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Nakagawa K, Sugiyama R. Tacrolimus treatment in women with repeated implantation failures. Reprod Med Biol 2024; 23:e12558. [PMID: 38196832 PMCID: PMC10775185 DOI: 10.1002/rmb2.12558] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 12/07/2023] [Accepted: 12/26/2023] [Indexed: 01/11/2024] Open
Abstract
Background Tacrolimus is an immunosuppressive drug that works as a calcineurin inhibitor to improve the reproductive outcomes for women who have experienced multiple implantation failures (RIF) and show elevated type 1 helper T (Th1)/Th2 cell ratios. Methods In the first part of this review, we indicate how we re-evaluated the cut-off index for selecting the participants in a tacrolimus regimen via transferred euploid blastocysts. In the second part, we cite cases where tacrolimus has improved the live birth rate for women who have experienced recurrent pregnancy losses (PRL) and we introduce the utility of tacrolimus treatment to prevent obstetrical complications. Main Findings After reconsideration of the cut-off index (Th1/Th2 ≥ 11.8), however, the pregnancy rates of women with tacrolimus were significantly higher than those of women without tacrolimus. The PRL women treated with tacrolimus showed significantly lower rates of biochemical pregnancy, but higher live-birth rates compared with women who were not treated with tacrolimus. Moreover, prior severe obstetrical complications could be controlled via the administration of tacrolimus during pregnancy. Conclusion Tacrolimus has become indispensable in the field of solid-organ transplantation, and in the near future, it should become an essential agent in the reproductive field, as well.
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Affiliation(s)
- Koji Nakagawa
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
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Sato M, Endo M, Tomooka K, Kuroda K, Ueda Y, Sato S, Ikemoto Y, Imai Y, Mitsui K, Tanaka A, Sugiyama R, Nakagawa K, Sato Y, Kuribayashi Y, Kitade M, Itakura A, Takeda S, Tanigawa T. Risk Factors for Alcohol Consumption after Starting Assisted Reproductive Technology Treatment among Japanese Women: Japan-Female Employment and Mental Health in Assisted Reproductive Technology (J-FEMA) Study. Int J Environ Res Public Health 2023; 20:7152. [PMID: 38131704 PMCID: PMC10742806 DOI: 10.3390/ijerph20247152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/25/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
AIMS To determine the association between drinking habits and social factors among women undergoing assisted reproductive technology (ART) treatment in Japan. METHODS The study participants who provided answers for the questionnaire concerning alcohol consumption were 1017 female patients undergoing ART treatment were enrolled in the Japan-Female Employment and Mental Health in assisted reproductive technology (J-FEMA) study between August and December 2018. Patient characteristics, including demographic, clinical, and socioeconomic status, were assessed using a self-administered questionnaire which was distributed only once during the period, regardless of their first or follow-up examination. We defined current drinkers who drank ≥46 g of ethanol per week as the habitual drinking group. The risk factors for habitual drinking were analyzed using multivariable-adjusted logistic regression. RESULTS The proportion of habitual drinkers was 15.5% in this study population. The multivariable-adjusted odds ratios (95% confidence interval) for habitual drinking were 2.27 (0.99-5.21) for women aged ≥35 years versus those <35 years, 4.26 (1.98-9.16) for women having partners who currently drink compared to those with partners without current drinking, 1.84 (1.08-3.12) for women without a history of childbirth versus those with, and 1.77 (1.00-3.14) for working women compared with those not working. CONCLUSIONS In our study, habitual drinking among women undergoing ART treatment was significantly associated with older age, no history of childbirth, partner's current drinking status, and working.
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Affiliation(s)
- Mamiko Sato
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
| | - Motoki Endo
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
| | - Kiyohide Tomooka
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
| | - Keiji Kuroda
- Department of Obstetrics and Gynaecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
- Centre for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi, Tokyo 100-0065, Japan
| | - Yuito Ueda
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
| | - Setsuko Sato
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
| | - Yuko Ikemoto
- Department of Obstetrics and Gynaecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Yuya Imai
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
| | - Kiyomi Mitsui
- Department of Hygiene, Public Health, and Preventive Medicine, Showa University, Tokyo 142-8555, Japan
| | - Atsushi Tanaka
- Saint Mother Hospital Infertility Clinic, Fukuoka 807-0825, Japan
| | - Rikikazu Sugiyama
- Centre for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi, Tokyo 100-0065, Japan
- Centre for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan
| | - Koji Nakagawa
- Centre for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan
| | | | - Yasushi Kuribayashi
- Centre for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi, Tokyo 100-0065, Japan
| | - Mari Kitade
- Department of Obstetrics and Gynaecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynaecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynaecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
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Hisano M, Nakagawa K, Suzuki T, Sugiyama R, Yamaguchi K. Immunosuppressive therapy with tacrolimus is a potential drug candidate for the prevention of unexplained or preeclamptic stillbirths with Th1-dominant immune states: a case series of five patients. J Matern Fetal Neonatal Med 2023; 36:2258254. [PMID: 37705258 DOI: 10.1080/14767058.2023.2258254] [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: 12/13/2021] [Revised: 08/28/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
Some of obstetrical complications such as unexplained pregnancy loss and preeclampsia (PE) are associated with maternal-fetal immune abnormalities, leading to uteroplacental dysfunction, insufficient fetal immune tolerance, or fetal rejection. Immunosuppressants with calcineurin inhibitors could be useful for the prevention of these complications by modulating the cellular immune balance by directly inhibiting activated T-helper (Th) 1 and natural killer (NK)/NKT cells. We present our experience with the immunosuppressant tacrolimus in five pregnant women who had a previous pregnancy history of unexplained or preeclamptic stillbirth. Th1 and Th2 cell populations and NK cell activities in peripheral blood were measured as clinical parameters during pregnancy. Case 1-3 achieved suppressions of predominant Th1 immunity and live births without pregnancy-related complications. In case 4, increased tacrolimus dose after a miscarriage resulted in her first live birth; however, she developed PE and severe fetal growth restriction with elevated Th1/Th2 cell ratios at 26 weeks of gestation. Case 5 had a previous history of early onset PE and the hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, and an emergency cesarean section was needed for maternal safety at 20 weeks of gestation. The course of the next pregnancy was stable under tacrolimus treatment; however, the HELLP syndrome recurred after PE at 33 weeks of gestation. Although an imbalance in the Th1/Th2 cell ratio was not observed during pregnancy, NK cell activity was markedly elevated before delivery. In conclusion, tacrolimus is a potential drug candidate for the prevention of unexplained or preeclamptic stillbirth with Th1-dominant immune states.
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Affiliation(s)
- Michi Hisano
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Koji Nakagawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Tomo Suzuki
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Koushi Yamaguchi
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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Nakagawa K, Horikawa T, Orita Y, Yamashiro E, Watanabe H, Shirai A, Ogata S, Kataoka H, Kuroda K, Takamizawa S, Sugiyama R. Hyaluronan-enriched transfer medium (HETM) can improve the implantation rate in morphologically poor euploid blastocyst transfer. Arch Gynecol Obstet 2023; 308:611-619. [PMID: 37256356 PMCID: PMC10293447 DOI: 10.1007/s00404-023-07083-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Accepted: 05/04/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE Hyaluronan-enriched transfer medium (HETM) could improve the clinical pregnancy rate (CPR) for patients with repeated implantation failures (RIF). In contrast, there have been seldom reports addressing the potentially beneficial effects of HETM for morphologically poor blastocysts (MPBLs). Our study aimed to evaluate whether the use of HETM would improve the CPR for the patients who were transferred with euploid MPBLs. METHODS Patients who underwent single euploid blastocyst transfer between July 2020 and June 2022 were enrolled. We included only those blastocysts confirmed as euploid by PGT-A, and those blastocysts were transferred after thawing. The natural ovulatory cycle or hormone replacement cycle (HRC) protocol were used for endometrial preparation for frozen embryo transfer (FET). A total of 1,168 FET cycles were performed in the study period, including 954 cycles of morphologically good blastocysts (≥ 4BB in Gardner's classification), and 85 cycles of MPBLs, of which 47 were transferred using HETM in FET (the HETM group), and the remaining 38 were transferred with the medium without hyaluronan (the control group). We compared the CPR between these two groups. RESULTS The characteristics of patients were similar between the HETM and control groups. The CPR in the HETM group was significantly higher than the control group (47.4% and 21.5%, respectively, p = 0.019). The multiple logistic regression analysis found that the use of HETM was a predictive factor of positive pregnancy outcomes (OR = 5.08, 95% CI = 1.62-16.0, p = 0.019). CONCLUSION Our data suggests that HETM used in the euploid blastocyst transfer can improve the clinical pregnancy rates of morphologically poor blastocysts.
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Affiliation(s)
- Koji Nakagawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, 1-19-6, Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan.
| | - Takashi Horikawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, 1-19-6, Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
| | - Yuji Orita
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, 1-19-6, Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
- Takeuchi Ladies Clinic, Aira City, Kagoshima, Japan
| | - Emi Yamashiro
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, 1-19-6, Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
| | - Hideaki Watanabe
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, 1-19-6, Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
| | - Asako Shirai
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, 1-19-6, Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
| | | | - Hisayo Kataoka
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, 1-19-6, Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
| | - Keiji Kuroda
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, 1-19-6, Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
| | - Satoru Takamizawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, 1-19-6, Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, 1-19-6, Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
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Oshina K, Kuroda K, Nakabayashi K, Tomikawa J, Kitade M, Sugiyama R, Hata K, Itakura A. Gene expression signatures associated with chronic endometritis revealed by RNA sequencing. Front Med (Lausanne) 2023; 10:1185284. [PMID: 37547609 PMCID: PMC10400718 DOI: 10.3389/fmed.2023.1185284] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Chronic endometritis (CE) is a persistent inflammatory condition of the endometrium characterized by the infiltration of plasma cells in the endometrial stroma. CD138 immunohistochemistry is considered to improve the CE diagnosis rate. Methods Using the number of CD138-positive cells equal or greater than five as a diagnostic criterion for CE, we identified 24 CE and 33 non-CE cases among women with infertility. We conducted RNA-sequencing analysis for these 57 cases in total as an attempt to elucidate the molecular pathogenesis of CE and to search for new biomarkers for CE. Results and Discussion By comparing CE and non-CE groups, we identified 20 genes upregulated in the endometria of CE patients, including 12 immunoglobulin-related genes and eight non-immunoglobulin genes as differentially expressed genes. The eight genes were MUC5AC, LTF, CAPN9, MESP1, ACSM1, TVP23A, ALOX15, and MZB1. By analyzing samples in the proliferative and secretory phases of the menstrual cycle separately, we also identified four additional non-immunoglobulin genes upregulated in CE endometria: CCDC13 by comparing the samples in the proliferative phase, and OVGP1, MTUS2, and CLIC6 by comparing the samples in the secretory phase. Although the genes upregulated in CE may serve as novel diagnostic markers of CE, many of them were upregulated only in a limited number of CE cases showing an extremely high number of CD138-positive cells near or over one hundred. Exceptionally, TVP23A was upregulated in the majority of CE cases regardless of the number of CD138-positive cells. The upregulation of TVP23A in the endometria of CE cases may reflect the pathophysiology of a cell-type or cell-types intrinsic to the endometrium rather than the accumulation of plasma cells. Our data, consisting of clinical and transcriptomic information for CE and non-CE cases, helped us identify gene expression signatures associated with CE.
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Affiliation(s)
- Kyoko Oshina
- Department of Maternal-Fetal Biology, National Center for Child Health and Development, Setagaya, Tokyo, Japan
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Bunkyo, Tokyo, Japan
| | - Keiji Kuroda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Bunkyo, Tokyo, Japan
- Center for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi, Chiyoda, Tokyo, Japan
| | - Kazuhiko Nakabayashi
- Department of Maternal-Fetal Biology, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Junko Tomikawa
- Department of Maternal-Fetal Biology, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Mari Kitade
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Bunkyo, Tokyo, Japan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Shinjuku, Tokyo, Japan
| | - Kenichiro Hata
- Department of Maternal-Fetal Biology, National Center for Child Health and Development, Setagaya, Tokyo, Japan
- Department of Human Molecular Genetics, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Bunkyo, Tokyo, Japan
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Kuroda K, Matsumoto A, Horikawa T, Takamizawa S, Ochiai A, Kawamura K, Nakagawa K, Sugiyama R. Transcriptomic profiling analysis of human endometrial stromal cells treated with autologous platelet-rich plasma. Reprod Med Biol 2023; 22:e12498. [PMID: 36704119 PMCID: PMC9868347 DOI: 10.1002/rmb2.12498] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/24/2023] Open
Abstract
Purpose To clarify the mechanisms of intrauterine platelet-rich plasma (PRP) infusion that support embryo implantation in in vitro fertilization treatment. Methods Blood and endometrial samples were collected from four infertile women. Human endometrial stromal cells (HESCs) were cultured and passaged equally into four cell culture dishes in each patient. Two were treated with PRP twice, and the other two were treated with vehicle. Subsequently, two cultures with and without PRP were decidualized with 8-bromoadenosine 3',5'-cyclic AMP and progesterone for 5 days. Results The gene expression in undifferentiated or decidualized HESCs with and without PRP was compared. In the microarray analysis, 381 and 63 differentially expressed genes were detected in undifferentiated and decidualized HESCs, respectively. In the undifferentiated HESCs, PRP was found to promote the gene expression associated with cell growth, tissue regeneration, proinflammatory response, and antibiotic effects. In decidualized HESCs, PRP was found to attenuate the gene expression involved in cell proliferation and inflammation by inhibiting the expression of phosphoinositide 3-kinase signaling. Conclusions Platelet-rich plasma regulates the reprogramming of cell proliferation and inflammation depending on menstrual cycle phases in an appropriate manner, suggesting that PRP has the potential to increase endometrial thickness in the proliferative phase and improve immune tolerance in the secretory phase.
