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Road to in vitro maturation (IVM), from basic science to an informed clinical practice. 体外成熟(IVM)之路,从基础科学到临床实践。
IF 6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-01 DOI: 10.1093/humrep/deae182
Sofia Makieva, Juan J Fraire-Zamora, Omar Farhan Ammar, George Liperis, Flor Sanchez, Christian C Kramme, Lan N Vuong, Robert B Gilchrist, Pietro Bortoletto, Claudia Massarotti
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引用次数: 0
Do we need placebo-controlled studies to validate new medical treatments of severe pain associated with endometriosis? 我们是否需要安慰剂对照研究来验证子宫内膜异位症剧痛的新医疗方法?
IF 6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-01 DOI: 10.1093/humrep/deae222
Michel Canis
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引用次数: 0
Do sperm factors influence embryonic aneuploidy? Long live the oocyte. 精子因素会影响胚胎非整倍体吗?卵细胞万岁
IF 6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-01 DOI: 10.1093/humrep/deae224
Yuval Fouks, Denis Vaughan, Veda Sripada, Alan S Penzias, Pietro Bortoletto, Denny Sakkas
<p><strong>Study question: </strong>What is the impact of male age- and sperm-related factors on embryonic aneuploidy?</p><p><strong>Summary answer: </strong>Using a 3-fold analysis framework encompassing patient-level, embryo-level, and matching analysis, we found no clinically significant interactions between male age and sperm quality with embryo ploidy.</p><p><strong>What is known already: </strong>While the effect of maternal age on embryo chromosomal aneuploidy is well-established, the impact of male age and sperm quality on ploidy is less well-defined.</p><p><strong>Study design, size, duration: </strong>This retrospective cohort study analyzed autologous preimplantation genetic testing for aneuploidy (PGT-A) and frozen embryo transfer cycles from December 2014 to June 2021. The study involved 11 087 cycles from 8484 patients, with a total of 35 797 embryos.</p><p><strong>Participants/materials, setting, methods: </strong>The aneuploidy rate, calculated as the ratio of aneuploid blastocysts to the total number of blastocysts biopsied in a single treatment cycle, was evaluated. In the embryo-level analysis, the main outcome measure was the ploidy state of the embryos. The study employed a multifaceted analytical approach that included a patient-level analysis using generalized linear mixed models, an embryo-level analysis focusing on chromosomal ploidy, and a propensity score matching analysis contrasting groups with distinct ploidy rates (0% and 100%). There were no interventions as this was an observational study of PGT-A cycles.</p><p><strong>Main results and the role of chance: </strong>No clinically relevant factors influencing ploidy rate related to male and sperm quality were revealed. In contrast, female age (coefficient = -0.053), BMI (coefficient = 0.003), prior ART cycle (coefficient = -0.066), and number of oocytes retrieved (coefficient = -0.018) were identified at the patient level. Embryo analysis identified age (coefficient = -0.1244) and ICSI usage (coefficient = -0.0129) as significant factors. Despite these, no significant interactions between male and female assessed factors on the ploidy rate emerged. Propensity score matching between maximal (100% vs 0%) euploid rates did not reveal significant differences of influence by male age and sperm quality.</p><p><strong>Limitations, reasons for caution: </strong>The focus on patients having blastocyst biopsy for PGT-A may not reflect the broader IVF population. Other semen quality parameters like DNA fragmentation were not included. Exclusion of embryo mosaicism from the analysis could affect aneuploidy rate interpretations. There may also be unmeasured influences like lifestyle or environmental factors.</p><p><strong>Wider implications of the findings: </strong>Male age and sperm quality parameters were consistent across both maximal and minimal ploidy rate comparisons. No significant clinical characteristics related to the factors assessed for the male-influenced blastocyst
