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Tremellen K, Alfer J, Cotán D, Pérez-Sánchez M, Harvey AJ, Gardner DK. Effect of a novel copper chloride gel on endometrial growth and function in healthy volunteers. Reprod Biomed Online 2024; 49:104107. [PMID: 39067212 DOI: 10.1016/j.rbmo.2024.104107] [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: 02/07/2024] [Revised: 04/10/2024] [Accepted: 05/07/2024] [Indexed: 07/30/2024]
Abstract
RESEARCH QUESTION Does the application of a micro-dose of copper chloride gel increase endometrial production of vascular endothelial growth factor (VEGF) without compromising endometrial function or producing embryo toxicity? DESIGN An estimate of optimal dose was made based on cell culture studies. Ten healthy participants received an initial uterine application of placebo gel, followed by copper chloride gel (37.5 μM, 75 μM, or 150 μM dose) in a later hormone replacement cycle. Endometrial biopsies (day 5.5 luteal) and pelvic ultrasound were carried out during each cycle to evaluate endometrial function and growth. Uterine fluid was assessed for residual copper levels on the day of biopsy, and copper chloride gel underwent mouse embryos assay assessment for potential embryo toxicity. RESULTS The copper gel significantly increased endometrial VEGF expression (quantitative polymerase chain reaction), and also increasing endometrial thickness by an average of 2.2 mm compared with matched control cycles. The copper gel did not adversely affect endometrial morphology or maturation (histological dating and molecular receptivity testing), and mouse embryos assay studies showed no evidence of embryo toxicity. Furthermore, uterine cavity flush samples mostly lacked copper, with only negligible amounts present in one sample. CONCLUSION Applying copper chloride gel to the uterine cavity upregulated endometrial VEGF and significantly increased endometrial thickness and volume. No adverse effects on the endometrium or embryos were observed. Copper chloride gels show promise for treating suboptimal endometrial thickness if the results of this study are confirmed by larger randomized controlled trials.
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Affiliation(s)
- Kelton Tremellen
- Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Bedford Park, South Australia; Repromed, Dulwich, South Australia.
| | | | | | | | | | - David K Gardner
- School of Biosciences, University of Melbourne, Victoria, Australia
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Lacconi V, Massimiani M, Carriero I, Bianco C, Ticconi C, Pavone V, Alteri A, Muzii L, Rago R, Pisaturo V, Campagnolo L. When the Embryo Meets the Endometrium: Identifying the Features Required for Successful Embryo Implantation. Int J Mol Sci 2024; 25:2834. [PMID: 38474081 DOI: 10.3390/ijms25052834] [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: 01/18/2024] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Evaluation of the optimal number of embryos, their quality, and the precise timing for transfer are critical determinants in reproductive success, although still remaining one of the main challenges in assisted reproduction technologies (ART). Indeed, the success of in vitro fertilization (IVF) treatments relies on a multitude of events and factors involving both the endometrium and the embryo. Despite concerted efforts on both fronts, the overall success rates of IVF techniques continue to range between 25% and 30%. The role of the endometrium in implantation has been recently recognized, leading to the hypothesis that both the "soil" and the "seed" play a central role in a successful pregnancy. In this respect, identification of the molecular signature of endometrial receptivity together with the selection of the best embryo for transfer become crucial in ART. Currently, efforts have been made to develop accurate, predictive, and personalized tests to identify the window of implantation and the best quality embryo. However, the value of these tests is still debated, as conflicting results are reported in the literature. The purpose of this review is to summarize and critically report the available criteria to optimize the success of embryo transfer and to better understand current limitations and potential areas for improvement.