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Affiliation(s)
- Keiji Kuroda
- Center for Reproductive Medicine and EndoscopySugiyama Clinic MarunouchiTokyoJapan,Centre for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan,Department of Obstetrics and GynaecologyJuntendo University Faculty of MedicineTokyoJapan
| | - Akemi Matsumoto
- Department of Obstetrics and GynaecologyJuntendo University Faculty of MedicineTokyoJapan
| | - Takashi Horikawa
- Centre for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Satoru Takamizawa
- Centre for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Asako Ochiai
- Department of Obstetrics and GynaecologyJuntendo University Faculty of MedicineTokyoJapan
| | - Kazuhiro Kawamura
- Department of Obstetrics and GynaecologyJuntendo University Faculty of MedicineTokyoJapan
| | - Koji Nakagawa
- Centre for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Rikikazu Sugiyama
- Centre for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
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Kuroda K, Ishiyama S, Shiobara K, Nakao K, Moriyama A, Kataoka H, Horikawa T, Ojiro Y, Takamizawa S, Nakagawa K, Sugiyama R. Therapeutic efficacy of gentle endometrial curettage on antibiotic-resistant chronic endometritis in infertile women. Reprod Med Biol 2023; 22:e12525. [PMID: 37409240 PMCID: PMC10318421 DOI: 10.1002/rmb2.12525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/08/2023] [Revised: 06/05/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose To identify the efficacy of endometrial curettage on antibiotic-resistant chronic endometritis (CE) in infertile women. Methods Of 1580 women with CE, 87 with antibiotic-resistant CE after two to five cycles of antibiotic treatment were recruited between 2019 and 2021. The women who underwent endometrial curettage without applying any force and, in the subsequent menstrual cycle, endometrial sampling for CD138 immunostaining without antibiotic use. Pregnancy outcomes after in vitro fertilization treatment were analyzed in women who did not desire endometrial curettage and in those with cured and persistent CE after endometrial curettage. Results In 64 women who underwent endometrial curettage, the number of CD138-positive cells decreased from 28.0 ± 35.3 to 7.7 ± 14.0 (p < 0.0001), and CE in 41 women (64.1%) was cured (<5 CD138-positive cells). The pathological findings detected 3.1% of endometrial hyperplasia and 1.6% of endometrial cancer. The ongoing pregnancy rates in women aged ≤42 without endometrial curettage were significantly lower than those of women with cured and persistent CE (26.7%, 67.6%, and 57.1%, respectively, p = 0.03). Conclusions Gentle endometrial curettage for antibiotic-resistant CE significantly decreased the number of CD138-positive cells, resulting in improved pregnancy outcomes regardless of remaining CE. Endometrial curettage is also important as a screening for endometrial malignancy.
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Affiliation(s)
- Keiji Kuroda
- Center for Reproductive Medicine and EndoscopySugiyama Clinic MarunouchiTokyoJapan
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
- Department of Obstetrics and GynecologyJuntendo University Faculty of MedicineTokyoJapan
| | - Shunsuke Ishiyama
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Keisuke Shiobara
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Kazuki Nakao
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Azusa Moriyama
- Center for Reproductive Medicine and EndoscopySugiyama Clinic MarunouchiTokyoJapan
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Hisayo Kataoka
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Takashi Horikawa
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Yuko Ojiro
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Satoru Takamizawa
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Koji Nakagawa
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
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8
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Kuroda K, Horikawa T, Moriyama A, Ojiro Y, Takamizawa S, Watanabe H, Maruyama T, Nojiri S, Nakagawa K, Sugiyama R. Therapeutic efficacy of the optimization of thyroid function, thrombophilia, immunity and uterine milieu (OPTIMUM) treatment strategy on pregnancy outcomes after single euploid blastocyst transfer in advanced age women with recurrent reproductive failure. Reprod Med Biol 2023; 22:e12554. [PMID: 38144238 PMCID: PMC10739138 DOI: 10.1002/rmb2.12554] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Purpose To clarify the efficacy of the OPtimization of Thyroid function, Thrombophilia, IMmunity and Uterine Milieu (OPTIMUM) treatment strategy on pregnancy outcomes after euploid blastocyst transfer in advanced age women with recurrent implantation failure (RIF) and/or recurrent pregnancy loss (RPL). Methods Between January 2019 and May 2022, 193 consecutive women aged ≥40 years with RIF and/or RPL received single euploid blastocyst transfer. Before embryo transfer, 127 women underwent RIF/RPL testing. Chronic endometritis was treated with mainly antibiotics, aberrant high Th1/Th2 cell ratios with vitamin D and/or tacrolimus, overt/subclinical hypothyroidism with levothyroxine, and thrombophilia with low-dose aspirin. We compared pregnancy outcomes in the women who did and did not receive the OPTIMUM treatment strategy. Results Women with RIF/RPL in the OPTIMUM group had significantly higher clinical pregnancy and livebirth rates than did those in the control group (clinical pregnancy rate of 71.7% and 45.5%, p < 0.001; livebirth rate of 64.6% and 39.4%, p = 0.001, respectively). However, preimplantation genetic testing for aneuploidy with and without OPTIMUM promoted low miscarriage rates with no significant difference between them (9.9%, and 13.3%, respectively; p = 0.73). Conclusions The OPTIMUM treatment strategy improved clinical pregnancy rates after single euploid blastocyst transfer; but not miscarriage rates.
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Affiliation(s)
- Keiji Kuroda
- Center for Reproductive Medicine and EndoscopySugiyama Clinic MarunouchiTokyoJapan
- Department of Obstetrics and GynecologyJuntendo University Faculty of MedicineTokyoJapan
| | - Takashi Horikawa
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Azusa Moriyama
- Center for Reproductive Medicine and EndoscopySugiyama Clinic MarunouchiTokyoJapan
| | - Yuko Ojiro
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Satoru Takamizawa
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Hideaki Watanabe
- Center for Reproductive Medicine and EndoscopySugiyama Clinic MarunouchiTokyoJapan
| | - Tetsuo Maruyama
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Shuko Nojiri
- Medical Technology Innovation CenterJuntendo UniversityTokyoJapan
- Clinical Research and Trial CenterJuntendo University HospitalTokyoJapan
| | - Koji Nakagawa
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
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Hisano M, Nakagawa K, Kwak-Kim J, Sugiyama R, Sago H, Yamaguchi K. Changes in the T-helper 1 and 2 cell populations during pregnancy in tacrolimus-treated women with repeated implantation failure and recurrent pregnancy loss. HUM FERTIL 2022; 25:975-982. [PMID: 34304683 DOI: 10.1080/14647273.2021.1955415] [Citation(s) in RCA: 4] [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] [Indexed: 01/03/2023]
Abstract
Tacrolimus has received considerable attention as a treatment approach for infertility associated with maternal-foetal immune abnormalities, such as repeated implantation failure (RIF) and recurrent pregnancy loss (RPL). This study examined the changes in T-helper (Th) 1 and 2 cell populations during pregnancy in peripheral blood of tacrolimus-treated RIF patients who delivered a liveborn infant from August 2012 to February 2020 at the National Centre for Child Health and Development. A total of 58 eligible study subjects were divided into two groups according to the presence of a history of RPL: (i) RIF-alone group (n = 31); and (ii) RIF-plus-RPL group (n = 27). In a flow cytometric analysis, the Th1/Th2 cell ratios were significantly higher before pregnancy than after pregnancy, and during the first trimester than the second trimester in the RIF-alone group (p = 0.0071 and p = 0.0087, respectively). However, no significant differences were present in the RIF-plus-RPL group. Although the Th1 immunity was suppressed under tacrolimus treatment in both groups, a delayed reduction in the Th1 cell percentage after initiation of treatment was observed in the RIF-plus-RPL group. In conclusion, the cellular immune alterations in tacrolimus-treated patients with RIF were different depending on the presence or absence of a history of RPL.
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Affiliation(s)
- Michi Hisano
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Koji Nakagawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Joanne Kwak-Kim
- Reproductive Medicine, Department of Obstetrics and Gynecology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Haruhiko Sago
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Koushi Yamaguchi
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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Kuroda K, Yamanaka A, Takamizawa S, Nakao K, Kuribayashi Y, Nakagawa K, Nojiri S, Nishi H, Sugiyama R. Prevalence of and risk factors for chronic endometritis in patients with intrauterine disorders after hysteroscopic surgery. Fertil Steril 2022; 118:568-575. [PMID: 35718544 DOI: 10.1016/j.fertnstert.2022.05.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 03/21/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To identify the prevalence of and risk factors for chronic endometritis (CE) in patients with intrauterine disorders and the therapeutic efficacy of hysteroscopic surgery in the treatment of CE without antibiotic therapy. DESIGN Prospective cohort study. SETTING Hospital specializing in reproductive medicine. PATIENT(S) The study population consisted of 350 women with infertility, of whom 337 were recruited, who underwent hysteroscopic surgery between November 2018 and June 2021. Eighty-nine consecutive patients without intrauterine disorders were also recruited as controls. INTERVENTION(S) Endometrial samples were collected during the surgery for CD138 immunostaining for the diagnosis of CE. In women diagnosed with CE, endometrial biopsy was performed without antibiotic use in the subsequent menstrual cycle. MAIN OUTCOME MEASURE(S) Prevalence of and risk factors for CE in intrauterine disorders and therapeutic effects of hysteroscopic surgery on CE. RESULT(S) The prevalence of CE with ≥5 CD138-positive cells in women with no intrauterine disorder and with endometrial polyps, myomas, intrauterine adhesions (IUAs), and septate uterus was 15.7%, 85.7%, 69.0%, 78.9%, and 46.2%, respectively. A multivariate analysis revealed that CE was diagnosed significantly more often in the endometrial polyp (odds ratio, 27.69; 95% confidence interval, 15.01-51.08) and IUA groups (odds ratio, 8.85; 95% confidence interval, 3.26-24.05). The rate of recovery from CE with surgery in women with endometrial polyps, myomas, IUA, and septate uterus was 89.7%, 100%, 92.8%, and 83.3%, respectively. CONCLUSION(S) Endometrial polyp and IUA were risk factors for CE. Most CE cases with intrauterine disorders were cured with hysteroscopic surgery without antibiotic therapy, regardless of the type of intrauterine abnormalities.
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Affiliation(s)
- Keiji Kuroda
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan; Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Akina Yamanaka
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan; Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan
| | - Satoru Takamizawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Kazuki Nakao
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Yasushi Kuribayashi
- Center for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi, Tokyo, Japan
| | - Koji Nakagawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan; Clinical Research and Trial Center, Juntendo University Hospital, Tokyo, Japan
| | - Hirotaka Nishi
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
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11
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Gekka Y, Nakagawa K, Watanabe H, Kuroda K, Horikawa T, Takamizawa S, Sugiyama R. Comparison of Pregnancy Outcomes Between Fresh Embryo Transfer in a Natural IVF Cycle and IUI Cycle Among Infertile Young Women. J Reprod Infertil 2022; 23:93-99. [PMID: 36043131 PMCID: PMC9363904 DOI: 10.18502/jri.v23i2.8993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/26/2021] [Indexed: 12/03/2022] Open
Abstract
Background: The purpose of the current study was comparing pregnancy outcomes for natural cycle in vitro fertilization (IVF) per fresh embryo transfer (ET) and oocyte pick-up (OPU) in intrauterine insemination (IUI). Methods: This was a retrospective cohort study of women who underwent either IUI (n=246) or OPU with fresh ET for natural cycle IVF (n=291), conducted between April 2017 and February 2018 at the Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan. Patients in both groups did not receive ovarian stimulation and luteal support; gonadotropin-releasing agonist spray was administered 35 hr before OPU or IUI. The clinical pregnancy rate was compared between the IUI and IVF groups. Data analysis was based on the number of cycles. The p≦0.05 was considered significant. Results: The clinical pregnancy rate per OPU in the IVF group was higher than the one in IUI group (20.6% vs. 10.1%), and the difference was significant (p<0.01). The pregnancy rate for natural cycle IVF calculated per fresh ET was 36.8%. The miscarriage rate did not significantly differ between the IVF (4.1%) and IUI (8.0%) groups. Conclusion: Fresh ET in natural cycle IVF provides a higher implantation rate than IUI.
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Affiliation(s)
- Yoko Gekka
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Koji Nakagawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Hideaki Watanabe
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Keiji Kuroda
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Takashi Horikawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Satoru Takamizawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
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12
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Nakao K, Kuroda K, Horikawa T, Moriyama A, Juen H, Itakura A, Watanabe H, Takamizawa S, Ojiro Y, Nakagawa K, Sugiyama R. Therapeutic effects of an oral gonadotropin-releasing hormone receptor antagonist, relugolix, on preventing premature ovulation in mild ovarian stimulation for IVF. Reprod Med Biol 2021; 21:e12422. [PMID: 34938146 PMCID: PMC8656665 DOI: 10.1002/rmb2.12422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/09/2021] [Revised: 09/26/2021] [Accepted: 10/07/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose Can relugolix, a novel oral gonadotropin-releasing hormone receptor (GnRH) antagonist, function as an alternative ovulation inhibitor to GnRH antagonist injections? Methods This single-center, cross-sectional retrospective study compared premature ovulation rates and clinical outcomes in IVF treatment after mild ovarian stimulation with 40 mg of relugolix (relugolix group) or 0.25-mg injections of ganirelix acetate or cetrorelix acetate (injection group) between March 2019 and January 2020. Of 247 infertile women (256 IVF cycles) aged ≤42 years, 223 women (230 cycles) were evaluated. In the relugolix and injection groups, we compared 104 and 85 cycles after GnRH antagonist use before the LH surge (LH levels <10 mIU/ml) and 22 and 19 cycles during the LH surge (LH levels ≥10 mIU/ml), respectively. Results Before the LH surge, the ovulation rates in the two groups were very low (p = 0.838), however; during the LH surge, the cycles using relugolix had a high ovulation rate of 40.9% compared with no ovulation in the injection group (p = 0.002). There were no significant differences in embryo culture findings and pregnancy outcomes between the two groups. Conclusions Although relugolix had a high ovulation suppressive effect, when the LH surge occurred, its effect was insufficient.
