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Gurunath S. Premature Progesterone Elevation in in vitro Fertilisation Cycles - Current Perspectives. J Hum Reprod Sci 2022; 15:325-336. [PMID: 37033132 PMCID: PMC10077738 DOI: 10.4103/jhrs.jhrs_162_22] [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: 11/22/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 04/11/2023] Open
Abstract
The impact of premature elevation of progesterone (PPE) on the day of the trigger on pregnancy outcome in in vitro fertilisation (IVF) cycles has been a matter of contention and debate for decades. Research over the last 30 years has indicated that PPE >1.5 ng/ml is associated with declining live birth rates following fresh embryo transfer. Freeze-only approach has become a universal solution to overcome the issue of PPE. However, the topic is still mired with controversy. Few studies have not shown a negative impact on pregnancy rates. The impact of PPE on embryological parameters such as oocyte and embryo quality and ploidy is still very controversial. An important contentious issue is the choice of the threshold P value above which it is considered abnormal and a freeze-all strategy would be cost-effective. Currently, though a cutoff of >1.5 ng/ml is widely used, practices are not uniform and varying thresholds from 0.4 to 3 ng/ml are utilised. This review addresses the current understanding of PPE in IVF and the above controversies. The incidence, aetiology and source of progesterone rise, impact on endometrial receptivity, oocyte and embryo quality, impact on live birth and cumulative live birth and impact on frozen embryo transfer and donor oocyte cycles are discussed. Current controversies regarding the optimal threshold, assay performance and future directions are addressed.
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Affiliation(s)
- Sumana Gurunath
- Department of Infertility and Reproductive Medicine, Cloudnine Hospital, 47, 17 Cross, 11 Main, Malleshwaram, Bengaluru, Karnataka, India
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2
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Fernandez RGO, Barbosa CP, Christofolini DM, de Alcantara Sousa LV, de Oliveira R, Bianco B. Impact of blood levels of progesterone on the day of ovulation onset on clinical, laboratory and reproductive parameters of young patients undergoing assisted reproduction: a cross-sectional study. EINSTEIN-SAO PAULO 2022; 20:eAO6896. [PMID: 35649054 PMCID: PMC9126603 DOI: 10.31744/einstein_journal/2022ao6896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: To assess whether there is an association between the level of progesterone on the day of administration of human chorionic gonadotropin and clinical and laboratory characteristics, in addition to the results of in vitro fertilization of patients with a good prognosis. Methods: A cross-sectional study comprising 103 women who underwent intracytoplasmic sperm injection treatment, between November 2009 and May 2015, aged ≤35 years, with no comorbidities, with fresh embryo transfer. Data were collected from patient medical records. Results: There was a weak positive correlation between the level of progesterone on the day of human chorionic gonadotropin and the number of follicles larger than 14mm (ß=0.02, p=0.001), retrieved oocytes (ß=0.01, p=0.01) and oocytes in metaphase II (MII) (ß=0.02, p=0.02); that is, the increase in progesterone level has a slight association with increased values of these variables. Body mass index was inversely correlated with progesterone level on the day of human chorionic gonadotropin (ß=-0.01, p=0.02). No association was found between the level of progesterone on the day of human chorionic gonadotropin and the protocols used for controlled ovarian stimulation, quality of transferred embryos and the pregnancy rate. Conclusion: There is an association between the value of progesterone on the day of human chorionic gonadotropin administration with body mass index, number of follicles larger than 14mm, number of retrieved oocytes and oocytes in metaphase II. Unlike embryo quality and pregnancy rate, which do not have a statistically significant relation with this value in the population studied.
