Some newer aspects of management of infertility. Fundamental role of folliculo-luteal function in recurrent miscarriage. Sonntag B, Ludwig M. An integrated view on the luteal phase: Common pathophysiological mechanisms involved in luteal phase deficiency and polycystic ovary syndrome. Transvaginal sonographic evaluation at different menstrual cycle phases in diagnosis of uterine lesions. Int J Womens Health. Luteal phase support for assisted reproduction cycles. Cochrane Database Syst Rev. Current clinical irrelevance of luteal phase deficiency:
Dating the endometrial biopsy.
A and B, concentration dependence. Data in A are from a representative endometrium patient 8. B, densitometric analysis of six conditioned media. Values from the media conditioned during the first and the second day of explant culture three endometria each were standardized according to protein concentration and normalized according to the corresponding control value measured in the media conditioned without recombinant LEFTY-A.
C, kinetics of response. Data are from a representative endometrium patient 8.
A biopsy was used for endometrial dating according to the Noyes and Hertig criteria, and assessed for the presence of pinopodes via a scanning electron microscope. Endometria were examined in Real Time-Polymerase Chain Reaction cycles for the mRNA expression of leukemia inhibitory factor (LIF) and matrix metalloproteinase 2 (MMP2).
To examine the relationship between endometrial histological maturation and reproductive hormones, we studied 11 fertile women, aged 18—37 yr. All participants had had at least 1 previous pregnancy and cycled regularly, every 25—35 days. Women collected daily, first morning voided urine for measurement of estradiol and progesterone metabolite excretion, estrone conjugates E1c , and pregnanediol glucuronide Pdg , respectively, throughout the cycle of study.
Hormones were normalized for creatinine. Between 7—9 days after home detection of a LH surge Sure Step , participants underwent an endometrial biopsy using a small bore Pipelle catheter. Tissue was prepared for histological and biochemical analyses. The histological analysis is reported herein. Endometrium was dated by 3 authors N.
Final dating was agreed upon based upon the method of Noyes et al. E1c and Pdg were integrated throughout the cycle using the trapezoidal rule, and correlations were sought between deviation from expected histology based upon urinary hormones and LH surge and integrated hormone values. No relationship could be found between histological lagging of endometrial maturation and lower excretion of E1c. We conclude that normal fertile women experience a wide range of hormone concentrations in the face of normal endometrial maturation.
Progesterone appears to exert a dose-related effect on endometrial maturation, and the techniques we used, although relatively crude clinical measures, appeared to be sufficient to detect this relationship.
Dating the endometrial biopsy.
Bikerdatingsite com Dating the endometrial biopsy noyes Blighted ovum was designated in cases where embryonic echoes were never visualized in the gestational sac, and embryonic death in cases where embryo heart action, which had been once identified, disappeared within 11 weeks of gestation menstrual age. Over the last decade, research to improve success rates in reproductive medicine has focused predominantly on the understanding and optimization of embryo quality.
Of pregnancies, persisted successfully to live birth, but 42 ended in early pregnancy loss.
Decidualization is the combination of changes on endometrium structure and hormone profiles, along with gene expression, cell differentiation and tissue modification, that allow for implantation of the embryo.
The utility of histological dating of endometrium in the evaluation of infertile couples is uncertain. Design Prospective multicenter study, with subjects randomly assigned to biopsy timing. Criterion standard for infertility was 12 months of unprotected, regular intercourse without conception and for fertility at least one live birth within 2 years. Setting University-based infertility practices.
Patient s Volunteer subjects recruited at 12 clinical sites participating in the National Institutes of Health-funded Reproductive Medicine Network. Inclusion criteria included ages 20—39 years, regular menstrual cycles, and no hormonal treatment or contraceptive use for 1 month before the study. Fertile controls were excluded if they had a history of infertility, recurrent pregnancy loss, or recent breastfeeding.
Intervention s Subjects underwent daily urinary LH testing.
Endometrial Receptivity and the ERA biopsy
Bush on November 28, , by means of Executive Order The Council’s purpose is to advise the President on bioethical issues related to advances in biomedical science and technology. In connection with its advisory role, the mission of the Council includes the following functions:
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Received Sep 2; Accepted Nov 6. Materials and methods Prospective, self-controlled study. The thirty-five volunteers were studied for two cycles: Endometrial biopsy was performed on day 6 after ovulation for histological dating and morphometric study. Results No statistical differences between histological dating and the endometrial thickness in the control and GnRH antagonist-treated cycles. All morphometric parameters were also not different.
Conclusion GnRH antagonist has no effect on the endometrium of regularly menstruating women as assessed by either histological dating or morphometric analysis. The role of GnRH agonist is to prevent premature LH surge which is associated with cycle cancellation. Furthermore, some women may suffer common problems of hypoestrogenism such as hot flashes, headaches and vaginal dryness during the desensitization period of the long GnRH agonist protocol [ 3 , 4 ].
The third generation of GnRH antagonists which are devoid of anaphylactoid reactions, have recently been introduced as an alternative for the prevention of premature LH surge.
The Endometrium and Frozen Embryo Transfer
Uterine fibroids are the most common benign tumors of the female genital tract. The management of symptomatic fibroids has traditionally been surgical; however, alternative pharmacological approaches have been proposed to control symptoms. To date, gonadotropin-releasing hormone analogs are the only available drugs for the preoperative treatment of fibroids.
