Physiological aspects of blastocyst uterine interaction

Pregnancy outcomes in oocyte donation recipients: vaginal gel versus intramuscular injection progesterone replacement

PURPOSE

Compare outcomes with vaginal gel versus intramuscular progesterone replacement in donor oocyte recipients.

METHODS

A single-center retrospective analysis (January 2004-December 2006) evaluated pregnancy outcomes (serum human chorionic gonadotropin, implantation, clinical pregnancy, delivery, total pregnancy loss rates) for 225 recipients of embryos from donor (aged <32 years) oocytes. Vaginal progesterone gel (Crinone® 8%; 90 mg twice daily; n = 105) or intramuscular progesterone (50 mg once daily; n = 120) was started the afternoon of oocyte retrieval and continued until a negative pregnancy test or 10 weeks' gestation.

RESULTS

There were no statistically significant differences between groups for the five pregnancy outcomes; numerical results favored vaginal progesterone in all cases. Confidence intervals showed vaginal gel was within, or <1% from, a noninferiority limit of 10% versus intramuscular progesterone for four of five pregnancy outcomes.

CONCLUSIONS

Pregnancy outcomes were comparable for progesterone replacement with vaginal gel and intramuscular progesterone in an oocyte donation program.

Synthesis of prostaglandins by pig blastocysts cultured in medium containing estradiol or catechol estrogen

Two experiments were conducted to determine the effects of 2-hydroxy-estradiol-17 beta (2-OH-E2; 0, 50 and 100 microM) and estradiol-17 beta (E2; 0, 25 and 50 microM) on prostaglandin (PG) E and PGF2 alpha synthesis by day-10 pig blastocysts (day 0 is first day of estrus). Blastocysts were incubated in a modified Krebs-Ringer bicarbonate medium, supplemented with bovine serum albumin (4 mg/ml) and the vitamins and amino acids (essential and nonessential) in Minimum Essential Medium (without phenol red or antibiotics). The incubations were conducted at 39 degrees C for three 2-h periods; the second and third periods included an E2 or catechol estrogen treatment. Release of PGF2 alpha into the culture medium decreased (p less than 0.001) linearly with increasing concentrations of 2-OH-E2 in both periods. Release of PGE was not affected by 2-OH-E2, therefore 2-OH-E2 increased (p less than 0.06) the PGE:PGF2 alpha. When E2 was added to the medium, release of PGE was decreased (p less than 0.01) during the second and third periods. Release of PGF2 alpha also was decreased (p less than 0.05) by E2 during period 2, but E2 did not alter the PGE:PGF2 alpha. Content of PGs in blastocysts at recovery was less than 10% of the PGs released in vitro. Therefore, these studies demonstrate effects of both the primary and catechol forms of E2 on the synthesis of PGE and PGF2 alpha. Catechol estrogens and E2 may inhibit PG synthesis and modify the PGE:PGF2 alpha during the establishment of pregnancy in pigs.

Regulation of ovarian function by catecholestrogens: current concepts

Development of the ovarian follicle(s) destined for ovulation appears to be a process in which antral follicles undergo a recruitment, selection and subsequent dominance phase. Several intraovarian or autocrine/paracrine regulatory mechanisms have been evoked to explain these processes. One of these potential autocrine/paracrine regulators is a catecholestrogen, 2-hydroxy-estradiol (2-OH-E2). Evidence implicating 2-OH-E2 as an autocrine/paracrine regulator of follicular function is reviewed. Studies have shown 2-OH-E2 to be present in nanomolar concentrations in fluid of human and equine follicles. In addition, the enzyme responsible for converting estradiol (E2) into 2-OH-E2, estrogen 2-hydroxylase (E-2-H), is abundant in granulosa and thecal cells (but not corpora lutea) of porcine follicles. Moreover, activity of E-2-H increases during follicular development in pigs. In vitro, the actions of 2-OH-E2 have been compared to those of E2, gonadotropins, catecholamines, and androgens. Studies indicated that the maximal stimulatory effects of 2-OH-E2 on progesterone production were comparable to those of E2 and gonadotropins, and greater than androgens or catecholamines. The effect of 2-OH-E2 was found to be significantly additive to each of the other classes of compounds at maximally effective concentrations, suggesting that the mechanism of action of 2-OH-E2 was different. The mode of action of the several stimulators of progesterone biosynthesis were examined additionally with antihormones for E2, catecholamines, and androgens. In each instance, the hormonal antagonists were able to inhibit the action of the predicted class of effector compounds. However, with the exception of the antiandrogen, hydroxyflutamide, no effects of anti-hormones on the action of 2-OH-E2 were observed. In the aggregate, these studies suggested that the action of 2-OH-E2 is mediated by a mechanism discrete from those of the other classes of hormones examined to date, and that hydroxyflutamide exhibits both antiandrogen and anticatecholestrogen activity. 2-OH-E2 can also enhance the actions of other trophic hormones, epinephrine, LH and FSH, by enhancing hormone-stimulated cAMP production. This effect on epinephrine action appears to be due to a 2-OH-E2-stimulated increase in the density of beta-adrenergic receptors. Whether 2-OH-E2 stimulates an increase in the number of LH and FSH receptors remains to be determined. The precise locus of the stimulatory effect of 2-OH-E2 alone on steroidogenesis is unclear but preliminary data would suggest that 2-OH-E2 may be stimulating side-chain cleavage enzyme activity.(ABSTRACT TRUNCATED AT 400 WORDS)

Hormonal control of implantation in guinea pigs

In the guinea pig, for which implantation is supposedly progesterone-dependent, actual hormonal requirements were assessed by measuring the levels of circulating estradiol and progesterone and correlating them with their content in the ovaries and uterus, and uterine concentrations of their receptors prior to, during, and immediately after implantation. Ovarian and uterine content and plasma levels of estradiol and progesterone, as well as uterine cytosolic receptors of these two hormones, were high at proestrus. Up to day 3 of pregnancy, estradiol remained high in peripheral plasma, ovarian and uterine tissues, but reached low levels at the time of implantation. The levels of progesterone showed a gradual increase in plasma and ovaries till the time of implantation, with the embryonic site of the uterus accumulating more of progesterone compared to estradiol. As pregnancy progressed, a gradual translocation of cytosolic to nuclear receptors occurred, both with estradiol and progesterone receptors. Comparing the receptor values for estradiol at each uterine site showed no significant alterations between embryonic and interembryonic cytosolic receptors. While significantly high levels of nuclear estradiol receptor were found at the inter-embryonic site on day 9 of pregnancy, the cytosolic and nuclear progesterone receptor concentrations were greater at the embryonic site on the same day. These findings demonstrated that the uterus is adequately exposed to estradiol and progesterone prior to ovulation and again in early pregnancy (day 1-3), thus facilitating implantation in the guinea pig (on days 7-8).