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Smith KA, Parvinian A, Ainsworth AJ, Shenoy CC, Packard AT. Normal and Abnormal Appearances of the Ovaries during Assisted Reproduction: Multimodality Imaging Review. Radiographics 2023; 43:e230089. [PMID: 37883303 DOI: 10.1148/rg.230089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Infertility is a common diagnosis that prompts many couples and individuals to seek assisted reproductive technology (ART) for assistance with conception. These technologies have become increasingly used in the United States in the past several decades, with 326 468 ART cycles performed in 2020, resulting in 75 023 live births. This ubiquity of ART also increases the likelihood that radiologists will encounter both normal and abnormal imaging findings associated with these treatments. Thus, radiologists of all subspecialties should be familiar with the multimodality appearance of the ovaries and pelvis in patients undergoing ART treatments. Furthermore, it is imperative that radiologists understand the appearance expected during different stages of the ART process. During stimulated ovulatory cycles, it is normal and expected for the ovaries to appear enlarged and to contain numerous cystic follicles, often with a small to moderate volume of pelvic free fluid. After oocyte retrieval, hemorrhagic ovarian follicles and a small to moderate volume of blood products in the cul-de-sac can be expected to be seen. Multiple nonemergency and emergency complications are related to ART, many of which can be seen at imaging. The most encountered emergency complications of ART include ovarian hyperstimulation syndrome, ectopic pregnancy, heterotopic pregnancy, multiple gestations, ovarian torsion, and procedural complications related to oocyte retrieval. These complications have important clinical implications, thus necessitating accurate and timely detection by the radiologist and the clinical team. ©RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Katherine A Smith
- From the Departments of Radiology (K.A.S., A.P., A.T.P.) and Obstetrics and Gynecology (A.J.A., C.C.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Ahmad Parvinian
- From the Departments of Radiology (K.A.S., A.P., A.T.P.) and Obstetrics and Gynecology (A.J.A., C.C.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Alessandra J Ainsworth
- From the Departments of Radiology (K.A.S., A.P., A.T.P.) and Obstetrics and Gynecology (A.J.A., C.C.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Chandra C Shenoy
- From the Departments of Radiology (K.A.S., A.P., A.T.P.) and Obstetrics and Gynecology (A.J.A., C.C.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Ann T Packard
- From the Departments of Radiology (K.A.S., A.P., A.T.P.) and Obstetrics and Gynecology (A.J.A., C.C.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Abdulrazaq AA, Ainsworth AJ, Britton JW, Shenoy CC, Babayev SN, Cascino GD, Smith KM. Seizure control in women with epilepsy undergoing assisted reproductive technology. Epilepsia 2023; 64:e207-e213. [PMID: 37596834 DOI: 10.1111/epi.17748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/01/2023] [Accepted: 08/15/2023] [Indexed: 08/20/2023]
Abstract
The objective of this study was to determine seizure control in women with epilepsy (WWE) undergoing assisted reproductive technology (ART). Through retrospective chart review, WWE undergoing ART were identified. Demographics and details regarding epilepsy type, seizure control, and ART procedures were extracted. Seizure frequency prior to and during ART were compared. We identified 12 WWE, who underwent 29 embryo transfers, resulting in 16 pregnancies and 10 live births. Nine women were seizure-free at least 2 years before fertility treatment, including three with resolved epilepsy. Seven were on antiseizure medications throughout fertility treatment and pregnancy, with only one on polytherapy. Eleven (all with controlled epilepsy or epilepsy in remission) remained seizure-free throughout fertility treatment. One woman with drug-resistant epilepsy continued to have seizures throughout fertility treatment and pregnancy without an exacerbation of seizure frequency. There was no increased seizure frequency associated with fertility treatment and subsequent pregnancy in this small series of WWE. Although this study was statistically underpowered, our results provide some preliminary evidence that ART might not pose a threat to seizure control, but larger, confirmatory studies are necessary.
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Affiliation(s)
| | | | | | - Chandra C Shenoy
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Samir N Babayev
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kelsey M Smith
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Riggan KA, Rousseau AC, DSouza KN, Woodward KT, Lue J, Phelan SM, Allyse MA, Shenoy CC. Patient perceptions of body mass index restrictions limiting fertility care for women with high body mass index. Reprod Biomed Online 2023; 47:103210. [PMID: 37246105 DOI: 10.1016/j.rbmo.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/24/2023] [Accepted: 04/04/2023] [Indexed: 05/30/2023]
Abstract
RESEARCH QUESTION What is the patient experience of women with high body mass index (BMI) with BMI restrictions that limit fertility care? DESIGN Qualitative study using in-depth, semi-structured interview methodology. Interview transcripts were analysed for iterative themes in accordance with principles of grounded theory. RESULTS Forty women with a BMI of 35 kg/m2 or higher with scheduled or completed appointment at the Reproductive Endocrinology and Infertility (REI) clinic completed an interview. Most participants experienced BMI restrictions as unjust. Many perceived that BMI restrictions on fertility care may be medically justified and were in support of weight loss discussions to improve chances of pregnancy; however, several argued that they should have autonomy to commence treatment following an individualized risk assessment. Participants offered recommendations to improve discussion of BMI restrictions and weight loss, including framing the conversation as supportive of their reproductive goals and offering proactive referral to weight loss support to prevent the perception that BMI is a categorical exclusion to future fertility care. CONCLUSIONS Participant experiences highlight a need for enhanced strategies for communicating BMI restrictions and weight loss recommendations in ways that are perceived to be supportive of patients' fertility goals without further contributing to weight bias and stigma experienced in medical settings. Opportunities for training to mitigate experiences of weight stigma may be beneficial for clinical and non-clinical staff. Evaluation of BMI policies should be undertaken within the context of clinic policies that permit or prohibit fertility care for other high-risk groups.
