1
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Chadchan SB, Popli P, Liao Z, Andreas E, Dias M, Wang T, Gunderson SJ, Jimenez PT, Lanza DG, Lanz RB, Foulds CE, Monsivais D, DeMayo FJ, Yalamanchili HK, Jungheim ES, Heaney JD, Lydon JP, Moley KH, O'Malley BW, Kommagani R. A GREB1-steroid receptor feedforward mechanism governs differential GREB1 action in endometrial function and endometriosis. Nat Commun 2024; 15:1947. [PMID: 38431630 PMCID: PMC10908778 DOI: 10.1038/s41467-024-46180-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/16/2024] [Indexed: 03/05/2024] Open
Abstract
Cellular responses to the steroid hormones, estrogen (E2), and progesterone (P4) are governed by their cognate receptor's transcriptional output. However, the feed-forward mechanisms that shape cell-type-specific transcriptional fulcrums for steroid receptors are unidentified. Herein, we found that a common feed-forward mechanism between GREB1 and steroid receptors regulates the differential effect of GREB1 on steroid hormones in a physiological or pathological context. In physiological (receptive) endometrium, GREB1 controls P4-responses in uterine stroma, affecting endometrial receptivity and decidualization, while not affecting E2-mediated epithelial proliferation. Of mechanism, progesterone-induced GREB1 physically interacts with the progesterone receptor, acting as a cofactor in a positive feedback mechanism to regulate P4-responsive genes. Conversely, in endometrial pathology (endometriosis), E2-induced GREB1 modulates E2-dependent gene expression to promote the growth of endometriotic lesions in mice. This differential action of GREB1 exerted by a common feed-forward mechanism with steroid receptors advances our understanding of mechanisms that underlie cell- and tissue-specific steroid hormone actions.
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Affiliation(s)
- Sangappa B Chadchan
- Department of Pathology and Immunology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Pooja Popli
- Department of Pathology and Immunology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Zian Liao
- Department of Pathology and Immunology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Eryk Andreas
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Michelle Dias
- Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Tianyuan Wang
- Integrative Bioinformatics, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Stephanie J Gunderson
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Patricia T Jimenez
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Denise G Lanza
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Rainer B Lanz
- Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Charles E Foulds
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Diana Monsivais
- Department of Pathology and Immunology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Francesco J DeMayo
- Reproductive and Developmental Biology Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Hari Krishna Yalamanchili
- Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, 77030, USA
| | - Emily S Jungheim
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Obstetrics and Gynecology, Fienberg School of Medicine, Chicago, IL, 77030, USA
| | - Jason D Heaney
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - John P Lydon
- Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Kelle H Moley
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Bert W O'Malley
- Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Ramakrishna Kommagani
- Department of Pathology and Immunology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
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Spurlin EE, Jimenez PT. Peek and shriek or look and learn: when an aborted surgery leads to the best outcome. Fertil Steril 2024; 121:52-53. [PMID: 37995799 DOI: 10.1016/j.fertnstert.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Emily E Spurlin
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - Patricia T Jimenez
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
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Portugal A, Kosturakis AK, Onyewuenyi TL, Rivera-Cruz G, Jimenez PT. Breaking Down Barriers: Advancing Toward Health Equity in Fertility Care for Black and Hispanic Patients. Obstet Gynecol Clin North Am 2023; 50:735-746. [PMID: 37914491 DOI: 10.1016/j.ogc.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Infertility can affect all people, regardless of race, ethnicity, or socioeconomic status. Barriers to quality fertility care include access, financial limitations, education, and social stigmas. Although racial disparities in outcomes of assisted reproductive technology can be largely attributed to the influences of systemic racism (not race), we can make changes to improve equity of care. We propose strategies in the areas of advocacy, clinical setting, community, and outcomes to address the racial disparities.
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Affiliation(s)
- Aileen Portugal
- Department of Obstetrics, Gynecology, University of California San Francisco, 490 Illinois Street, 10th Floor, Box 0132, San Francisco, CA 94158, USA; Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University, 4444 Forest Park Avenue, Ste. 3100, St. Louis, MO 63108, USA
| | - Alyssa K Kosturakis
- Department of Obstetrics and Gynecology, University of Washington, 1959 NE Pacific Street, Box 356460, Seattle, WA 98195-6460, USA
| | - Ticara L Onyewuenyi
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA 94611, USA
| | - Greysha Rivera-Cruz
- Herbert Wertheim College Medicine, Florida International University, 3251 North State Road 7 Suite 200, Margate, FL 33063, USA
| | - Patricia T Jimenez
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University, 4444 Forest Park Avenue, Ste. 3100, St. Louis, MO 63108, USA.
