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Tremellen K, Alfer J, Cotán D, Pérez-Sánchez M, Harvey AJ, Gardner DK. Effect of a novel copper chloride gel on endometrial growth and function in healthy volunteers. Reprod Biomed Online 2024; 49:104107. [PMID: 39067212 DOI: 10.1016/j.rbmo.2024.104107] [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: 02/07/2024] [Revised: 04/10/2024] [Accepted: 05/07/2024] [Indexed: 07/30/2024]
Abstract
RESEARCH QUESTION Does the application of a micro-dose of copper chloride gel increase endometrial production of vascular endothelial growth factor (VEGF) without compromising endometrial function or producing embryo toxicity? DESIGN An estimate of optimal dose was made based on cell culture studies. Ten healthy participants received an initial uterine application of placebo gel, followed by copper chloride gel (37.5 μM, 75 μM, or 150 μM dose) in a later hormone replacement cycle. Endometrial biopsies (day 5.5 luteal) and pelvic ultrasound were carried out during each cycle to evaluate endometrial function and growth. Uterine fluid was assessed for residual copper levels on the day of biopsy, and copper chloride gel underwent mouse embryos assay assessment for potential embryo toxicity. RESULTS The copper gel significantly increased endometrial VEGF expression (quantitative polymerase chain reaction), and also increasing endometrial thickness by an average of 2.2 mm compared with matched control cycles. The copper gel did not adversely affect endometrial morphology or maturation (histological dating and molecular receptivity testing), and mouse embryos assay studies showed no evidence of embryo toxicity. Furthermore, uterine cavity flush samples mostly lacked copper, with only negligible amounts present in one sample. CONCLUSION Applying copper chloride gel to the uterine cavity upregulated endometrial VEGF and significantly increased endometrial thickness and volume. No adverse effects on the endometrium or embryos were observed. Copper chloride gels show promise for treating suboptimal endometrial thickness if the results of this study are confirmed by larger randomized controlled trials.
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Affiliation(s)
- Kelton Tremellen
- Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Bedford Park, South Australia; Repromed, Dulwich, South Australia.
| | | | | | | | | | - David K Gardner
- School of Biosciences, University of Melbourne, Victoria, Australia
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2
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Yang T, Hou Z, Zhang Q, Zhao J, Liu N, Liu D, Li Y, Wang Y, Xu B, Zou Y, Wan C, Li Y. Personalized embryo transfer guided by rsERT with hourly precision improves pregnancy outcomes in patients with a receptive window of implantation: a pilot study. J Assist Reprod Genet 2024:10.1007/s10815-024-03246-y. [PMID: 39254797 DOI: 10.1007/s10815-024-03246-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 08/29/2024] [Indexed: 09/11/2024] Open
Abstract
PURPOSE To investigate whether personalized embryo transfer (pET) predicted by a modified RNA-sequencing-based endometrial receptivity test (rsERT) model can improve intrauterine pregnancy rate (IPR) in patients with a receptive window of implantation (WOI). DESIGN A retrospective pilot study was conducted in the Center for Reproductive Medicine, Central South University, from January 2018 to December 2023. A total of 524 patients with receptive WOI results from rsERT were assigned into two groups based on whether they underwent conventional embryo transfer (conventional ET) or pET. Patients in the conventional ET were matched with those in the pET group at a 1:1 ratio using propensity score matching (PSM). RESULTS Before PSM, the IPR (55.73% vs. 46.19%, P = 0.032) and implantation rate (IR) (47.51% vs. 34.03%, P = 0.000) in the pET group were significantly higher than that in the conventional ET group. However, the number and types of transferred embryos differed significantly between the two groups. After adjusting for confounding factors, IPR (57.38% vs. 44.81, P = 0.016) and IR (46.81% vs. 33.10%, P = 0.001) remained significantly higher in the pET group compared to the conventional ET group. The implantation failure rate was significantly lower in the pET group compared to controls (42.62% vs. 55.19%, P = 0.016). Additionally, the multiple-pregnancy rate was significantly higher in the pET group compared to the conventional ET group (10.29% vs. 1.68%, P = 0.001). CONCLUSIONS Women with receptive WOI results could benefit from the receptivity-timed pET predicted by the newly refined rsERT. These findings provide a basis for future research in precision medicine for embryo transfer.
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Affiliation(s)
- Tianli Yang
- Reproductive Medicine Center, Xiangya Hospital of Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, P. R. China.
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410008, Hunan, P. R. China.
| | - Zhaojuan Hou
- Reproductive Medicine Center, Xiangya Hospital of Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, P. R. China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410008, Hunan, P. R. China
| | - Qiong Zhang
- Reproductive Medicine Center, Xiangya Hospital of Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, P. R. China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410008, Hunan, P. R. China
| | - Jing Zhao
- Reproductive Medicine Center, Xiangya Hospital of Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, P. R. China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410008, Hunan, P. R. China
| | - Nenghui Liu
- Reproductive Medicine Center, Xiangya Hospital of Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, P. R. China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410008, Hunan, P. R. China
| | - Donge Liu
- Reproductive Medicine Center, Xiangya Hospital of Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, P. R. China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410008, Hunan, P. R. China
| | - Yumei Li
- Reproductive Medicine Center, Xiangya Hospital of Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, P. R. China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410008, Hunan, P. R. China
| | - Yonggang Wang
- Reproductive Medicine Center, Xiangya Hospital of Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, P. R. China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410008, Hunan, P. R. China
| | - Bin Xu
- Reproductive Medicine Center, Xiangya Hospital of Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, P. R. China
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410008, Hunan, P. R. China
| | - Yangyun Zou
- Department of Clinical Research, Yikon Genomics Company, Ltd., Suzhou, 215123, Jiangsu, P. R. China
| | - Cheng Wan
- Department of Clinical Research, Yikon Genomics Company, Ltd., Suzhou, 215123, Jiangsu, P. R. China
| | - Yanping Li
- Reproductive Medicine Center, Xiangya Hospital of Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, P. R. China.
- Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha, 410008, Hunan, P. R. China.
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3
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Deryabin PI, Borodkina AV. The Role of the Endometrium in Implantation: A Modern View. Int J Mol Sci 2024; 25:9746. [PMID: 39273693 PMCID: PMC11395593 DOI: 10.3390/ijms25179746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 09/06/2024] [Accepted: 09/08/2024] [Indexed: 09/15/2024] Open
Abstract
According to the current data, the endometrium acts as a "sensor" of embryo quality, which promotes the implantation of euploid embryos and prevents the implantation and/or subsequent development of genetically abnormal embryos. The present review addresses the nature of the "sensory function" of the endometrium and highlights the necessity for assessing its functional status. The first section examines the evolutionary origin of the "sensory" ability of the endometrium as a consequence of spontaneous decidualization that occurred in placental animals. The second section details the mechanisms for implementing this function at the cellular level. In particular, the recent findings of the appearance of different cell subpopulations during decidualization are described, and their role in implantation is discussed. The pathological consequences of an imbalance among these subpopulations are also discussed. Finally, the third section summarizes information on currently available clinical tools to assess endometrial functional status. The advantages and disadvantages of the approaches are emphasized, and possible options for developing more advanced technologies for assessing the "sensory" function of the endometrium are proposed.
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Affiliation(s)
- Pavel I Deryabin
- Mechanisms of Cellular Senescence Laboratory, Institute of Cytology of the Russian Academy of Sciences, Tikhoretsky Ave. 4, Saint-Petersburg 194064, Russia
| | - Aleksandra V Borodkina
- Mechanisms of Cellular Senescence Laboratory, Institute of Cytology of the Russian Academy of Sciences, Tikhoretsky Ave. 4, Saint-Petersburg 194064, Russia
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Kurmanova G, Ashirbekov Y, Kurmanova A, Mamedaliyeva N, Moshkalova G, Anartayeva G, Salimbayeva D, Tulesheva A. Altered Expression of C4BPA and CXCL1 Genes in the Endometrium of Patients with Recurrent Implantation Failure after In Vitro Fertilization and Thin Endometrium. Diagnostics (Basel) 2024; 14:1967. [PMID: 39272751 PMCID: PMC11394423 DOI: 10.3390/diagnostics14171967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Revised: 08/30/2024] [Accepted: 09/04/2024] [Indexed: 09/15/2024] Open
Abstract
Currently, recurrent implantation failure (RIF) after in vitro fertilization is a problem that is commonly faced by reproductive specialists. The phenomenon of a thin endometrium in RIF patients is not yet completely understood or sufficiently treated. This study aimed to reveal the dysregulated expression of selected genes between RIF patients with a thin endometrium and fertile women. Endometrial samples were collected in the implantation window (21-24 days of the natural menstrual cycle) from RIF patients (n = 20) and fertile women (n = 14). Ten genes were chosen as target genes regarding their possible relations with the implantation process. The endometrial gene expression levels showed differences in RIF samples compared to fertile samples. Significant downregulation was observed for the CXCL1 (p = 0.005) and C4BPA (p = 0.03) genes. There was no statistically significant difference between the RIF group and the fertile group in the expression of eight genes: CXCL8, HPRT1, MMP10, INFG, VEGFB, HAND2, IL-15, and TNC (p > 0.05). The use of a combination of two markers (C4BPA + CXCL1) allows for the good discrimination of RIF patients from fertile women (AUC 0.806).
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Affiliation(s)
- Gaukhar Kurmanova
- Medicine and Healthcare Faculty, Al Farabi Kazakh National University, 71 Al-Farabi Avenue, Almaty 050040, Kazakhstan
| | - Yeldar Ashirbekov
- M. Aitkhozhin Institute of Molecular Biology and Biochemistry, 86 Dosmukhamedov Street, Almaty 050012, Kazakhstan
| | - Almagul Kurmanova
- Medicine and Healthcare Faculty, Al Farabi Kazakh National University, 71 Al-Farabi Avenue, Almaty 050040, Kazakhstan
| | - Nagima Mamedaliyeva
- Medicine and Healthcare Faculty, Al Farabi Kazakh National University, 71 Al-Farabi Avenue, Almaty 050040, Kazakhstan
| | - Gaukhar Moshkalova
- Medicine and Healthcare Faculty, Al Farabi Kazakh National University, 71 Al-Farabi Avenue, Almaty 050040, Kazakhstan
| | - Gaini Anartayeva
- Medicine and Healthcare Faculty, Al Farabi Kazakh National University, 71 Al-Farabi Avenue, Almaty 050040, Kazakhstan
| | - Damilya Salimbayeva
- Scientific Center of Obstetrics, Gynecology and Perinatology, 125 Dostyk Ave., Almaty 050010, Kazakhstan
| | - Aidana Tulesheva
- Medicine and Healthcare Faculty, Al Farabi Kazakh National University, 71 Al-Farabi Avenue, Almaty 050040, Kazakhstan
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Loid M, Obukhova D, Kask K, Apostolov A, Meltsov A, Tserpelis D, van den Wijngaard A, Altmäe S, Yahubyan G, Baev V, Saare M, Peters M, Minajeva A, Adler P, Acharya G, Krjutškov K, Nikolova M, Vilella F, Simon C, Zamani Esteki M, Salumets A. Aging promotes accumulation of senescent and multiciliated cells in human endometrial epithelium. Hum Reprod Open 2024; 2024:hoae048. [PMID: 39185250 PMCID: PMC11344589 DOI: 10.1093/hropen/hoae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 06/26/2024] [Indexed: 08/27/2024] Open
Abstract
STUDY QUESTION What changes occur in the endometrium during aging, and do they impact fertility? SUMMARY ANSWER Both the transcriptome and cellular composition of endometrial samples from women of advanced maternal age (AMA) are significantly different from that of samples from young women, suggesting specific changes in epithelial cells that may affect endometrial receptivity. WHAT IS KNOWN ALREADY Aging is associated with the accumulation of senescent cells in aging tissues. Reproductive aging is mostly attributed to the decline in ovarian reserve and oocyte quality, whereas the endometrium is a unique complex tissue that is monthly renewed under hormonal regulation. Several clinical studies have reported lower implantation and pregnancy rates in oocyte recipients of AMA during IVF. Molecular studies have indicated the presence of specific mutations within the epithelial cells of AMA endometrium, along with altered gene expression of bulk endometrial tissue. STUDY DESIGN SIZE DURATION Endometrial transcriptome profiling was performed for 44 women undergoing HRT during the assessment of endometrial receptivity before IVF. Patients younger than 28 years were considered as the young maternal age (YMA) group (age 23-27 years) and women older than 45 years were considered as the AMA group (age 47-50 years). Endometrial biopsies were obtained on Day 5 of progesterone treatment and RNA was extracted. All endometrial samples were evaluated as being receptive based on the expression of 68 common endometrial receptivity markers. Endometrial samples from another 24 women classified into four age groups (YMA, intermediate age group 1 (IMA1, age 29-35), intermediate age group 2 (IMA2, age 36-44), and AMA) were obtained in the mid-secretory stage of a natural cycle (NC) and used for validation studies across the reproductive lifespan. PARTICIPANTS/MATERIALS SETTING METHODS A total of 24 HRT samples (12 YMA and 12 AMA) were subject to RNA sequencing (RNA-seq) and differential gene expression analysis, 20 samples (10 YMA and 10 AMA) were used for qPCR validation, and 24 NC samples (6 YMA, 6 IMA1, 6 IMA2 and 6AMA) were used for RNA-seq validation of AMA genes across the woman's reproductive lifespan. Immunohistochemistry (IHC) was used to confirm some expression changes at the protein level. Computational deconvolution using six endometrial cell type-specific transcriptomic profiles was conducted to compare the cellular composition between the groups. MAIN RESULTS AND THE ROLE OF CHANCE Comparisons between YMA and AMA samples identified a lower proportion of receptive endometria in the AMA group (P = 0.007). Gene expression profiling identified 491 differentially expressed age-sensitive genes (P adj < 0.05) that revealed the effects of age on endometrial epithelial growth and receptivity, likely contributing to decreased reproductive performance. Our results indicate that changes in the expression of the cellular senescence marker p16INK4a and genes associated with metabolism, inflammation, and hormone response are involved in endometrial aging. Importantly, we demonstrate that the proportion of multi-ciliated cells, as discovered based on RNA-seq data deconvolution and tissue IHC results, is affected by endometrial aging, and propose a putative onset of age-related changes. Furthermore, we propose that aging has an impact on the transcriptomic profile of endometrial tissue in the context of endometrial receptivity. LARGE SCALE DATA The raw sequencing data reported in this article are deposited at the Gene Expression Omnibus under accession code GSE236128. LIMITATIONS REASONS FOR CAUTION This retrospective study identified changes in the endometrium of patients undergoing hormonal replacement and validated these changes using samples obtained during a NC. However, future studies must clarify the importance of these findings on the clinical outcomes of assisted reproduction. WIDER IMPLICATIONS OF THE FINDINGS The findings reported in this study have important implications for devising future strategies aimed at improving fertility management in women of advanced reproductive age. STUDY FUNDING/COMPETING INTERESTS This research was funded by the Estonian Research Council (grant no. PRG1076), Horizon 2020 innovation grant (ERIN, grant no. EU952516), Enterprise Estonia (grant no. EU48695), MSCA-RISE-2020 project TRENDO (grant no. 101008193), EU 874867 project HUTER, the Horizon Europe NESTOR grant (grant no. 101120075) of the European Commission, the EVA specialty program (grant no. KP111513) of the Maastricht University Medical Center (MUMC+), MICIU/AEI/10.13039/501100011033 and FEDER, EU projects Endo-Map (grant no. PID2021-12728OB-100), ROSY (grant no. CNS2022-135999), and the National Science Fund of Bulgaria (grant no. KII-06 H31/2). The authors declare no competing interests.
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Affiliation(s)
- Marina Loid
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
| | - Darina Obukhova
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Keiu Kask
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
| | - Apostol Apostolov
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
| | - Alvin Meltsov
- Competence Centre on Health Technologies, Tartu, Estonia
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Demis Tserpelis
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Arthur van den Wijngaard
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Signe Altmäe
- Department of Biochemistry and Molecular Biology, Faculty of Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Galina Yahubyan
- Department of Molecular Biology, Faculty of Biology, University of Plovdiv, Plovdiv, Bulgaria
| | - Vesselin Baev
- Department of Molecular Biology, Faculty of Biology, University of Plovdiv, Plovdiv, Bulgaria
| | - Merli Saare
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
| | - Maire Peters
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
| | - Ave Minajeva
- Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Priit Adler
- Faculty of Science and Technology, Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Ganesh Acharya
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Kaarel Krjutškov
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
| | - Maria Nikolova
- Department of Molecular Biology, Faculty of Biology, University of Plovdiv, Plovdiv, Bulgaria
- Center for Women's Health, Plovdiv, Bulgaria
| | - Felipe Vilella
- Research & Medical Department, Carlos Simon Foundation, INCLIVA Health Research Institute, Valencia, Spain
| | - Carlos Simon
- Research & Medical Department, Carlos Simon Foundation, INCLIVA Health Research Institute, Valencia, Spain
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
- Department of Pediatrics, Obstetrics & Gynecology, University of Valencia, Valencia, Spain
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Masoud Zamani Esteki
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Andres Salumets
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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6
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Diaz-Gimeno P, Sebastian-Leon P, Spath K, Marti-Garcia D, Sanchez-Reyes JM, Vidal MDC, Devesa-Peiro A, Sanchez-Ribas I, Martinez-Martinez A, Pellicer N, Wells D, Pellicer A. Predicting risk of endometrial failure: a biomarker signature that identifies a novel disruption independent of endometrial timing in patients undergoing hormonal replacement cycles. Fertil Steril 2024; 122:352-364. [PMID: 38518993 DOI: 10.1016/j.fertnstert.2024.03.015] [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: 05/17/2023] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE To propose a new gene expression signature that identifies endometrial disruptions independent of endometrial luteal phase timing and predicts if patients are at risk of endometrial failure. DESIGN Multicentric, prospective study. SETTING Reproductive medicine research department in a public hospital affiliated with private fertility clinics and a reproductive genetics laboratory. PATIENTS Caucasian women (n = 281; 39.4 ± 4.8 years old with a body mass index of 22.9 ± 3.5 kg/m2) undergoing hormone replacement therapy between July 2018 and July 2021. Endometrial samples from 217 patients met RNA quality criteria for signature discovery and analysis. INTERVENTION(S) Endometrial biopsies collected in the mid-secretory phase. MAIN OUTCOME MEASURE(S) Endometrial luteal phase timing-corrected expression of 404 genes and reproductive outcomes of the first single embryo transfer (SET) after biopsy collection to identify prognostic biomarkers of endometrial failure. RESULTS Removal of endometrial timing variation from gene expression data allowed patients to be stratified into poor (n = 137) or good (n = 49) endometrial prognosis groups on the basis of their clinical and transcriptomic profiles. Significant differences were found between endometrial prognosis groups in terms of reproductive rates: pregnancy (44.6% vs. 79.6%), live birth (25.6% vs. 77.6%), clinical miscarriage (22.2% vs. 2.6%), and biochemical miscarriage (20.4% vs. 0%). The relative risk of endometrial failure for patients predicted as a poor endometrial prognosis was 3.3 times higher than those with a good prognosis. The differences in gene expression between both profiles were proposed as a biomarker, coined the endometrial failure risk (EFR) signature. Poor prognosis profiles were characterized by 59 upregulated and 63 downregulated genes mainly involved in regulation (17.0%), metabolism (8.4%), immune response, and inflammation (7.8%). This EFR signature had a median accuracy of 0.92 (min = 0.88, max = 0.94), median sensitivity of 0.96 (min = 0.91, max = 0.98), and median specificity of 0.84 (min = 0.77, max = 0.88), positioning itself as a promising biomarker for endometrial evaluation. CONCLUSION(S) The EFR signature revealed a novel endometrial disruption, independent of endometrial luteal phase timing, present in 73.7% of patients. This EFR signature stratified patients into 2 significantly distinct and clinically relevant prognosis profiles providing opportunities for personalized therapy. Nevertheless, further validations are needed before implementing this gene signature as an artificial intelligence (AI)-based tool to reduce the risk of patients experiencing endometrial failure.