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Affiliation(s)
- Kazuki Nakao
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
| | - Keiji Kuroda
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan.,Department of Obstetrics and Gynecology Faculty of Medicine Juntendo University Tokyo Japan
| | - Takashi Horikawa
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
| | - Azusa Moriyama
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
| | - Hiroyasu Juen
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
| | - Akiko Itakura
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
| | - Hideaki Watanabe
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
| | - Satoru Takamizawa
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
| | - Yuko Ojiro
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
| | - Koji Nakagawa
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan
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13
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Kuroda K, Nakagawa K, Horikawa T, Moriyama A, Ojiro Y, Takamizawa S, Ochiai A, Matsumura Y, Ikemoto Y, Yamaguchi K, Sugiyama R. Increasing number of implantation failures and pregnancy losses associated with elevated Th1/Th2 cell ratio. J Reprod Immunol 2021. [DOI: 10.1016/j.jri.2021.103423] [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: 10/19/2022]
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14
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Kuroda K, Ikemoto Y, Horikawa T, Moriyama A, Ojiro Y, Takamizawa S, Uchida T, Nojiri S, Nakagawa K, Sugiyama R. Novel approaches to the management of recurrent pregnancy loss: The OPTIMUM (OPtimization of Thyroid function, Thrombophilia, Immunity, and Uterine Milieu) treatment strategy. Reprod Med Biol 2021; 20:524-536. [PMID: 34646081 PMCID: PMC8499598 DOI: 10.1002/rmb2.12412] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/26/2021] [Revised: 08/26/2021] [Accepted: 09/03/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Does the OPtimization of Thyroid function, Thrombophilia, Immunity, and Uterine Milieu (OPTIMUM) treatment strategy, developed for treating repeated implantation failure (RIF), contribute to improving pregnancy outcomes in patients with a history of recurrent pregnancy loss (RPL)? METHODS Between 2018 and 2019, women with RPL after two or more clinical pregnancy losses underwent RPL testing. We treated chronic endometritis with antibiotics, high Th1/Th2 cell ratios with vitamin D and/or tacrolimus, overt/subclinical hypothyroidism with levothyroxine, and thrombophilia with low-dose aspirin. Of 168 consecutive women aged ≤43 years, 115 underwent RPL testing. We compared 100 pregnancies (90 women) and 46 pregnancies (41 women) with and without the OPTIMUM treatment strategy, respectively. RESULTS RPL testing identified intrauterine abnormalities in 66 (57.4%), elevated Th1/Th2 cell ratios in 50 (43.5%), thyroid dysfunction in 33 (28.7%), and thrombophilia in 33 (28.7%). The live birth rate in the OPTIMUM group was significantly higher than that in the control group among women aged <40 years (78.1% and 42.3%, respectively; p = 0.002), but no significant difference was observed in women aged ≥40 years (55.6% and 30.0%, respectively; p = 0.09). CONCLUSIONS The OPTIMUM treatment strategy improved pregnancy outcomes in patients with not only RIF but also RPL.
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Affiliation(s)
- Keiji Kuroda
- Centre for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
- Department of Obstetrics and GynaecologyFaculty of MedicineJuntendo UniversityTokyoJapan
| | - Yuko Ikemoto
- Department of Obstetrics and GynaecologyFaculty of MedicineJuntendo UniversityTokyoJapan
| | - Takashi Horikawa
- Centre for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Azusa Moriyama
- Centre for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Yuko Ojiro
- Centre for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Satoru Takamizawa
- Centre for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Toyoyoshi Uchida
- Departments of Metabolism and EndocrinologyFaculty of MedicineJuntendo UniversityTokyoJapan
| | - Shuko Nojiri
- Medical Technology Innovation CentreJuntendo UniversityTokyoJapan
- Clinical Research and Trial CentreJuntendo University HospitalTokyoJapan
| | - Koji Nakagawa
- Centre for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Rikikazu Sugiyama
- Centre for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
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15
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Kuroda K, Nakagawa K, Horikawa T, Moriyama A, Ojiro Y, Takamizawa S, Ochiai A, Matsumura Y, Ikemoto Y, Yamaguchi K, Sugiyama R. Increasing number of implantation failures and pregnancy losses associated with elevated Th1/Th2 cell ratio. Am J Reprod Immunol 2021; 86:e13429. [PMID: 33835626 DOI: 10.1111/aji.13429] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 11/05/2020] [Revised: 03/01/2021] [Accepted: 04/06/2021] [Indexed: 12/16/2022] Open
Abstract
PROBLEM We aimed to assess whether an imbalance of T-helper (Th) 1 and Th2 cells contributes to implantation failure and pregnancy loss. METHOD OF STUDY In this cross-sectional study, 197 consecutive patients with a history of repeated implantation failure (RIF) after three or more embryo transfer (ET) cycles and/or recurrent pregnancy loss (RPL) after two or more clinical pregnancy losses underwent Th cell testing. After excluding 42 women aged ≥44 and 9 with vitamin D supplementation, we recruited 146 women including 79 with RIF and 81 with RPL. Fourteen women had a history of both RIF and RPL. We also recruited 45 fertile women and 40 general infertile women without a history of in vitro fertilization treatment. This study was approved by the local ethics committee. RESULTS There was no significant difference in IFN-γ-producing Th1 and IL-4-producing Th2 cell levels between the fertile and general infertile women, but Th1 cell levels and the Th1/Th2 cell ratio were significantly higher in the women with ≥4 ET cycles and ≥2 pregnancy losses than in the fertile and general infertile women. In the general infertile women, the total livebirth rates including natural conception after two ET cycles in the normal and high Th1/Th2 groups (Th1/Th2 <11.8 and ≥11.8, respectively) were 66.7% and 87.5%, respectively (p = .395). CONCLUSIONS A high Th1/Th2 cell ratio was linked to ≥4 implantation failure cycles and ≥2 pregnancy losses but not to general infertility.
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Affiliation(s)
- Keiji Kuroda
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan.,Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Koji Nakagawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Takashi Horikawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Azusa Moriyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Yuko Ojiro
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Satoru Takamizawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Asako Ochiai
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuko Matsumura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuko Ikemoto
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Koushi Yamaguchi
- Department of Maternal-Fetal Biology, National Center for Child Health and Development, Tokyo, Japan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
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16
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Kuroda K, Horikawa T, Gekka Y, Moriyama A, Nakao K, Juen H, Takamizawa S, Ojiro Y, Nakagawa K, Sugiyama R. Effects of Periconceptional Multivitamin Supplementation on Folate and Homocysteine Levels Depending on Genetic Variants of Methyltetrahydrofolate Reductase in Infertile Japanese Women. Nutrients 2021; 13:nu13041381. [PMID: 33923969 PMCID: PMC8073279 DOI: 10.3390/nu13041381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 12/11/2022] Open
Abstract
Methylenetetrahydrofolate reductase (MTHFR) has various polymorphisms, and the effects of periconceptional folic acid supplementation for decreasing neural tube defects (NTDs) risk differ depending on the genotypes. This study analyzed the effectiveness of multivitamin supplementation on folate insufficiency and hyperhomocysteinemia, depending on MTHFR polymorphisms. Of 205 women, 72 (35.1%), 100 (48.8%) and 33 (16.1%) had MTHFR CC, CT and TT, respectively. Serum folate and homocysteine levels in women with homozygous mutant TT were significantly lower and higher, respectively, than those in women with CC and CT. In 54 women (26.3% of all women) with a risk of NTDs, multivitamin supplementation containing folic acid and vitamin D for one month increased folate level (5.8 ± 0.9 to 19.2 ± 4.0 ng/mL, p < 0.0001) and decreased the homocysteine level (8.2 ± 3.1 to 5.8 ± 0.8 nmol/mL, p < 0.0001) to minimize the risk of NTDs in all women, regardless of MTHFR genotype. Regardless of MTHFR genotype, multivitamin supplements could control folate and homocysteine levels. Tests for folate and homocysteine levels and optimal multivitamin supplementation in women with risk of NTDs one month or more before pregnancy should be recommended to women who are planning a pregnancy.
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Affiliation(s)
- Keiji Kuroda
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan; (T.H.); (Y.G.); (A.M.); (K.N.); (H.J.); (S.T.); (Y.O.); (K.N.); (R.S.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo 113-8421, Japan
- Correspondence: ; Tel.: +81-3-5381-3000; Fax: +81-3-5381-4124
| | - Takashi Horikawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan; (T.H.); (Y.G.); (A.M.); (K.N.); (H.J.); (S.T.); (Y.O.); (K.N.); (R.S.)
| | - Yoko Gekka
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan; (T.H.); (Y.G.); (A.M.); (K.N.); (H.J.); (S.T.); (Y.O.); (K.N.); (R.S.)
| | - Azusa Moriyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan; (T.H.); (Y.G.); (A.M.); (K.N.); (H.J.); (S.T.); (Y.O.); (K.N.); (R.S.)
| | - Kazuki Nakao
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan; (T.H.); (Y.G.); (A.M.); (K.N.); (H.J.); (S.T.); (Y.O.); (K.N.); (R.S.)
| | - Hiroyasu Juen
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan; (T.H.); (Y.G.); (A.M.); (K.N.); (H.J.); (S.T.); (Y.O.); (K.N.); (R.S.)
| | - Satoru Takamizawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan; (T.H.); (Y.G.); (A.M.); (K.N.); (H.J.); (S.T.); (Y.O.); (K.N.); (R.S.)
| | - Yuko Ojiro
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan; (T.H.); (Y.G.); (A.M.); (K.N.); (H.J.); (S.T.); (Y.O.); (K.N.); (R.S.)
| | - Koji Nakagawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan; (T.H.); (Y.G.); (A.M.); (K.N.); (H.J.); (S.T.); (Y.O.); (K.N.); (R.S.)
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan; (T.H.); (Y.G.); (A.M.); (K.N.); (H.J.); (S.T.); (Y.O.); (K.N.); (R.S.)
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17
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Tsunemi A, Uchida T, Kuroda K, Ikemoto Y, Ochiai A, Goto H, Sugiyama R, Satoh H, Itakura A, Watada H. Effect of thyroxine treatment on pregnancy outcomes in infertile Japanese women with TSH levels between 2.5 μIU/mL and the upper reference limit: a retrospective study. Endocr J 2021; 68:171-177. [PMID: 32999139 DOI: 10.1507/endocrj.ej20-0380] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Recent randomized controlled studies have revealed that levothyroxine (LT4) treatment improves pregnancy outcomes only in infertile women with subclinical hypothyroidism who have thyroid autoantibodies (TAs), but not for those with high TSH levels within the normal range who have TAs. Here, we retrospectively investigated pregnancy outcomes in infertile Japanese women with 2.5 μIU/mL ≤ TSH < upper reference limit (URL). Between 2012 and 2018, 286 patients diagnosed with infertility were followed for more than 1 year at our institution. Among them, we included 106 patients with 2.5 μIU/mL ≤ TSH < URL. We divided these patients into four groups based on the combination of TA positivity and LT4 treatment status to assess the effects of LT4 treatment considering TA positivity on the incidence of pregnancy or miscarriage. In this study, we did not find any significant differences in the rates of pregnancy or miscarriage among the four groups (p = 0.81 and 0.52, respectively). In addition, logistic regression analysis showed that age and history of miscarriage were associated with the incidence of pregnancy, but presence of TAs and LT4 treatment status were not and that no variables examined were associated with the incidence of miscarriage. In summary, we were not able to demonstrate the benefit of LT4 treatment for pregnancy outcomes in Japanese euthyroid infertile women with 2.5 μIU/mL ≤ TSH < URL regardless of TA status in this study.
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Affiliation(s)
- Asako Tsunemi
- Department of Metabolism & Endocrinology, Juntendo University Graduate School, Tokyo 113-8421, Japan
| | - Toyoyoshi Uchida
- Department of Metabolism & Endocrinology, Juntendo University Graduate School, Tokyo 113-8421, Japan
| | - Keiji Kuroda
- Department of Obstetrics and Gynaecology, Juntendo University Graduate School, Tokyo 113-8421, Japan
- Centre for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan
| | - Yuko Ikemoto
- Department of Obstetrics and Gynaecology, Juntendo University Graduate School, Tokyo 113-8421, Japan
| | - Asako Ochiai
- Department of Obstetrics and Gynaecology, Juntendo University Graduate School, Tokyo 113-8421, Japan
| | - Hiromasa Goto
- Department of Metabolism & Endocrinology, Juntendo University Graduate School, Tokyo 113-8421, Japan
| | - Rikikazu Sugiyama
- Centre for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan
| | - Hiroaki Satoh
- Department of Metabolism & Endocrinology, Juntendo University Graduate School, Tokyo 113-8421, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynaecology, Juntendo University Graduate School, Tokyo 113-8421, Japan
| | - Hirotaka Watada
- Department of Metabolism & Endocrinology, Juntendo University Graduate School, Tokyo 113-8421, Japan
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Kuroda K, Takamizawa S, Motoyama H, Tsutsumi R, Sugiyama R, Nakagawa K, Sugiyama R, Kuribayashi Y. Analysis of the therapeutic effects of hysteroscopic polypectomy with and without doxycycline treatment on chronic endometritis with endometrial polyps. Am J Reprod Immunol 2021; 85:e13392. [PMID: 33501741 DOI: 10.1111/aji.13392] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 11/11/2020] [Revised: 12/15/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022] Open
Abstract
PROBLEM We aimed to compare the therapeutic effects of hysteroscopic polypectomy with and without doxycycline treatment on chronic endometritis (CE) with endometrial polyps. METHOD OF STUDY DESIGN: A cross-sectional study was conducted on 267 infertile patients, of whom 243 were recruited, who underwent hysteroscopic polypectomy between March 2019 and March 2020. During surgery, the endometrial specimens for the immunohistochemistry analysis of the plasma cell marker CD138 and for the intrauterine bacterial culture were obtained to diagnose CE, and the prevalence of CE was analyzed. Of the 222 women who were diagnosed with CE after polypectomy, we treated 62 women with doxycycline (antibiotic group) and did not provide antibiotics in 160 women (non-antibiotic group). RESULTS Most of the infertile patients with endometrial polyps had CE (92.6%). The recovery rate from CE by hysteroscopic polypectomy was significantly higher in the non-antibiotic group than in the antibiotic group (88.8% and 58.1%, respectively, p < 0.0001). The duration of recovery from CE in the non-antibiotic group was shorter than that in the antibiotic group (42.6 ± 41.0 and 56.5 ± 32.3 days, respectively, p < 0.0001). The clinical pregnancy rate within 6 months in non-antibiotic group was higher than that in the antibiotic group (63.2% and 43.8%, respectively, p = 0.034). CONCLUSION Endometrial polyps are significantly associated with CE. Most CE patients with endometrial polyps had been cured by polypectomy without doxycycline. Inappropriate antibiotic therapy may delay recovery from CE and decrease the efficacy of polypectomy on CE and pregnancy rates.
