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Kushniruk N, Stastna A, Fait T, Lenertova T. Feasible Influence of G-CSF on Clinical Pregnancy Outcome in Oocyte Donation Cycles for Patients with Recurrent Implantation Failure. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:966. [PMID: 38929583 PMCID: PMC11205449 DOI: 10.3390/medicina60060966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/04/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: The aim of our single-center cohort study was the determination of the influence of the intrauterine lavage of granulocyte colony-stimulating growth factor (G-CSF) on clinical pregnancy rate in patients with a history of implantation failure older than 40 years. Materials and Methods: The study was conducted in Ferticare Prague SE between May 2018 and June 2020. Overall, 115 patients were distributed into two arms, with 48 subjects in the experimental and 67 in the control arm. All women have had a previous history of unsuccessful history of infertility treatment with their own genetic material and at least one ineffective cycle with the donated oocytes. The experimental arm underwent the intrauterine lavage of 0.5 mL of pure G-CSF from 120 to 48 h prior to embryo transfer. Results: The clinical pregnancy rate was 63.3% in the experimental arm and 47.8% in the control arm (p = 0.097 for Pearsonߣs χ2, and p = 0.133 for Fisher's exact test). However, the mean endometrial thickness on the day of embryo transfer did not appear to be statistically different (p = 0.139). Only the difference in endometrium thickness growth was statistically significant (p = 0.023). The increase in pregnancy rate is still encouraging for the future, even if it is not significant. Conclusion: Our study suggests the trend of increased pregnancy rate after the intrauterine G-CSF lavage in the interval of 120-48 h prior to embryo transfer.
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Affiliation(s)
- Nataliya Kushniruk
- 1st Faculty of Medicine, Charles University Prague, 120 00 Prague, Czech Republic;
| | - Anna Stastna
- Department of Demography and Geodemography, Faculty of Science, Charles University Prague, 120 00 Prague, Czech Republic
| | - Tomas Fait
- Department of Obstetrics and Gynecology, 2nd Faculty of Medicine, Charles University Prague, 150 00 Prague, Czech Republic
- Department of Health Studies, Polytechnic College Jihlava, 586 01 Jihlava, Czech Republic
| | - Tereza Lenertova
- Department of Obstetrics and Gynecology, 2nd Faculty of Medicine, Charles University Prague, 150 00 Prague, Czech Republic
- FertiCarePrague, SE, 150 00 Prague, Czech Republic
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Xie Q, Quan X, Lan Y, Yang X. Uterine infusion strategies for infertile patients with recurrent implantation failure: a systematic review and network meta-analysis. Reprod Biol Endocrinol 2024; 22:44. [PMID: 38627790 PMCID: PMC11020641 DOI: 10.1186/s12958-024-01221-x] [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: 01/30/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Intra-uterine infusion treatments were reported to be beneficial to embryo implantation and pregnancy outcomes, and considered as potential therapies for infertile patients with recurrent implantation failure (RIF). Nevertheless, their efficiencies were controversial and there lack of consensus on which intrauterine treatment is the most effective. METHODS All prospective trials (in Chinese or English) were searched in Databases PubMed, Cochrane, Web of Science, and CNKI from July 2013 to July 2023. We included studies that investigated various uterine infusions, including chorionic gonadotropin, granulocyte colony-stimulating factor, monocytes, platelet-rich plasma, etc. during IVF treatment and reported subsequent pregnancy outcomes. RESULTS We finally included 56 researches, including 40 randomized controlled trials, 14 non-randomized controlled trials, and 3 prospective cohort studies. This study included a total of 11 uterine perfusion methods: Placebo, Human Chorionic Gonadotropin (HCG), Granulocyte Colony-Stimulating Factor (G-CSF), platelet-rich plasma (PRP), Peripheral Blood Mononuclear Cell (PBMC), Growth hormone (GH), dexamethasone (DEX), Embryo culture supernatant (ESC), PRP combined with G-CSF (PRP + G-CSF), RPR combined with subcutaneous injection of G-CSF (RPR + G-CSFsc), G-CSF combined with subcutaneous injection of AXaIU (G-CSF + AXaIUsc). Intrauterine infusion of HCG, PBMC, G-CSF, and PRP significantly improves pregnancy outcomes in patients with repeated implantation failure compared with blank controls or placebo, and PRP improved the clinical pregnancy and live birth most. GH and ESC infusion might improve the pregnancy outcomes, but uterine infusion of DEX was shown with high miscarriage. The combination therapy did not show a significant advantage over the mono-therapy. CONCLUSIONS Intrauterine infusion of HCG, PBMC, G-CSF, and PRP are promising strategies for improving pregnancy outcomes for infertile patients with recurrent implantation failure. Among these treatments, PRP may be the best. More researches are required to explore the effect of drug combinations and less commonly used drugs as well. TRIAL REGISTRATION Our study was registered in PROSPERO and the ID was CRD42023467188.