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Turner KA, Spurlin EE, Jimenez PT. Disparities in Female Oncofertility Care in the United States: More Questions Than Answers. Life (Basel) 2023; 13:1547. [PMID: 37511921 PMCID: PMC10381734 DOI: 10.3390/life13071547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
As cancer therapies continue to improve, the survival rates of adolescent and young adult patients have increased. Consequently, considering patient quality of life after cancer, including family building, has become an essential aspect of establishing a treatment plan. However, the gonadotoxic nature of many chemotherapeutic agents limits the option of using one's own gamete for family building. In recent years, significant advancements have been made in oncofertility, particularly vitrification of oocytes. Unfortunately, as with many areas of medicine, health disparities limit those that can access and utilize fertility preservation prior to cancer treatment. This review aims to shed light on existing disparities in oncofertility for female patients, to offer recommendations to enhance education, access, and advocacy, as well as identify potential areas for future research.
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Affiliation(s)
- Kati A Turner
- Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
| | - Emily E Spurlin
- Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
| | - Patricia T Jimenez
- Department of Obstetrics and Gynecology, Washington University, St. Louis, MO 63110, USA
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Singh P, Martin CE, Jamro-Comer E, Andrews MV, Almgren-Bell A, Riley J, Jimenez PT. Effect of accessibility of a genetic counselor on uptake of preimplantation genetic testing for aneuploidy (PGT-A) and carrier screening for patients undergoing in vitro fertilization. J Genet Couns 2023. [PMID: 37042036 DOI: 10.1002/jgc4.1701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 02/18/2023] [Accepted: 03/04/2023] [Indexed: 04/13/2023]
Abstract
This retrospective cohort study assessed the accessibility of a genetic counselor on uptake of preimplantation genetic testing for aneuploidy (PGT-A) and carrier screening in a single academic Reproductive Endocrinology and Infertility (REI) clinic. A total of 420 patients were evaluated with 219 patients counseled by a REI physician only and 201 patients after the addition of a genetic counselor (GC) to the REI clinic team. Cycles initiated before hiring of a GC (pre-GC) were assessed from June 2018 to December 2018 and after integration of a GC (post-GC) from March 2019 to August 2019. Additionally, information regarding carrier screening was collected if available in the medical record. Results showed more patients utilized PGT-A post-GC (9.5% vs. 5.5%), although the difference between groups did not reach statistical significance (p = 0.12). Individuals who were screened post-GC or who started screening pre-GC and continued screening post-GC were screened for a larger number of conditions than if they were only screened pre-GC (median pre-GC = 3, post-GC = 27, pre- and post-GC = 274; p < 0.0001). The change in practice from using physician-only counseling to counseling with accessibility to a GC did not change the utilization of PGT-A in a single clinic.
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Affiliation(s)
- Prapti Singh
- Department of Genetics and Genomic Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Caitlin E Martin
- Department of Obstetrics and Gynecology, Fertility and Reproductive Medicine Center, St. Louis, Missouri, USA
| | - Erica Jamro-Comer
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marisa V Andrews
- Department of Obstetrics and Gynecology, Fertility and Reproductive Medicine Center, St. Louis, Missouri, USA
| | | | - Joan Riley
- Division of Reproductive Endocrinology and Infertility, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Patricia T Jimenez
- Department of Obstetrics and Gynecology, Fertility and Reproductive Medicine Center, St. Louis, Missouri, USA
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Mauban EC, Santana EA, Jimenez PT, Martin CE. KNOWLEDGE AND ATTITUDES TOWARDS OOCYTE CYROPRESERVATION AND PROCREATIVE MANAGEMENT AMONG OBSTETRICIAN GYNECOLOGISTS. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Singh P, Martin CE, Andrews MV, Riley J, Jimenez PT. DOES HAVING A GENETIC COUNSELOR CHANGE THE UTILIZATION OF PREIMPLANTATION GENETIC TESTING? Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.1049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Mauban EC, Martin CE, Jimenez PT, Riley J, Bedrick BS, Jungheim ES. SERUM TRIGLYCERIDES AND TOTAL CHOLESTEROL ARE ASSOCIATED WITH ANTIMULLERIAN HORMONE LEVELS. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Anderson KL, Jimenez PT, Omurtag KR, Jungheim ES. Outcomes of in vitro fertilization pregnancies complicated by subchorionic hematoma detected on first-trimester ultrasound. F S Rep 2021; 1:149-153. [PMID: 34223231 PMCID: PMC8244369 DOI: 10.1016/j.xfre.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 11/16/2022] Open
Abstract
Objective To estimate the association between subchorionic hematoma (SCH) on ultrasound and pregnancy outcomes in in vitro fertilization (IVF) pregnancies. Design Institutional Review Board–approved, retrospective cohort study. Setting Tertiary care university-based facility. Patient(s) In this study, 1,004 patients who underwent IVF with a viable singleton pregnancy from January 1, 2009 through December 31, 2017. Intervention(s) Subchorionic hematoma versus no hematoma diagnosed on first-trimester ultrasound. Main Outcome Measure(s) Live birth, preterm birth, and spontaneous abortion. Result(s) We found that 1,004 women met the criteria and 187 (18.6%) had an SCH. In bivariate and multivariate regression models, there were no associations between SCH and the outcomes of live birth, preterm birth, or birth weight. Conclusion(s) Subchorionic hematoma detected on first-trimester ultrasound after IVF is not associated with probability of live birth, probability of preterm birth, or infant birth weight in this patient population.
