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Recombinant luteinizing hormone supplementation in assisted reproductive technology: a review of literature. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2021. [DOI: 10.1186/s43043-021-00083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Luteinizing hormone (LH) has the main role in ovarian function in both natural and artificial cycles. A normal LH concentration during controlled ovarian hyperstimulation is positively correlated to the number and quality of retrieved oocytes and resulting embryos.
Main body of the abstract
In this study, we reviewed whether rLH administration, adjunct to the ovarian stimulation regimen, could improve clinical outcomes. The literature review showed that rLH supplementation improves assisted reproductive technology (ART) outcomes among women with hypogonadotropic hypogonadism, and hyporesponsive women to follicle-stimulating hormone monotherapy. Besides, rLH supplementation has advantages for poor responder women 36–39 years of age. Even though the data suggested no priority regarding the LH source for improving ART outcome, women with different LH polymorphisms who did not respond similarly to ovarian stimulation may benefit from adjuvant rLH therapy.
Conclusion
rLH usage for improving ART outcome should be scrutinized via well-designed studies considering the subgroups of infertile women who benefit the most from rLH adjuvant therapy, the type of ovarian stimulation protocol to which rLH would be added, and also the exact dosage, as well as the proper timing (during or prior to a cycle).
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Changing stimulation protocol on repeat conventional ovarian stimulation cycles does not lead to improved laboratory outcomes. Fertil Steril 2021; 116:757-765. [PMID: 34045067 DOI: 10.1016/j.fertnstert.2021.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate whether physicians' choice of ovarian stimulation protocol is associated with laboratory outcomes. DESIGN Retrospective cohort study. SETTING Single academic center. PATIENT(S) The subjects were 4,458 patients who completed more than one in vitro fertilization ovarian stimulation cycle within 1 year. On second stimulation, 49% repeated the same protocol and 51% underwent a different one. INTERVENTION(S) Estradiol priming antagonist, antagonist +/- oral contraceptive pill priming, long luteal protocol, Lupron (Lupron [AbbVie Inc, North Chicago, IL]) stop protocol, and flare were compared. Logistic or linear regression with cluster robust standard errors to account for covariates and paired data was used. MAIN OUTCOME MEASURE(S) Oocytes collected (OC), fertilization rate, blastocyst progression (BP), usable embryos (UE), and euploid rate (ER). RESULT(S) First stimulation outcomes were comparable across all protocols for FR, BP, UE, and ER but were different for OC, after adjustment for covariates. For OC, the effect of switching protocols differed according to the type of the second stimulation. There was improvement in OC if the same stimulation was repeated, except for flare. In addition, there were slight, significant improvements in fertilization rate (difference in values or coefficient of 0.02; 95% confidence interval [CI], 0.004, 0.4) and UE (coefficient 1.25; 95% CI, 0.79, 1.72) when the same stimulation was repeated. There were no changes in BP (coefficient 0.03; 95% CI, -0.01, 0.08) or ER (coefficient 0.01; 95% CI, -0.04, 0.06) when protocols were changed. In a low-BP subgroup, greater improvement was seen when the same protocol was repeated (coefficient 0.03; 95% CI 0.01, 0.04). CONCLUSION(S) There was a slight but significant improvement in laboratory outcomes when the same stimulation protocol was repeated, so careful consideration should be made before switching stimulation protocols for the purpose of improving laboratory outcomes.
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Kan O, Simsir C, Atabekoglu CS, Sonmezer M. The impact of adding hp-hMG in r-FSH started GnRH antagonist cycles on ART outcome. Gynecol Endocrinol 2019; 35:869-872. [PMID: 30973022 DOI: 10.1080/09513590.2019.1600667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
While luteinizing hormone (LH) activity is believed to play a role in follicle maturation, human chorionic gonadotropin (hCG) might play an important role in implantation process. We aimed to investigate whether addition of human menopausal gonadotropin (hMG) in recombinant-follicle-stimulating hormone (r-FSH) started GnRH antagonist controlled ovarian hyperstimulation (COH) cycles might enhance implantation rate and improve in vitro fertilization (IVF) success. A total of 246 patients undergoing GnRH antagonist IVF cycles were analyzed. One hundred and twenty-three cycles (%50) were treated with only r-FSH and 123 cycles were treated with r-FSH plus hp-hMG combination. Total gonadotropin doses, total number of oocytes retrieved, metaphase 2 (MII) oocytes, top quality embryos, fertilization and implantation rates, clinical pregnancy rates (CPRs) and ovarian hyperstimulation syndrome (OHSS) rates were compared between the groups. Both groups were comparable in terms of demographic details and baseline characteristics. Peak estradiol and progesterone levels in hCG trigger day, number of retrieved oocytes and top quality embryo counts, fertilization rates were similar between the groups. In r-FSH + hp-hMG group, significantly higher implantation rates (35.3% vs 24.3%, p=.017), CPRs (51.2% vs 35.8%, p=.015) and lower OHSS rates (1.6% vs 7.4%, p = .03) were observed respectively compared to r-FSH only treated patients. In conclusion, addition of hp-hMG on the day of antagonist initiation might increase CPRs. A better endometrial receptivity associated with higher implantation rates might be achieved due to hCG component in hp-hMG.
