Prednisone vs Placebo and Live Birth in Patients With Recurrent Implantation Failure Undergoing In Vitro Fertilization: A Randomized Clinical Trial

Effect of hysteroscopic adhesiolysis for mild intrauterine adhesions on live birth rate following embryo transfer: a retrospective cohort study

BACKGROUND

Numerous studies have demonstrated that the presence of IUAs can have detrimental effects on female reproductive function, potentially leading to infertility. Hysteroscopic adhesiolysis is widely regarded as the primary treatment for IUAs. A 2021 consensus development study on the top 10 research priorities for the future of infertility suggested that the impact on live birth rates after surgical treatment of mild IUAs is uncertain.

MATERIALS AND METHODS

The study was a retrospective cohort study that included 442 patients who were diagnosed with mild IUAs and underwent embryo transfer (fresh or frozen embryo) from January 2017 to December 2023 at a University-based reproductive medical center. Patients were divided into two groups according to whether underwent hysteroscopic adhesiolysis. The non-surgical group consisted of 204 patients, while the surgical group consisted of 238 patients. all patients underwent fresh or frozen embryo transfer. We compared the pregnancy outcomes and obstetric outcomes of the first embryo transfer after diagnosis or surgery of IUAs between the two groups. The main outcome measure is live birth rates. Between-group variances were evaluated using either the Pearson χ² test or the t-test. Multiple logistic regression analyses were applied to control for potential confounding effects.

RESULTS

There were no significant differences in live birth rates of the non-surgical group and the surgical group(45.1% versus 42.0%,aOR,0.824;95%CI,0.558-1.217;P,0.330).All other pregnancy indicators showed no significant difference between the groups either.

CONCLUSION

Hysteroscopic adhesiolysis does not significantly improve the live birth rates in patients with mild IUAs. Therefore, for patients with mild IUAs, it is recommended to prioritize expectant treatment.

CLINICAL TRIAL NUMBER

Not applicable.

Analysis of the Application Value of Low Molecular Weight Heparin Combined with Heparin in Patients with Chorionic Bump in Early Pregnancy

Objective

To explore the application value of low molecular weight heparin combined with heparin in patients with chorionic bump in early pregnancy.

Methods

This retrospective study collected 86 cases of patients with early pregnancy complicated by chorionic bump treated in our hospital from January 2020 to February 2022. According to the treatment methods, the patients were divided into the combined treatment group (n=41) and the control group (n=45). Patients in the combined treatment group were treated with oral prednisone combined with low molecular weight heparin injection, while patients in the control group received no additional treatment. The changes and differences in chorionic size, serum hormone levels, and uterine artery blood flow parameters before treatment and at 1 month and 2 months after treatment were compared between the two groups. The pregnancy outcomes and adverse reaction rates were also analyzed.

Results

At 1 month and 2 months after treatment, the average size of the chorionic bump in the combined treatment group was significantly smaller than before treatment and the control group (P<0.05). Two months after treatment, the average levels of E2, P, and LH in the combined treatment group were significantly higher, and the average FSH level was significantly lower than those before treatment and in the control group (P<0.05). At 1 month and 2 months after treatment, the average RI in the combined treatment group was significantly lower than before treatment and the control group, and although the average S/D ratio was higher than before treatment, it was still lower than that of the control group (P<0.05). The incidence of adverse pregnancy outcomes in the combined treatment group was significantly lower than that in the control group (χ²/P=5.469/0.019). There was no significant difference in the incidence of adverse reactions between the two groups (χ²/P=0.613/0.434).

Conclusion

Prednisone combined with low molecular weight heparin can effectively reduce the size of the chorionic bump, improve uterine artery blood flow parameters, and ultimately lower the risk of adverse pregnancy outcomes in patients with early pregnancy complicated by chorionic bump. This treatment approach has reliable clinical safety and holds potential for broader application in such patients.

Effect of Comprehensive Individualised Interventions on the Clinical Outcomes of Patients With Recurrent Implantation Failure: A Single-Centre Retrospective Cohort Study

OBJECTIVE

The objective of this study is to evaluate the impact of comprehensive individualised interventions on the clinical outcomes of patients with recurrent implantation failure (RIF), as few studies have evaluated their effectiveness.

DESIGN

Retrospective cohort study.

SETTING

Tertiary hospital, from June 2016 to December 2022.

POPULATION

Overall, 1546 patients with RIF underwent endometrial biopsy during implantation.

METHODS

The comprehensive individualised interventions were conducted on the basis of the endometrial histological dating, endometrial CD138 count, endometrial immune-cell proportion and endometrial microbiota testing.

