Molecular profiling of human blastocysts reveals primitive endoderm defects among embryos of decreased implantation potential

Human embryo implantation is remarkably inefficient, and implantation failure remains among the greatest obstacles in treating infertility. Gene expression data from human embryos have accumulated rapidly in recent years; however, identification of the subset of genes that determine successful implantation remains a challenge. We leverage clinical morphologic grading-known for decades to correlate with implantation potential-and transcriptome analyses of matched embryonic and abembryonic samples to identify factors and pathways enriched and depleted in human blastocysts of good and poor morphology. Unexpectedly, we discovered that the greatest difference was in the state of extraembryonic primitive endoderm (PrE) development, with relative deficiencies in poor morphology blastocysts. Our results suggest that implantation success is most strongly influenced by the embryonic compartment and that deficient PrE development is common among embryos with decreased implantation potential. Our study provides a valuable resource for those investigating the markers and mechanisms of human embryo implantation.

Ibuprofen inhibits key genes involved in androgen production in theca-interstitial cells

OBJECTIVE

To study the effects of ibuprofen on androgen production, gene expression, and cell viability in rat theca-interstitial cells exposed to the proinflammatory stimuli interleukin-1β (IL-1β) and lipopolysaccharide (LPS).

DESIGN

Animal study.

SETTING

University-based research laboratory.

PATIENTS/ANIMALS

Theca-interstitial cells were isolated from 30 day old female Sprague Dawley rats.

INTERVENTIONS

Theca cells were cultured with pro-inflammatory media containing IL-1β and LPS and compared with cells cultured in control media.

MAIN OUTCOME MEASURES

Androstenedione quantification was performed on conditioned cell culture medium using liquid chromatography-mass spectrometry. Theca cell viability was assessed using PrestoBlue cell viability assay. The gene expression of Cyp17a1, Cyp11a1, and Hsd3b was analyzed using quantitative polymerase chain reaction.

RESULTS

Both proinflammatory stimuli IL-1β and LPS increased androstenedione concentration in cell culture medium, and these effects were mitigated with ibuprofen. Both inflammatory agents in addition increased the expression of key genes involved in androgen synthesis: Cyp17a1, Cyp11a1, and Hsd3b; the addition of ibuprofen to the culture medium inhibited these effects. Theca cell viability increased with IL-1β and LPS. Ibuprofen inhibited the IL-1β-mediated increase in cell viability but did not reverse the effects of LPS.

CONCLUSIONS

In conclusion, our findings support the hypothesis that many of the alterations induced by inflammatory stimuli in theca-interstitial cells are abrogated by the addition of ibuprofen.

Equivalency of In vitro fertilization Success Rates in Elective Single Blastocyst Transfer and Elective Double Blastocyst Transfer: An Example of Equivalence Methodology in Clinical Reproductive Health

CONTEXT

When comparing success rates between treatments, it is more appropriate to structure analyses in terms of equivalence rather than traditional analyses that assess differences. Unfortunately, no studies of elective single blastocyst transfer (eSBT) have been conducted in this manner.

AIMS

The objective of this study was to assess clinical equivalence of in vitro fertilization success rates among patients undergoing eSBT.

SETTINGS AND DESIGN

A historical prospective study was conducted at a private fertility center.

METHODS

Medical records were reviewed to identify patients eligible for eSBT. Equivalency of success rates, defined as no more than a 10% difference based on 95% confidence intervals (CIs), was compared between eSBT (n = 125) and eDBT (n = 213) groups.

RESULTS

Using traditional analysis techniques, no differences in pregnancy or live-birth rates were seen (eSBT: 84.6% vs. eDBT: 84.5%, P = 0.99; eSBT: 65.3% vs. eDBT: 72.3%, P = 0.23). The 95% CI around the difference in pregnancy rates ranged from -7.9 to 8.1, suggesting clinically equivalent pregnancy rates. Clinical equivalence was not established for live-births (95% CI = -18.5-4.5).