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Affiliation(s)
- Ozgur Kan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hitit University, Corum, Turkey
| | - Coskun Simsir
- Department of Obstetrics and Gynecology, Liv Hospital, Ankara, Turkey
| | - Cem Somer Atabekoglu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Murat Sonmezer
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Cao Y, Li Z, Jiang W, Ling Y, Kuang H. Reproductive functions of Kisspeptin/KISS1R Systems in the Periphery. Reprod Biol Endocrinol 2019; 17:65. [PMID: 31399145 PMCID: PMC6689161 DOI: 10.1186/s12958-019-0511-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/07/2019] [Indexed: 12/16/2022] Open
Abstract
Kisspeptin and its G protein-coupled receptor KISS1R play key roles in mammalian reproduction due to their involvement in the onset of puberty and control of the hypothalamic-pituitary-gonadal axis. However, recent studies have indicated a potential role of extra-hypothalamic kisspeptin in reproductive function. Here, we summarize recent advances in our understanding of the physiological significance of kisspeptin/KISS1R in the peripheral reproductive system (including the ovary, testis, uterus, and placenta) and the potential role of kisspeptin/KISS1R in reproductive diseases. A comprehensive understanding of the expression, function, and potential molecular mechanisms of kisspeptin/KISS1R in the peripheral reproductive system will contribute to the diagnosis, treatment and prevention of reproductive diseases.
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Affiliation(s)
- Yubin Cao
- 0000 0001 2182 8825grid.260463.5Department of Physiology, Basic Medical College, Nanchang University, Nanchang, Jiangxi 330006 People’s Republic of China
- 0000 0001 2182 8825grid.260463.5Department of Clinic medicine, School of Queen Mary, Nanchang University, Nanchang, Jiangxi 330006 People’s Republic of China
| | - Zeping Li
- 0000 0001 2182 8825grid.260463.5Department of Physiology, Basic Medical College, Nanchang University, Nanchang, Jiangxi 330006 People’s Republic of China
- 0000 0001 2182 8825grid.260463.5Department of Clinic medicine, School of Queen Mary, Nanchang University, Nanchang, Jiangxi 330006 People’s Republic of China
| | - Wenyu Jiang
- 0000 0001 2182 8825grid.260463.5Department of Physiology, Basic Medical College, Nanchang University, Nanchang, Jiangxi 330006 People’s Republic of China
- 0000 0001 2182 8825grid.260463.5Department of Clinic medicine, School of Queen Mary, Nanchang University, Nanchang, Jiangxi 330006 People’s Republic of China
| | - Yan Ling
- 0000 0004 1757 8108grid.415002.2Department of Obstetrics and Gynecology, Jiangxi Province People’s Hospital, Nanchang, Jiangxi 330006 People’s Republic of China
| | - Haibin Kuang
- 0000 0001 2182 8825grid.260463.5Department of Physiology, Basic Medical College, Nanchang University, Nanchang, Jiangxi 330006 People’s Republic of China
- 0000 0001 2182 8825grid.260463.5Jiangxi Provincial Key Laboratory of Reproductive Physiology and Pathology, Medical Experimental Teaching Center, Nanchang University, Nanchang, Jiangxi 330006 People’s Republic of China
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Huseyin K, Berk B, Tolga K, Eser O, Ali G, Murat A. Management of ovulation induction and intrauterine insemination in infertile patients with hypogonadotropic hypogonadism. J Gynecol Obstet Hum Reprod 2019; 48:833-838. [PMID: 30930300 DOI: 10.1016/j.jogoh.2019.03.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/19/2019] [Accepted: 03/26/2019] [Indexed: 11/19/2022]
Abstract