研究问题:男性年龄和精子相关因素对胚胎非整倍体有何影响?我们采用了包括患者水平、胚胎水平和匹配分析在内的三重分析框架,发现男性年龄和精子质量与胚胎倍性之间没有临床意义上的相互作用:虽然母体年龄对胚胎染色体非整倍体的影响已得到证实,但男性年龄和精子质量对胚胎染色体非整倍体的影响尚不明确:这项回顾性队列研究分析了2014年12月至2021年6月的自体植入前非整倍体基因检测(PGT-A)和冷冻胚胎移植周期。研究涉及8484名患者的11 087个周期,共35 797个胚胎:对非整倍体率进行了评估,非整倍体率的计算方法是非整倍体囊胚占单个治疗周期活检囊胚总数的比率。在胚胎层面的分析中,主要结果指标是胚胎的倍性状态。该研究采用了多方面的分析方法,包括使用广义线性混合模型进行的患者水平分析、以染色体倍性为重点的胚胎水平分析,以及对不同倍率组(0% 和 100% 组)进行的倾向得分匹配分析。由于这是一项针对 PGT-A 周期的观察性研究,因此没有干预措施:主要结果和偶然性的作用:没有发现与男性和精子质量有关的影响倍性率的临床相关因素。相比之下,在患者层面发现了女性年龄(系数 = -0.053)、体重指数(系数 = 0.003)、之前的 ART 周期(系数 = -0.066)和取回的卵母细胞数量(系数 = -0.018)。胚胎分析发现,年龄(系数 = -0.1244)和使用 ICSI(系数 = -0.0129)是重要因素。尽管如此,男性和女性评估因素之间在倍性率上没有出现明显的交互作用。最高(100% vs 0%)倍性率之间的倾向得分匹配并未显示出男性年龄和精子质量的显著影响差异:局限性和值得警惕的原因:PGT-A 的重点是囊胚活检患者,这可能无法反映更广泛的试管婴儿人群。其他精液质量指标,如 DNA 片段未包括在内。分析中不包括胚胎嵌合可能会影响非整倍体率的解释。此外,还可能存在生活方式或环境因素等无法测量的影响因素:男性年龄和精子质量参数在最大和最小非整倍体率比较中都是一致的。在评估受男性影响的囊胚倍性状态的因素时,没有发现与之相关的重要临床特征,这证实了卵母细胞和女性年龄的主导作用:研究未获资助。无利益冲突。试验注册号:不详。
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引用次数: 0
Prenatal phthalate exposure and pubertal development in 16-year-old daughters: reproductive hormones and number of ovarian follicles. 产前接触邻苯二甲酸盐与 16 岁女儿的青春期发育:生殖激素和卵泡数量。
IF 6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-01 DOI: 10.1093/humrep/deae229
Maria Assens, Hanne Frederiksen, Anette Tønnes Pedersen, Jørgen Holm Petersen, Anna-Maria Andersson, Karin Sundberg, Lisa Neerup Jensen, Paul Curtin, Niels E Skakkebæk, Shanna H Swan, Katharina M Main
<p><strong>Study question: </strong>Is there a possible association between prenatal phthalate exposure and late effects in teenage daughters with respect to reproductive hormone levels, uterine volume, and number of ovarian follicles?</p><p><strong>Summary answer: </strong>Our study showed subtle associations between phthalate metabolite concentrations in maternal serum from pregnancy or cord blood and LH and insulin-like growth factor 1 (IGF-1) levels as well as uterine volume in their daughters 16 years later.</p><p><strong>What is known already: </strong>Endocrine-disrupting environmental chemicals may adversely affect human reproductive health, and many societies have experienced a trend toward earlier puberty and an increasing prevalence of infertility in young couples. The scientific evidence of adverse effects of foetal exposure to a large range of chemicals, including phthalates, on male reproductive health is growing, but very few studies have explored effects on female reproduction.</p><p><strong>Study design, size, duration: </strong>This follow-up study included 317 teenage daughters who were part of the Copenhagen Mother-Child Cohort, a population-based longitudinal birth cohort of 1210 females born between 1997 and 2002.</p><p><strong>Participants/materials, setting, methods: </strong>A total of 317 female participants (median age 16 years) were examined for weight, height, and menstrual pattern. A serum sample was analysed for concentrations of reproductive hormones, and trans-abdominal 3D ultrasonography was performed to obtain the number of ovarian follicles, ovarian and uterine size. Prenatal maternal serum samples were available for 115 females, and cord blood samples were available for 118 females. These were analysed for concentrations of 32 phthalate metabolites. Weighted quantile sum regression was used for modelling associations of combined prenatal phthalate exposure with the reproductive outcomes in post-menarcheal females.