CONCLUSIONS

Findings suggest comparable pregnancy rates can be achieved in a clinical setting when utilizing eSBT in good-prognosis patients. Although live-birth rate equivalence was not demonstrated, it is thought the additional complications associated with multiple gestations outweigh the potentially higher live-birth rate. The present study highlights the importance of utilizing equivalence analyses when making statements regarding the similarity of two treatments in reproductive health, rather than relying on superiority analyses alone.

Granulosa cells of polycystic ovaries: are they normal or abnormal?

Understanding whether granulosa cells are normal or abnormal in women with polycystic ovary syndrome (PCO) could have clinical importance. For this purpose, we compared the ability of normal and PCO granulosa cells to synthesize oestrogen and progesterone in vitro in response to follicle stimulating hormone (FSH) and/or insulin-like growth factor-I (IGF-I). The normal granulosa cells were from a 7 mm dominant follicle from a women with regular menstrual cycles. The PCO granulosa cells were from 5-7 mm follicles of three patients who had classical PCO. Several interesting points emerge from the comparison: in each PCO patient there was a high level of bioactive FSH in the follicular microenvironment (greater than or equal to 5 mIU/ml; greater than or equal to 250 ng/ml). This is paradoxical because the concentration of steroids in follicular fluid suggests that PCO follicles are highly atretic and therefore should not contain detectable FSH activity. The capacity to secrete progesterone when challenged with a maximally effective dose of FSH and/or IGF-I, was markedly reduced (8- to 10-fold) in PCO compared to normal granulosa cells. This is in sharp contrast to the oestradiol responses which were much the same for PCO and normal granulosa cells. Also, the time course and dose-response effects of FSH showed some major differences between normal and PCO cells, that is, PCO cells lost their capacity to produce oestradiol when treated continuously with a maximally effective dose of FSH. They were also significantly more sensitive to FSH and failed to become more sensitive to IGF-I when treated with FSH.(ABSTRACT TRUNCATED AT 250 WORDS)

Phorbol ester increases plasminogen activator inhibitor accumulation in cultures of human granulosa cells

Proteolytic enzymes such as plasminogen activators (PAs) and collagenases are implicated in the process of ovarian follicle rupture. Data obtained in rats support the concept that PAs are both hormonally regulated and temporally related to the ovulatory process; however, such data are lacking in the human ovary. The recent identification of a family of PA inhibitors (PAIs) adds a new dimension to the control of PA activity, and in contrast to animal studies, the human preovulatory follicle is characterized by PA inhibitory activity. To initially examine the PA and PAI system in the human ovary, granulosa cells obtained from women undergoing gonadal hyperstimulation for in vitro fertilization were cultured in the presence or absence of the protein kinase-C activator, phorbol 12-myristate 13-acetate. Reverse fibrin autography of conditioned medium from control cells revealed the presence of a putative PAI with an apparent mol wt of 50,000. Phorbol ester stimulated the accumulation of this PAI in a specific and dose-dependent manner. Cumulus cells and noncumulus granulosa cells were similar in terms of presence and regulation of PAI. Immunoprecipitation with specific antisera revealed that this human granulosa cell PAI was immunochemically related to PAI-1. This identification was supported by quantitative analysis revealing a 3.7-fold increase in PAI-1 antigen, as assessed by a specific enzyme-linked immunoabsorbent assay. These findings are the first demonstration of the in vitro regulation of PAI activity in the human ovary.