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Affiliation(s)
- Valentina Lacconi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
- Saint Camillus International University of Health Sciences, Via di Sant'Alessandro 8, 00131 Rome, Italy
| | - Micol Massimiani
- Saint Camillus International University of Health Sciences, Via di Sant'Alessandro 8, 00131 Rome, Italy
| | - Ilenia Carriero
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Claudia Bianco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Carlo Ticconi
- Department of Surgical Sciences, Section of Gynaecology and Obstetrics, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Valentina Pavone
- Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alessandra Alteri
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Rocco Rago
- Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Via dei Monti Tiburtini 385/389, 00157 Rome, Italy
| | - Valerio Pisaturo
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Luisa Campagnolo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
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Li T, Liao R, Chan C, Greenblatt EM. Deep learning analysis of endometrial histology as a promising tool to predict the chance of pregnancy after frozen embryo transfers. J Assist Reprod Genet 2023; 40:901-910. [PMID: 36862259 PMCID: PMC10224884 DOI: 10.1007/s10815-023-02745-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/03/2023] [Indexed: 03/03/2023] Open
Abstract
PURPOSE Endometrial histology on hematoxylin and eosin (H&E)-stained preparations provides information associated with receptivity. However, traditional histological examination by Noyes' dating method is of limited value as it is prone to subjectivity and is not well correlated with fertility status or pregnancy outcome. This study aims to mitigate the weaknesses of Noyes' dating by analyzing endometrial histology through deep learning (DL) algorithm to predict the chance of pregnancy. METHODS Endometrial biopsies were taken during the window of receptivity from healthy volunteers in natural menstrual cycles (group A) and infertile patients undergoing mock artificial cycles (group B). H&E staining was performed followed by whole slide image scanning for DL analysis. RESULTS In a proof-of-concept trial to differentiate group A (n=24) vs. B (n=37), a DL-based binary classifier was trained, cross-validated, and achieved 100% for accuracy. Patients in group B underwent subsequent frozen-thawed embryo transfers (FETs) and were further categorized into "pregnant (n=15)" or "non-pregnant (n=18)" sub-groups based on the outcomes. In the following trial to predict pregnancy outcome in group B, the DL-based binary classifier yielded 77.8% for accuracy. Its performance was further validated by an accuracy of 75% in a "held-out" test set where patients had euploid embryo transfers. Furthermore, the DL model identified histo-characteristics including stromal edema, glandular secretion, and endometrial vascularity as important features related to pregnancy prediction. CONCLUSIONS DL-based endometrial histology analysis demonstrated its feasibility and robustness in pregnancy prediction for patients undergoing FETs, indicating its value as a prognostic tool in fertility treatment.
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Affiliation(s)
- Tiantian Li
- Lunenfeld-Tanenbaum Research Institute (LTRI), Sinai Health System, Toronto, ON Canada
- Mount Sinai Fertility (MSF), Sinai Health System, Toronto, ON Canada
| | - Renjie Liao
- Department of Computer Science, University of Toronto, Toronto, ON Canada
| | - Crystal Chan
- Lunenfeld-Tanenbaum Research Institute (LTRI), Sinai Health System, Toronto, ON Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario Canada
| | - Ellen M. Greenblatt
- Lunenfeld-Tanenbaum Research Institute (LTRI), Sinai Health System, Toronto, ON Canada
- Mount Sinai Fertility (MSF), Sinai Health System, Toronto, ON Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario Canada
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Alfer J, Fattahi A, Bleisinger N, Antoniadis S, Krieg J, Dittrich R, Beckmann MW, Hartmann A, Popovici RM, Tremellen K. Individual dynamics of uterine natural killer cells in natural and stimulated cycles monitored using a new endometrial dating method. Am J Reprod Immunol 2022; 88:e13620. [PMID: 36148557 PMCID: PMC9787954 DOI: 10.1111/aji.13620] [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: 12/04/2021] [Revised: 08/14/2022] [Accepted: 09/06/2022] [Indexed: 12/30/2022] Open
Abstract
PROBLEM It is important to evaluate the dynamics of uterine natural killer (uNK) cells in hormone replacement therapy (HRT) cycles, given their potential role in implantation and the common usage of HRT cycles with in vitro fertilization (IVF). METHOD OF STUDY A total of 132 subfertile patients were evaluated during the secretory phase of either natural ovulation (OV) or HRT cycles, with two biopsies taken on approximately days 5 and 10 after ovulation/progesterone administration in a single menstrual cycle. Immunohistochemical Personal Endometrial Maturation Analysis (PEMA) was used to better quantify secretory-phase endometrial development, in combination with subsequent evaluation of uNK cell density. RESULTS uNK cell density increased rapidly from the early to mid-secretory phase, with mean uNK densities of 113 and 117 per mm2 in first biopsies and 315 and 387 per mm2 in second biopsies for OV and HRT cycles, respectively. After reassessment of endometrial development with PEMA, the first and second biopsies in HRT and OV cycles were histologically dated to developmental ranges between days 15-20 (first biopsy) and days 19-25 (second biopsy). CONCLUSION Subfertile women showed variable endometrial development in PEMA assessment, with uNK cell density correlating with the dating results. Overall, comparable levels of uNK cell density were observed in OV and HRT cycles. Importantly, uNK cell density depends on the histological maturation stage, with similar low coefficients of determination. This observation suggests that aberrant uNK cell results more likely reflect displaced endometrial maturation, rather than an intrinsic anomaly in uNK cell trafficking.