MAIN OUTCOME MEASURES

Cumulative ongoing pregnancy rate (cOPR).

RESULTS

The median number of failed transfer cycles was 3 (range, 2-12), and the cOPR was 58.0%. The rates of window of implantation (WOI) displacement, CD138 positivity, imbalanced endometrial immune-cell proportion, endometrial microbiota testing, multiple factors and unexplained RIF were 34.0%, 9.3%, 7.5%, 4.1%, 32.4% and 12.7%, respectively. The cOPRs of the individualised frozen embryo transfers in patients having RIF with WOI displacement, WOI CD138 positivity, imbalanced endometrial immune-cell proportion, endometrial microbiota testing, multiple factors and unexplained RIF were 64.1%, 57.6%, 55.1%, 38%, 64.2% and 34.5%, respectively. After adjusting for basic characteristics through logistic regression analysis, the cOPRs of the WOI displacement group, WOI CD138 positive group and immune-cell proportion imbalanced group remained higher than that of the unexplained RIF group. However, the cOPR was comparable between the endometrial microbiota testing and unexplained RIF groups.

CONCLUSION

Comprehensive individualised interventions may improve clinical outcomes for patients with RIF, warranting further investigation.

Effect of Preimplantation Genetic Testing for Aneuploidy on Live Birth Rate in Young Women With Recurrent Implantation Failure: A Secondary Analysis of a Multicentre Randomised Trial

OBJECTIVE

To investigate the benefit of preimplantation genetic testing for aneuploidy (PGT-A) in recurrent implantation failure (RIF).

DESIGN

Secondary analysis of a multicentre, randomised, double-blind, placebo-controlled clinical trial.

SETTING

Eight academic fertility centres in China, 2018-2020.

POPULATION

Overall, 485 infertile women aged < 38 years were evaluated. They had a history of two or more unsuccessful embryo transfer cycles with at least three good-quality embryos that had been transferred cumulatively and underwent a single blastocyst transfer with or without PGT-A. Those with thin endometrium or recurrent pregnancy loss were excluded.

METHODS

Patients were categorised into PGT-A and non-PGT-A groups. All pregnancies were followed to delivery. Pregnancy and neonatal outcomes were obtained from obstetric and neonatal medical records. Propensity score matching (PSM) and multivariate logistic regression models were applied to adjust for potential confounding factors.

MAIN OUTCOME MEASURES

LBR per embryo transfer.

RESULT(S)

There was no significant difference in LBR between the PGT-A and non-PGT-A groups both before (39.1% vs. 41.5%, p = 0.760) and after (39.1% vs. 40.6%, p = 0.862) PSM. Unadjusted and adjusted logistic regression models revealed no beneficial effect of PGT-A on LBR per embryo transfer (crude odds ratio: 0.91, 95% confidence interval: 0.49-1.69; adjusted odds ratio: 1.04, 95% confidence interval: 0.53-2.03). The incidence of maternal and neonatal complications was not significantly different between the groups.

CONCLUSIONS

Patients with RIF aged < 38 years do not benefit from PGT-A. Thus, factors other than genetic abnormalities may contribute to this clinical conundrum.

The long noncoding RNA LUCAT1 regulates endometrial receptivity via the miR-495-3p/S100P axis

Recently, interest in investigating the effects of long noncoding RNAs (lncRNAs) on endometrial receptivity (ER) has increased within the field of assisted reproductive technology. Therefore, the objective of this study is to identify and analyze the role of the lncRNA LUCAT1 and to elucidate its specific mechanism in regulating ER. Hub genes associated with ER are identified via Weighted gene co-expression network analysis (WGCNA) in two datasets downloaded from the GEO database. These hub genes identified via WGCNA were subsequently validated. The combination of a dual-luciferase assay, qRT‒PCR, western blotting, and other techniques are used to investigate the molecular mechanism by which LUCAT1 regulates S100P. In this study, LUCAT1 expression is shown to significantly affect ER, and the depletion of LUCAT1 leads to impaired ER function. Additionally, LUCAT1 is shown to act as a molecular sponge for miR-495-3p, thereby modulating the expression of S100P. This modulation influences the proliferation, migration, and invasion capabilities of Ishikawa cells, as well as the adhesion of JAR cells to endometrial cells. Therefore, LUCAT1 can regulate ER via the miR-495-3p/S100P axis, which provides experimental evidence for the identification of innovative strategies aimed at enhancing endometrial receptivity.

