1
|
Khattak H, Aleem Husain S, Baker D, Greer I. Use of anticoagulants to improve pregnancy outcomes in couples positive for M2 haplotype: A systematic review. Eur J Obstet Gynecol Reprod Biol 2024; 296:179-184. [PMID: 38452530 DOI: 10.1016/j.ejogrb.2024.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 02/03/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Placental mediated pregnancy complications (PMPC) are common, often recurring, and pose a significant health risk to mother and fetus. Evidence suggests that the hypercoagulable state associated with many PMPC, could reflect reduced expression of Annexin 5 (ANXA5), a naturally occurring anticoagulant protein in placental tissue. The ANXA5 M2 haplotype is a genetic variant, which results in reduced expression of ANXA5 protein. M2 haplotype carrier couples may therefore be at increased risk of PMPC. Evidence regarding the effectiveness of anticoagulation to prevent PMPC is inconsistent. Furthermore, studies have not selected or stratified for M2 haplotype carriers, in whom there is a predisposition to hypercoagulability, to assess the effectiveness of anticoagulation, which may vary from those without the M2 haplotype. OBJECTIVES AND RATIONALE The aim of this study was to systematically review the current evidence to assess whether anticoagulant treatment improves pregnancy outcomes in couples positive for M2 haplotype. SEARCH METHODS The review was registered on PROSPERO (CRD42022343943). A comprehensive literature search was performed using MEDLINE, Embase and Cochrane collaboration databases from inception to January 2023. Two reviewers assessed the articles for eligibility and extracted the data simultaneously. Primary outcome was successful pregnancy and live birth. Secondary outcomes included PMPC (implantation failure, miscarriage, pre-eclampsia, preterm birth and fetal growth restriction). OUTCOMES From a pool of 410 references, 10 were selected for full text review, of which three studies (a post hoc analysis of a randomised controlled trial, cohort study and a case report) were included in this review. Included studies comprised of 223 individuals, 129 of whom who received anticoagulation treatment after testing positive for M2 haplotype. The studies collectively showed an improvement in pregnancy outcomes in M2 haplotype positive individuals however, given the heterogeneity of studies, it was not possible to conduct a meta-analysis and draw firm conclusions. WIDER IMPLICATIONS Current evidence is limited, such that the value of screening couples for the M2 haplotype to select or stratify for treatment with prophylactic anticoagulation remains unknown. Thus, further studies including well designed, large, multi-centre randomised controlled trials are required to assess whether anticoagulation treatment will be effective in improving pregnancy outcomes in M2 haplotype couples.
Collapse
Affiliation(s)
- Hajra Khattak
- WHO Collaborating Centre for Women's Health, Institute of Translational Medicine, University of Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK; Elizabeth Garrett Anderson Institute for Women's Health, University College, London, UK.
| | - Syed Aleem Husain
- Sandwell and West Birmingham NHS Trust, Dudley Rd, Birmingham B18 7QH, UK
| | - Deborah Baker
- IHG Pharmaco Ltd, 20-22 Wenlock Road, London N17GU, UK
| | - Ian Greer
- Queen's University Belfast, University Road, Belfast BT7 1NN, Northern Ireland, UK
| |
Collapse
|
2
|
Peng L, Yang W, Deng X, Bao S. Research progress on ANXA5 in recurrent pregnancy loss. J Reprod Immunol 2022; 153:103679. [PMID: 35964539 DOI: 10.1016/j.jri.2022.103679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/06/2022] [Accepted: 07/26/2022] [Indexed: 10/15/2022]
Abstract
The incidence of recurrent pregnancy loss (RPL) in fertile women ranges from 1% to 5%, of which about 50% of them are due to unknown causes. The possible pathogenesis of RPL is an urgent problem to be solved in the clinical. Mutations or polymorphisms of certain genes in the coagulation mechanism are associated with susceptibility to thrombotic diseases and are one of the main reasons for the occurrence of RPL. Among them, the ANXA5 gene was newly studied and some single nucleotide polymorphisms (SNPs) in the promoter region of ANXA5 have been reported to be associated with RPL in multiple races. In this review, we summarized the research progress on the correlation between the SNPs in ANXA5 and RPL, hoping to provide some valuable guidance for the future studies.