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3
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Lim PT, Chan JKY, Tharmalingam MD, Nadarajah S, Viardot-Foucault V. A Case of Pre-Existing Pregnancy During an In-Vitro Fertilization Cycle. J Med Cases 2021; 12:369-372. [PMID: 34527108 PMCID: PMC8425812 DOI: 10.14740/jmc3752] [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: 07/22/2021] [Accepted: 08/13/2021] [Indexed: 11/11/2022] Open
Abstract
Serum progesterone levels performed prior to oocyte pick-up is commonly used to guide embryo transfer in in-vitro fertilization (IVF) cycles, as elevated levels can negatively influence pregnancy outcomes. However, levels associated with normal pregnancies should trigger clinicians to consider alternative causes such as a pre-existing pregnancy. We report a case of a 37-year-old patient who underwent controlled ovarian hyperstimulation in a gonadotrophin-releasing hormone antagonist cycle while having an undetected early pregnancy. No oocytes were retrieved at oocyte retrieval despite adequate follicular responses. Her serum progesterone level on the day of her trigger injection was 57.8 nmol/L. She was found to have a pregnancy of unknown location, detected 3 weeks after her oocyte retrieval and was subsequently treated with systemic methotrexate.
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Affiliation(s)
- Poh Ting Lim
- Division of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore
| | | | - Sadhana Nadarajah
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore
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4
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Kazemi M, Jajarmi V, Nazarian H, Ghaffari Novin M, Salehpour S, Piryaei A, Heidari Khoei H, Choobineh H, Abdollahifar MA, Haji Molla Hoseini M, Heidari MH. Culture strategy as a modulator of target assessments: Functionality of suspension versus hanging drop-derived choriocarcinoma spheroids as in vitro model of embryo implantation. J Cell Biochem 2021; 122:1192-1206. [PMID: 33900644 DOI: 10.1002/jcb.29940] [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: 09/10/2019] [Revised: 01/11/2021] [Accepted: 04/05/2021] [Indexed: 11/06/2022]
Abstract
The choriocarcinoma spheroid model has been amply applied to study the underlying molecular mechanism of implantation. Reproducibility and functionality of spheroid tumor models were addressed precisely. To mimic embryo-endometrium crosstalk, no functional characteristics of spheroids have been provided based on culture strategies. In this study, choriocarcinoma spheroids were provided as suspension culture (SC) or hanging drop culture (HDC). Primary assessments were performed based on morphology, cellular density, and hormonal secretion. Spheroid-endometrial cross talk was assessed as coculture procedures. Further, alkaline phosphatase (ALP) activity and expression of genes involved in attachment, invasion, and inducing migration were quantified. We found HDC spheroids provided a homogenous-shaped aggregate with a high grade of viability, cellular integration, hormonal secretion, and the dominant role of WNTs expression in their microarchitecture. SC spheroids showed a higher level of ALP activity and the expression of integrated genes in modulating attachment, invasion, and migration abilities. Spheroid confrontation assays clearly clarified the superiority of SC spheroids to crosstalk with epithelial and stromal cells of endometrium in addition to motivating an ideal endometrial response. Conclusively, culture strategies by affecting various molecular signaling pathways should be chosen precisely according to specific target assessments. Specifically, SC assumed as an ideal model in spheroid-endometrial cross talk.
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Affiliation(s)
- Mahsa Kazemi
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahid Jajarmi
- Cellular and Molecular Biology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Nazarian
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marefat Ghaffari Novin
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saghar Salehpour
- Department of Obstetrics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Piryaei
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences
| | - Heidar Heidari Khoei
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Choobineh
- School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Abdollahifar
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Haji Molla Hoseini
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hasan Heidari
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Polyzos NP, Anckaert E, Drakopoulos P, Tournaye H, Schiettecatte J, Donner H, Bobba G, Miles G, Verhagen-Kamerbeek WDJ, Bosch E. EStradiol and PRogesterone in In vitro ferTilization (ESPRIT): a multicenter study evaluating third- versus second-generation estradiol and progesterone immunoassays. J Endocrinol Invest 2020; 43:1239-1248. [PMID: 32170594 PMCID: PMC7431432 DOI: 10.1007/s40618-020-01211-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/02/2020] [Indexed: 11/02/2022]
Abstract