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Affiliation(s)
- Qin Xie
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, 441021, P. R. China
| | - Xiaozhen Quan
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, 441021, P. R. China
| | - Yanli Lan
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, 441021, P. R. China
| | - Xuezhou Yang
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, 441021, P. R. China.
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Yang Y, Ru H, Zhang S, Wu C, Dong J, Wang X, Qie Y, Zhang H, Zhang P, Ma J, Du L. The Effect of Granulocyte Colony-Stimulating Factor on Endometrial Receptivity of Implantation Failure Mouse. Reprod Sci 2024:10.1007/s43032-024-01527-6. [PMID: 38600416 DOI: 10.1007/s43032-024-01527-6] [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: 09/11/2023] [Accepted: 03/19/2024] [Indexed: 04/12/2024]
Abstract
The purpose of this study was to investigate the effect of G-CSF on the endometrial receptivity of implantation failure mice. Sixty female mice were treated mifepristone to establish an implant failure model. The treatment groups received different doses of G-CSF. Endometrial tissue and serum were collected on day 5 after mating. The abundance of pinopodes on the endometrium was observed by scanning electron microscopy. The expressions of LPAR3, COX2, and HOXA10 were detected by RT-qPCR and Western blotting. Serum levels of E2, P, VEGF, LIF, TNF-α and IL-10 were measured by ELISA. The expressions of VEGF, CD34, CD57, TNF-α, and IL-10 were assessed by immunohistochemistry. Immunofluorescence analysis was performed to determine the number of CD57, Treg, and Th17 cells. G-CSF increased implantation and pregnancy rates of mifepristone-induced implantation failure mice, with the most significant effect seen at the intermediate dose. G-CSF increased the serum levels of E2 and P, the abundance of endometrial pinopodes, and the level of LIF in the endometrium. It also promoted the expression of VEGF, HOXA10, LPAR3, and COX2. Moreover, G-CSF reduced the level of CD57 cells and the ratio of Th17/Treg cells in endometrium. G-CSF reduced the inflammatory factor TNF-α, but IL-10 did not change significantly. G-CSF can enhance embryo implantation rate and pregnancy rate and improve endometrial receptivity by attenuating degeneration of pinopodes, upregulating estrogen and progesterone, facilitating angiogenesis, maintaining immune cell homeostasis, and reducing the production of inflammatory cytokines in implantation failure mouse.
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Affiliation(s)
- Yang Yang
- Hebei Key Laboratory of Reproductive Medicine, Hebei Reproductive Health Hospital, Shijiazhuang, 050071, China
| | - Huibo Ru
- Hebei Key Laboratory of Reproductive Medicine, Hebei Reproductive Health Hospital, Shijiazhuang, 050071, China
| | - Suzhi Zhang
- Hebei Key Laboratory of Reproductive Medicine, Hebei Reproductive Health Hospital, Shijiazhuang, 050071, China
| | - Chun Wu
- Hebei Key Laboratory of Reproductive Medicine, Hebei Reproductive Health Hospital, Shijiazhuang, 050071, China
| | - Jiuhua Dong
- Hebei Key Laboratory of Reproductive Medicine, Hebei Reproductive Health Hospital, Shijiazhuang, 050071, China
| | - Xiu Wang
- Hebei Key Laboratory of Reproductive Medicine, Hebei Reproductive Health Hospital, Shijiazhuang, 050071, China
| | - Yaxi Qie
- Hebei Key Laboratory of Reproductive Medicine, Hebei Reproductive Health Hospital, Shijiazhuang, 050071, China
| | - Hongxia Zhang
- NCPC Genetech Biotechnology Co., Ltd., Shijiazhuang, 050071, China
| | - Peng Zhang
- NCPC Genetech Biotechnology Co., Ltd., Shijiazhuang, 050071, China
| | - Jing Ma
- Hebei Key Laboratory of Reproductive Medicine, Hebei Reproductive Health Hospital, Shijiazhuang, 050071, China
| | - Lirong Du
- Hebei Key Laboratory of Reproductive Medicine, Hebei Reproductive Health Hospital, Shijiazhuang, 050071, China.
