14 research outputs found
Human Chorionic Gonadotropin: The Pregnancy Hormone and More
To thoroughly review the uses of human chorionic gonadotropin (hCG) related to the process of reproduction and also assess new, non-traditional theories. Review of the international literature and research studies. hCG and its receptor, LH/CGR, are expressed in numerous sites of the reproductive tract, both in gonadal and extra-goanadal tissues, promoting oocyte maturation, fertilization, implantation and early embryo development. Moreover, hCG seems to have a potential role as an anti-rejection agent in solid organ transplantation. Future research needs to focus extensively on the functions of hCG and its receptor LH/CGR, in an effort to reveal known, as well as unknown clinical potentials
The Impact of Genetics Profile (Gene Polymorphisms) in Obese Non-PCOS Women Entering an IVF/ICSI Program
Data concerning the effects of increased body mass index (BMI) on
ovarian and pregnancy outcome are rich, but the results are rather
controversial. Regarding pharmacogenetics, gene polymorphisms of
hormonal receptor genes, such as Estrogen Receptor alpha (ESR1),
Estrogen Receptor beta (ESR2) and FSH receptor (FSHR) genes, are
associated with ovarian stimulation and pregnancy outcome and may
constitute a useful tool for ART experts for the prediction of this
outcome. The aim of this study is to track differences in the
distribution of gene polymorphisms among obese non-PCOS and non-obese
patients concerning three distinct genes which are involved in the
ovarian stimulation mechanism: PvuII polymorphism of ESR1 gene, RsaI
polymorphism of ESR2 gene and Ser680Asn variation of FSHR gene, using
restriction fragment length polymorphism analysis and real-time
polymerase chain reaction. A total of 151 normally ovulating female
patients underwent IVF or ICSI. Interestingly, the pregnancy rate in the
BMI >= 30 kg/m(2) group was higher in a statistically significant way
(40.9% versus 17.8%, p=0.023). The obese patients of this study were
in need of increased total FSH dose in order to achieve a satisfactory
oocyte number (p<0.001) and needed more days of stimulation (p=0.002),
but also presented lower basal FSH levels (p=0.032), which may explain,
to an extend, the better pregnancy outcome. Concerning the polymorphisms
of ESR1, ESR2 and FSHR genes, we did not observe differences in the
genotype distribution when we compared the obese non-PCOS population
with the non-obese population. Thus, obesity does not constitute an
additional indication to perform a genetic analysis before entering an
IVF/ICSI program
Combined study on the single nucleotide polymorphisms in the follicle-stimulating hormone receptor (Ser680Asn) and anti-Mullerian hormone receptor type II (-482A>G) as genetic markers in assisted reproduction
Background: Infertile women may have underlying genetic abnormalities.
There is, at present, a significant number of studies on the relation
between the follicle stimulating hormone receptor (FSHR) or
anti-Mullerian hormone type II receptor (AMHRII) polymorphisms and
response to in-vitro fertilisation (IVF) treatment. However, it is not
yet clear which genotype or combination of genotypes is favourable
towards a better ovarian stimulation and pregnancy outcome.
Materials and methods: In this study we assessed the distribution of the
genotypes of FSHR Ser680Asn and of AMHRII -482A>G gene polymorphisms in
a group of 126 infertile women and a control group of 100 fertile women
by using real-time polymerase chain reaction (RT-PCR).
Results: Statistical analysis showed that the frequency of the genotypes
is similar in both control and IVF/ intracytoplasmic sperm injection
(ICSI) groups. Further investigation of the frequency of the nine
possible combinations of these polymorphisms in the groups revealed no
correlation between infertility and combination of the polymorphisms.
Women with one polymorphism have on average 5.5 units higher levels of
AMH compared to women carrying no polymorphism. In women with no
polymorphisms, for each unit of FSH increase, the average concentration
of blood AMH is expected to be 72% lower.