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Affiliation(s)
- Keiji Kuroda
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan.,Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Satoru Takamizawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Hiroshi Motoyama
- Center for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi, Tokyo, Japan
| | - Ryo Tsutsumi
- Center for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi, Tokyo, Japan
| | - Rie Sugiyama
- Center for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi, Tokyo, Japan
| | - Koji Nakagawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Yasushi Kuribayashi
- Center for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi, Tokyo, Japan
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Ikemoto Y, Kuroda K, Endo M, Tanaka A, Sugiyama R, Nakagawa K, Sato Y, Kuribayashi Y, Tomooka K, Imai Y, Deshpande GA, Tanigawa T, Itakura A, Takeda S. Analysis of severe psychological stressors in women during fertility treatment: Japan-Female Employment and Mental health in Assisted reproductive technology (J-FEMA) study. Arch Gynecol Obstet 2021; 304:253-261. [PMID: 33386414 PMCID: PMC7775729 DOI: 10.1007/s00404-020-05923-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/24/2020] [Indexed: 11/01/2022]
Abstract
PURPOSE To identify risk factors for severe psychological stress in women undergoing fertility treatment. METHODS This cross-sectional, multi-center study was conducted from August to December 2018. We recruited 1672 subjects who completed an anonymous, self-reported questionnaire regarding fertility treatment, conditions at work and home, and psychological stress using K6 score, which estimates psychological distress during the previous 30 days. We further focused our analysis on 1335 subjects who were working when starting fertility treatment. RESULTS Of 1672 women, mean K6 score (range 0-24) was 4.8 ± 4.4, including 103 women (6.2%) with K6 score ≥ 13 (high K6), and classified as probable severe psychological distress. Multivariate logistic regression analysis showed that high K6 was strongly associated with low annual family income of ≤ USD55,700 (JPY6 million) (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.04-3.42), infertility duration of ≥ 2 years (OR 1.87, 95% CI 1.08-3.25), and no experience of childbirth (OR 2.04, 95% CI 1.05-3.97). Focusing on 1335 working women, 266 (19.9%) experienced resignation from work. High K6 was strongly associated with low family income (OR 2.83, 95% CI 1.52-5.28), cessation of professional duties (OR 2.08, 95% CI 1.05-4.14), infertility-related harassment in the workplace (OR 2.07, 95% CI 1.08-3.98), and perceived difficulties to continue working during fertility treatment (OR 2.94, 95% CI 1.15-7.50). CONCLUSION Severe psychological stressors in women during fertility treatment included low family income, long infertility duration, childlessness, infertility-related harassment, and perceived difficulty in working conditions or cessation from work. Establishment of mental health care support systems is urgently required in this population.
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Affiliation(s)
- Yuko Ikemoto
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Keiji Kuroda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan. .,Sugiyama Clinic Shinjuku, Center for Reproductive Medicine and Implantation Research, 1-19-6, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Motoki Endo
- Department of Public Health, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsushi Tanaka
- Saint Mother Obstetrics and Gynecology Clinic, Institute for ART, Fukuoka, Japan
| | - Rikikazu Sugiyama
- Sugiyama Clinic Shinjuku, Center for Reproductive Medicine and Implantation Research, 1-19-6, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Koji Nakagawa
- Sugiyama Clinic Shinjuku, Center for Reproductive Medicine and Implantation Research, 1-19-6, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yuichi Sato
- Tatedebari Sato Hospital, Obstetrics and Gynecology, Gunma, Japan.,Takasaki ART Clinic, Gunma, Japan
| | - Yasushi Kuribayashi
- Sugiyama Clinic Marunouchi, Center for Reproductive Medicine and Endoscopy, Tokyo, Japan
| | - Kiyohide Tomooka
- Department of Public Health, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuya Imai
- Department of Public Health, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Gautam A Deshpande
- Department of General Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
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20
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Imai Y, Endo M, Kuroda K, Tomooka K, Ikemoto Y, Sato S, Mitsui K, Ueda Y, Deshpande GA, Tanaka A, Sugiyama R, Nakagawa K, Sato Y, Kuribayashi Y, Itakura A, Takeda S, Tanigawa T. Risk factors for resignation from work after starting infertility treatment among Japanese women: Japan-Female Employment and Mental health in Assisted reproductive technology (J-FEMA) study. Occup Environ Med 2020; 78:oemed-2020-106745. [PMID: 33273052 PMCID: PMC8142458 DOI: 10.1136/oemed-2020-106745] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 05/29/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To elucidate the risk factors associated with resignation from work of Japanese women undergoing infertility treatment. METHODS A total of 1727 female patients who attended a private fertility clinic in Japan participated in the Japan-Female Employment and Mental health in Assisted reproductive technology study. Questions related to demographic, clinical and socioeconomic characteristics were employed in the questionnaire. Out of the 1727 patients, 1075 patients who were working at the time of initiating infertility treatment and felt infertility treatment incompatible with work were included in the analysis. Risk factors for resignation were assessed by using multivariable logistic regression models. RESULTS Among 1075 working women who started infertility treatment, 179 (16.7%) subsequently resigned. Multivariable-adjusted ORs for resignation in those with lower educational background and infertility for ≥2 years were 1.58 (95% CI: 1.07 to 2.34) and 1.82 (95% CI: 1.15 to 2.89), respectively. The OR for resignation in non-permanent workers undergoing infertility treatment was 2.65 (95% CI: 1.61 to 4.37). While experiencing harassment in the workplace approached significance, lack of support from the company was significantly associated with resignation after starting infertility treatment, with ORs of 1.71 (95% CI: 0.98 to 2.99) and 1.91 (95% CI: 1.28 to 2.86), respectively. CONCLUSION One-sixth of women resigned after starting infertility treatments. It was found that factors related to education, infertility duration and work environment were significantly associated with resignation. Reducing the physical and psychological burden endured by women, for example, by increasing employer-provided support, is vitally important in balancing infertility treatment with maintenance of work life.
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Affiliation(s)
- Yuya Imai
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Motoki Endo
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Keiji Kuroda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Shinjuku-ku, Tokyo, Japan
| | - Kiyohide Tomooka
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yuko Ikemoto
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Setsuko Sato
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kiyomi Mitsui
- Department of Hygiene, Public Health, and Preventive Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
| | - Yuito Ueda
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Gautam A Deshpande
- Department of General Internal Medicine, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Atsushi Tanaka
- Saint Mother Hospital Infertility Clinic, Kitakyushu, Fukuoka, Japan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Shinjuku-ku, Tokyo, Japan
| | - Koji Nakagawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Shinjuku-ku, Tokyo, Japan
| | | | - Yasushi Kuribayashi
- Center for Reproductive Medicine and Endoscopy Sugiyama Clinic Marunouchi, Chiyoda-ku, Tokyo, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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21
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Kuroda K, Matsumura Y, Ikemoto Y, Segawa T, Hashimoto T, Fukuda J, Nakagawa K, Uchida T, Ochiai A, Horimoto Y, Arakawa A, Nojiri S, Itakura A, Sugiyama R. Analysis of the risk factors and treatment for repeated implantation failure: OPtimization of Thyroid function, IMmunity, and Uterine Milieu (OPTIMUM) treatment strategy. Am J Reprod Immunol 2020; 85:e13376. [PMID: 33166020 DOI: 10.1111/aji.13376] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/03/2020] [Revised: 07/12/2020] [Accepted: 10/28/2020] [Indexed: 01/05/2023] Open
Abstract
PROBLEM What are the pregnancy outcomes after the OPtimization of Thyroid function, Immunity, and Uterine Milieu (OPTIMUM) treatment strategy in patients with repeated implantation failure (RIF)? METHOD OF STUDY Infertile women with a history of RIF after more than three embryo transfer (ET) cycles underwent implantation testing, including a hysteroscopy, endometrial biopsy for CD138 immunostaining and bacterial culture, and serum 25-hydroxyvitamin D3 , interferon-γ-producing helper T (Th1) cell, IL-4-producing helper T (Th2) cell, thyroid-stimulating hormone, thyroid peroxidase antibody, and thrombophilia screening between April 2017 and August 2018. We treated chronic endometritis with antibiotics, aberrant high Th1/Th2 cell ratios with vitamin D and/or tacrolimus intake, overt/subclinical hypothyroidism with levothyroxine, and thrombophilia with low-dose aspirin. Of the 116 RIF women, 88 women with 133 ET cycles were recruited from a questionnaire-based survey regarding pregnancy outcomes. Fifty-nine consecutive RIF patients without the OPTIMUM treatment strategy were also recruited as a control. RESULTS The 116 women with RIF after the OPTIMUM treatment strategy were 38.3 ± 3.8 years old and had an implantation failure history over 5 (3-19) ET cycles. Implantation testing identified impaired intrauterine circumstances in 75 women (64.7%), an aberrant elevated Th1/Th2 cell ratio in 56 women (48.3%), and thyroid abnormalities in 33 women (28.4%). Cumulative ongoing pregnancy rates including spontaneous pregnancy in the patients aged < 40 and ≥ 40 years were 72.7% and 45.5% within two ET cycles, respectively. The pregnancy outcomes in the OPTIMUM group were significantly higher than those in the control. CONCLUSIONS The OPTIMUM treatment strategy improved pregnancy outcomes in patients with RIF.
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Affiliation(s)
- Keiji Kuroda
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan.,Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuko Matsumura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuko Ikemoto
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | | | | | | | - Koji Nakagawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Toyoyoshi Uchida
- Departments of Metabolism and Endocrinology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Asako Ochiai
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yoshiya Horimoto
- Departments of Human Pathology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsushi Arakawa
- Departments of Human Pathology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan.,Clinical Research and Trial Center, Juntendo University Hospital, Tokyo, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
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22
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Kuroda K, Horikawa T, Moriyama A, Nakao K, Juen H, Takamizawa S, Ojiro Y, Nakagawa K, Sugiyama R. Impact of chronic endometritis on endometrial receptivity analysis results and pregnancy outcomes. Immun Inflamm Dis 2020; 8:650-658. [PMID: 32969185 PMCID: PMC7654412 DOI: 10.1002/iid3.354] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/08/2020] [Accepted: 09/13/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the relationship between chronic endometritis (CE) and a personalized window of implantation (WOI), identified by results of endometrial receptivity analysis (ERA), and pregnancy outcomes following embryo transfer (ET) based on the ERA outcomes. METHODS The single-center, cross-sectional study was designed. The study population consisted of 101 infertile women who underwent endometrial sampling between June 2018 and February 2020. We recruited 88 patients who underwent ERA testing and immunohistochemistry of the plasma cell marker CD138 to diagnose CE within 3 months of testing. Subjects were divided into three groups as follows: 33 without CE (non-CE group); 19 with untreated CE at ERA testing (CE group); and 36 successfully treated for CE before ERA testing (cured-CE group). CE diagnosis was defined as ≥5 CD138-positive plasma cells per 10 random stromal areas at ×400 magnification. RESULTS In non-CE, CE, and cured-CE groups, the numbers of CD138-positive cells were 0.7 ± 1.0, 28.5 ± 30.4, and 1.3 ± 1.3, respectively (p < .001). The rates of "receptive" endometrium in non-CE and cured-CE groups were 57.6% (19 women) and 50.0% (18 women), respectively; however, in the CE group, this rate was significantly lower than the other two groups (p = .009) at only 15.8% (3 women). After CE were treated prior or posterior to the ERA test in cured-CE or CE groups, the clinical pregnancy rates at the first ET in non-CE, CE, and cured-CE groups were 77.8% (21/27 cycles), 22.2% (4/18 cycles), and 51.7% (15/29 cycles), respectively (p < 0.001). CONCLUSION CE had detrimental effects on the individual WOI, leading to embryo-endometrial asynchrony; therefore, diagnosis and treatment of CE should be done before ERA testing.
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Affiliation(s)
- Keiji Kuroda
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan.,Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takashi Horikawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Azusa Moriyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Kazuki Nakao
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Hiroyasu Juen
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Satoru Takamizawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Yuko Ojiro
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Koji Nakagawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
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23
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Kuroda K, Nagai S, Ikemoto Y, Matsumura Y, Ochiai A, Nojiri S, Itakura A, Sugiyama R. Incidences and risk factors of moderate-to-severe ovarian hyperstimulation syndrome and severe hemoperitoneum in 1,435,108 oocyte retrievals. Reprod Biomed Online 2020; 42:125-132. [PMID: 33051135 DOI: 10.1016/j.rbmo.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/28/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
RESEARCH QUESTION What are the risk factors affecting the incidences of moderate-to-severe ovarian hyperstimulation syndrome (OHSS) and severe hemoperitoneum in assisted reproductive technology (ART) treatment cycles? DESIGN A retrospective cohort study was conducted on 1,435,108 oocyte retrieval cycles among Japanese ART registry data between 2007 and 2015. The study included 11,378 cycles with moderate-to-severe OHSS, 1182 cycles with severe hemoperitoneum, including 27 cycles with both conditions, and 1,422,575 cycles without moderate-to-severe OHSS and severe hemoperitoneum. RESULTS The incidences of moderate-to-severe OHSS and severe hemoperitoneum were 0.79% and 0.08%, respectively, and decreased by 0.57-fold and 0.29-fold from 2007 to 2015, respectively. In cycles with OHSS and cycles with hemoperitoneum women were younger (odds ratios [OR] 0.91 and 0.95, respectively) and had more retrieved oocytes (OR 1.09 and 1.01, respectively) compared with cycles without both complications. The use of a gonadotrophin-releasing hormone (GnRH) agonist protocol for ovarian stimulation was the highest risk factor in cycles with OHSS and hemoperitoneum (OR 1.83 and 1.24, respectively), followed by GnRH antagonist protocol (reference), gonadotrophin with or without oral medicine (OR 0.45 and 0.56, respectively) and natural or oral medicine (OR 0.02 and 0.19, respectively). In fresh embryo transfer, clinical pregnancy was associated with an increased risk of OHSS and hemoperitoneum (OR 1.19 and 2.34, respectively). CONCLUSIONS The highest risk factors affecting OHSS and hemoperitoneum were the use of a GnRH agonist protocol and clinical pregnancy following fresh embryo transfer. The incidences of OHSS and hemoperitoneum have decreased yearly with a reduction of GnRH agonist use and fresh embryo transfer.