AIM To investigate the effectiveness of ovulation induction and intrauterine insemination (OI + IUI) in female patients with hypogonadotropic hypogonadism (HH), and to compare the outcomes of different stimulation protocols and cycle characteristics. MATERIAL AND METHODS The outcomes of OI + IUI treatments in patients with HH diagnosed between 2010 and 2018 were retrospectively evaluated. Cycles using recombinant (rec) luteinizing hormone (LH) or human menopausal gonadotropin (hMG) as LH sources were compared with each other. The cycle characteristics and pregnancy rates of the first cycles were compared with those of the second cycles in patients who underwent 2 or more cycles. RESULTS Of 104 patients diagnosed with World Health Organization type 1 anovulation, 99 were treated with hMG or rec LH + rec follicle-stimulating hormone (FSH) in a total of 220 cycles. The mean age of the study patients was 27.8 ± 4.6 years (range, 19-39 years). Rec FSH + rec LH was given in 37 cycles, and hMG was used in 183 cycles. The hormone values were as follows: FSH, 1.4 ± 1.6 mIU/mL; LH, 0.7 ± 1.2 mIU/mL; oestradiol, 13 (15.8 ± 12.0) pg/mL; and anti-Müllerian hormone, 2.1 (2.6 ± 1.2) ng/mL. A dominant follicle was observed in 85.7% of the first cycles and in 86.2% of the second cycles. The treatment lasted 17.2 ± 5.0 and 15.5 ± 3.8 days until the human chorionic gonadotropin (hCG) administration day in the first and second cycles, respectively, and the difference was statistically significant (p < 0.05). The cycle cancellation rate was 8.1% (n = 3) in cycles done using rec gonadotropins and 29% (n = 53) in patients stimulated with hMG, and the difference was statistically significant (p < 0.05). The pregnancy rates were 12.7% and 28.3% per cycle and per patient, respectively. The pregnancy rate in hCG-triggered patients (successful stimulation) was 17.1% per cycle in all patients. CONCLUSION OI with gonadotropins and IUI is a safe, efficient, and relatively cost-effective treatment option in patients with HH, yielding reasonable pregnancy rates per cycle and per patient. The use of rec FSH + rec LH facilitates cycle management but does not positively contribute to pregnancy rates and is more expensive than some other feasible options.
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Affiliation(s)
- Kiyak Huseyin
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Bulut Berk
- Department of Obstetrics and Gynecology, Liv Hospital, Istanbul, Turkey
| | - Karacan Tolga
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Ozyurek Eser
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gedikbasi Ali
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Api Murat
- Department of Obstetrics and Gynecology, Medipol University Hospital, Istanbul, Turkey
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Gorkem U, Togrul C, Arslan E, Sargin Oruc A, Buyukkayaci Duman N. Is there a role for kisspeptin in pathogenesis of polycystic ovary syndrome? Gynecol Endocrinol 2018; 34:157-160. [PMID: 28933574 DOI: 10.1080/09513590.2017.1379499] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AIM To investigate association of kisspeptin levels in infertile women with different ovarian reserve patterns. MATERIALS AND METHODS In this prospective cross-sectional study, 157 participants were recruited. The women were divided into three groups: (i) adequate ovarian reserve (AOR) (n = 57), (ii) high ovarian reserve (PCOS) (n = 60), (iii) diminished ovarian reserve (DOR) (n = 40). Weight, height, waist circumference (WC), hip circumference (HC), body mass index (BMI), waist/hip ratio (WHR) were measured. The blood samples were analyzed for estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), 17-hydroxy progesterone (17OHP), dehydroepiandrosterone sulfate (DHEAS), antimullerian hormone (AMH), kisspeptin measurements. RESULTS FSH concentration was higher and AMH concentration was lower in DOR group (p < .001, p < .001, respectively). The mean LH, TT and DHEAS levels were higher in PCOS group (p = .001, p < .00 and p = .003, respectively). The 17OHP level did not differ among the groups (p = .15). Women with PCOS possessed the highest kisspeptin level (p = .01). The kisspeptin level was negatively correlated with FSH level (r = -0.18, p = .02) and positively correlated with TT and DHEAS levels (r = 0.17, p = .02 and r = 0.23, p = .003, respectively). CONCLUSIONS Women with PCOS had increased serum kisspeptin levels. Kisspeptin concentrations were negatively correlated with serum FSH and positively correlated with serum TT and DHEAS levels.