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Affiliation(s)
- Joachim Alfer
- Department of PathologyErlangen University HospitalFriedrich‐Alexander University of Erlangen–NürnbergErlangenGermany,Kaufbeuren‐Ravensburg Institute of PathologyRavensburgGermany
| | - Amir Fattahi
- Department of Reproductive BiologySchool of Advanced Medical SciencesTabriz University of Medical SciencesTabrizIran,Department of Obstetrics and GynecologyErlangen University HospitalFriedrich‐Alexander University of Erlangen–NürnbergGermany
| | - Nathalie Bleisinger
- Department of Obstetrics and GynecologyErlangen University HospitalFriedrich‐Alexander University of Erlangen–NürnbergGermany
| | - Sophia Antoniadis
- Department of Obstetrics and GynecologyErlangen University HospitalFriedrich‐Alexander University of Erlangen–NürnbergGermany
| | | | - Ralf Dittrich
- Department of Obstetrics and GynecologyErlangen University HospitalFriedrich‐Alexander University of Erlangen–NürnbergGermany
| | - Matthias W. Beckmann
- Department of Obstetrics and GynecologyErlangen University HospitalFriedrich‐Alexander University of Erlangen–NürnbergGermany
| | - Arndt Hartmann
- Department of PathologyErlangen University HospitalFriedrich‐Alexander University of Erlangen–NürnbergErlangenGermany
| | | | - Kelton Tremellen
- Department of ObstetricsGynaecology and Reproductive MedicineFlinders UniversitySouth AustraliaAustralia
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Alfer J, Popovici RM, Fattahi A, Krieg J, Dittrich R, Beckmann MW, Hartmann A, Bleisinger N. Endometrial delay is found to be part of a normal individual dynamic transformation process. Arch Gynecol Obstet 2021; 304:1599-1609. [PMID: 34009460 PMCID: PMC8553713 DOI: 10.1007/s00404-021-06086-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/30/2021] [Indexed: 11/27/2022]
Abstract
Purpose Limited information is clinically available concerning endometrial receptivity; assessing endometrial transformation status is therefore an urgent topic in assisted reproductive technology. This study aimed to investigate individual endometrial transformation rates during the secretory phase in subfertile patients using personal endometrial transformation analysis. Methods Monitoring was carried out during the secretory phase to obtain endometrial receptivity profiles. For the investigation, two endometrial biopsies were taken within one menstrual cycle. The extended endometrial dating was based on the Noyes criteria, combined with immunohistochemical analyses of hormone receptors and proliferation marker Ki-67. Biopsies were taken mainly at days ovulation (OV, n = 76)/hormone replacement therapy (HRT, n = 58) + 5 and + 10. Results The results of the two biopsies were correlated with the clinically expected day of the cycle and showed temporal delays or hypercompensations, diverging from the expected cycle days by 0.5–5 days. In comparison with the first biopsies, the transformation rate in the second biopsies showed compensation, augmented delay, or constant transformation in 48.69, 22.37, and 28.94% of cases for ovulation in natural cycles and 56.89, 25.85, and 17.26% for HRT cycles, respectively. Conclusion The study revealed an individually dynamic transformation process of the endometrium, with the ability to compensate or enlarge an initial “delay”, which is now identified as a normal individual transformation process during the secretory phase. This information is of great importance for the scientific investigation of dynamic changes in endometrial tissue, as well as for the timing of embryo transfers.
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Affiliation(s)
- Joachim Alfer
- Department of Pathology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany.