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Affiliation(s)
- Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | | | - Karen N DSouza
- Graduate School of Biomedical Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Kristen T Woodward
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Jaida Lue
- Graduate School of Biomedical Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Sean M Phelan
- Division of Health Care Delivery Research, Robert D. & Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Chandra C Shenoy
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA; Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, MN, USA.
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Neblett MF, Baumgarten SC, Babayev SN, Shenoy CC. Ovulation induction with letrozole and dexamethasone in infertile patients with letrozole-resistant polycystic ovary syndrome. J Assist Reprod Genet 2023:10.1007/s10815-023-02817-9. [PMID: 37129726 DOI: 10.1007/s10815-023-02817-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/25/2023] [Indexed: 05/03/2023] Open
Abstract
PURPOSE To assess efficacy of adjuvant dexamethasone during letrozole cycles for ovulation induction (OI) in women with letrozole-resistant polycystic ovary syndrome (PCOS). METHODS We retrospectively evaluated 42 cycles of OI from 28 infertile women with letrozole-resistant PCOS between September 2019 and November 2022. Letrozole was initiated on cycle day 3 for 5 days and increased via a stair-step approach to 7.5 mg as indicated. Patients were deemed letrozole-resistant if no dominant follicle was identified on transvaginal ultrasound following this dose. Resistant patients then received 5 additional days of letrozole 7.5 mg with low-dose dexamethasone 0.5 mg for 7 days and had a repeat ultrasound. The primary outcome was ovulation rate determined by the presence of a dominant follicle on ultrasound. Secondary outcomes included endometrial thickness, number of measurable follicles, and pregnancy outcomes among responders. RESULTS Twenty-two of 28 (79%) letrozole-resistant PCOS patients had evidence of ovulation after the addition of dexamethasone in 35 out of 42 (83%) cycles. Clinical pregnancy occurred in 20% of ovulatory cycles with a cumulative rate of 32%. All clinical pregnancies resulted in a live birth. Patients who responded to adjuvant dexamethasone were more likely to have a shorter duration of infertility; however, there were no differences in other demographics, serum androgens including DHEA-S, or pretreatment glycemic status. CONCLUSION Adding dexamethasone to letrozole increased ovulation rates in letrozole-resistant PCOS patients undergoing OI with similar pregnancy outcomes to prior studies. The addition of dexamethasone is an effective, inexpensive, and safe option for PCOS patients otherwise at risk for cycle cancelation.
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Affiliation(s)
- Michael F Neblett
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Sarah C Baumgarten
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Samir N Babayev
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Chandra C Shenoy
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA.
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Melo VD, Liseth OY, Schmidt WM, Pruthi RK, Marshall AL, Shenoy CC. Risk of thrombosis in women with cancer undergoing controlled ovarian hyperstimulation for fertility preservation. J Assist Reprod Genet 2022; 39:2847-2856. [PMID: 36427171 PMCID: PMC9790832 DOI: 10.1007/s10815-022-02661-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/11/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The study aims to evaluate the risk factors and incidence of thromboembolic events among adult women with cancer who underwent controlled ovarian hyperstimulation (COH) for fertility preservation. METHODS Retrospective, descriptive cohort analysis of patient demographics, medical history, cancer type/treatment, laboratory values, thrombosis within 6 months of COH. RESULTS 4 of 127 study participants experienced a venous thromboembolic event within 6 months of COH. The median time between oocyte aspiration and the event was 0.25 years (range = 0.10-0.50). The average age at time of event was 25.3 years (SD = 5.3). Three of four thrombotic patients had ovarian cancer, one had breast cancer. All had received surgery and chemotherapy for treatment. All underwent an antagonist cycle ovarian stimulation protocol - none developed ovarian hyperstimulation syndrome. The average anti-mullerian hormone level at the time of hyperstimulation in the thrombosis group was 1.6 (SD = 1.3), compared to 3.6 in the non-thrombosis group. The average max estradiol level reached during ovarian stimulation was 1281.3 (SD = 665.3) in the thrombosis group and 1839.1 (SD = 1513.9) in the non-thrombosis group. Thromboembolic events were not directly associated with mortality. CONCLUSIONS Within this small descriptive study, the incidence of thromboembolic events in women with cancer undergoing COH for fertility preservation is high. Cancer may play a greater role than COH in thrombosis risk. Ovarian cancer patients who undergo ovarian stimulation may have an increased risk compared to other cancer types. These findings may inform future, prospective studies to determine the role of thromboprophylaxis.
