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Vogt C, Malhotra NR. Fertility Preservation in Children and Adolescents: Where We Are and Where We Are Going. Curr Urol Rep 2024; 25:133-140. [PMID: 38727983 DOI: 10.1007/s11934-024-01204-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE OF REVIEW This review will describe current pediatric and adolescent fertility preservation methodologies and the ethical concerns surrounding these procedures, as well as highlight recent research that may pave the way for the development of new fertility preservation options. RECENT FINDINGS Research is ongoing to allow prepubertal patients, particularly those with testes, to be able to have biologic children in the future. Studies on sperm in vitro maturation highlight the importance of supporting the spermatogonial stem cell niche for the development of mature sperm. The live birth of a rhesus macaque from in vitro fertilization using prepubertal testicular tissue and in vivo matured sperm gives hope to future human births. For patients with ovaries, prior work has led to successful fertility but further research is underway to refine these techniques and optimize outcomes. Organoid scaffolds have shown promise when being used for in vitro oocyte maturation. For children and adolescents undergoing gonadotoxic treatment, such as chemotherapy, or hormonal treatment, such as gender-affirming hormone therapy, future fertility potential may be negatively impacted. It is recommended that fertility preservation (FP) be offered to these patients and families prior to undergoing treatment. Fertility preservation for postpubertal patients mimics that in adults. For prepubertal children, however, the options are limited and in some cases still experimental. It is essential that this work continues so that we may offer children and adolescents the right to an open future and preserve their fertility potential.
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Affiliation(s)
- Campbell Vogt
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Neha R Malhotra
- Icahn School of Medicine at Mount Sinai, New York, USA.
- Mount Sinai Kravis Children's Hospital, New York, USA.
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2
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Fiscus J, Fraison É, Renault L, Salle B, Panthu B, Labrune E. Metabolic signature of follicular fluid in infertility-related diseases: a narrative review. Reprod Biomed Online 2024; 48:103762. [PMID: 38537523 DOI: 10.1016/j.rbmo.2023.103762] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 06/11/2024]
Abstract
Metabolomics offers new methods to identify biomarkers for oocyte and embryo quality, and for a better understanding of the physiopathology of infertility. This review investigated the latest findings regarding metabolome-derived biomarkers in follicular fluid of women with the most common types of infertility, and the potential impact on reproductive medicine outcomes. PubMed was searched for publications on metabolomics and human follicular fluid, and key biomarkers, kinetics and relationships with infertility diseases were identified. A reduced concentration of glucose and increased concentrations of lactate and pyruvate were found in follicular fluid of patients with endometriosis and diminished ovarian reserve, and the opposite was found in patients with polycystic ovary syndrome. These signatures may lead to the hypothesis of changed metabolite concentrations in patients with endometriosis and diminished ovarian reserve, and a metabolic pathway alteration with decreased aerobic glycolysis in patients with polycystic ovary syndrome. However, the pattern found in patients with endometriosis and low responders may also be expected in follicular fluid of fertile women. Larger studies are needed to confirm the results. An international database may help to highlight follicular fluid biomarkers in order to improve the selection of cryopreserved oocytes, and to enrich culture medium to restore normal metabolism and improve reproductive treatment outcomes.
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Affiliation(s)
- Julie Fiscus
- Hospices Civils de Lyon, service de médecine de la reproduction et préservation de fertilité, Inserm U1208, SBRI, Bron, France; Université Claude Bernard Lyon 1, faculté de médecine Laennec, Lyon, France
| | - Éloïse Fraison
- Hospices Civils de Lyon, service de médecine de la reproduction et préservation de fertilité, Inserm U1208, SBRI, Bron, France; Université Claude Bernard Lyon 1, faculté de médecine Laennec, Lyon, France
| | - Lucie Renault
- Hospices Civils de Lyon, service de médecine de la reproduction et préservation de fertilité, Inserm U1208, SBRI, Bron, France; Université Claude Bernard Lyon 1, faculté de médecine Laennec, Lyon, France
| | - Bruno Salle
- Hospices Civils de Lyon, service de médecine de la reproduction et préservation de fertilité, Inserm U1208, SBRI, Bron, France; Université Claude Bernard Lyon 1, faculté de médecine Laennec, Lyon, France
| | - Baptiste Panthu
- CarMeN Laboratory, Université Claude Bernard Lyon 1, Pierre-Bénite, France.
| | - Elsa Labrune
- Hospices Civils de Lyon, service de médecine de la reproduction et préservation de fertilité, Inserm U1208, SBRI, Bron, France; Université Claude Bernard Lyon 1, faculté de médecine Laennec, Lyon, France.