Endometrial immune profiling and precision therapy increase live birth rate after embryo transfer: a randomised controlled trial

Introduction

Despite advancements in assisted reproductive treatments, 70% of transferred embryos fail to implant successfully, yielding significant personal and global repercussions. One promising avenue of research is to take into account the individual's immune uterine profile in order to tailor treatment and optimise outcomes. This randomised controlled trial represents the initial exploration into the consequences of disregarding the state of the uterine immune environment in infertile women embarking on IVF/ICSI.

Materials and methods

This randomised controlled open two-arm trial included IVF patients, with assessment of immune endometrial environment and precision therapy before embryo transfer (ET). 493 patients were enrolled from October 2015 to February2023. Endometrial biopsies were collected during the mid-luteal phase. Endometrial immune profiling involves the analysis of cytokine biomarkers in the endometrium. If an immune endometrial dysregulation was diagnosed, a computerised randomisation assigned patients to either a conventional ET (disregarding the immune profile) or a personalised ET (with a precision therapy adapted to the immune profile). The primary analysis focussed on demonstrating the superiority of precision treatments using the modified intent-to-treat population (mITT), excluding patients without ET. The primary endpoint was the live birth rate (LBR) following the first attempt of ET.

Results

Among the population, 78% had an endometrial immune dysregulation and were randomised. The mITT analysis showed a significant increase in LBR with precision care compared to conventional care (29.7% vs. 41.4%; OR: 1.68 [1.04-2.73], p=0.036). The positive impact of precision care was particularly noticeable in patients with morphologically suboptimal embryos (LBR: 21.2% vs. 39.6%; OR: 2.12 [1.02-4.41]) or those with a history of two or more failed ET (LBR: 23.4% vs. 48.1%; OR: 3.03 [1.17-7.85]).

Limitations and reasons for caution

The data should be interpreted with caution due to inherent structural limitations of human IVF trials. Generalising and empowering our findings would rely on the replication of controlled trials by independent research teams possibly integrating the usage of optimised embryo quality with PGT-A.

Conclusion

The regulation of the endometrial immune environment emerges as one of the leading innovative strategies to facilitate embryo implantation and enhance the overall performance of assisted reproductive therapies (ART). Based on these findings, endometrial immune profiling could become an essential part of routine ART practice.

Clinical trial registration

clinicaltrials.gov, identifier NCT02262117.

Exploring the Immunological Aspects and Treatments of Recurrent Pregnancy Loss and Recurrent Implantation Failure

Recurrent pregnancy loss (RPL) is defined as the occurrence of two or more consecutive pregnancy losses before 24 weeks of gestation. It affects 3-5% of women who are attempting to conceive. RPL can stem from a variety of causes and is frequently associated with psychological distress and a diminished quality of life. By contrast, recurrent implantation failure (RIF) refers to the inability to achieve a successful pregnancy after three or more high-quality embryo transfers or at least two instances of egg donation. RIF shares several causative factors with RPL. The immunological underpinnings of these conditions involve alterations in uterine NK cells, reductions in M2 macrophages and myeloid-derived suppressor cells, an increased Th1/Th2 ratio, a decreased Treg/Th17 ratio, the presence of shared ≥3 HLA alleles between partners, and autoimmune disorders. Various therapeutic approaches have been employed to address these immunological concerns, achieving varying degrees of success, although some therapies remain contentious within the medical community. This review intends to explore the immunological factors implicated in RPL and RIF and to analyze the immunological treatments employed for these conditions, which may include steroids, intravenous immunoglobulins, calcineurin inhibitors, anti-TNF antibodies, intralipid infusions, granulocyte colony-stimulating factor, and lymphocyte immunotherapy.

Preimplantation genetic testing might not be the necessity for male patients with 47,XYY syndrome: A pilot study

Purpose

This pilot study aimed to explore the necessity for 47,XYY syndrome males (couples) to perform PGT rather than conventional In Vitro Fertilization (IVF)/Intracytoplasmic Sperm Injection (ICSI) cycles.

Methods

A retrospective cohort study was conducted with 36 nonmosaic and mosaic 47,XYY syndrome patients (couples) undergoing 43 oocyte retrieval cycles (37 planned for PGT and 6 for IVF/ICSI) between December 2017 and December 2023. The couples were given either next-generation sequencing-based PGT or conventional IVF/ICSI followed by 45 embryo transfer (ET) cycles (38 from PGT and 7 from IVF/ICSI). The detailed cytogenetic results of the 129 embryos from PGT were analyzed, and the pregnancy and neonatal outcomes between PGT-ET and conventional IVF/ICSI-ET cycles were compared.