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Affiliation(s)
- Valeria D Melo
- Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Ariela L Marshall
- Division of Hematology, University of Pennsylvania, Philadelphia, PA, USA
| | - Chandra C Shenoy
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Neblett MF, Baumgarten SC, Babayev SN, Shenoy CC. Title: OVULATION INDUCTION WITH LETROZOLE AND DEXAMETHASONE IN INFERTILE PATIENTS WITH LETROZOLE-RESISTANT POLYCYSTIC OVARIAN SYNDROME. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.09.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Neblett MF, Shenoy CC, Babayev S. OUTCOMES FOLLOWING THAW, BIOPSY, AND REFREEZE CYCLES OF PREVIOUSLY UNTESTED VITRIFIED BLASTOCYSTS. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Reckhow J, Ainsworth AJ, Habermann EB, Holst K, Bates R, Kok S, Shenoy CC. REPRODUCTIVE EXPERIENCES OF PHYSICIANS: WHAT ARE WE MISSING? Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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DSouza KN, Orellana M, Ainsworth AJ, Cummings G, Riggan KA, Shenoy CC, Allyse MA. Impact of the COVID-19 Pandemic on Patient Fertility Care. J Patient Exp 2022; 9:23743735221098255. [PMID: 35548663 PMCID: PMC9083039 DOI: 10.1177/23743735221098255] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The effects of the COVID-19 pandemic on the healthcare system have been widespread, with many institutions in the United States pausing elective procedures to redirect resources to critical care. Fertility care and assisted reproductive procedures were classified as elective procedures and similarly paused. We conducted qualitative interviews with patients and/or their partners (n = 25 female patients; n = 3 male partners) receiving care at a fertility clinic in the Midwest to understand patient appraisal of COVID-19 risk on the resumption of care following a month-long closure of an infertility clinic, and patient agreement with the clinic closure. Interview transcripts were thematically analyzed from a grounded theory approach. Study participants reported an increased sense of urgency due to the delay in fertility procedures. This urgency often superseded concerns of potential COVID-19 infection, motivating patients to continue fertility treatment during a pandemic. In hindsight, some participants did not agree with the clinic's closure and treatment cessation, feeling that these steps negatively interrupted time-sensitive reproductive goals. Patient responses highlight the need for additional resources to support decision-making during times of crisis. Triaging patients based on time-sensitivity of treatment instead of a total shutdown respects patient autonomy for continuing treatment amidst uncertain COVID-19-impact.
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Affiliation(s)
- Karen N DSouza
- Mayo Clinic, Graduate School of Biomedical Sciences, Rochester, MN, USA
| | - Minerva Orellana
- Mayo Clinic, Graduate School of Biomedical Sciences, Rochester, MN, USA
| | | | | | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Chandra C Shenoy
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Megan A Allyse
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
- Megan A Allyse, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.
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10
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Miller CM, Duong S, Weaver AL, Zhao Y, Shenoy CC. Outcomes of Frozen Oocyte Donor In Vitro Fertilization (IVF) Cycles Using Fresh Versus Frozen Sperm. Reprod Sci 2021; 29:1226-1231. [PMID: 34816374 DOI: 10.1007/s43032-021-00796-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
The ability to use frozen sperm for insemination during in vitro fertilization (IVF) is crucial for patients and for reproductive endocrinologists. However, concerns exist regarding the effects of cryopreservation on sperm quality and IVF outcomes. This study compares outcomes of frozen donor oocyte IVF cycles with intracytoplasmic sperm injection (ICSI) of good quality fresh versus frozen ejaculated sperm. Patients who underwent their first frozen donor oocyte IVF cycle between 2013 and 2019 at Mayo Clinic were identified. The primary outcome was live birth rate (LBR). Secondary outcomes included fertilization rate (FR), blastocyst development rate (BR), and clinical pregnancy rate (CPR). Twenty-six patients used fresh sperm and 19 patients utilized frozen sperm; there were no significant demographic differences between the groups. There were no significant differences noted in CPR, FR, and BR. Although the LBR was not statistically different when frozen versus fresh sperm was utilized (52.6% vs. 61.5%, p = 0.55), there was a distinct trend towards improved outcomes with fresh sperm that may be clinically significant. This data suggests that frozen sperm may be an alternative to a fresh sample, however fresh sperm may ultimately be a better option. This finding should be further explored with studies utilizing a larger sample size.