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Affiliation(s)
- Patricia Diaz-Gimeno
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain.
| | - Patricia Sebastian-Leon
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | | | - Diana Marti-Garcia
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Josefa Maria Sanchez-Reyes
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
| | - Maria Del Carmen Vidal
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain; Reproductive Medicine Center, IVI RMA Valencia, Valencia, Spain
| | - Almudena Devesa-Peiro
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
| | - Immaculada Sanchez-Ribas
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain; Reproductive Medicine Center, IVI RMA Barcelona, Barcelona, Spain
| | - Asunta Martinez-Martinez
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Nuria Pellicer
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain; Reproductive Medicine Center, IVI RMA Valencia, Valencia, Spain
| | - Dagan Wells
- JUNO Genetics, Winchester House, Oxford, United Kingdom; Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre John Radcliffe Hospital, Oxford, United Kingdom
| | - Antonio Pellicer
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain; JUNO Genetics, Winchester House, Oxford, United Kingdom; Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain; Reproductive Medicine Center, IVI RMA Rome, Largo Il de brando Pizzetti, Roma, Italy
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7
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Poh QH, Rai A, Pangestu M, Salamonsen LA, Greening DW. Rapid generation of functional nanovesicles from human trophectodermal cells for embryo attachment and outgrowth. Proteomics 2024; 24:e2300056. [PMID: 37698557 DOI: 10.1002/pmic.202300056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/09/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
Extracellular vesicles (EVs) are important mediators of embryo attachment and outgrowth critical for successful implantation. While EVs have garnered immense interest in their therapeutic potential in assisted reproductive technology by improving implantation success, their large-scale generation remains a major challenge. Here, we report a rapid and scalable production of nanovesicles (NVs) directly from human trophectoderm cells (hTSCs) via serial mechanical extrusion of cells; these NVs can be generated in approximately 6 h with a 20-fold higher yield than EVs isolated from culture medium of the same number of cells. NVs display similar biophysical traits (morphologically intact, spherical, 90-130 nm) to EVs, and are laden with hallmark players of implantation that include cell-matrix adhesion and extracellular matrix organisation proteins (ITGA2/V, ITGB1, MFGE8) and antioxidative regulators (PRDX1, SOD2). Functionally, NVs are readily taken up by low-receptive endometrial HEC1A cells and reprogram their proteome towards a receptive phenotype that support hTSC spheroid attachment. Moreover, a single dose treatment with NVs significantly enhanced adhesion and spreading of mouse embryo trophoblast on fibronectin matrix. Thus, we demonstrate the functional potential of NVs in enhancing embryo implantation and highlight their rapid and scalable generation, amenable to clinical utility.
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Affiliation(s)
- Qi Hui Poh
- Baker Heart and Diabetes Institute, Molecular Proteomics, Melbourne, Victoria, Australia
- Department of Biochemistry and Chemistry, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, Victoria, Australia
- Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, Victoria, Australia
| | - Alin Rai
- Baker Heart and Diabetes Institute, Molecular Proteomics, Melbourne, Victoria, Australia
- Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Mulyoto Pangestu
- Education Program in Reproduction and Development (EPRD), Department of Obstetrics and Gynaecology, Monash Clinical School, Monash University, Clayton, Victoria, Australia
| | - Lois A Salamonsen
- Hudson Institute of Medical Research and Monash University, Clayton, Victoria, Australia
| | - David W Greening
- Baker Heart and Diabetes Institute, Molecular Proteomics, Melbourne, Victoria, Australia
- Department of Biochemistry and Chemistry, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, Victoria, Australia
- Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia
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8
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Khan NLA, Muhandiram S, Dissanayake K, Godakumara K, Midekessa G, Andronowska A, Heath PR, Kodithuwakku S, Hart AR, Fazeli A. Effect of 3D and 2D cell culture systems on trophoblast extracellular vesicle physico-chemical characteristics and potency. Front Cell Dev Biol 2024; 12:1382552. [PMID: 38835509 PMCID: PMC11148233 DOI: 10.3389/fcell.2024.1382552] [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: 02/05/2024] [Accepted: 04/30/2024] [Indexed: 06/06/2024] Open
Abstract
The growing understanding of the role of extracellular vesicles (EVs) in embryo-maternal communication has sparked considerable interest in their therapeutic potential within assisted reproductive technology, particularly in enhancing implantation success. However, the major obstacle remains the large-scale production of EVs, and there is still a gap in understanding how different culture systems affect the characteristics of the EVs. In the current study, trophoblast analogue human chorionic carcinoma cell line was cultivated in both conventional monolayer culture (2D) and as spheroids in suspension culture (3D) and how the cell growth environment affects the physical, biochemical and cellular signalling properties of EVs produced by them was studied. Interestingly, the 3D system was more active in secreting EVs compared to the 2D system, while no significant differences were observed in terms of morphology, size, and classical EV protein marker expression between EVs derived from the two culture systems. There were substantial differences in the proteomic cargo profile and cellular signalling potency of EVs derived from the two culture systems. Notably, 2D EVs were more potent in inducing a cellular response in endometrial epithelial cells (EECs) compared to 3D EVs. Therefore, it is essential to recognize that the biological activity of EVs depends not only on the cell of origin but also on the cellular microenvironment of the parent cell. In conclusion, caution is warranted when selecting an EV production platform, especially for assessing the functional and therapeutic potential of EVs through in vitro studies.
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Affiliation(s)
- Norhayati Liaqat Ali Khan
- Division of Clinical Medicine, School of Medicine and Population Health, The Medical School, University of Sheffield, Sheffield, United Kingdom
- Centre of Preclinical Science Studies, Faculty of Dentistry, University Teknologi MARA (UiTM), Sg. Buloh, Selangor, Malaysia
| | - Subhashini Muhandiram
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Tartu, Estonia
| | - Keerthie Dissanayake
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Tartu, Estonia
- Department of Pathophysiology, Institute of Biomedicine and Translational Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Kasun Godakumara
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Tartu, Estonia
- Department of Pathophysiology, Institute of Biomedicine and Translational Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Getnet Midekessa
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Tartu, Estonia
- Department of Pathophysiology, Institute of Biomedicine and Translational Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Aneta Andronowska
- Department of Hormonal Action Mechanisms, Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Paul R Heath
- Division of Clinical Medicine, School of Medicine and Population Health, The Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Suranga Kodithuwakku
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Tartu, Estonia
- Department of Animal Science, Faculty of Agriculture, University of Peradeniya, Peradeniya, Sri Lanka
| | - Amber Rose Hart
- Division of Clinical Medicine, School of Medicine and Population Health, The Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Alireza Fazeli
- Division of Clinical Medicine, School of Medicine and Population Health, The Medical School, University of Sheffield, Sheffield, United Kingdom
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Tartu, Estonia
- Department of Pathophysiology, Institute of Biomedicine and Translational Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
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9
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Li N, Zhang Y, Li R, Chen Y, Huang L, Tan Z, Ban X, Zhou L, Xu C, Qiu Y, Li R. Personalized embryo transfer guided by rsERT improves pregnancy outcomes in patients with repeated implantation failure. Front Med (Lausanne) 2024; 11:1369317. [PMID: 38813375 PMCID: PMC11133691 DOI: 10.3389/fmed.2024.1369317] [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: 01/12/2024] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction Embryo implantation requires synchronous communication between the embryo and maternal endometrium. Inadequate maternal endometrial receptivity is one of the principal causes for embryo implantation failure [especially repeated implantation failure (RIF)] when biopsied good-quality euploid embryos are transferred. An RNA-seq-based endometrial receptivity test (rsERT) was previously established to precisely guide successful embryo implantation. In this study, we aimed to evaluate the effect of personalized embryo transfer (pET) via rsERT on the clinical outcomes in patients with RIF. Methods A total of 155 patients with RIF were included in the present retrospective study and were divided into two groups: 60 patients who underwent rsERT and pET (Group rsERT) and 95 patients who underwent standard frozen embryo transfer (FET) without rsERT (Group FET). Reproductive outcomes were compared for patients who underwent rsERT-guided pET and standard FET. Results Forty percent (24/60) of the patients who underwent rsERT were receptive, and the remaining 60% (36/60) were non-receptive. The positive human chorionic gonadotropin (β-hCG) rate (56.3% vs. 30.5%, P = 0.003) and clinical pregnancy rate (43.8% vs. 24.2%, P = 0.017) were significantly higher in Group rsERT patients than in FET group patients. Additionally, Group rsERT patients also showed a higher implantation rate (32.1% vs. 22.1%, P = 0.104) and live birth rate (35.4% vs. 21.1%, P = 0.064) when compared with FET patients, although without significance. For subpopulation analysis, the positive β-hCG rate, clinical pregnancy rate, implantation rate, and live birth rate of receptive patients were not statistically significant different from those of non-receptive patients. Conclusions The rsERT can significantly improve the pregnancy outcomes of RIF patients, indicating the clinical potential of rsERT-guided pET.
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Affiliation(s)
- Ning Li
- Reproductive Medical Center of the Second Nanning People's Hospital, Nanning, China
| | - Yisheng Zhang
- Reproductive Medical Center of the Guangxi Zhuang Autonomous Region People's Hospital, Nanning, China
| | - Rufei Li
- Reproductive Medical Center of the Second Nanning People's Hospital, Nanning, China
| | - Yulin Chen
- Department of Research and Development, Yikon Genomics (Suzhou) Company Limited, Suzhou, China
| | - Lin Huang
- Reproductive Medical Center of the Second Nanning People's Hospital, Nanning, China
| | - Zhuojie Tan
- Reproductive Medical Center of the Second Nanning People's Hospital, Nanning, China
| | - Xiaoying Ban
- Reproductive Medical Center of the Second Nanning People's Hospital, Nanning, China
| | - Ling Zhou
- Reproductive Medical Center of the Second Nanning People's Hospital, Nanning, China
| | - Changlong Xu
- Reproductive Medical Center of the Second Nanning People's Hospital, Nanning, China
| | - Ying Qiu
- Reproductive Medical Center of the Second Nanning People's Hospital, Nanning, China
| | - Rong Li
- Reproductive Medical Center of the Second Nanning People's Hospital, Nanning, China
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10
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Garg A, Zielinska AP, Yeung AC, Abdelmalak R, Chen R, Hossain A, Israni A, Nelson SM, Babwah AV, Dhillo WS, Abbara A. Luteal phase support in assisted reproductive technology. Nat Rev Endocrinol 2024; 20:149-167. [PMID: 38110672 DOI: 10.1038/s41574-023-00921-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/20/2023]
Abstract
Infertility affects one in six couples, with in vitro fertilization (IVF) offering many the chance of conception. Compared to the solitary oocyte produced during the natural menstrual cycle, the supraphysiological ovarian stimulation needed to produce multiple oocytes during IVF results in a dysfunctional luteal phase that can be insufficient to support implantation and maintain pregnancy. Consequently, hormonal supplementation with luteal phase support, principally exogenous progesterone, is used to optimize pregnancy rates; however, luteal phase support remains largely 'black-box' with insufficient clarity regarding the optimal timing, dosing, route and duration of treatment. Herein, we review the evidence on luteal phase support and highlight remaining uncertainties and future research directions. Specifically, we outline the physiological luteal phase, which is regulated by progesterone from the corpus luteum, and evaluate how it is altered by the supraphysiological ovarian stimulation used during IVF. Additionally, we describe the effects of the hormonal triggers used to mature oocytes on the degree of luteal phase support required. We explain the histological transformation of the endometrium during the luteal phase and evaluate markers of endometrial receptivity that attempt to identify the 'window of implantation'. We also cover progesterone receptor signalling, circulating progesterone levels associated with implantation, and the pharmacokinetics of available progesterone formulations to inform the design of luteal phase support regimens.
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Affiliation(s)
- Akanksha Garg
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Agata P Zielinska
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Arthur C Yeung
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Rebecca Abdelmalak
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Runzhi Chen
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Aleena Hossain
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Alisha Israni
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Scott M Nelson
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
- NIHR Biomedical Research Centre, University of Bristol, Bristol, UK
- The Fertility Partnership (TFP), Oxford, UK
| | - Andy V Babwah
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Waljit S Dhillo
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Ali Abbara
- Section of Endocrinology and Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK.
- Imperial College Healthcare NHS Trust, London, UK.
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11
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Lacconi V, Massimiani M, Carriero I, Bianco C, Ticconi C, Pavone V, Alteri A, Muzii L, Rago R, Pisaturo V, Campagnolo L. When the Embryo Meets the Endometrium: Identifying the Features Required for Successful Embryo Implantation. Int J Mol Sci 2024; 25:2834. [PMID: 38474081 DOI: 10.3390/ijms25052834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Evaluation of the optimal number of embryos, their quality, and the precise timing for transfer are critical determinants in reproductive success, although still remaining one of the main challenges in assisted reproduction technologies (ART). Indeed, the success of in vitro fertilization (IVF) treatments relies on a multitude of events and factors involving both the endometrium and the embryo. Despite concerted efforts on both fronts, the overall success rates of IVF techniques continue to range between 25% and 30%. The role of the endometrium in implantation has been recently recognized, leading to the hypothesis that both the "soil" and the "seed" play a central role in a successful pregnancy. In this respect, identification of the molecular signature of endometrial receptivity together with the selection of the best embryo for transfer become crucial in ART. Currently, efforts have been made to develop accurate, predictive, and personalized tests to identify the window of implantation and the best quality embryo. However, the value of these tests is still debated, as conflicting results are reported in the literature. The purpose of this review is to summarize and critically report the available criteria to optimize the success of embryo transfer and to better understand current limitations and potential areas for improvement.
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Affiliation(s)
- Valentina Lacconi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
- Saint Camillus International University of Health Sciences, Via di Sant'Alessandro 8, 00131 Rome, Italy
| | - Micol Massimiani
- Saint Camillus International University of Health Sciences, Via di Sant'Alessandro 8, 00131 Rome, Italy
| | - Ilenia Carriero
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Claudia Bianco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Carlo Ticconi
- Department of Surgical Sciences, Section of Gynaecology and Obstetrics, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Valentina Pavone
- Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alessandra Alteri
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Rocco Rago
- Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Via dei Monti Tiburtini 385/389, 00157 Rome, Italy
| | - Valerio Pisaturo
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Luisa Campagnolo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
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12
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Zhang WB, Li J, Li Q, Lu X, Chen JL, Li L, Chen H, Fu W, Chen JC, Lu BJ, Wu H, Sun XX. Endometrial transcriptome profiling of patients with recurrent implantation failure during hormone replacement therapy cycles. Front Endocrinol (Lausanne) 2024; 14:1292723. [PMID: 38352249 PMCID: PMC10863671 DOI: 10.3389/fendo.2023.1292723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/28/2023] [Indexed: 02/16/2024] Open
Abstract
Background The molecular mechanisms underlying window of implantation (WOI) displacement in patients with recurrent implantation failure (RIF) remain unclear. This study aims to explore the transcriptomic signatures of endometrium with normal and displaced WOIs and to identify the causes of endometrial receptivity (ER) abnormalities and WOI displacement in RIF patients. Methods In this study, 40 RIF patients were recruited and underwent personalized embryo transfer (pET) guided by the predicted results of endometrial receptivity diagnosis (ERD) model. Transcriptome analysis of endometrium from patients with clinical pregnancies after pET was performed to identify differentially expressed genes (DEGs) associated with WOI displacement. Gene expression data from HRT and natural cycle endometrium were compared to identify specific gene expression patterns of ER-related genes during WOI. Results The ERD results indicated that 67.5% of RIF patients (27/40) were non-receptive in the conventional WOI (P+5) of the HRT cycle. The clinical pregnancy rate in RIF patients improved to 65% (26/40) after ERD-guided pET, indicating the effectiveness of transcriptome-based WOI prediction. Among the 26 patients with clinical pregnancy, the gene expression profiles of P+5 endometrium from advanced (n=6), normal (n=10) and delayed (n=10) WOI groups were significantly different from each other. Furthermore, 10 DEGs identified among P+5 endometrium of 3 groups were involved in immunomodulation, transmembrane transport and tissue regeneration, which could accurately classify the endometrium with different WOIs. Additionally, a large number of ER-related genes showed significant correlation and similar gene expression patterns in P+3, P+5, and P+7 endometrium from HRT cycles and LH+5, LH+7, and LH+9 endometrium from natural cycles. Conclusion Our study shows that ER-related genes share similar gene expression patterns during WOI in both natural and HRT cycles, and their aberrant expression is associated with WOI displacements. The improvement of pregnancy outcomes in RIF patients by adjusting ET timing according to ERD results demonstrates the importance of transcriptome-based endometrial receptivity assessment and the clinical efficiency of ERD model.