PURPOSE To assess estradiol (E2) and progesterone levels during ovarian stimulation determined by third-generation (Gen III) and second-generation (Gen II) Elecsys® immunoassays. METHODS E2 and progesterone concentrations were measured using Elecsys® Gen III and Gen II immunoassays, and progesterone concentrations on the day of ovulation triggering were determined by LC-MS/MS. This was a retrospective, non-interventional study conducted at European tertiary referral infertility clinics in women aged 18-45 years, with a body mass index 18-35 kg/m2, regular menses, and both ovaries. RESULTS Serum samples were obtained from 230 women classified by oocyte retrieval as poor (33.0%; 0-3 oocytes), normal (40.9%; 4-15 oocytes), or high (26.1%; > 15 oocytes) responders. E2 and progesterone levels increased during ovarian stimulation, with greatest increases observed in high responders. Elecsys® Gen III and Gen II assay results were highly correlated for E2 (Pearson's r = 0.99) and progesterone (r = 0.89); Gen III results were lower than Gen II for both E2 and progesterone. On the day of triggering, Gen III E2 and progesterone levels showed a difference of - 15.0% and - 27.9%, respectively. Progesterone levels (on day of triggering) measured by LC-MS/MS correlated better with Gen III (0.98) than Gen II (0.90). Mean relative differences for Gen III and Gen II assays versus LC-MS/MS were 14.6% and 62.8%, respectively. CONCLUSION E2 and progesterone levels determined with Elecsys® Gen II and III assays were highly correlated; results were lower for Gen III versus Gen II. Differences observed for progesterone on the day of triggering may be clinically relevant.
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Affiliation(s)
- N P Polyzos
- Department of Reproductive Medicine, Dexeus University Hospital, Gran Via Carles, 11171-75, 08028, Barcelona, Spain.
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
- Department of Clinical Medicine, Faculty of Health, Aarhus University Incuba/Skejby, Building 2, Palle Juul-Jensens Boulevard 82, Aarhus N, 8200, Aarhus, Denmark.
| | - E Anckaert
- Laboratory of Hormonology and Tumour Markers, Universitair Ziekenhuis Brussel, Free University of Brussels, Brussels, Belgium
| | - P Drakopoulos
- Centre for Reproductive Medicine, University Hospital (UZB), Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - H Tournaye
- Centre for Reproductive Medicine, University Hospital (UZB), Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - J Schiettecatte
- Laboratory of Hormonology and Tumour Markers, Universitair Ziekenhuis Brussel, Free University of Brussels, Brussels, Belgium
| | - H Donner
- Medical and Scientific Affairs, Roche Diagnostics GmbH, Nonnenwald 2, 82377, Penzberg, Germany
| | - G Bobba
- Medical and Scientific Affairs, Roche Diagnostics International Ltd, Forrenstrasse 2, 6343, Rotkreuz, Switzerland
| | - G Miles
- Biostatistics and Data Management, Roche Diagnostics Operations Inc., 9115 Hague Road, Building R, Indianapolis, IN, 46256, USA
| | - W D J Verhagen-Kamerbeek
- Medical and Scientific Affairs, Roche Diagnostics International Ltd, Forrenstrasse 2, 6343, Rotkreuz, Switzerland
| | - E Bosch
- Human Reproduction Unit, IVI-RMA, Plaza de la Policia Local 3, 46015, Valencia, Spain
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Sahar N, Mujihartini N, Pudjianto DA, Pradhita AD, Thuffi R, Kusmardi K. Increased Progesterone on the Day of Administration of hCG in Controlled Ovarian Hyperstimulation Affects the Expression of HOXA10 in Primates' Endometrial Receptivity. Biomedicines 2019; 7:biomedicines7040083. [PMID: 31640230 PMCID: PMC6966495 DOI: 10.3390/biomedicines7040083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/12/2019] [Accepted: 10/15/2019] [Indexed: 11/21/2022] Open
Abstract
The increase in progesterone (P4) levels on the day of human chorionic gonadotropin (hCG) administration have a negative effect on endometrial receptivity. There are few reports regarding the expression of homeobox A10 (HOXA10) as one of many biomolecular factors of endometrial receptivity. To evaluate the effect of increased P4 concentration on the day of hCG administration on HOXA10, a total of 16 Macaca nemestrina were divided into three dose groups of recombinant-follicle stimulating hormone (rFSH) (30IU, 50IU, and 70IU) and one control group. Injection of rFSH combined with gonadotropin release hormone (GnRH) at 160 ug/day was given subcutaneously using a long protocol technique. Blood samples for estradiol (E2) and (P4) concentration measurements were taken on the day of injecting hCG in the final follicular phase, while the collection of endometrial tissue for HOXA10 measurement was carried out 8 to 10 days after hCG administration. E2 and P4 were measured by ELISA, whereas HOXA10 expression was measured with immunohistochemical (IHC) techniques. The concentration of E2 and P4 was found to be higher in dose groups compared with the natural group, but no significant differences were found within the group. For the Hscore for HOXA10 expression, no significant differences within dose groups were found. In addition, no significant differences for the Hscore for HOXA10 were found when compared to E2 groups. Significantly, the Hscore of HOXA10 was found to be >1 ng/mL in the P4 group compared with the Hscore HOXA10 in the P4 natural group (p = 0.022). The high concentration of P4 caused by ovarian hyperstimulation in the follicular phase stimulates the expression of HOXA10 in the secretion phase.