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Dakre SM, More A, Dutta S, Ulhe SM, Choudhary N. Combination Therapy With Platelet-Rich Plasma (PRP) and Granulocyte Colony-Stimulating Factor (G-CSF) for Thin Endometrium: A Case Report. Cureus 2024; 16:e54378. [PMID: 38505459 PMCID: PMC10948380 DOI: 10.7759/cureus.54378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/17/2024] [Indexed: 03/21/2024] Open
Abstract
This case study highlights the challenges faced by a couple with a history of two failed in-vitro fertilization (IVF) attempts, including miscarriage and ectopic pregnancy. After treating the female partner for pelvic inflammatory disease (PID) with ceftriaxone and doxycycline, the decision was made to proceed with intra-cytoplasmic sperm injection (ICSI) and fresh embryo transfer. Despite the transfer of two good-quality (4AB and 3AA) day five embryos, the human chorionic gonadotropin (β-hCG) test yielded a negative result. Upon re-examination, a thin endometrium measuring 6.5mm was identified, prompting the implementation of the protocol for improvement of endometrial receptivity (PRIMER) protocol, which involves a combination of platelet-rich plasma (PRP) and granulocyte colony-stimulating factor (G-CSF). Following PRP administration and G-CSF injection, significant improvement was observed in the endometrial thickness. Subsequently, frozen embryo transfer (FET) was performed on day six of progesterone, resulting in a positive pregnancy outcome with a β-hCG level of 234 mIU/ml. Continuous adherence to instructions and ongoing administration of G-CSF until the 12th week of gestation remains important. This case underscores the efficacy of the PRIMER protocol in overcoming obstacles such as recurrent implantation failure (RIF) and achieving positive outcomes in assisted reproductive technology (ART).
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Affiliation(s)
- Sudhanshu M Dakre
- Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akash More
- Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shilpa Dutta
- Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shradha M Ulhe
- Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Namrata Choudhary
- Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Maziotis E, Kalampokas T, Giannelou P, Grigoriadis S, Rapani A, Anifantakis M, Kotsifaki A, Pantou A, Triantafyllidou O, Tzanakaki D, Neofytou S, Vogiatzi P, Bakas P, Simopoulou M, Vlahos N. Commercially Available Molecular Approaches to Evaluate Endometrial Receptivity: A Systematic Review and Critical Analysis of the Literature. Diagnostics (Basel) 2022; 12:2611. [PMID: 36359455 PMCID: PMC9689742 DOI: 10.3390/diagnostics12112611] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/26/2022] [Indexed: 08/17/2023] Open
Abstract
Despite the advances in the field of reproductive medicine, implantation failure represents a challenging condition affecting 10-30% of patients subjected to in vitro fertilization (IVF). Research has focused on the identification of molecules playing crucial roles in endometrial receptivity, with the aim of designing predictive tools for efficient detection of the implantation window. To that end, novel molecular genomic and transcriptomic approaches have been introduced as promising tools to enable personalized approaches with the aim of optimizing embryo transfer dating. However, the clinical value of these approaches remains unclear. The aim of this study is to provide a systematic review and critical analysis of the existing evidence regarding the employment of commercially available novel approaches to evaluate endometrial receptivity. An Embase and PubMed/Medline search was performed on 1 February 2022. From the 475 articles yielded, only 27 were included and analyzed. The considerable heterogeneity of the included articles indicates the uniqueness of the implantation window, showcasing that the optimal time for embryo transfer varies significantly between women. Moreover, this study provides information regarding the technical aspects of these advanced molecular tools, as well as an analysis of novel possible biomarkers for endometrial receptivity, providing a basis for future research in the field.