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Pasquariello R, Bogliolo L, Di Filippo F, Leoni GG, Nieddu S, Podda A, Brevini TAL, Gandolfi F. Use of assisted reproductive technologies (ARTs) to shorten the generational interval in ruminants: current status and perspectives. Theriogenology 2024; 225:16-32. [PMID: 38788626 DOI: 10.1016/j.theriogenology.2024.05.026] [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: 03/05/2024] [Revised: 05/18/2024] [Accepted: 05/18/2024] [Indexed: 05/26/2024]
Abstract
The challenges posed by climate change and increasing world population are stimulating renewed efforts for improving the sustainability of animal production. To meet such challenges, the contribution of genomic selection approaches, in combination with assisted reproductive technologies (ARTs), to spreading and preserving animal genetics is essential. The largest increase in genetic gain can be achieved by shortening the generation interval. This review provides an overview of the current status and progress of advanced ARTs that could be applied to reduce the generation time in both female and male of domestic ruminants. In females, the use of juvenile in vitro embryo transfer (JIVET) enables to generate offspring after the transfer of in vitro produced embryos derived from oocytes of prepubertal genetically superior donors reducing the generational interval and acceleration genetic gain. The current challenge is increasing in vitro embryo production (IVEP) from prepubertal derived oocytes which is still low and variable. The two main factors limiting IVEP success are the intrinsic quality of prepubertal oocytes and the culture systems for in vitro maturation (IVM). In males, advancements in ARTs are providing new strategies to in vitro propagate spermatogonia and differentiate them into mature sperm or even to recapitulate the whole process of spermatogenesis from embryonic stem cells. Moreover, the successful use of immature cells, such as round spermatids, for intracytoplasmic injection (ROSI) and IVEP could allow to complete the entire process in few months. However, these approaches have been successfully applied to human and mouse whereas only a few studies have been published in ruminants and results are still controversial. This is also dependent on the efficiency of ROSI that is limited by the current isolation and selection protocols of round spermatids. In conclusion, the current efforts for improving these reproductive methodologies could lead toward a significant reduction of the generational interval in livestock animals that could have a considerable impact on agriculture sustainability.
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Affiliation(s)
- Rolando Pasquariello
- Department of Agricultural and Environmental Sciences, University of Milan, Milano, Italy
| | - Luisa Bogliolo
- Department of Veterinary Medicine, University of Sassari, Sassari, Italy
| | - Francesca Di Filippo
- Department of Agricultural and Environmental Sciences, University of Milan, Milano, Italy
| | | | - Stefano Nieddu
- Department of Veterinary Medicine, University of Sassari, Sassari, Italy
| | - Andrea Podda
- Department of Veterinary Medicine, University of Sassari, Sassari, Italy
| | - Tiziana A L Brevini
- Laboratory of Biomedical Embryology and Tissue Engineering, Department of Veterinary Medicine and Animal Science, University of Milan, Lodi, Italy
| | - Fulvio Gandolfi
- Department of Agricultural and Environmental Sciences, University of Milan, Milano, Italy.