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Affiliation(s)
- Nurhuda Sahar
- Depatment of Medical Biology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia.
| | - Ninik Mujihartini
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia.
| | - Dwi Ari Pudjianto
- Depatment of Medical Biology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia.
| | - Adhea Debby Pradhita
- Biomedical Science Master Program, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia.
| | - Rosalina Thuffi
- Biomedical Science Master Program, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia.
| | - Kusmardi Kusmardi
- Department of Pathology Anatomy, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia.
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Long J, Yang CS, He JL, Liu XQ, Ding YB, Chen XM, Tong C, Peng C, Wang YX, Gao RF. FOXO3a is essential for murine endometrial decidualization through cell apoptosis during early pregnancy. J Cell Physiol 2018; 234:4154-4166. [PMID: 30132880 DOI: 10.1002/jcp.27167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/17/2018] [Indexed: 12/19/2022]
Abstract
Embryo implantation is essential for normal pregnancy, and the process of decidualization is critical for embryo implantation. However, the mechanism of decidualization during early pregnancy is still unknown. Forkhead box O3a (FOXO3a) is the most important functional transcription factor of the forkhead box family and is a highly conserved transcription factor of apoptosis-related genes. In the mouse uterus, FOXO3a was found to be expressed regularly from Days 1-7 of early pregnancy. Upon further exploration, it was found that FOXO3a was expressed at significantly higher levels at the implantation site than at the interimplantation site on Days 5-7 of pregnancy. Under artificial decidualization, FOXO3a was highly expressed in the first and second decidual zones. After decidualization, the expression of FOXO3a was significantly increased both in vivo and vitro. In primary stromal cells, apoptosis was reduced by decreased expression of FOXO3a after inducing decidualization. Moreover, when FOXO3a-small interfering RNA was transfected into the uteri of mice, the expression of decidualization- and apoptosis-related factors was impaired. Thus, FOXO3a might play an important role in decidualization during early pregnancy, and cell apoptosis might be one of pathways for FOXO3a-regulated decidualization.
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Affiliation(s)
- Jing Long
- Laboratory of Reproductive Biology, School of Public Health and Management, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, China
| | - Cheng-Shun Yang
- Laboratory of Reproductive Biology, School of Public Health and Management, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, China
| | - Jun-Lin He
- Laboratory of Reproductive Biology, School of Public Health and Management, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, China
| | - Xue-Qing Liu
- Laboratory of Reproductive Biology, School of Public Health and Management, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, China
| | - Yu-Bin Ding
- Laboratory of Reproductive Biology, School of Public Health and Management, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, China
| | - Xue-Mei Chen
- Laboratory of Reproductive Biology, School of Public Health and Management, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, China
| | - Chao Tong
- Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, China.,Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chuan Peng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Laboratory of Maternal and Fetal Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying-Xiong Wang
- Laboratory of Reproductive Biology, School of Public Health and Management, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, China
| | - Ru-Fei Gao
- Laboratory of Reproductive Biology, School of Public Health and Management, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development, Chongqing Medical University, Chongqing, China
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