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Affiliation(s)
- Wen-bi Zhang
- Shanghai Ji Ai Genetics and In vitro Fertilization and Embryo Transfer (IVF-ET) Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Jue Li
- Unimed Biotech (Shanghai) Co., Ltd., Shanghai, China
| | - Qing Li
- Unimed Biotech (Shanghai) Co., Ltd., Shanghai, China
| | - Xiang Lu
- Shanghai Ji Ai Genetics and In vitro Fertilization and Embryo Transfer (IVF-ET) Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Jun-ling Chen
- Shanghai Ji Ai Genetics and In vitro Fertilization and Embryo Transfer (IVF-ET) Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Lu Li
- Shanghai Ji Ai Genetics and In vitro Fertilization and Embryo Transfer (IVF-ET) Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Hua Chen
- Shanghai Ji Ai Genetics and In vitro Fertilization and Embryo Transfer (IVF-ET) Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Wei Fu
- Shanghai Ji Ai Genetics and In vitro Fertilization and Embryo Transfer (IVF-ET) Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | | | - Bing-jie Lu
- Unimed Biotech (Shanghai) Co., Ltd., Shanghai, China
| | - Han Wu
- Unimed Biotech (Shanghai) Co., Ltd., Shanghai, China
| | - Xiao-xi Sun
- Shanghai Ji Ai Genetics and In vitro Fertilization and Embryo Transfer (IVF-ET) Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Key Laboratory of Female Reproductive Endocrine-Related Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
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13
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Chen MJ, Hsu A, Lin PY, Chen YL, Wu KW, Chen KC, Wang T, Yi YC, Kung HF, Chang JC, Yang WJ, Lu F, Guu HF, Chen YF, Chuan ST, Chen LY, Chen CH, Yang PE, Huang JYJ. Development of a Predictive Model for Optimization of Embryo Transfer Timing Using Blood-Based microRNA Expression Profile. Int J Mol Sci 2023; 25:76. [PMID: 38203247 PMCID: PMC10779357 DOI: 10.3390/ijms25010076] [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: 10/30/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
MicroRNAs (miRNAs) can regulate the expression of genes involved in the establishment of the window of implantation (WOI) in the endometrium. Recent studies indicated that cell-free miRNAs in uterine fluid and blood samples could act as alternative and non-invasive sample types for endometrial receptivity analysis. In this study, we attempt to systematically evaluate whether the expression levels of cell-free microRNAs in blood samples could be used as non-invasive biomarkers for assessing endometrial receptivity status. We profiled the miRNA expression levels of 111 blood samples using next-generation sequencing to establish a predictive model for the assessment of endometrial receptivity status. This model was validated with an independent dataset (n = 73). The overall accuracy is 95.9%. Specifically, we achieved accuracies of 95.9%, 95.9%, and 100.0% for the pre-receptive group, the receptive group, and the post-respective group, respectively. Additionally, we identified a set of differentially expressed miRNAs between different endometrial receptivity statuses using the following criteria: p-value < 0.05 and fold change greater than 1.5 or less than -1.5. In conclusion, the expression levels of cell-free miRNAs in blood samples can be utilized in a non-invasive manner to distinguish different endometrial receptivity statuses.
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Affiliation(s)
- Ming-Jer Chen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics Gynecology & Women’s Health, Taichung Veterans General Hospital, Taichung 40764, Taiwan; (M.-J.C.); (Y.-C.Y.); (H.-F.K.); (J.-C.C.); (H.-F.G.); (Y.-F.C.); (S.-T.C.); (L.-Y.C.)
| | - An Hsu
- Inti Labs, Hsinchu 30261, Taiwan; (A.H.); (P.-Y.L.); (Y.-L.C.); (K.-W.W.); (K.-C.C.); (T.W.)
| | - Pei-Yi Lin
- Inti Labs, Hsinchu 30261, Taiwan; (A.H.); (P.-Y.L.); (Y.-L.C.); (K.-W.W.); (K.-C.C.); (T.W.)
| | - Yu-Ling Chen
- Inti Labs, Hsinchu 30261, Taiwan; (A.H.); (P.-Y.L.); (Y.-L.C.); (K.-W.W.); (K.-C.C.); (T.W.)
| | - Ko-Wen Wu
- Inti Labs, Hsinchu 30261, Taiwan; (A.H.); (P.-Y.L.); (Y.-L.C.); (K.-W.W.); (K.-C.C.); (T.W.)
| | - Kuan-Chun Chen
- Inti Labs, Hsinchu 30261, Taiwan; (A.H.); (P.-Y.L.); (Y.-L.C.); (K.-W.W.); (K.-C.C.); (T.W.)
| | - Tiffany Wang
- Inti Labs, Hsinchu 30261, Taiwan; (A.H.); (P.-Y.L.); (Y.-L.C.); (K.-W.W.); (K.-C.C.); (T.W.)
| | - Yu-Chiao Yi
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics Gynecology & Women’s Health, Taichung Veterans General Hospital, Taichung 40764, Taiwan; (M.-J.C.); (Y.-C.Y.); (H.-F.K.); (J.-C.C.); (H.-F.G.); (Y.-F.C.); (S.-T.C.); (L.-Y.C.)
| | - Hsiao-Fan Kung
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics Gynecology & Women’s Health, Taichung Veterans General Hospital, Taichung 40764, Taiwan; (M.-J.C.); (Y.-C.Y.); (H.-F.K.); (J.-C.C.); (H.-F.G.); (Y.-F.C.); (S.-T.C.); (L.-Y.C.)
| | - Jui-Chun Chang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics Gynecology & Women’s Health, Taichung Veterans General Hospital, Taichung 40764, Taiwan; (M.-J.C.); (Y.-C.Y.); (H.-F.K.); (J.-C.C.); (H.-F.G.); (Y.-F.C.); (S.-T.C.); (L.-Y.C.)
| | - Wen-Jui Yang
- Taiwan IVF Group Center for Reproductive Medicine and Infertility, Hsinchu 30274, Taiwan; (W.-J.Y.); (F.L.); (C.-H.C.)
| | - Farn Lu
- Taiwan IVF Group Center for Reproductive Medicine and Infertility, Hsinchu 30274, Taiwan; (W.-J.Y.); (F.L.); (C.-H.C.)
| | - Hwa-Fen Guu
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics Gynecology & Women’s Health, Taichung Veterans General Hospital, Taichung 40764, Taiwan; (M.-J.C.); (Y.-C.Y.); (H.-F.K.); (J.-C.C.); (H.-F.G.); (Y.-F.C.); (S.-T.C.); (L.-Y.C.)
| | - Ya-Fang Chen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics Gynecology & Women’s Health, Taichung Veterans General Hospital, Taichung 40764, Taiwan; (M.-J.C.); (Y.-C.Y.); (H.-F.K.); (J.-C.C.); (H.-F.G.); (Y.-F.C.); (S.-T.C.); (L.-Y.C.)
| | - Shih-Ting Chuan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics Gynecology & Women’s Health, Taichung Veterans General Hospital, Taichung 40764, Taiwan; (M.-J.C.); (Y.-C.Y.); (H.-F.K.); (J.-C.C.); (H.-F.G.); (Y.-F.C.); (S.-T.C.); (L.-Y.C.)
| | - Li-Yu Chen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics Gynecology & Women’s Health, Taichung Veterans General Hospital, Taichung 40764, Taiwan; (M.-J.C.); (Y.-C.Y.); (H.-F.K.); (J.-C.C.); (H.-F.G.); (Y.-F.C.); (S.-T.C.); (L.-Y.C.)
| | - Ching-Hung Chen
- Taiwan IVF Group Center for Reproductive Medicine and Infertility, Hsinchu 30274, Taiwan; (W.-J.Y.); (F.L.); (C.-H.C.)
| | - Pok Eric Yang
- Inti Labs, Hsinchu 30261, Taiwan; (A.H.); (P.-Y.L.); (Y.-L.C.); (K.-W.W.); (K.-C.C.); (T.W.)
| | - Jack Yu-Jen Huang
- Taiwan IVF Group Center for Reproductive Medicine and Infertility, Hsinchu 30274, Taiwan; (W.-J.Y.); (F.L.); (C.-H.C.)
- Department of Obstetrics & Gynecology, Stanford University, Stanford, CA 94305, USA
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Frankfurter D, Kliman H. Progress on the Endometrium. Obstet Gynecol Clin North Am 2023; 50:677-694. [PMID: 37914487 DOI: 10.1016/j.ogc.2023.09.002] [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] [Indexed: 11/03/2023]
Abstract
The endometrium is a dynamic tissue that facilitates mammalian internal reproduction and thus, the ability to deliver live born progeny that are more easily protected from predators. This tissue is unique in its ability to undergo cyclic regeneration and destruction in the absence of pregnancy. Ovarian steroids guide endometrial proliferation and maturation promoting its receptivity and selectivity with regards to blastocyst implantation. It is decidualization, terminal stromal maturation, that prevents the trophoblast from breeching containment of the uterus and allows for endometrial sloughing should pregnancy not occur. Endometrial pathology is highly variable and therefore a wide array of diagnostic measures are required for its interrogation. There remains no single test that can distinguish between all potential issues and it is critical that appropriate and evidence-based endometrial assessment is carried out. Emerging data on developmental markers, inflammatory mediators, and bacterial profiling offer hope that conditions including endometriosis, cancer, infertility, and implantation failure will be more easily and less invasively diagnosed. This will allow for a more timely and targeted approach to intervention. Accordingly, assessing novel measures requires an evidence-based approach prior to their mass utilization.
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Affiliation(s)
- David Frankfurter
- Yale Meidcal School, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale Fertility Center, 200 West Campus Drive, 2nd Floor, Orange, CT 06477, USA.
| | - Harvey Kliman
- Yale University School of Medicine, Kliman Laboratories, Reproductive and Placental Research Unit, Department of Obstetrics, Gynecology and Reproductive Sciences, 310 Cedar Street, FMB 225, New Haven, CT 06510, USA. https://twitter.com/placentatalk
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Sui C, Liao Z, Bai J, Hu D, Yue J, Yang S. Current knowledge on the role of extracellular vesicles in endometrial receptivity. Eur J Med Res 2023; 28:471. [PMID: 37899459 PMCID: PMC10614333 DOI: 10.1186/s40001-023-01459-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/19/2023] [Indexed: 10/31/2023] Open
Abstract
Endometrial receptivity has been widely understood as the capacity of the endometrium to receive implantable embryos. The establishment of endometrial receptivity involves multiple biological processes including decidualization, tissue remodeling, angiogenesis, immune regulation, and oxidative metabolism. Extracellular vesicles (EVs) are lipid-bilayer-membrane nanosized vesicles mediating cell-to-cell communication. Recently, EVs and their cargo have been proven as functional factors in the establishment of endometrial receptivity. In this review, we comprehensively summarized the alteration of endometrium/embryo-derived EVs during the receptive phase and retrospected the current findings which revealed the pivotal role and potential mechanism of EVs to promote successful implantation. Furthermore, we highlight the potentiality and limitations of EVs being translated into clinical applications such as biomarkers of endometrial receptivity or reproductive therapeutic mediators, and point out the direction for further research.
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Affiliation(s)
- Cong Sui
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095#, Wuhan, 430030, People's Republic of China
| | - Zhiqi Liao
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095#, Wuhan, 430030, People's Republic of China
| | - Jian Bai
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095#, Wuhan, 430030, People's Republic of China
| | - Dan Hu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095#, Wuhan, 430030, People's Republic of China
| | - Jing Yue
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095#, Wuhan, 430030, People's Republic of China
| | - Shulin Yang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095#, Wuhan, 430030, People's Republic of China.
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16
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Meltsov A, Saare M, Teder H, Paluoja P, Arffman RK, Piltonen T, Laudanski P, Wielgoś M, Gianaroli L, Koel M, Peters M, Salumets A, Krjutškov K, Palta P. Targeted gene expression profiling for accurate endometrial receptivity testing. Sci Rep 2023; 13:13959. [PMID: 37633957 PMCID: PMC10460380 DOI: 10.1038/s41598-023-40991-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/20/2023] [Indexed: 08/28/2023] Open
Abstract
Expressional profiling of the endometrium enables the personalised timing of the window of implantation (WOI). This study presents and evaluates a novel analytical pipeline based on a TAC-seq (Targeted Allele Counting by sequencing) method for endometrial dating. The expressional profiles were clustered, and differential expression analysis was performed on the model development group, using 63 endometrial biopsies spanning over proliferative (PE, n = 18), early-secretory (ESE, n = 18), mid-secretory (MSE, n = 17) and late-secretory (LSE, n = 10) endometrial phases of the natural cycle. A quantitative predictor model was trained on the development group and validated on sequenced samples from healthy women, consisting of 52 paired samples taken from ESE and MSE phases and five LSE phase samples from 31 individuals. Finally, the developed test was applied to 44 MSE phase samples from a study group of patients diagnosed with recurrent implantation failure (RIF). In validation samples (n = 57), we detected displaced WOI in 1.8% of the samples from fertile women. In the RIF study group, we detected a significantly higher proportion of the samples with shifted WOI than in the validation set of samples from fertile women, 15.9% and 1.8% (p = 0.012), respectively. The developed model was evaluated with an average cross-validation accuracy of 98.8% and an accuracy of 98.2% in the validation group. The developed beREADY screening model enables sensitive and dynamic detection of selected transcriptome biomarkers, providing a quantitative and accurate prediction of endometrial receptivity status.
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Affiliation(s)
- Alvin Meltsov
- Competence Centre On Health Technologies, 50411, Tartu, Estonia
- Department of Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University, 6200 MD, Maastricht, The Netherlands
| | - Merli Saare
- Competence Centre On Health Technologies, 50411, Tartu, Estonia.
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, 50406, Tartu, Estonia.
| | - Hindrek Teder
- Competence Centre On Health Technologies, 50411, Tartu, Estonia
- Institute of Biomedicine and Translational Medicine, University of Tartu, 50411, Tartu, Estonia
| | - Priit Paluoja
- Competence Centre On Health Technologies, 50411, Tartu, Estonia
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, 50406, Tartu, Estonia
| | - Riikka K Arffman
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, FI-90014, Oulu, Finland
| | - Terhi Piltonen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, FI-90014, Oulu, Finland
| | - Piotr Laudanski
- Oviklinika Infertility Center, 01-377, Warsaw, Poland
- Women's Health Research Institute, Calisia University, 62-800, Kalisz, Poland
- Department of Obstetrics, Gynecology and Gynaecological Oncology, Medical University of Warsaw, 02-091, Warsaw, Poland
| | | | - Luca Gianaroli
- SISMeR, Reproductive Medicine Institute, 40138, Bologna, Italy
| | - Mariann Koel
- Institute of Genomics, University of Tartu, 51010, Tartu, Estonia
| | - Maire Peters
- Competence Centre On Health Technologies, 50411, Tartu, Estonia
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, 50406, Tartu, Estonia
| | - Andres Salumets
- Competence Centre On Health Technologies, 50411, Tartu, Estonia
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, 50406, Tartu, Estonia
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, SE-141 52, Stockholm, Sweden
| | - Kaarel Krjutškov
- Competence Centre On Health Technologies, 50411, Tartu, Estonia
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, 50406, Tartu, Estonia
| | - Priit Palta
- Competence Centre On Health Technologies, 50411, Tartu, Estonia
- Institute of Genomics, University of Tartu, 51010, Tartu, Estonia
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, FI-00014, Helsinki, Finland
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17
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Edimiris P, Doehmen C, Baston-Buest DM, Kruessel JS, Bielfeld AP. One center experience with a personalized frozen-thawed embryo transfer in patients with recurrent implantation failure. J Assist Reprod Genet 2023:10.1007/s10815-023-02835-7. [PMID: 37261585 DOI: 10.1007/s10815-023-02835-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/19/2023] [Indexed: 06/02/2023] Open
Abstract
PURPOSE Displaced endometrial receptivity has been discussed as a possible cause of recurrent implantation failure in patients undergoing assisted reproductive technology. The aim of this study was to document our experience with the endometrial receptivity analysis in patients with recurrent implantation failure. METHODS This retrospective cohort study, conducted at the Fertility Centre of the University Hospital, Duesseldorf Germany, presents the results of the endometrial receptivity analysis in 67 patients with recurrent implantation failure and compares the clinical outcome between these 67 patients who underwent a personalized frozen-thawed embryo transfer guided by the results of the endometrial receptivity analysis and 32 patients with recurrent implantation failure who performed a standardized frozen-thawed embryo transfer. RESULTS The data analysis revealed a displaced endometrial receptivity in 73% (49/67) of all tested patients. Out of these patients, 24% (12/49) were early receptive, 74% (36/49) were pre-receptive, and 2% (1/49) were post-receptive. Comparison of pregnancy rate, clinical pregnancy rate, and live-birth rate between personalized (49%, 39%, 27%, respectively) and standardized embryo transfer (44%, 31%, 19%, respectively) reveals no statistically significant difference. In both groups, patients had an average of four unsuccessful embryo transfers. CONCLUSION In this cohort of patients with recurrent implantation failure, the endometrial receptivity analysis showed a high incidence of displaced endometrial receptivity. However, a personalized embryo transfer did not increase reproductive outcome. Displaced endometrial receptivity might not be the main cause for recurrent implantation failure in this cohort.
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Affiliation(s)
- Philippos Edimiris
- Department of OB/GYN and REI (UniKiD), Medical Center University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
| | - Cornelius Doehmen
- Department of OB/GYN and REI (UniKiD), Medical Center University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
- Kinderwunschzentrum Niederrhein, Madrider Str. 6, 41069, Moenchengladbach, Germany
| | - Dunja Maria Baston-Buest
- Department of OB/GYN and REI (UniKiD), Medical Center University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Jan-Steffen Kruessel
- Department of OB/GYN and REI (UniKiD), Medical Center University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Alexandra Petra Bielfeld
- Department of OB/GYN and REI (UniKiD), Medical Center University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
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18
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Li T, Liao R, Chan C, Greenblatt EM. Deep learning analysis of endometrial histology as a promising tool to predict the chance of pregnancy after frozen embryo transfers. J Assist Reprod Genet 2023; 40:901-910. [PMID: 36862259 PMCID: PMC10224884 DOI: 10.1007/s10815-023-02745-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/03/2023] [Indexed: 03/03/2023] Open
Abstract
PURPOSE Endometrial histology on hematoxylin and eosin (H&E)-stained preparations provides information associated with receptivity. However, traditional histological examination by Noyes' dating method is of limited value as it is prone to subjectivity and is not well correlated with fertility status or pregnancy outcome. This study aims to mitigate the weaknesses of Noyes' dating by analyzing endometrial histology through deep learning (DL) algorithm to predict the chance of pregnancy. METHODS Endometrial biopsies were taken during the window of receptivity from healthy volunteers in natural menstrual cycles (group A) and infertile patients undergoing mock artificial cycles (group B). H&E staining was performed followed by whole slide image scanning for DL analysis. RESULTS In a proof-of-concept trial to differentiate group A (n=24) vs. B (n=37), a DL-based binary classifier was trained, cross-validated, and achieved 100% for accuracy. Patients in group B underwent subsequent frozen-thawed embryo transfers (FETs) and were further categorized into "pregnant (n=15)" or "non-pregnant (n=18)" sub-groups based on the outcomes. In the following trial to predict pregnancy outcome in group B, the DL-based binary classifier yielded 77.8% for accuracy. Its performance was further validated by an accuracy of 75% in a "held-out" test set where patients had euploid embryo transfers. Furthermore, the DL model identified histo-characteristics including stromal edema, glandular secretion, and endometrial vascularity as important features related to pregnancy prediction. CONCLUSIONS DL-based endometrial histology analysis demonstrated its feasibility and robustness in pregnancy prediction for patients undergoing FETs, indicating its value as a prognostic tool in fertility treatment.