Collapse
Affiliation(s)
- Liying Peng
- Department of Reproductive Immunology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai 200092, China; Shanghai Key Laboratory of Maternal and Fetal Medicine, Shanghai First Maternity & Infant Hospital, Shanghai 201204, China
| | - Wanli Yang
- Department of Medical Genetics, The First Rehabilitation Hospital of Shanghai, School of Medicine, Tongji University, Shanghai 200092, China
| | - Xujing Deng
- Department of Reproductive Immunology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai 200092, China; Shanghai Key Laboratory of Maternal and Fetal Medicine, Shanghai First Maternity & Infant Hospital, Shanghai 201204, China
| | - Shihua Bao
- Department of Reproductive Immunology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai 200092, China; Shanghai Key Laboratory of Maternal and Fetal Medicine, Shanghai First Maternity & Infant Hospital, Shanghai 201204, China.
| |
Collapse
|
3
|
Benchaib M, Labrune E, Giscard d'Estaing S, Salle B, Lornage J. Shallow artificial networks with morphokinetic time‐lapse parameters coupled to
ART
data allow to predict live birth. Reprod Med Biol 2022; 21:e12486. [PMID: 36310657 PMCID: PMC9601773 DOI: 10.1002/rmb2.12486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/10/2022] [Accepted: 09/08/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The purpose of this work was to construct shallow neural networks (SNN) using time‐lapse technology (TLT) from morphokinetic parameters coupled to assisted reproductive technology (ART) parameters in order to assist the choice of embryo(s) to be transferred with the highest probability of achieving a live birth (LB). Methods A retrospective observational single‐center study was performed, 654 cycles were included. Three SNN: multilayers perceptron (MLP), simple recurrent neuronal network (simple RNN) and long short term memory RNN (LSTM‐RNN) were trained with K‐fold cross‐validation to avoid sampling bias. The predictive power of SNNs was measured using performance scores as AUC (area under curve), accuracy, precision, Recall and F1 score. Results In the training data group, MLP and simple RNN provide the best performance scores; however, all AUCs were above 0.8. In the validating data group, all networks were equivalent with no performance scores difference and all AUC values were above 0.8. Conclusion Coupling morphokinetic parameters with ART parameters allows to SNNs to predict the probability of LB, and all SNNs seems to be efficient according to the performance scores. An automatic time recognition system coupled to one of these SNNs could allow a complete automation to choose the blastocyst(s) to be transferred.
Collapse
Affiliation(s)
- Mehdi Benchaib
- Hospices Civil de Lyon, HFME, Médecine de la Reproduction & Préservation de la Fertilité Féminine Bron cedex France
- UMR CNRS 5558 LBBE Villeurbanne Cedex France
- Université Lyon I, Faculté de Médecine Lyon Est Lyon France
| | - Elsa Labrune
- Hospices Civil de Lyon, HFME, Médecine de la Reproduction & Préservation de la Fertilité Féminine Bron cedex France
- Université Lyon I, Faculté de Médecine Lyon Est Lyon France
- Inserm U1208 Bron cedex France
| | - Sandrine Giscard d'Estaing
- Hospices Civil de Lyon, HFME, Médecine de la Reproduction & Préservation de la Fertilité Féminine Bron cedex France
- Inserm U1208 Bron cedex France
- Université Lyon I, Faculté de Médecine Lyon Sud Oullins cedex France
| | - Bruno Salle
- Hospices Civil de Lyon, HFME, Médecine de la Reproduction & Préservation de la Fertilité Féminine Bron cedex France
- Inserm U1208 Bron cedex France
- Université Lyon I, Faculté de Médecine Lyon Sud Oullins cedex France
| | - Jacqueline Lornage
- Hospices Civil de Lyon, HFME, Médecine de la Reproduction & Préservation de la Fertilité Féminine Bron cedex France
- Inserm U1208 Bron cedex France
- Université Lyon I, Faculté de Médecine Lyon Sud Oullins cedex France
| |
Collapse
|
4
|
Rana B, Zimmerman R, Marin D, Xu J, Messick E, Fishel S, Treff N. A novel test for annexin A5 M2 haplotyping in in vitro fertilization patients and preimplantation embryos. F&S SCIENCE 2021; 2:278-286. [PMID: 35560278 DOI: 10.1016/j.xfss.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/26/2021] [Accepted: 06/03/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To develop a test for evaluating the annexin A5 M2 haplotype in in vitro fertilization patients and preimplantation embryos. DESIGN Test performance was measured by comparing Sanger sequencing of parental blood DNA and quantitative real-time polymerase chain reaction (qPCR) of saliva DNA, 3 fibroblast cell line 7-cell aliquots and their corresponding purified DNA, 123 trophectoderm biopsy samples, and DNA isolated from 1 embryonic stem cell line along with the Mendelian inheritance expectations, embryo Sanger sequencing, and single-nucleotide polymorphism (SNP) microarray-based linkage analysis. SETTING Preimplantation genetic testing laboratory research on IVF patient and embryo DNA. PATIENT(S) An assay was developed for the detection of the M2 haplotype on saliva samples of 6 in vitro fertilization patients. In addition, 13 patients who underwent preimplantation genetic testing with data on parental and embryo biopsy DNA available for research use were evaluated. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The concordance rates between Sanger sequencing, SNP array-based linkage analysis, and Mendelian inheritance expectations with qPCR. RESULT(S) The concordance rate between Sanger sequencing and qPCR was 100% on parental blood DNA and saliva DNA. The sample concordance rate between all replicates of 7-cell aliquots was 100%. The sample concordance rate between 3 cell lines used to prepare 7-cell aliquots and purified genomic DNA was 100%. The concordance rate between qPCR and Sanger sequencing results from a single trophectoderm biopsy and isolated embryonic stem cell line was 100%. The concordance rate of trophectoderm biopsy qPCR results and expectations from Mendelian inheritance rules was 97%; however, when SNP array-based linkage analysis was included, the concordance rate reached 100%. CONCLUSION(S) This study resulted in the development of a convenient saliva collection method and qPCR-based genotyping method to screen for the M2 haplotype. In addition, a novel method for testing preimplantation embryos has been established, providing an alternative to the use of low molecular weight heparin, through selection of embryos without the M2 haplotype.