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Affiliation(s)
- Kelsey L Anderson
- Division of Reproductive Endocrinology and Infertility, Washington University Obstetrics and Gynecology, St. Louis, Missouri
| | - Patricia T Jimenez
- Division of Reproductive Endocrinology and Infertility, Northwestern University Obstetrics and Gynecology, Chicago, Illinois
| | - Kenan R Omurtag
- Division of Reproductive Endocrinology and Infertility, Northwestern University Obstetrics and Gynecology, Chicago, Illinois
| | - Emily S Jungheim
- Division of Reproductive Endocrinology and Infertility, Northwestern University Obstetrics and Gynecology, Chicago, Illinois
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Reed BG, Babayev SN, Chen LX, Carr BR, Word RA, Jimenez PT. Estrogen-regulated miRNA-27b is altered by bisphenol A in human endometrial stromal cells. Reproduction 2020; 156:559-567. [PMID: 30328349 PMCID: PMC6215928 DOI: 10.1530/rep-18-0041] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 09/28/2018] [Indexed: 12/25/2022]
Abstract
MicroRNAs (miRs) are small molecules important for regulation of transcription and translation. The objective was to identify hormonally regulated miRs in human endometrial stromal cells and to determine the impact of the endocrine disruptor, bisphenol A (BPA), on those miRs. miR microarray analysis and multiple confirmatory cell preparations treated with 17β-estradiol (E2) and BPA altered miR-27b, let-7c, let-7e and miR-181b. Further, decidualization downregulated miR-27b. VEGFB and VEGFC were validated as targets of miR-27b. Identification of miR-27b target genes suggests that BPA and E2 downregulate miR-27b thereby leading to upregulation of genes important for vascularization and angiogenesis of the endometrium during the menstrual cycle and decidualization.
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Affiliation(s)
- Beverly G Reed
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Samir N Babayev
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lucy X Chen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bruce R Carr
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - R Ann Word
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Patricia T Jimenez
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Eskew AM, Stout MJ, Bedrick BS, Riley JK, Omurtag KR, Jimenez PT, Odem RR, Ratts VS, Keller SL, Jungheim ES, Wylie KM. Association of the eukaryotic vaginal virome with prophylactic antibiotic exposure and reproductive outcomes in a subfertile population undergoing in vitro fertilisation: a prospective exploratory study. BJOG 2019; 127:208-216. [PMID: 31529767 DOI: 10.1111/1471-0528.15951] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of this study was to use high-throughput sequencing to describe the vaginal eukaryotic DNA virome in patients undergoing in vitro fertilisation (IVF) to examine associations between the vaginal virome, antibiotic exposure and IVF outcomes. DESIGN Prospective exploratory study. SETTING Single academic fertility centre. POPULATION Subfertile women age 18-43 years undergoing their first IVF cycle with a fresh embryo transfer. METHODS The primary exposure was prophylactic azithromycin or no azithromycin before IVF. A mid-vaginal swab was obtained at the time of embryo transfer for virome analysis. MAIN OUTCOME MEASURES The primary outcomes compared between exposure groups were characteristics of vaginal virome and clinical pregnancy rates. Secondary outcomes were virome associations with number of oocytes retrieved, number of blastocysts and implantation rate. RESULTS Twenty-six women contributed a vaginal swab before embryo transfer. There were no significant differences in IVF outcomes between azithromycin groups. There was no association between viral diversity and clinical pregnancy overall. A higher diversity of herpesviruses and α-papillomaviruses was observed in samples from the azithromycin-treated group compared with the no azithromycin group (P = 0.04). In women that received azithromycin, viral diversity was higher in the group that did not achieve clinical pregnancy compared with those who did (P = 0.06). CONCLUSIONS We demonstrate that the vaginal eukaryotic virome in women undergoing IVF is associated with antibiotic exposure. Additionally, we demonstrate an inverse trend between viral diversity and pregnancy, with a higher number of viruses detected associated with failure to achieve clinical pregnancy in the azithromycin group. TWEETABLE ABSTRACT Higher viral diversity is associated with prophylactic antibiotic exposure in subfertile women undergoing IVF.