However, the US Food and Drug Administration recently authorized ulipristal acetate UPA , an oral selective progesterone-receptor modulator, for the same indication. UPA is a new, effective, and well-tolerated option for the preoperative treatment of moderate and severe symptoms of uterine fibroids in women of reproductive age. According to clinical data, UPA shows several advantages:
Endometrial dating • Interpreting the cycle based on histomorphology of endometrium. • First by Noyes et al • Current modifications of his chart are in use for benign endometrium. aj
Human implantation includes three stages which are called apposition, adhesion, and invasion. The initial unstable contact of the blastocyst to the uterine wall is apposition which occurs most commonly in the fundal wall of the uterus. The next stage, adhesion, is characterized by increased physical interaction between the blastocyst and the uterine epithelium.
Subsequently, the third stage of implantation, invasion, begins and trophoblast cells infiltrate the uterine epithelium 1. The endometrial epithelium is an important element where the molecular interactions between the embryo and the endometrium are initiated 2 , 3 , 4. A specific molecular cross-talk between embryo and endometrium has been reported during the human implantation process 5.
These chemokines exert their effects through a shared receptor called CXCR3 12 , Recent studies demonstrated that these three chemokines were expressed in both pregnant and nonpregnant endometrium 15 , 16 , 17 , Notably, a recent study showed that CXCL10 stimulates the migration and attachment of ovine trophoblast cells Mouse mAbs to human cytokeratin type 7 were obtained from Immunologicals Direct.
Regulation and Function of LEFTY
Obstetrics — drughealth A number of abnormalities can affect each of these processes and lead to infertility or pregnancy loss. In most women, spontaneous, cyclical ovulation at to day intervals continues throughout almost 40 years between the time of menarche and menopause. For women who never use contraception, there are approximately opportunities for pregnancy, which may occur with sexual intercourse on any of days the day of ovulation and the 2 preceding days.
This narrow window available for fertilization is controlled by tightly regulated production of ovarian steroids that cause the optimal regeneration of endometrium that begins with the ending of menstruation. Should fertilization occur, the events that unfold after the initial implantation of the blastocyst onto the surface of the endometrium through to parturition result from a unique interaction between the trophoblasts of the fetus and the endometrium—decidua of the mother.
Expression of the transmembrane mucins, MUC1, MUC4 and MUC16, in normal endometrium and in endometriosis. Human Reproduction, Aug
The correct identification of the appropriate window of implantation in a given patient, by using endometrial receptivity biomarkers, can help to prevent reproductive failure resulting from misplaced timing of the endometrial window of implantation WOI. Although to date no single, clinically relevant morphologic, molecular, or histologic marker capable of indicating endometrial receptivity status has been identified, global transcriptomic analysis of human endometria performed in the last decade has given us insights into a genomic signature that is capable of identifying endometrial receptivity.
As a consequence, a genomic tool named the Endometrial Receptivity Array ERA , based on a customized microarray, was developed, and along with it a specially trained bioinformatic prediction computer algorithm was created to identify WOI timing in the endometrium. This tool has proven more accurate and consistent than histologic Noyes dating at identifying the personalized WOI day, thus leading to the new clinical concept of personalized ET on the optimum day of endometrial receptivity, identified individually case by case.
Previous article in issue.
[Full text] Ulipristal acetate: a novel pharmacological approach for the treatment
Original studies on endometrial transcriptomics in assisted reproductive medicine Most of these studies investigate the transcriptomic signature in the whole endometrial tissue without separating the different compartments. However, in some studies, laser capture micro-dissection has facilitated specific compartment gene expression profiles Yanaihara et al.
Even the specific profiles for stromal cells and glands at different depths in the endometrium have been reported Gaide Chevronnay et al.
In the past, this was done using histological criteria, i.e. the microscope appearance of the endometrium (termed the Noyes Criteria). Certain days of the menstrual cycle have typical microscopic characteristics and a pathologist would determine if the sample looked like day 16 or etc (dates were reported with ovulation normalized to day so an endometrium that was day 17 by Noyes Criteria should be 2 .
It is of interest to note that over this period of time, there have been literally hundreds of thousands of scientific papers published in the medical literature relative to obstetrics, gynecology and reproductive medicine. It is generally not possible for practicing physicians, or even those in academic medicine, to keep abreast of that volume of literature.
This then becomes the platform of information upon which physicians support their own approach to obstetrics, gynecology and reproductive medicine. With the advent of the oral contraceptive in , followed rapidly by the legalization of induced abortion and the wide availability of in vitro fertilization artificial reproductive technologies , contraception, sterilization, abortion and the artificial reproductive technologies have become a mainstay for physicians practicing in this field.
In addition, organizations such as the American College of Obstetrics and Gynecology which strongly supports this approach to medicine, wrap their committee opinions in this approach. While this is being accomplished, a wide availability of medical literature has been slipped aside and, for most physicians, completely lost to their access. In fact, residency programs for the training of young physicians tend to follow these approaches and it has built a profession which often thinks there is no other alternative.
It is not in the general thrust of the profession, but, at the same time, this is not the same as saying this is not scientifically sound. This section of the web site presents some of those references. First of all, it begins with a biographical sketch of Thomas W.