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Boumerdassi Y, Labrosse J, Hammami F, Dahoun M, Bouyer J, O'Neill L, Sarandi S, Peigné M, Cedrin I, Grynberg M, Sifer C. Impact of oxygen tension during in vitro maturation: a sibling-oocyte prospective double-blinded study. Fertil Steril 2024; 121:615-621. [PMID: 38103883 DOI: 10.1016/j.fertnstert.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE To determine whether oxygen (O2) tension (20% vs. 5%) has an impact on oocyte maturation rates and morphology during in vitro maturation (IVM). DESIGN A prospective, observational, monocentric, sibling-oocyte study. SETTING University Hospital. PATIENTS A total of 143 patients who underwent IVM for fertility preservation purposes from November 2016 to April 2021 were analyzed. Patients were included when ≥2 cumulus-oocyte complexes (COCs) were retrieved. The cohort of COCs obtained for each patient was randomly split into two groups: group 20% O2 and group 5% O2. INTERVENTION Cumulus-oocyte complexes were incubated for 48 hours either under 5% O2 or 20% O2. After 24 and 48 hours of culture, every oocyte was assessed for maturity and morphology, to estimate oocyte quality. Morphology was evaluated considering six parameters (shape, size, ooplasm, perivitelline space, zona pellucida, and polar body characteristics), giving a total oocyte score ranging from -6 to +6. MAIN OUTCOME MEASURES Maturation rates and total oocyte scores were compared using paired-sample analysis between group 20% O2 and group 5% O2. RESULTS Patient median age was 31.4 [28.1-35.2] years-old. The mean serum antimüllerian hormone levels and antral follicle count were 3.2 ± 2.3 ng/mL and 27.2 ± 16.0 follicles, respectively. A mean of 10.7 COCs per cycle were retrieved, leading to 6.1 ± 2.4 metaphase II oocytes vitrified (total maturation rate = 57.3%; 991 metaphase II oocytes/1,728 COCs). A total of 864 COCs were included in each group. Oocyte maturation rates were not different between the two groups (group 20% O2: 56.82% vs. group 5% O2: 57.87%, respectively). Regarding oocyte morphology, the mean total oocyte score was significantly higher in group 5% O2 compared with group 20% O2 (3.44 ± 1.26 vs. 3.16 ± 1.32, P=.014). CONCLUSION As culture under low O2 tension (5% O2) improves oocyte morphology IVM, our results suggest that culture under hypoxia should be standardized. Additional studies are warranted to assess the impact of O2 tension on oocyte maturation and the benefit of IVM under low O2 tension for embryo culture after utilization of frozen material.
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Affiliation(s)
- Yasmine Boumerdassi
- Department of Reproductive Biology, Hôpital Jean Verdier, Bondy, France; Université Sorbonne Paris Nord, Villetaneuse, France
| | - Julie Labrosse
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Jean Verdier, Bondy, France
| | - Fatma Hammami
- Department of Reproductive Biology, Hôpital Jean Verdier, Bondy, France
| | - Mehdi Dahoun
- Department of Reproductive Biology, Hôpital Jean Verdier, Bondy, France
| | - Jean Bouyer
- Centre for Research in Epidemiology and Population Health, Université Paris Saclay, France
| | - Louis O'Neill
- Department of Reproductive Biology, Hôpital Jean Verdier, Bondy, France
| | - Solmaz Sarandi
- Department of Reproductive Biology, Hôpital Jean Verdier, Bondy, France
| | - Maeliss Peigné
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Jean Verdier, Bondy, France
| | - Isabelle Cedrin
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Jean Verdier, Bondy, France
| | - Michael Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Jean Verdier, Bondy, France; Department of Reproductive Medicine and Fertility Preservation, Hôpital Antoine Béclère, Clamart, France; Université Paris Saclay, Le Kremlin Bicêtre, France; Université Paris-Diderot, Paris, France
| | - Christophe Sifer
- Department of Reproductive Biology, Hôpital Jean Verdier, Bondy, France; Équipe RHuMA, UMR-BREED, UFR Simone Veil Santé, Montigny le Bretonneux, France.