Collapse
Affiliation(s)
- Bhavini Rana
- Genomic Prediction Clinical Laboratory, North Brunswick, New Jersey; School of Graduate Studies, Microbiology and Molecular Genetics, Rutgers University, Piscataway, New Jersey.
| | | | - Diego Marin
- Genomic Prediction Clinical Laboratory, North Brunswick, New Jersey
| | - Jia Xu
- Genomic Prediction Clinical Laboratory, North Brunswick, New Jersey
| | - Edward Messick
- Genomic Prediction Clinical Laboratory, North Brunswick, New Jersey
| | - Simon Fishel
- Care Fertility Group, Nottingham, United Kingdom; School of Pharmacy and Biomolecular Sciences, Liverpool John Moore's University, Byrom Street, Liverpool, United Kingdom
| | - Nathan Treff
- Genomic Prediction Clinical Laboratory, North Brunswick, New Jersey; School of Graduate Studies, Microbiology and Molecular Genetics, Rutgers University, Piscataway, New Jersey
| |
Collapse
|
5
|
Giscard d'Estaing S, Labrune E, Forcellini M, Edel C, Salle B, Lornage J, Benchaib M. A machine learning system with reinforcement capacity for predicting the fate of an ART embryo. Syst Biol Reprod Med 2021; 67:64-78. [PMID: 33719832 DOI: 10.1080/19396368.2020.1822953] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this work was to construct a score issued from a machine learning system with self-improvement capacity able to predict the fate of an ART embryo incubated in a time lapse monitoring (TLM) system. A retrospective study was performed. For the training data group, 110 couples were included and, 891 embryos were cultured. For the global setting data group, 201 couples were included, and 1186 embryos were cultured. No image analysis was used; morphokinetic parameters from the first three days of embryo culture were used to perform a logistic regression between the cell number and time. A score named DynScore was constructed, the prediction power of the DynScore on blastocyst formation and the baby delivery were tested via the area under the curve (AUC) obtained from the receiver operating characteristic (ROC). In the training data group, the DynScore allowed the blastocyst formation prediction (AUC = 0.634, p < 0.001), this approach was the higher among the set of the tested scores. Similar results were found with the global setting data group (AUC = 0.638, p < 0.001) and it was possible to increase the AUC of the DynScore with a regular update of the prediction system by reinforcement, with an AUC able to reach a value above 0.9. As only the best blastocysts were transferred, none of the tested scores was able to predict delivery. In conclusion, the DynScore seems to be able to predict the fate of an embryo. The reinforcement of the prediction system allows maintaining the predictive capacity of DynScore irrespective of the various events that may occur during the ART process. The DynScore could be implemented in any TLM system and adapted by itself to the data of any ART center.Abbreviations: ART: assisted reproduction technology; TLM: time lapse monitoring system; AUC: area under the curve; ROC: receiver operating characteristic; eSET: elective single embryo transfer; AIS: artificial intelligence system; KID: known implantation data; AMH: anti-Müllerian hormone; BMI: body mass index; WHO: World Health Organization; c-IVF: conventional in-vitro fertilization; ICSI: intracytoplasmic sperm injection; PNf: pronuclear formation; D3: day 3; D5: day 5; D6: day 6; GnRH: gonadotrophin releasing hormone; FSH: follicle stimulating hormone; LH: luteinizing hormone; hCG: human chorionic gonadotropin; PVP: polyvinyl pyrrolidone; PNf: time of pronuclear fading; tx: time of cleavage to x blastomeres embryo; ICM: inner cell mass; TE: trophectoderm; NbCellt: number of cells at t time; FIFO: first in first out; TD: training data group; SD: setting data group; R: real world.