</p><p><strong>Main results and the role of chance: </strong>In bivariate correlation analyses, negative significant associations were found between several prenatal phthalate metabolite concentrations and serum hormone concentrations (testosterone, 17-OH-progesterone, and IGF-1) as well as number of ovarian follicles in puberty. Positive significant correlations were found between prenatal phthalate exposure and FSH and sex hormone-binding globulin concentrations. Combined analyses of phthalate exposure (weighted quantile sums) showed significant negative associations with IGF-1 concentration and uterine volume as well as a significant positive association with LH concentration.</p><p><strong>Limitations, reasons for caution: </strong>Phthalate metabolites were measured in serum from single prenatal maternal blood samples and cord blood samples. Potential concomitant exposure to other endocrine-disrupting environmental chemicals before or after birth was not controlled for. The study population size
研究问题:产前接触邻苯二甲酸盐与青少年女儿生殖激素水平、子宫体积和卵巢卵泡数量的后期影响之间是否可能存在关联?我们的研究表明,妊娠期母体血清或脐带血中的邻苯二甲酸酯代谢物浓度与 16 年后女儿的 LH 和胰岛素样生长因子 1 (IGF-1) 水平以及子宫体积之间存在微妙的联系:已知情况:干扰内分泌的环境化学物质可能会对人类生殖健康产生不利影响,许多社会都出现了青春期提前的趋势,年轻夫妇不孕症的发病率也越来越高。有越来越多的科学证据表明,胎儿接触包括邻苯二甲酸盐在内的大量化学品会对男性生殖健康产生不利影响,但很少有研究探讨其对女性生殖的影响:这项跟踪研究包括哥本哈根母婴队列中的 317 名少女,该队列是一个基于人口的纵向出生队列,共有 1210 名女性,她们出生于 1997 年至 2002 年之间:共对 317 名女性参与者(中位数年龄为 16 岁)的体重、身高和月经模式进行了检查。对血清样本进行了生殖激素浓度分析,并进行了经腹三维超声波检查,以获得卵泡数量、卵巢和子宫大小。115 名女性获得了产前母体血清样本,118 名女性获得了脐带血样本。这些样本分析了 32 种邻苯二甲酸酯代谢物的浓度。主要结果和偶然性的作用:在双变量相关性分析中,发现产前邻苯二甲酸酯代谢物浓度与血清激素浓度(睾酮、17-OH-孕酮和 IGF-1)以及青春期卵巢卵泡数量之间存在负相关。研究发现,产前接触邻苯二甲酸盐与前列腺素和性激素结合球蛋白的浓度之间存在明显的正相关。邻苯二甲酸盐暴露量的综合分析(加权量子和)显示,IGF-1浓度与子宫体积呈显著负相关,与LH浓度呈显著正相关:邻苯二甲酸酯代谢物是在产前单个母体血液样本和脐带血样本的血清中测定的。没有控制产前或产后同时接触其他干扰内分泌的环境化学物质的可能性。研究人群规模有限:我们的研究结果表明,有必要进一步研究环境化学物质在女性生殖系统胎儿发育过程中可能产生的不良影响:这项工作得到了丹麦环境保护局和环境与食品部下属的内分泌干扰素中心(CeHoS)的支持(资助编号:MST-621-00 065)。未声明利益冲突。试验注册号:不适用。
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引用次数: 0
Psychological characteristics and structural brain changes in women with endometriosis and endometriosis-independent chronic pelvic pain. 患有子宫内膜异位症和独立于子宫内膜异位症的慢性盆腔痛妇女的心理特征和大脑结构变化。
IF 6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-01 DOI: 10.1093/humrep/deae207
L Maulitz, S Nehls, E Stickeler, A Ignatov, T Kupec, A T Henn, N Chechko, S N Tchaikovski
<p><strong>Study question: </strong>Are there neurobiological changes induced by endometriosis?</p><p><strong>Summary answer: </strong>Women with endometriosis demonstrate specific neurobiological changes distinct from those in patients with chronic pelvic pain (CPP) in the absence of endometriosis.</p><p><strong>What is known already: </strong>Endometriosis is a chronic disease affecting women of reproductive age that presents with pain and infertility often accompanied by comorbid mental disorders. Only one study with a number of limitations has investigated changes in gray matter volumes and functional connectivity in a small group of patients with endometriosis.