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Affiliation(s)
- Umit Gorkem
- a Department of Obstetrics and Gynecology , Hitit University Medical School , Corum , Turkey
| | - Cihan Togrul
- a Department of Obstetrics and Gynecology , Hitit University Medical School , Corum , Turkey
| | - Emine Arslan
- a Department of Obstetrics and Gynecology , Hitit University Medical School , Corum , Turkey
| | - Ayla Sargin Oruc
- b Department of Obstetrics and Gynecology , Ankara Guven Hospital , Ankara , Turkey
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Mumusoglu S, Ata B, Turan V, Demir B, Kahyaoglu I, Aslan K, Seyhan Ata A, Yilmaz B, Yakin K, Avci B, Uncu G, Bozdag G. Does pituitary suppression affect live birth rate in women with congenital hypogonadotrophic hypogonadism undergoing intra-cytoplasmic sperm injection? A multicenter cohort study. Gynecol Endocrinol 2017; 33:728-732. [PMID: 28447505 DOI: 10.1080/09513590.2017.1318278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
In this retrospective multicenter cohort study, women with congenital hypogonadotrophic hypogonadism (CHH) (n = 57) who underwent intra-cytoplasmic sperm injection in-between 2010-2014 were compared to age-matched controls with tubal factor infertility (n = 114) to assess ovarian stimulation cycle and pregnancy outcomes. Live birth rates (LBRs) per started cycle were 31.6 and 24.6% in CHH and controls groups, respectively (p = 0.36). Comparable success rates were also confirmed with the logistic regression analysis (OR: 1.44, 95% CI: 0.78-2.67, p = 0.24). Of the 57 women with CHH, 19 were stimulated with the gonadotropin-releasing hormone (GnRH) antagonist protocol, 13 with the long-GnRH-agonist protocol. Pituitary suppression (PS) was not employed in the remaining 25 cases. Compared to women with PS, women without PS had significantly higher embryo implantation rates (21.6 versus 52.6%, p = 0.03). Although there was a trend favoring no PS, LBRs (25.0 versus 40.0%, p = 0.26) per cycle were short of statistical significance. LBRs per cycle (57.1 versus 31.2%, p = 0.11) and miscarriage rates (11.1 versus 16.7%, p = 0.75) were similar between CHH women who were given estrogen + progesterone and progesterone alone to support the luteal phase. In conclusion, the optimal stimulation protocol appears to be exogenous gonadotropin stimulation alone, without PS, and progesterone-only luteal phase support in CHH patients.
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Affiliation(s)
- Sezcan Mumusoglu
- a Department of Obstetrics and Gynecology , Hacettepe University School of Medicine , Ankara , Turkey
| | - Baris Ata
- b Department of Obstetrics and Gynecology , Koc University School of Medicine , Istanbul , Turkey
| | - Volkan Turan
- c Department of Obstetrics and Gynecology , Yeni Yuzyil University School of Medicine, GOP Hospital , Istanbul , Turkey
| | - Berfu Demir
- d Department of Obstetrics and Gynecology , Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara , Turkey
| | - Inci Kahyaoglu
- d Department of Obstetrics and Gynecology , Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara , Turkey
| | - Kiper Aslan
- e Department of Obstetrics and Gynecology , Uludag University School of Medicine , Bursa , Turkey
| | - Ayse Seyhan Ata
- f Women's Health and Assisted Reproduction Center of American Hospital , Istanbul , Turkey
| | - Bulent Yilmaz
- g Department of Obstetrics and Gynecology , Katip Celebi University School of Medicine , Izmir , Turkey
- h Department of Obstetrics and Gynecology , Tepecik Education and Research Hospital , Izmir , Turkey , and
| | - Kayhan Yakin
- b Department of Obstetrics and Gynecology , Koc University School of Medicine , Istanbul , Turkey
| | - Berrin Avci
- i Department of Histology Embryology , Uludag University School of Medicine , Bursa , Turkey
| | - Gurkan Uncu
- e Department of Obstetrics and Gynecology , Uludag University School of Medicine , Bursa , Turkey
| | - Gurkan Bozdag
- a Department of Obstetrics and Gynecology , Hacettepe University School of Medicine , Ankara , Turkey
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Hu KL, Zhao H, Chang HM, Yu Y, Qiao J. Kisspeptin/Kisspeptin Receptor System in the Ovary. Front Endocrinol (Lausanne) 2017; 8:365. [PMID: 29354093 PMCID: PMC5758547 DOI: 10.3389/fendo.2017.00365] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/13/2017] [Indexed: 12/26/2022] Open
Abstract
Kisspeptins are a family of neuropeptides that are critical for initiating puberty and regulating ovulation in sexually mature females via the central control of the hypothalamic-pituitary-gonadal axis. Recent studies have shown that kisspeptin and its receptor kisspeptin receptor (KISS1R) are expressed in the mammalian ovary. Convincing evidence indicates that kisspeptins can activate a wide variety of signals via its binding to KISS1R. Experimental data gathered recently suggest a putative role of kisspeptin signaling in the direct control of ovarian function, including follicular development, oocyte maturation, steroidogenesis, and ovulation. Dysregulation or naturally occurring mutations of the kisspeptin/KISS1R system may negatively affect the ovarian function, leading to reproductive pathology or female infertility. A comprehensive understanding of the expression, actions, and underlying molecular mechanisms of this system in the human ovary is essential for novel approaches to therapeutic and diagnostic interventions in reproductive diseases and infertility.
