Endometrial receptivity defects MUC-1 and COX-2 polymorphisms in endometriosis

The endometrium produces MUCIN-1 (MUC-1) and cyclooxygenase-2 (COX-2), which are essential for implantation. MUC-1 is required for adhesion, while COX-2 is necessary for decidualization. Variations or polymorphisms in MUC-1 and COX-2 can lead to changes in endometrial receptivity. This study investigated the relationship between MUC-1 and COX-2 polymorphisms and endometrial receptivity in endometriosis patients. Blood DNA samples were collected from 35 patients with endometriosis and 32 healthy patients between days 19 to 24 of their menstrual cycle (secretory phase). MUC-1 polymorphism was determined using the Amplification Refractory Mutation System (ARMS), and COX-2 gene polymorphism was assessed using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). The frequency distribution of gene polymorphisms between the two groups was compared using bivariate analysis. There were seven genotypic combinations of MUC-1 and COX-2: AAGC; AAGG; GACC; GAGC; GAGG; GGGC; GGGG. The AAGC genotype combination test was significant, with an OR=6.43 (95% CI:1.09-7.62) and p=0.01. In conclusion, combining MUC-1 and COX-2 (AAGC) genotypes results in endometrial receptivity defects in endometriosis.

Electroacupuncture Effectiveness for Treating Idiopathic Male Infertility

Background

Male infertility accounts for ∼50% of all infertility cases. The reasons for male infertility may vary, and one of them is related to an idiopathic factor that may impair spermatogenesis. Acupuncture is one of the most well-known and widely accepted alternative treatments and is becoming known as an effective complementary therapy for infertility.

Case

The case in this article demonstrated the effectiveness of electroacupuncture (EA) for improving male fertility by referring to the total motile sperm count (TMSC), sperm morphology and motility, DNA Fragmentation Index (DFI) of the sperm before and after EA, and pregnancy success in a couple with male infertility. Couples are given therapy with EA twice per week for up to 12 sessions and planned intercourse during the fertile period (ovulation). After planned intercourse, the wife became pregnant; an intrauterine gestational sac (GS) was seen on transvaginal ultrasound and her human chorionic gonadotropin urine test was positive.

Results

The TMSC parameter, sperm morphology and sperm motility, post-EA DFI was improved, compared to pre-EA. The couple was became pregnant after undergoing EA 12 times to treat male infertility.

Conclusions

This case illustrated that EA therapy for idiopathic male infertility has an effect toward improvement of the spermiogram test result, DFI, and success in achieving a pregnancy. However, further research is needed because there are many patients with different causes for their infertility.

The Association Between Body Mass Index, Waist to Hip Ratio and Mid-Upper Arm Circumference with Endometriosis

Endometriosis is characterized by the presence of endometrial tissue, in the form of glands and stroma outside of the uterus. This study aimed to determine the relationship between body mass index, waist to hip circumference ratio, and mid-upper arm circumference with the incidence of endometriosis. This study was analytical observational research with a case-control. The subjects were 63 patients diagnosed with endometriosis through laparoscopic action and 63 normal women who both met inclusion and exclusion criteria. The measurement result of body mass index (BMI) in kg/m² is categorized into ≤25 and >25, waist to hip ratio is categorized to <0.85 and ≥0.85, mid-upper arm circumference in centimeters to ≤23.0 and >23.0. The result showed the relationship of body mass index, waist to hip ratio, and mid-upper arm circumference with endometriosis incidence obtained BMI with endometriosis (b=0.824, CI 95%=0.99 to 5.25, p=0.053), waist to hip ratio (b=0.893, CI 95%=1.03 to 5.82, p=0.044), and mid-upper arm circumference (b=-0.246, CI 95%=0.10 to 6.09, p=0.814). There is a significant relationship between BMI and waist to hip ratio with the incidence of endometriosis. There is no significant relationship between mid-upper arm circumference with the incidence of endometriosis.

Electroacupuncture to Improve Endometrial Receptivity and Folliculogenesis in Polycystic Ovary Syndrome