Progesterone production by human granulosa cells cultured in serum free medium: effects of gonadotrophins and insulin-like growth factor I (IGF-I)

There is evidence that insulin-like growth factor I (IGF-I) is a potent regulator of oestradiol synthesis by human granulosa and luteal cells; however, the question of whether IGF-I regulates progesterone synthesis by these cell types has yet to be answered. As a first step towards this goal, we have compared the effects of IGF-I, follicle stimulating hormone (FSH), and human chorionic gonadotrophin (HCG) on progesterone production by human granulosa cells obtained from individual dominant and cohort follicles, and granulosa luteal cells from preovulatory follicles of patients undergoing in-vitro fertilization (IVF). Granulosa cells from normal, unstimulated follicles cultured in serum-free medium as controls (no additions) produced some progesterone spontaneously. In all cases, FSH stimulated basal progesterone levels (10-fold average increase) and the effect was dose-dependent (ED50 of FSH = 9.1 +/- 3.9 ng/ml). Similar effects were observed when granulosa cells from large follicles were incubated with HCG (ED50 of HCG = 6.9 +/- 2.8 ng/ml). By comparison, the effects of IGF-I on progesterone production were not marked, being absent in 80% of the follicles tested. However, granulosa cells from healthy follicles co-incubated with IGF-I and FSH or HCG produced more progesterone compared with cells treated with the gonadotrophins alone; this effect of IGF-I was dose dependent (ED50 of IGF-I = 10 ng/ml). When the effect of each agonist was tested on IVF granulosa luteal cells, HCG but not FSH or IGF-I stimulated basal progesterone levels but the HCG effect required a two-day lag phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of the antiprogesterone RU486 in the early follicular phase of the menstrual cycle

To investigate the role of progesterone (P) in the early follicular phase, the antiprogesterone effect of RU486 was examined in five normally cycling women monitored by daily hormonal levels during three consecutive cycles (control, treatment, and recovery). In addition, luteinizing hormone (LH) pulse characteristics were assessed by frequent blood sampling (10 minutes for 10 hours) on day 3 of the control and the corresponding day of treatment cycles. Administration of RU486 (3 mg/kg, orally) for the first 3 days of the menstrual cycle did not significantly alter the length of the follicular phase (13.4 +/- 1.7 to 15.2 +/- 1.3 days), the LH surge, or the luteal phase length (12.2 +/- 0.5 to 12.6 +/- 0.7 days). The intermenstrual length of the treatment cycle (29.8 +/- 1.9 days) did not differ from the control (27.6 +/- 1.8 days) or recovery cycles (29.6 +/- 2.5 days). Integrated secretion of P and estradiol (E2) did not vary during the luteal phase of the control, treatment, or recovery cycles. During RU486 treatment, LH pulse frequency, pulse amplitude, and mean LH were not altered. Whereas mean E2 levels were significantly decreased from 150.5 +/- 15.1 to 110.1 +/- 7.0 pmol/L, follicle-stimulating hormone, P, adrenocorticotropin hormone, and cortisol were not significantly altered. Thus, in spite of the transient decrement in E2 secretion during RU486 treatment, the integrity of the ovulatory menstrual cycle was maintained. We conclude that administration of the antiprogesterone RU486 at the dose used during the first 3 days of the follicular phase does not perturb menstrual cyclicity.

Insulin-like growth factor-I regulates aromatase activity in human granulosa and granulosa luteal cells