Results

The PGT results showed that the chance of sex chromosome abnormalities was low (1.55%), with chromosomal errors being observed more often in autosomes. Importantly, no differences were observed in the rates of biochemical pregnancy, implantation, clinical pregnancy, ongoing pregnancy, pregnancy loss, live birth, and preterm delivery between PGT-ET cycles and conventional IVF/ICSI-ET cycles. Comparable results regarding gestational age, birthweight, low birthweight rate, macrosomia rate, male rate, as well as the rate of congenital anomalies were also observed between the two groups.

Conclusions

Preimplantation genetic testing might not be necessary to conduct for 47,XYY syndrome males unless there are other indications. Studies with large populations are in demand to confirm the present results.

Efficacy of Corticosteroids in Patients With Recurrent Pregnancy Loss: A Systematic Review and Meta-Analysis

Recurrent pregnancy loss (RPL) represents a complication of pregnancy occurring in 1%-3% of all couples trying to conceive. About 50%-60% of RPL cases remain idiopathic, therefore therapeutic strategies seem empirical and based on unproven evidence. We investigated the efficacy of corticosteroids in women with RPL. We conducted a systematic review and meta-analysis, up to August 2024, in the PubMed, Scopus, and Web of Science databases, including studies on idiopathic RPL women and comparing corticosteroids versus control treatment. Primary outcome was the ongoing pregnancy rate beyond 12 weeks of gestation; secondary outcomes were live birth rate (LBR), stillbirth, birth weight, incidence of preeclampsia and/or gestational diabetes, gestational age at delivery, and fetal abnormalities. Four studies comprising 417 RPL women randomly assigned to steroid or control treatment were included. We found that oral corticosteroids significantly increase the ongoing pregnancy rate beyond 12 weeks of gestation compared to the control group (log OR [odds ratio] = 1.49 [0.32, 2.67], p = 0.01), with high heterogeneity (I2 = 75%), and improve LBR (log OR = 0.9 [0.11, 1.69], p = 0.03), with low heterogeneity (I2 = 0.05%). However, the limited number of studies significantly limits the strength of the findings. Also, the benefit/risk assessment of the use of corticosteroids in early pregnancy for RPL is still unclear.

Dose-, stage- and sex- difference of prenatal prednisone exposure on placental morphological and functional development

Prednisone, a synthetic glucocorticoid, is commonly used to treat autoimmune diseases in pregnant women. However, some studies suggest that the use of prednisone during pregnancy may lead to adverse pregnancy outcomes. In this study, we established PPE mouse models at different doses (0.25, 0.5, 1.0 mg/kg·d) and different stages (whole pregnancy, early pregnancy and middle-late pregnancy) and determined outcomes on the placenta and fetus. The results of our study indicated that at the highest dose of 1 mg/kg PPE using a GD 0-18 dosing regime, PPE caused placental morphological changes measured as a decrease in placental weight relative to controls and a decrease in the placenta junctional zone (JZ)/labyrinth zone (LZ) ratio. No changes were observed on the fetuses for number of live, stillborn, and absorbed fetuses between the experimental groups and the control group. In the placentas at some doses, there were decreases in cell proliferation markers measured at the RNA and protein level by Western blot and increased apoptosis. Measures of gene expression at the mRNA level showed altered nutrients (including glucose, amino acid, and cholesterol) transport gene expressions with the most significant change associated with the male placentas at high-dose and whole pregnancy PPE group. It was further found that PPE led to the inhibition of the insulin-like growth factor 2 (IGF2)/insulin-like growth factor 1 receptor (IGF1R) signaling pathway, which was well correlated with the indicators of cell proliferation, syncytialization and nutrient (glucose and amino acid) transport indices. In conclusion, PPE can alter placental morphology and nutrient transport function, with differences in effect related to dose, stage and gender. Differential gene expressions measured for genes of the IGF2/IGF1R signaling pathway suggested this pathway may be involved in the effects seen with PPE. This study provides a theoretical and experimental basis for enhancing the understanding of the effects of prednisone use on placenta during human pregnancy but does not currently raise concerns for human use as effects were not seen on the fetuses and while the effects on cell proliferation are informative they were inconsistent and the differential effects on female and male placentas unexplained suggesting that further work is required to elucidate if these findings have relevance for human use of PPE during pregnancy.

Effects of the Zishen Yutai Pill on live births compared with placebo among infertile women with frozen-thawed embryo transfer cycle: A multicentre double-blind randomized controlled trial

BACKGROUND

Zishen Yutai Pill exhibited clinical benefit to infertile women undergoing fresh embryo transfer cycles, improving their pregnancy outcomes. However, as the endometrial environment in frozen embryo transfer (FET) is different from fresh cycles, the effects of ZYP on fresh embryo transfer could not be generalized to FET.