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Affiliation(s)
- A M Eskew
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University in St Louis, St Louis, MO, USA
| | - M J Stout
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington University in St Louis, St Louis, MO, USA
| | - B S Bedrick
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University in St Louis, St Louis, MO, USA
| | - J K Riley
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University in St Louis, St Louis, MO, USA
| | - K R Omurtag
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University in St Louis, St Louis, MO, USA
| | - P T Jimenez
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University in St Louis, St Louis, MO, USA
| | - R R Odem
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University in St Louis, St Louis, MO, USA
| | - V S Ratts
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University in St Louis, St Louis, MO, USA
| | - S L Keller
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University in St Louis, St Louis, MO, USA
| | - E S Jungheim
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University in St Louis, St Louis, MO, USA
| | - K M Wylie
- Department of Pediatrics, Division of Infectious Diseases, Washington University in St Louis, St Louis, MO, USA.,McDonnell Genome Institute, Washington University in St Louis, St Louis, MO, USA
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Anderson K, Jungheim ES, Jimenez PT, Omurtag K. Is first trimester subchorionic hemorrhage associated with adverse pregnancy outcomes after in vitro fertilization? Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Eskew AM, Reschke LD, Woolfolk C, Schulte MB, Boots CE, Broughton DE, Jimenez PT, Omurtag KR, Keller SL, Ratts VS, Odem RR, Jungheim ES. Effect of endometrial mechanical stimulation in an unselected population undergoing in vitro fertilization: futility analysis of a double-blind randomized controlled trial. J Assist Reprod Genet 2018; 36:299-305. [PMID: 30397897 DOI: 10.1007/s10815-018-1356-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Implantation failure is a major limiting factor of successful in vitro fertilization (IVF). The objective of this study was to determine if endometrial mechanical stimulation (EMS) by endometrial biopsy in the luteal phase of the cycle prior to embryo transfer (ET) improves clinical outcomes in an unselected subfertile population. METHODS Double-blind, randomized controlled trial of EMS versus sham biopsy and odds of clinical pregnancy after IVF and embryo transfer. Secondary outcomes included spontaneous miscarriage and live birth. RESULTS One hundred women enrolled and were randomized from 2013 to 2017. Enrollment was terminated after futility analysis showed no difference in clinical pregnancy between EMS versus control, 47.2% vs 61.7% (OR 0.55, 95% CI 0.25-1.23, p = 0.15). There were no significant differences between women who underwent EMS and those who did not in terms of positive pregnancy test 54.7% vs 63.8% (OR 0.69, 95% CI 0.31-1.53, p = 0.36), miscarriage 7.5% vs 2.1% (OR 3.76 95% CI 0.41-34.85, p = 0.22), or live birth 43.4% vs 61.7% (OR 0.48 95% CI 0.21-1.06, p = 0.07). CONCLUSIONS EMS in the luteal phase of the cycle preceding embryo transfer does not improve clinical outcomes in an unselected subfertile population and may result in a lower live birth rate. We caution the routine use of EMS in an unselected population.
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Affiliation(s)
- Ashley M Eskew
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA.
| | - Lauren D Reschke
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Candice Woolfolk
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Maureen B Schulte
- Reproductive Medical Associates of St. Louis, 641 N New Ballas, Creve Coeur, MO, 63141, USA
| | - Christina E Boots
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University, 259 E. Erie Street, Chicago, IL, 60611, USA
| | - Darcy E Broughton
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Patricia T Jimenez
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Kenan R Omurtag
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Sarah L Keller
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Valerie S Ratts
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Randall R Odem
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Emily S Jungheim
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA
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Affiliation(s)
- Lucy X Chen
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Texas Southwestern Medical Center, Dallas, Texas 75390
| | - Patricia T Jimenez
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Texas Southwestern Medical Center, Dallas, Texas 75390
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Abstract
For successful embryo implantation, endometrial stromal cells must undergo functional and morphological changes, referred to as decidualization. However, the molecular mechanisms that regulate implantation and decidualization are not well defined. Here we demonstrate that the estradiol- and progesterone-regulated microRNA (miR)-200 family was markedly down-regulated in mouse endometrial stromal cells prior to implantation, whereas zinc finger E-box binding homeobox-1 and -2 and other known and predicted targets were up-regulated. Conversely, miR-200 was up-regulated during in vitro decidualization of human endometrial stromal cells. Knockdown of miR-200 negatively affected decidualization and prevented the mesenchymal-epithelial transition-like changes that accompanied decidual differentiation. Notably, superovulation of mice and humans altered miR-200 expression. Our findings suggest that hormonal alterations that accompany superovulation may negatively impact endometrial development and decidualization by causing aberrant miR-200 expression.