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Affiliation(s)
- Keiji Kuroda
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan; Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan.
| | - Saki Nagai
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Yuko Ikemoto
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Yuko Matsumura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Asako Ochiai
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo 113-8421, Japan; Clinical Research and Trial Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 116-0023, Japan
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24
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Yamashita S, Ikemoto Y, Ochiai A, Yamada S, Kato K, Ohno M, Segawa T, Nakaoka Y, Toya M, Kawachiya S, Sato Y, Takahashi T, Takeuchi S, Nomiyama M, Tabata C, Fujiwara T, Okamoto S, Kawamura T, Kawagoe J, Yamada M, Sato Y, Marumo G, Sugiyama R, Kuroda K. Analysis of 122 triplet and one quadruplet pregnancies after single embryo transfer in Japan. Reprod Biomed Online 2019; 40:374-380. [PMID: 32033910 DOI: 10.1016/j.rbmo.2019.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 07/06/2019] [Revised: 11/11/2019] [Accepted: 11/21/2019] [Indexed: 11/24/2022]
Abstract
RESEARCH QUESTION What is the prevalence of triplet and quadruplet pregnancies after single embryo transfer (SET) in Japan. DESIGN A retrospective observational study was conducted on 274,605 pregnancies after 937,848 SET cycles in registered assisted reproductive technology (ART) data from the Japanese ART national registry database between 2007 and 2014. A questionnaire survey of ART centres was also conducted. Data on pregnancies with embryo division into three or more after SET were analysed. RESULTS According to the Japanese ART national registry database, SET resulted in 109 triplet pregnancies (0.04% of pregnancies), and the questionnaire reports from 31 centres revealed 33 triplet and one quadruplet pregnancies. After exclusion of 20 duplicated cases, 122 triplet and one quadruplet pregnancies included 46 monochorionic (one gestational sac [37.4%]), 18 dichorionic (two gestational sacs [14.6%]) and 59 trichorionic pregnancies (three gestational sacs [48.0%]). Compared with singleton pregnancies, patients with monozygotic triplet or quadruplet pregnancies were less frequently diagnosed with unexplained infertility (P = 0.004), more often received gonadotrophin injections for ovarian stimulation in 39 cases with information available (P = 0.021) and underwent more blastocyst transfers and assisted hatching (P = 0.002 and P < 0.001, respectively). The proportion of live birth, defined as at least one baby born, excluding induced abortion, was 64.6% (73/116 pregnancies) of monozygotic triplet or quadruplet pregnancies. CONCLUSIONS Combined Japanese ART national registry and survey data revealed 122 triplet and one quadruplet pregnancies, the majority after cryopreserved embryo transfer. Most were conceived after blastocyst transfer and often after assisted hatching, which are potential risk factors for zygotic splitting.
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Affiliation(s)
- Satoko Yamashita
- Juntendo University Faculty of Medicine, Department of Obstetrics and Gynecology, Tokyo 113-8421, Japan; Oita University, Faculty of Medicine, Department of Obstetrics and Gynecology, Oita 879-5593, Japan
| | - Yuko Ikemoto
- Juntendo University Faculty of Medicine, Department of Obstetrics and Gynecology, Tokyo 113-8421, Japan
| | - Asako Ochiai
- Juntendo University Faculty of Medicine, Department of Obstetrics and Gynecology, Tokyo 113-8421, Japan
| | | | | | - Motoharu Ohno
- Juntendo University Faculty of Medicine, Department of Obstetrics and Gynecology, Tokyo 113-8421, Japan; Saint Mother Obstetrics and Gynecology Clinic, Institute for ART, Fukuoka 807-0825, Japan
| | | | | | | | | | | | - Toshifumi Takahashi
- Fukushima Medical University, Fukushima Medical Center for Children and Women, Fukushima 960-1295, Japan
| | - Shigeto Takeuchi
- ART Reproductive Medical Center, Saiseikai Matsusaka General Hospital, Mie 515-8557, Japan
| | - Mari Nomiyama
- Takagi Hospital, Department of Obstetrics and Gynecology, Fukuoka 831-0016, Japan
| | - Chisa Tabata
- Sanno Hospital, Center for Human Reproduction and Gynecologic Endoscopy, Tokyo 107-0052, Japan
| | - Toshihiro Fujiwara
- Sanno Hospital, Center for Human Reproduction and Gynecologic Endoscopy, Tokyo 107-0052, Japan; Phoenix ART Clinic, Tokyo 151-0051, Japan
| | | | | | - Jun Kawagoe
- Yamagata University Faculty of Medicine, Department of Obstetrics and Gynecology, Yamagata 990-9585, Japan
| | - Mitsutoshi Yamada
- Keio University School of Medicine, Department of Obstetrics and Gynecology, Tokyo 160-8582, Japan
| | - Yuichi Sato
- Tatedebari Sato Hospital, Obstetrics & Gynecology, Gunma 370-0836, Japan
| | - Genzo Marumo
- Marumo Ladies Clinic, Department of Obstetrics and Gynecology, Tokyo 106-6004, Japan
| | - Rikikazu Sugiyama
- Sugiyama Clinic Shinjuku, Center for Reproductive Medicine and Implantation Research, Tokyo 116-0023, Japan
| | - Keiji Kuroda
- Juntendo University Faculty of Medicine, Department of Obstetrics and Gynecology, Tokyo 113-8421, Japan; Sugiyama Clinic Shinjuku, Center for Reproductive Medicine and Implantation Research, Tokyo 116-0023, Japan.
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Kuroda K, Ikemoto Y, Ochiai A, Ozaki R, Matsumura Y, Nojiri S, Nakagawa K, Sugiyama R. Combination Treatment of Preoperative Embryo Cryopreservation and Endoscopic Surgery (Surgery-ART Hybrid Therapy) in Infertile Women with Diminished Ovarian Reserve and Uterine Myomas or Ovarian Endometriomas. J Minim Invasive Gynecol 2019; 26:1369-1375. [DOI: 10.1016/j.jmig.2019.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 11/15/2022]
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26
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Ochiai A, Kuroda K, Ikemoto Y, Ozaki R, Nakagawa K, Nojiri S, Takeda S, Sugiyama R. Influence of resveratrol supplementation on IVF–embryo transfer cycle outcomes. Reprod Biomed Online 2019; 39:205-210. [DOI: 10.1016/j.rbmo.2019.03.205] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/13/2019] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
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Nakagawa K, Kwak-Kim J, Hisano M, Kasahara Y, Kuroda K, Sugiyama R, Yamaguchi K. Obstetric and perinatal outcome of the women with repeated implantation failures or recurrent pregnancy losses who received pre- and post-conception tacrolimus treatment. Am J Reprod Immunol 2019; 82:e13142. [PMID: 31081959 DOI: 10.1111/aji.13142] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 02/04/2019] [Revised: 03/10/2019] [Accepted: 04/09/2019] [Indexed: 12/11/2022] Open
Abstract
PROBLEM Previously, we reported the clinical efficacy of tacrolimus in women with repeated implantation failures (RIF) of immune etiologies. Safety of tacrolimus in pregnant women has been reported in women with organ transplantations. However, the safety of tacrolimus for women with RIF undergoing assisted reproductive technology cycles and their babies has not been reported prior. METHOD OF STUDY This study is a prospective observational study of 109 women with RIF or recurrent pregnancy losses (RPL) who showed elevated peripheral blood Th1/Th2 (CD4+ IFN-γ+ /CD4+ IL-4+ ) cell ratios (≥10.3). All received tacrolimus before and during pregnancy (1-4 mg/d) and delivered a live-born infant(s). Blood concentrations of tacrolimus were measured. Neuromotor development of the babies was also evaluated. RESULTS Total 113 babies were born from 109 women, including four twin pregnancies. Nine pregnancies including four twins were delivered prematurely (8.3%). Two of 109 women showed obstetric complications, such as hypertensive disorder of pregnancy, and only one baby (0.9%) had a congenital abnormality. There were no differences in babies' birthweight, placental weight, and lymphocyte proportion (%) of the umbilical cord among the women with different tacrolimus dosing. Tacrolimus was detected in the maternal plasma, and its concentration did not significantly fluctuate during pregnancy while on daily administration regimen. Neuromotor development of the babies exposed to tacrolimus in utero was comparable with that of babies from the general population. CONCLUSION According to our data, tacrolimus treatment for women with RIF and RPL was not associated with obstetrical and perinatal complications. A large size study is needed to confirm this finding.
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Affiliation(s)
- Koji Nakagawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Joanne Kwak-Kim
- Reproductive Medicine and Immunology, Department of Obstetrics and Gynecology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, Illinois
| | - Michi Hisano
- Department of Maternal-Fetal Biology, National Center for Child Health and Development, Tokyo, Japan
| | | | - Keiji Kuroda
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo, Japan
| | - Koushi Yamaguchi
- Department of Maternal-Fetal Biology, National Center for Child Health and Development, Tokyo, Japan
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Abstract
A Rho-incompatible pregnancy induces anemia in the fetus and can ultimately lead to fetal hydrops and intrauterine fetal death. A patient who had experienced recurrent implantation failures following a first successful delivery finally succeeded in achieving a second pregnancy via the use of tacrolimus. The second pregnancy was Rho-incompatible. During the course of the pregnancy, the treatment with tacrolimus was continued because the patient's T helper type 1 (Th1) cell population remained at a high level following the achievement of pregnancy. The dose was increased during pregnancy because of the elevated Th1 cell count at 28-week gestation. Tacrolimus maintains a stable state of pregnancy while simultaneously suppressing the production of anti-D antibodies. Using tacrolimus, we succeeded in resolving the infertility and inhibition of antibody production in this case of an alloimmunized pregnancy.
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Affiliation(s)
- Koji Nakagawa
- Sugiyama Clinic, Center for Reproductive Medicine and Implantation Research, Shinjuku, Japan
| | - Satoru Funaki
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Michi Hisano
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Rikikazu Sugiyama
- Sugiyama Clinic, Center for Reproductive Medicine and Implantation Research, Shinjuku, Japan
| | - Koushi Yamaguchi
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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Nakagawa K, Kuroda K, Sugiyama R. Clinical strategies for ART treatment of infertile women with advanced maternal age. Reprod Med Biol 2019; 18:27-33. [PMID: 30814909 PMCID: PMC6378758 DOI: 10.1002/rmb2.12240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/08/2018] [Revised: 08/01/2018] [Accepted: 09/02/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND An ever-increasing number of women in our country with advanced maternal age are choosing to achieve pregnancy. This means effective strategies are needed for infertile patients. Questions arise, however, concerning the need for ovarian stimulation, and, if so, whether intracytoplasmic sperm injection (ICSI) is better than conventional insemination for those women who may have only one mature oocyte. METHODS We evaluated our data to answer these questions. Herein, we also introduce our strategy for patients who show unsynchronized follicular growth. MAIN FINDINGS Ovarian stimulation in ART treatment for patients with advanced maternal age has resulted in the achievement of higher pregnancy rates, and therefore, this form of stimulation is often selected. Based on our data, ICSI as an insemination procedure has not improved clinical pregnancy rates compared with conventional insemination and has actually decreased the clinical pregnancy rates. CONCLUSION In this article, we reviewed and compared the protocols and strategies that are available to increase the number of developed embryos for the patients with advanced maternal age. We hope that this review will be helpful for both patients and clinicians.
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Affiliation(s)
- Koji Nakagawa
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Keiji Kuroda
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation ResearchSugiyama Clinic ShinjukuTokyoJapan
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Ikemoto Y, Kuroda K, Nakagawa K, Ochiai A, Ozaki R, Murakami K, Jinushi M, Matsumoto A, Sugiyama R, Takeda S. Vitamin D Regulates Maternal T-Helper Cytokine Production in Infertile Women. Nutrients 2018; 10:nu10070902. [PMID: 30011861 PMCID: PMC6073370 DOI: 10.3390/nu10070902] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/02/2018] [Accepted: 07/10/2018] [Indexed: 12/31/2022] Open
Abstract
Vitamin D (VD) deficiency is associated with reproductive failure. However, the relationship between VD and maternal immunity remains unclear. We investigated the clinical efficacy of VD in maternal T-helper (Th) cytokines in 276 infertile women and examined for Th1 and Th2 cells based on the deficient, insufficient, and sufficient serum 25-hydroxyvitamin D3 (25[OH]VD) levels (<12, 12–30, and >30 ng/mL, respectively). Most infertile women had a low-level of VD (87.3%). Immunological tests of pre-/post-VD supplementation were performed in patients who were deficient and insufficient in VD. Of 23 patients, 11 (47.8%) exhibited sufficient VD levels after supplementation. Th1/Th2 cell ratio in patients with insufficient VD was significantly decreased after supplementation (p = 0.004). After supplementation, serum 25(OH)VD levels of the patients: 11 in the sufficient group showed significant decreases in Th1 cell level and Th1/Th2 cell ratio (p = 0.032 and 0.010, respectively), whereas no significant differences in Th1/Th2 cell ratio were recognized in the insufficient group. Furthermore, mid-luteal endometrial biopsies (n = 18) were processed for primary cultures and measured interferon [IFN]-γ and interleukin [IL]-4 in condition media. Decidualizing cultures with 1,25-dihydroxvitamin D3 (1,25[OH]2VD) decreased IFN-γ. Sufficient VD supplementation in women with insufficient VD may optimize maternal T-helper cytokines during pregnancy via rebalancing the Th1/Th2 cell ratio.
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Affiliation(s)
- Yuko Ikemoto
- Department of Obstetrics and Gynecology, Juntendo University, Faculty of Medicine, Tokyo 1138421, Japan.
| | - Keiji Kuroda
- Department of Obstetrics and Gynecology, Juntendo University, Faculty of Medicine, Tokyo 1138421, Japan.