OBJECTIVE

We aimed to explore the effects of ZYP on live birth rate in women's FET cycles.

METHODS

This multicentre, double-blind, placebo-controlled, randomized study was conducted at 11 reproductive medical centres in China. Women were recruited and randomly assigned to ZYP or placebo intervention (5 g once, 3 times per day) around the time of FET. The live birth rate was set as the primary outcome. Secondary outcomes included implantation rate, biochemical pregnancy rate, clinical pregnancy rate, pregnancy loss rates. Data was analyzed based on the intention-to-treat principle, with per protocol analysis as sensitivity analysis.

RESULTS

Between December 2017 and April 2019, 934 women were screened, of whom 880 met all eligibility criteria and were allocated to ZYP (n=441) or placebo (n=439). In ITT analysis, the live birth rates were 38.32% (169/441) in ZYP group and 32.57% (143/439) (absolute difference 5.75%, 95%CI [-0.57%, 12.00%], OR 1.29, 95%CI [0.98, 1.70], P=0.08). The intervention of ZYP did not result in significantly differences in all secondary outcomes compared with placebo (all P>0.05). Similar trends were observed in PP analysis. In post hoc analysis, ZYP resulted in higher rates of live birth than placebo among women in specific subgroups, i.e., with miscarriage history (39.23% vs. 26.45%, P=0.01) or advanced maternal age (33.93% vs. 21.85%, P=0.04).

CONCLUSION

In infertile women undergoing FET cycle, intervention with ZYP led to a trend of live birth rate increment compared with placebo, but without statistical significance. However, women with miscarriage history and advanced age could experience possible benefits from ZYP intervention.

REGISTRATION

ChiCTR-INR-17010809 (http://www.chictr.org.cn).

Early pregnancy exposure to Microcystin-LR compromises endometrial decidualization in mice via the PI3K/AKT/FOXO1 signaling pathway

Previous experimental studies have found that exposure to Microcystin-leucine arginine can impact pregnancy outcomes in female mice. The impact of MC-LR on early pregnancy in mammals is not yet well understood. Both mice and humans need to undergo decidualization to maintain pregnancy. In this study, we tried to evaluate whether MC-LR affects decidualization process in mice. Our research showed that MC-LR decreased maternal weight gain, uterine weight, and implantation site weight. These findings suggested that MC-LR exerted adverse effects on decidualization. In mice, we examined decreased number of polyploid decidual cells, but marked proliferation of mouse endometrial stromal cells the expression levels of prolactin (PRL)and insulin-like growth factor binding protein 1 (IGFBP1) were significantly downregulated in the decidual tissue and primary endometrial stromal cells following MC-LR treatment. Furthermore, further in vitro experiments identified that MC-LR promoted endometrial stromal cell division and cycle transition. Lastly, our study demonstrated that MC-LR impaired decidualization through the PI3K/AKT/FOXO1 pathway. Collectively, these data suggested that exposure to MC-LR impaired decidualization during early pregnancy.

Immunosuppressants in women with repeated implantation failure in assisted reproductive techniques: a systematic review and meta-analysis

Objective

To compare outcomes in patients with repeated implantation failure undergoing Intracytoplasmic Sperm Injection/In vitro fertilization (IVF/ICSI) plus immunosuppressants such as prednisolone, prednisone, or cyclosporine A versus the use of IVF/ICSI alone.

Data source

Databases were systematically searched in PubMed, Cochrane, and Embase databases in September 2023.

Study Selection

Randomized clinical trials and observational studies with the outcomes of interest were included.

Data collect

We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. Data were analyzed using Review Manager 5.4.The main outcomes were live birth, miscarriage, implantation rate, clinical pregnancy, and biochemical pregnancy.

Data synthesis

Seven studies with 2,829 patients were included. Immunosuppressive treatments were used in 1,312 (46.37%). Cyclosporine A improved implantation rate (OR 1.48; 95% CI 1.01-2.18) and clinical pregnancy (1.89, 95% CI 1.14-3.14). Compared to non-immunosuppressive treatment, prednisolone and prednisone did not improve live birth (OR 1.13, 95% CI 0.88-1.46) and miscarriage (OR 1.49, 95% CI 1.07-2.09). Prednisolone showed no significant effect in patients undergoing IVF/ICSI, clinical pregnancy (OR 1.34; 95% CI 0.76-2.36), or implantation rate (OR 1.36; 95% CI 0.76-2.42).