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Affiliation(s)
- Colleen M Miller
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, 200 First Street SW, Rochester, MN, 55901, USA
| | - Stephanie Duong
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Amy L Weaver
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Yulian Zhao
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, 200 First Street SW, Rochester, MN, 55901, USA
| | - Chandra C Shenoy
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, 200 First Street SW, Rochester, MN, 55901, USA.
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Shenoy CC, Khan Z, Coddington CC, Stewart EA, Morbeck DE. Symmetry at the 4-Cell Stage Is Associated with Embryo Aneuploidy. Reprod Sci 2021; 28:3473-3479. [PMID: 34664220 DOI: 10.1007/s43032-021-00758-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to determine if morphometric parameters that can be measured quantitatively using a time-lapse embryo incubator are associated with aneuploidy. Embryos cultured in a time-lapse incubator and assessed with preimplantation genetic testing for aneuploidy (PGT-A) were analyzed retrospectively. Morphokinetic analysis included timing of cell divisions. Quantitative morphometric measurements included the distance between the second and first polar body, zona pellucida thickness at the pronuclear stage and at the 2-cell stage, and blastomere area at the 2- and 4-cell stages. Symmetry at the 2-cell stage was determined by percent difference between blastomeres; symmetry at the 4-cell stage was the percent difference between the smallest and largest blastomeres. Maternal age, blastocyst grade and day of biopsy were recorded. Euploid embryo characteristics were compared to aneuploid embryos. A receiver operating characteristic (ROC) curve was used to evaluate cell symmetry as a predictor of aneuploidy. Embryos (n = 182) from 21 patients (age 22-43; median = 34) were analyzed. Of the 182 embryos, 45% were euploid. Euploid and aneuploid embryos had similar morphokinetics and morphometry across many measures. As expected, age and blastocyst grade were associated with embryo ploidy. It was notable that, additionally, symmetry at the 4-cell stage (27% vs 31%, p = 0.01) was also associated with embryo ploidy. The optimized cutoff from the ROC curve to predict aneuploidy was determined to be 21%. Embryos with > 21% asymmetry at the 4-cell stage had high rates of aneuploidy while morphokinetic parameters were similar. In conclusion, this suggests that embryo selection models using time-lapse parameters would improve if they incorporate cleavage-stage morphometrics.
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Affiliation(s)
- Chandra C Shenoy
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, MN, USA.
| | - Zaraq Khan
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, MN, USA
| | - Charles C Coddington
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth A Stewart
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, MN, USA
| | - Dean E Morbeck
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, MN, USA
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Neblett MF, Kim T, Jones TL, Baumgarten SC, Coddington CC, Zhao Y, Shenoy CC. Is there still a role for a cleavage-stage embryo transfer? F S Rep 2021; 2:269-274. [PMID: 34553150 PMCID: PMC8441559 DOI: 10.1016/j.xfre.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/05/2022] Open
Abstract
Objective To determine whether pregnancy outcomes are poor or futile when an intended day 5 transfer is converted to a cleavage-stage transfer because of poor embryo development or a lower number of embryos. Design Retrospective cohort study. Setting Academic medical center. Patient(s) Women with a limited number of embryos, defined as ≤6 two pronuclear embryos, after in vitro fertilization. Intervention(s) Patients who had a cleavage-stage transfer were age matched with patients who had a day 5 transfer. Main Outcome Measure(s) Live birth rate. Result(s) A total of 146 women were included in the study with 73 women in each group. Cleavage-stage transfer was associated with significantly lower implantation and clinical pregnancy rates compared with those of day 5 transfer. Although the live birth rate of the cleavage-stage transfer group was lower than that of the day 5 transfer group (25% vs. 40%, respectively), the cleavage-stage transfer still resulted in a live birth rate of 25%. A subanalysis comparing women who did and did not achieve live birth after cleavage-stage transfer demonstrated a live birth rate of 27% when at least one grade A embryo was transferred vs. 17% when a lesser quality embryo (grade B or C) was transferred. Conclusion(s) As expected, the live birth rate after cleavage-stage transfer was lower than that after day 5 transfer. However, the live birth rate of cleavage-stage transfer still fell into acceptable practice, >5%, for patients who were otherwise at very high risk of having no day 5 embryo transfer. Extended culture may not be necessary for all patients.