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 1160023, Japan.
| | - Koji Nakagawa
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 1160023, Japan.
| | - Asako Ochiai
- Department of Obstetrics and Gynecology, Juntendo University, Faculty of Medicine, Tokyo 1138421, Japan.
| | - Rie Ozaki
- Department of Obstetrics and Gynecology, Juntendo University, Faculty of Medicine, Tokyo 1138421, Japan.
| | - Keisuke Murakami
- Department of Obstetrics and Gynecology, Juntendo University, Faculty of Medicine, Tokyo 1138421, Japan.
| | - Makoto Jinushi
- Department of Obstetrics and Gynecology, Juntendo University, Faculty of Medicine, Tokyo 1138421, Japan.
| | - Akemi Matsumoto
- Department of Obstetrics and Gynecology, Juntendo University, Faculty of Medicine, Tokyo 1138421, Japan.
| | - Rikikazu Sugiyama
- Center for Reproductive Medicine and Implantation Research, Sugiyama Clinic Shinjuku, Tokyo 1160023, Japan.
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University, Faculty of Medicine, Tokyo 1138421, Japan.
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Nakagawa K, Oba M, Ehara K, Ishigaki N, Ino N, Itakura A, Tsutsumi R, Nakao K, Ojiro Y, Sugiyama R. Clinical outcomes of assisted reproductive technology treatment by using a self-injection of recombinant human chorionic gonadotropin as the final maturation trigger. Reprod Med Biol 2018; 17:203-208. [PMID: 29692679 PMCID: PMC5902473 DOI: 10.1002/rmb2.12095] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 02/04/2018] [Indexed: 11/10/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of self-injections of the prefilled recombinant human chorionic gonadotropin (r-hCG) in a syringe in assisted reproductive technology (ART) treatment for the maturation trigger (MT), as compared to self-injections of conventional hCG and intranasal administration of gonadotropin-releasing hormone agonist (GnRH-a). Methods Between January and April, 2017, 396 patients who underwent oocyte retrieval were recruited. Of these, 396 patients were classified into three groups, according to the types of MT: (1) the urinary human chorionic gonadotropin (u-hCG) group that consisted of patients who had a self-injection of u-hCG (n = 127); (2) the GnRH-a group that received nasal administration of GnRH-a (n = 159); and (3) the r-hCG group that had a self-injection of r-hCG (n = 110). Several ART outcomes were evaluated. Results The mature oocyte retrieval rate was not different between the u-hCG, r-hCG, and GnRH-a groups and the fertilization and cleavage rates were similar between the three groups. The clinical pregnancy rates did not significantly differ between the GnRH-a group and the u-hCG group; however, it was significantly lower in the GnRH-a group, compared to the r-hCG group. No difference was observed in the incidence of moderate or more severe ovarian hyperstimulation syndrome among the three groups. Conclusion The self-injection of the prefilled r-hCG is a favorable MT for ART patients.
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Affiliation(s)
- Koji Nakagawa
- Division of Reproductive Medicine Sugiyama Clinic Tokyo Japan
| | - Midori Oba
- Division of Reproductive Medicine Sugiyama Clinic Tokyo Japan
| | - Kaori Ehara
- Division of Reproductive Medicine Sugiyama Clinic Tokyo Japan
| | - Nozomi Ishigaki
- Division of Reproductive Medicine Sugiyama Clinic Tokyo Japan
| | - Nao Ino
- Division of Reproductive Medicine Sugiyama Clinic Tokyo Japan
| | - Akiko Itakura
- Division of Reproductive Medicine Sugiyama Clinic Tokyo Japan
| | - Ryo Tsutsumi
- Division of Reproductive Medicine Sugiyama Clinic Tokyo Japan
| | - Katsuki Nakao
- Division of Reproductive Medicine Sugiyama Clinic Tokyo Japan
| | - Yuko Ojiro
- Division of Reproductive Medicine Sugiyama Clinic Tokyo Japan
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Kawai K, Harada T, Ishikawa T, Sugiyama R, Kawamura T, Yoshida A, Tsutsumi O, Ishino F, Kubota T, Kohda T. Parental age and gene expression profiles in individual human blastocysts. Sci Rep 2018; 8:2380. [PMID: 29402920 PMCID: PMC5799158 DOI: 10.1038/s41598-018-20614-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/22/2018] [Indexed: 11/19/2022] Open
Abstract
The epigenetic status of the genome changes dynamically from fertilization to implantation. In addition, the physiological environment during the process of gametogenesis, including parental age, may affect the epigenome of the embryo after fertilization. It is important to clarify the influence of parental age on gene expression in the embryo in terms of transgenerational epigenetics to improve the techniques currently used in assisted reproductive medicine. Here, we performed single-embryo RNA-seq analysis on human blastocysts fertilized by intracytoplasmic sperm injection, including from relatively elderly mothers, to elucidate the effects of parental age on the embryonic gene expression profile. We identified a number of genes in which the expression levels were decreased with increasing maternal age. Among these genes, several are considered to be important for meiotic chromosomal segregation, such as PTTG1, AURKC, SMC1B and MEIKIN. Furthermore, the expression levels of certain genes critical for autophagy and embryonic growth, specifically GABARAPL1 and GABARAPL3, were negatively correlated with advanced paternal age. In addition, levels of transcripts derived from major satellite repeats also decreased as the maternal age increased. These results suggest that epigenetic modifications of the oocyte genome may change with parental age and be transmitted to the next generation.
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Affiliation(s)
- Kiyotaka Kawai
- Department of Epigenetics, Medical Research Institute, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Department of Comprehensive Reproductive Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,AMED (Japan Agency for Medical Research and Development), Tokyo, Japan.,Department of Reproductive Medicine, Kameda Medical Center, Chiba, Japan
| | - Tatsuya Harada
- Department of Comprehensive Reproductive Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Department of Reproductive Medicine, Kameda IVF Clinic Makuhari, Chiba, Japan
| | - Tomonori Ishikawa
- Department of Comprehensive Reproductive Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,AMED (Japan Agency for Medical Research and Development), Tokyo, Japan
| | | | | | | | - Osamu Tsutsumi
- Sanno Hospital, Center for Human Reproduction and Gynecologic Endoscopy, Tokyo, Japan
| | - Fumitoshi Ishino
- Department of Epigenetics, Medical Research Institute, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Toshiro Kubota
- AMED (Japan Agency for Medical Research and Development), Tokyo, Japan.,Tokyo Kyosai Hospital, Tokyo, Japan
| | - Takashi Kohda
- Department of Epigenetics, Medical Research Institute, Tokyo Medical and Dental University (TMDU), Tokyo, Japan. .,AMED (Japan Agency for Medical Research and Development), Tokyo, Japan.
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Hobo R, Nakagawa K, Usui C, Sugiyama R, Ino N, Motoyama H, Kuribayashi Y, Inoue M, Sugiyama R. The Endometriosis Fertility Index Is Useful for Predicting the Ability to Conceive without Assisted Reproductive Technology Treatment after Laparoscopic Surgery, Regardless of Endometriosis. Gynecol Obstet Invest 2017; 83:493-498. [DOI: 10.1159/000480454] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/17/2017] [Indexed: 11/19/2022]
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Kuribayashi Y, Nakagawa K, Sugiyama R, Motoyama H, Sugiyama R. Frequency of endometrial cancer and atypical hyperplasia in infertile women undergoing hysteroscopic polypectomy. J Obstet Gynaecol Res 2017; 43:1465-1471. [DOI: 10.1111/jog.13408] [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] [Received: 01/10/2017] [Revised: 04/12/2017] [Accepted: 05/01/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Koji Nakagawa
- Division of Reproductive Medicine; Sugiyama Clinic; Tokyo Japan
| | - Rie Sugiyama
- Reproductive Medicine and Surgery; Sugiyama Clinic Marunouchi; Tokyo Japan
| | - Hiroshi Motoyama
- Reproductive Medicine and Surgery; Sugiyama Clinic Marunouchi; Tokyo Japan
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Nakagawa K, Kuroda K, Sugiyama R, Yamaguchi K. After 12 consecutive miscarriages, a patient received immunosuppressive treatment and delivered an intact baby. Reprod Med Biol 2017; 16:297-301. [PMID: 29259481 PMCID: PMC5715883 DOI: 10.1002/rmb2.12040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 05/07/2017] [Indexed: 11/17/2022] Open
Abstract
Aim An immune etiology for idiopathic recurrent miscarriage is an important issue because a fetus is allogenetically different from the mother. Type 1 T helper (Th1) and Type 2 (Th2) cells have important functions in immune responses and there is a general agreement that pregnancy is associated with Th2 cell dominance. The purpose of this case report is to establish the effectiveness of an immunosuppressive treatment for a patient who had 11 consecutive miscarriages despite several treatments, such as anticoagulation, that showed elevated Th1/Th2 cell ratios. Methods This patient visited our clinic following 11 consecutive miscarriages between 2009 and 2014 that occurred between 5 and 8 weeks’ gestation. The Th1/Th2 cell ratio was evaluated after the 12th conception and she received an immunosuppressive treatment (tacrolimus; 1 mg/d). Results The Th1/Th2 cell ratio was elevated after the 12th conception, but the patient miscarried, with a normal karyotype of chorionic villi despite the immunosuppressive treatment. After the 13th conception, she began receiving treatment with 2 mg/d of tacrolimus at 4 weeks’ gestation, which was continued until delivery. Conclusion For recurrent miscarriage cases that show an elevated Th1/Th2 cell ratio after achieving pregnancy, immunosuppressive treatment with tacrolimus could be effective.
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Affiliation(s)
- Koji Nakagawa
- Division of Reproductive Medicine Sugiyama Clinic Tokyo Japan
| | - Keiji Kuroda
- Department of Obstetrics and Gynecology Faculty of Medicine Juntendo University Tokyo Japan
| | | | - Koushi Yamaguchi
- Department of Maternal-Fetal Biology National Center for Child Health and Development Tokyo Japan
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Nakagawa K, Kwak-Kim J, Kuroda K, Sugiyama R, Yamaguchi K. Immunosuppressive treatment using tacrolimus promotes pregnancy outcome in infertile women with repeated implantation failures. Am J Reprod Immunol 2017; 78. [PMID: 28466977 DOI: 10.1111/aji.12682] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 12/28/2016] [Accepted: 03/05/2017] [Indexed: 01/19/2023] Open
Abstract
PROBLEM We aim to investigate whether the peripheral blood T helper (Th) 1 cell level could predict pregnancy outcome in patients who have experienced repeated implantation failure (RIF, three or more) after ART cycles. METHOD OF STUDY This is a prospective cohort study of total 124 women with RIF who showed elevated Th1/Th2 (CD4+ IFN-γ+ /CD4+ IL-4+ ) cell ratios (≥10.3) and received tacrolimus at Sugiyama Clinic between November 2011 and July 2016. Patients were divided into three groups as per Th1 cell levels: Th1 level of <22.8 as Low; 22.8 to <28.8 as Middle, and 28.8 or greater as High group. The study patients received daily dose of tacrolimus 1-3 mg based on initial Th1/Th2 cell ratio. RESULTS The clinical pregnancy rates of Low, Middle, and High groups were 48.8%, 43.9%, and 33.3%, respectively (P=NS), with tacrolimus treatment. The ongoing pregnancy/delivery rate of Low group (46.3%) was significantly higher than that of High group (21.4%, P<.05). Middle group (34.3%) had higher success rate than High group, albeit without statistical significant. CONCLUSION We confirm our previous report that Th1/Th2 ratio can predict ART outcomes in patients with RIF and immunosuppressant treatment with tacrolimus, and peripheral blood Th1 cell levels were negatively correlated with pregnancy outcome.
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Affiliation(s)
- Koji Nakagawa
- Division of Reproductive Medicine, Sugiyama Clinic, Tokyo, Japan
| | - Joanne Kwak-Kim
- Reproductive Medicine, Department of Obstetrics and Gynecology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA
| | - Keiji Kuroda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | | | - Koushi Yamaguchi
- Department of Maternal-Fetal Biology, National Center for Child Health and Development, Tokyo, Japan
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Nakagawa K, Hisano M, Sugiyama R, Yamaguchi K. Measurement of oxidative stress in the follicular fluid of infertility patients with an endometrioma. Arch Gynecol Obstet 2015; 293:197-202. [PMID: 26246415 DOI: 10.1007/s00404-015-3834-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 03/29/2015] [Accepted: 07/27/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Follicular fluid (FF) might reflect the environment during follicle and oocyte growth, and an evaluation of oxidative stress in the FF might be useful in predicting oocyte quality. In order to measure the oxidative stress (OS) in the FF from a single follicle of patients with endometrioma (EM), we evaluated whether an EM might affect the environment of follicular growth. METHODS Between December 2011 and July 2013, 26 patients with a unilateral EM (EM group) and 29 without EM (control group) were enrolled in this study. The FF was obtained during the first puncture of follicular aspiration, and was stored at -30 °C until it was assayed. A Free Radical Elective Evaluator (WISMERLL, USA) was used to perform d-ROM and BAP tests to measure oxidative stress (U.CARR) and antioxidant power (μmol/L). RESULTS The d-ROM values in the EMC and control groups were 328.7 ± 97.8 and 414.9 ± 84.2, respectively, and the BAP values for the two groups were 2474.3 ± 432.0 and 2552.8 ± 435.58, respectively. These values were similar between the two groups (mean ± SD). The number of patients with a modified BAP/d-ROM ratio of <1.0 in the EM group was similar to that for the control group at 16 and 15, respectively (61.5 and 51.7 %). CONCLUSIONS The oxidative stress and antioxidant potential in the FF of the patients with unilateral EM showed values similar to those without an EM. Therefore, we concluded that EMs do not affect the environment for follicle growth during ART treatment.