</p><p><strong>Study design, size, duration: </strong>This prospective study recruited 53 women undergoing a laparoscopy due to suspicion of symptomatic endometriosis and 25 healthy, pain-free women. Clinical and psychological characteristics, thermal pain perception, and voxel- and surface-based morphology were assessed in all study participants. Thereafter, the patients underwent a laparoscopy, where endometriosis was either histologically confirmed and removed, or ruled out. Correspondingly, patients were assigned into the group with endometriosis (n = 27) or with endometriosis-independent CPP (n = 26) and compared to the pain-free controls.</p><p><strong>Participants/materials, setting, methods: </strong>The study groups were generally representative for the population of women with endometriosis. Sociodemographic, medical, clinical, and psychological characteristics were collected using various questionnaires and a structured clinical interview. Thermal pain perception and voxel- and surface-based morphometry were assessed using thermode and MRI, respectively.</p><p><strong>Main results and the role of chance: </strong>Despite comparable pain intensity and burden of mental disorders, both patient groups demonstrated distinct neurobiological patterns. Women with endometriosis exhibited increased gray matter volume (GMV) in the left cerebellum, lingual gyrus and calcarine gyrus, compared to those with endometriosis-independent CPP. Patients with CPP had decreased GMV in the right cerebellum as compared to controls. Dysmenorrhoea severity correlated positively with GMV in the left inferior parietal lobule, whereas depressive symptoms were associated with decreased GMV in the right superior medial gyrus across patient groups. Dyspareunia correlated negatively with cortical thickness in the left inferior temporal gyrus and left middle temporal gyrus.</p><p><strong>Limitations, reasons for caution: </strong>The study groups differed in a few baseline-characteristics, including educational levels, smoking and BMI. While measuring pain perception thresholds, we did not attempt to mimic CPP by placement of the thermode on the abdominal wall.</p><p><strong>Wider implications of the findings: </strong>Changes in gray matter volume associated with endometriosis differ from those observed in w
研究问题:子宫内膜异位症是否会诱发神经生物学变化?患有子宫内膜异位症的妇女会表现出特殊的神经生物学变化,这些变化不同于没有子宫内膜异位症的慢性盆腔疼痛(CPP)患者:已知信息:子宫内膜异位症是一种影响育龄妇女的慢性疾病,表现为疼痛和不孕,通常伴有精神障碍。只有一项研究对一小部分子宫内膜异位症患者的灰质体积和功能连接性的变化进行了调查,但该研究存在一些局限性:这项前瞻性研究招募了 53 名因怀疑患有无症状子宫内膜异位症而接受腹腔镜检查的妇女和 25 名无痛的健康妇女。研究人员对所有参与者的临床和心理特征、热痛感知、体细胞和表面形态进行了评估。之后,患者接受腹腔镜检查,经组织学证实并切除子宫内膜异位症,或排除子宫内膜异位症。相应地,患者被分为子宫内膜异位症组(n = 27)或子宫内膜异位症独立 CPP 组(n = 26),并与无痛对照组进行比较:研究小组在患有子宫内膜异位症的妇女群体中具有普遍代表性。通过各种问卷和结构化临床访谈收集了社会人口学、医学、临床和心理特征。主要结果和偶然性的作用:主要结果和偶然性的作用:尽管两组患者的疼痛强度和精神障碍负担相当,但她们都表现出了不同的神经生物学模式。与患有子宫内膜异位症的CPP患者相比,患有子宫内膜异位症的妇女左侧小脑、舌回和钙回的灰质体积(GMV)增加。与对照组相比,CPP患者右侧小脑的灰质体积减少。痛经严重程度与左侧顶叶下小叶的GMV呈正相关,而抑郁症状则与各组患者右侧内侧上回的GMV下降有关。排便困难与左侧颞下回和左侧颞中回的皮质厚度呈负相关:研究组在一些基础特征上存在差异,包括教育水平、吸烟和体重指数。在测量痛觉阈值时,我们没有试图通过在腹壁上放置热电极来模拟CPP:研究结果的广泛意义:与子宫内膜异位症相关的灰质体积变化不同于在子宫内膜异位症独立型 CPP 妇女中观察到的变化。我们的研究结果强调了小脑参与疼痛感知和子宫内膜异位症相关疼痛的发病机制:本研究由德国亚琛工业大学医学院START项目资助,并得到德国研究基金会(DFG)国际研究培训小组(IRTG 2150)-269953372/GRK2150的支持。S.T. 得到了德国亚琛工业大学医学院博士后奖学金的支持。无利益冲突。试验注册号:DRKS00021236:DRKS00021236.
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引用次数: 0
Association of uric acid and fructose levels in polycystic ovary syndrome. 多囊卵巢综合征患者尿酸和果糖水平的关系
IF 6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-01 DOI: 10.1093/humrep/deae219
Di Feng, Xiao Wang, Jiahui Song, Hongyue Yang, Yuanyuan Peng, Xinmei Wang, Wanting Chen, Peiyu Li, Yuanyuan Fang, Bei Shi, Da Li