- Kaufbeuren-Ravensburg Institute of Pathology, Elisabethenstrasse 19, 88212, Ravensburg, Germany.
| | | | - Amir Fattahi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | | | - Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Arndt Hartmann
- Department of Pathology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Nathalie Bleisinger
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
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Buck VU, Kohlen MT, Sternberg AK, Rösing B, Neulen J, Leube RE, Classen-Linke I. Steroid hormones and human choriogonadotropin influence the distribution of alpha6-integrin and desmoplakin 1 in gland-like endometrial epithelial spheroids. Histochem Cell Biol 2021; 155:581-591. [PMID: 33502623 PMCID: PMC8134296 DOI: 10.1007/s00418-020-01960-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2020] [Indexed: 12/11/2022]
Abstract
In human glandular endometrial epithelial cells, desmosomal and adherens junction proteins have been shown to extend from a subapically restricted lateral position to the entire lateral membrane during the implantation window of the menstrual cycle. Similarly, a menstrual cycle stage-dependent redistribution of the extracellular matrix adhesion protein α6-integrin has been reported. These changes are believed to be important for endometrial receptiveness and successful embryo implantation. To prove the hypothesis that steroid hormones and human choriogonadotropin can induce the redistribution of these adhesion molecules, we used the human endometrial cell line Ishikawa in a 3D culture system. Gland-like spheroids were grown in reconstituted basement membrane (Matrigel™). The lumen-bearing spheroids were treated for 2 or 4 days with ovarian steroids or human choriogonadotropin and then assessed by immunofluorescence microscopy. In addition, human endometrial biopsies were obtained from patients, who were in therapy for assisted reproductive technology, and were examined in parallel. Lateral redistribution of the desmosomal plaque protein desmoplakin 1 was observed in the spheroids treated either with progesterone, medroxyprogesterone acetate or human choriogonadotropin. Furthermore, the extracellular matrix adhesion protein α6-integrin showed an increased lateral membrane localization upon gestagen stimulation in the 3D culture system. The results of this study demonstrate that the 3D endometrial Ishikawa cell culture might be suited as an experimental model system to prove the effect of hormonal changes like those occurring during the window of implantation.
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Affiliation(s)
- V U Buck
- Institute of Molecular and Cellular Anatomy, Uniklinik RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany.
| | - M T Kohlen
- Institute of Molecular and Cellular Anatomy, Uniklinik RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
| | - A K Sternberg
- Institute of Molecular and Cellular Anatomy, Uniklinik RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
| | - B Rösing
- Clinic for Gynaecological Endocrinology and Reproductive Medicine, Uniklinik RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - J Neulen
- Clinic for Gynaecological Endocrinology and Reproductive Medicine, Uniklinik RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - R E Leube
- Institute of Molecular and Cellular Anatomy, Uniklinik RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
| | - I Classen-Linke
- Institute of Molecular and Cellular Anatomy, Uniklinik RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
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Expression of E-Cadherin in Pig-Tailed Monkey ( Macaca nemestrina) Endometrium after Controlled Ovarian Hyperstimulation. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8824614. [PMID: 33708995 PMCID: PMC7932768 DOI: 10.1155/2021/8824614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/28/2020] [Accepted: 01/28/2021] [Indexed: 11/17/2022]
Abstract
An increase of steroid hormones in controlled ovarian hyperstimulation (COH) procedures is reducing the success rate in assisted reproductive technology (ART), and this includes the pregnancy rate and/or implantation rate. Research has found that the decrease in the success rate occurred due to the decreased expression of the protein that is needed to prepare the endometrium so that the embryo could attach. The aim of the study was to analyse the changes in E-chaderin expression due to COH and its relations with increased level of steroid hormones as one of the proteins in the endometrium. There were 13 samples of stored biological tissue from Macaca nemestrina endometrial tissue; came from one group of natural cycles as the control group (n = 4) and three groups of stimulated cycles. The first stimulated cycle group was injected by a 30 IU dose of rFSH (n = 2). The second stimulated cycle group was injected by a 50 IU dose of rFSH (n = 4). The third stimulated cycle group was injected by a 70 IU dose of rFSH (n = 3). The expression of E-cadherin was measured by the immunohistochemistry (IHC) technique. Estradiol (E2) and progesterone (P4) levels were assessed using ELISA and have already been done. The IHC staining expression of E-cadherin was found in the cytoplasm of glandular epithelium. Immunostaining measurement used the H_SCORE. We found that the expression of E-cadherin within the group was not significantly different (p value: 0.178). Similarly, both the correlation between the estradiol level with E-cadherin and the correlation between the progesterone level with E-cadherin were not significantly different (p value: 0.872 and p value: 0.836). The conclusion is that the level of E-Cadherin expression in the endometrium that were taken in themiddle secretion phase not affected by the dose regimen that given. In addition, the level of expression is not influenced by the increase of serum E2 and P4 levels.
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