O-137 Evaluation of the effect of seminal plasma exosomes from unexplained infertile men on the expression of implantation-related genes

Study question

Do exosomes from seminal plasma of men with unexplained infertility affect endometrial receptivity?

Summary answer

Seminal plasma exosomes from unexplained infertile men alter the expression of genes and signaling pathways related to endometrial receptivity.

What is known already

Unexplained infertile Men are a challenging group with no obvious cause of infertility. Many Complicated mechanisms play a crucial role in preparing the receptive endometrium for embryo implantation. The exosomes of seminal plasma are a heterogeneous cargo of nucleic acids, proteins, and lipids that participate in sperm maturation and function by binding to sperm. It is now apparent that the seminal plasma and its exosomes play a complex role in controlling the female reproductive system. There is no study investigating the effect of Unexplained seminal plasma exosomes on endometrial receptivity.

Study design, size, duration

Samples were collected from 10 men with normal semen parameters from couples undergoing infertility treatment and from 10 donor men with proven fertility and analyzed according to WHO -2010 criteria. Endometrial biopsy tissue was collected from 6 women in the proliferative phase of a natural menstrual cycle. Endometrial epithelial cells were cultured immediately after tissue processing and treated with 100 μg/ml seminal exosomes for (6 and 24 hours); then analyzed for gene expression.

Participants/materials, setting, methods

Exosomes isolated by an ultracentrifuge and characterized size and ultrastructure with dynamic light scattering and transmission electron microscopy. Western blot analysis showed the presence of the exosome markers. After incubation of exosomes with DiI dye, cytoplasmic localization of exosomes detected by fluorescence microscopy. The endometrial receptivity and signaling pathway genes were analyzed by qRT-PCR and immunocytochemistry. Image J and Prism software were used to quantify and analyze the data. P-value <0.05 was considered statistically significant.

Main results and the role of chance

Compared with the embryo donation group, the mRNA levels of MUC1, LIF, G-CSF, CX3CL1, and VEGF were significantly downregulated in the endometrium treated with unexplained infertile exosomes, especially after 24 hours of treatment. Mean mRNA levels of IL6, IL8, and TGFB genes in the unexplained infertile group changed compared with the embryo donation group but were not significant (p > 0.05). Immunocytochemical analysis showed that  MUC1 and LIFR protein levels were increased in endometrial epithelial cells.

Limitations, reasons for caution

larger sample size and exosomal compositions assessment will be useful to identify the effect of exosomes on the endometrium.

Wider implications of the findings

Alterations in the expression of genes associated with endometrial receptivity by exosomes of the unexplained infertile men compared with embryo donation could be one of the causes of infertility in these individuals. Presumably, the atypical composition of exosomes has a different effect on sperm functions and endometrial genes expression.

Trial registration number

Not applicable

P-383 Endometrial scratching: A strategy to stimulate the angiogenesis aspect of implantation in unexplained, repeated implantation failure

Study question

Does endometrial scratching serve as an angiogenic stimulator during implantation in unexplained, repeated implantation failure (uRIF) patients?

Summary answer

Endometrial scratching can reimburse and regulate genes involved in both endometrial angiogenesis and receptivity.

What is known already

The vascular endothelial growth factor (VEGF), as an angiogenic factor, is well-known for its function in a variety of physiological and pathological aspects of female reproduction. Following the embryo transfer in the In-Vitro Fertilization cycles, the most challenging clinical obstacle to overcome is RIF. Endometrial scratching is a technique considered as an option for enhancing the embryo implantation of uRIF patients by modulating the different cellular and molecular components regulating endometrial receptivity before and during implantation.

Study design, size, duration

Twenty uRIF patients were enrolled based on a randomized controlled trial (RCT) to study the expression of genes involved in endometrial angiogenesis and receptivity functions (VEGFR1, VEGFR2, COL18A1, E-cadherin, FGF1) following ES. Ten uRIF patients were randomly assigned to the intervention group (twice endometrial sampling in the follicular and luteal phases) and ten in the control group (only luteal phase sampling) prior to the ovarian stimulation cycle.