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Affiliation(s)
- Evangelos Maziotis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., 11527 Athens, Greece
| | - Theodoros Kalampokas
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Polina Giannelou
- Centre for Human Reproduction, Genesis Athens Clinic, 14-16, Papanikoli Str., 15232 Athens, Greece
| | - Sokratis Grigoriadis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., 11527 Athens, Greece
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Anna Rapani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., 11527 Athens, Greece
| | - Marios Anifantakis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., 11527 Athens, Greece
| | - Amalia Kotsifaki
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., 11527 Athens, Greece
| | - Agni Pantou
- Centre for Human Reproduction, Genesis Athens Clinic, 14-16, Papanikoli Str., 15232 Athens, Greece
| | - Olga Triantafyllidou
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Despoina Tzanakaki
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Spyridoula Neofytou
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Paraskevi Vogiatzi
- Andromed Health & Reproduction, Fertility Diagnostics Center, 3, Mesogion Str., 15126 Athens, Greece
| | - Panagiotis Bakas
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Mara Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., 11527 Athens, Greece
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Nikolaos Vlahos
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece
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Russell SJ, Kwok YSS, Nguyen TTTN, Librach C. Autologous platelet-rich plasma improves the endometrial thickness and live birth rate in patients with recurrent implantation failure and thin endometrium. J Assist Reprod Genet 2022; 39:1305-1312. [PMID: 35508692 PMCID: PMC9068225 DOI: 10.1007/s10815-022-02505-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 04/22/2022] [Indexed: 11/02/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the effects of intrauterine platelet-rich plasma (PRP) infusion on endometrial thickness and pregnancy outcomes in a population of patients with either recurrent implantation failure (RIF), thin endometrium (TE), or both (RIF + TE) METHODS: This retrospective study included patients attending the CReATe Fertility Centre between October 2018 and July 2021 who received intrauterine PRP infusion to prepare the endometrium for frozen embryo transfer. PRP was prepared from 21 cc of whole blood using the 2-step centrifugation method to yield 0.5-0.75 cc of concentrated platelets. Endometrial thickness was measured before infusion and within 72 h after infusion. All embryos transferred were tested for genetic abnormalities using next-generation sequencing. RESULTS A total of 85 patients, 133 cycles, and 211 infusions were included. The majority of patients (56.5%) were diagnosed with RIF, some with TE (27.0%), and the remainder with both RIF and TE (16.5%). The majority of patients received one PRP infusion per cycle (55%). The endometrial thickness significantly increased across all diagnoses with a significant increase of 1.0 mm (0.5-1.7), which was also significantly greater than in previous cycles. The clinical pregnancy rate per embryo transfer after intrauterine PRP infusion was significantly greater compared to previous cycles (37% vs 20%, odds ratio 2.2) as was the live birth rate (19% vs 2%, odds ratio 11.6). CONCLUSION Our study suggests that PRP should be considered a noninvasive front-line therapy for improving endometrial thickness and implantation in patients with RIF, a TE, or both.
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Affiliation(s)
- Stewart J Russell
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, ON, M5G 1N8, Canada.
| | - Yat Sze Sheila Kwok
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, ON, M5G 1N8, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Tina Tu-Thu Ngoc Nguyen
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, ON, M5G 1N8, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Clifford Librach
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, ON, M5G 1N8, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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Amooee S, Shomali Z, Namazi N, Jannati F. Is There any Role for Granulocyte Colony Stimulating Factor in Improvement of Implantation in Intrauterine Insemination? A Prospective Double-Blind Randomized Control Trial. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2022; 16:281-285. [PMID: 36273314 PMCID: PMC9627008 DOI: 10.22074/ijfs.2021.537125.1171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Granulocyte colony stimulating factor (GCSF) has been introduced as an immunomodulatory agent by increasing implantation rate in vitro fertilization (IVF) patients but it has not been studied in intrauterine insemination (IUI) patients. The aim of this study is to answer the role of GCSF in implantation rate of IUI. MATERIALS AND METHODS In this prospective double-blind randomized control trial, 320 eligible patients were enrolled, who were referred to the referral infertility clinic of Shiraz University of Medical Sciences from February 2018 till the end of 2019. They were divided into two groups randomly. After collecting the demographic data, all patients received clomiphene citrate from the 5th day of the menstruation cycle for 5 days. 50-150 units of recombinant purified follicle-stimulating factor (FSH) were started from the 8th day of the cycle. Follicle monitoring was done by transvaginal sonography till a mature follicle of 18 mm or more was developed. Human chorionic gonadotropin (HCG) injection was done in both groups with intrauterine administration of 300 μg GCSF in the case group and normal saline in the control group simultaneously. After 36 hours, IUI was performed. The clinical pregnancy, miscarriage, and ongoing pregnancy rates of both groups were calculated by SPSS software. RESULTS The results showed improvement of clinical pregnancy rate [15.38% vs. 13.81% OR=1.17 (0.62-2.21)], miscarriage rate [3.84% vs. 5.26% OR=0.74 (0.25-2.20)] and ongoing pregnancy rate [11.53% vs. 8.55% OR=1.37 (0.65-2.92)] in the GCSF group compared to the control. However, the results revealed no statistically significance (P>0.05). CONCLUSION Although it was not statistically significant, 300 μg Intrauterine GCSF administration simultaneously with hCG injection in standard IUI procedure might increase the pregnancy outcomes. Further studies are warranted (registration number: IRCT201212079281N2).