Collapse
Affiliation(s)
- Sandrine Giscard d'Estaing
- Biologie de la Reproduction, Hospices Civil de Lyon, HFME, Bron, France.,Inserm U1208, Bron, France.,Faculté de Médecine Lyon Sud, Université Claude Bernard, Oullins, France
| | - Elsa Labrune
- Biologie de la Reproduction, Hospices Civil de Lyon, HFME, Bron, France.,Inserm U1208, Bron, France.,Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon, France
| | | | - Cecile Edel
- Biologie de la Reproduction, Hospices Civil de Lyon, HFME, Bron, France.,Faculté de Médecine Lyon Sud, Université Claude Bernard, Oullins, France
| | - Bruno Salle
- Biologie de la Reproduction, Hospices Civil de Lyon, HFME, Bron, France.,Inserm U1208, Bron, France.,Faculté de Médecine Lyon Sud, Université Claude Bernard, Oullins, France
| | - Jacqueline Lornage
- Biologie de la Reproduction, Hospices Civil de Lyon, HFME, Bron, France.,Inserm U1208, Bron, France.,Faculté de Médecine Lyon Sud, Université Claude Bernard, Oullins, France
| | - Mehdi Benchaib
- Biologie de la Reproduction, Hospices Civil de Lyon, HFME, Bron, France.,Inserm U1208, Bron, France.,Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon, France.,Riverly, IRSTEA, Villeurbanne, France
| |
Collapse
|
6
|
Rogenhofer N, Markoff A, Ennerst X, Bogdanova N, Thaler C. Maternal and paternal carriage of the annexin A5 M2 haplotype: a possible risk factor for recurrent implantation failure (RIF). J Assist Reprod Genet 2020; 38:235-242. [PMID: 33231792 PMCID: PMC7822994 DOI: 10.1007/s10815-020-01978-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/30/2020] [Accepted: 10/12/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE This study was carried out to determine the potential role of the M2/ANXA5 haplotype as a risk factor for recurrent implantation failure (RIF). Carriage of the M2/ANXA5 haplotype that induces prothrombotic changes has been implicated in failure of early pregnancies and placenta-mediated complications (preeclampsia, IUGR, preterm birth). MATERIAL AND METHODS In the present case control study, 63 couples (females and males) with RIF presenting for IVF/ICSI to the Fertility Center of [masked] were analyzed. RIF was defined as ≥ 4 consecutive failed ART-transfers of ≥ 4 blastocysts or ≥ 8 cleavage-stage embryos of optimal quality and maternal age ≤ 41. Fertile female controls (n = 90) were recruited from the same center. Population controls (n = 533) were drafted from the PopGen biobank, UKSH Kiel. RESULTS Couples carrying the M2/ANXA5 haplotype turned out to have a significantly increased relative risk (RR) for RIF. Compared with female fertile controls, RR was 1.81 with p = 0.037 (OR 2.1, 95%CI 1.0-4.3) and RR was 1.70, with p = 0.004 (OR 2.0, 95%CI 1.2-3.1) compared with population controls (15.4% M2 carriers). Male partners were comparable with RIF females for M2/ANXA5 haplotypes (28.6% vs. 23.8%, p = 0.54). RIF females compared with population controls had a RR of 1.55 (p = 0.09) and RIF males compared with population controls had a RR of 1.9 (p = 0.01). Couples with ≥ 7 failed transfers showed a RR of 1.82 (p = 0.02) compared with population controls. CONCLUSION Our findings suggest that maternal as well as paternal M2/ANXA5 haplotype carriages are risk factors for RIF. These results allow new insights into the pathogenesis of RIF and might help to identify relevant risk groups.