The purpose of this research was to test the hypothesis that insulin-like growth factor-I (IGF-I) regulates estradiol (E2) synthesis in human granulosa and granulosa luteal cells. Cells from individual follicles from spontaneous and human menopausal gonadotropin/CG-stimulated cycles were cultured in serum-free medium containing androstenedione, IGF-I, FSH, and/or CG. At 2, 4, and 6 days, E2 in the medium was measured by RIA. In the granulosa experiments, control cells produced basal levels of E2 at 2 days, and the levels increased with increasing follicle size. Treatment with FSH stimulated E2 production (on the average, 5-fold), and the effect was dose dependent (ED50 = 5 ng/mL or 16 mIU/mL). Incubation with IGF-I alone caused increases in E2 production comparable to those caused by FSH, and the IGF-I effect was dose dependent (ED50 = 8 ng/mL). In most cases, coincubation with FSH and IGF-I augmented E2 levels more than either hormone alone, and at 4 and 6 days the interaction was synergistic. The data from dose-response experiments suggested that the basis of the synergy between FSH and IGF-I was a marked potentiation by either hormone (approximately 10-fold) in the potency of the complementary hormone to stimulate E2 production. In the experiments with granulosa luteal cells from spontaneous and in vitro fertilization preovulatory follicles, the controls synthesized very high levels of E2 spontaneously at 2 days; however, E2 production declined 700% at 4 days, and no E2 was produced by control cells at 6 days. Treatment with FSH, CG, or IGF-I did not cause a significant increase in the high basal levels of E2 at 2 days. During subsequent culture, however, all three hormones stimulated E2 production at 4 and 6 days, but the increases were modest and not sustained. In contrast, coincubation of granulosa luteal cells with FSH plus IGF-I or CG plus IGF-I dramatically enhanced E2 production at 4 and 6 days (on the average, 4-fold), and the effects were sustained throughout the culture period. (ABSTRACT TRUNCATED AT 400 WORDS)

Pharmacodynamics of the antiprogesterone RU486 in women after oral administration

The pharmacokinetic characteristics of RU486 and its acute effects on anterior pituitary hormone secretion after oral administration were examined in six normal women. Serum RU486 concentrations were determined by a radioimmunoassay. The absorption of RU486 was rapid with peak serum levels reached approximately 90 minutes after a single oral dose (4 mg/kg). The disappearance of RU486 and its metabolites conformed to a noncompartmental model with a mean apparent half-life of 53.7 +/- 6.9 hours. The mean apparent volume of distribution and clearance rate were 1.47 +/- 0.25 l/kg and 1.04 +/- 0.09 1/hour, respectively. In comparison with a control group of normal women (n = 9), there were significant elevations in transverse mean cortisol levels in the RU486 group (P less than 0.01). However, mean adrenocorticotropic hormone (ACTH) levels and the diurnal pattern of ACTH and cortisol secretion were not changed. RU486 induced a mild prolactin (PRL) elevation (P less than 0.01), whereas thyroid-stimulating hormone (TSH) and luteinizing hormone (LH) levels were not altered. In view of the relatively slow clearance rate for RU486 and its metabolites, our findings suggest that the pharmacologic action of RU486 is prolonged after a single oral dose.

Effects of an antiprogesterone (RU486) on the hypothalamic-hypophyseal-ovarian-endometrial axis during the luteal phase of the menstrual cycle

The impact of the antiprogesterone RU486 [17 beta-hydroxy-11 beta-(4-dimethylaminophenyl) 17 alpha-(1-propynyl)estra- 4,9-dien-3-one] on the hypothalamic-pituitary-ovarian-endometrial axis was examined in normal cycling women during the mid (MLP)- and late (LLP) luteal phases. During the MLP, 10 women received 3 mg/kg RU486 for 3 days. During the LLP, a single dose of 600 mg RU486 was administered to 4 women, and in another 4 women a single dose of 3 mg/kg was given during corpus luteum rescue by hCG. Longitudinal studies with daily and frequent blood samples (every 10 min for 10 h) were conducted during 3 consecutive cycles (control-treatment-recovery). During the MLP, RU486-induced uterine bleeding occurred in all 10 women 36-72 h after the first dose. No histological evidence of endometrial breakdown was found in endometrial biopsies taken 12-24 h before the onset of bleeding. Significant decreases in LH secretion (P less than 0.001) and LH pulse amplitude (P less than 0.006) and blunted pituitary responses to GnRH (P less than 0.01) were evident by the last treatment day, but LH pulse frequency did not change. Complete luteolysis occurred in 2 of the 10 women. Incomplete luteolysis occurred in 8 women and was associated with an initial decline of serum estradiol (P less than 0.001), but not progesterone levels, followed by rebound increases (P less than 0.001) in LH, estradiol, and progesterone levels 3 days later, which may have reversed the luteolytic processes and prolonged corpus luteum function. Spontaneous luteolysis ensued 3-5 days later with the onset of second episodes of uterine bleeding. For serum FSH, an early rise occurred during the luteal phase in advance of the onset of the second episodes of uterine bleeding. This rise may have resulted in early follicle recruitment and accounted for the shorter duration of the follicular phase during recovery cycles. During the LLP, the single RU486 dose resulted in significant decreases in LH pulse amplitude (P less than 0.03), frequency (P less than 0.05), and secretion (not significant) within 12 h. The recovery cycle was entirely normal. Corpus luteum rescue with incremental doses of hCG did not prevent uterine bleeding after RU486 treatment. These findings indicate that RU486 operates at multiple sites and implies that progesterone is important in the control of luteal function. Further, our data provide a basis for exploring the potential use of RU486 as a once a month birth control agent.