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Affiliation(s)
- Tiantian Li
- Lunenfeld-Tanenbaum Research Institute (LTRI), Sinai Health System, Toronto, ON Canada
- Mount Sinai Fertility (MSF), Sinai Health System, Toronto, ON Canada
| | - Renjie Liao
- Department of Computer Science, University of Toronto, Toronto, ON Canada
| | - Crystal Chan
- Lunenfeld-Tanenbaum Research Institute (LTRI), Sinai Health System, Toronto, ON Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario Canada
| | - Ellen M. Greenblatt
- Lunenfeld-Tanenbaum Research Institute (LTRI), Sinai Health System, Toronto, ON Canada
- Mount Sinai Fertility (MSF), Sinai Health System, Toronto, ON Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario Canada
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19
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Abdullah KAL, Atazhanova T, Chavez-Badiola A, Shivhare SB. Automation in ART: Paving the Way for the Future of Infertility Treatment. Reprod Sci 2023; 30:1006-1016. [PMID: 35922741 PMCID: PMC10160149 DOI: 10.1007/s43032-022-00941-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/09/2022] [Indexed: 01/11/2023]
Abstract
In vitro fertilisation (IVF) is estimated to account for the birth of more than nine million babies worldwide, perhaps making it one of the most intriguing as well as commoditised and industrialised modern medical interventions. Nevertheless, most IVF procedures are currently limited by accessibility, affordability and most importantly multistep, labour-intensive, technically challenging processes undertaken by skilled professionals. Therefore, in order to sustain the exponential demand for IVF on one hand, and streamline existing processes on the other, innovation is essential. This may not only effectively manage clinical time but also reduce cost, thereby increasing accessibility, affordability and efficiency. Recent years have seen a diverse range of technologies, some integrated with artificial intelligence, throughout the IVF pathway, which promise personalisation and, at least, partial automation in the not-so-distant future. This review aims to summarise the rapidly evolving state of these innovations in automation, with or without the integration of artificial intelligence, encompassing the patient treatment pathway, gamete/embryo selection, endometrial evaluation and cryopreservation of gametes/embryos. Additionally, it shall highlight the resulting prospective change in the role of IVF professionals and challenges of implementation of some of these technologies, thereby aiming to motivate continued research in this field.
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Affiliation(s)
- Kadrina Abdul Latif Abdullah
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Level 3, Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, England
| | - Tomiris Atazhanova
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Level 3, Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, England
| | | | - Sourima Biswas Shivhare
- TFP Simply Fertility, W Hanningfield Rd, Great Baddow, Chelmsford, CM2 8HN, England.
- The Centre for Reproductive and Genetic Health, London, UK.
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20
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Poh QH, Rai A, Salamonsen LA, Greening DW. Omics insights into extracellular vesicles in embryo implantation and their therapeutic utility. Proteomics 2023; 23:e2200107. [PMID: 36591946 DOI: 10.1002/pmic.202200107] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 01/03/2023]
Abstract
Implantation success relies on intricate interplay between the developing embryo and the maternal endometrium. Extracellular vesicles (EVs) represent an important player of this intercellular signalling through delivery of functional cargo (proteins and RNAs) that reprogram the target cells protein and RNA landscape. Functionally, the signalling reciprocity of endometrial and embryo EVs regulates the site of implantation, preimplantation embryo development and hatching, antioxidative activity, embryo attachment, trophoblast invasion, arterial remodelling, and immune tolerance. Omics technologies including mass spectrometry have been instrumental in dissecting EV cargo that regulate these processes as well as molecular changes in embryo and endometrium to facilitate implantation. This has also led to discovery of potential cargo in EVs in human uterine fluid (UF) and embryo spent media (ESM) of diagnostic and therapeutic value in implantation success, fertility, and pregnancy outcome. This review discusses the contribution of EVs in functional hallmarks of embryo implantation, and how the integration of various omics technologies is enabling design of EV-based diagnostic and therapeutic platforms in reproductive medicine.
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Affiliation(s)
- Qi Hui Poh
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Biochemistry and Chemistry, School of Agriculture, Biomedicine and Environment, La Trobe University, Melbourne, Victoria, Australia
| | - Alin Rai
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, Victoria, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Lois A Salamonsen
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Molecular and Translational Medicine, Monash University, Clayton, Victoria, Australia
| | - David W Greening
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Biochemistry and Chemistry, School of Agriculture, Biomedicine and Environment, La Trobe University, Melbourne, Victoria, Australia.,Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, Victoria, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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21
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Zhao W, Diao H, Chen X, Xu S, Jiang S, Cao H, Zhang C, Zhang Y. The serum oestradiol/progesterone ratio on the day of OPU + 7, but not the day of OPU + 5, affects the rates of live birth in fresh blastocyst embryo transfer cycles. J Ovarian Res 2023; 16:4. [PMID: 36611200 PMCID: PMC9826588 DOI: 10.1186/s13048-023-01096-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In an in vitro fertilization (IVF) cycle, the embryo ends its wandering time and begins the process of implantation into the uterine cavity on the seventh day after oocyte pick-up (OPU + 7), which is closer than OPU + 5 to the time of nidation. Therefore, measuring the oestradiol (E2)/progesterone (P) ratio on OPU + 7 may be helpful for predicting pregnancy outcomes. METHODS This is a retrospective cohort study of 2,257 women undergoing a follicular-phase depot gonadotropin-releasing hormone agonist (GnRH-a) protocol for in vitro fertilization /intracytoplasmic sperm injection (IVF/ICSI) treatment and fresh blastocyst embryo transfer cycles at a university-affiliated fertility center between January 2016 and April 2021. First, 2,257 women were split into two groups based on clinical pregnancy for analyzing the levels of E2 and P and the E2/P ratio on the day of OPU + 2, OPU + 5 and OPU + 7. And then 2,257 cycles were stratified into three groups based on E2/P ratio tertiles on OPU + 7: the low group (1.3-15.7 pg/ng), middle group (15.7-28.8 pg/ng), and high group (28.8-487.2 pg/ng). The threshold effect of the E2/P ratio on OPU + 7 on live birth was investigated using a two-piecewise linear regression model and a smoothing function curve. RESULTS The level of P in the clinical pregnancy group were lower than that in the nonclinical pregnancy group on both OPU + 2 and OPU + 7 (201.9 ± 71.6 ng/ml vs 213.1 ± 77.6 ng/ml, 89.5 ± 88.5 ng/ml vs 99.5 ± 94.9 ng/ml, P < 0.05). The E2/P ratio in the clinical pregnancy group were higher than that in the nonclinical pregnancy group on both OPU + 2 and OPU + 7 (8.4 ± 6.5 pg/ng vs 8.0 ± 6.8 pg/ng, 32.3 ± 38.5 pg/ng vs 25.2 ± 31.0 pg/ng, P < 0.01). The E2/P ratio on OPU + 7 was positively associated with positive hCG (adjusted OR = 1.01; 95% CI, 1.01-1.02; P < 0.0001), clinical pregnancy (adjusted OR = 1.01; 95% CI, 1.00-1.01; P = 0.0067) and live birth (adjusted OR = 1.01; 95% CI, 1.00-1.01; P < 0.001), and a nonlinear correlation was observed between the E2/P ratio and LBR on OPU + 7. CONCLUSIONS A higher E2/P ratio is associated with a higher LBR, but the E2/P ratio should be maintained within a suitable range.
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Affiliation(s)
- Wenxian Zhao
- grid.443573.20000 0004 1799 2448Reproductive Medicine Centre, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China ,Hubei Clinical Research Centre for Reproductive Medicine, Shiyan, People’s Republic of China
| | - Honglu Diao
- grid.443573.20000 0004 1799 2448Reproductive Medicine Centre, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China ,Hubei Clinical Research Centre for Reproductive Medicine, Shiyan, People’s Republic of China ,grid.443573.20000 0004 1799 2448Biomedical Engineering College, Hubei University of Medicine, Shiyan, People’s Republic of China ,grid.443573.20000 0004 1799 2448Biomedical Research Institute, Hubei University of Medicine, Shiyan, People’s Republic of China ,grid.443573.20000 0004 1799 2448Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Xin Chen
- grid.443573.20000 0004 1799 2448Reproductive Medicine Centre, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China ,Hubei Clinical Research Centre for Reproductive Medicine, Shiyan, People’s Republic of China ,grid.443573.20000 0004 1799 2448Biomedical Engineering College, Hubei University of Medicine, Shiyan, People’s Republic of China ,grid.443573.20000 0004 1799 2448Biomedical Research Institute, Hubei University of Medicine, Shiyan, People’s Republic of China ,grid.443573.20000 0004 1799 2448Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Shaoyuan Xu
- grid.443573.20000 0004 1799 2448Reproductive Medicine Centre, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China ,Hubei Clinical Research Centre for Reproductive Medicine, Shiyan, People’s Republic of China ,grid.443573.20000 0004 1799 2448Biomedical Engineering College, Hubei University of Medicine, Shiyan, People’s Republic of China ,grid.443573.20000 0004 1799 2448Biomedical Research Institute, Hubei University of Medicine, Shiyan, People’s Republic of China ,grid.443573.20000 0004 1799 2448Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Shengfang Jiang
- grid.443573.20000 0004 1799 2448Reproductive Medicine Centre, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China ,Hubei Clinical Research Centre for Reproductive Medicine, Shiyan, People’s Republic of China ,grid.443573.20000 0004 1799 2448Biomedical Engineering College, Hubei University of Medicine, Shiyan, People’s Republic of China ,grid.443573.20000 0004 1799 2448Biomedical Research Institute, Hubei University of Medicine, Shiyan, People’s Republic of China ,grid.443573.20000 0004 1799 2448Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Hong Cao
- grid.443573.20000 0004 1799 2448Department of Orthopaedic Surgery, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Changjun Zhang
- grid.443573.20000 0004 1799 2448Reproductive Medicine Centre, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China ,Hubei Clinical Research Centre for Reproductive Medicine, Shiyan, People’s Republic of China ,grid.443573.20000 0004 1799 2448Biomedical Engineering College, Hubei University of Medicine, Shiyan, People’s Republic of China ,grid.443573.20000 0004 1799 2448Biomedical Research Institute, Hubei University of Medicine, Shiyan, People’s Republic of China ,grid.443573.20000 0004 1799 2448Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Ying Zhang
- grid.443573.20000 0004 1799 2448Reproductive Medicine Centre, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China ,Hubei Clinical Research Centre for Reproductive Medicine, Shiyan, People’s Republic of China ,grid.443573.20000 0004 1799 2448Biomedical Engineering College, Hubei University of Medicine, Shiyan, People’s Republic of China ,grid.443573.20000 0004 1799 2448Biomedical Research Institute, Hubei University of Medicine, Shiyan, People’s Republic of China ,grid.443573.20000 0004 1799 2448Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei University of Medicine, Shiyan, People’s Republic of China
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22
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Fatmous M, Rai A, Poh QH, Salamonsen LA, Greening DW. Endometrial small extracellular vesicles regulate human trophectodermal cell invasion by reprogramming the phosphoproteome landscape. Front Cell Dev Biol 2022; 10:1078096. [PMID: 36619864 PMCID: PMC9813391 DOI: 10.3389/fcell.2022.1078096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
A series of cyclical events within the uterus are crucial for pregnancy establishment. These include endometrial regeneration following menses, under the influence of estrogen (proliferative phase), then endometrial differentiation driven by estrogen/progesterone (secretory phase), to provide a microenvironment enabling attachment of embryo (as a hatched blastocyst) to the endometrial epithelium. This is followed by invasion of trophectodermal cells (the outer layer of the blastocyst) into the endometrium tissue to facilitate intrauterine development. Small extracellular vesicles (sEVs) released by endometrial epithelial cells during the secretory phase have been shown to facilitate trophoblast invasion; however, the molecular mechanisms that underline this process remain poorly understood. Here, we show that density gradient purified sEVs (1.06-1.11 g/ml, Alix+ and TSG101+, ∼180 nm) from human endometrial epithelial cells (hormonally primed with estrogen and progesterone vs. estrogen alone) are readily internalized by a human trophectodermal stem cell line and promote their invasion into Matrigel matrix. Mass spectrometry-based proteome analysis revealed that sEVs reprogrammed trophectoderm cell proteome and their cell surface proteome (surfaceome) to support this invasive phenotype through upregulation of pro-invasive regulators associated with focal adhesions (NRP1, PTPRK, ROCK2, TEK), embryo implantation (FBLN1, NIBAN2, BSG), and kinase receptors (EPHB4/B2, ERBB2, STRAP). Kinase substrate prediction highlighted a central role of MAPK3 as an upstream kinase regulating target cell proteome reprogramming. Phosphoproteome analysis pinpointed upregulation of MAPK3 T204/T202 phosphosites in hTSCs following sEV delivery, and that their pharmacological inhibition significantly abrogated invasion. This study provides novel molecular insights into endometrial sEVs orchestrating trophoblast invasion, highlighting the microenvironmental regulation of hTSCs during embryo implantation.
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Affiliation(s)
- Monique Fatmous
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia,Department of Microbiology, Anatomy, Physiology and Pharmacology, La Trobe University (LTU), Melbourne, VIC, Australia
| | - Alin Rai
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia,Central Clinical School, Monash University, Melbourne, VIC, Australia,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia,Baker Department of Cardiovascular Research, Translation and Implementation, LTU, Melbourne, VIC, Australia
| | - Qi Hui Poh
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia,Baker Department of Cardiovascular Research, Translation and Implementation, LTU, Melbourne, VIC, Australia,Department of Biochemistry and Chemistry, LTU, Melbourne, VIC, Australia
| | - Lois A. Salamonsen
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia,Department of Molecular and Translational Medicine, Monash University, Clayton, VIC, Australia
| | - David W. Greening
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia,Central Clinical School, Monash University, Melbourne, VIC, Australia,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia,Baker Department of Cardiovascular Research, Translation and Implementation, LTU, Melbourne, VIC, Australia,Department of Biochemistry and Chemistry, LTU, Melbourne, VIC, Australia,*Correspondence: David W. Greening,
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23
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Bulletti C, Bulletti FM, Sciorio R, Guido M. Progesterone: The Key Factor of the Beginning of Life. Int J Mol Sci 2022; 23:ijms232214138. [PMID: 36430614 PMCID: PMC9692968 DOI: 10.3390/ijms232214138] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 11/17/2022] Open
Abstract
Progesterone is the ovarian steroid produced by the granulosa cells of follicles after the LH peak at mid-cycle. Its role is to sustain embryo endometrial implantation and ongoing pregnancy. Other biological effects of progesterone may exert a protective function in supporting pregnancy up to birth. Luteal phase support (LPS) with progesterone is the standard of care for assisted reproductive technology. Progesterone vaginal administration is currently the most widely used treatment for LPS. Physicians and patients have been reluctant to change an administration route that has proven to be effective. However, some questions remain open, namely the need for LPS in fresh and frozen embryo transfer, the route of administration, the optimal duration of LPS, dosage, and the benefit of combination therapies. The aim of this review is to provide an overview of the uterine and extra-uterine effects of progesterone that may play a role in embryo implantation and pregnancy, and to discuss the advantages of the use of progesterone for LPS in the context of Good Medical Practice.
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Affiliation(s)
- Carlo Bulletti
- Extra Omnes, Assisted Reproductive Technology, ART Center, Via Gallinelli, 8, 47841 Cattolica, Italy
- Department of Obstetrics, Gynecology, and Reproductive Science, Yale University, New Haven, CT 06510, USA
- Correspondence:
| | | | - Romualdo Sciorio
- Edinburgh Assisted Conception Programme, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Maurizio Guido
- Obstetrics and Gynecology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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24
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Maziotis E, Kalampokas T, Giannelou P, Grigoriadis S, Rapani A, Anifantakis M, Kotsifaki A, Pantou A, Triantafyllidou O, Tzanakaki D, Neofytou S, Vogiatzi P, Bakas P, Simopoulou M, Vlahos N. Commercially Available Molecular Approaches to Evaluate Endometrial Receptivity: A Systematic Review and Critical Analysis of the Literature. Diagnostics (Basel) 2022; 12:2611. [PMID: 36359455 PMCID: PMC9689742 DOI: 10.3390/diagnostics12112611] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/26/2022] [Indexed: 08/17/2023] Open
Abstract
Despite the advances in the field of reproductive medicine, implantation failure represents a challenging condition affecting 10-30% of patients subjected to in vitro fertilization (IVF). Research has focused on the identification of molecules playing crucial roles in endometrial receptivity, with the aim of designing predictive tools for efficient detection of the implantation window. To that end, novel molecular genomic and transcriptomic approaches have been introduced as promising tools to enable personalized approaches with the aim of optimizing embryo transfer dating. However, the clinical value of these approaches remains unclear. The aim of this study is to provide a systematic review and critical analysis of the existing evidence regarding the employment of commercially available novel approaches to evaluate endometrial receptivity. An Embase and PubMed/Medline search was performed on 1 February 2022. From the 475 articles yielded, only 27 were included and analyzed. The considerable heterogeneity of the included articles indicates the uniqueness of the implantation window, showcasing that the optimal time for embryo transfer varies significantly between women. Moreover, this study provides information regarding the technical aspects of these advanced molecular tools, as well as an analysis of novel possible biomarkers for endometrial receptivity, providing a basis for future research in the field.