Collapse
Affiliation(s)
- Nina Rogenhofer
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynaecology and Obstetrics, University Hospital of the Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Arseni Markoff
- Institute of Human Genetics, UKM and WWU, Muenster, Germany
| | - Xenia Ennerst
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynaecology and Obstetrics, University Hospital of the Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | | | - Christian Thaler
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynaecology and Obstetrics, University Hospital of the Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| |
Collapse
|
7
|
Association between M2/ANXA5 haplotype and repeated pregnancy loss: a meta-analysis. Fertil Steril 2019; 111:971-981.e2. [PMID: 30922645 DOI: 10.1016/j.fertnstert.2019.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/08/2019] [Accepted: 01/08/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To ascertain the magnitude and precision of the association between M2/ANXA5 haplotype and repeated pregnancy loss (RPL). DESIGN Meta-analysis of odds ratios. SETTING Not applicable. PATIENT(S) Subjects were women with RPL and their partners. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) The association between M2/ANXA5 haplotype and RPL was evaluated in a meta-analysis of odds ratios. We further scrutinized this association according to [1] the sequence of miscarriages, [2] the number of consecutive losses, [3] the extent of excluding other pathologies of RPL, and [4] the timing of fetal loss. RESULT(S) Fourteen individual studies (n = 4,664 subjects) were included in this meta-analysis. The results show that women with the M2/ANXA5 haplotype have 1.54 times (95% confidence interval, 1.08-2.20) the odds of having associated RPL compared with women with the normal haplotype, regardless of consecutive or nonconsecutive pregnancy losses. Acknowledging the clinical heterogeneity among the studies, this significant association comes with a caveat that the lower bound of the confidence interval is close to unity. In couple populations (n = 2,449), M2/ANXA5 haplotype subjects have an odds ratio of 1.48 (95% confidence interval, 1.14-1.91) of experiencing RPL, which suggests contributions from paternal M2/ANXA5 carriers in RPL. CONCLUSION(S) This meta-analysis ascertains that women with the M2/ANXA5 haplotype have a higher risk of experiencing RPL, especially consecutive early idiopathic RPL. Male partners with the M2/ANXA5 haplotype partly contribute to this risk. Hence, screening for the M2/ANXA5 haplotype as a panel of laboratory investigations for RPL is recommended.
Collapse
|
8
|
Time-lapse imaging algorithms rank human preimplantation embryos according to the probability of live birth. Reprod Biomed Online 2018; 37:304-313. [DOI: 10.1016/j.rbmo.2018.05.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 05/15/2018] [Accepted: 05/22/2018] [Indexed: 01/20/2023]
|
9
|
Yang XL, Chen F, Yang XY, Du GH, Xu Y. Efficacy of low-molecular-weight heparin on the outcomes of in vitro fertilization/intracytoplasmic sperm injection pregnancy in non-thrombophilic women: a meta-analysis. Acta Obstet Gynecol Scand 2018; 97:1061-1072. [PMID: 29700821 PMCID: PMC6100106 DOI: 10.1111/aogs.13359] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/17/2018] [Indexed: 01/25/2023]
Abstract
Introduction The aim of our study was to evaluate the effect of low‐molecular‐weight heparin on pregnancy outcomes in women without thrombophilia during in vitro fertilization/intracytoplasmic sperm injection treatment. Material and methods We searched Pubmed, Web of Science, Embase, Cochrane and CNKI (from inception to 2 February 2018). Our study identified randomized controlled trials or quasi‐randomized controlled trials comparing low‐molecular‐weight heparin subcutaneous treatment with no treatment or only luteal support control. The outcomes included live birth rate, clinical pregnancy rate and miscarriage rate. Results Five trials, including 935 women receiving in vitro fertilization/intracytoplasmic sperm injection treatment, were included in meta‐analyses. There were 458 women receiving low‐molecular‐weight heparin and 477 in the control group. No significant differences for live birth rate, clinical pregnancy rate and miscarriage rate were found between the low‐molecular‐weight heparin and control groups. Of them, four trials reported live birth rate as an outcome and the risk ratio was 1.13 (95% confidence interval 0.88–1.43, p = 0.34). All five trials reported clinical pregnancy rate as an outcome, the risk ratio was 1.08 (95% confidence interval 0.87–1.32, p = 0.47). Three trials reported miscarriage rate and the risk ratio was 0.58 (95% confidence interval 0.30–1.10, p = 0.09). In women with two or more failed in vitro fertilization/intracytoplasmic sperm injection cycles, the risk ratio of live birth rate was 1.15 and the risk ratio of clinical pregnancy rate was 1.17. In women with three or more failed in vitro fertilization/intracytoplasmic sperm injection cycles, the risk ratios of live birth rate and clinical pregnancy rate were 1.36 and 1.35, respectively. Conclusions Our results suggested that low‐molecular‐weight heparin had no effect on pregnancy success rate in non‐thrombophilic women undergoing in vitro fertilization/intracytoplasmic sperm injection treatment. However, to justify the use of low‐molecular‐weight heparin in clinical practice, multicenter trials are still necessary.
