BACKROUND: The goal of assisted reproduction is for a couple treated with IVF techniques to end the treatment by giving birth to a healthy baby. A neccessary presumption for success is the identification of the best embryo with high implantation and developmental potential. One option is to select an euploid embryo by invasive preimplantaion genetic testing for aneuploidy (PGT-A) or it is possible to select the best embryo by non-invasive time-lapse monitoring (TLM), specifically based on morphokinetic parameters and morphological markers that are able to identify an embryo with high developmental potential. MATERIALS AND METHODS: The study involved a total of 1060 embryos (585 euploid and 475 aneuploid embryos after PGT-A) with good morphology from 329 patients in the period 01/2016-10/2021. All embryos were cultured in a time-lapse incubator, trophectoderm (TE) cells biopsies for PGT-A examination were performed on day 5 (D5) or day 6 (D6) of culture. During the study period, 225 frozen embryo transfers (FET) of one euploid embryo were performed. Based on the treatment outcome, the embryos were divided into 2 groups - euploid embryos, which led to the birth of a healthy child, and euploid embryos that did not show fetal heartbeat (FHB) after FET. RESULTS: Based on the statistical analysis of the embryos without implantation and the embryos with live birth, it is clear that the morphokinetic parameters t5 (time of division into 5 cells) and tSB (time of start of blastulation) are significantly different. CONCLUSION: The results suggest that of the morphokinetic parameters tSB and t5 are predictive indicators for selecting an embryo with high developmental potential and with a high probability of achieving the birth of a healthy child.
- MeSH
- aneuploidie MeSH
- blastocysta * MeSH
- genetické testování metody MeSH
- implantace embrya MeSH
- lidé MeSH
- narození živého dítěte * MeSH
- novorozenec MeSH
- přenos embrya metody MeSH
- retrospektivní studie MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Background and Objectives: The aim of our single-center cohort study was the determination of the influence of the intrauterine lavage of granulocyte colony-stimulating growth factor (G-CSF) on clinical pregnancy rate in patients with a history of implantation failure older than 40 years. Materials and Methods: The study was conducted in Ferticare Prague SE between May 2018 and June 2020. Overall, 115 patients were distributed into two arms, with 48 subjects in the experimental and 67 in the control arm. All women have had a previous history of unsuccessful history of infertility treatment with their own genetic material and at least one ineffective cycle with the donated oocytes. The experimental arm underwent the intrauterine lavage of 0.5 mL of pure G-CSF from 120 to 48 h prior to embryo transfer. Results: The clinical pregnancy rate was 63.3% in the experimental arm and 47.8% in the control arm (p = 0.097 for Pearsonߣs χ2, and p = 0.133 for Fisher's exact test). However, the mean endometrial thickness on the day of embryo transfer did not appear to be statistically different (p = 0.139). Only the difference in endometrium thickness growth was statistically significant (p = 0.023). The increase in pregnancy rate is still encouraging for the future, even if it is not significant. Conclusion: Our study suggests the trend of increased pregnancy rate after the intrauterine G-CSF lavage in the interval of 120-48 h prior to embryo transfer.
- MeSH
- darování oocytu * metody MeSH
- dospělí MeSH
- faktor stimulující kolonie granulocytů * terapeutické užití MeSH
- implantace embrya * účinky léků MeSH
- kohortové studie MeSH
- lidé MeSH
- přenos embrya metody MeSH
- těhotenství MeSH
- úhrn těhotenství na počet žen v reprodukčním věku MeSH
- výsledek těhotenství * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Healing of dense regular connective tissue, due to a high fiber-to-cell ratio and low metabolic activity and regeneration potential, frequently requires surgical implantation or reconstruction with high risk of reinjury. An alternative to synthetic implants is using bioscaffolds obtained through decellularization, a process where the aim is to extract cells from the tissue while preserving the tissue-specific native molecular structure of the ECM. Proteins, lipids, nucleic acids and other various extracellular molecules are largely involved in differentiation, proliferation, vascularization and collagen fibers deposit, making them the crucial processes in tissue regeneration. Because of the multiple possible forms of cell extraction, there is no standardized protocol in dense regular connective tissue (DRCT). Many modifications of the structure, shape and composition of the bioscaffold have also been described to improve the therapeutic result following the implantation of decellularized connective tissue. The available data provide a valuable source of crucial information. However, the wide spectrum of decellularization makes it important to understand the key aspects of bioscaffolds relative to their potential use in tissue regeneration.