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Affiliation(s)
- Evangelos Maziotis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., 11527 Athens, Greece
| | - Theodoros Kalampokas
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Polina Giannelou
- Centre for Human Reproduction, Genesis Athens Clinic, 14-16, Papanikoli Str., 15232 Athens, Greece
| | - Sokratis Grigoriadis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., 11527 Athens, Greece
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Anna Rapani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., 11527 Athens, Greece
| | - Marios Anifantakis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., 11527 Athens, Greece
| | - Amalia Kotsifaki
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., 11527 Athens, Greece
| | - Agni Pantou
- Centre for Human Reproduction, Genesis Athens Clinic, 14-16, Papanikoli Str., 15232 Athens, Greece
| | - Olga Triantafyllidou
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Despoina Tzanakaki
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Spyridoula Neofytou
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Paraskevi Vogiatzi
- Andromed Health & Reproduction, Fertility Diagnostics Center, 3, Mesogion Str., 15126 Athens, Greece
| | - Panagiotis Bakas
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Mara Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., 11527 Athens, Greece
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece
| | - Nikolaos Vlahos
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece
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25
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Koel M, Krjutškov K, Saare M, Samuel K, Lubenets D, Katayama S, Einarsdottir E, Vargas E, Sola-Leyva A, Lalitkumar PG, Gemzell-Danielsson K, Blesa D, Simon C, Lanner F, Kere J, Salumets A, Altmäe S. Human endometrial cell-type-specific RNA sequencing provides new insights into the embryo-endometrium interplay. Hum Reprod Open 2022; 2022:hoac043. [PMID: 36339249 PMCID: PMC9632455 DOI: 10.1093/hropen/hoac043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 09/21/2022] [Indexed: 08/17/2023] Open
Abstract
STUDY QUESTION Which genes regulate receptivity in the epithelial and stromal cellular compartments of the human endometrium, and which molecules are interacting in the implantation process between the blastocyst and the endometrial cells? SUMMARY ANSWER A set of receptivity-specific genes in the endometrial epithelial and stromal cells was identified, and the role of galectins (LGALS1 and LGALS3), integrin β1 (ITGB1), basigin (BSG) and osteopontin (SPP1) in embryo-endometrium dialogue among many other protein-protein interactions were highlighted. WHAT IS KNOWN ALREADY The molecular dialogue taking place between the human embryo and the endometrium is poorly understood due to ethical and technical reasons, leaving human embryo implantation mostly uncharted. STUDY DESIGN SIZE DURATION Paired pre-receptive and receptive phase endometrial tissue samples from 16 healthy women were used for RNA sequencing. Trophectoderm RNA sequences were from blastocysts. PARTICIPANTS/MATERIALS SETTING METHODS Cell-type-specific RNA-seq analysis of freshly isolated endometrial epithelial and stromal cells using fluorescence-activated cell sorting (FACS) from 16 paired pre-receptive and receptive tissue samples was performed. Endometrial transcriptome data were further combined in silico with trophectodermal gene expression data from 466 single cells originating from 17 blastocysts to characterize the first steps of embryo implantation. We constructed a protein-protein interaction network between endometrial epithelial and embryonal trophectodermal cells, and between endometrial stromal and trophectodermal cells, thereby focusing on the very first phases of embryo implantation, and highlighting the molecules likely to be involved in the embryo apposition, attachment and invasion. MAIN RESULTS AND THE ROLE OF CHANCE In total, 499 epithelial and 581 stromal genes were up-regulated in the receptive phase endometria when compared to pre-receptive samples. The constructed protein-protein interactions identified a complex network of 558 prioritized protein-protein interactions between trophectodermal, epithelial and stromal cells, which were grouped into clusters based on the function of the involved molecules. The role of galectins (LGALS1 and LGALS3), integrin β1 (ITGB1), basigin (BSG) and osteopontin (SPP1) in the embryo implantation process were highlighted. LARGE SCALE DATA RNA-seq data are available at www.ncbi.nlm.nih.gov/geo under accession number GSE97929. LIMITATIONS REASONS FOR CAUTION Providing a static snap-shot of a dynamic process and the nature of prediction analysis is limited to the known interactions available in databases. Furthermore, the cell sorting technique used separated enriched epithelial cells and stromal cells but did not separate luminal from glandular epithelium. Also, the use of biopsies taken from non-pregnant women and using spare IVF embryos (due to ethical considerations) might miss some of the critical interactions characteristic of natural conception only. WIDER IMPLICATIONS OF THE FINDINGS The findings of our study provide new insights into the molecular embryo-endometrium interplay in the first steps of implantation process in humans. Knowledge about the endometrial cell-type-specific molecules that coordinate successful implantation is vital for understanding human reproduction and the underlying causes of implantation failure and infertility. Our study results provide a useful resource for future reproductive research, allowing the exploration of unknown mechanisms of implantation. We envision that those studies will help to improve the understanding of the complex embryo implantation process, and hopefully generate new prognostic and diagnostic biomarkers and therapeutic approaches to target both infertility and fertility, in the form of new contraceptives. STUDY FUNDING/COMPETING INTERESTS This research was funded by the Estonian Research Council (grant PRG1076); Horizon 2020 innovation grant (ERIN, grant no. EU952516); Enterprise Estonia (grant EU48695); the EU-FP7 Marie Curie Industry-Academia Partnerships and Pathways (IAPP, grant SARM, EU324509); Spanish Ministry of Economy, Industry and Competitiveness (MINECO) and European Regional Development Fund (FEDER) (grants RYC-2016-21199, ENDORE SAF2017-87526-R, and Endo-Map PID2021-127280OB-100); Programa Operativo FEDER Andalucía (B-CTS-500-UGR18; A-CTS-614-UGR20), Junta de Andalucía (PAIDI P20_00158); Margarita Salas program for the Requalification of the Spanish University system (UJAR01MS); the Knut and Alice Wallenberg Foundation (KAW 2015.0096); Swedish Research Council (2012-2844); and Sigrid Jusélius Foundation; Academy of Finland. A.S.-L. is funded by the Spanish Ministry of Science, Innovation and Universities (PRE2018-085440). K.G.-D. has received consulting fees and/or honoraria from RemovAid AS, Norway Bayer, MSD, Gedeon Richter, Mithra, Exeltis, MedinCell, Natural cycles, Exelgyn, Vifor, Organon, Campus Pharma and HRA-Pharma and NIH support to the institution; D.B. is an employee of IGENOMIX. The rest of the authors declare no conflict of interest.
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Affiliation(s)
- Mariann Koel
- Competence Centre on Health Technologies, Tartu, Estonia
- Department of Cell Biology, Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | - Kaarel Krjutškov
- Competence Centre on Health Technologies, Tartu, Estonia
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Merli Saare
- Competence Centre on Health Technologies, Tartu, Estonia
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Külli Samuel
- Competence Centre on Health Technologies, Tartu, Estonia
| | - Dmitri Lubenets
- Department of Cell Biology, Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | - Shintaro Katayama
- Stem Cells and Metabolism Research Program, Research Programs Unit, University of Helsinki, and Folkhälsan Research Center, Helsinki, Finland
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Elisabet Einarsdottir
- Stem Cells and Metabolism Research Program, Research Programs Unit, University of Helsinki, and Folkhälsan Research Center, Helsinki, Finland
- Science for Life Laboratory, Department of Gene Technology, KTH-Royal Institute of Technology, Solna, Sweden
| | - Eva Vargas
- Department of Biochemistry and Molecular Biology, Faculty of Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Systems Biology Unit, Department of Experimental Biology, Faculty of Experimental Sciences, University of Jaén, Jaén, Spain
| | - Alberto Sola-Leyva
- Department of Biochemistry and Molecular Biology, Faculty of Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Parameswaran Grace Lalitkumar
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet, and Karolinska Univeristy Hospital, Stockholm,Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet, and Karolinska Univeristy Hospital, Stockholm,Sweden
| | - David Blesa
- Department of Product Development, IGENOMIX, Valencia, Spain
| | - Carlos Simon
- Department of Obstetrics and Gynecology, Valencia University and INCLIVA in Valencia, Valencia, Spain
- Department of Obstetrics and Gynecology, BIDMC, Harvard University, Boston, MA, USA
| | - Fredrik Lanner
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm,Sweden
- Ming Wai Lau Center for Reparative Medicine, Stockholm node, Karolinska Institutet, Stockholm, Sweden
| | - Juha Kere
- Stem Cells and Metabolism Research Program, Research Programs Unit, University of Helsinki, and Folkhälsan Research Center, Helsinki, Finland
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Andres Salumets
- Competence Centre on Health Technologies, Tartu, Estonia
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm,Sweden
| | - Signe Altmäe
- Competence Centre on Health Technologies, Tartu, Estonia
- Department of Biochemistry and Molecular Biology, Faculty of Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm,Sweden
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26
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Pearson-Farr JE, Wheway G, Jongen MSA, Goggin P, Lewis RM, Cheong Y, Cleal JK. Endometrial gland specific progestagen-associated endometrial protein and cilia gene splicing changes in recurrent pregnancy loss. REPRODUCTION AND FERTILITY 2022; 3:RAF-22-0002. [PMID: 35971960 PMCID: PMC9513660 DOI: 10.1530/raf-22-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 08/15/2022] [Indexed: 11/08/2022] Open
Abstract
Endometrial glands are essential for fertility, consisting of ciliated and secretory cells that facilitate a suitable uterine environment for embryo implantation. This study sought to determine whether an endometrial gland specific transcriptome and splicing profile are altered in women with recurrent pregnancy loss. Our data provide a comprehensive catalogue of cilia and PAEP gene isoforms and relative exon usage in endometrial glands. We report a previously unannotated endometrial gland cilia transcript GALNT11 and its susceptibility to exon skipping. Key endometrial receptivity gene transcripts are also reported to change in endometrial glands of women with recurrent pregnancy loss. The endometrial gland cilia and PAEP targets identified in this study could be used to identify a perturbed endometrium, isolate causes of recurrent pregnancy loss and develop targeted therapies in personalised medicine.
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Affiliation(s)
- Jennifer E Pearson-Farr
- Human Development and Health, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Gabrielle Wheway
- Human Development and Health, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Maaike S A Jongen
- Human Development and Health, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Patricia Goggin
- Biomedical Imaging Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rohan M Lewis
- Human Development and Health, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Ying Cheong
- Human Development and Health, University of Southampton, Faculty of Medicine, Southampton, UK
- Complete Fertility Centre Southampton, Princess Anne Hospital, Division of Women and Newborn, Southampton, UK
| | - Jane K Cleal
- Human Development and Health, University of Southampton, Faculty of Medicine, Southampton, UK
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27
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Liu Z, Liu X, Wang M, Zhao H, He S, Lai S, Qu Q, Wang X, Zhao D, Bao H. The Clinical Efficacy of Personalized Embryo Transfer Guided by the Endometrial Receptivity Array/Analysis on IVF/ICSI Outcomes: A Systematic Review and Meta-Analysis. Front Physiol 2022; 13:841437. [PMID: 35574479 PMCID: PMC9092494 DOI: 10.3389/fphys.2022.841437] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/04/2022] [Indexed: 01/10/2023] Open
Abstract
Objective: To assess the prevalence of displaced window of implantation (WOI) in infertile women, and the clinical utility of personalized embryo transfer (pET) guided by the endometrial receptivity array/analysis (ERA) on IVF/ICSI outcomes. Methods: The protocol was registered at Prospero: CRD42020204237. We systematically searched all published English literature related to the prevalence of WOI displacement and ongoing pregnancy rate/live birth rate in the overall good-prognosis infertile patients (GPP) and/or repeated implantation failure (RIF) patients undergoing IVF/ICSI-ET cycles after ERA test until August 2021. Result(s): 11 published studies were enrolled in the final analysis. The estimate of the incidence of WOI displacement based on ERA was 38% (95%CI 19–57%) in GPP and 34% (95%CI 24–43%) in RIF, respectively. There was no difference in OPR/LBR between patients undergoing routine ET without ERA test and those who following pET with ERA (39.5 vs. 53.7%, OR 1.28, p = 0.49, 95%CI 0.92–1.77, I2 = 0%) in relative GPP. Notably, the meta-analysis revealed that OPR/LBR of patients with RIF undergoing pET who had non-receptive ERA increased to the level of to those undergoing sET with receptive ERA (40.7 vs.49.6%, OR 0.94, p = 0.85, 95%CI 0.70–1.26, I2 = 0%). Conclusion: Considering the approximately one third of infertile women could suffered from displaced WOI, the ERA test emerged as a promising tool. Although the present meta-analysis demonstrates that patients with general good-prognosis may not benefit from ERA, pET guided by ERA significantly increases the chances of pregnancy for non-receptive patients with RIF of endometrial origin.
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Affiliation(s)
- Zhenteng Liu
- Department of Reproductive Medicine, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Xuemei Liu
- Department of Reproductive Medicine, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Meimei Wang
- Department of Reproductive Medicine, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Huishan Zhao
- Department of Reproductive Medicine, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Shunzhi He
- Department of Reproductive Medicine, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Shoucui Lai
- Department of Reproductive Medicine, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Qinglan Qu
- Department of Reproductive Medicine, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Xinrong Wang
- Department of Reproductive Medicine, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Dongmei Zhao
- Department of Reproductive Medicine, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Hongchu Bao
- Department of Reproductive Medicine, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
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28
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Sun B, Yeh J. Non-Invasive and Mechanism-Based Molecular Assessment of Endometrial Receptivity During the Window of Implantation: Current Concepts and Future Prospective Testing Directions. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:863173. [PMID: 36303672 PMCID: PMC9580756 DOI: 10.3389/frph.2022.863173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/07/2022] [Indexed: 12/03/2022] Open
Abstract
Suboptimal endometrial receptivity and altered embryo-endometrial crosstalk account for approximately two-thirds of human implantation failures. Current tests of the window of implantation, such as endometrial thickness measurements and the endometrial receptivity assay, do not consistently improve clinical outcomes as measured by live birth rates. Understanding the mechanisms regulating the endometrial receptivity during the window of implantation is a critical step toward developing clinically meaningful tests. In this narrative review, the available literature is evaluated regarding mechanisms that regulate the endometrial receptivity during the window of implantation and the current tests developed. Overall, both animal and human studies point to five possible and interrelated mechanisms regulating the endometrial window of implantation: suitable synchrony between endometrial cells, adequate synchrony between the endometrium and the embryo, standard progesterone signaling and endometrial responses to progesterone, silent genetic variations, and typical morphological characteristics of the endometrial glands. The biological basis of current clinical markers or tests of window of implantation is poor. Future studies to elucidate the mechanisms shaping the window of implantation and to investigate the potential markers based on these mechanisms are required. In addition, molecular testing of the endometrium at single-cell resolution should be an initial step toward developing clinically meaningful tests for the optimal window of implantation. As understanding of the optimal window of implantation continues to evolve, one can envision the future development of non-invasive, mechanism-based testing of the window of implantation.
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Affiliation(s)
- Bei Sun
- Sackler Faculty of Medicine, Sackler School of Medicine, New York State/American Program of Tel Aviv University, Tel Aviv University, Tel Aviv, Israel
| | - John Yeh
- Reproductive Endocrinology and Infertility, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, United States
- *Correspondence: John Yeh
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29
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Tang Z, Wang L, Huang Z, Guan H, Leung W, Chen X, Xia H, Zhang W. CD55 is upregulated by cAMP/PKA/AKT and modulates human decidualization via Src and ERK pathway and decidualization-related genes. Mol Reprod Dev 2022; 89:256-268. [PMID: 35474595 DOI: 10.1002/mrd.23569] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 12/12/2022]
Abstract
Decidualization is an essential process for embryo implantation and maintenance of pregnancy, and abnormal decidualization contributed to several pregnancy disorders like a miscarriage. The objective of this study was to explore the regulation and function of CD55 in human decidualization. By immunohistochemical staining, it was found that CD55 expression was higher in first-trimester decidua than in the endometrium. In both primary endometrial stromal cells and immortalized cell line T-hESCs, CD55 was upregulated by induction of in vitro decidualization with medroxyprogesterone acetate (MPA) and 8-Br-cAMP. During decidualization in vitro, CD55 was stimulated by 8-Br-cAMP in a time- and concentration-dependent manner, which was reversed by a PKA inhibitor H89 and partially by an AKT activator SC79. Knocking down CD55 expression diminished the expression of decidualization markers prolactin (PRL) and insulin-like growth factor-binding protein 1 (IGFBP1), accompanied by inhibition of Src, aberrant activation of ERK and decreased expression of several decidualization-related genes, including FOXO1, EGFR, and STAT3. Furthermore, the decidua of unexplained miscarriage women and the endometrium of unexplained infertile women both exhibited decreased CD55 expression. Collectively, these findings revealed that 8-Br-cAMP promotes CD55 expression via PKA activation and AKT dephosphorylation, and decreased CD55 impairs decidualization by inactivation of Src, aberrant activation of ERK pathway, and compromised expression of decidualization-related genes, indicating that CD55 deficiency may contribute to the pathogenesis of spontaneous miscarriage and infertility.
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Affiliation(s)
- Zhijing Tang
- Department of Reproductive Endocrinology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Lu Wang
- Department of Reproductive Endocrinology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Zengshu Huang
- Department of Reproductive Endocrinology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Haiyun Guan
- Department of Reproductive Endocrinology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Wingting Leung
- Department of Reproductive Endocrinology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Xiuying Chen
- Department of Reproductive Endocrinology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Hexia Xia
- Department of Reproductive Endocrinology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Wei Zhang
- Department of Reproductive Endocrinology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
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30
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Vargas E, García-Moreno E, Aghajanova L, Salumets A, Horcajadas JA, Esteban FJ, Altmäe S. The mid-secretory endometrial transcriptomic landscape in endometriosis: a meta-analysis. Hum Reprod Open 2022; 2022:hoac016. [PMID: 35464885 PMCID: PMC9022214 DOI: 10.1093/hropen/hoac016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 03/16/2022] [Indexed: 12/01/2022] Open
Abstract
STUDY QUESTION Do women with endometriosis have a different endometrial gene expression profile at the time of embryo implantation than women without endometriosis? SUMMARY ANSWER The endometrial gene expression profile of women with endometriosis differs from that of women without endometriosis at the mid-secretory phase, although the differences are small. WHAT IS KNOWN ALREADY About 50% of women with endometriosis suffer infertility. Several molecular studies have suggested impaired endometrial receptivity in women with endometriosis, while others have detected no dysregulation of endometrial receptivity. Nevertheless, the previous endometrial transcriptome studies comparing women with and without endometriosis have been performed in small sample size with limited statistical power. We set out to systematically search and compile data of endometrial gene expression signatures at the receptive phase in women with endometriosis versus control women. Based on the obtained data, we conducted a meta-analysis of differentially expressed genes in order to raise the power of the analysis for identifying the molecular profiles of receptive phase endometria in endometriosis. STUDY DESIGN, SIZE, DURATION A systematic literature search was conducted up to February 2022 following PRISMA criteria and included PubMed, Cochrane and Web of Science databases. For the systematic search, the term ‘endometriosis’ was paired with the terms ‘transcriptomics’, ‘transcriptome’, ‘gene expression’, ‘RNA-seq’, ‘sequencing’ and ‘array’, by using the Boolean operator ‘AND’ to connect them. Articles written in English were screened and interrogated for data extraction. PARTICIPANTS/MATERIALS, SETTING, METHODS A meta-analysis was performed on the selected studies to extract the differentially expressed genes described at the mid-secretory phase in women with endometriosis versus women without endometriosis in natural cycles, using the robust rank aggregation method. In total, transcriptome data of 125 women (78 patients and 47 controls) were meta-analysed, with a special focus on endometrial receptivity-specific genes based on commercial endometrial receptivity tests. MAIN RESULTS AND THE ROLE OF CHANCE In total, 8 studies were eligible for the quantitative meta-analysis, gathering transcriptome data from the mid-secretory phase endometria of 125 women. A total of 7779 differentially expressed transcripts between the study groups were retrieved (3496 up-regulated and 4283 down-regulated) and were meta-analysed. After stringent multiple correction, there was no differential expression of any single molecule in the endometrium of women with endometriosis versus controls, while enrichment analysis detected that the pathways of chemotaxis and locomotion are dysregulated in endometriosis. Further analysis of endometrial receptivity-specific genes highlighted dysregulation of C4BPA, MAOA and PAEP and enrichment of immune and defence pathways in women with endometriosis. LIMITATIONS, REASONS FOR CAUTION Most of the studies included into the meta-analysis were relatively small and had different study designs, which might have contributed to a bias. WIDER IMPLICATIONS OF THE FINDINGS The current meta-analysis supports the hypothesis that endometrial receptivity is altered in women with endometriosis, although the changes are small. The molecules and pathways identified could serve as future biomarkers and therapeutical targets in detecting and treating endometriosis-associated infertility. STUDY FUNDING/COMPETING INTEREST(S) The authors declare no competing interests. This work was supported by the Spanish Ministry of Education, Culture and Sport [grant FPU15/01193] and the Margarita Salas program for the Requalification of the Spanish University system [grant UJAR01MS]; Spanish Ministry of Economy, Industry and Competitiveness (MINECO) and European Regional Development Fund (FEDER): grants RYC-2016-21199 and ENDORE SAF2017-87526-R; Programa Operativo FEDER Andalucía (B-CTS-500-UGR18; A-CTS-614-UGR20); the Junta de Andalucía [BIO-302; and PAIDI P20_00158]; the University of Jaén [PAIUJA-EI_CTS02_2017]; the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES), and by the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades and European Regional Development Fund (ERDF), ref. SOMM17/6107/UGR; the Estonian Research Council (grant PRG1076); Horizon 2020 innovation (ERIN, grant no. EU952516) of the European Commission and Enterprise Estonia (grant EU48695). TRIAL REGISTRATION NUMBER The systematic review was registered at PROSPERO (identifier: CRD42020122054).