<p><strong>Study question: </strong>Is there a relationship between serum uric acid and fructose levels in polycystic ovary syndrome (PCOS)?</p><p><strong>Summary answer: </strong>Elevated serum uric acid levels in women with PCOS positively correlate with serum fructose levels, and elevated serum fructose levels are an independent risk factor for hyperuricemia in women with PCOS.</p><p><strong>What is known already: </strong>Our previous study suggested a link between elevated serum fructose levels and PCOS. Fructose is unique as it generates uric acid during metabolism, and high uric acid levels are associated with metabolic disorders and an increased risk of anovulation. However, the relationship between serum uric acid and fructose levels in women with PCOS remains unclear.</p><p><strong>Study design, size, duration: </strong>In a case-control study of 774 women (482 controls and 292 patients with PCOS) between May and October 2020 at the Shengjing Hospital of China Medical University, the relationship between uric acid and fructose levels in women with PCOS was examined. Participants were divided into subgroups based on various factors, including BMI, insulin resistance, dyslipidemia, metabolic syndrome, and hyperuricemia.</p><p><strong>Participants/materials, setting, methods: </strong>Serum uric acid concentrations were measured using enzymatic assays, and serum fructose levels were determined using a fluorescent enzyme immunoassay. Dietary fructose data were collected through a validated food-frequency questionnaire of 81 food items. We applied restricted cubic splines to a flexibly model and visualized the linear/nonlinear relationships between serum uric acid and fructose levels in PCOS. Multivariate logistic analysis was executed to assess the association between serum fructose levels and hyperuricemia in PCOS. Human granulosa cell and oocyte mRNA profile sequencing data were downloaded for mapping uric acid and fructose metabolism genes in PCOS. Further downstream analyses, including Gene Ontology, Kyoto Encyclopedia of Genes and Genomes analysis, and protein-protein interactions were then carried out on the differentially expressed genes (DEGs). The correlation between uric acid and fructose metabolism genes was calculated using the Pearson correlation coefficient. The GeneCards database was used to identify DEGs related to uric acid and fructose metabolism in PCOS, and then several DEGs were confirmed by quantitative real-time PCR.</p><p><strong>Main results and the role of chance: </strong>Both serum fructose and uric acid levels were significantly increased in women with PCOS compared with the control women (P  <  0.001), and there was no statistically significant difference in dietary fructose intake between PCOS and controls, regardless of metabolic status. There was a positive linear correlation between serum uric acid and fructose levels in women with PCOS (Poverall < 0.001, Pnon-linear = 0.30). In contrast, no correlation was
研究问题:多囊卵巢综合征(PCOS)患者的血清尿酸和果糖水平之间是否存在关系?多囊卵巢综合征女性血清尿酸水平升高与血清果糖水平呈正相关,血清果糖水平升高是多囊卵巢综合征女性高尿酸血症的独立危险因素:我们之前的研究表明,血清果糖水平升高与多囊卵巢综合症之间存在联系。果糖的独特之处在于它在代谢过程中会产生尿酸,而高尿酸水平与代谢紊乱和无排卵风险增加有关。然而,多囊卵巢综合症女性血清尿酸和果糖水平之间的关系仍不清楚:2020年5月至10月,中国医科大学附属盛京医院对774名女性(482名对照组和292名多囊卵巢综合征患者)进行了一项病例对照研究,探讨了多囊卵巢综合征女性尿酸和果糖水平之间的关系。根据体重指数(BMI)、胰岛素抵抗、血脂异常、代谢综合征和高尿酸血症等不同因素将参与者分为不同的亚组:使用酶法测定血清尿酸浓度,使用荧光酶免疫测定法测定血清果糖水平。膳食果糖数据通过包含 81 种食物的有效食物频率问卷收集。我们在一个灵活的模型中应用了限制性三次样条,并将多囊卵巢综合征患者血清尿酸和果糖水平之间的线性/非线性关系可视化。多变量逻辑分析评估了多囊卵巢综合征患者血清果糖水平与高尿酸血症之间的关系。下载了人类颗粒细胞和卵母细胞 mRNA 图谱测序数据,以绘制 PCOS 中的尿酸和果糖代谢基因图谱。然后对差异表达基因(DEGs)进行了进一步的下游分析,包括基因本体、京都基因和基因组百科全书分析以及蛋白质-蛋白质相互作用分析。利用皮尔逊相关系数计算了尿酸和果糖代谢基因之间的相关性。利用 GeneCards 数据库确定了 PCOS 中与尿酸和果糖代谢相关的 DEGs,然后通过实时定量 PCR 对几个 DEGs 进行了确认:主要结果和偶然性的作用:与对照组妇女相比,多囊卵巢综合征妇女的血清果糖和尿酸水平均明显升高(P 局限性,需谨慎的原因:由于条件有限,更多可能的协变量(如吸烟和种族)没有包括在内,多囊卵巢综合征妇女的果糖和尿酸水平之间的潜在分子机制仍有待进一步研究:本研究结果和我们之前的研究结果表明,多囊卵巢综合征的高尿酸状态可能是由果糖代谢紊乱介导的,这凸显了在多囊卵巢综合征的临床诊断过程中分析果糖代谢,尤其是其代谢副产物尿酸的重要性。这些结果表明了高尿酸对多囊卵巢综合征的不利影响,以及对尿酸水平采取早期干预措施的重要性,以减少多囊卵巢综合征女性代谢紊乱等进一步临床症状的发生和发展:本研究得到了国家自然科学基金(编号:82371647、82071607、32100691)、辽宁省振兴人才计划(编号:XLYC1907071)、霍英东教育基金会(编号:151039)、盛京医院优秀科研基金(编号:202003)的资助。试验注册号:不适用。