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Affiliation(s)
- Koji Nakagawa
- Division of Reproductive Medicine, Sugiyama Clinic, 1-53-1, Ohara, Setagaya, Tokyo, 156-0041, Japan.
| | - Michi Hisano
- Department of Maternal-Fetal Biology, National Center for Child Health and Development, Tokyo, Japan
| | - Rikikazu Sugiyama
- Division of Reproductive Medicine, Sugiyama Clinic, 1-53-1, Ohara, Setagaya, Tokyo, 156-0041, Japan
| | - Koushi Yamaguchi
- Department of Maternal-Fetal Biology, National Center for Child Health and Development, Tokyo, Japan
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Nakagawa K, Nishi Y, Kaneyama M, Sugiyama R, Motoyama H, Sugiyama R. The Effect of a Newly Designed Needle on the Pain and Bleeding of Patients During Oocyte Retrieval of a Single Follicle. J Reprod Infertil 2015; 16:207-11. [PMID: 27110519 PMCID: PMC4819210] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of needle type on pain and bleeding during oocyte pick-up (OPU). METHODS From May through November 2013, patients undergoing OPU from a single follicle without any analgesic treatment were including this study. Eligible patients (n=75) were randomized 1:1 to undergo the procedure with either a reduced needle (17 gauge body, 20 gauge tip; RN group) or a standard needle (19 gauge; SN group). Overall pain was assessed by patients using a visual analogue scale (VAS), and vaginal bleeding after the procedure was recorded. Fisher exact, t-test or Wilcoxon test were used, and p<0.05 was considered to be statistically significant. RESULTS The percentage of mature oocytes was 86.5% in the RN group and 91.7% in the SN group. Pain during OPU was significantly lower in the RN group than in the SN group (mean VAS score±SD: 3.2±2.0 cm vs. 4.9±2.2 cm, p<0.01; mean±SD). The frequency of vaginal bleeding was also significantly lower in the SN group (26.3% vs. 48.6%; p<0.05). The frequency of bleeding in the RN group was also significantly lower than that in the SN group (26.3% vs. 48.6%; p<0.05). No significant differences were found between the two groups with regard to fertilization and pregnancy rates. CONCLUSION The newly designed needle significantly reduced pain and vaginal bleeding associated with single-follicle OPU in patients receiving no analgesic treatment, in comparison with a standard needle. The RN had no adverse effect on the quality of retrieved oocytes.
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Affiliation(s)
- Koji Nakagawa
- Division of Reproductive Medicine, Sugiyama Clinic, Tokyo, Japan,Corresponding Author: Koji Nakagawa, Division of Reproductive Medicine, Sugiyama Clinic, 1-53-1, Ohara, Setagaya, Tokyo, 156-0041, Japan, E-mail:
| | - Yayoi Nishi
- Division of Reproductive Medicine, Sugiyama Clinic, Tokyo, Japan
| | - Masayo Kaneyama
- Division of Reproductive Medicine, Sugiyama Clinic, Tokyo, Japan
| | - Rie Sugiyama
- Center for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi, Tokyo, Japan
| | - Hiroshi Motoyama
- Center for Reproductive Medicine and Endoscopy, Sugiyama Clinic Marunouchi, Tokyo, Japan
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Nakagawa K, Kwak-Kim J, Ota K, Kuroda K, Hisano M, Sugiyama R, Yamaguchi K. Immunosuppression with Tacrolimus Improved Reproductive Outcome of Women with Repeated Implantation Failure and Elevated Peripheral Blood Th1/Th2 Cell Ratios. Am J Reprod Immunol 2014; 73:353-61. [DOI: 10.1111/aji.12338] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/03/2014] [Indexed: 11/26/2022] Open
Affiliation(s)
- Koji Nakagawa
- Division of Reproductive Medicine; Sugiyama Clinic; Tokyo Japan
| | - Joanne Kwak-Kim
- Reproductive Medicine; Department of Obstetrics and Gynecology; Chicago Medical School at Rosalind Franklin University of Medicine and Science; Vernon Hills IL USA
| | - Kuniaki Ota
- Department of Obstetrics and Gynecology; Keio University; Tokyo Japan
| | - Keiji Kuroda
- Department of Obstetrics and Gynecology; Faculty of Medicine; Juntendo University; Tokyo Japan
| | - Michi Hisano
- Department of Maternal-Fetal Biology; National Center for Child Health and Development; Tokyo Japan
| | | | - Koushi Yamaguchi
- Department of Maternal-Fetal Biology; National Center for Child Health and Development; Tokyo Japan
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Nakagawa K, Kaneyama M, Nishi Y, Sugiyama R, Motoyama H, Sugiyama R. Clomiphene citrate affects the receptivity of the uterine endometrium. Reprod Med Biol 2014; 14:73-78. [PMID: 29259405 DOI: 10.1007/s12522-014-0195-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 05/09/2014] [Accepted: 09/21/2014] [Indexed: 11/26/2022] Open
Abstract
Purpose To investigate whether clomiphene citrate (CC) affects uterine receptivity or not, we evaluated pregnancy rates (PR) during the hormone replacement cycle (HRC) according to the period between the last day of CC administration and the day of embryo transfer (ET). Methods From March 2008 through March 2010, a total of 378 treatment cycles among 378 patients who received CC and had to avoid fresh ET due to a thin uterine endometrium were recruited. All patients underwent thawed ET using HRC. PRs were evaluated according to the period between the last CC treatment and the day of ET. Results PR for the groups in which the period between the last CC treatment and the day of ET increased to more than 91 days were significantly higher than that for group in which the period was less than 90 days (p < 0.05). Conclusions A lower PR was shown by the patients who underwent thawed ET in the HRC within 90 days after their last CC treatment, which shows that CC affects the receptivity of the uterine endometrium.
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Affiliation(s)
- Koji Nakagawa
- Division of Reproductive Medicine Sugiyama Clinic 1-53-1, Ohara 156-0041 Tokyo Setagaya Japan
| | - Masayo Kaneyama
- Division of Reproductive Medicine Sugiyama Clinic 1-53-1, Ohara 156-0041 Tokyo Setagaya Japan
| | - Yayoi Nishi
- Division of Reproductive Medicine Sugiyama Clinic 1-53-1, Ohara 156-0041 Tokyo Setagaya Japan
| | - Rie Sugiyama
- Center for Reproductive Medicine and Endoscopy Sugiyama Clinic Tokyo Marunouchi Japan
| | - Hiroshi Motoyama
- Center for Reproductive Medicine and Endoscopy Sugiyama Clinic Tokyo Marunouchi Japan
| | - Rikikazu Sugiyama
- Division of Reproductive Medicine Sugiyama Clinic 1-53-1, Ohara 156-0041 Tokyo Setagaya Japan
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Nakagawa K, Juen H, Nishi Y, Sugiyama R, Motoyama H, Kuribayashi Y, Inoue M, Akira S, Sugiyama R. Advanced scheduling for zygote intrafallopian transfer is possible via the use of a hormone replacement cycle for patients who have experienced repeated implantation failures. Arch Gynecol Obstet 2014; 290:1031-5. [PMID: 24966120 DOI: 10.1007/s00404-014-3324-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 06/16/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Zygote intrafallopian transfer (ZIFT) is an effective option for patients who have experienced repeated implantation failures (RIF) in assisted reproductive technology (ART) treatment. However, advance planning for the day of the operation can be problematic. Using a hormone replacement cycle (HRC) makes it possible to plan for the day of ZIFT. In the present study, we evaluated whether HRC-ZIFT is useful for RIF patients who have experienced difficulties obtaining morphologically good embryos in vitro. METHODS A total of 55 patients with a history of five or more unsuccessful transfers received HRC-ZIFT between June 2008 and June 2013. The oocyte pick-ups were performed and the oocytes showing two pronuclei (2PN) were cryopreserved. After receiving more than five 2PN oocytes, the operation day was scheduled in advance, and as a consequence, a HRC was started and ZIFT was performed. The clinical outcomes were evaluated. RESULTS The average age of the patients was 39.3 years, and the previous OPU and ET attempts numbered 7.5 and 6.9, respectively. The number of previously transferred embryos was 11.8, and the number of morphologically good embryos (MGEs) was only 1.2. The number of transferred 2PN oocytes was 6.7, and the subsequent pregnancy rate was 23.6 %. No ectopic or multiple pregnancies were observed, but there were 6 cases of miscarriage. CONCLUSION Among RIF patients, in particular those who have difficulty obtaining MGEs in vitro, ZIFT might be a useful option. The HRC allows patients and medical staff to plan for the operation day in advance.
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Affiliation(s)
- Koji Nakagawa
- Division of Reproductive Medicine, Sugiyama Clinic, 1-53-1, Ohara, Setagaya-ku, Tokyo, 156-0041, Japan,
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Nakagawa K, Ojiro Y, Jyuen H, Nishi Y, Sugiyama R, Kuribayashi Y, Sugiyama R. Prostaglandin therapy during the proliferative phase improves pregnancy rates following frozen embryo transfer in a hormone replacement cycle. J Obstet Gynaecol Res 2014; 40:1331-7. [DOI: 10.1111/jog.12328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 10/11/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Koji Nakagawa
- Division of Reproductive Medicine; Sugiyama Clinic; Tokyo Japan
| | - Yuko Ojiro
- Division of Reproductive Medicine; Sugiyama Clinic; Tokyo Japan
| | - Hiroyasu Jyuen
- Division of Reproductive Medicine; Sugiyama Clinic; Tokyo Japan
| | - Yayoi Nishi
- Division of Reproductive Medicine; Sugiyama Clinic; Tokyo Japan
| | - Rie Sugiyama
- Center for Reproductive Medicine and Endoscopy; Sugiyama Clinic Marunouchi; Tokyo Japan
| | - Yasushi Kuribayashi
- Center for Reproductive Medicine and Endoscopy; Sugiyama Clinic Marunouchi; Tokyo Japan
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Tan CW, Lee YH, Choolani M, Tan HH, Griffith L, Chan J, Chuang PC, Wu MH, Lin YJ, Tsai SJ, Rahmati M, Petitbarat M, Dubanchet S, Bensussan A, Chaouat G, Ledee N, Bissonnette L, Haouzi D, Monzo C, Traver S, Bringer S, Faidherbe J, Perrochia H, Ait-Ahmed O, Dechaud H, Hamamah S, Ibrahim MG, de Arellano MLB, Sachtleben M, Chiantera V, Frangini S, Younes S, Schneider A, Plendl J, Mechsner S, Ono M, Hamai H, Chikawa A, Teramura S, Takata R, Sugimoto T, Iwahashi K, Ohhama N, Nakahira R, Shigeta M, Park IH, Lee KH, Sun HG, Kim SG, Lee JH, Kim YY, Kim HJ, Jeon GH, Kim CM, Bocca S, Wang H, Anderson S, Yu L, Horcajadas J, Oehninger S, Bastu E, Mutlu MF, Celik C, Yasa C, Dural O, Buyru F, Quintana F, Cobo A, Remohi J, Ferrando M, Matorras R, Bermejo A, Iglesias C, Cerrillo M, Ruiz M, Blesa D, Simon C, Garcia-Velasco JA, Chamie L, Ribeiro DMF, Riboldi M, Pereira R, Rosa MB, Gomes C, de Mello PH, Fettback P, Domingues T, Cambiaghi A, Soares ACP, Kimati C, Motta ELA, Serafini P, Hapangama DK, Valentijn AJ, Al-Lamee H, Palial K, Drury JA, von Zglinicki T, Saretzki G, Gargett CE, Liao CY, Lee KH, Sung YJ, Li HY, Morotti M, Remorgida V, Venturini PL, Ferrero S, Nabeta M, Iki A, Hashimoto H, Koizumi M, Matsubara Y, Hamada K, Fujioka T, Matsubara K, Kusanagi Y, Nawa A, Zanatta A, Riboldi M, da Rocha AM, Guerra JL, Cogliati B, Pereira R, Motta ELA, Serafini P, Bianchi PDM, Zanatta A, Riboldi M, da Rocha AM, Cogliati B, Guerra JL, Pereira R, Motta ELA, Serafini P, Prieto B, Exposito A, Mendoza R, Rabanal A, Matorras R, Bedaiwy M, Yi L, Dahoud W, Liu J, Hurd W, Falcone T, Biscotti C, Mesiano S, Sugiyama R, Nakagawa K, Nishi Y, Kuribayashi Y, Akira S, Germeyer A, Rosner S, Jauckus J, Strowitzki T, von Wolff M, Khan KN, Kitajima M, Fujishita A, Nakashima M, Masuzaki H, Kajihara T, Ishihara O, Brosens J, Ledee N, Petitbarat M, Rahmati M, Vezmar K, Savournin V, Dubanchet S, Chaouat G, Balet R, Bensussan A, Chaouat G, Lee YH, Loh SF, Tannenbaum SR, Chan JKY, Scarella A, Chamy V, Devoto L, Abrao M, Sovino H, Krasnopolskaya K, Popov A, Kabanova D, Beketova A, Ivakhnenko V, Shohayeb A, Wahba A, Abousetta A, al-inany H, Wahba A, El Daly A, Zayed M, Kvaskoff M, Han J, Missmer SA, Navarro P, Meola J, Ribas CP, Paz CP, Ferriani RA, Donabela FC, Tafi E, Maggiore ULR, Scala C, Remorgida V, Venturini PL, Ferrero S, Hackl J, Strehl J, Wachter D, Dittrich R, Cupisti S, Hildebrandt T, Lotz L, Attig M, Hoffmann I, Renner S, Hartmann A, Beckmann MW, Urquiza F, Ferrer C, Incera E, Azpiroz A, Junovich G, Pappalardo C, Guerrero G, Pasqualini S, Gutierrez G, Corti L, Sanchez AM, Bordignon PP, Santambrogio P, Levi S, Persico P, Vigano P, Papaleo E, Ferrari S, Candiani M, van der Houwen LEE, Schreurs AMF, Lambalk CB, Schats R, Hompes PGA, Mijatovic V, Xu SY, Li J, Chen XY, Chen SQ, Guo LY, Mathew D, Nunes Q, Lane B, Fernig D, Hapangama D, Lind T, Hammarstrom M, Golmann D, Rodriguez-Wallberg K, Hestiantoro A, Cakra A, Aulia A, Al-Inany H, Houston B, Farquhar C, Abousetta A, Tagliaferri V, Gagliano D, Immediata V, Tartaglia C, Zumpano A, Campagna G, Lanzone A, Guido M, Matsuzaki S, Darcha C, Botchorishvili R, Pouly JL, Mage G, Canis M, Shivhare SB, Bulmer JN, Innes BA, Hapangama DK, Lash GE, de Graaff AA, Zandstra H, Smits LJ, Van Beek JJ, Dunselman GAJ, Bozdag G, Calis PT, Demiralp DO, Ayhan B, Igci N, Yarali H, Acar N, Er H, Ozmen A, Ustunel I, Korgun ET, Kuroda K, Kuroda M, Arakawa A, Kitade M, Brosens AI, Brosens JJ, Takeda S, Yao T. Endometriosis, endometrium, implantation and fallopian tube. Hum Reprod 2013. [DOI: 10.1093/humrep/det211] [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: 10/26/2022] Open
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Nakagawa K, Nishi Y, Sugiyama R, Kuribayashi Y, Akira S, Sugiyama R, Inoue M. Role of salpingoscopy in assessing the inner fallopian tubes of infertility patients with ovarian endometriomas. J Obstet Gynaecol Res 2013; 39:979-84. [PMID: 23551876 DOI: 10.1111/jog.12033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 11/08/2012] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to observe the insides of the fallopian tubes of patients with unilateral or bilateral endometriomas by using salpingoscopy and evaluate the inner cavity of the fallopian tubes according to our original scoring system. MATERIAL AND METHODS From April 2008 through December 2010, patients with unilateral or bilateral endometriomas were recruited (n = 157, endometrioma group). All patients underwent laparoscopic ovarian cystectomy and salpingoscopy. Using salpingoscopy, we observed the tubal lumen and calculated a fallopian tube score (F score) paying attention to the following six results: adhesions, loss of mucosal folds, rounded edges of mucosal folds, debris, foreign bodies, and abnormal vessels. The F scores were compared with those of the unexplained infertility patients who received those same procedures during the same period (n = 235; control group). RESULTS Slightly more than three-quarters (75.9%) of the patients in the endometrioma group received F scores of 0, and this percentage was significantly higher than that for the control group (139/235 = 59.1%, P < 0.05). The pregnancy rate after conventional treatment for the endometrioma group was 21.7%, and all pregnant patients had achieved an F score of less than 2. CONCLUSION It is highly possible that infertility patients with ovarian endometriomas are more likely to have intact fallopian tubes, by comparison with infertility patients who do not have ovarian endometriomas.