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Affiliation(s)
- E Vargas
- Systems Biology Unit, Department of Experimental Biology, Faculty of Experimental Sciences, University of Jaén, Jaén, 23003, Spain
- Department of Biochemistry and Molecular Biology, Faculty of Sciences, University of Granada, Granada, 18071, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, 18014, Spain
| | - E García-Moreno
- Immunology Unit,Hospital Universitario Puerta del Mar, Cádiz, Cádiz, 11009, Spain
| | - L Aghajanova
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford School of Medicine, Sunnyvale, CA, 94305, USA
| | - A Salumets
- Competence Centre on Health Technologies, Tartu, 50410, Estonia
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, 17177, Sweden
- Department of Obstetrics and Gyneaecology, Institute of Clinical Medicine, University of Tartu, Tartu, 50406, Estonia
| | - J A Horcajadas
- University Pablo de Olavide, Sevilla, Sevilla, 41013, Spain
| | - F J Esteban
- Systems Biology Unit, Department of Experimental Biology, Faculty of Experimental Sciences, University of Jaén, Jaén, 23003, Spain
| | - S Altmäe
- Department of Biochemistry and Molecular Biology, Faculty of Sciences, University of Granada, Granada, 18071, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, 18014, Spain
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford School of Medicine, Sunnyvale, CA, 94305, USA
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Aplin JD, Stevens A. Use of 'omics for endometrial timing: the cycle moves on. Hum Reprod 2022; 37:644-650. [PMID: 35147196 PMCID: PMC8971645 DOI: 10.1093/humrep/deac022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/05/2022] [Indexed: 12/23/2022] Open
Abstract
For some years, the prospect of precise and personalized timing of the endometrial cycle for optimal embryo replacement has been held out as a potential solution to low implantation rates. It is envisaged that a receptive state can be defined and reached at a predictable time, and embryo replacement performed in synchrony. In the last century, morphological changes characteristic of the mid secretory phase were defined in precisely timed cycles in women of proven fertility, but when deviations from this standardized schedule occur, their significance for implantation has remained uncertain. ‘Omics technologies have been widely advocated for staging the endometrial cycle and defining a set of biochemical requirements for implantation, but after two decades of research, improvements to pregnancy rates have not followed, and there is a striking lack of agreement regarding the molecular characterization of the receptive state. Some of the rationale underlying these problems is now emerging with the application of higher-level computational and biological methodology. Here, we consider the challenges of defining an endometrial phenotype that can support implantation and continuing pregnancy. Receptivity may be an emergent trait depending on contributions from multiple proteins that have low pathway connectivity. We recommend that authors choose language which rigorously avoids the implication that protocols for molecular staging of the mid secretory phase inherently identify a state of receptivity to the implanting blastocyst.
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Affiliation(s)
- John D Aplin
- Maternal and Fetal Health Centre, Manchester Academic Health Sciences Centre, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Adam Stevens
- Maternal and Fetal Health Centre, Manchester Academic Health Sciences Centre, University of Manchester, St Mary's Hospital, Manchester, UK
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Diaz-Gimeno P, Sebastian-Leon P, Sanchez-Reyes JM, Spath K, Aleman A, Vidal C, Devesa-Peiro A, Labarta E, Sánchez-Ribas I, Ferrando M, Kohls G, García-Velasco JA, Seli E, Wells D, Pellicer A. Identifying and optimizing human endometrial gene expression signatures for endometrial dating. Hum Reprod 2022; 37:284-296. [PMID: 34875061 DOI: 10.1093/humrep/deab262] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/29/2021] [Indexed: 12/22/2022] Open
Abstract
STUDY QUESTION What are the key considerations for developing an enhanced transcriptomic method for secretory endometrial tissue dating? SUMMARY ANSWER Multiple gene expression signature combinations can serve as biomarkers for endometrial dating, but their predictive performance is variable and depends on the number and identity of the genes included in the prediction model, the dataset characteristics and the technology employed for measuring gene expression. WHAT IS KNOWN ALREADY Among the new generation of transcriptomic endometrial dating (TED) tools developed in the last decade, there exists variation in the technology used for measuring gene expression, the gene makeup and the prediction model design. A detailed study, comparing prediction performance across signatures for understanding signature behaviour and discrepancies in gene content between them, is lacking. STUDY DESIGN, SIZE, DURATION A multicentre prospective study was performed between July 2018 and October 2020 at five different centres from the same group of clinics (Spain). This study recruited 281 patients and finally included in the gene expression analysis 225 Caucasian patients who underwent IVF treatment. After preprocessing and batch effect filtering, gene expression measurements from 217 patients were combined with artificial intelligence algorithms (support vector machine, random forest and k-nearest neighbours) allowing evaluation of different prediction models. In addition, secretory-phase endometrial transcriptomes from gene expression omnibus (GEO) datasets were analysed for 137 women, to study the endometrial dating capacity of genes independently and grouped by signatures. This provided data on the consistency of prediction across different gene expression technologies and datasets. PARTICIPANTS/MATERIALS, SETTING, METHODS Endometrial biopsies were analysed using a targeted TruSeq (Illumina) custom RNA expression panel called the endometrial dating panel (ED panel). This panel included 301 genes previously considered relevant for endometrial dating as well as new genes selected for their anticipated value in detecting the secretory phase. Final samples (n = 217) were divided into a training set for signature discovery and an independent testing set for evaluation of predictive performance of the new signature. In addition, secretory-phase endometrial transcriptomes from GEO were analysed for 137 women to study endometrial dating capacity of genes independently and grouped by signatures. Predictive performance among these signatures was compared according to signature gene set size. MAIN RESULTS AND THE ROLE OF CHANCE Testing of the ED panel allowed development of a model based on a new signature of 73 genes, which we termed 'TED' and delivers an enhanced tool for the consistent dating of the secretory phase progression, especially during the mid-secretory endometrium (3-8 days after progesterone (P) administration (P + 3-P + 8) in a hormone replacement therapy cycle). This new model showed the best predictive capacity in an independent test set for staging the endometrial tissue in the secretory phase, especially in the expected window of implantation (average of 114.5 ± 7.2 h of progesterone administered; range in our patient population of 82-172 h). Published sets of genes, in current use for endometrial dating and the new TED genes, were evaluated in parallel in whole-transcriptome datasets and in the ED panel dataset. TED signature performance was consistently excellent for all datasets assessed, frequently outperforming previously published sets of genes with a smaller number of genes for dating the endometrium in the secretory phase. Thus, this optimized set exhibited prediction consistency across datasets. LARGE SCALE DATA The data used in this study is partially available at GEO database. GEO identifiers GSE4888, GSE29981, GSE58144, GSE98386. LIMITATIONS, REASONS FOR CAUTION Although dating the endometrial biopsy is crucial for investigating endometrial progression and the receptivity process, further studies are needed to confirm whether or not endometrial dating methods in general are clinically useful and to guide the specific use of TED in the clinical setting. WIDER IMPLICATIONS OF THE FINDINGS Multiple gene signature combinations provide adequate endometrial dating, but their predictive performance depends on the identity of the genes included, the gene expression platform, the algorithms used and dataset characteristics. TED is a next-generation endometrial assessment tool based on gene expression for accurate endometrial progression dating especially during the mid-secretory. STUDY FUNDING/COMPETING INTEREST(S) Research funded by IVI Foundation (1810-FIVI-066-PD). P.D.-G. visiting scientist fellowship at Oxford University (BEFPI/2010/032) and Josefa Maria Sanchez-Reyes' predoctoral fellowship (ACIF/2018/072) were supported by a program from the Generalitat Valenciana funded by the Spanish government. A.D.-P. is supported by the FPU/15/01398 predoctoral fellowship from the Ministry of Science, Innovation and Universities (Spanish Government). D.W. received support from the NIHR Oxford Biomedical Research Centre. The authors do not have any competing interests to declare.
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Affiliation(s)
- P Diaz-Gimeno
- Genomic & Systems Reproductive Medicine, IVI Foundation/Instituto de investigación sanitaria La Fe (IIS La Fe), Valencia, Spain
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Level 3, Women's Centre John Radcliffe Hospital, Oxford, UK
| | - P Sebastian-Leon
- Genomic & Systems Reproductive Medicine, IVI Foundation/Instituto de investigación sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - J M Sanchez-Reyes
- Genomic & Systems Reproductive Medicine, IVI Foundation/Instituto de investigación sanitaria La Fe (IIS La Fe), Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
| | - K Spath
- Research Department, JUNO Genetics, Oxford, UK
| | - A Aleman
- Genomic & Systems Reproductive Medicine, IVI Foundation/Instituto de investigación sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - C Vidal
- Genomic & Systems Reproductive Medicine, IVI Foundation/Instituto de investigación sanitaria La Fe (IIS La Fe), Valencia, Spain
- Reproductive medicine, IVI RMA Valencia, Valencia, Spain
| | - A Devesa-Peiro
- Genomic & Systems Reproductive Medicine, IVI Foundation/Instituto de investigación sanitaria La Fe (IIS La Fe), Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
| | - E Labarta
- Genomic & Systems Reproductive Medicine, IVI Foundation/Instituto de investigación sanitaria La Fe (IIS La Fe), Valencia, Spain
- Reproductive medicine, IVI RMA Valencia, Valencia, Spain
| | - I Sánchez-Ribas
- Genomic & Systems Reproductive Medicine, IVI Foundation/Instituto de investigación sanitaria La Fe (IIS La Fe), Valencia, Spain
- Reproductive medicine, IVI RMA Barcelona, Barcelona, Spain
| | - M Ferrando
- Reproductive medicine, IVI RMA Bilbao, Leioa, Bizkaia, Spain
| | - G Kohls
- Reproductive medicine, IVI RMA Madrid, Madrid, Spain
| | - J A García-Velasco
- Reproductive medicine, IVI RMA Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, Universidad Rey Juan Carlos, Madrid, Spain
| | - E Seli
- Research Department, IVI RMA New Jersey, Basking Ridge, NJ, USA
- Department of Obstetrics, Gynecology & Reproductive Science, Yale School of Medicine, New Haven, CT, USA
| | - D Wells
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Level 3, Women's Centre John Radcliffe Hospital, Oxford, UK
- Research Department, JUNO Genetics, Oxford, UK
| | - A Pellicer
- Genomic & Systems Reproductive Medicine, IVI Foundation/Instituto de investigación sanitaria La Fe (IIS La Fe), Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
- Research Department, JUNO Genetics, Oxford, UK
- Reproductive medicine, IVI RMA Rome, Roma, Italy
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Prašnikar E, Kunej T, Gorenjak M, Potočnik U, Kovačič B, Knez J. Transcriptomics of receptive endometrium in women with sonographic features of adenomyosis. Reprod Biol Endocrinol 2022; 20:2. [PMID: 34980152 PMCID: PMC8722101 DOI: 10.1186/s12958-021-00871-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/06/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Women with uterine adenomyosis seeking assisted reproduction have been associated with compromised endometrial receptivity to embryo implantation. To understand the mechanisms involved in this process, we aimed to compare endometrial transcriptome profiles during the window of implantation (WOI) between women with and without adenomyosis. METHODS We obtained endometrial biopsies LH-timed to the WOI from women with sonographic features of adenomyosis (n=10) and controls (n=10). Isolated RNA samples were subjected to RNA sequencing (RNA-seq) by the Illumina NovaSeq 6000 platform and endometrial receptivity classification with a molecular tool for menstrual cycle phase dating (beREADY®, CCHT). The program language R and Bioconductor packages were applied to analyse RNA-seq data in the setting of the result of accurate endometrial dating. To suggest robust candidate pathways, the identified differentially expressed genes (DEGs) associated with the adenomyosis group in the receptive phase were further integrated with 151, 173 and 42 extracted genes from published studies that were related to endometrial receptivity in healthy uterus, endometriosis and adenomyosis, respectively. Enrichment analyses were performed using Cytoscape ClueGO and CluePedia apps. RESULTS Out of 20 endometrial samples, 2 were dated to the early receptive phase, 13 to the receptive phase and 5 to the late receptive phase. Comparison of the transcriptomics data from all 20 samples provided 909 DEGs (p<0.05; nonsignificant after adjusted p value) in the adenomyosis group but only 4 enriched pathways (Bonferroni p value < 0.05). The analysis of 13 samples only dated to the receptive phase provided suggestive 382 DEGs (p<0.05; nonsignificant after adjusted p value) in the adenomyosis group, leading to 33 enriched pathways (Bonferroni p value < 0.05). These included pathways were already associated with endometrial biology, such as "Expression of interferon (IFN)-induced genes" and "Response to IFN-alpha". Data integration revealed pathways indicating a unique effect of adenomyosis on endometrial molecular organization (e.g., "Expression of IFN-induced genes") and its interference with endometrial receptivity establishment (e.g., "Extracellular matrix organization" and "Tumour necrosis factor production"). CONCLUSIONS Accurate endometrial dating and RNA-seq analysis resulted in the identification of altered response to IFN signalling as the most promising candidate of impaired uterine receptivity in adenomyosis.
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Affiliation(s)
- Erika Prašnikar
- Department of Reproductive Medicine and Gynaecological Endocrinology, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Tanja Kunej
- Department of Animal Science, Biotechnical Faculty, University of Ljubljana, 1230 Domžale, Slovenia
| | - Mario Gorenjak
- Centre for Human Molecular Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
| | - Uroš Potočnik
- Centre for Human Molecular Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
- Laboratory for Biochemistry, Molecular Biology and Genomics, Faculty of Chemistry and Chemical Engineering, University of Maribor, 2000 Maribor, Slovenia
| | - Borut Kovačič
- Department of Reproductive Medicine and Gynaecological Endocrinology, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Jure Knez
- Department of Gynaecology, University Medical Centre Maribor, 2000 Maribor, Slovenia
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Emerging in vitro platforms and omics technologies for studying the endometrium and early embryo-maternal interface in humans. Placenta 2022; 125:36-46. [DOI: 10.1016/j.placenta.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/09/2021] [Accepted: 01/09/2022] [Indexed: 12/11/2022]
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Lipecki J, Mitchell AE, Muter J, Lucas ES, Makwana K, Fishwick K, Odendaal J, Hawkes A, Vrljicak P, Brosens JJ, Ott S. OUP accepted manuscript. Hum Reprod 2022; 37:747-761. [PMID: 35092277 PMCID: PMC8971653 DOI: 10.1093/humrep/deac006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/09/2021] [Indexed: 11/18/2022] Open
Abstract
STUDY QUESTION Can the accuracy of timing of luteal phase endometrial biopsies based on urinary ovulation testing be improved by measuring the expression of a small number of genes and a continuous, non-categorical modelling approach? SUMMARY ANSWER Measuring the expression levels of six genes (IL2RB, IGFBP1, CXCL14, DPP4, GPX3 and SLC15A2) is sufficient to obtain substantially more accurate timing estimates and to assess the reliability of timing estimates for each sample. WHAT IS KNOWN ALREADY Commercially available endometrial timing approaches based on gene expression require large gene sets and use a categorical approach that classifies samples as pre-receptive, receptive or post-receptive. STUDY DESIGN, SIZE, DURATION Gene expression was measured by RTq-PCR in different sample sets, comprising a total of 664 endometrial biopsies obtained 4–12 days after a self-reported positive home ovulation test. A further 36 endometrial samples were profiled by RTq-PCR as well as RNA-sequencing. PARTICIPANTS/MATERIALS, SETTING, METHODS A computational procedure, named ‘EndoTime’, was established that models the temporal profile of each gene and estimates the timing of each sample. Iterating these steps, temporal profiles are gradually refined as sample timings are being updated, and confidence in timing estimates is increased. After convergence, the method reports updated timing estimates for each sample while preserving the overall distribution of time points. MAIN RESULTS AND THE ROLE OF CHANCE The Wilcoxon rank-sum test was used to confirm that ordering samples by EndoTime estimates yields sharper temporal expression profiles for held-out genes (not used when determining sample timings) than ordering the same expression values by patient-reported times (GPX3: P < 0.005; CXCL14: P < 2.7e−6; DPP4: P < 3.7e−13). Pearson correlation between EndoTime estimates for the same sample set but based on RTq-PCR or RNA-sequencing data showed a high degree of congruency between the two (P = 8.6e−10, R2 = 0.687). Estimated timings did not differ significantly between control subjects and patients with recurrent pregnancy loss or recurrent implantation failure (P > 0.05). LARGE SCALE DATA The RTq-PCR data files are available via the GitHub repository for the EndoTime software at https://github.com/AE-Mitchell/EndoTime, as is the code used for pre-processing of RTq-PCR data. The RNA-sequencing data are available on GEO (accession GSE180485). LIMITATIONS, REASONS FOR CAUTION Timing estimates are informed by glandular gene expression and will only represent the temporal state of other endometrial cell types if in synchrony with the epithelium. Methods that estimate the day of ovulation are still required as these data are essential inputs in our method. Our approach, in its current iteration, performs batch correction such that larger sample batches impart greater accuracy to timing estimations. In theory, our method requires endometrial samples obtained at different days in the luteal phase. In practice, however, this is not a concern as timings based on urinary ovulation testing are associated with a sufficient level of noise to ensure that a variety of time points will be sampled. WIDER IMPLICATIONS OF THE FINDINGS Our method is the first to assay the temporal state of luteal-phase endometrial samples on a continuous domain. It is freely available with fully shared data and open-source software. EndoTime enables accurate temporal profiling of any gene in luteal endometrial samples for a wide range of research applications and, potentially, clinical use. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by a Wellcome Trust Investigator Award (Grant/Award Number: 212233/Z/18/Z) and the Tommy's National Miscarriage Research Centre. None of the authors have any competing interests. J.L. was funded by the Biotechnology and Biological Sciences Research Council (UK) through the Midlands Integrative Biology Training Partnership (MIBTP, BB/M01116X/1).