Objective: Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting folliculogenesis and endometrial receptivity. PCOS causes low fertility due to failures in folliculogenesis and ovulation. Electroacupuncture (EA) may help improve folliculogenesis and endometrial receptivity. EA can decrease tonic activity in the sympathetic vasoconstrictor pathway to the uterus. This study was conducted to determine the effect of the addition of EA therapy on folliculogenesis and endometrial receptivity in women with PCOS. Materials and Methods: This case-control study was conducted at the Dr. Moewardi General Hospital, in Jawa Tengah, Indonesia. The subjects were women with PCOS, ages 20-45, who were infertile. They were divided into a control group (17 women) and an experimental group (17 women). The control group received letrozole therapy, and the experimental group received EA + letrozole therapy. Folliculogenesis is determined by measuring the growth of follicle diameter on days 2, 6, 8, 10, and 12 of the menstrual cycle. Endometrial receptivity is determined by resistance index (RI) and pulsatility index (PI) examinations on days 19 and 21; endometrial thickness is measured on day 12. Results: There was a significant difference in folliculogenesis on days 2, 6, 8, 10, and 12. Folliculogenesis with letrozole versus EA + letrozole, respectively, were: day 2 = 5.59 ± 1.06 versus 7.01 ± 1.53, P = 0.004; day 6 = 6.71 ± 1.59 versus 9.11 ± 1.23, P < 0.001; day 8 = 9.51 ± 2.68 versus 12.44 ± 1.49, P < 0.001; day 10 = 11.30 ± 3.08 versus 15.53 ± 2.34, P < 0.001; and day 12 = 13.92 ± 3.61 versus 19.86 ± 0.75, P < 0.001. RI value with letrozole versus EA + letrozole were, respectively, day 19 = 0.91 ± 0.07 versus 0.88 ± 0.07, P = 0.150; day 21 = 0.88 ± 0.07 versus 0.79 ± 0.09, P < 0.001. PI value with letrozole versus EA + letrozole were respectively, day 19 = 3.00 ± 0.89 versus 2.30 ± 0.65, P = 0.009; and day 21 = 2.72 ± 0.88 versus 2.02 ± 0.55, P = 0.009. Endometrial thickness with letrozole versus EA + letrozole were, respectively, day 12 = 6.95 ± 1.82 versus 8.22 ± 1.76, P = 0.005. Conclusions: The addition of EA to letrozole therapy improved folliculogenesis, RI, PI, and endometrial thickness in patients with PCOS. Further studies are needed to gain a better understanding of the dosage and timing of this therapy and its potential synergy with other current treatments.

Waist circumference, hip circumference, arm span, and waist-to-hip ratio high risk of polycystic ovarian syndrome

BACKGROUND AND AIMS

Polycystic ovarian syndrome is a reproductive problem of women with high prevalence cases accompanied by obesity conditions. Obesity condition can be seen from the size of waist circumference, hip circumference, arm span, and waist-to-hip ratio. This study aims to find out the risk factors between waist circumference size, hip circumference, arm span, and waist-to-hip ratio with polycystic ovarian syndrome.

METHODS

This research is an analytical observation using a case-control approach conducted at Sekar Fertility Clinic and Poly Obgyn Dr Moewardi General Hospital Surakarta. Subjects were 150 consisting of 75 polycystic ovarian syndrome women and 75 normal fertile women. Sampling techniques used in this study are purposive sampling, researchers doing anthropometric measurements in the form of waist circumference, hip circumference, arm span, and waist-to-hip ratio simultaneously. The results were analyzed using Statistic Product and Service Solution 25.

RESULTS

The results of the study obtained waist circumference with polycystic ovarian syndrome (b = 3.002; CI 95% = 3.41-123.5; p = 0.001), hip circumference (b = -2.671; CI 95% = 0.01-0.37; p = 0.002), arm span (b = 5.318; CI 95% = 32.23-129.58; p < 0.001) and waist-to-hip ratio (b = 1.761; CI 95% = 1.02-33.01; p = 0.047).

CONCLUSION

Waist circumference size, hip circumference, arm span, and waist-to-hip ratio correlate to a high risk of polycystic ovarian syndrome. Arm span is more dominant as an indicator of high risk to polycystic ovarian syndrome compared to waist circumference, hip circumference, and waist-to-hip ratio.

Hypoxia Inducible Factor-1-Alpha Expression on Preeclampsia Mice Model With L-Arginine Administration

Preeclampsia is hypertension in pregnancy that affects 2% to 8% of pregnancies worldwide and causes significant maternal and perinatal morbidity and mortality. In the pathogenesis of preeclampsia, placental hypoxia plays an important role, associated with excessive trophoblast apoptosis resulting in decreased trophoblast and spiral arteries invasion. This placental hypoxic condition will induce increased expression of Hypoxia Inducible Factor -1-Alpha (HIF-1-A). L-Arginine is a potent vasodilator presumably to improve preeclampsia placental hypoxic conditions and reduce HIF-1-A expression. This study was an experimental study with a parallel-group post-test only design. Thirty-six preeclamptic mice models were divided into 2 groups. The control group (K1) 18 preeclamptic mice model without treatment and the treatment group (K2) 18 preeclamptic mice given L-Arginine. The independent variable was the administration of L-Arginine and the dependent variable is the placental HIF-1-A expression. Statistical analysis used unpaired t-test on normal data distribution, and Mann Whitney test on abnormal data distribution. The mean of placental HIF-1-A expression K1 was 2.47 ± 1.65 with a minimum value of 0.4 and a maximum value of 6.6. At K2 0.93 ± 0.55 with a minimum value of 0.0 and a maximum value of 2.0. Statistical tests showed that the placental HIF-1-A expression in the treatment group was significantly lower than that in the control group (p <0.001). In conclusion, the expression of HIF-1-A in preeclamptic mice model placenta decreased with L-Arginine administration.