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Affiliation(s)
- Patricia T Jimenez
- Departments of Obstetrics and Gynecology (P.T.J., R.A.W., W.L.K., C.R.M.) and Biochemistry (C.R.M.) and Green Center for Reproductive Biology Sciences (P.T.J., R.A.W., W.L.K., C.R.M.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; and Department of Obstetrics and Gynecology (M.A.M.), University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104
| | - Monica A Mainigi
- Departments of Obstetrics and Gynecology (P.T.J., R.A.W., W.L.K., C.R.M.) and Biochemistry (C.R.M.) and Green Center for Reproductive Biology Sciences (P.T.J., R.A.W., W.L.K., C.R.M.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; and Department of Obstetrics and Gynecology (M.A.M.), University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104
| | - R Ann Word
- Departments of Obstetrics and Gynecology (P.T.J., R.A.W., W.L.K., C.R.M.) and Biochemistry (C.R.M.) and Green Center for Reproductive Biology Sciences (P.T.J., R.A.W., W.L.K., C.R.M.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; and Department of Obstetrics and Gynecology (M.A.M.), University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104
| | - W Lee Kraus
- Departments of Obstetrics and Gynecology (P.T.J., R.A.W., W.L.K., C.R.M.) and Biochemistry (C.R.M.) and Green Center for Reproductive Biology Sciences (P.T.J., R.A.W., W.L.K., C.R.M.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; and Department of Obstetrics and Gynecology (M.A.M.), University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104
| | - Carole R Mendelson
- Departments of Obstetrics and Gynecology (P.T.J., R.A.W., W.L.K., C.R.M.) and Biochemistry (C.R.M.) and Green Center for Reproductive Biology Sciences (P.T.J., R.A.W., W.L.K., C.R.M.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; and Department of Obstetrics and Gynecology (M.A.M.), University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104
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Louden ED, Luzzo KM, Jimenez PT, Chi T, Chi M, Moley KH. TallyHO obese female mice experience poor reproductive outcomes and abnormal blastocyst metabolism that is reversed by metformin. Reprod Fertil Dev 2015; 27:31-9. [PMID: 25472042 DOI: 10.1071/rd14339] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Obese women experience worse reproductive outcomes than normal weight women, specifically infertility, pregnancy loss, fetal malformations and developmental delay of offspring. The aim of the present study was to use a genetic mouse model of obesity to recapitulate the human reproductive phenotype and further examine potential mechanisms and therapies. New inbred, polygenic Type 2 diabetic TallyHO mice and age-matched control C57BL/6 mice were superovulated to obtain morula or blastocyst stage embryos that were cultured in human tubal fluid (HTF) medium. Deoxyglucose uptake was determined for individual insulin-stimulated blastocysts. Apoptosis was detected by confocal microscopy using the terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick end-labelling (TUNEL) assay and Topro-3 nuclear dye. Embryos were scored for TUNEL-positive as a percentage of total nuclei. AMP-activated protein kinase (AMPK) activation, tumour necrosis factor (TNF)-α expression and adiponectin expression were analysed by western immunoblot and confocal immunofluorescent microscopy. Lipid accumulation was assayed by BODIPY. Comparisons were made between TallyHO morulae cultured to blastocyst embryos in either HTF medium or HTF medium with 25 μg mL(-1) metformin. TallyHO mice developed whole body abnormal insulin tolerance, had decreased litter sizes and increased non-esterified fatty acid levels. Blastocysts from TallyHO mice exhibited increased apoptosis, decreased insulin sensitivity and decreased AMPK. A possible cause for the insulin resistance and abnormal AMPK phosphorylation was the increased TNF-α expression and lipid accumulation, as detected by BODIPY, in TallyHO blastocysts and decreased adiponectin. Culturing TallyHO morulae with the AMPK activator metformin led to a reversal of all the abnormal findings, including increased AMPK phosphorylation, improved insulin-stimulated glucose uptake and normalisation of lipid accumulation. Women with obesity and insulin resistance experience poor pregnancy outcomes. Previously we have shown in mouse models of insulin resistance that AMPK activity is decreased and that activators of AMPK reverse poor embryo outcomes. Here, we show for the first time using a genetically altered obese model, not a diet-induced model, that metformin reverses many of the adverse effects of obesity at the level of the blastocyst. Expanding on this we determine that activation of AMPK via metformin reduces lipid droplet accumulation, presumably by eliminating the inhibitory effects of TNF-α, resulting in normalisation of fatty acid oxidation and HADH2 (hydroxyacyl-CoA dehydrogenase/3-ketoacyl-CoA thiolase/enoyl-CoA hydratase (trifunctional protein), alpha subunit) activity. Metformin exposure in vitro was able to partially reverse these effects, at the level of the blastocyst, and may thus be effective in preventing the adverse effects of obesity on pregnancy and reproductive outcomes.