Aromatase activity in human granulosa cells during follicular development and the modulation by follicle-stimulating hormone and insulin

Granulosa cells were isolated from follicles that ranged in size from 0.4 to 2.0 cm in diameter, obtained from patients during the follicular phase of the menstrual cycle. Aromatase activity, assessed by the release of tritiated water from [1 beta-3H]testosterone, was undetectable in follicles with a diameter of less than 1.0 cm; thereafter, there was a direct correlation between aromatase activity and follicular diameter. When cultured in the presence of 200 ng of National Institutes of Health follicle-stimulating hormone-15 per milliliter, aromatase activity was stimulated in cells isolated from all sizes of follicles from 0.4 to 1.5 cm. Insulin (500 ng/ml) further augmented follicle-stimulating hormone (FSH)-induced aromatase activity, as evidenced both by an increase in 17 beta-estradiol production and by the release of tritiated water from [1 beta-3H]testosterone by granulosa cells. This study further delineates the role of FSH in estrogen production during human follicular development and suggests that insulin or insulin-like growth factors may play a role in modifying the FSH-dependent cellular differentiation of human granulosa cells.

An experimental study of the correction of gastroesophageal reflux by gastroplasty

The rationale and efficacy of gastroplasty in controlling gastroesophageal reflux were studied by manometry and cinefluorography in the dog. The pressure in a 7 by 3 centimeter gastric tube, constructed from the lesser curvature of the stomach and interposed between the esophagus and the stomach, was 3.6 +/- 1.0 centimeters higher than in the stomach. When abdominal compression was applied, the pressures were similar in the tube and the adjacent stomach, 19.0 +/- 4.0 and 19.4 +/- 4.0 centimeters, and free reflux was demonstrated between the two. When the gastric fundus was wrapped around the gastroplasty tube, its resting pressure was 13.1 +/- 0.5 centimeters higher than gastric pressure. During abdominal compression, the pressure in the gastric tube increased to 23.0 +/- 0.6 centimeters suggesting a flutter-valve arrangement that produced an effective antireflux barrier. These data suggest that gastroplasty can be an effective antireflux method only when combined with fundic wrap.

Evaluation of posterior gastropexy for gastroesophageal reflux

The efficacy of posterior gastropexy as an antireflux procedure and its mechanism of action were studied by manometry and cinefluorography in a canine model. Gastroesophageal incompetence was produced in 13 dogs by dividing the vagi below the diaphragm and displacing the gastroesophageal junction into the chest. Reflux was associated with a decrease in the lower esophageal sphincter (LES) pressure measurements and in its response to abdominal compression. Posterior gastropexy done in seven dogs, improved both the resting and compression pressures in the LES, increased the length of the LES, and corrected reflux in five dogs. Replacement of the LES in the abdomen and crural (Allison) repair resulted in a similar increase in LES pressures and restored competence in four of the six animals. Neither procedure was able to restore the LES response to abdominal compression. Posterior gastropexy, like Allison repair, improves LES function by replacing it below the diaphragm, but does not produce a new valve.