Participants/materials, setting, methods

Women who failed to conceive following three or more IVF/ICSI cycles, high-quality embryo transfer, and at least one blastocyst embryo transfer cycle met the inclusion criteria. Post-biopsy endometrial samples were divided evenly. One component was placed in 10% formalin for histology dating and another in RNALater for genomic analysis and preserved at -80 °C for RNA extraction.

Main results and the role of chance

The expression levels of VEGFR1 and VEGFR2 (both as the receptors of VEGF) were significantly increased after ES (P <0.05).

The mRNA expression level of COL18A1 was significantly decreased after ES. COL18A1 is an inhibitor of VEGF which can impede VEGF-mediated signaling and endothelial cell proliferation, via blocking of its receptor specifically VEGFR2.

The E-cadherin expression level was significantly decreased (P <0.05) in the endometrium of the intervention group after scratching. E-cadherin is a cell-cell adhesion molecule that has a pivotal role in maintaining normal epithelial architecture, establishing cell polarity, glandular differentiation, and morphogenesis.

Data showed that Fibroblast Growth Factor1 (FGF1) expression level was significantly increased in the intervention group (P <0.05). FGF1 promotes the formation of blood vessels which improves endometrial trophoblastic interaction and affects embryo implantation.

Limitations, reasons for caution

To further understand the function of these changes, it is preferable to compare the data with endometrium from a fertile group, which is ongoing.

Wider implications of the findings

On the timeline of embryo implantation, angiogenic factors (e.g., VEGFR1 and VEGFR2), their inhibitors (e.g., E-cadherin and COL18A1), and activators (e.g., FGF1) work together to establish a dynamic environment responsible for endometrial receptivity, which has been compromised in the endometrium of RIF patients.ES can reimburse and regulate these angiogenesis processes.

Trial registration number

IRCT20210316050723N1

Gestational age-specific reference values of placental thickness in normal pregnant women

The aim of this study was to determine the reference values of the placental thickness in 400 normal pregnant women during weeks 16-41 of gestation who were referred to the Mahdiyeh hospital during January 2014-February 2015. The placental thickness at the junction of the umbilical artery was measured using ultrasonography. Multivariable linear regression was used to model the mean placental thickness and assess associations with measured covariates, including gestational age (GA). Centiles for placental thickness distribution were estimated according to the modulus exponential-normal model. The mean and standard deviation of the age of the participants was 31.4 ± 5.7 years. The Pearson correlation coefficient indicated a very strong positive linear correlation between GA and placental thickness (p <.001; r = 0.93). A nonlinear increase of placental thickness with estimated fetal weights was observed. GA-specific placental thicknesses for the 2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97.5th percentiles of placental thickness were calculated. By making use of the provided nomogram in this study, neonatal outcomes associated with the placental thickness, such as Hemoglobin Bart's disease, can be diagnosed early to improve maternal and newborn health.

Correction to: Age-specific reference values and cut-off points for anti-müllerian hormone in infertile women following a long agonist treatment protocol for IVF

Unfortunately, the first author name was incorrectly published in the original publication. The complete correct name should read as follows.

Age-specific reference values and cut-off points for anti-müllerian hormone in infertile women following a long agonist treatment protocol for IVF

PURPOSE

The aims of this study were to determining the reference value of anti-müllerian hormone (AMH) in infertile women and effect of AMH on different ovarian responses in the stratum of BMI categories.

METHODS

Through a retrospective cohort study the information of 816 infertile patients referring to the referral infertility clinic of Mahdiyeh Hospital since the beginning of 2011 until the end of January 2016 were used. The normal-based method was undertaken to calculate age-specific AMH percentiles. To determine the effect of AMH on the outcomes of different ovarian responses following adjustment of associated variables, the multinomial regression model was used.