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Affiliation(s)
- Erica D Louden
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 425 S. Euclid Ave, Campus Box 8064, St Louis, MO 63110, USA
| | - Kerri M Luzzo
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 425 S. Euclid Ave, Campus Box 8064, St Louis, MO 63110, USA
| | - Patricia T Jimenez
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 425 S. Euclid Ave, Campus Box 8064, St Louis, MO 63110, USA
| | - Tiffany Chi
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 425 S. Euclid Ave, Campus Box 8064, St Louis, MO 63110, USA
| | - Maggie Chi
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 425 S. Euclid Ave, Campus Box 8064, St Louis, MO 63110, USA
| | - Kelle H Moley
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 425 S. Euclid Ave, Campus Box 8064, St Louis, MO 63110, USA
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Reynolds KA, Rhee JS, Jimenez PT, Omurtag KR, Tuuli MG, Jungheim ES. Reply: poor ovarian responders: to meta-analyse or not, that is the question. Hum Reprod 2014; 29:635-6. [PMID: 24401202 DOI: 10.1093/humrep/det425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K A Reynolds
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO, USA
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Jimenez PT, Frolova AI, Chi MM, Grindler NM, Willcockson AR, Reynolds KA, Zhao Q, Moley KH. DHEA-mediated inhibition of the pentose phosphate pathway alters oocyte lipid metabolism in mice. Endocrinology 2013; 154:4835-44. [PMID: 24036000 PMCID: PMC3836065 DOI: 10.1210/en.2012-2140] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Women with polycystic ovary syndrome (PCOS) and hyperandrogenism have altered hormone levels and suffer from ovarian dysfunction leading to subfertility. We have attempted to generate a model of hyperandrogenism by feeding mice chow supplemented with dehydroepiandrosterone (DHEA), an androgen precursor that is often elevated in women with PCOS. Treated mice had polycystic ovaries, low ovulation rates, disrupted estrous cycles, and altered hormone levels. Because DHEA is an inhibitor of glucose-6-phosphate dehydrogenase, the rate-limiting enzyme in the pentose phosphate pathway, we tested the hypothesis that oocytes from DHEA-exposed mice would have metabolic disruptions. Citrate levels, glucose-6-phosphate dehydrogenase activity, and lipid content in denuded oocytes from these mice were significantly lower than controls, suggesting abnormal tricarboxylic acid and pentose phosphate pathway metabolism. The lipid and citrate effects were reversible by supplementation with nicotinic acid, a precursor for reduced nicotinamide adenine dinucleotide phosphate. These findings suggest that elevations in systemic DHEA can have a negative impact on oocyte metabolism and may contribute to poor pregnancy outcomes in women with hyperandrogenism and PCOS.
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Affiliation(s)
- Patricia T Jimenez
- 425 South Euclid Avenue, BJC Institute of Health, Box 8064, St Louis, MO 63110.
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Reynolds KA, Omurtag KR, Jimenez PT, Rhee JS, Tuuli MG, Jungheim ES. Cycle cancellation and pregnancy after luteal estradiol priming in women defined as poor responders: a systematic review and meta-analysis. Hum Reprod 2013; 28:2981-9. [PMID: 23887073 DOI: 10.1093/humrep/det306] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does a luteal estradiol (LE) stimulation protocol improve outcomes in poor responders to IVF? SUMMARY ANSWER LE priming is associated with decreased cycle cancellation and increased chance of clinical pregnancy in poor responders WHAT IS KNOWN ALREADY Poor responders to IVF are one of the most challenging patient populations to treat. Many standard protocols currently exist for stimulating these patients but all have failed to improve outcomes. STUDY DESIGN, SIZE, DURATION Systematic review and meta-analysis including eight published studies comparing assisted reproduction technology (ART) outcomes in poor responders exposed to controlled ovarian hyperstimulation with and without LE priming. A search of the databases MEDLINE, EMBASE and PUBMED was carried out for studies in the English language published up to January 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS Studies evaluating women defined as poor responders to ART were evaluated. These studies were identified following a systematic review of the literature and data were analyzed using the DerSimonian-Laird random effects model. The main outcomes of interest were cycle cancellation rate and clinical pregnancy. Although the definition of clinical pregnancy varied between studies, the principal definition included fetal cardiac activity as assessed by transvaginal ultrasonography after 5 weeks of gestation. MAIN RESULTS AND THE ROLE OF CHANCE A total of 2249 publications were identified from the initial search, and the bibliographies, abstracts and other sources yielded 11 more. After excluding duplications, 1227 studies remained and 8 ultimately met the inclusion criteria. Compared with women undergoing non-LE primed protocols (n = 621), women exposed to LE priming (n = 468) had a lower risk of cycle cancellation [relative risk (RR): 0.60, 95% confidence interval (CI): 0.45-0.78] and an improved chance of clinical pregnancy (RR: 1.33, 95% CI: 1.02-1.72). There was no significant improvement in the number of mature oocytes obtained or number of zygotes obtained per cycle. LIMITATIONS, REASONS FOR CAUTION These findings are limited by the body of literature currently available. As the poor responder lacks a concrete definition, there is some heterogeneity to these results, which merits caution when applying our findings to individual patients. Furthermore, the increased clinical pregnancy rate demonstrated when using the LE protocol may be principally related to the decreased cycle cancellation rate. WIDER IMPLICATIONS OF THE FINDINGS The LE protocol may be of some utility in the poor responder to IVF and may increase clinical pregnancy rates in this population by improving stimulation and thereby decreasing cycle cancellation. STUDY FUNDING/COMPETING INTERESTS NIH K12 HD063086 (ESJ, MGT), NIH T32 HD0040135-11 (KAR), F32 HD040135-10 NIH (KRO), 5K12HD000849-25 (PTJ). No competing interests.