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Affiliation(s)
- Julia Lipecki
- School of Life Sciences, University of Warwick, Coventry, UK
| | | | - Joanne Muter
- Warwick Medical School, University of Warwick, Coventry, UK
- Tommy’s National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire National Health Service Trust, Coventry, UK
| | - Emma S Lucas
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Komal Makwana
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Amelia Hawkes
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Pavle Vrljicak
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jan J Brosens
- Warwick Medical School, University of Warwick, Coventry, UK
- Tommy’s National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire National Health Service Trust, Coventry, UK
| | - Sascha Ott
- Warwick Medical School, University of Warwick, Coventry, UK
- Bioinformatics RTP, Research Technology Platforms, University of Warwick, Coventry, UK
- Correspondence address. E-mail: https://orcid.org/0000-0002-5411-8114
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Ohara Y, Matsubayashi H, Suzuki Y, Takaya Y, Yamaguchi K, Doshida M, Takeuchi T, Ishikawa T, Handa M, Miyake T, Takiuchi T, Kimura T. Clinical relevance of a newly developed endometrial receptivity test for patients with recurrent implantation failure in Japan. Reprod Med Biol 2022; 21:e12444. [PMID: 35386362 PMCID: PMC8967283 DOI: 10.1002/rmb2.12444] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/07/2022] [Accepted: 01/19/2022] [Indexed: 01/10/2023] Open
Abstract
Purpose To assess the clinical efficacy of personalized embryo transfer (pET) guided by a new endometrial receptivity test, ERPeakSM, in patients with recurrent implantation failure (RIF). Methods Recurrent implantation failure patients of all ages at two private Japanese clinics from April 2019 to June 2020 were retrospectively analyzed. The intervention group (n = 244) received pET in accordance with endometrial receptivity testing results and was compared to control group (n = 306) receiving standardized timing, non-personalized embryo transfer (npET). In propensity score matching analysis, the clinical pregnancy rate (CPR) and live birth rate (LBR) were compared between groups, and a subanalysis of advanced maternal age (AMA) (≥38 years old) versus non-AMA (<38 years old) patients was also conducted. Results The CPR and LBR of the pET group were significantly higher than those of the npET group (37.7% vs. 20.0%, adjusted OR: 2.64; 95%CI, 1.70-4.11, p < 0.001 and 29.9% vs. 9.7%, adjusted OR: 4.13; 95%CI, 2.40-7.13, p < 0.001, respectively). Furthermore, in the subanalyses, the CPR and LBR of the pET group were significantly higher than those of the npET group in both the AMA non-AMA patients. Conclusions The new ERPeakSM endometrial receptivity test is a useful alternative diagnostic tool for poor-prognosis patients, regardless of age.
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Affiliation(s)
- Yasuhiro Ohara
- Department of Reproductive MedicineReproduction Clinic TokyoTokyoJapan
- Department of Obstetrics and GynecologyGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Hidehiko Matsubayashi
- Department of Reproductive MedicineReproduction Clinic TokyoTokyoJapan
- Department of Reproductive MedicineReproduction Clinic OsakaOsakaJapan
| | - Yosuke Suzuki
- Department of Reproductive MedicineReproduction Clinic OsakaOsakaJapan
| | - Yukiko Takaya
- Department of Reproductive MedicineReproduction Clinic OsakaOsakaJapan
| | - Kohei Yamaguchi
- Department of Reproductive MedicineReproduction Clinic TokyoTokyoJapan
- Department of Reproductive MedicineReproduction Clinic OsakaOsakaJapan
| | - Masakazu Doshida
- Department of Reproductive MedicineReproduction Clinic TokyoTokyoJapan
| | - Takumi Takeuchi
- Department of Reproductive MedicineReproduction Clinic TokyoTokyoJapan
| | - Tomomoto Ishikawa
- Department of Reproductive MedicineReproduction Clinic TokyoTokyoJapan
- Department of Reproductive MedicineReproduction Clinic OsakaOsakaJapan
| | - Mika Handa
- Department of Obstetrics and GynecologyGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Tatsuya Miyake
- Department of Obstetrics and GynecologyGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Tsuyoshi Takiuchi
- Department of Clinical GenomicsGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Tadashi Kimura
- Department of Obstetrics and GynecologyGraduate School of MedicineOsaka UniversitySuitaJapan
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A review of the pathophysiology of recurrent implantation failure. Fertil Steril 2021; 116:1436-1448. [PMID: 34674825 DOI: 10.1016/j.fertnstert.2021.09.014] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/06/2021] [Accepted: 09/14/2021] [Indexed: 11/20/2022]
Abstract
Implantation is a critical step in human reproduction. The success of this step is dependent on a competent blastocyst, receptive endometrium, and successful cross talk between the embryonic and maternal interfaces. Recurrent implantation failure is the lack of implantation after the transfer of several embryo transfers. As the success of in vitro fertilization has increased and failures have become more unacceptable for patients and providers, the literature on recurrent implantation failure has increased. While this clinical phenomenon is often encountered, there is not a universally agreed-on definition-something addressed in an earlier portion of this Views and Reviews. Implantation failure can result from several different factors. In this review, we discuss factors including the maternal immune system, genetics of the embryo and parents, anatomic factors, hematologic factors, reproductive tract microbiome, and endocrine milieu, which factors into embryo and endometrial synchrony. These potential causes are at various stages of research and not all have clear implications or immediately apparent treatment.
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El estudio de receptividad endometrial ER®map mejora los resultados reproductivos tras fallos previos de implantación en ciclos de fecundación in vitro. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2021.100688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Wang B, Shao Y. Annexin A2 acts as an adherent molecule under the regulation of steroids during embryo implantation. Mol Hum Reprod 2021; 26:825-836. [PMID: 33010173 DOI: 10.1093/molehr/gaaa065] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/16/2020] [Indexed: 12/16/2022] Open
Abstract
We previously showed that annexin A2 (Axna2) was transiently expressed at the embryo-uterine luminal epithelium interface during the window of implantation and was involved in mouse embryo implantation. At the same time, Axna2 was reported to be upregulated in human receptive endometrium, which was critical for embryo attachment as an intracellular molecule. Here, we identified Axna2 as a membrane-bound molecule on human endometrial epithelial cells and trophoblast cells, and the outer surface membrane-bound Axna2 was involved in human embryo attachment. In addition, physiological levels of estrogen and progesterone increased the expression of overall Axna2 as well as that in the extracellular surface membrane protein fraction in human endometrial cells. Furthermore, p11 (or S100A10, a member of the S100 EF-hand family protein, molecular weight 11 kDa) was involved in the translocation of Axna2 to the outer surface membrane of endometrial epithelial cells without affecting its overall expression. Finally, the surface relocation of Axna2 was also dependent on cell-cell contact and calcium binding. A better understanding of the function and regulation of Axna2 in human endometrium may help us to identify a potential therapeutic target for subfertile and infertile patients.
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Affiliation(s)
- Bing Wang
- Department of Obstetrics and Gynecology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
- R & D Department, Shenzhen Wingor Biotechnology Co., Ltd, Room 304, Shenzhen IC Design & Application Industrial Park, Shenzhen City, Guangdong Province, People's Republic of China
| | - Yan Shao
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Shatin, NT, People's Republic of China
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Pathare ADS, Hinduja I. Endometrial Expression of Cell Adhesion Genes in Recurrent Implantation Failure Patients in Ongoing IVF Cycle. Reprod Sci 2021; 29:513-523. [PMID: 34410653 DOI: 10.1007/s43032-021-00708-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/30/2021] [Indexed: 11/28/2022]
Abstract
Recurrent implantation failure (RIF) is one of the major obstacles in IVF. Transcriptomic literature has revealed the various biological processes involved in endometrial receptivity (ER) under different physiological circumstances, especially in natural cycle. We intended to determine the function-specific ER profile under controlled ovarian stimulation (COS) cycle. This can help to back trace the genomic impairment in RIF patients during the IVF cycle and to validate the genes involved in enriched pathways. In our study, retrospective gene expression microarray dataset was reanalysed after the follow-up, in classic non pregnant RIF (cases) vs fertile women (controls) under COS (n = 5/group). Reanalysis of microarray revealed significant downregulation of cell adhesion function (P:3.11E-05) with the maximum gene count. For validation purpose, downregulation of eight genes (COMP, HABP2, ITGAD, CDH3, COL22A1, MFAP4, THBS1and CD300A) involved in enriched cell adhesion pathway having fold change > 3 were assessed by real-time PCR in independent cohorts of cases and controls (n = 24, each). Downregulation of six out of eight genes (COMP, HABP2, ITGAD, CDH3, MFAP4 and THBS1) were confirmed by real-time PCR (P < 0.05) with fold change > 2. This indicates the importance of analysed genes in the ER mechanism under COS, thus mimicking the fresh embryo transfer. The further analysis in larger cohorts would substantiate the study findings in RIF patients undergoing IVF cycle.
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Affiliation(s)
- Amruta D S Pathare
- Department of IVF and Research, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, 400016, Maharashtra, India
| | - Indira Hinduja
- Department of IVF and Research, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, 400016, Maharashtra, India.
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García-Foncillas J, Argente J, Bujanda L, Cardona V, Casanova B, Fernández-Montes A, Horcajadas JA, Iñiguez A, Ortiz A, Pablos JL, Pérez Gómez MV. Milestones of Precision Medicine: An Innovative, Multidisciplinary Overview. Mol Diagn Ther 2021; 25:563-576. [PMID: 34331269 DOI: 10.1007/s40291-021-00544-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 12/11/2022]
Abstract
Although the concept of precision medicine, in which healthcare is tailored to the molecular and clinical characteristics of each individual, is not new, its implementation in clinical practice has been heterogenous. In some medical specialties, precision medicine has gone from being just a promise to a reality that achieves better patient outcomes. This is a fact if we consider, for example, the great advances made in the genetic diagnosis and subsequent treatment of countless hereditary diseases, such as cystic fibrosis, which have improved the life expectancy of many of the affected children. In the field of oncology, the development of targeted therapies has prolonged the survival of patients with breast, lung, colorectal, melanoma, and hematological malignancies. In other disciplines, clinical milestones are perhaps less well known, but no less important. The current challenge is to expand and generalize the use of technologies that are central to precision medicine, such as massively parallel sequencing, to improve the management (prevention and treatment) of complex conditions such as cardiovascular, kidney, or autoimmune diseases. This process requires investment in specialized expertise, multidisciplinary collaboration, and the nationwide organization of genetic laboratories for diagnosis of specific diseases.
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Affiliation(s)
- Jesús García-Foncillas
- Department of Oncology, Oncohealth Institute, Fundacion Jimenez Diaz University Hospital, Autonomous University, Madrid, Spain. .,Medical Oncology Department, University Hospital Fundación Jiménez Díaz-Universidad Autonoma de Madrid, Madrid, Spain.
| | - Jesús Argente
- Department of Endocrinology, Instituto de Salud Carlos III, IMDEA Institute, Hospital Infantil Universitario Niño Jesús, Spanish PUBERE Registry, CIBER of Obesity and Nutrition (CIBEROBN), Universidad Autónoma de Madrid, Madrid, Spain.,Department of Pediatrics, Instituto de Salud Carlos III, IMDEA Institute, Hospital Infantil Universitario Niño Jesús, Spanish PUBERE Registry, CIBER of Obesity and Nutrition (CIBEROBN), Universidad Autónoma de Madrid, Madrid, Spain
| | - Luis Bujanda
- Department of Gastroenterology, Hospital Donostia/Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Universidad del País Vasco (UPV/EHU), San Sebastian, Spain
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain.,ARADyAL Research Network, Barcelona, Spain
| | - Bonaventura Casanova
- Neuroimmunology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.,Department of Medicine, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Ana Fernández-Montes
- Medical Oncology, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | - Andrés Iñiguez
- Department of Cardiology, Hospital Álvaro Cunqueiro-Complejo Hospitalario Universitario, Vigo, Spain
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - José L Pablos
- Grupo de Enfermedades Inflamatorias y Autoinmunes, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain.,Servicio de Reumatología, Hospital 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
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Enciso M, Aizpurua J, Rodríguez-Estrada B, Jurado I, Ferrández-Rives M, Rodríguez E, Pérez-Larrea E, Climent AB, Marron K, Sarasa J. The precise determination of the window of implantation significantly improves ART outcomes. Sci Rep 2021; 11:13420. [PMID: 34183760 PMCID: PMC8238935 DOI: 10.1038/s41598-021-92955-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022] Open
Abstract
The human endometrium is receptive to the embryo for a specific period of time known as the window of implantation (WOI). During this period, the endometrium shows a specific gene expression profile suitable for endometrial function evaluation. ER Map is a molecular tool able to accurately predict endometrial receptivity status by transcriptomic analysis. In this retrospective study, including 2256 subfertile patients undergoing ART treatment, the clinical value of precise WOI determination is studied in detail. Results obtained when single embryo transfers (sET) were scheduled either within the WOI timeframe as established by ER Map, or deviating from this WOI, are assessed and compared. Data obtained showed that 34.18% (771/2256) of patients had a displaced WOI. Analysis of ART outcomes showed significantly higher pregnancy rates in transfers scheduled within the WOI predicted compared to transfers that deviated more than 12h from this WOI (44.35% vs 23.08%, p < 0.001). The deviation from the WOI had also an impact on the progression of pregnancy, with a significant increase in pregnancy loss (~ twofold) observed in transfers that deviated more than 12h from the WOI predicted. These results indicate that the precise determination of the WOI and personalised embryo transfer can significantly improve clinical outcomes.
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Affiliation(s)
- M Enciso
- IGLS Alicante, C/Britania 7, Alicante, Spain.
| | - J Aizpurua
- IVF Spain, Av. Ansaldo 13, 03540, Alicante, Spain
| | | | - I Jurado
- IGLS Alicante, C/Britania 7, Alicante, Spain
| | | | - E Rodríguez
- IVF Donostia, Av. Tolosa 71-73, 20018, San Sebastian, Spain
| | - E Pérez-Larrea
- IVF Donostia, Av. Tolosa 71-73, 20018, San Sebastian, Spain
| | - A B Climent
- IVF Spain, Av. Ansaldo 13, 03540, Alicante, Spain
| | - K Marron
- Sims IVF Clinic, Clonskeagh Road, Clonskeagh, Dublin, Ireland
| | - J Sarasa
- IGLS Alicante, C/Britania 7, Alicante, Spain
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Extracellular vesicles as a potential diagnostic tool in assisted reproduction. Curr Opin Obstet Gynecol 2021; 32:179-184. [PMID: 32205524 DOI: 10.1097/gco.0000000000000621] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Extracellular vesicles have emerged as a promising field of research for their potential to serve as biomarkers. In the pathophysiology of reproduction, they have attracted significant attention because of their diverse roles in gametogenesis and embryo-endometrial cross-talk. Advances in extracellular vesicle translational potential are herein reviewed with a particular focus in oocyte competence, semen quality diagnostics, embryo selection and detection of endometrial receptivity. RECENT FINDINGS Specific miRNAs present in follicular fluid-derived extracellular vesicles have been associated with follicle development and oocyte maturation. Some proteins known to regulate sperm function and capacitation such as glycodelin, and CRISP1 have been found as overrepresented in semen exosomes isolated from severe asthenozoospermic compared to normozoospermic men. In vitro developed human embryos can secrete extracellular vesicles whose propitiousness for preimplantation genetic testing is being increasingly investigated. Endometrial cell-derived extracellular vesicles recovered from uterine flushings might represent a reservoir of molecular markers potentially exploited for monitoring the endometrial status. SUMMARY Accumulated knowledge on extracellular vesicles deriving from endometrium, follicular fluid, embryos or male reproductive system may be translated to clinical practice to inform diagnostics in assisted reproduction technology (ART). Validation studies and technology developments are required to implement the profiling of extracellular vesicles as diagnostic tests in ART.
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Poh QH, Rai A, Carmichael II, Salamonsen LA, Greening DW. Proteome reprogramming of endometrial epithelial cells by human trophectodermal small extracellular vesicles reveals key insights into embryo implantation. Proteomics 2021; 21:e2000210. [PMID: 33860638 DOI: 10.1002/pmic.202000210] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 01/02/2023]
Abstract
Embryo implantation into the receptive endometrium is critical in pregnancy establishment, initially requiring reciprocal signalling between outer layer of the blastocyst (trophectoderm cells) and endometrial epithelium; however, factors regulating this crosstalk remain poorly understood. Although endometrial extracellular vesicles (EVs) are known to signal to the embryo during implantation, the role of embryo-derived EVs remains largely unknown. Here, we provide a comprehensive proteomic characterisation of a major class of EVs, termed small EVs (sEVs), released by human trophectoderm cells (Tsc-sEVs) and their capacity to reprogram protein landscape of endometrial epithelium in vitro. Highly purified Tsc-sEVs (30-200 nm, ALIX+ , TSG101+ , CD9/63/81+ ) were enriched in known players of implantation (LIFR, ICAM1, TAGLN2, WNT5A, FZD7, ROR2, PRICKLE2), antioxidant activity (SOD1, PRDX1/4/6), tissue integrity (EZR, RAC1, RHOA, TNC), and focal adhesions (FAK, ITGA2/V, ITGB1/3). Functionally, Tsc-sEVs were taken up by endometrial cells, altered transepithelial electrical resistance, and upregulated proteins implicated in embryo attachment (ITGA2/V, ITGB1/3), immune regulation (CD59, CD276, LGALS3), and antioxidant activity (GPX1/3/4, PRDX1/2/4/5/6): processes that are critical for successful implantation. Collectively, we provide critical insights into Tsc-sEV-mediated regulation of endometrial function that contributes to our understanding of the molecular basis of implantation.