Collapse
Affiliation(s)
- Xiu-Li Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Fei Chen
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Xiu-Ying Yang
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines and Beijing Key Laboratory of Drug Target and Screening Research, Institute of Materia Medica of Peking Union Medical College, Beijing, China
| | - Guan-Hua Du
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines and Beijing Key Laboratory of Drug Target and Screening Research, Institute of Materia Medica of Peking Union Medical College, Beijing, China
| | - Yang Xu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| |
Collapse
|
10
|
Danisik H, Bogdanova N, Markoff A. Micromolar Zinc in Annexin A5 Anticoagulation as a Potential Remedy for RPRGL3-Associated Recurrent Pregnancy Loss. Reprod Sci 2018; 26:348-356. [PMID: 29716435 DOI: 10.1177/1933719118773497] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Deficient expression of the placental anticoagulant annexin A5 (ANXA5) has been associated with thrombophilia-related pregnancy complications and ultimately with recurrent pregnancy loss (RPL). Carrier status of M2/ANXA5 ( RPRGL3), common ANXA5 promoter variant, has been identified as genetic cause of reduced ANXA5 levels and proposed as biomarker for successful anticoagulant treatment of RPL women. A murine model of AnxA5 loss of function displayed characteristic placental pathology and fetal loss that was alleviated through anticoagulant intervention. This study identified an alternative means of supplementing anticoagulation, through elevated ANXA5 expression. Physiological micromolar Zn2+ stimulated ANXA5 transcription, raising ANXA5 protein expression and surface abundance on BeWo and human umbilical vein endothelial cells (HUVEC), thus resulting in prolonged coagulation times. Zn2-fed AnxA5 functionally deficient pregnant mice showed a trend to increase litter size when primiparous that grew comparable to wild-type progeny in subsequent pregnancies. Elevated AnxA5 signal upon Zn2+ treatment was confirmed in murine placentae. Micromolar Zn2+ stimulated ANXA5 expression in cell culture directly and alleviated RPL in AnxA5 genetically deficient mice, without notable toxicity effects.
Collapse
Affiliation(s)
- Hayrünnisa Danisik
- 1 Institute of Human Genetics, University Clinic Muenster, Muenster, Germany
| | - Nadia Bogdanova
- 1 Institute of Human Genetics, University Clinic Muenster, Muenster, Germany
| | - Arseni Markoff
- 1 Institute of Human Genetics, University Clinic Muenster, Muenster, Germany
| |
Collapse
|
11
|
Aranda F, Udry S, Perés Wingeyer S, Amshoff LC, Bogdanova N, Wieacker P, Latino JO, Markoff A, de Larrañaga G. Maternal carriers of the ANXA5 M2 haplotype are exposed to a greater risk for placenta-mediated pregnancy complications. J Assist Reprod Genet 2018; 35:921-928. [PMID: 29497952 DOI: 10.1007/s10815-018-1142-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/15/2018] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Annexin A5 (ANXA5) is a protein abundantly expressed in normal placenta where it contributes to the healthy outcome of a pregnancy. Lower ANXA5 levels have been observed in M2/ANXA5 haplotype carrying chorion. Consequently, this study aimed to assess the potential association of M2 maternal carrier status with the risk of recurrent pregnancy loss (RPL), the timing of miscarriages, and other obstetric complications, for the first time in a population from Latin America. METHODS This study was designed as a prospective recruitment of RPL patients with post hoc analysis. The distribution of the M2/ANXA5 haplotype was compared between a group of 229 Argentine women with RPL and 100 parous controls, and was further analyzed in subgroups of patients stratified according to the timing of miscarriages and in relation to other obstetric complications. RESULTS No significant differences were found in the distribution of M2 haplotype among either RPL patients or the subgroups with embryonic, early fetal, or late fetal losses compared to parous controls. Notwithstanding, maternal M2/ANXA5 was found to be independently associated with a higher risk of suffering intrauterine growth restriction (IUGR) and/or preeclampsia (PE). Simultaneously, the presence of inherited and/or acquired thrombophilia also proved to be an independent risk factor for these. CONCLUSIONS The association found between the maternal carriage of the M2/ANXA5 haplotype and an elevated risk of IUGR and/or PE supports the hypothesis that carrier status of this haplotype and the consequently reduced placental ANXA5 expression might be responsible, at least partially, for the onset of these gestational vascular complications.
Collapse
Affiliation(s)
- Federico Aranda
- Hemostasis and Thrombosis Laboratory, Hospital of Infectious Diseases "Dr Francisco J. Muñiz", Uspallata 2272, C1282AEN, Buenos Aires, Argentina.