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Affiliation(s)
- Kasey A Reynolds
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Ave., Ste. 3100, St Louis, MO 63108, USA
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Jimenez PT, Schon SB, Odem RR, Ratts VS, Jungheim ES. A retrospective cross-sectional study: fresh cycle endometrial thickness is a sensitive predictor of inadequate endometrial thickness in frozen embryo transfer cycles. Reprod Biol Endocrinol 2013; 11:35. [PMID: 23663223 PMCID: PMC3656781 DOI: 10.1186/1477-7827-11-35] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 05/06/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The purpose of this study is to assess predictors of inadequate endometrial cavity thickness (ECT), defined as < 8 mm, in frozen embryo transfer (FET) cycles. METHODS This is a retrospective cross-sectional study at an academic fertility center including 274 women who underwent their first endometrial preparation with estradiol for autologous FET in our center from 2001-2009. Multivariable logistic regression was performed to determine predictors of inadequate endometrial development in FET cycles. RESULTS Neither age nor duration of estrogen supplementation were associated with FET endometrial thickness. Lower body mass index, nulliparity, previous operative hysteroscopy and thinner fresh cycle endometrial lining were associated with inadequate endometrial thickness in FET cycles. A maximum thickness of 11.5 mm in a fresh cycle was 80% sensitive and 70% specific for inadequate frozen cycle thickness. CONCLUSIONS Previous fresh cycle endometrial cavity thickness is associated with subsequent FET cycle endometrial cavity thickness. Women with a fresh cycle thickness of 11.5 mm or less may require additional intervention to achieve adequate endometrial thickness in preparation for a frozen cycle.
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Affiliation(s)
- Patricia T Jimenez
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Samantha B Schon
- Department of Obstetrics and Gynecology, Washington University School of Medicine, Washington, DC, USA
| | - Randall R Odem
- Department of Obstetrics and Gynecology, Washington University School of Medicine, Washington, DC, USA
| | - Valerie S Ratts
- Department of Obstetrics and Gynecology, Washington University School of Medicine, Washington, DC, USA
| | - Emily S Jungheim
- Department of Obstetrics and Gynecology, Washington University School of Medicine, Washington, DC, USA
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Luzzo KM, Wang Q, Purcell SH, Chi M, Jimenez PT, Grindler N, Schedl T, Moley KH. High fat diet induced developmental defects in the mouse: oocyte meiotic aneuploidy and fetal growth retardation/brain defects. PLoS One 2012; 7:e49217. [PMID: 23152876 PMCID: PMC3495769 DOI: 10.1371/journal.pone.0049217] [Citation(s) in RCA: 245] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 10/04/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Maternal obesity is associated with poor outcomes across the reproductive spectrum including infertility, increased time to pregnancy, early pregnancy loss, fetal loss, congenital abnormalities and neonatal conditions. Furthermore, the proportion of reproductive-aged woman that are obese in the population is increasing sharply. From current studies it is not clear if the origin of the reproductive complications is attributable to problems that arise in the oocyte or the uterine environment. METHODOLOGY/PRINCIPAL FINDINGS We examined the developmental basis of the reproductive phenotypes in obese animals by employing a high fat diet mouse model of obesity. We analyzed very early embryonic and fetal phenotypes, which can be parsed into three abnormal developmental processes that occur in obese mothers. The first is oocyte meiotic aneuploidy that then leads to early embryonic loss. The second is an abnormal process distinct from meiotic aneuploidy that also leads to early embryonic loss. The third is fetal growth retardation and brain developmental abnormalities, which based on embryo transfer experiments are not due to the obese uterine environment but instead must be from a defect that arises prior to the blastocyst stage. CONCLUSIONS/SIGNIFICANCE Our results suggest that reproductive complications in obese females are, at least in part, from oocyte maternal effects. This conclusion is consistent with IVF studies where the increased pregnancy failure rate in obese women returns to the normal rate if donor oocytes are used instead of autologous oocytes. We postulate that preconceptional weight gain adversely affects pregnancy outcomes and fetal development. In light of our findings, preconceptional counseling may be indicated as the preferable, earlier target for intervention in obese women desiring pregnancy and healthy outcomes.