RESULTS

Estimated reference intervals for AMH corresponding to the 2.5 and 97.5th‰ in patients with normal ovarian response are from 0.096 to 6.2 ng/mL. These values for percentiles of 5, 10, 25, 50, 75, 90, and 95% are, respectively, 0.18, 0.33, 0.77, 1.68, 3.05, 4.45, and 5.36 ng/dL. Also the reference value for the 20-year-old participants has a maximum range (0.12-7.64), while for 43-year-old ones has the lowest range (0.08-5.3). Among participants under and above 35 years old, the optimal cut-off points for predicting normal ovarian response are, respectively, 1.5 and 1.2 ng/dL. With each unit increase in the log of AMH concentration, the odds of having excessive ovarian response in patients with normal weight compared to that of having normal ovarian response is 32% higher.

CONCLUSIONS

Determining AMH reference values in IVF candidates allows specialists to measure only AMH plasma levels in IVF candidates so as to find whether or not the ovarian response is normal before applying other therapeutic measures; accordingly, they can adjust a treatment plan for each individual separately.

Spinal cord injury and women's sexual life: case-control study

Study design :This is a case-control study.

OBJECTIVE

The objective of this study was to estimate the magnitude of association between spinal cord injury (SCI) and women's quality of sexual life and sexual function.

SETTING

This study was conducted in the Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran.

METHODS

From the referral university-based clinics, we used simple random sampling to recruit 62 women: 31 women with SCI and 31 women without SCI. Socio-demographic and reproductive traits questionnaire, Sexual Quality of life-Female (SQOL-F), Female Sexual Function Index (FSFI) and Spinal Cord Independence Measure (SCIM) were completed using telephone and face-to-face interviews in the cases and controls. After univariate analyses, multivariate linear and proportional odds regression models were conducted to investigate the relation between SCI and women's quality of sexual life, as well as sexual function.

RESULTS

The mean age of cases and controls was 35.42±6.51 and 33.77±4.02 years. Most women were high school-educated and housewives. Adjusting for probable confounders, the proportional odds regression model showed a significant relationship between the spinal cord injury (AOR=4.2, 95% CI: 1.8-9.2), non-college-educated (AOR=3.1, 95% CI: 1.2-5.9) and employed (AOR=1.8, 95% CI: 1.1-1.8) variables and being in one of the moderate or poor quality of life classes. Scores of SQOL-F and FSFI domains, except satisfaction, were significantly worse in cases versus controls (P<0.001).

CONCLUSION

Although our participants showed low sexual dysfunction, they tended to report moderate to poor quality of sexual life. Our findings support the implication that sexual rehabilitation must be provided for women with SCI soon after injury.

Prediction of different ovarian responses using anti-Müllerian hormone following a long agonist treatment protocol for IVF

OBJECTIVE

The purpose of this study was to predict the poor and excessive ovarian response using anti-Müllerian hormone (AMH) levels following a long agonist protocol in IVF candidates.

RESEARCH DESIGN AND METHODS

Through a prospective cohort study, the type of relationship and appropriate scale for AMH were determined using the fractional polynomial regression. To determine the effect of AMH on the outcomes of ovarian stimulation and different ovarian responses, the multi-nominal and negative binomial regression models were fitted using backward stepwise method. The ovarian response of study subject who entered a standard long-term treatment cycle with GnRH agonist was evaluated using prediction model, separately and in combined models with (ROC) curves.

RESULTS

The use of standard long-term treatments with GnRH agonist led to positive pregnancy test results in 30% of treated patients. With each unit increase in the log of AMH, the odds ratio of having poor response compared to normal response decreases by 64% (OR 0.36, 95% CI 0.19-0.68). Also the results of negative binomial regression model indicated that for one unit increase in the log of AMH blood levels, the odds of releasing an oocyte increased 24% (OR 1.24, 95% CI 1.14-1.35). The optimal cut-off points of AMH for predicting excessive and poor ovarian responses were 3.4 and 1.2 ng/ml, respectively, with area under curves of 0.69 (0.60-0.77) and 0.76 (0.66-0.86), respectively.

CONCLUSION

By considering the age of the patient undergoing infertility treatment as a variable affecting ovulation, use of AMH levels showed to be a good test to discriminate between different ovarian responses.