Conclusion

Cyclosporine A may promote implantation and clinical pregnancy rates. However, given the limited sample size, it is important to approach these findings with caution. Our results indicate that prednisolone and prednisone do not have any beneficial effects on clinical outcomes of IVF/ICSI patients with repeated implantation failure.

PROSPERO

CRD42023449655.

Impact of Systemic Lupus Erythematosus on Conception: Insights into Infertility, Fertility Preservation, Assisted Reproductive Technology, and Pregnancy Outcomes

Many individuals with systemic lupus erythematosus (SLE) face significant challenges manifesting their family planning goals due to numerous factors, including disease-related complications, treatment-induced effects, immunological factors, self-imposed limitations, and the socioeconomic impacts of having a chronic disease. Instances of unexplained infertility are also prevalent. Encouragingly, advancements in treatment modalities, risk factor management, specialized training within the medical community, and enhanced patient/provider education have contributed to an increase in successful pregnancies among SLE patients, fostering a safer, more promising reproductive landscape. However, despite advances, individuals with SLE continue to struggle with the complexities of family building. This review explores infertility and pregnancy outcomes in SLE, fertility preservation, the role of assisted reproductive technology, and considerations for tailoring these approaches to SLE patients.

Immunomodulatory Treatment Impact on IVF Outcomes in KIR AA Genotype: Personalized Fertility Insights

Background and Objectives: Recurrent implantation failure (RIF) affects 10% of couples undergoing in vitro fertilization (IVF), spurring exploration into tailored treatments to enhance implantation rates. Maternal immune tolerance towards embryos, particularly killer-cell immunoglobulin-like receptors (KIRs) on natural killer (NK) cells, is a focal point in RIF research. Materials and Methods: This retrospective cohort study, conducted at fertility clinic in Oradea, Romania, involved 65 infertile couples undergoing IVF treatment between January 2022 and December 2023. Couples were divided into two groups: KIR AA (Group A) and KIR Bx (Group B). Results: Factors such as age, type of infertility, oocytes retrieved, embryos produced, pregnancy rates in Group A without and with immunomodulatory treatment were documented. Group A, receiving immunomodulatory treatment, achieved a pregnancy rate of 47.8%, significantly higher than the 23.73% rate without treatment (p = 0.008). Group B had a higher mean patient age than Group A. However, miscarriage rates did not significantly differ between Group A with treatment and Group B (p = 0.2457), suggesting comparable outcomes with immunomodulation. Conclusions: The impact of immunological factors on recurrent implantation failure is being more and more emphasized and warrants the attention of specialists in human reproduction. Uterine natural killers and their function though KIR receptors deserve particular attention as immunomodulatory treatment may improve pregnancy rates in patients with KIR AA haplotype.

Maternal prednisone exposure during pregnancy elevates susceptibility to osteoporosis in female offspring: The role of mitophagy/FNDC5 alteration in skeletal muscle

Maternal exposure to glucocorticoids has been associated with adverse outcomes in offspring. However, the consequences and mechanisms of gestational exposure to prednisone on susceptibility to osteoporosis in the offspring remain unclear. Here, we found that gestational prednisone exposure enhanced susceptibility to osteoporosis in adult mouse offspring. In a further exploration of myogenic mechanisms, results showed that gestational prednisone exposure down-regulated FNDC5/irisin protein expression and activation of OPTN-dependent mitophagy in skeletal muscle of adult offspring. Additional experiments elucidated that activated mitophagy significantly inhibited the expression of FNDC5/irisin in skeletal muscle cells. Likewise, we observed delayed fetal bone development, downregulated FNDC5/irisin expression, and activated mitophagy in fetal skeletal muscle upon gestational prednisone exposure. In addition, an elevated total m6A level was observed in fetal skeletal muscle after gestational prednisone exposure. Finally, gestational supplementation with S-adenosylhomocysteine (SAH), an inhibitor of m6A activity, attenuated mitophagy and restored FNDC5/irisin expression in fetal skeletal muscle, which in turn reversed fetal bone development. Overall, these data indicate that gestational prednisone exposure increases m6A modification, activates mitophagy, and decreases FNDC5/irisin expression in skeletal muscle, thus elevating osteoporosis susceptibility in adult offspring. Our results provide a new perspective on the earlier prevention and treatment of fetal-derived osteoporosis.