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Affiliation(s)
- Kerri M. Luzzo
- Washington University School of Medicine, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States of America
| | - Qiang Wang
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
| | - Scott H. Purcell
- Washington University School of Medicine, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States of America
| | - Maggie Chi
- Washington University School of Medicine, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States of America
| | - Patricia T. Jimenez
- Washington University School of Medicine, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States of America
| | - Natalia Grindler
- Washington University School of Medicine, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States of America
| | - Tim Schedl
- Washington University School of Medicine, Department of Genetics, St. Louis, Missouri, United States of America
| | - Kelle H. Moley
- Washington University School of Medicine, Department of Obstetrics and Gynecology, St. Louis, Missouri, United States of America
- * E-mail:
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Omurtag K, Jimenez PT, Ratts V, Odem R, Cooper AR. The ART of social networking: how SART member clinics are connecting with patients online. Fertil Steril 2011; 97:88-94. [PMID: 22088209 DOI: 10.1016/j.fertnstert.2011.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 09/19/2011] [Accepted: 10/01/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To study and describe the use of social networking websites among Society for Assisted Reproductive Technology (SART) member clinics. DESIGN Cross-sectional study. SETTING University-based practice. PATIENT(S) Not applicable. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Prevalence of social networking websites among SART member clinics and evaluation of content, volume, and location (i.e., mandated state, region) using multivariate regression analysis. RESULT(S) A total of 384 SART-registered clinics and 1,382 social networking posts were evaluated. Of the clinics, 96% had a website and 30% linked to a social networking website. The majority of clinics (89%) with social networking websites were affiliated with nonacademic centers. Social networking posts mostly provided information (31%) and/or advertising (28%), and the remaining offered support (19%) or were irrelevant (17%) to the target audience. Only 5% of posts involved patients requesting information. Clinic volume correlated with the presence of a clinic website and a social networking website. CONCLUSION(S) Almost all SART member clinics have a website. Nearly one-third of these clinics host a social networking website such as Facebook, Twitter, and/or a blog. Large-volume clinics commonly host social networking websites. These sites provide new ways to communicate with patients, but clinics should maintain policies on the incorporation of social networks into practice.
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Affiliation(s)
- Kenan Omurtag
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA.
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Jungheim ES, Allsworth JE, Jimenez PT, Schon SB, Doblado MA. Discussion: 'Early menstrual characteristics and endometriosis' by Treloar et al. Am J Obstet Gynecol 2010; 202:e1-4. [PMID: 20510955 DOI: 10.1016/j.ajog.2010.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 03/15/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Emily S Jungheim
- Instructor, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
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Jungheim ES, Allsworth JE, Jimenez PT, Schon SB, Doblado MA. Early menstrual characteristics and endometriosis: Treloar et al. Am J Obstet Gynecol 2010. [DOI: 10.1016/j.ajog.2010.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bassett MH, Suzuki T, Sasano H, De Vries CJM, Jimenez PT, Carr BR, Rainey WE. The orphan nuclear receptor NGFIB regulates transcription of 3beta-hydroxysteroid dehydrogenase. implications for the control of adrenal functional zonation. J Biol Chem 2004; 279:37622-30. [PMID: 15208301 DOI: 10.1074/jbc.m405431200] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
3beta-Hydroxysteroid dehydrogenase type 2 (HSD3B2) is a steroid-metabolizing enzyme that is essential for adrenal production of mineralocorticoids and glucocorticoids. Thus, HSD3B2 is expressed at high levels in the glomerulosa and fasciculata, where these steroids are produced. In contrast, the production of dehydroepiandrosterone (DHEA) and DHEA sulfate in the adrenal reticularis is inversely correlated with the expression of HSD3B2. The reasons for the zonal expression of HSD3B2 are not known but represent an important aspect in the biochemical zonation of the adrenal. Using microarray, real time reverse transcriptase-PCR, immunohistochemistry, and HSD3B2 promoter analysis, we demonstrate that the NGFIB family of nuclear hormone receptors plays a critical part in the regulation of HSD3B2 transcription and may play an important role in the functional zonation of the adrenal gland. Microarray analysis of cortisol- versus DHEA sulfate-producing adrenal tissue demonstrated that NGIFB paralleled expression of HSD3B2 with expression much higher in cortisol-producing adrenal tissue; this observation was also demonstrated using real time reverse transcriptase-PCR analysis. In addition, immunohistochemistry confirmed that within adult and fetal adrenal gland NGFIB expression paralleled expression of HSD3B2. Transient transfections into H295R adrenal cells demonstrated that NGFIB family members enhanced HSD3B2 reporter activity but had no effect on a 17alpha-hydroxylase (CYP17) promoter construct. Deletion and mutational analyses of the 5'-flanking region of the HSD3B2 gene identified a consensus NGFIB response element that bound NGFIB in mobility shift assays. Infection of cultured human adrenal cells with adenovirus-containing NGFIB increased cortisol production by 8-fold and increased expression of HSD3B2 mRNA 26-fold over that observed in mock-infected cells. In primary cultures of adrenal cells, ACTH, an activator of HSD3B2, rapidly induced expression of NGFIB. These results suggest that NGFIB plays a crucial role in adrenal zonation by regulating HSD3B2 gene transcription.
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Affiliation(s)
- Mary H Bassett
- Division of Reproductive Endocrinology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9032, USA
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