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Affiliation(s)
- Michael F Neblett
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota.,Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Tana Kim
- Reproductive Medicine and Infertility Associates, Woodbury, Minnesota
| | | | - Sarah C Baumgarten
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Charles C Coddington
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota.,Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Yulian Zhao
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota.,Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Chandra C Shenoy
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota.,Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota
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Bole R, Yang D, Ziegelmann M, Bleess JL, Miller C, Shenoy CC, Kohler T, Helo S. TOTAL MOTILE SPERM COUNT IS ASSOCIATED WITH ICSI SUCCESS USING SPERM OBTAINED BY TESE. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Wyatt MA, Baumgarten SC, Weaver AL, Van Oort CC, Fedyshyn B, Ruano R, Shenoy CC, Enninga EAL. Evaluating Markers of Immune Tolerance and Angiogenesis in Maternal Blood for an Association with Risk of Pregnancy Loss. J Clin Med 2021; 10:jcm10163579. [PMID: 34441875 PMCID: PMC8397206 DOI: 10.3390/jcm10163579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 12/20/2022] Open
Abstract
Pregnancy loss affects approximately 20% of couples. The lack of a clear cause complicates half of all miscarriages. Early evidence indicates the maternal immune system and angiogenesis regulation are both key players in implantation success or failure. Therefore, this prospective study recruited women in the first trimester with known viable intrauterine pregnancy and measured blood levels of immune tolerance proteins galectin-9 (Gal-9) and interleukin (IL)-4, and angiogenesis proteins (vascular endothelial growth factors (VEGF) A, C, and D) between 5 and 9 weeks gestation. Plasma concentrations were compared between groups defined based on (a) pregnancy outcome and (b) maternal history of miscarriage, respectively. In total, 56 women were recruited with 10 experiencing a miscarriage or pregnancy loss in the 2nd or 3rd trimester and 11 having a maternal history or miscarriage. VEGF-C was significantly lower among women with a miscarriage or pregnancy loss. Gal-9 and VEGF-A concentrations were decreased in women with a prior miscarriage. Identification of early changes in maternal immune and angiogenic factors during pregnancy may be a tool to improve patient counseling on pregnancy loss risk and future interventions to reduce miscarriage in a subset of women.
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Affiliation(s)
- Michelle A. Wyatt
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA; (M.A.W.); (S.C.B.); (C.C.V.O.); (B.F.); (R.R.); (C.C.S.)
| | - Sarah C. Baumgarten
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA; (M.A.W.); (S.C.B.); (C.C.V.O.); (B.F.); (R.R.); (C.C.S.)
| | - Amy L. Weaver
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN 55905, USA;
| | - Chelsie C. Van Oort
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA; (M.A.W.); (S.C.B.); (C.C.V.O.); (B.F.); (R.R.); (C.C.S.)
| | - Bohdana Fedyshyn
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA; (M.A.W.); (S.C.B.); (C.C.V.O.); (B.F.); (R.R.); (C.C.S.)
| | - Rodrigo Ruano
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA; (M.A.W.); (S.C.B.); (C.C.V.O.); (B.F.); (R.R.); (C.C.S.)
| | - Chandra C. Shenoy
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA; (M.A.W.); (S.C.B.); (C.C.V.O.); (B.F.); (R.R.); (C.C.S.)
| | - Elizabeth Ann L. Enninga
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA; (M.A.W.); (S.C.B.); (C.C.V.O.); (B.F.); (R.R.); (C.C.S.)
- Department of Immunology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
- Correspondence:
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15
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Kendall Rauchfuss LM, Kim T, Bleess JL, Ziegelmann MJ, Shenoy CC. Testicular sperm extraction vs. ejaculated sperm use for nonazoospermic male factor infertility. Fertil Steril 2021; 116:963-970. [PMID: 34233843 DOI: 10.1016/j.fertnstert.2021.05.087] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To study the potential benefit of testicular sperm compared with ejaculated sperm for men with oligospermia. DESIGN After exemption from institutional review board approval, we performed a retrospective cohort study using the Mayo Clinic Assisted Reproductive Technology database. SETTING Single academic center. PATIENT(S) Couples with nonazoospermic male factor infertility (total motile sperm <25 million per ejaculate) undergoing intracytoplasmic sperm injection with sperm obtained by testicular sperm extraction (TESE) or ejaculated sperm between 2016 and 2019. INTERVENTION(S) In vitro fertilization, Intracytoplasmic sperm injection, TESE. MAIN OUTCOME MEASURE(S) The primary outcome was live birth rate. The secondary outcomes were fertilization rate, blastulation rate, pregnancy rate, and miscarriage rate. RESULT(S) Subjects in the two groups were similar in age, body mass index, and ovarian reserve. Baseline sperm parameters were similar in the two groups: total motile sperm (5.4 in the ejaculate sperm group vs. 3.6 million motile per ejaculate), except that baseline motility was higher in the group that used ejaculated sperm (40% vs. 29%). The total number of mature oocytes retrieved was similar in the two groups, but the use of TESE was associated with a 20% decrease in fertilization (60.0% vs. 80.6%) and half the number of blastocyst embryos (two vs. four) compared with ejaculated sperm. Compared with ejaculated sperm, use of TESE did not improve the miscarriage rate (11% vs. 9%) or the live birth rate (50.0% vs. 31.3%). CONCLUSION(S) Patients with male factor infertility and oligozoospermia did not have improved ICSI outcomes with the use of TESE samples compared with ejaculated sperm.