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5
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Weaver AC, Kind KL, Kelly JM, Herde P, van Wettere WHJ. Effect of split weaning on follicle development and oocyte quality in multiparous sows. Anim Reprod Sci 2024; 262:107434. [PMID: 38368653 DOI: 10.1016/j.anireprosci.2024.107434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/11/2024] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
Increasing piglet weaning age while maintaining the reproductive efficiency of the breeding herd depends on being able to stimulate sows to ovulate during lactation without reducing subsequent pregnancy rates and litter sizes. Embryo survival is affected by the quality of the oocytes shed at ovulation, and oocyte quality is profoundly impacted by the follicular environment in which the oocyte matures. This study determined the effect of reducing suckled litter size from 11 to 7 piglets on day 18 of lactation on the ovarian follicular environment and oocyte developmental competence at day 21 of lactation. Thirty-nine, Large White X Landrace sows (parity 3.2 ± 0.2; mean ± SEM; range 2-6) had their litter size either maintained at 11 piglets (control); or reduced to seven piglets on day 18 of lactation (split wean (SW)). Sows were slaughtered on day 21 of lactation and ovaries were collected for analysis of follicular fluid composition and in vitro blastocyst development rates. There was no effect of split weaning on fertilisation rate and development to blastocyst stage; however, a greater proportion of blastocysts from control sows were classified as early blastocyst stage. Furthermore, follicular fluid concentrations of oestradiol were higher in SW sows. Together, these results indicate split weaning prior to mating in lactation alters the ovarian follicular environment and while blastocyst development rates were unaffected, embryos from control sows may be of poorer quality as indicated by a delay in development.
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Affiliation(s)
- Alice C Weaver
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy Campus, Roseworthy, SA 5371, Australia.
| | - Karen L Kind
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy Campus, Roseworthy, SA 5371, Australia; Robinson Research Institute, The University of Adelaide, SA 5005, Australia
| | - Jennifer M Kelly
- South Australian Research and Development Institute, Turretfield Research Centre, Rosedale, SA 5350 Australia
| | - Paul Herde
- South Australian Research and Development Institute, Pig and Poultry Production Institute, University of Adelaide, Roseworthy, SA 5371, Australia
| | - William He J van Wettere
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy Campus, Roseworthy, SA 5371, Australia
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Hanassab S, Abbara A, Yeung AC, Voliotis M, Tsaneva-Atanasova K, Kelsey TW, Trew GH, Nelson SM, Heinis T, Dhillo WS. The prospect of artificial intelligence to personalize assisted reproductive technology. NPJ Digit Med 2024; 7:55. [PMID: 38429464 PMCID: PMC10907618 DOI: 10.1038/s41746-024-01006-x] [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: 01/25/2023] [Accepted: 01/10/2024] [Indexed: 03/03/2024] Open
Abstract
Infertility affects 1-in-6 couples, with repeated intensive cycles of assisted reproductive technology (ART) required by many to achieve a desired live birth. In ART, typically, clinicians and laboratory staff consider patient characteristics, previous treatment responses, and ongoing monitoring to determine treatment decisions. However, the reproducibility, weighting, and interpretation of these characteristics are contentious, and highly operator-dependent, resulting in considerable reliance on clinical experience. Artificial intelligence (AI) is ideally suited to handle, process, and analyze large, dynamic, temporal datasets with multiple intermediary outcomes that are generated during an ART cycle. Here, we review how AI has demonstrated potential for optimization and personalization of key steps in a reproducible manner, including: drug selection and dosing, cycle monitoring, induction of oocyte maturation, and selection of the most competent gametes and embryos, to improve the overall efficacy and safety of ART.
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Affiliation(s)
- Simon Hanassab
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK
- Department of Computing, Imperial College London, London, UK
- UKRI Centre for Doctoral Training in AI for Healthcare, Imperial College London, London, UK
| | - Ali Abbara
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Arthur C Yeung
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Margaritis Voliotis
- Department of Mathematics and Statistics, University of Exeter, Exeter, UK
- Living Systems Institute, University of Exeter, Exeter, UK
- EPSRC Hub for Quantitative Modelling in Healthcare, University of Exeter, Exeter, UK
| | - Krasimira Tsaneva-Atanasova
- Department of Mathematics and Statistics, University of Exeter, Exeter, UK
- Living Systems Institute, University of Exeter, Exeter, UK
- EPSRC Hub for Quantitative Modelling in Healthcare, University of Exeter, Exeter, UK
| | - Tom W Kelsey
- School of Computer Science, University of St Andrews, St Andrews, UK
| | - Geoffrey H Trew
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK
- The Fertility Partnership, Oxford, UK
| | - Scott M Nelson
- The Fertility Partnership, Oxford, UK
- School of Medicine, University of Glasgow, Glasgow, UK
- Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Thomas Heinis
- Department of Computing, Imperial College London, London, UK
| | - Waljit S Dhillo
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK.