| | - Sebastián Udry
- Section of Autoimmune Diseases, Thrombophilia and Pregnancy, Acute Care Hospital "Dr Carlos G. Durand", Av. Díaz Vélez 5044, C1405DCS, Buenos Aires, Argentina
| | - Silvia Perés Wingeyer
- Hemostasis and Thrombosis Laboratory, Hospital of Infectious Diseases "Dr Francisco J. Muñiz", Uspallata 2272, C1282AEN, Buenos Aires, Argentina
| | - Lea Christina Amshoff
- Institute of Human Genetics, University Clinic Muenster, Vesaliusweg 12, 48149, Muenster, Germany
| | - Nadja Bogdanova
- Institute of Human Genetics, University Clinic Muenster, Vesaliusweg 12, 48149, Muenster, Germany
| | - Peter Wieacker
- Institute of Human Genetics, University Clinic Muenster, Vesaliusweg 12, 48149, Muenster, Germany
| | - José Omar Latino
- Section of Autoimmune Diseases, Thrombophilia and Pregnancy, Acute Care Hospital "Dr Carlos G. Durand", Av. Díaz Vélez 5044, C1405DCS, Buenos Aires, Argentina
| | - Arseni Markoff
- Institute of Human Genetics, University Clinic Muenster, Vesaliusweg 12, 48149, Muenster, Germany
| | - Gabriela de Larrañaga
- Hemostasis and Thrombosis Laboratory, Hospital of Infectious Diseases "Dr Francisco J. Muñiz", Uspallata 2272, C1282AEN, Buenos Aires, Argentina
| |
Collapse
|
12
|
Fishel S, Campbell A, Montgomery S, Smith R, Nice L, Duffy S, Jenner L, Berrisford K, Kellam L, Smith R, D'Cruz I, Beccles A. Live births after embryo selection using morphokinetics versus conventional morphology: a retrospective analysis. Reprod Biomed Online 2017; 35:407-416. [DOI: 10.1016/j.rbmo.2017.06.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 11/16/2022]
|
13
|
Association of silent infarcts in sickle cell anemia with decreased annexin A5 resistance. Blood Cells Mol Dis 2017; 69:53-56. [PMID: 28911832 DOI: 10.1016/j.bcmd.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sickle cell anemia (SCA) is characterized by abnormally shaped, adhesive RBCs that interact with white blood cells and the endothelium, leading to chronic hemolysis, vasculopathy and a prothrombotic state. About 10% of subjects with a thrombotic event in the general population will have an associated antiphospholipid (aPL) antibody. One proposed mechanism for the thrombophilic nature of aPL antibodies is the disruption of the potent anticoagulant annexin A5 or Annexin A5 resistance (A5R). We designed a pilot study assessing the presence of aPL antibodies and disruption of A5R in pediatric sickle cell subjects. METHODS 39 subjects with SCA participated in this study. A5R, DRVVT, anti-β2GP1, anti-β2GP1, anti-phosphatidylserine and anti-cardiolipin antibody assays were performed. RESULTS There was a high prevalence of abnormal A5R despite a low prevalence of antiphospholipid antibodies. Multivariate logistic regression analyses showed an association with silent infarcts (p=0.015), lower hemoglobin (p=0.037), older age (p=0.047) and abnormal A5R. CONCLUSION We report an association between annexin A5 resistance and presence of silent infarct, low hemoglobin, and older age in a subgroup of SCA subjects. A potential role for perturbed A5R in the pathophysiology of SCA needs to be evaluated further.
Collapse
|
14
|
Assessment of M2/ANXA5 haplotype as a risk factor in couples with placenta-mediated pregnancy complications. J Assist Reprod Genet 2017; 35:157-163. [PMID: 28900802 DOI: 10.1007/s10815-017-1041-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The aim of this study was to confirm the associated M2/ANXA5 carrier risk in women with placenta-mediated pregnancy complications (PMPC) and to test their male partners for such association. Further analysis evaluated the influence of maternal vs. paternal M2 alleles on miscarriage. METHODS Two hundred eighty-eight couples with preeclampsia (PE), intrauterine growth restriction (IUGR), or premature birth (PB) were recruited (n = 96 of each phenotype). The prevalence of the M2 haplotype was compared to two control cohorts. They included a group of women with a history of normal pregnancy without gestational pathology (Munich controls, n = 94) and a random population sample (PopGen controls, n = 533). RESULTS Significant association of M2 haplotype and pregnancy complications was confirmed for women and for couples, where prevalence was elevated from 15.4 to 23.8% (p < 0.001). Post hoc analyses demonstrated an association for IUGR and PB individually. A strong link between previous miscarriages and M2 carrier status was identified which may explain the predisposition to placental pregnancy complication. M2/ANXA5 appears to be a risk factor for adverse pregnancy outcomes related, but not limited to miscarriages, with similar prevalence in women and their male partners. CONCLUSION These findings support the proposed physiological function of ANXA5 as an embryonic anticoagulant that appears deficient in contiguous specter of thrombophilia-related pregnancy complications culminating more frequently in miscarriage in a maternal M2 carrier background.