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引用次数: 0
Livebirth rates are influenced by an interaction between male and female partners' age: analysis of 59 951 fresh IVF/ICSI cycles with and without male infertility. 活产率受男性和女性伴侣年龄相互作用的影响:对 59 951 例有男性不育和无男性不育的新鲜试管婴儿/卵胞浆单精子显微注射周期进行的分析。
IF 6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-01 DOI: 10.1093/humrep/deae198
A K Datta, S Campbell, R Diaz-Fernandez, G Nargund
<p><strong>Study question: </strong>Does advanced male partner's age impact live birth rates (LBRs) in IVF treatment when female partner's age is factored in?</p><p><strong>Summary answer: </strong>In fresh IVF cycles LBRs decline with male partner's age ≥40 years when the female partner is aged 35-39 years, irrespective of the presence or absence of male factor; but not when the female partner is <35 years or ≥40 years of age; this decline is not observed in ICSI cycles.</p><p><strong>What is known already: </strong>Advanced paternal age is associated with declining sperm parameters, impaired embryo development, compromised pregnancy outcomes, and abnormalities in the offspring in IVF/ICSI cycles. However, data on the interaction between maternal and paternal age on IVF outcomes are very limited and inconsistent. No significant effect of male partner's age on pregnancy outcomes has been noted in donor oocyte cycles.</p><p><strong>Study design, size, duration: </strong>Retrospective analysis of all eligible autologous IVF/ICSI cycles with oocyte retrieval and intended fresh embryo transfer (ET) from the UK's national anonymized registry, published online by the Human Fertilisation and Embryology Authority (HFEA). There were 59 951 cycles that qualified the inclusion criteria in the study period: 1 January 2017 to 31 December 2018.</p><p><strong>Participants/materials, setting, methods: </strong>Couples underwent IVF (n = 27 226) or ICSI (n = 32 725) treatment with partner's sperm followed by fresh ET due to unexplained (n = 31 846), tubal (n = 6605), or male infertility (n = 22 905). Treatment cycles with endometriosis (n = 5563), ovulatory disorders (n = 9970), female partner aged >44 years (n = 636), and PGT (n = 280) were excluded. Women were stratified by age in the following groups: <35, 35-39, 40-42, and 43-44 years; male partner's age as <35 (reference group), 35-37, 38-39, 40-42, 43-44, 45-50, 51-55, 55-60, and >55 years as presented by the HFEA. Some age-groups were merged in the analysis to increase the population size. Chi-square test was used to compare binominal data; and multiple logistic regression to find any association between male and female age-groups on live birth adjusting for other confounders that had a significant effect on this outcome.</p><p><strong>Main results and the role of chance: </strong>LBRs per oocyte retrieval as well as per ET were no different across the male partners' age-groups when the female partners were aged <35 years or in 40- to 44-year age-group, whether male-factor infertility was included or excluded and whether it was IVF or ICSI cycle. However, when IVF was the method of insemination in the female partner's age-group of 35-39 years, LBRs per oocyte retrieval dropped significantly from 27.0% in the male age-group of <35 years (reference group) to 22.9% (P = 0.002), 22.0% (P = 0.006), and 18.8% (P = 0.004) in 40-44, 45-50, and >50 years age-group, respectively in population that included male-fact