- Imperial College Healthcare NHS Trust, London, UK.
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7
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Dai M, Hong L, Yin T, Liu S. Disturbed Follicular Microenvironment in Polycystic Ovary Syndrome: Relationship to Oocyte Quality and Infertility. Endocrinology 2024; 165:bqae023. [PMID: 38375912 DOI: 10.1210/endocr/bqae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 02/21/2024]
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with infertility and poor reproductive outcomes. The follicular fluid (FF) microenvironment plays a crucial role in oocyte development. This review summarizes evidence elucidating the alterations in FF composition in PCOS. Various studies demonstrated a pronounced proinflammatory milieu in PCOS FF, characterized by increased levels of cytokines, including but not limited to interleukin-6 (IL-6), tumor necrosis factor α, C-reactive protein, and IL-1β, concomitant with a reduction in anti-inflammatory IL-10. T lymphocytes and antigen-presenting cells are dysregulated in PCOS FF. PCOS FF exhibit heightened reactive oxygen species production and the accumulation of lipid peroxidation byproducts, and impaired antioxidant defenses. Multiple microRNAs are dysregulated in PCOS FF, disrupting signaling critical to granulosa cell function. Proteomic analysis reveals changes in pathways related to immune responses, metabolic perturbations, angiogenesis, and hormone regulation. Metabolomics identify disturbances in glucose metabolism, amino acids, lipid profiles, and steroid levels with PCOS FF. Collectively, these pathological alterations may adversely affect oocyte quality, embryo development, and fertility outcomes. Further research on larger cohorts is needed to validate these findings and to forge the development of prognostic biomarkers of oocyte developmental competence within FF. Characterizing the follicular environment in PCOS is key to elucidating the mechanisms underlying subfertility in this challenging disorder.
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Affiliation(s)
- Mengyang Dai
- Reproductive Medical Center, Renmin Hospital of Wuhan University and Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan 430061, China
| | - Ling Hong
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Shenzhen Zhongshan Obstetrics & Gynecology Hospital (formerly Shenzhen Zhongshan Urology Hospital), Shenzhen 518000, China
- Guangdong Engineering Technology Research Center of Reproductive Immunology for Peri-implantation, Shenzhen 518000, China
| | - Tailang Yin
- Reproductive Medical Center, Renmin Hospital of Wuhan University and Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan 430061, China
| | - Su Liu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Shenzhen Zhongshan Obstetrics & Gynecology Hospital (formerly Shenzhen Zhongshan Urology Hospital), Shenzhen 518000, China
- Guangdong Engineering Technology Research Center of Reproductive Immunology for Peri-implantation, Shenzhen 518000, China
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8
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Sananmuang T, Puthier D, Nguyen C, Chokeshaiusaha K. Differential transcript usage across mammalian oocytes at the germinal vesicle and metaphase II stages. Theriogenology 2024; 215:1-9. [PMID: 37995439 DOI: 10.1016/j.theriogenology.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
Ongoing progress in mRNA-Sequencing technologies has significantly contributed to the refinement of assisted reproductive technologies. However, the prior investigations have predominantly concentrated on alterations in overall gene expression levels, thereby leaving a considerable gap in our understanding of the influence of transcript isoform expression on fundamental cellular mechanisms of oocytes. Given the efficacy of differential transcript usage (DTU) analysis to address such knowledge, we conducted comprehensive DTU analysis utilizing mRNA-Seq datasets of germinal vesicle (GV) and metaphase II (MII) oocytes across six mammalian species from the SRA database, including cow, donkey, horse, human, mouse, and pig. To further illuminate the roles of these genes, we also conducted a rigorous Gene Ontology (GO) term enrichment analysis. While the DTU analysis of each species exhibited several genes with alterations in their transcript isoform usage, referred to as DTU genes, this study focused on only ten cross-species DTU genes sharing among a minimum of five distinct species (FDR≤0.05). These cross-species DTU genes were as follows: ABCF1, CDC6, CFAP36, CNOT10, DNM3, IWS1, NBN, NDEL1, RAD50 and ZCCHC17. GO term enrichment analysis unveiled the alignment of these cross-species DTU gene functions with RNA and cell-cycle control mechanisms across diverse mammalian species, thereby suggesting their vital roles during oocyte maturation. Further exploration of the transcript isoforms of these genes hence bore the potential to uncover novel transcript isoform markers for future reproductive technologies in both human and animal contexts.
