured in NC and HRT, respectively. Meanwhile, the expression levels of endometrial progesterone receptor A (PRA) and progesterone receptor B (PRB) were also compared between NC and HRT cycles during the window of receptivity. All statistical analyses were performed using GraphPad Prism 5, and data were averaged across subjects and tested for significance by pair-samples t-test.

RESULTS

Hormone replacement slightly decreased serum E2 and P levels (0.9- and 0.8-fold in average, respectively), significantly elevated endometrial E2 and P (2.1- and 14.5-fold in average, respectively), and reduced endometrial E2/P ratio (0.34-fold in average) compared to the NC condition. However, no correlation was found between serum and endometrial hormone concentrations. Further, the PRA/PRB ratios of both stromal and glandular cells were comparable between HRT and NC conditions, even though stromal PRA expression was slightly elevated by HRT compared to NC (1.63±0.96 vs 1.18±0.99, p =.0173).

CONCLUSION

The effects of HRT for endometrial preparation are similar or slightly superior to NC in RPL patients.

Aberrant endometrial steroid receptor expression in in-vitro maturation cycles despite hormonal luteal support: A pilot study

Clinical outcomes of fresh embryo transfer in non-hCG triggered in vitro maturation (IVM) cycles are inferior compared to vitrified-warmed embryo transfer. This is a prospective observational pilot study in a consecutive cohort of 31 polycystic ovary syndrome (PCOS) patients and 37 normo-ovulatory egg donors who underwent IVM without fresh embryo transfer between July 2009 and June 2014. All subjects received 150 IU of highly purified menotropin (HP-hMG) daily for three days. On cycle day 6, all patients started transdermal oestradiol (E2) at a daily dose of 9 mg. There was no human chorionic gonadotropin (hCG) trigger before oocyte retrieval (OR). Vaginal micronized progesterone was commenced on the evening after OR, at a daily dose of 600 mg. Additional luteal phase support (LPS) was administered as follows: Group A: no additional LPS; Group B: 1500 IU of hCG administered 4 h after OR and Group C: 5000 IU of hCG administered 4 h after OR + an additional injection of 5000 IU of hCG 1 day before endometrial biopsy. Endometrial biopsy for histology and immunohistochemistry (IHC) was performed on day 5 or 6 after OR. Instead of being downregulated, both PR-B and ERα in endometrial glands and stroma were moderately to strongly expressed in all three protocols, suggesting that the mid-luteal histological signature of endometrial receptivity is deficient in a non-hCG-triggered IVM cycle. Poor clinical outcomes after fresh embryo transfer following IVM are probably related to inappropriate endometrial development which may be linked to the short follicular phase of IVM cycles.