Cíl: Shrnutí nových poznatků v oblasti implantace embrya v závislosti na kvalitě endometria. Metodika: Rešerše literatury publikované do srpna 2022 v databázích WoS, Scopus, PubMed/Medline se zaměřením na „endometrial receptivity“, „polycystic ovary syndrome“, „endometriosis“, „SARS-CoV-2“. Výsledky: Receptivní stav endometria je výsledkem fyziologické remodelace, činnosti imunity modulované mikrobiomem. Tuto rovnováhu narušují myomy, polypy, saktosalpingy, adenomyóza, endometrióza, syndrom polycystických vaječníků, infekce. Diskutuje se dopad infekce SARS-CoV-2. Pro úspěšnou implantaci je klíčové časování embryotransferu. Konvenčně se pro tyto účely využívá ultrazvuk. Ve specifických případech hysteroskopie a biopsie endometria. Vzorek se hodnotí histologicky, imunohistochemicky, vyšetřuje se mikrobiom anebo transkriptom. Jako podpora implantace jsou využívány gestageny, u syndromu polycystických ovarií metformin. U opakovaného selhání implantace intrauterinní infuze mononukleárů, plazmy bohaté na destičky, subkutánní aplikace granulocyty stimulujícího růstového faktoru, intravenózní podání atosibanu, intrauterinní aplikace choriogonadotropinu. Závěr: Nejnovější výzkumy na poli transkriptomiky, proteomiky a reprodukční imunologie hlouběji odkrývají implantaci a otvírají novou etapu asistované reprodukce.
Objective: A summary of new knowledge on embryo implantation in dependence on quality of the endometrium. Methods: Literature review from August 2022 of the relevant publications in Web of Science, Scopus and PubMed/Medline databases, focused on “endometrial receptivity”, “polycystic ovary syndrome”, “endometriosis”, “SARS-CoV-2”. Results: The receptive state of the endometrium is a result of physiological remodeling and immune system activity modulated by the microbiome. This balance can be disturbed by myomas, polyps, sactosalpings, adenomyosis, endometriosis, polycystic ovary syndrome, infections. The effect of SARS-CoV-2 infection is being discussed. For a successful implantation, timing of transfer is crucial. The ultrasound examination is used conventionally. In specific cases, hysteroscopy and endometrium biopsy are recommended. Histological and immunohistochemical evaluation is performed together with examination of microbiome or transcriptome. To support the implantation, gestagenes are used, or metformin in the patients with polycystic ovary syndrome. In cases of a repeated implantation failure, the intrauterine infusion of mononuclear cells or platelet rich plasma is used, subcutaneous application of granulocyte colony stimulating growth factor, intravenous application of atosiban or intrauterine application of human chorionic gonadotropin. Conclusion: Recent research in the field of transcriptomics, proteomics and reproductive immunology uncovers the process of implantation more deeply and opens a new stage of the assisted reproduction.
- MeSH
- choriogonadotropin MeSH
- COVID-19 metabolismus MeSH
- endometrióza MeSH
- implantace embrya * fyziologie MeSH
- lidé MeSH
- syndrom polycystických ovarií MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
Infertility affects approximately 48 million couples globally. Despite the enormous progress of the methods of reproductive medicine that has been made since the first test-tube baby was born in 1978, the implantation rate of day-3 embryos is only around 15-20 % and 30 % of day-5 embryos. Numerous strategies aim to improve implantation rates and prevent repeated implantation failure, however there is no specific general recommendation leading to satisfying results. One of the many risk factors relevant in this regard is the uterine immunological make-up, mainly the uterine Natural Killer (uNK) cells. They orchestrate the overall immune response during implantation by influencing trophoblast invasion and vascular remodeling and throughout pregnancy, uNK cells are also the main immune cells at the maternal-foetal interface. Previously, uNK count has been correlated with various fertility issues including idiopathic reccurent miscarriage. The present study used endometrial samples collected from 256 patients with recurrent implantation failure (RIF), habitual abortion (HA) and idiopathic sterility. Samples were collected between day 19 and 21 of the menstrual cycle mainly by Pipelle endometrial sampling. The samples were fixed in formalin for 24 hours and further processed for immunohistochemistry using anti-CD56 to visualize this antigen marker of uNK cells. Immunohistochemical counting was performed to assess the low, normal, or elevated count of uNK cells. According to the one-way ANOVA test, the age of our patients did not have any influence on the count of uNK cells. With Spearman correlation analysis, we found statistically significant correlation (p-value 0.05) of -0.133 between prior miscarriage and lower uNK cell count. Using the same analysis we found statistically significant correlation (correlation 0.233 with p-value 0.01) between number of uNK cells and activation status. Patients with higher uNK cells were more frequenty diagnosed with endometriosis (p-value 0.05, correlation 0.130). Patients with an immunological factor of sterility (defined by a clinical immunologist) had a lower chance of gravidity (-0.203 with p-value 0.01). Based on our results, we can confirm that there is a correlation between RIF, HA, idiopathic sterility, endometriosis, and immunological factor of sterility (uNK cell count). The true predictive value with regard to fertility outcomes needs to be addressed in future research.
