Expression of Markers of Endometrial Receptivity in Obese Infertile PCOS Women before and after the Weight Loss Program-A Preliminary Study

TLR signaling pathway and the effects of main immune cells and epigenetics factors on the diagnosis and treatment of infertility and sterility

Recurrent pregnancy loss (RPL), often known as spontaneous miscarriages occurring two or more times in a row, is a reproductive disease that affects certain couples. The cause of RPL is unknown in many cases, leading to difficulties in therapy and increased psychological suffering in couples. Toll-like receptors (TLR) have been identified as crucial regulators of inflammation in various human tissues. The occurrence of inflammation during parturition indicates that Toll-like receptor activity in tissues related to pregnancy may play a crucial role in the onset and continuation of normal function, as well as in various pregnancy complications like infection-related preterm. TLRs or their signaling molecules may serve as effective therapeutic targets for inhibiting premature activity. At the maternal-fetal interface, TLRs are found in both immune and non-immune cells, such as trophoblasts and decidual cells. TLR expression patterns are influenced by the phases of pregnancy. In this way, translational combinations like epigenetics, have indicated their impact on the TLRs.Importantly, abnormal DNA methylation patterns and histone alterations have an impressive performance in decreasing fertility by influencing gene expression and required molecular and cellular activities which are vital for a normal pregnancy and embryonic process. TLRs, play a central duty in the innate immune system and can regulate epigenetic elements by many different signaling pathways. The potential roles of TLRs in cells, epigenetics factors their ability to identify and react to infections, and their place in the innate immune system will all be covered in this narrative review essay.

Association between oocyte donors' or recipients' body mass index and clinical outcomes after first single blastocyst transfers-the uterus is the most affected

OBJECTIVE

To assess whether high body mass index (BMI) in either oocyte donors or recipients is associated with poorer outcomes after the first single blastocyst transfer.

DESIGN

Retrospective study including 1,394 first blastocyst single embryo transfers (SETs) conducted by 1,394 recipients during oocyte donation cycles with the gametes retrieved from 1,394 women (January 2019-July 2021). Four BMI clusters were defined for both donors and recipients (underweight: <18.5 kg; normal weight: 18.5-24.9 kg; overweight: 25-29.9 kg; and obese: ≥30 kg).

SETTING

Network of private IVF centers.

PATIENTS

A total of 1,394 recipients aged 42.4 ± 4.0 and with a BMI of 23.2 ± 3.8 kg/m2, and 1,394 donors aged 26.1 ± 4.2 and with a BMI of 21.9 ± 2.5 kg/m2.

INTERVENTION

All oocytes were vitrified at 2 egg banks and warmed at 8 in vitro fertilization clinics that were part of the same network. Intracytoplasmic sperm injection, blastocyst culture, and either fresh or vitrified-warmed SETs were conducted. Putative confounders were investigated, and the data were adjusted through regression analyses.

MAIN OUTCOME MEASURES

The primary outcome was the live birth rate (LBR) per SET according to donors' and/or recipients' BMI. The main secondary outcome was the miscarriage rate (<22 gestational weeks) per clinical pregnancy.

RESULTS

The LBR per blastocyst SET showed no significant association with donors' BMI. Regarding recipients' BMI, instead, the multivariate odds ratio was significant in obese vs. normal-weight recipients (0.58, 95% confidence interval, 0.37-0.91). The miscarriage rate per clinical pregnancy was also significantly associated with recipients' obesity, with a multivariate odds ratio of 2.31 (95% confidence interval, 1.18-4.51) vs. normal-weight patients. A generalized additive model method was used to represent the relationship between predicted LBR or miscarriage rates and donors' or recipients' BMI; it pictured a scenario where the former outcome moderately but continuously decreases with increasing recipients' BMI to then sharply decline in the BMI range of 25-35 kg/m2. The miscarriage rate, instead, increases almost linearly with respect to both donors' and recipients' increasing BMI.

CONCLUSION

Obesity mostly affects the uterus, especially because of higher miscarriage rates. Yet, poorer outcomes can be appreciated already with a BMI of 25 kg/m2 in both oocyte donors and recipients. Finer markers of nutritional homeostasis are therefore desirable; recipients should be counseled about poorer expected outcomes in cases of overweight and obesity; and oocyte banks should avoid assigning oocytes from overweight donors to overweight and obese recipients.

Obesity and female infertility

Infertility is a significant global health issue, with a negative impact on people's wellbeing and human rights. Despite the longstanding association between obesity and infertility, there remains uncertainty, about the precise mechanisms underpinning this association and best management strategies. In this article, we aimed to address these uncertainties by reviewing the recent literature, and focusing on studies which evaluated live birth rates. We found that just over half of the studies, investigating the relationship between preconception maternal weight and live birth rates found an inverse correlation. There was, however, insufficient evidence, that preconception maternal lifestyle or pharmacological interventions in obese women with infertility, resulted in improved live birth rates. The implications for clinical practice and future research are highlighted. For example, the need to consider some flexibility in applying strict preconception body mass index targets, limiting access to fertility treatment, and a need for large clinical trials of new pharmacological options and bariatric surgery.