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Affiliation(s)
| | - Tana Kim
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Jessica L Bleess
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | | | - Chandra C Shenoy
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
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16
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Miller CM, Shenoy CC, Khan Z. Three degrees of separation: complete uterine and cervical septa. Fertil Steril 2021; 116:915-916. [PMID: 34016433 DOI: 10.1016/j.fertnstert.2021.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review the diagnosis and management of 3 variations of incomplete müllerian duct fusion and reabsorption. DESIGN Narrated video delineating the surgical management of 3 müllerian anomalies; this video was deemed exempt from review by the institutional review board of the Mayo Clinic. SETTING Tertiary care academic medical center. PATIENT(S) This video focuses on 3 müllerian anomalies: complete septate uterus with a single septate cervix (septate uterus unicollis); complete septate uterus with duplicated cervix (septate uterus bicollis); and complete duplication of the uterus and cervix (uterine didelphys). INTERVENTION(S) Magnetic resonance imaging (MRI), cervical septoplasty, operative hysteroscopy, and uterine septoplasty. MAIN OUTCOME MEASURE(S) Several variations of uterine malformations exist. In our practice, we differentiate complete septate uteri as either unicollis or bicollis via MRI and vaginal examination. The bicollis presentation can be identified on MRI by the "lambda sign," which is seen as the 2 cervices that diverge as they enter the vagina. This is in comparison with the unicollis presentation when the single septate cervix can be traced with parallel lines as it enters the vagina. The circle method is described in this video to help distinguish between a single and duplicated cervix on examination. RESULT(S) The cervical and uterine septa were resected completely in the patient with a complete septate uterus unicollis. In contrast, the uterine septum was resected completely and the 2 cervical canals were not incised in the case of the complete septate uterus bicollis. Although uterine and cervical septa resection is controversial, our practice is to avoid the incision of the 2 cervical canals in cases that are more clearly consistent with a bicollis classification. CONCLUSION(S) Müllerian anomalies represent a continuum of disorders caused by different degrees of disruption in embryogenesis. MRI with vaginal gel and vaginal examination are tools to help classify the anomaly and guide surgical management.
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Affiliation(s)
- Colleen M Miller
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic Rochester, Rochester, Minnesota.
| | - Chandra C Shenoy
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic Rochester, Rochester, Minnesota
| | - Zaraq Khan
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic Rochester, Rochester, Minnesota
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17
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Rauchfuss LK, Ainsworth AJ, Shenoy CC. Abnormal rate of human chorionic gonadotropin rise: a case series of patients with viable intrauterine pregnancies after embryo transfer. F S Rep 2021; 2:129-132. [PMID: 34223284 PMCID: PMC8244357 DOI: 10.1016/j.xfre.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/22/2020] [Accepted: 11/29/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To report three cases of viable intrauterine pregnancies after embryo transfer with lower quantitative human chorionic gonadotropin (hCG) rates of rise than that expected in 99% of normal intrauterine pregnancies, based on current guidelines. DESIGN Case series. SETTING Tertiary care center. PATIENTS Three patients underwent in vitro fertilization for ovulatory dysfunction or male factor infertility and had successful live births after an unusually low rate of hCG rise following embryo transfer. INTERVENTIONS In vitro fertilization was utilized for all three patients. MAIN OUTCOME MEASURES Serial hCG levels. RESULTS Three cases of abnormally rising hCG levels were described. All cases presented achieved pregnancy through assisted reproductive technologies. The lowest documented rate of rise for each case, over 48 hours, was 22.1%, 23.3%, and 26.9%. All three cases resulted in live births. Literature on this topic was reviewed. CONCLUSIONS Based on the cases presented, we recommend conservative management for patients found to have abnormally low rise hCG levels after embryo transfer; a high clinical suspicion for ectopic pregnancy should be maintained.
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Affiliation(s)
| | | | - Chandra C. Shenoy
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
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18
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Khan Z, Zheng Y, Jones TL, Delaney AA, Correa LF, Shenoy CC, Khazaie K, Daftary GS. Epigenetic Therapy: Novel Translational Implications for Arrest of Environmental Dioxin-Induced Disease in Females. Endocrinology 2018; 159:477-489. [PMID: 29165700 DOI: 10.1210/en.2017-00860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/14/2017] [Indexed: 02/07/2023]
Abstract
Increased toxicant exposure and resultant environmentally induced diseases are a tradeoff of industrial productivity. Dioxin [2,3,7,8 tetrachlorodibenzo-p-dioxin (TCDD)], a ubiquitous byproduct, is associated with a spectrum of diseases including endometriosis, a common, chronic disease in women. TCDD activates cytochrome (CYP) p450 metabolic enzymes that alter organ function to cause disease. In contrast, the transcription factor, Krüppel-like factor (KLF) 11, represses these enzymes via epigenetic mechanisms. In this study, we characterized these opposing mechanisms in vitro and in vivo as well as determining potential translational implications of epigenetic inhibitor therapy. KLF11 antagonized TCDD-mediated activation of CYP3A4 gene expression and function in endometrial cells. The repression was pharmacologically replicated by selective use of an epigenetic histone acetyltransferase inhibitor (HATI). We further showed phenotypic relevance of this mechanism using an animal model for endometriosis. Fibrotic extent in TCDD-exposed wild-type animals was similar to that previously observed in Klf11-/- animals. When TCDD-exposed animals were treated with a HATI, Cyp3 messenger RNA levels and protein expression decreased along with disease progression. Fibrotic progression is ubiquitous in environmentally induced chronic, untreatable diseases; this report shows that relentless disease progression can be arrested through targeted epigenetic modulation of protective mechanisms.