研究问题:如果将女性伴侣的年龄考虑在内,高龄男性伴侣的年龄是否会影响试管婴儿治疗中的活产率(LBRs)?在新的试管婴儿周期中,如果女方年龄在 35-39 岁之间,则无论是否存在男性因素,活产率都会随着男方年龄≥40 岁而下降;但如果女方年龄在 35-39 岁之间,则活产率不会随着男方年龄≥40 岁而下降:在试管婴儿/卵胞浆内单精子显微注射(IVF/ICSI)周期中,父方高龄与精子参数下降、胚胎发育受损、妊娠结局受损和后代畸形有关。然而,关于母方和父方年龄对试管婴儿结果的相互影响的数据非常有限,而且不一致。在捐献卵细胞周期中,男方年龄对妊娠结果没有明显影响:研究设计、规模、持续时间:对英国国家匿名登记处所有符合条件的自体IVF/ICSI周期进行回顾性分析,包括卵母细胞检索和预定新鲜胚胎移植(ET),由人类受精与胚胎学管理局(HFEA)在线发布。在研究期间,共有59 951个周期符合纳入标准:参与者/材料、环境、方法:因不明原因(n = 31 846)、输卵管(n = 6605)或男性不育(n = 22 905)而接受试管婴儿(n = 27 226)或ICSI(n = 32 725)治疗后进行新鲜ET的夫妇。不包括子宫内膜异位症(n = 5563)、排卵障碍(n = 9970)、女性伴侣年龄大于 44 岁(n = 636)和 PGT(n = 280)的治疗周期。妇女按年龄分为以下几组:55 岁,如 HFEA 所示。分析中合并了一些年龄组,以扩大样本量。使用卡方检验比较二项式数据;使用多元逻辑回归寻找男性和女性年龄组在活产方面的关联,并调整对这一结果有显著影响的其他混杂因素:主要结果和偶然性的作用:在包括男性因素不孕症的人群中,当女性伴侣的年龄组为 50 岁时,每次取卵和每次 ET 的 LBR 在男性伴侣的年龄组之间没有差异。同样,在没有男性不育的周期中,每次取卵的 LBR 从 35 岁年龄组的 27.6% 下降到 40-44 岁和更大年龄组的 23.5% (P = 0.002)和 22.2%(P = 002)。然而,在有或没有男性不育的情况下进行卵胞浆内单精子显微注射时,男性年龄对任何女性伴侣年龄组的 LBR 都没有影响。在综合试管婴儿和卵胞浆内单精子显微注射周期的分析中,35-39 岁女性年龄组每次取卵和每次 ET 的 LBR 也出现了类似的下降。如果只包括第一个治疗周期(按患者分析)或对单囊胚移植周期进行分析,消除了移植胚胎数量和阶段的影响,推论仍保持不变。在调整了包括男性年龄、女性年龄、先前治疗周期数、先前活产数、人工授精方法(体外受精或卵胞浆内单精子显微注射)、移植胚胎数和胚胎移植日(阶段)在内的混杂因素后,在 35-39 岁女性年龄组中,男性伴侣的年龄与 LBR 仍有显著相关性,但在女性年龄组中,男性伴侣的年龄与 LBR 没有显著相关性:没有关于卵巢储备和刺激方案的信息。鉴于所研究的人群规模较大,这可能影响不大。女性和男性伴侣的年龄是以组为单位给出的,因此在回归分析中必须将其作为序数变量。由于无法追踪后续冷冻解冻 ET 周期的信息,且 HFEA 数据库中没有精液参数异常的严重程度或原因,因此无法确定累积 LBR。为了获得可靠的结果,对一些患者人数较少的年龄组进行了合并:这是支持实验室证据的最大临床数据,证明年轻女性的卵母细胞能够逆转与年龄相关的精子质量下降。由于衰老的卵母细胞失去了这种修复机制,衰老的精子会对LBR产生不利影响。这项研究传递的信息对于咨询患者和制定治疗计划非常重要。对男性和女性年龄之间相互作用的进一步研究将加深我们对这一问题的理解,并有助于确定即使精液无明显异常,ICSI程序是否更适合年龄较大的男性伴侣:不需要资助。无利益冲突。试验注册号:不适用(回顾性分析)。
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引用次数: 0
A heterozygous SPRY4 variant identified in female infertility characterized by reduced oocyte potential and early embryonic arrest. 在女性不孕症中发现了一种杂合子 SPRY4 变体,其特点是卵母细胞潜能降低和早期胚胎停育。
IF 6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-01 DOI: 10.1093/humrep/deae231
Lingjin Xia, Jiami Huang, Qi Che, Jian Zhang, Zhaofeng Zhang, Yupei Shen, Difei Wang, Yushun Zhong, Suying Liu, Jing Du
<p><strong>Study question: </strong>Can novel genetic factors contributing to early embryonic arrest in infertile patients be identified, along with the underlying mechanisms of the pathogenic variant?</p><p><strong>Summary answer: </strong>We identified a heterozygous variant in the SPRY4 (sprouty RTK signaling antagonist 4) in infertile patients and conducted in vitro and in vivo studies to investigate the effects of the variant/deletion, highlighting its critical role in female reproductive health.</p><p><strong>What is known already: </strong>SPRY4 acts as a negative regulator of receptor tyrosine kinases (RTKs) and functions as a tumor suppressor. Its abnormal expression can lead to recurrent miscarriage by affecting trophoblast function. In mice, Spry4 knockout (KO) leads to craniofacial anomalies and growth defects. A human study links the SPRY4 variant to a male patient with isolated hypogonadotropic hypogonadism (IHH), hypothetically impacting gonadotropin-releasing hormone (GnRH) neurons, and causing reproductive dysfunctions. SPRY4 is thus potentially integral in regulating endocrine homeostasis and reproductive function. To date, no study has reported SPRY4 variants associated with female fertility, and a causal relationship has not been established with functional evidence.