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Affiliation(s)
- Kai-Lun Hu
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Hongcui Zhao
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- *Correspondence: Hongcui Zhao, ; Yang Yu,
| | - Hsun-Ming Chang
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yang Yu
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- *Correspondence: Hongcui Zhao, ; Yang Yu,
| | - Jie Qiao
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Ministry of Education, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
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Zhou Q, Chen H, Yang S, Li Y, Wang B, Chen Y, Wu X. High-fat diet decreases the expression of Kiss1 mRNA and kisspeptin in the ovary, and increases ovulatory dysfunction in postpubertal female rats. Reprod Biol Endocrinol 2014; 12:127. [PMID: 25542298 PMCID: PMC4292805 DOI: 10.1186/1477-7827-12-127] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/15/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Female reproductive health is noticeably compromised by obesity. The underlying mechanisms remain to be elucidated. Accumulating evidence indicates that the expression level of ovarian Kiss1 peaks in the afternoon during prooestrus, suggesting local regulatory roles for Kiss1 in the ovulatory process. We used a diet-induced model of obesity to evaluate whether the ovarian Kiss1 system is affected by obesity, and, to investigate the association of the Kiss1 system with ovulatory disorders in female rats. METHODS Post-weaning, female, Sprague-Dawley rats were randomly fed either a high-fat diet (HFD) or a normal chow diet (NCD) until they reached postnatal day 30 (PND 30), PND 42, or PND 70. The timing of vaginal opening was recorded, and oestrous cyclicity was monitored for 2 consecutive weeks immediately post puberty and again at 8-9 weeks of age. Tissues from the left ovary were collected for determination of the levels of Kiss1 and G protein-coupled receptor 54 (GPR54) mRNA, and tissues from the right ovary were collected for assessment of the immunoreactivity (IR) of the corresponding protein products, kisspeptin and GPR54. RESULTS The high-fat diet resulted in a significantly higher body weight and an earlier puberty onset. Oestrous cyclicity was disrupted by the HFD with significant reductions in the expression of ovulation-related genes. A marked suppression of ovarian Kiss1 mRNA levels was observed during prooestrus and oestrus at PND 42, and, during prooestrus, oestrus, and metoestrus at PND 70 in the HFD rats compared with the NCD controls. In the HFD group, the immunoreactivity of kisspeptin was significantly lower in theca cells from antral follicles during prooestrus and oestrus at PND 42, and, during prooestrus, oestrus at PND 70. At the prooestrus stage, in the HFD group the immunoreactivity of kisspeptin was also lower in the theca cells of preovulatory follicles at both PND 42 and PND 70. CONCLUSIONS Exposure of female rats to an post-weaning, high-fat diet has long-term deleterious effects on ovulation, that may involve down-regulation of ovarian Kiss1 mRNA and kisspeptin.
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Affiliation(s)
- Qiangyong Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Haiyan Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Simeng Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Yuehua Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Binqiao Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Yuanyuan Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Xueqing Wu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang China
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Moro F, Scarinci E, Palla C, Romani F, Familiari A, Tropea A, Leoncini E, Lanzone A, Apa R. Highly purified hMG versus recombinant FSH plus recombinant LH in intrauterine insemination cycles in women >=35 years: a RCT. Hum Reprod 2014; 30:179-85. [DOI: 10.1093/humrep/deu302] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hofmann J, Watzlawik M, Richter-Appelt H. Living with Kallmann Syndrome - Analysis of Subjective Experience Reports from Women. Geburtshilfe Frauenheilkd 2013; 73:1112-1120. [PMID: 24771897 DOI: 10.1055/s-0033-1350881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 05/21/2013] [Accepted: 08/09/2013] [Indexed: 10/25/2022] Open
Abstract
Five women were questioned on their experiences with Kallmann Syndrome (KS) in thematically focused, open interviews. This investigation complements the study of the experiences of men with KS 1. The results show that the consequences and pressures of KS extend beyond the somato-medical field and that those affected are also burdened by mental and psycho-social impacts. The pressures experienced by those affected include a distorted body image resulting from the lack of physical development, which in turn leads to difficulties in developing a healthy feeling of self-worth. Furthermore, particular attention should be paid to the influence of hormone therapy on mood and libido during medical treatment. Some of the affected women reported experiencing depressive moods and low libido, and pressures in their relationship associated with this. The affected women wanted KS to be viewed as a whole in order to achieve better handling. In particular, attentive handling of issues relating to fertility was important to them. Additional relevant support included offers of confidential discussions, and offers of psychotherapy and, where required, sex education or sex therapy.