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Affiliation(s)
- Thanida Sananmuang
- Rajamangala University of Technology Tawan-OK, Faculty of Veterinary Medicine, Chonburi, Thailand
| | - Denis Puthier
- Aix-Marseille Université, INSERM UMR 1090, TAGC, Marseille, France
| | - Catherine Nguyen
- Aix-Marseille Université, INSERM UMR 1090, TAGC, Marseille, France
| | - Kaj Chokeshaiusaha
- Rajamangala University of Technology Tawan-OK, Faculty of Veterinary Medicine, Chonburi, Thailand.
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Zeng X, Du L, Yang H, Wang F. Efficacy and safety of recombinant human granulocyte colony-stimulating factor in patients with poor ovarian response: protocol for a multicentre, randomised, controlled trial. BMJ Open 2023; 13:e074135. [PMID: 38159964 PMCID: PMC10759079 DOI: 10.1136/bmjopen-2023-074135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/25/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Approximately 17.5% of couples of reproductive age have experienced infertility. Women with a poor ovarian response (POR) must undergo in vitro fertilisation (IVF) and embryo transfer to achieve pregnancy. However, studies have reported a poor response to gonadotropin stimulation in women undergoing IVF-ET. Results from animal experiments suggest that granulocyte colony-stimulating factor (G-CSF) has a curative effect by protecting ovarian function, reducing follicle loss and delaying premature ovarian failure in rats caused by chemotherapy. Clinical studies on the therapeutic effect of G-CSF are deficient; therefore, this study will investigate its ability to improve ovum quality and maturity among women with POR undergoing IVF/intracytoplasmic sperm injection (ICSI). METHODS AND ANALYSIS This clinical, multicentre, triple-blind, placebo-controlled trial will employ balanced randomisation (1:1). The planned sample size is 312 participants (156 subjects in each group). A total of 312 patients with infertility undergoing IVF/ICSI will be recruited from four public hospitals in China. The participants will be randomly divided into an experimental group (G-CSF) and a placebo group (control). All patients will be treated by using the progestin-primed ovarian stimulation superovulation protocol. The primary outcome will be D3 embryo quality. The number of ova obtained, MII ova and transferable embryos will be inclusive in the secondary outcome. ETHICS AND DISSEMINATION To our knowledge, this is the first clinical trial to investigate the effect of G-CSF treatment timing and stimulation protocol in patients with POR in China. This study will provide new information about G-CSF efficacy among patients with POR undergoing IVF/ICSI and can help improve ovum quality and maturity. Clinical trials on this subject are deficient in China; therefore, a well-designed randomised trial is needed to determine the ability of G-CSF to improve ovum quality and maturity to facilitate conception among women with POR treated with IVF/ICSI. TRIAL REGISTRATION NUMBER ChiCTR2200062412.
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Affiliation(s)
- Xianghui Zeng
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou, China
- Reproductive Center, Qinghai Province People's Hospital, Xining, China
| | - Lirong Du
- Hebei Key Laboratory of Reproductive Medicine, Hebei Reproductive Health Hospital, Shijiazhuang, China
| | | | - Fang Wang
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou, China
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