Collapse
|
15
|
Elevated annexin A5 plasma levels in term pregnancies of M2/ANXA5 carriers. Thromb Res 2017; 156:87-90. [DOI: 10.1016/j.thromres.2017.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/01/2017] [Accepted: 06/07/2017] [Indexed: 11/18/2022]
|
16
|
Collins SC. Precision reproductive medicine: multigene panel testing for infertility risk assessment. J Assist Reprod Genet 2017; 34:967-973. [PMID: 28470451 DOI: 10.1007/s10815-017-0938-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/27/2017] [Indexed: 12/11/2022] Open
Abstract
The concept of precision medicine relies on a thorough understanding of the consequences of unique features of individual patients, such as environmental exposures and genetic profiles. A key component of implementing individualized care in this paradigm will be improved assessment of genetic risk. Compared with single gene tests, multigene panel testing-which has recently become commercially available for female infertility-offers the possibility of a more comprehensive and efficient risk evaluation. However, as the use of multigene panel testing for breast cancer risk has shown, this approach must be used judiciously to ensure its usefulness in a clinical setting. Key challenges which have been encountered in oncology include the interpretation of gene variants of questionable clinical effect and a lack of evidence to guide management after variants are identified. In this review, the core concepts of multigene panel testing for risk assessment are discussed, with careful attention to both its shortcomings as well as its potential for benefit in reproductive medicine.
Collapse
Affiliation(s)
- Stephen C Collins
- Division of Reproductive Endocrinology and Infertility, Yale School of Medicine, 150 Sargent Drive, Second Floor, New Haven, CT, 06511, USA.
| |
Collapse
|
17
|
Ormesher L, Simcox LE, Tower C, Greer IA. 'To test or not to test', the arguments for and against thrombophilia testing in obstetrics. Obstet Med 2017; 10:61-66. [PMID: 28680464 DOI: 10.1177/1753495x17695696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 01/26/2017] [Indexed: 11/16/2022] Open
Abstract
Clinicians increasingly investigate women for thrombophilias due to their associations with venous thromboembolism and placenta-mediated pregnancy complication. These associations, however, are modest and based largely on retrospective data from studies with heterogeneous classifications and populations, leading to discordance between evidence and guidelines. Current evidence suggests a contributory rather than causative role for thrombophilia in placenta-mediated pregnancy complication and venous thromboembolism. With little evidence of benefit from antithrombotic therapy in placenta-mediated pregnancy complication, thrombophilia screening remains controversial. Given the low absolute risk of placenta-mediated pregnancy complication and gestational venous thromboembolism with heritable thrombophilia, universal screening is inappropriate. Selective screening for antiphospholipid syndrome is supported by robust evidence of benefit. Conversely, selective screening for heritable thrombophilia has not been shown to effectively manage placenta-mediated pregnancy complication. Therefore, at present heritable thrombophilia screening is not warranted for placenta-mediated pregnancy complication. Until we have better evidence from better stratified patient groups, caution should remain if we wish to practice evidence-based medicine.
Collapse
Affiliation(s)
- Laura Ormesher
- Department of Obstetrics, St Mary's Hospital, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK.,Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester, UK
| | - Louise E Simcox
- Department of Obstetrics, St Mary's Hospital, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK.,Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester, UK
| | - Clare Tower
- Department of Obstetrics, St Mary's Hospital, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK.,Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester, UK
| | - Ian A Greer
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
18
|
Genetic analysis of the M2/ANXA5 haplotype as recurrent pregnancy loss predisposition in the Malay population. J Assist Reprod Genet 2017; 34:517-524. [PMID: 28108842 DOI: 10.1007/s10815-017-0871-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate a new predisposition factor, M2/ANXA5 (RPRGL3), in recurrent pregnancy loss (RPL) patients of Malay origin, since it was previously known that the prevalence of this condition is relatively high among the Malay population of Malaysia, where conventional hereditary thrombophilia factors have been generally ruled out. METHODS A total of 232 women who had experienced ≥2 unexplained RPL and 141 available male partners were recruited, with 360 healthy Malay and 166 parous female controls. Prevalence of M2 carriage and RPL odds ratios were calculated in (a) control and patient groups; (b) clinically defined subgroups in categories of pregnancy loss, primary, secondary, and tertiary; and (c) timing of pregnancy loss in early, ≤15th gestation week and "late" fetal losses, and >15th gestation week subgroups. RESULTS Both male and female subjects had similar M2/ANXA5 allele frequencies. The carrier rate of M2/ANXA5 for the general Malay population was 42.2 and 34.9% for parous controls. These carrier rates compared to Malay RPL subjects (52% M2 carriers) resulted in elevated odds ratios (95% confidence interval) of 1.53 (1.1 to 2.1) and 1.97 (1.3 to 3.1) accordingly for early fetal losses. Moreover, exceeding copy numbers of M2/ANXA5 alleles seemed to afflict a greater chance of RPL in couples, especially when both partners were M2 carriers. CONCLUSION This study confirmed the proposed role of M2/ANXA5 as embryonic, genetically associated thrombophilia predisposition factor for early RPL among ethnic Malay of Malaysia.
Collapse
|