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Affiliation(s)
- J Hofmann
- Institute and Polyclinic for Sex Research and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg
| | - M Watzlawik
- Institute of Psychology, University of Osnabrück, Osnabrück
| | - H Richter-Appelt
- Institute and Polyclinic for Sex Research and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg
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Witchel SF, Tena-Sempere M. The Kiss1 system and polycystic ovary syndrome: lessons from physiology and putative pathophysiologic implications. Fertil Steril 2013; 100:12-22. [DOI: 10.1016/j.fertnstert.2013.05.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 05/13/2013] [Accepted: 05/15/2013] [Indexed: 01/02/2023]
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Fábregues F, Creus M, Casals G, Carmona F, Balasch J. Outcome from consecutive ICSI cycles in patients treated with recombinant human LH and those supplemented with urinary hCG-based LH activity during controlled ovarian stimulation in the long GnRH-agonist protocol. Gynecol Endocrinol 2013; 29:430-5. [PMID: 23350573 DOI: 10.3109/09513590.2012.754873] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Clinical results were compared in a well-established, assisted reproduction program during the cross-over from highly purified (HP)-human menopausal gonadotropin (hMG) to rhFSH/rhLH. We included the last 33 patients treated with HP-hMG and the first 33 patients receiving rhFSH/rhLH for ovarian stimulation in their first intracytoplasmic sperm injection cycle. Patient baseline characteristics were almost identical in the two groups. Ovarian stimulation characteristics (days of stimulation, total amount of FSH administered using a modest initial loading dose of 150 IU/d, patients with oocyte retrieval) were similar for the two groups. However, the number of total and leading follicles and E2 serum levels on the human chorionic gonadotropin injection day were significantly higher in the rhFSH/rhLH group. The oocyte yield was significantly higher in the rhFSH/rhLH group as well as the number of metaphase II oocytes, difference almost reaching the statistical significance. The number of oocytes fertilized was also higher in patients receiving rhFSH/rhLH treatment. Implantation and clinical pregnancy rates were similar in both the study groups. It is concluded that in women undergoing controlled ovarian hyperstimulation under pituitary suppression for ART, the recombinant combined product containing FSH and LH in a fixed 2:1 ratio is more effective than HP-hMG in terms of follicle development, oocyte yield and quality, and fertilization rates.
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Affiliation(s)
- Francisco Fábregues
- Faculty of Medicine, Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic - Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Awwad JT, Farra C, Mitri F, Abdallah MA, Jaoudeh MA, Ghazeeri G. Split daily recombinant human LH dose in hypogonadotrophic hypogonadism: a nonrandomized controlled pilot study. Reprod Biomed Online 2012. [PMID: 23177418 DOI: 10.1016/j.rbmo.2012.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This prospective controlled nonrandomized pilot study was conducted to investigate whether split daily doses of recombinant human LH (rHLH) is more efficacious than the single daily dose in supporting follicular development and ovulation in primary hypogonadotrophic hypogonadism (HH). Twenty-seven women with HH received a 150 IU fixed daily subcutaneous dose of recombinant human FSH, supplemented by 75 IU daily dose of rHLH given either as a single dose (n=9; single-dose group) or four equally divided doses (n=18; split-dose group). Ovulation was defined by three efficacy end points: at least one follicle ⩾17mm in diameter, pre-ovulatory serum oestradiol ⩾400pmol/l and a midluteal progesterone ⩾25nmol/l. Although lacking statistical significance, the proportion of women in the rHLH split-dose group who fulfilled all three end points was higher than the single-dose group (72.2% versus 55.6%). Women in the split-dose group achieved higher serum oestradiol concentrations per follicle, endometrial thickness measurements and numbers of follicles than in the single-dose group (not statistically significant). The odds ratio for ovulation rate was 2.08 (not statistically significant). There were no serious untoward side effects. Administering rHLH in split daily doses could provide superior results compared with the traditional single daily dose. We conducted this clinical study to investigate whether a split daily dose protocol of recombinant human LH (rHLH) is more efficacious than the single daily dose in supporting follicular development and ovulation in primary hypogonadotrophic hypogonadism (HH). HH is an uncommon entity that can lead to very low or undetectable serum gonadotrophin concentrations. It manifests in anovulation, amenorrhoea and subsequent infertility. Twenty-seven women with HH received a 150 IU fixed daily subcutaneous dose of recombinant human FSH, supplemented by a 75 IU daily dose of rHLH given either as a single dose (n=9; single-dose group) or four equally divided doses (n=18; split-dose group). Ovulation was defined by these three efficacy end points: at least one follicle ⩾17mm in mean diameter, pre-ovulatory serum oestradiol concentration ⩾400pmol/l and a midluteal progesterone concentration ⩾25nmol/l. The proportion of women in the rHLH split-dose group who fulfilled all three end points was higher than the single-dose group (72.2% versus 55.6%). Women in the split-dose group achieved higher serum oestradiol concentrations per follicle, endometrial thickness measurements and numbers of follicles than in the single-dose group, without statistical significance. Women who received the split-dose regimen were more likely to have ovulation than the other group. We had no serious problematic side effects. Our results suggest that administering rHLH in split daily doses could provide superior results compared to the traditional single daily dose.