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Affiliation(s)
- Koji Nakagawa
- Division of Reproductive Medicine, Sugiyama Clinic, Tokyo, Japan.
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Ando K, Fujiya M, Ito T, Sugiyama R, Nata T, Nomura Y, Ueno N, Kashima S, Ishikawa C, Inaba Y, Moriichi K, Okamoto K, Ikuta K, Tanabe H, Tokusashi Y, Miyokawa N, Watari J, Mizukami Y, Kohgo Y. A pseudosarcomatous lesion resembling a malignant tumor of the esophagocardiac junction, diagnosed by a total biopsy with endoscopic surgery. Endoscopy 2012; 44 Suppl 2 UCTN:E21-2. [PMID: 22396258 DOI: 10.1055/s-0031-1291502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- K Ando
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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Nakagawa K, Nishi Y, Sugiyama R, Jyuen H, Takahashi C, Ojiro Y, Kuribayashi Y, Sugiyama R. A programmed schedule of oocyte retrieval using mild ovarian stimulation (clomiphene citrate and recombinant follicle-stimulating hormone). Reprod Med Biol 2012; 11:85-89. [PMID: 29699111 PMCID: PMC5906904 DOI: 10.1007/s12522-011-0110-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [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: 05/30/2011] [Accepted: 08/30/2011] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose was to establish a mild ovarian stimulation protocol that would help assisted reproductive technology (ART) units to avoid scheduling on weekends. METHODS This protocol directed patients to take 50 mg/day of clomiphene citrate between days 3 and 7 of the menstrual cycle: 225 IU of recombinant follicle-stimulating hormone (rec-FSH) were administered on days 3, 5 and 7; human chorionic gonadotropin (hCG) was administered on day 9; and, oocyte pick-up (OPU) was planned for day 11. From October 2008 through October 2009, 514 women underwent ART treatment with mild stimulation at the Sugiyama Clinic, and we evaluated whether OPU was accomplished on the planned day. RESULTS Of all the treatment cycles, 419 (81.5%) underwent OPU on day 11 (scheduled group). Additional rec-FSH administration was needed in 83 cycles, in which case OPU was performed on day 12 or later. In 12 cycles, OPU was canceled. The unscheduled group (n = 95) consisted of delayed OPU cycles and canceled cycles. Of all treatment cycles, 332 cycles in the scheduled group and 68 cycles in the unscheduled group underwent embryo transfer, with 81 and 16, respectively, resulting in pregnancies. CONCLUSIONS Using this protocol, OPU was performed on the scheduled day in about 80% of the cycles. Most weekend scheduling of OPU can be avoided using this mild stimulation.
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Affiliation(s)
- Koji Nakagawa
- Division of Reproductive MedicineSugiyama Clinic1‐53‐1, Ohara, Setagaya156‐0041TokyoJapan
| | - Yayoi Nishi
- Division of Reproductive MedicineSugiyama Clinic1‐53‐1, Ohara, Setagaya156‐0041TokyoJapan
| | - Rie Sugiyama
- Division of Reproductive MedicineSugiyama Clinic1‐53‐1, Ohara, Setagaya156‐0041TokyoJapan
| | - Hiroyasu Jyuen
- Division of Reproductive MedicineSugiyama Clinic1‐53‐1, Ohara, Setagaya156‐0041TokyoJapan
| | - Chie Takahashi
- Division of Reproductive MedicineSugiyama Clinic1‐53‐1, Ohara, Setagaya156‐0041TokyoJapan
| | - Yuko Ojiro
- Division of Reproductive MedicineSugiyama Clinic1‐53‐1, Ohara, Setagaya156‐0041TokyoJapan
| | - Yasushi Kuribayashi
- Division of Reproductive MedicineSugiyama Clinic1‐53‐1, Ohara, Setagaya156‐0041TokyoJapan
| | - Rikikazu Sugiyama
- Division of Reproductive MedicineSugiyama Clinic1‐53‐1, Ohara, Setagaya156‐0041TokyoJapan
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Panagiotidis Y, Kasapi E, Goudakou M, Papatheodorou A, Pasadaki T, Petousis S, Nikolettos N, Maroulis G, Vanderzwalmen P, Prapas Y, Desai N, Goldberg J, Austin C, Falcone T, Nakagawa K, Ojiro Y, Takahashi C, Sugiyama R, Juen H, Nishi Y, Yoneda Y, Shirai A, Sugiyama R, Force A, Schubert B, Chomier M, Sergeant P, Lescaille M, Rochigneux S, Chassagnard F, Rollet J, Robert F, Baucher S, Sergeant MV, Ginon J, Rodrigue M, Nicollet B, Barblett H, Mehmet D, Rebollar-Lazaro I, Turner S. SESSION 43: EMBRYOLOGY - EMBRYO CRYOPRESERVATION. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sato R, Fujiya M, Watari J, Ueno N, Moriichi K, Kashima S, Maeda S, Ando K, Kawabata H, Sugiyama R, Nomura Y, Nata T, Itabashi K, Inaba Y, Okamoto K, Mizukami Y, Saitoh Y, Kohgo Y. The diagnostic accuracy of high-resolution endoscopy, autofluorescence imaging and narrow-band imaging for differentially diagnosing colon adenoma. Endoscopy 2011; 43:862-8. [PMID: 21732270 DOI: 10.1055/s-0030-1256510] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND STUDY AIMS Conventional colonoscopy can result in unnecessary biopsy or endoscopic resection due to its inability to distinguish adenomas from hyperplastic polyps. This study therefore evaluated the efficacy of high-resolution endoscopy (HRE), autofluorescence imaging (AFI), and narrow-band imaging (NBI) in discriminating colon adenoma from hyperplastic polyps. PATIENTS AND METHODS This was a prospective multicenter study in patients undergoing AFI and NBI examinations. HRE, AFI, and NBI images were classified into two groups based on morphological characteristics, the predominant color intensities, and the visibility of meshed capillary vessels, respectively. Each of the endoscopic photographs were independently evaluated by a single endoscopist. The images were then assessed by three specialists and three residents, the latter having performed < 500 colonoscopies and < 30 NBI and AFI examinations. Diagnostic test statistics were calculated to compare the accuracy in differentiating colon adenoma from hyperplastic polyps for each method. RESULTS A total of 183 patients were enrolled in the study and 339 adenomas and 85 hyperplastic polyps were identified. AFI and NBI could distinguish adenoma from hyperplastic polyps with an accuracy of 84.9 % and 88.4 %, respectively, whereas HRE exhibited an accuracy of 75.9 %. In the 358 lesions in which the AFI diagnosis was consistent with that of NBI, the accuracy, sensitivity, and specificity were high, at 91.9 %, 92.7 %, and 92.9 %, respectively. During the study comparing specialists and residents, AFI and NBI dramatically improved the diagnostic accuracy of residents from 69.1 % to 86.1 % and 84.7 %, respectively. CONCLUSIONS Both AFI and NBI are considered to be feasible tools that can discriminate colon adenoma from hyperplastic polyps, and their use may be particularly beneficial for less-experienced endoscopists.
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Affiliation(s)
- R Sato
- Internal Medicine, Engaru-Kosei General Hospital, Asahikawa, Japan
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Johannesson L, Enskog A, Dahm-Kahler P, Diaz-Garcia C, Tzakis A, Olausson M, Brannstrom M, Zavos A, Polyzos NP, Dragamestianos C, Blockeel C, Papanikolaou EG, Stoop D, De Vos M, Tournaye H, Devroey P, Messinis IE, Leonardi M, Benaglia L, Somigliana E, De Benedictis S, Scarduelli C, Ragni G, Sugiyama R, Nakagawa K, Nishi Y, Jyuen H, Kuribayashi Y, Sugiyama R, Inoue M, Motoyama K, Akira S, Diaz-Garcia C, Akhi SN, Brannstrom M. SELECTED ORAL COMMUNICATION SESSION, SESSION 44: SURGERY, Tuesday 5 July 2011 15:15 - 16:30. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fourati Ben Mustapha S, Khrouf M, Kacem Ben Rejeb K, Elloumi Chaabene H, Merdassi G, Wahbi D, Ben Meftah M, Zhioua F, Zhioua A, Azzarello A, Host T, Mikkelsen AL, Theofanakis CP, Dinopoulou V, Mavrogianni D, Partsinevelos GA, Drakakis P, Stefanidis K, Bletsa A, Loutradis D, Rienzi L, Cobo A, Paffoni A, Scarduelli C, Capalbo A, Garrido N, Remohi J, Ragni G, Ubaldi FM, Herrer R, Quera M, GIL E, Serna J, Grondahl ML, Bogstad J, Agerholm IE, Lemmen JG, Bentin-Ley U, Lundstrom P, Kesmodel US, Raaschou-Jensen M, Ladelund S, Guzman L, Ortega C, Albuz FK, Gilchrist RB, Devroey P, Smitz J, De Vos M, Bielanska M, Leveille MC, Borghi E, Magli MC, Figueroa MJ, Mascaretti G, Ferraretti AP, Gianaroli L, Szlit E, Leocata Nieto F, Maggiotto G, Arenas G, Tarducci Bonfiglio N, Ahumada A, Asch R, Sciorio R, Dayoub N, Thong J, Pickering S, Ten J, Carracedo MA, Guerrero J, Rodriguez-Arnedo A, Llacer J, Bernabeu R, Tatone C, Heizenrieder T, Di Emidio G, Treffon P, Seidel T, Eichenlaub-Ritter U, Cortezzi SS, Cabral EC, Ferreira CR, Trevisan MG, Figueira RCS, Braga DPAF, Eberlin MN, Iaconelli Jr. A, Borges Jr. E, Zabala A, Pessino T, Blanco L, Rey Valzacchi G, Leocata F, Ahumada A, Vanden Meerschaut F, Heindryckx B, Qian C, Deforce D, Leybaert L, De Sutter P, De las Heras M, De Pablo JL, Navarro B, Agirregoikoa JA, Barrenetxea G, Cruz M, Perez-Cano I, Gadea B, Herrero J, Martinez M, Roldan M, Munoz M, Pellicer A, Meseguer M, Munoz M, Cruz M, Roldan M, Gadea B, Galindo N, Martinez M, Pellicer A, Meseguer M, Perez-Cano I, Scarselli F, Alviggi E, Colasante A, Minasi MG, Rubino P, Lobascio M, Ferrero S, Litwicka K, Varricchio MT, Giannini P, Piscitelli P, Franco G, Zavaglia D, Nagy ZP, Greco E, Urner F, Wirthner D, Murisier F, Mock P, Germond M, Amorocho Llanos B, Calderon G, Lopez D, Fernandez L, Nicolas M, Landeras J, Finn-Sell SL, Leandri R, Fleming TP, Macklon NS, Cheong YC, Eckert JJ, Lee JH, Jung YJ, Hwang HK, Kang A, An SJ, Jung JY, Kwon HC, Lee SJ, Palini S, Zolla L, De Stefani S, Scala V, D'Alessandro A, Polli V, Rocchi P, Tiezzi A, Pelosi E, Dusi L, Bulletti C, Fadini R, Lain M, Mignini Renzini M, Brambillasca F, Coticchio G, Merola M, Guglielmo MC, Dal Canto M, Figueira R, Setti AS, Braga DPAF, Iaconelli Jr. A, Borges Jr. E, Worrilow KC, Uzochukwu CD, Eid S, Le Gac S, Esteves TC, van Rossem F, van den Berg A, Boiani M, Kasapi E, Panagiotidis Y, Goudakou M, Papatheodorou A, Pasadaki T, Prapas N, Prapas Y, Panagiotidis Y, Kasapi E, Goudakou M, Papatheodorou A, Pasadaki T, Vanderzwalmen P, Prapas N, Prapas Y, Norasing S, Atchajaroensatit P, Tawiwong W, Thepmanee O, Saenlao S, Aojanepong J, Hunsajarupan P, Sajjachareonpong K, Punyatanasakchai P, Maneepalviratn S, Jetsawangsri U, Herrero J, Cruz M, Tejera A, Rubio I, Romero JL, Meseguer M, Nordhoff V, Schlatt S, Schuring AN, Kiesel L, Kliesch S, Azambuja R, Okada L, Lazzari V, Dorfman L, Michelon J, Badalotti M, Badalotti F, Petracco A, Schwarzer C, Esteves TC, Nordhoff V, Schlatt S, Boiani M, Versieren K, Heindryckx B, 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POSTER VIEWING SESSION - EMBRYOLOGY. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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