Molecular Basis of Müllerian Agenesis Causing Congenital Uterine Factor Infertility-A Systematic Review

Associations Between Total and Regional Fat-to-Muscle Mass Ratio with the Prevalence of Infertility: A Cross-Sectional Study

Purpose

The fat-to-muscle mass ratio (FMR) is a novel anthropometric parameter that integrates the antagonistic effects of fat and muscle mass. The current study aimed to examine the associations between total and region-specific FMR with the prevalence of self-reported infertility in US women.

Methods

US women aged 20 to 44 years from the 2013-2018 National Health and Nutrition Examination Survey were included. Total, trunk, arm, and leg FMR were calculated from fat mass and muscle mass in the corresponding body part by dual-energy X-ray absorptiometry. Binary logistic regression, restricted cubic spline analysis and subgroup analysis were primarily used for statistical analyses.

Results

Infertility prevalence was 12.77% among the 1958 women included. Arm and leg FMR were not associated with infertility prevalence, while the odds ratio and 95% confidence intervals for infertility by each 0.1 point increase in trunk and total FMR were 1.19 (1.07-1.33) and 1.16 (1.04-1.30), respectively. Restricted cubic spline analysis indicated a positive and linear relationship between trunk or total FMR and infertility prevalence. Subgroup analysis consistently demonstrated that the associations between trunk or total FMR with infertility prevalence were more pronounced in women without a pregnancy history than in those with a pregnancy history. The receiver-operating characteristic curves indicated that the trunk FMR outperformed total, arm, and leg FMR in discriminating infertility from women without infertility.

Conclusion

Trunk and total FMR, rather than arm or leg FMR, were associated with an increased risk of infertility in US women, especially those without a prior pregnancy history.

Whole-genome and whole-exome sequencing of Mayer-Rokitansky-Küster-Hauser syndrome-discordant monozygotic twins

PURPOSE

Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS), characterized by congenital uterine and vaginal aplasia, lacks definitive etiology. Discordant monozygotic (MZ) twins provide a unique model to dissect postzygotic drivers of phenotypic divergence. This study aimed to identify postzygotic mutations (SNVs, Indels, CNVs, SVs) underlying MRKHS discordance and redefine its molecular etiology.

METHODS

Whole-genome and exome sequencing (WGS/WES) were performed on blood-derived DNA from MRKHS discordant MZ twins. Variant detection utilized VarScan2, GATK, BreakDancer, and CNVnator, with stringent filtering for somatic mutations. Putative discordant variants were validated via Sanger sequencing.

RESULTS

High-coverage sequencing (mean WGS: 66.2x-68.2x; WES: 94.5x-126.6x) revealed four low-quality discordant SNVs, none of which were validated by Sanger sequencing. No pathogenic CNVs/SVs were detected, including in genes critical to Müllerian development (e.g., WNT4, LHX1). Blood-derived DNA analysis failed to identify high-penetrance coding mutations or tissue-specific mosaicism.

CONCLUSIONS

The absence of validated postzygotic mutations challenges coding variants as primary MRKHS drivers. Findings implicate Müllerian-restricted somatic mosaicism or epigenetic dysregulation (e.g., WNT4/LHX1 methylation) during embryogenesis, undetectable in peripheral blood. This underscores limitations of blood-based genomics and highlights the need for non-invasive biomarkers (e.g., cfDNA methylation) and prenatal environmental risk mitigation (e.g., endocrine disruptor avoidance). The study advocates integrating tissue-specific multi-omics and patient derived organoids to resolve MRKHS mechanisms, guiding fertility preservation and personalized reproductive interventions.

Zinner syndrome: report of a case and whole exome sequencing

BACKGROUND

Zinner syndrome is a rare congenital malformation of the male genitourinary system, characterized by a triad: seminal vesicle cyst, unilateral renal agenesis, and ipsilateral ejaculatory duct obstruction. The etiology of this uncommon disease remains largely elusive; however, genetic mutations may contribute to its development. In this report, we present a case of symptomatic Zinner syndrome that was surgically treated, alongside an investigation into the potential genetic basis of the syndrome via whole exome sequencing.