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Affiliation(s)
- Johnny T Awwad
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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FSH receptor in vitro modulation by testosterone and hCG in human luteinized granulosa cells. Eur J Obstet Gynecol Reprod Biol 2012; 165:259-64. [PMID: 22964136 DOI: 10.1016/j.ejogrb.2012.08.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 07/24/2012] [Accepted: 08/14/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the effect of testosterone and hCG on FSH receptor (FSHR) protein and mRNA expression in human granulosa cells (GC) in vitro. STUDY DESIGN Experimental in vitro cell culture obtained from healthy women undergoing IVF/ICSI due to male factor infertility. Human follicular fluid samples were obtained and after cumulus-oocyte complexes were identified, fluids were pipetted onto Ficoll gradients and centrifuged for 15 min at 400 × g at room temperature. Cells at the interface were removed and plated in 24-well plates for 3 days in M-199 with 10% FBS. Cells were treated with different concentrations of testosterone and hCG. After purification, cells were labeled with specific antibodies and the protein expression of the FSHR was evaluated by flow cytometry in the GC population. Also, total RNA was extracted from confluent GC and the FSHR gene expression was evaluated by RT-PCR. RESULTS FSHR expression was modulated by treating GC in vitro at different testosterone/hCG concentrations. When compared with untreated GC, we observed a significant effect of testosterone and hCG on the expression of the FSHR at the protein level. Time course experiments confirmed that the gene expression of the FSHR peaked at 12-24h when testosterone or hCG was used as a stimulus. CONCLUSIONS Both testosterone and hCG are able to positively modulate FSHR expression at gene and protein level in human GC in vitro.
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Pinilla L, Aguilar E, Dieguez C, Millar RP, Tena-Sempere M. Kisspeptins and Reproduction: Physiological Roles and Regulatory Mechanisms. Physiol Rev 2012; 92:1235-316. [DOI: 10.1152/physrev.00037.2010] [Citation(s) in RCA: 529] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Procreation is essential for survival of species. Not surprisingly, complex neuronal networks have evolved to mediate the diverse internal and external environmental inputs that regulate reproduction in vertebrates. Ultimately, these regulatory factors impinge, directly or indirectly, on a final common pathway, the neurons producing the gonadotropin-releasing hormone (GnRH), which stimulates pituitary gonadotropin secretion and thereby gonadal function. Compelling evidence, accumulated in the last few years, has revealed that kisspeptins, a family of neuropeptides encoded by the Kiss1 gene and produced mainly by neuronal clusters at discrete hypothalamic nuclei, are pivotal upstream regulators of GnRH neurons. As such, kisspeptins have emerged as important gatekeepers of key aspects of reproductive maturation and function, from sexual differentiation of the brain and puberty onset to adult regulation of gonadotropin secretion and the metabolic control of fertility. This review aims to provide a comprehensive account of the state-of-the-art in the field of kisspeptin physiology by covering in-depth the consensus knowledge on the major molecular features, biological effects, and mechanisms of action of kisspeptins in mammals and, to a lesser extent, in nonmammalian vertebrates. This review will also address unsolved and contentious issues to set the scene for future research challenges in the area. By doing so, we aim to endow the reader with a critical and updated view of the physiological roles and potential translational relevance of kisspeptins in the integral control of reproductive function.