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Affiliation(s)
- Sedigheh Amooee
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shomali
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Niloofar Namazi
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,P.O.Box: 7134846114Department of Obstetrics and GynecologySchool of MedicineShiraz University of Medical SciencesShirazIran
| | - Fatemeh Jannati
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Montenegro IS, Kuhl CP, Schneider RDA, Zachia SDA, Durli ICLDO, Terraciano PB, Rivero RC, Passos EP. Use of clomiphene citrate protocol for controlled ovarian stimulation impairs endometrial maturity. JBRA Assist Reprod 2021; 25:90-96. [PMID: 33118715 PMCID: PMC7863098 DOI: 10.5935/1518-0557.20200056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/30/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Despite recent advances in assisted reproduction techniques and recent knowledge regarding embryo and endometrium quality, implantation and birth rates remain low. The objective of this study was to investigate whether clomiphene citrate alters endometrial maturation in infertile patients. METHODS In a prospective self-matched cohort study, we assessed the ovulation of women in spontaneous and stimulated cycles (with clomiphene citrate). We determined the ovulation day by ultrasound scanning. In both cycles, we took four blood samples (BS1 - at early proliferative phase, BS2 - at mid proliferative phase, BS3 - after ovulation and BS4 - at mid luteal phase) to determine the serum concentrations of FSH, LH, estradiol and progesterone. We retrieved an endometrial biopsy five days after ovulation, followed by blinded analysis and classification according to Noyes criteria, in both cycles. RESULTS Twenty-two participants completed the study. There were significant differences in FSH BS3 (p=0.001), in LH BS3 and BS4 (p<0.001 and p=0.049, respectively), in estradiol BS2, BS3 and BS4 (p<0.001, p=0.024 and p<0.001, respectively) and in progesterone BS3 and BS4 (p=0.028 and p<0.001, respectively). Considering Noyes criteria, there was a one-day delay when comparing the stimulated cycle with the spontaneous cycle (p=0.004), and a two-day delay when comparing the stimulated cycle with the biopsy day. CONCLUSION This study indicates that ovarian stimulation with clomiphene citrate delays the endometrial maturity, and could possibly impair the implantation process due to asynchrony.
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Affiliation(s)
- Ivan Sereno Montenegro
- Gynecology and Obstetrics Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Gynecology and Obstetrics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Embryology and Cellular Differentiation Lab, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Pathology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics of Universidade Federal do Rio Grande do Sul
| | - Cristiana Palma Kuhl
- Gynecology and Obstetrics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Embryology and Cellular Differentiation Lab, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics of Universidade Federal do Rio Grande do Sul
| | - Raquel de Almeida Schneider
- Gynecology and Obstetrics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Embryology and Cellular Differentiation Lab, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics of Universidade Federal do Rio Grande do Sul
| | - Suzana de Azevedo Zachia
- Embryology and Cellular Differentiation Lab, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Isabel Cirne Lima de Oliveira Durli
- Gynecology and Obstetrics Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Gynecology and Obstetrics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Embryology and Cellular Differentiation Lab, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics of Universidade Federal do Rio Grande do Sul
| | - Paula Barros Terraciano
- Gynecology and Obstetrics Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Gynecology and Obstetrics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Embryology and Cellular Differentiation Lab, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics of Universidade Federal do Rio Grande do Sul
| | - Raquel Camara Rivero
- Gynecology and Obstetrics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Pathology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Eduardo P Passos
- Gynecology and Obstetrics Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Gynecology and Obstetrics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Embryology and Cellular Differentiation Lab, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics of Universidade Federal do Rio Grande do Sul
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Lin Y, Qi J, Sun Y. Platelet-Rich Plasma as a Potential New Strategy in the Endometrium Treatment in Assisted Reproductive Technology. Front Endocrinol (Lausanne) 2021; 12:707584. [PMID: 34733236 PMCID: PMC8558624 DOI: 10.3389/fendo.2021.707584] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/28/2021] [Indexed: 12/03/2022] Open
Abstract
The success rate of assisted reproduction techniques (ART) has long been less than satisfactory albeit the great progress made in recent years, demonstrating the need for alternative options in the ART cycles. Growing evidence correlates the effect of intrauterine platelet-rich plasma (PRP) infusion on the endometrium with reassuring reproductive results. Thus, in this review, we focus on the current clinical and mechanical evidence on PRP and its effect on endometrial receptivity, and assess the features, benefits and limitations of the current studies and potential risks of PRP in ART.
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Affiliation(s)
- Yunying Lin
- Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Jia Qi
- Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Yun Sun
- Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
- *Correspondence: Yun Sun,
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