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Affiliation(s)
- Zaraq Khan
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Ye Zheng
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Tiffanny L Jones
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Abigail A Delaney
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Luiz F Correa
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Chandra C Shenoy
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Khashayarsha Khazaie
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
- Department of Immunology, Mayo Clinic, Rochester, Minnesota
| | - Gaurang S Daftary
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
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Shenoy CC, Khan Z, Zheng Y, Jones TL, Khazaie K, Daftary GS. Progressive Fibrosis: A Progesterone- and KLF11-Mediated Sexually Dimorphic Female Response. Endocrinology 2017; 158:3605-3619. [PMID: 28938437 DOI: 10.1210/en.2017-00171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 08/08/2017] [Indexed: 01/06/2023]
Abstract
Progressive scarring is ubiquitous postoperatively and in an array of chronic systemic diseases. Recent studies indicate that such scarring has a high female propensity; females are also almost exclusively affected by endometriosis, a common sex steroid-dependent fibrotic disease. Endometriosis-related fibrosis is regulated epigenetically through transcription factor Krüppel-like factor 11 (KLF11). In response to surgical induction of endometriosis, Klf11-/- female mice develop significant fibrosis in contrast to wild-type mice. We therefore hypothesized that female fibrotic predilection was mediated by differential sex steroid regulation of KLF11/collagen 1a1 signaling and investigated the fibrotic response in wild-type and Klf11-/- male and female animals using a sterile peritonitis model. Fibrosis selectively developed in Klf11-/- females. Fibrosis in these animals was almost completely abrogated by ovariectomy. Ovariectomized animals were selectively supplemented with estradiol, medroxyprogesterone acetate (MPA), or dihydrotestosterone; fibrosis was only observed in mice exposed to MPA. Fibrosis therefore selectively developed in Klf11-/- female mice in response to physiological or pharmacological progesterone. The fibrotic response in these animals was also mitigated in response to antiprogestin therapy. Profibrotic gene expression was activated in a primary human peritoneal cell line in response to KLF11 short hairpin RNA and MPA but not estradiol. KLF11/collagen 1a1 signaling previously shown to be linked to fibrosis was thus selectively dysregulated in MPA-treated cells. Our in vivo and in vitro findings in an animal model and human cells, respectively, suggest that progressive fibrotic scarring is a sexually dimorphic response irrespective of etiology; moreover, it is responsive to novel, individualized therapeutic intervention.
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Affiliation(s)
- Chandra C Shenoy
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905
| | - Zaraq Khan
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905
| | - Ye Zheng
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905
| | - Tiffanny L Jones
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905
| | | | - Gaurang S Daftary
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905
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20
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Richards EG, Zheng Y, Shenoy CC, Ainsworth AJ, Delaney AA, Jones TL, Khan Z, Daftary GS. KLF11 is an Epigenetic Mediator of DRD2/Dopaminergic Signaling in Endometriosis. Reprod Sci 2017; 24:1129-1138. [DOI: 10.1177/1933719117698582] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Elliott G. Richards
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Ye Zheng
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Chandra C. Shenoy
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Alessandra J. Ainsworth
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Abigail A. Delaney
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Tiffanny L. Jones
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Zaraq Khan
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Gaurang S. Daftary
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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Abstract
Endometriosis, a chronic disease of heterogeneous etiopathology affects 10% of young women and is characterized by ectopic implantation of endometrial cells. Growth and spread of endometriosis lesions involves biological interplay between intrinsic lesion-driven and extrinsic host-responsive mechanisms. We propose a role for TGFβ and its target transcription factor Krüppel-like factor 11 (KLF11) in mediating such mechanisms. Although TGFβ, a pleiotropic cytokine implicated in endometriosis potentially, mediates its pathological phenotypes, KLF11 is associated with endocrine and reproductive tract diseases, specifically progression of endometriosis. In Ishikawa cells, TGFβ1 treatment resulted in noncanonical SMAD-mediated transient up-regulation and sustained repression of KLF11. KLF11 recruits histone deacetylases to epigenetically repress multiple synthetic and metabolic cytochrome P450 (CYP) enzymes such as CYP3A4, which affects endometrial metabolism and pathophysiology. In contrast to KLF11, TGFβ1 treatment caused transient repression and sustained activation of CYP3A4 expression. CYP3A4 increased endometrial cell proliferation and was also increased in human endometriosis lesions compared with eutopic endometrium. To determine whether dysregulation of TGFβ/Klf11/Cyp3a signaling affected endometriotic progression, we treated wild-type control and Klf11-/- mice with a Tgfβ type 1 receptor inhibitor (TGFβR1I) that inhibits Tgfβ signaling upstream of the canonical Smad proteins or a combination of TGFβR1I and a histone acetyltransferase inhibitor that additionally inhibits Klf11 signaling. Disease progression and lesional Cyp3a expression was diminished in TGFβR1I-treated animals and more so in animals treated synergistically with TGFβR1I and histone acetyltransferase inhibitor. TGFβ and KLF11 thus mediate critical, translationally relevant host and lesion-driven responses that enable establishment and progression of endometriosis.