Nanoparticles (NPs) have many toxic effects on fertility and can prevent successful implantation by affecting the maternal uterine tissue. Herein, by deploying 30 female NMRI mice, the effect of silver NPs on the endometrium and implantation has been investigated. Using spherical silver NPs of a diameter of 18-30 nm at doses of 2 and 4 mg/kg, mice in two groups were treated. Then, female mice mated with male mice. Endometrial tissue was extracted 4.5 days later. On the fourth day of pregnancy, the mice were anesthetized and blood samples were taken from the heart; furthermore, endometrial tissue was isolated and used for molecular tests, inductively coupled plasma, and examination of pinopods. The results revealed that the levels of interleukin 6 (IL-6) and IL-1β and the accumulation of NPs in endometrial tissue in the group receiving NPs at a dose of 4 mg/kg had a major increase relative to the other two groups (p < 0.05); the group receiving a dose of 4 mg/kg exhibited a decrease in pinopods and microvillus compared with the other two groups. According to the results, NPs can reach the endometrium, suggesting that caution should be exercised due to serious exposure to NPs throughout pregnancy.
- MeSH
- endometrium účinky léků metabolismus MeSH
- implantace embrya účinky léků MeSH
- interleukin-1beta metabolismus MeSH
- interleukin-6 metabolismus MeSH
- kovové nanočástice toxicita MeSH
- myši MeSH
- stříbro toxicita MeSH
- těhotenství MeSH
- velikost částic MeSH
- vztah mezi dávkou a účinkem léčiva MeSH
- zvířata MeSH
- Check Tag
- mužské pohlaví MeSH
- myši MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
A recent study published in Human Reproduction claimed that uterine lavage offers a non-surgical, minimally invasive strategy for the recovery of human embryos from fertile women who do not want or need IVF for medical reasons but who desire preimplantation genetic testing (PGT) for embryos. To prove this hypothesis, the researchers recruited dozens of young Mexican women. The prospective oocyte donors underwent ovarian stimulation to induce the production of multiple mature oocytes. Subsequently, these women were inseminated by donor semen. A few days later, the developing embryos were collected by uterine lavage (uterine flushing) and subjected to genetic testing for aneuploidies (PGT-A). Oocyte donors with persistently elevated hCG levels, indicating the implantation of one or more embryos after uterine lavage, had to undergo uterine curettage and/or treatment with methotrexate. A critical opinion paper discussing the aforementioned study was published by De Santis and colleagues and has raised critical issues that are largely technical in nature. However, this opinion paper neglects-from our point of view-critical issues of the Mexican study regarding ethical principles and moral standards in human research. These aspects are summarized below.