Mucin-1 expression in endometrium is higher in polycystic ovary syndrome than in normal women

BackgroundThe polycystic ovary syndrome (PCOS) is caused by endocrine system dysfunction in women. MUCIN-1 (MUC-1) expression is found in endometrial tissues, which leads to implantation process dysfunction because of imbalance of trophoblast adhesion process. This study was conducted to compare endometrial MUC-1 expression between PCOS and normal women considering all existing external variables.MethodsThis cross-sectional study was conducted in General Hospital Dr. Moewardi Surakarta. Endometrial samples were obtained from 30 infertile PCOS women based on Rotterdam criteria, and 30 normal women. Life style and reproductive data such as age, menstrual problems, menstrual cycle, age at menarche, and BMI were collected. Subjects underwent endometrial biopsy in luteinizing hormone (LH) secretion phase LH + 5 days to LH + 10 days for immunohistochemistry (IHC) of MUC-1 expression. An independent-t and multiple linear regression test were used to analyze the data at significance level of p<0.05. ResultsMean MUC-1 expression in the PCOS endometrium (49.66 ± 47.79) was significantly higher than in normal women (7.66 ± 14.55) (p=0.03). Multivariate linear regression model of life style and reproductive variables with MUC-1 showed that PCOS (b=29.54; 95% CI 9.57-49.49; p=0.004) and BMI (b= 29.99; 95% CI 5.91-54.07; p=0.001) significantly increase MUC-1 expression. PCOS (Beta=0.37) was more important than BMI (Beta=0.30) in increasing the MUC-1 expression. ConclusionExpression of MUC-1 levels in the PCOS endometrium was higher than in normal women. This suggests that MUC-1 contributes to the unexplained reproductive failure in PCOS.

Electroacupuncture Effect on Polycystic Ovary Syndrome to Improve Oocytes' Growth

Objective: Polycystic ovary syndrome (PCOS) is a condition of anovulation causing infertility. Many kinds of therapy have been used to treat PCOS. However, the results have not been satisfactory. Acupuncture is a trusted way to repair the reproductive system. Yet, there is not enough evidence of the effectiveness of acupuncture to induce ovulation or to treat infertility in patients who have PCOS. The objectives of this study were to find out how successfully electroacupuncture (EA) could complete conventional therapy for patients with PCOS-related infertility, to analyze the effect of EA on these patients, and if EA could repair folliculogenesis to create quality oocytes so that these patients could become pregnant. Materials and Methods: A case controlled study was conducted in Sekar Dr. Moewardi General Hospital, Surakarta, Central Java, Indonesia. There were 44 patients with PCOS who were included according to Rotterdam criteria and exclusion criteria. The patients' characteristics studied were age, height, weight, and duration of infertility. Subjects were divided randomly into 2 groups (22 subjects in a PCOS+Lifestyle Management as a control group and 22 subjects in a PCOS Lifestyle Management+EA case group. EA was performed for 15 minutes twice per week for a total of 12 sessions. The main outcome measure was transvaginal ultrasonographic detection of follicle size in ovulation on days 2, 6, 8, 10 and 12, starting from the first day of each patient's last menstruation. Results: There were significant differences in follicle growth on days 2, 6, 8, 10, and 12. Follicle growth in the PCOS+Lifestyle Management group versus the PCOS Lifestyle Management+EA group was, respectively, on day 2: 5.59 ± 0.73 versus 6.45 ± 1.22, p = 0.012; on day 6: 7.40 ± 1.14 versus 9.45 ± 1.94, p = 0.012; on day 8: 9.50 ± 1.40, versus 11.63 ± 2.25, p = 0.002; on day 10: 11.59 ± 1.36, versus 13.77 ± 2.22, p = 0.001, and on day 12: 13.72 ± 1.20; versus 16.13 ± 2.43; p = 0.001. Conclusions: EA improves oocytes' growth in patients with PCOS.

Difference of Cyclooxygenase-2 (COX2) Expression in Endometrium Between Patients with Polycystic Ovary Syndrome (PCOS) and Fertile Women

Objective: The study was conducted to determine whether there were differences in COX-2 expression in endometrial women with PCOS compared to fertile women.

Methods: This study is a case-control study investigating the relationship between exposure (research factors) and disease, by comparing case group and control group based on their exposure status. The samples of this study were infertile polycystic ovary syndrome patients who were treated at the Sekar Fertility Clinic in Dr. Moewardi Hospital Surakarta, and fertile women seeking treatment at Dr. Moewardi Hospital Surakarta. The number of samples were 60 subjects consisting of 30 PCOS patients and 30 fertile women. The expression of COX-2 in endometrial biopsy LH + 5 until LH + 10 which meet the inclusion with Rotterdam criteria and exclusion criteria was checked by immunohistochemistry. The data was analyzed using the Mann-Whitney test.

Results: The mean COX-2 expression in PCOS (10.83 ± 5.35) in fertile women (37.00 ± 7.76), p = 0.005. Regression test of COX-2 by adjusting external variables (occupation, age, education, menstrual disorders, familial history, menstrual cycle, menarche, obesity, contraception history) shows also higher expression in PCOS patient with OR = -7.063; CI = 0.462–108.066; p = 0.160.

Conclusion: COX-2 expression in endometrium of women with PCOS is lower than it is in fertile women.