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Affiliation(s)
- Luiz F Correa
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905
| | - Ye Zheng
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905
| | - Abigail A Delaney
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905
| | - Zaraq Khan
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905
| | - Chandra C Shenoy
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905
| | - Gaurang S Daftary
- Laboratory of Translational Epigenetics in Reproduction, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905
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22
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Delaney AA, Khan Z, Zheng Y, Correa LF, Zanfagnin V, Shenoy CC, Schoolmeester JK, Saadalla AM, El-Nashar S, Famuyide AO, Subramaniam M, Hawse JR, Khazaie K, Daftary GS. KLF10 Mediated Epigenetic Dysregulation of Epithelial CD40/CD154 Promotes Endometriosis. Biol Reprod 2016; 95:62. [PMID: 27488034 PMCID: PMC5333936 DOI: 10.1095/biolreprod.116.140764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/27/2016] [Indexed: 12/11/2022] Open
Abstract
Endometriosis is a highly prevalent, chronic, heterogeneous, fibro-inflammatory disease that remains recalcitrant to conventional therapy. We previously showed that loss of KLF11, a transcription factor implicated in uterine disease, results in progression of endometriosis. Despite extensive homology, co-expression, and human disease association, loss of the paralog Klf10 causes a unique inflammatory, cystic endometriosis phenotype in contrast to fibrotic progression seen with loss of Klf11. We identify here for the first time a novel role for KLF10 in endometriosis. In an animal endometriosis model, unlike wild-type controls, Klf10−/− animals developed cystic lesions with massive immune infiltrate and minimal peri-lesional fibrosis. The Klf10−/− disease progression phenotype also contrasted with prolific fibrosis and minimal immune cell infiltration seen in Klf11−/− animals. We further found that lesion genotype rather than that of the host determined each unique disease progression phenotype. Mechanistically, KLF10 regulated CD40/CD154-mediated immune pathways. Both inflammatory as well as fibrotic phenotypes are the commonest clinical manifestations in chronic fibro-inflammatory diseases such as endometriosis. The complementary, paralogous Klf10 and Klf11 models therefore offer novel insights into the mechanisms of inflammation and fibrosis in a disease-relevant context. Our data suggests that divergence in underlying gene dysregulation critically determines disease-phenotype predominance rather than the conventional paradigm of inflammation being precedent to fibrotic scarring. Heterogeneity in clinical progression and treatment response are thus likely from disparate gene regulation profiles. Characterization of disease phenotype-associated gene dysregulation offers novel approaches for developing targeted, individualized therapy for recurrent and recalcitrant chronic disease.
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Affiliation(s)
- Abigail A Delaney
- Laboratory of Translational Epigenetics in Reproduction, Mayo Clinic, Rochester, Minnesota Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Zaraq Khan
- Laboratory of Translational Epigenetics in Reproduction, Mayo Clinic, Rochester, Minnesota Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Ye Zheng
- Laboratory of Translational Epigenetics in Reproduction, Mayo Clinic, Rochester, Minnesota Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Luiz F Correa
- Laboratory of Translational Epigenetics in Reproduction, Mayo Clinic, Rochester, Minnesota Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Valentina Zanfagnin
- Laboratory of Translational Epigenetics in Reproduction, Mayo Clinic, Rochester, Minnesota Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Chandra C Shenoy
- Laboratory of Translational Epigenetics in Reproduction, Mayo Clinic, Rochester, Minnesota Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - John K Schoolmeester
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Sherif El-Nashar
- Laboratory of Translational Epigenetics in Reproduction, Mayo Clinic, Rochester, Minnesota
| | - Abimbola O Famuyide
- Laboratory of Translational Epigenetics in Reproduction, Mayo Clinic, Rochester, Minnesota
| | | | - John R Hawse
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
| | | | - Gaurang S Daftary
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
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