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Affiliation(s)
- Leonor Pinilla
- Department of Cell Biology, Physiology and Immunology, University of Córdoba; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III; and Instituto Maimónides de Investigaciones Biomédicas, Córdoba, Spain; Department of Physiology, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain; and Centre for Integrative Physiology, School of Biomedical Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Enrique Aguilar
- Department of Cell Biology, Physiology and Immunology, University of Córdoba; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III; and Instituto Maimónides de Investigaciones Biomédicas, Córdoba, Spain; Department of Physiology, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain; and Centre for Integrative Physiology, School of Biomedical Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Carlos Dieguez
- Department of Cell Biology, Physiology and Immunology, University of Córdoba; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III; and Instituto Maimónides de Investigaciones Biomédicas, Córdoba, Spain; Department of Physiology, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain; and Centre for Integrative Physiology, School of Biomedical Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Robert P. Millar
- Department of Cell Biology, Physiology and Immunology, University of Córdoba; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III; and Instituto Maimónides de Investigaciones Biomédicas, Córdoba, Spain; Department of Physiology, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain; and Centre for Integrative Physiology, School of Biomedical Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Manuel Tena-Sempere
- Department of Cell Biology, Physiology and Immunology, University of Córdoba; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III; and Instituto Maimónides de Investigaciones Biomédicas, Córdoba, Spain; Department of Physiology, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain; and Centre for Integrative Physiology, School of Biomedical Sciences, University of Edinburgh, Edinburgh, United Kingdom
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The value of human chorionic gonadotropin stimulation test in predicting ovarian response during in-vitro fertilization. J Assist Reprod Genet 2011; 28:893-9. [PMID: 21779785 DOI: 10.1007/s10815-011-9612-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 07/11/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To assess the predictive value of human Chorionic Gonadotropin (hCG) theca-stimulation test for ovarian reserve in women undergoing in-vitro fertilization (IVF) treatments. METHODS 39 women were included in the study. All participants received a single hCG 10000 IU injection on cycle day 2-3. Serum levels of estradiol, testosterone, androstenedione and 17-OH progesterone were measured prior to the injection and on days 1, 3 and 7 following the injection. hCG-induced hormone levels were compared with ovarian response during the subsequent IVF cycle. RESULTS There were 11 good responders (>10 oocytes) and 22 low responders (<3 oocytes). Before hCG stimulation serum E2 levels were higher in low responders compared to good responders (370.3 ± 443 vs. 138.3 ± 54 pmol/ml). Following hCG stimulation, day 3 androstendione levels showed an increase in good responders compared to low responders. The ratio between day 3 androstendione and day 0 estradiol was significantly different between the two groups (p = 0.03). ROC analysis of this test revealed area = 0.837 (good prediction), which was much better than day 3 FSH (area = 0.635, poor prediction). CONCLUSIONS These preliminary results demonstrate the potential use of the hCG theca stimulation test in differentiating between good and poor responders. Larger series are needed for further verification of the test in routine clinical application.
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Day-5 inhibin B serum concentrations and antral follicle count as predictors of ovarian response and live birth in assisted reproduction cycles stimulated with gonadotropin after pituitary suppression. Fertil Steril 2010; 94:2590-5. [PMID: 20400077 DOI: 10.1016/j.fertnstert.2010.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 02/14/2010] [Accepted: 03/05/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the usefulness of day-5 inhibin B and antral follicle count (AFC) in predicting ovarian response and live birth in the first cycle of assisted reproduction. DESIGN Prospective cohort study. SETTING University hospital. PATIENT(S) Ninety-eight infertile women treated with in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) comprising 72 normal responders and 26 poor responders. INTERVENTION(S) Ovarian stimulation with gonadotropin-releasing hormone agonist-gonadotropin treatment. MAIN OUTCOME MEASURE(S) Basal ultrasonographic (AFC, total ovarian volume) and basal (follicle-stimulating hormone, estradiol, and inhibin B) and stimulation day-5 (estradiol, inhibin B) hormone parameters. RESULT(S) The AFC had the best predictive value among the basal variables for outcome of ovarian stimulation. Among the dynamic hormone measurements, day-5 inhibin serum measurement emerged as the best predictive variable of poor response in IVF-ICSI cycles, but it was not statistically significantly better than basal AFC. The association of day-5 inhibin B with live-birth rate was statistically significant and stronger than the effect of any other variable investigated. CONCLUSION(S) Basal AFC and day-5 inhibin B have similar predictive properties for ovarian response in assisted reproduction cycles stimulated with gonadotropin after pituitary suppression, but day-5 inhibin B is a superior predictor of live birth.
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