Prenatal prednisone exposure impacts liver development and function in fetal mice and its characteristics

Prednisone, a widely used glucocorticoid drug in human and veterinary medicine, has been reported to cause developmental toxicity. However, systematic studies about the effect of prednisone on fetal liver development are still unclear. We investigated the potential effects of maternal exposure to clinically equivalent doses of prednisone during different gestational stages on cell proliferation and apoptosis, cell differentiation, glucose and lipid metabolism, and hematopoiesis in the liver of fetal mice, and explored the potential mechanisms. Results showed that prenatal prednisone exposure (PPE) could suppress cell proliferation, inhibit hepatocyte differentiation, and promote cholangiocyte differentiation in the fetal liver. Meanwhile, PPE could result in the enhancement of glyconeogenesis and bile acid synthesis and the inhibition of fatty acid β-oxidation and hematopoiesis in the fetal liver. Further analysis found that PPE-induced alterations in liver development had obvious stage and sex differences. Overall, the alteration in fetal liver development and function induced by PPE was most pronounced during the whole pregnancy (GD0-18), and the males were relatively more affected than the females. Additionally, fetal hepatic insulin-like growth factor 1 (IGF1) signaling pathway was inhibited by PPE. In conclusion, PPE could impact fetal liver development and multiple functions, and these alterations might be partially related to the inhibition of IGF1 signaling pathway.

Predictive models of recurrent implantation failure in patients receiving ART treatment based on clinical features and routine laboratory data

STUDY QUESTION

The objective was to construct a model for predicting the probability of recurrent implantation failure (RIF) after assisted reproductive technology (ART) treatment based on the clinical characteristics and routine laboratory test data of infertile patients. A model was developed to predict RIF. The model showed high calibration in external validation, helped to identify risk factors for RIF, and improved the efficacy of ART therapy.

WHAT IS KNOWN ALREADY

Research on the influencing factors of RIF has focused mainly on embryonic factors, endometrial receptivity, and immune factors. However, there are many kinds of examinations regarding these aspects, and comprehensive screening is difficult because of the limited time and economic conditions. Therefore, we should try our best to analyse the results of routine infertility screenings to make general predictions regarding the occurrence of RIF.

STUDY DESIGN, SIZE, DURATION

A retrospective study was conducted with 5212 patients at the Reproductive Center of the First Affiliated Hospital of USTC from January 2018 to June 2022.

PARTICIPANTS/MATERIALS, SETTING, METHODS

This study included 462 patients in the RIF group and 4750 patients in the control group. The patients' basic characteristics, clinical treatment data, and laboratory test indices were compared. Logistic regression was used to analyse RIF-related risk factors, and the prediction model was evaluated by receiver operating characteristic (ROC) curves and the corresponding areas under the curve (AUCs). Further analysis of the influencing factors of live births in the first cycle of subsequent assisted reproduction treatment in RIF patients was performed, including the live birth subgroup (n = 116) and the no live birth subgroup (n = 200).

MAIN RESULTS AND THE ROLE OF CHANCE

(1) An increased duration of infertility (1.978; 95% CI, 1.264-3.097), uterine cavity abnormalities (2.267; 95% CI, 1.185-4.336), low AMH levels (0.504; 95% CI, 0.275-0.922), insulin resistance (3.548; 95% CI, 1.931-6.519), antinuclear antibody (ANA)-positive status (3.249; 95% CI, 1.20-8.797) and anti-β2-glycoprotein I antibody (A-β2-GPI Ab)-positive status (5.515; 95% CI, 1.481-20.536) were associated with an increased risk of RIF. The area under the curve of the logistic regression model was 0.900 (95% CI, 0.870-0.929) for the training cohort and 0.895 (95% CI, 0.865-0.925) for the testing cohort. (2) Advanced age (1.069; 95% CI, 1.015-1.126) was a risk factor associated with no live births after the first cycle of subsequent assisted reproduction treatment in patients with RIF. Blastocyst transfer (0.365; 95% CI = 0.181-0.736) increased the probability of live birth in subsequent cycles in patients with RIF. The area under the curve of the logistic regression model was 0.673 (95% CI, 0.597-0.748).

LIMITATIONS, REASONS FOR CAUTION

This was a single-centre regression study, for which the results need to be evaluated and verified by prospective large-scale randomized controlled studies. The small sample size for the analysis of factors influencing pregnancy outcomes in subsequent assisted reproduction cycles for RIF patients resulted in the inclusion of fewer covariates, and future studies with larger samples and the inclusion of more factors are needed for assessment and validation.

WIDER IMPLICATIONS OF THE FINDINGS

Prediction of embryo implantation prior to transfer will facilitate the clinical management of patients and disease prediction and further improve ART treatment outcomes.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by the General Project of the National Natural Science Foundation of China (Nos. 82,201,792, 82,301,871, 81,971,446, and 82,374,212) and the Natural Science Foundation of Anhui Province (No. 2208085MH206). There are no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

This study was registered with the Chinese Clinical Trial Register (Clinical Trial Number: ChiCTR1800018298 ).