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Affiliation(s)
- Qi Hui Poh
- Baker Heart and Diabetes Institute, Molecular Proteomics, Melbourne, Victoria, Australia.,Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Victoria, Australia
| | - Alin Rai
- Baker Heart and Diabetes Institute, Molecular Proteomics, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Irena Iśka Carmichael
- Monash Micro Imaging, Monash, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lois A Salamonsen
- Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
| | - David W Greening
- Baker Heart and Diabetes Institute, Molecular Proteomics, Melbourne, Victoria, Australia.,Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia
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Craciunas L, Pickering O, Chu J, Choudhary M, Žurauskienė J, Coomarasamy A. The transcriptomic profile of endometrial receptivity in recurrent miscarriage. Eur J Obstet Gynecol Reprod Biol 2021; 261:211-216. [PMID: 33971384 DOI: 10.1016/j.ejogrb.2021.04.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/14/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To characterise the endometrial transcriptomic profiles of women who suffered recurrent miscarriage and to set the foundation for the development of an endometrial receptivity test that could predict the fate of subsequent pregnancies. STUDY DESIGN This was a prospective multicentre cohort study performed at the Tommy's National Centre for Miscarriage Research in Birmingham, Saint Mary's Hospital in Manchester and Royal Devon & Exeter Hospital, United Kingdom. The study was conducted between December 2017 and December 2019. Endometrial biopsies were obtained during the window of implantation from 24 women aged 18-35 years, who were not pregnant and regularly menstruating, diagnosed with unexplained recurrent miscarriage by standard investigations as per the ESHRE guidelines. Exclusion criteria included risk factors such as smoking, obesity or hyperprolactinemia. The RNA transcripts abundances were quantified using Kallisto. R packages tximport and DESeq2 were used to summarize count estimates at the gene level and to analyse the differential gene expression. RESULTS Women who suffered four or more miscarriages had 19 differently expressed genes after adjustment for multiple comparisons. They were related to biological processes such as immunity (HLA-DMA, CCR8, ALOX5), energy production (ATP12A), hormone secretion (CGA), adhesion (CHAD, ADGRF2, AQP5, TBCD, CTNND1, NKD2) and cell proliferation (NCCRP1). Based on 421 differently expressed genes, women who achieved a subsequent live birth displayed an enrichment of processes related to the regulation of cell structure and proliferation, and a depletion of processes related to immunity, trans-membrane transport and coagulation. CONCLUSIONS Women in the extreme miscarriage cohort had a distinctive endometrial transcriptomic signature compared to women with low order miscarriages. There was a partial overlap with the transcriptome of asynchronous endometrium suggesting the endometrial factor to be a different entity in the context of recurrent miscarriage. Women who achieved a live birth in their subsequent pregnancy displayed an enrichment of genes related to the regulation of cell structure and proliferation, while women who suffered a subsequent miscarriage displayed an enrichment of genes related to immunity, trans-membrane transport and coagulation.
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Affiliation(s)
- Laurentiu Craciunas
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
| | - Oonagh Pickering
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Justin Chu
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Meenakshi Choudhary
- Newcastle Fertility Centre, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - Justina Žurauskienė
- Centre for Computational Biology, Institute of Cancer and Genomic Sciences, Haworth Building, University of Birmingham, UK
| | - Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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Ruiz-Alonso M, Valbuena D, Gomez C, Cuzzi J, Simon C. Endometrial Receptivity Analysis (ERA): data versus opinions. Hum Reprod Open 2021; 2021:hoab011. [PMID: 33880420 PMCID: PMC8045472 DOI: 10.1093/hropen/hoab011] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Indexed: 12/14/2022] Open
Abstract
This article summarises and contextualises the accumulated basic and clinical data on the ERA test and addresses specific comments and opinions presented by the opponent as part of an invited debate. Progress in medicine depends on new technologies and concepts that translate to practice to solve long-standing problems. In a key example, combining RNA sequencing data (transcriptomics) with artificial intelligence (AI) led to a clinical revolution in personalising disease diagnosis and fostered the concept of precision medicine. The reproductive field is no exception. Translation of endometrial transcriptomics to the clinic yielded an objective definition of the limited time period during which the maternal endometrium is receptive to an embryo, known as the window of implantation (WOI). The WOI is induced by the presence of exogenous and/or endogenous progesterone (P) after proper oestradiol (E2) priming. The window lasts 30-36 hours and, depending on the patient, occurs between LH + 6 and LH + 9 in natural cycles or between P + 4 and P + 7 in hormonal replacement therapy (HRT) cycles. In approximately 30% of IVF cycles in which embryo transfer is performed blindly, the WOI is displaced and embryo-endometrial synchrony is not achieved. Extending this application of endometrial transcriptomics, the endometrial receptivity analysis (ERA) test couples next-generation sequencing (NGS) to a computational predictor to identify transcriptomic signatures for each endometrial stage: proliferative (PRO), pre-receptive (PRE), receptive (R) and post-receptive (POST). In this way, personalised embryo transfer (pET) may be possible by synchronising embryo transfer with each patient's WOI. Data are the only way to confront arguments sustained in opinions and/or misleading concepts; it is up to the reader to make their own conclusions regarding its clinical utility.
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Affiliation(s)
- Maria Ruiz-Alonso
- Igenomix Foundation-INCLIVA, Valencia, Spain
- Igenomix SL, Valencia, Spain
| | - Diana Valbuena
- Igenomix Foundation-INCLIVA, Valencia, Spain
- Igenomix SL, Valencia, Spain
| | | | | | - Carlos Simon
- Igenomix Foundation-INCLIVA, Valencia, Spain
- Department of Pediatrics, Obstetrics & Gynecology, University of
Valencia, Valencia, Spain
- Department of Obstetrics and Gynecology, BIMDC, Harvard
University, Boston, MA, USA
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Rai A, Poh QH, Fatmous M, Fang H, Gurung S, Vollenhoven B, Salamonsen LA, Greening DW. Proteomic profiling of human uterine extracellular vesicles reveal dynamic regulation of key players of embryo implantation and fertility during menstrual cycle. Proteomics 2021; 21:e2000211. [PMID: 33634576 DOI: 10.1002/pmic.202000211] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 12/22/2022]
Abstract
Endometrial extracellular vesicles (EVs) are emerging as important players in reproductive biology. However, how their proteome is regulated throughout the menstrual cycle is not known. Such information can provide novel insights into biological processes critical for embryo development, implantation, and successful pregnancy. Using mass spectrometry-based quantitative proteomics, we show that small EVs (sEVs) isolated from uterine lavage of fertile women (UL-sEV), compared to infertile women, are laden with proteins implicated in antioxidant activity (SOD1, GSTO1, MPO, CAT). Functionally, sEVs derived from endometrial cells enhance antioxidant function in trophectoderm cells. Moreover, there was striking enrichment of invasion-related proteins (LGALS1/3, S100A4/11) in fertile UL-sEVs in the secretory (estrogen plus progesterone-driven, EP) versus proliferative (estrogen-driven, E) phase, with several players downregulated in infertile UL-sEVs. Consistent with this, sEVs from EP- versus E-primed endometrial epithelial cells promote invasion of trophectoderm cells. Interestingly, UL-sEVs from fertile versus infertile women carry known players/predictors of embryo implantation (PRDX2, IDHC), endometrial receptivity (S100A4, FGB, SERPING1, CLU, ANXA2), and implantation success (CAT, YWHAE, PPIA), highlighting their potential to inform regarding endometrial status/pregnancy outcomes. Thus, this study provides novel insights into proteome reprograming of sEVs and soluble secretome in uterine fluid, with potential to enhance embryo implantation and hence fertility.
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Affiliation(s)
- Alin Rai
- Baker Heart and Diabetes Institute, Molecular Proteomics, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Qi Hui Poh
- Baker Heart and Diabetes Institute, Molecular Proteomics, Melbourne, Victoria, Australia.,Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Victoria, Australia
| | - Monique Fatmous
- Baker Heart and Diabetes Institute, Molecular Proteomics, Melbourne, Victoria, Australia.,Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Victoria, Australia
| | - Haoyun Fang
- Baker Heart and Diabetes Institute, Molecular Proteomics, Melbourne, Victoria, Australia
| | - Shanti Gurung
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Beverley Vollenhoven
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,Monash IVF, Clayton, Victoria, Australia.,Women's and Newborn Program, Monash Health, Clayton, Victoria, Australia
| | - Lois A Salamonsen
- Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
| | - David W Greening
- Baker Heart and Diabetes Institute, Molecular Proteomics, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Victoria, Australia
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Montenegro IS, Kuhl CP, Schneider RDA, Zachia SDA, Durli ICLDO, Terraciano PB, Rivero RC, Passos EP. Use of clomiphene citrate protocol for controlled ovarian stimulation impairs endometrial maturity. JBRA Assist Reprod 2021; 25:90-96. [PMID: 33118715 PMCID: PMC7863098 DOI: 10.5935/1518-0557.20200056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/30/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Despite recent advances in assisted reproduction techniques and recent knowledge regarding embryo and endometrium quality, implantation and birth rates remain low. The objective of this study was to investigate whether clomiphene citrate alters endometrial maturation in infertile patients. METHODS In a prospective self-matched cohort study, we assessed the ovulation of women in spontaneous and stimulated cycles (with clomiphene citrate). We determined the ovulation day by ultrasound scanning. In both cycles, we took four blood samples (BS1 - at early proliferative phase, BS2 - at mid proliferative phase, BS3 - after ovulation and BS4 - at mid luteal phase) to determine the serum concentrations of FSH, LH, estradiol and progesterone. We retrieved an endometrial biopsy five days after ovulation, followed by blinded analysis and classification according to Noyes criteria, in both cycles. RESULTS Twenty-two participants completed the study. There were significant differences in FSH BS3 (p=0.001), in LH BS3 and BS4 (p<0.001 and p=0.049, respectively), in estradiol BS2, BS3 and BS4 (p<0.001, p=0.024 and p<0.001, respectively) and in progesterone BS3 and BS4 (p=0.028 and p<0.001, respectively). Considering Noyes criteria, there was a one-day delay when comparing the stimulated cycle with the spontaneous cycle (p=0.004), and a two-day delay when comparing the stimulated cycle with the biopsy day. CONCLUSION This study indicates that ovarian stimulation with clomiphene citrate delays the endometrial maturity, and could possibly impair the implantation process due to asynchrony.
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Affiliation(s)
- Ivan Sereno Montenegro
- Gynecology and Obstetrics Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Gynecology and Obstetrics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Embryology and Cellular Differentiation Lab, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Pathology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics of Universidade Federal do Rio Grande do Sul
| | - Cristiana Palma Kuhl
- Gynecology and Obstetrics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Embryology and Cellular Differentiation Lab, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics of Universidade Federal do Rio Grande do Sul
| | - Raquel de Almeida Schneider
- Gynecology and Obstetrics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Embryology and Cellular Differentiation Lab, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics of Universidade Federal do Rio Grande do Sul
| | - Suzana de Azevedo Zachia
- Embryology and Cellular Differentiation Lab, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Isabel Cirne Lima de Oliveira Durli
- Gynecology and Obstetrics Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Gynecology and Obstetrics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Embryology and Cellular Differentiation Lab, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics of Universidade Federal do Rio Grande do Sul
| | - Paula Barros Terraciano
- Gynecology and Obstetrics Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Gynecology and Obstetrics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Embryology and Cellular Differentiation Lab, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics of Universidade Federal do Rio Grande do Sul
| | - Raquel Camara Rivero
- Gynecology and Obstetrics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Pathology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Eduardo P Passos
- Gynecology and Obstetrics Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Gynecology and Obstetrics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Embryology and Cellular Differentiation Lab, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics of Universidade Federal do Rio Grande do Sul
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Haouzi D, Entezami F, Torre A, Innocenti C, Antoine Y, Mauries C, Vincens C, Bringer-Deutsch S, Gala A, Ferrieres-Hoa A, Ohl J, Gonzalez Marti B, Brouillet S, Hamamah S. Customized Frozen Embryo Transfer after Identification of the Receptivity Window with a Transcriptomic Approach Improves the Implantation and Live Birth Rates in Patients with Repeated Implantation Failure. Reprod Sci 2021; 28:69-78. [PMID: 32725589 PMCID: PMC7782404 DOI: 10.1007/s43032-020-00252-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/04/2020] [Accepted: 06/30/2020] [Indexed: 01/10/2023]
Abstract
The aim of this prospective study was to evaluate outcome benefits expected in repeated implantation failure (RIF) patients (n = 217) after customized embryo transfer based upon identification of the receptivity window by transcriptomic approach using the Win-Test. In this test, the expression of 11 endometrial genes known to be predictive of endometrial receptivity is assessed by RT-PCR in biopsies collected during the implantation window (6-9 days after the spontaneous luteinizing hormone surge during natural cycles, 5-9 days after progesterone administration during hormone replacement therapy cycles). Then, patients underwent either customized embryo transfer (cET, n = 157 patients) according to the Win-Test results or embryo transfer according to the classical procedure (control group, n = 60). Pregnancy and live birth rates were compared in the two groups. The Win-Test showed that in 78.5% of women, the receptivity window lasted less than 48 h, although it could be shorter (< 24 h, 9.5%) or longer (> 48 h, 12%). This highlighted that only in 20% of patients with RIF the endometrium would have been receptive if the classical embryo transfer protocol was followed. In the other 80% of patients, the receptivity window was delayed by 1-3 days relative to the classical timing. This suggests that implantation failure could be linked to inadequate timing of embryo transfer. In agreement, both implantation (22.7% vs. 7.2%) and live birth rates per patient (31.8% vs. 8.3%) were significantly higher in the cET group than in the control group. cET on the basis of the Win-Test results could be proposed to improve pregnancy and live birth rates.ClinicalTrials.gov ID: NCT04192396; December 5, 2019, retrospectively registered.
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Affiliation(s)
- Delphine Haouzi
- Univ Montpellier, INSERM U1203, EmbryoPluripotency, Montpellier, France.
- IRMB, Univ Montpellier, INSERM, Montpellier, France.
- CHU Montpellier, ART/PGD Department, Arnaud de Villeneuve Hospital, Montpellier, France.
| | - Frida Entezami
- Univ Montpellier, INSERM U1203, EmbryoPluripotency, Montpellier, France
- ART Department, American Hospital of Paris, Neuilly-Sur-Seine, France
- Laboratoire Eylau-UNILABS-La Muette, Clinique de La Muette-Ramsay-Générale de Santé, Paris, France
| | - Antoine Torre
- Division of Child Health, Obstetrics & Gynaecology Department, University of Nottingham, Nottingham, UK
| | - Charlène Innocenti
- Univ Montpellier, INSERM U1203, EmbryoPluripotency, Montpellier, France
- IRMB, Univ Montpellier, INSERM, Montpellier, France
- CHU Montpellier, ART/PGD Department, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Yannick Antoine
- Univ Montpellier, INSERM U1203, EmbryoPluripotency, Montpellier, France
- IRMB, Univ Montpellier, INSERM, Montpellier, France
| | - Charlotte Mauries
- CHU Montpellier, ART/PGD Department, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Claire Vincens
- CHU Montpellier, ART/PGD Department, Arnaud de Villeneuve Hospital, Montpellier, France
| | | | - Anna Gala
- Univ Montpellier, INSERM U1203, EmbryoPluripotency, Montpellier, France
- CHU Montpellier, ART/PGD Department, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Alice Ferrieres-Hoa
- Univ Montpellier, INSERM U1203, EmbryoPluripotency, Montpellier, France
- CHU Montpellier, ART/PGD Department, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Jeanine Ohl
- Department of reproductive medicine, CMCO, Schiltigheim, France
| | - Beatriz Gonzalez Marti
- ART Department, American Hospital of Paris, Neuilly-Sur-Seine, France
- Laboratoire Eylau-UNILABS-La Muette, Clinique de La Muette-Ramsay-Générale de Santé, Paris, France
| | - Sophie Brouillet
- Univ Montpellier, INSERM U1203, EmbryoPluripotency, Montpellier, France
- IRMB, Univ Montpellier, INSERM, Montpellier, France
- CHU Montpellier, ART/PGD Department, Arnaud de Villeneuve Hospital, Montpellier, France
- Univ Grenoble-Alpes, INSERM U1036, Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Institut de Biosciences et Biotechnologies de Grenoble (BIG), Laboratoire Biologie du Cancer et de l'Infection (BCI), 38000, Grenoble, France
| | - Samir Hamamah
- Univ Montpellier, INSERM U1203, EmbryoPluripotency, Montpellier, France
- IRMB, Univ Montpellier, INSERM, Montpellier, France
- CHU Montpellier, ART/PGD Department, Arnaud de Villeneuve Hospital, Montpellier, France
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Tesarik J, Conde-López C, Galán-Lázaro M, Mendoza-Tesarik R. Luteal Phase in Assisted Reproductive Technology. FRONTIERS IN REPRODUCTIVE HEALTH 2020; 2:595183. [PMID: 36304702 PMCID: PMC9580649 DOI: 10.3389/frph.2020.595183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/02/2020] [Indexed: 09/16/2023] Open
Abstract
Luteal phase (LP) is the period of time beginning shortly after ovulation and ending either with luteolysis, shortly before menstrual bleeding, or with the establishment of pregnancy. During the LP, the corpus luteum (CL) secretes progesterone and some other hormones that are essential to prepare the uterus for implantation and further development of the embryo, the function known as uterine receptivity. LP deficiency (LPD) can occur when the secretory activity of the CL is deficient, but also in cases of normal CL function, where it is caused by a defective endometrial response to normal levels of progesterone. LPD is particularly frequent in treatments using assisted reproductive technology (ART). Controlled ovarian stimulation usually aims to obtain the highest number possible of good-quality oocytes and requires the use of gonadotropin-releasing hormone (GnRH) analogs, to prevent premature ovulation, as well as an ovulation trigger to achieve timed final oocyte maturation. Altogether, these treatments suppress pituitary secretion of luteinizing hormone (LH), required for the formation and early activity of the CL. In addition to problems of endometrial receptivity for embryos, LPD also leads to dysfunction of the local uterine immune system, with an increased risk of embryo rejection, abnormally high uterine contractility, and restriction of uterine blood flow. There are two alternatives of LPD prevention: a direct administration of exogenous progesterone to restore the physiological progesterone serum concentration independently of the CL function, on the one hand, and treatments aimed to stimulate the CL activity so as to increase endogenous progesterone production, on the other hand. In case of pregnancy, some kind of LP support is often needed until the luteal-placental shift occurs. If LPD is caused by defective response of the endometrium and uterine immune cells to normal concentrations of progesterone, a still poorly defined condition, symptomatic treatments are the only available solution currently available.
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