- MeSH
- aneuploidie MeSH
- biomedicínský výzkum etika MeSH
- dospělí MeSH
- fertilizace in vitro etika MeSH
- implantace embrya genetika MeSH
- lidé MeSH
- odběr oocytu etika MeSH
- oocyty cytologie růst a vývoj MeSH
- preimplantační diagnóza etika MeSH
- přenos embrya etika MeSH
- reprodukční lékařství etika MeSH
- sperma cytologie MeSH
- těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- receptivita endometria,
- MeSH
- biopsie MeSH
- cervikální hlen MeSH
- endometrium * diagnostické zobrazování MeSH
- fertilizace in vitro MeSH
- hysteroskopie MeSH
- implantace embrya MeSH
- infertilita * MeSH
- lidé MeSH
- ultrazvuk MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
- MeSH
- implantace embrya fyziologie imunologie MeSH
- infertilita etiologie imunologie MeSH
- lidé MeSH
- placenta fyziologie imunologie MeSH
- preeklampsie etiologie imunologie patologie MeSH
- rizikové faktory MeSH
- těhotenství * fyziologie imunologie MeSH
- Check Tag
- lidé MeSH
- těhotenství * fyziologie imunologie MeSH
- Publikační typ
- přehledy MeSH
Cíl studie: V reprodukčním období ženy dochází k opakovaným a častým strukturálním a funkčním proměnám endometria. Schopnost regenerace, remodelace a diferenciace je předpokladem receptivity endometria, implantace a vývoje embrya. Důležitým faktorem těchto procesů je vzájemná přeměna mezenchymálního a epiteliálního fenotypu endometriálních buněk – epiteliálně- -mezenchymální transice (EMT = epitelial-mesenchymal transition) a mezenchymálně-epiteliální transice (MET = mesenchymal-epithelial transition). Cílem práce je prezentovat současné poznatky o vzájemné přeměně epiteliálních a mezenchymální buněk děložní sliznice a jejich možném vlivu na poruchy plodnosti. Typ studie: Přehledová práce. Název a sídlo pracoviště: Gynekologicko-porodnická klinika Lékařské fakulty Masarykovy univerzity a FN Brno; Porodnicko-gynekologická klinika FN a LF UP Olomouc. Metodika: Literární rešerše databáze PubMed publikované do února 2019 s termíny zaměřenými na „endometrial receptivity“, „embryo implantation“, „endometrial regeneration“, „mesenchymal–epithelial transition/transformation“. Výsledky: Bylo prokázáno, že stromální buňky se podílejí na regeneraci nejen stromatu, ale také epitelu endometria. V průběhu decidualizace působením ovariálních steroidů a dalších faktorů probíhá MET, fibroblasty stromatu získávají postupně vlastnosti epiteliálních buněk – morfologicky i funkčně (sekreční endoplazmatické retikulum, pevné intercelulární spoje). V průběhu implantace embrya vlivem interakce trofoblastu s decidualizovaným endometriem dochází k přeměně epiteliálních buněk na mezenchymální (EMT), které jsou schopny migrace a regulace pronikajícího trofoblastu. Závěr: Vzájemná přeměna stromálních a epiteliálních buněk endometria je nezbytná pro fyziologickou funkci děložní sliznice včetně implantace a vývoje embrya.
Objective: During reproductive age of a woman, endometrium undergoes frequent stuctural and functional changes. Abilities of regeneration, remodelation and differentiation are precondition of endometrial receptivity and implantation and development of an embryo. These processes are conditioned by mutual transformation between mesenchymal and epithelial fenotype of endometrial cells: epithelial-mesenchymal transition (EMT) and mesenchymal-epithelial transition (MET). The aim of this study is to present contemporary knowledge of transformation between epithelial and mesenchymal endometrial cells and its influence on human fertility. Design: Review article. Setting: Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk university and University Hospital Brno; Department of Obstetrics and Gynecology, University Hospital Faculty of Medicine, Palacky University, Olomouc. Methods: PubMed was searched for articles in English indexed until February 2019 with terms of „endometrial receptivity“, „embryo implantation“, „endometrial regeneration“, „mesenchymal-epithelial transition/ transformation“. Results: It has been proved, that mesenchymal stromal cells participate on regeneration of not only the endometrial stroma, but also of the epithelium. During endometrial decidualisation under influence of ovarian steroids, the MET is under way. Stromal fibroblasts gain the morfological and functional properties of epithelial cells. During implantaion of an embryo, the trofoblast interacts with decidualised endometrium. Epithelial cells transform into mesenchymal (EMT), which mediate the growth of trofoblast. Conclusion: Mutual transformation between stromal and epithelial cells in essential for normal function of endometrium and implantation and development of an embryo.
- Klíčová slova
- mezenchymálněepiteliální transformace buněk, receptivita endometria, regenerace endometria,
- MeSH
- endometrium * fyziologie MeSH
- implantace embrya MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