Conclusion: The distribution of the FSHR Ser680Asn and of the AMHRII
-482A>G gene polymorphisms, in the Greek population is similar in
fertile and infertile women. The study showed that FSH and AMH
correlated levels in certain cases could be used to estimate a patient’s
ovarian reserve
Past, Present, and Future of Gonadotropin Use in Controlled Ovarian Stimulation During Assisted Reproductive Techniques
A variety of protocols have evaluated the use of several forms of
gonadotropins in controlled ovarian stimulation (COS). We aim to review
the evolving trends on the use of gonadotropins human chorionic
gonadotropin (hCG), follicle-stimulating hormone (FSH) and luteinizing
hormone (LH) over time and their combinations in COS for patients who
undergo assisted reproductive techniques (ART) protocols. A meticulous
search of three electronic databases was performed for articles
published in the field up to September 2020. The administration of hCG
seems a promising alternative to conventional modalities for COS related
to the enhancement of LH activity. The use of gonadotropins was
associated with significantly elevated pregnancy rates that ranged from
20.8% to 46.2%. However, the currently available outcomes with regards
to oocytes retrieved, number of embryos are still conflicting. A
potential beneficial effect was observed by the majority of the studies
in terms of the number of embryos and implantation rates, which is,
however, highly affected by the type of protocol used
(gonadotropin-releasing hormone [GnRH] agonist or antagonist). Further
studies are warranted to elucidate the exact pathways of action of
gonadotropins in controlled ovarian stimulation to attain the optimal
effect
Single nucleotide polymorphisms in the Anti-Mullerian hormone (AMH Ile(49)Ser) and Anti-Mullerian hormone type II receptor (AMHRII-482 A > G) as genetic markers in assisted reproduction technology
The aim of the study was to evaluate whether the presence Antimullerian
hormone (AMH) and Antimullerian hormone type II receptor (AMHRII) single
nucleotide polymorphisms (SNPs) Ile(49)Ser and -482A > G respectively
are related to the assisted reproduction outcome.
A prospective cross-sectional observational study was conducted in order
to assess the distribution of AMH and AMHRII SNPs in two cohorts, one of
healthy women (N = 100) and the control group and the IVF/ICSI group (N
= 151) consisted of women undergoing IVF/ICSI treatment for infertility.
Furthermore, a prospective longitudinal observational study was
performed on the latter group to assess possible associations of these
SNPs with patients’ characteristics and controlled ovarian stimulation
(COS) and pregnancy outcome.
Among non-carriers of the AMH (Ile(49)Ser) polymorphism, basal FSH
levels were lower in those with more than two of previous IVF attempts
and fertilization rate was statistically higher in those with peak serum
E2 levels below 1500 pg/ml, whereas among non-carriers of the AMHRII
(-482 A > G) polymorphism, number of follicles was higher in those with
more than two previous IVF attempts and total dose of gonadotropins was
lower in those with peak serum E2 levels above 1500 pg/ml.
There was evidence that in specific subgroups of women undergoing
IVF/ICSI, AMH and AMHRII SNPs may be related to patients’
characteristics and controlled ovarian stimulation and pregnancy outcome
and thus may provide a means for the prediction of ovarian response in
specific subgroups of women entering an IVF/ICSI program
EBCOG hospital visit in the First Department of Obstetrics and Gynecology, University of Athens Medical School, Greece. Proposals for the improvement of training in obstetrics and gynecology
Evaluation of IOTA-ADNEX Model and Simple Rules for Identifying Adnexal Masses by Operators with Varying Levels of Expertise: A Single-Center Diagnostic Accuracy Study
Objectives The discrimination of ovarian lesions presents a significant
problem in everyday clinical practice with ultrasonography appearing to be the
most effective diagnostic technique. The aim of our study was to externally
evaluate the performance of different diagnostic models when applied by
examiners with various levels of experience
Second Trimester Amniotic Fluid Angiotensinogen Levels Linked to Increased Fetal Birth Weight and Shorter Gestational Age in Term Pregnancies
Background: Despite the considerable progress made in recent years in fetal assessment, the etiology of fetal growth disturbances is not as yet well understood. In an effort to enhance our knowledge in this area, we investigated the associations of the amniotic fluid angiotensinogen of the renin–angiotensin system with fetal growth abnormalities. Methods: We collected amniotic fluid samples from 70 pregnant women who underwent amniocentesis during their early second trimester. Birth weight was documented upon delivery, after which the embryos corresponding to the respective amniotic fluid samples were categorized into three groups as follows: small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA). Amniotic fluid angiotensinogen levels were determined by using ELISA kits. Results: Mean angiotensinogen values were 3885 ng/mL (range: 1625–5375 ng/mL), 4885 ng/mL (range: 1580–8460 ng/mL), and 4670 ng/mL (range: 1995–7250 ng/mL) in the SGA, LGA, and AGA fetuses, respectively. The concentrations in the three groups were not statistically significantly different. Although there were wide discrepancies between the mean values of the subgroups, the large confidence intervals in the three groups negatively affected the statistical analysis. However, multiple regression analysis revealed a statistically significant negative correlation between the angiotensinogen levels and gestational age and a statistically significant positive correlation between the birth weight and angiotensinogen levels. Discussion: Our findings suggest that fetal growth abnormalities did not correlate with differences in the amniotic fluid levels of angiotensinogen in early second trimester pregnancies. However, increased angiotensinogen levels were found to be consistent with a smaller gestational age at birth and increased BMI of neonates
Detection and Quantification of Neurotrophin-3 (NT-3) and Nerve Growth Factor (NGF) Levels in Early Second Trimester Amniotic Fluid: Investigation into a Possible Correlation with Abnormal Fetal Growth Velocity Patterns
Background: Abnormal fetal growth is associated with adverse perinatal and long-term outcomes. The pathophysiological mechanisms underlying these conditions are still to be clarified. Nerve growth factor (NGF) and neurotrophin-3 (NT-3) are two neurotrophins that are mainly involved in the neuroprotection process, namely promotion of growth and differentiation, maintenance, and survival of neurons. During pregnancy, they have been correlated with placental development and fetal growth. In this study, we aimed to determine the early 2nd trimester amniotic fluid levels of NGF and NT-3 and to investigate their association with fetal growth. Methods: This is a prospective observational study. A total of 51 amniotic fluid samples were collected from women undergoing amniocentesis early in the second trimester and were stored at −80 °C. Pregnancies were followed up until delivery and birth weight was recorded. Based on birth weight, the amniotic fluid samples were divided into three groups: appropriate for gestational age (AGA), small for gestational age (SGA), and large for gestational age (LGA). NGF and NT-3 levels were determined by using Elisa kits. Results: NGF concentrations were similar between the studied groups; median values were 10.15 pg/mL, 10.15 pg/mL, and 9.14 pg/mL in SGA, LGA, and AGA fetuses, respectively. Regarding NT-3, a trend was observed towards increased NT-3 levels as fetal growth velocity decreased; median concentrations were 11.87 pg/mL, 15.9 pg/mL, and 23.5 pg/mL in SGA, AGA, and LGA fetuses, respectively, although the differences among the three groups were not statistically significant. Conclusions: Our findings suggest that fetal growth disturbances do not induce increased or decreased production of NGF and NT-3 in early second trimester amniotic fluid. The trend observed towards increased NT-3 levels as fetal growth velocity decreased shows that there may be a compensatory mechanism in place that operates in conjunction with the brain-sparing effect. Further associations between these two neurotrophins and fetal growth disturbances are discussed
Does the type of GnRH analogue used, affect live birth rates in women with endometriosis undergoing IVF/ICSI treatment, according to the rAFS stage?
<p>Since the introduction of gonadotropin-releasing hormone (GnRH) antagonists, an extensive amount of literature investigating the role of the downregulation protocols on pregnancy outcomes has been published. However, these studies were mainly performed in the general infertile population where patients with endometriosis were often excluded or underrepresented. This study is a large retrospective cohort study including 386 endometriosis patients undergoing IVF/ICSI, who had been previously classified according to the rAFS system. Patients were stimulated either a long GnRH agonist or GnRH antagonist protocol. Depending on endometriosis stage, patients were divided into two groups: endometriosis stage I–II and endometriosis stage III–IV. Each group was subdivided, based on the type GnRH analog used. When comparing the GnRH agonist and antagonist groups, patients with endometriosis stage I–II, had a tendency toward higher β-hCG positive, clinical pregnancy, and live birth rates (42.8% vs. 26.7%; <i>p</i> = .07) in favor of GnRH agonist use. In endometriosis stage III–IV, no differences were observed between agonist and antagonist cycle in any of the pregnancy outcomes. Multivariate regression analysis did not reveal any significant predictor of live birth after adjusting for relevant confounders. Based on our findings, the chance to have a liveborn in endometriosis population seems not to be affected by the type of GnRH analog used, at least in advanced stages. Findings from stage I–II endometriosis cases merit consideration and further evaluation in a larger sample size is warranted.</p