Intrauterine perfusion of dexamethasone improves pregnancy outcomes in recurrent reproductive failure patients with elevated uterine natural killer cells. A retrospective cohort study

OBJECTIVE

To determine the effect of intrauterine perfusion of dexamethasone (DXM) on pregnancy outcomes in recurrent reproductive failure (RRF) patients with elevated uNK cells.

METHODS

This retrospective cohort study included 132 RRF patients with elevated uNK cells: 56 patients received DXM treatment and 76 patients refused it in the frozen-thawed embryo transfer cycles. To determine the efficacy of intrauterine perfusion of DXM, multivariate logistic regression models and diagnosis-based subgroup analysis were performed. We also compared the pregnancy outcomes of patients with different responsiveness to DXM treatment.

RESULTS

Intrauterine perfusion of DXM significantly improved clinical pregnancy rate (aOR: 3.188, 95% CI: 1.395-7.282, P = .006) and live birth rate (aOR: 3.176, 95% CI: 1.318-7.656, P = .010) in RRF patients with elevated uNK cells, but there was no significant association with miscarriage rate. Subgroup analysis revealed that intrauterine perfusion of DXM in patients with recurrent implantation failure (RIF) showed significant improvement in clinical pregnancy rate (aOR: 6.110, 95% CI: 1.511-24.713, P = .011) and live birth rate (aOR: 9.904, 95% CI: 1.963-49.968, P = .005), but there was insufficient evidence of benefit in recurrent pregnancy loss (RPL) patients. Additionally, uNK cell levels dropped to normal range was achieved in only 35.90% of RRF patients after DXM treatment, no significant difference was found in pregnancy outcomes among patients with different responsiveness to DXM treatment (all P > .05).

CONCLUSION

Intrauterine perfusion of DXM was a promising and effective treatment to enhance clinical pregnancy rate and live birth rate in RRF women with abnormally elevated uNK cells, and RIF patients are more likely to benefit than RPL patients.

The Neglected Uterine NK Cells/Hamperl Cells/Endometrial Stromal Granular Cell, or K Cells: A Narrative Review from History through Histology and to Medical Education

Reproductive immunology is at the forefront of research interests, aiming to better understand the mechanisms of immune regulation during gestation. The relationship between the immune system and the implanting embryo is profound because the embryo is semi-allogenic but not targeted by the maternal immune system, as expected in graft-versus-host reactions. The most prominent cell population at the maternal-fetal interface is the population of uterine natural killer (uNK) cells. Uterine NK cells are two-faced immunologically active cells, bearing comparison with Janus, the ancient Roman god of beginnings and endings. Their first face can be seen as natural killer cells, namely lymphocytes, which are critical for host defense against viruses and tumors. Even though uNK cells contain cytolytic molecules, their cytotoxic effect is not applied to classical target cells in vivo, playing a permissive rather than a defensive role. Their second face is crucial in maintaining physiological gestation-uNK cells show critical immunomodulatory functions with the potential to control embryo implantation and trophoblast invasion, regulate placental vascular remodeling, and promote embryonic/fetal growth. Therefore, we believe that their current designation "natural killer cells" (the first "cytotoxic" Janus's face) is misleading and inappropriate, considering their principal function is supporting and maintaining pregnancy. In this narrative review, we will focus on three lesser-known areas of knowledge about uNK cells. First, from the point of view of histology, we will comprehensively map the history of the discovery of these cells, as well as the current histological possibilities of their identification within the endometrium. To be brief, the discovery of uNK cells is generally attributed to Herwig Hamperl, one of the most influential and prominent representatives of German pathology in the 20th century, and his co-worker, Gisela Hellweg. Secondly, we will discuss the interesting aspect of terminology, since uNK cells are probably one of the human cells with the highest number of synonymous names, leading to significant discrepancies in their descriptions in scientific literature. From the first description of this cell type, they were referred to as endometrial granulocytes, granular endometrial stromal cells, or large granular lymphocytes until the end of the 1980s and the beginning of the 1990s of the last century, when the first publications appeared where the name "uterine NK cells" was used. The third area of present review is medical teaching of histology and clinical embryology. We can confirm that uNK cells are, in most textbooks, overlooked and almost forgotten cells despite their enormous importance. In the present narrative review, we summarize the lesser-known historical and terminological facts about uNK cells. We can state that within the textbooks of histology and embryology, this important cell population is still "overlooked and neglected" and is not given the same importance as in fields of clinical research and clinical practice.