CASE PRESENTATION

We report the case of an 18-year-old male presenting with urinary pain and was diagnosed with right renal agenesis and a left seminal vesicle cyst following comprehensive imaging. The patient also experienced perineal pain and urgency, without symptoms of frequent urination, dysuria, or hematuria, and no familial history of genitourinary anomalies was documented. He successfully underwent laparoscopic resection of a pelvic mass, with pathological examination confirming a seminal vesicle cyst. Postoperative recovery was uneventful. Whole exome sequencing of blood and tissue samples highlighted myeloma overexpressed gene (MYEOV), B melanoma antigen family member (BAGE), and N-acetylated-alpha-linked acidic dipeptidase 2 (NAALAD2) as potential mutated genes related to Zinner syndrome. Additionally, two predisposing genetic variants were identified.

CONCLUSIONS

Zinner syndrome is a rare condition commonly diagnosed via various imaging modalities. Surgical resection remains the most effective treatment for symptomatic cases. Gene sequencing provides valuable insights into the genetic etiology of Zinner syndrome, enhancing our understanding and potentially guiding future diagnostic approaches.

Unraveling the impact of hyperleptinemia on female reproduction: insights from transgenic pig model

BACKGROUND

Infertility is a growing global health concern affecting millions of couples worldwide. Among several factors, an extreme body weight adversely affects reproductive functions. Leptin is a well-known adipokine that serves as an endocrine signal between adiposity and fertility. However, the exact mechanisms underlying the effects of high leptin level on female reproduction remain unclear.

METHODS

Transgenic pigs overexpressing leptin (♀) were produced by backcrossing and screened for leptin overexpression. The growth curve, fat deposition, reproductive performance, apoptosis, serum hormones and cholesterol production, RNA sequencing, and single-nucleus RNA sequencing (snRNA-seq) of the leptin-overexpressing pigs and wild-type group were evaluated.

RESULTS

Transgenic pigs overexpressing leptin (♀) were obtained, which exhibited significantly reduced body weight, body size, and back fat thickness. These pigs manifested a late onset of puberty (330 ± 54.3 vs. 155 ± 14.7 days), irregular estrous behavior characterized by increased inter-estrous interval (29.2 ± 0 vs. 21.3 ± 0.7 days), and more number of matings until pregnancy (at least 3 times). This reproductive impairment in leptin pigs was related to hormonal imbalances characterized by increased levels of FSH, LH, prolactin, E2, P4, and TSH, altered steroidogenesis such as increased levels of serum cholesterol esters along with steroidogenic markers (StAR, CYP19A), and ovarian dysfunctions manifested by neutrophilic infiltration and low expression of caspase-3 positive cells in the ovaries. Moreover, bulk RNA sequencing of the ovaries also revealed neutrophilic infiltration followed by upregulation of inflammation-related genes. Furthermore, snRNA-seq reflected that leptin overexpression triggered immune response, suppressed follicle development and luteinization, resulting in metabolic dysfunction and hormone imbalance in the ovary.

CONCLUSIONS

Low body weight in leptin overexpressing pigs adversely affects the reproductive performance, causing delayed puberty, irregular estrous cycles, and reduced breeding efficiency. This is linked to metabolic imbalances, an increased immune response, and altered ovarian functions. This study provides a theoretical basis for the complex mechanisms underlying leptin, and infertility by employing leptin-overexpressing female pigs.

A rare variant of mullerian agenesis: a case report and review of the literature

INTRODUCTION

Menstruation is a developmental milestone and usually marks healthy and normal pubertal changes in females. Menarche refers to the onset of first menstruation in a female. The causes of primary amenorrhea include outflow tract abnormalities, resistant endometrium, primary ovarian insufficiency, and disorders of the hypothalamus, pituitary, or other endocrine glands. A rare variant of mullerian agenesis, which warrants an individualized approach to management, is presented here.

CASE REPORT

We present here the case of a 25-year-old Indian female with pain in the lower abdomen and primary amenorrhea. After a thorough history, clinical examination, imaging, and diagnostic laparoscopy, two small uteri, a blind upper half vagina, bilateral polycystic ovaries, and a blind transverse connection between the two uteri-a horseshoe band cervix-were detected, which confirmed the diagnosis of mullerian agenesis. There was evidence of adenomyosis in the mullerian duct element. This is a rare form of Müllerian abnormality with an unusual presentation.

CONCLUSION

Mullerian agenesis is the most common cause of primary amenorrhea with well-developed secondary sexual characteristics. There are various forms of mullerian agenesis. Most of the cases are managed by a multidisciplinary team. Rare variants warrant an individualized approach to management.