</p><p><strong>Study design, size, duration: </strong>Whole-exome sequencing (WES) was performed in 392 infertile women who suffered from primary infertility of unknown reason, and the heterozygous SPRY4 variant were identified in one independent family. The infertile patients presenting were recruited from July 2017 to November 2023.</p><p><strong>Participants/materials, setting, methods: </strong>Women diagnosed with primary infertility were recruited from the Reproduction Center of Zhongshan Hospital, Fudan University. Genomic DNA was extracted from peripheral blood for WES analysis. The SPRY4 variant were identified through WES, in silico analysis, and variant screening. All variants were confirmed by Sanger sequencing. The effects of the variants were investigated in human embryonic kidney (HEK) 293T (HEK293T) cells via western blotting, and in mouse oocytes and embryos through complementary RNA (cRNA) injection, RNA sequencing, fluorescence, absorbance, and RT-qPCR assays. Gene function was further examined in Spry4 KO mice via histology, western blotting, ELISA, and RT-qPCR assays.</p><p><strong>Main results and the role of chance: </strong>We identified a missense heterozygous pathogenic variant in SPRY4 (GRCh38, GenBank: NM_030964.5, c.157C>T p.(Arg53Trp), rs200531302) that reduces SPRY4 protein levels in HEK293T cells and disrupts the redox system and mitochondrial function in mouse oocyte, and perturbs developmental potential in mouse embryos. These phenotypes could be partially reversed by the exogenous addition of Nrf1 cRNA. Additionally, Spry4-/- mice exhibit ovarian oxidative stress and decreased ovarian function.</p><p><strong>Limitations, reasons f
研究问题:能否确定导致不孕患者早期胚胎停育的新遗传因素以及致病变体的潜在机制?我们在不孕不育患者中发现了 SPRY4(胚芽 RTK 信号转导拮抗剂 4)的杂合子变体,并进行了体外和体内研究,以探讨变体/缺失的影响,强调其在女性生殖健康中的关键作用:SPRY4是受体酪氨酸激酶(RTKs)的负调控因子,具有肿瘤抑制因子的功能。它的异常表达会影响滋养细胞的功能,从而导致复发性流产。在小鼠中,Spry4基因敲除(KO)会导致颅面畸形和生长缺陷。一项人类研究将 SPRY4 变体与一名男性孤立性性腺功能减退症(IHH)患者联系起来,推测该变体会影响促性腺激素释放激素(GnRH)神经元,导致生殖功能障碍。因此,SPRY4 有可能是调节内分泌平衡和生殖功能不可或缺的因素。迄今为止,还没有研究报告称SPRY4变异与女性生育力有关,也没有功能性证据证明两者之间存在因果关系:对392名原因不明的原发性不孕妇女进行了全外显子组测序(WES),并在一个独立的家庭中发现了杂合子SPRY4变体。不孕症患者的招募时间为2017年7月至2023年11月:从复旦大学附属中山医院生殖中心招募被诊断为原发性不孕的女性。从外周血中提取基因组 DNA 进行 WES 分析。通过WES、硅分析和变异筛选,确定了SPRY4变异。所有变异均通过桑格测序得到证实。在人胚胎肾(HEK)293T(HEK293T)细胞中通过 Western 印迹法研究了变体的影响,在小鼠卵母细胞和胚胎中通过互补 RNA(cRNA)注射、RNA 测序、荧光、吸光度和 RT-qPCR 试验研究了变体的影响。通过组织学、Western 印迹、ELISA 和 RT-qPCR 检测进一步检查了 Spry4 KO 小鼠的基因功能:我们发现了 SPRY4 的一个错义杂合致病变体(GRCh38,GenBank:GRCh38,GenBank:NM_030964.5,c.157C>T p.(Arg53Trp), rs200531302),它降低了SPRY4在HEK293T细胞中的蛋白水平,破坏了小鼠卵母细胞的氧化还原系统和线粒体功能,并干扰了小鼠胚胎的发育潜能。外源添加 Nrf1 cRNA 可部分逆转这些表型。此外,Spry4-/-小鼠表现出卵巢氧化应激和卵巢功能下降:由于 WES 数据和人群有限,我们只发现了一个 SPRY4 突变的家族。研究结果的广泛意义:我们的研究发现了一种与人类早期胚胎停育相关的 SPRY4 致病变异。这些发现加深了我们对 SPRY4 在早期胚胎发育中作用的理解,并为女性不孕症提供了一个新的遗传标记:本研究得到了国家自然科学基金(82071643 和 82171655)和上海市自然科学基金(22ZR1456200)的资助。所有作者均无任何利益冲突:不适用。
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引用次数: 0
Ethical considerations on the moral status of the embryo and embryo-like structures†. 关于胚胎和类胚胎结构道德地位的伦理思考†。
IF 6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-01 DOI: 10.1093/humrep/deae228
Guido Pennings, Wybo Dondorp, Mina Popovic, Susana Chuva de Sousa Lopes, Heidi Mertes

The current article provides an ethical reflection on the moral status of the human embryo, which is a crucial factor in determining permissible actions involving embryos and the extent of their protection. It advocates for the extension of the research period for embryos to 28-days post fertilization. It also states that integrated embryo-like structures (ELSs) should not currently be given the same moral status as natural embryos. However, if they pass the relevant tests, they should be subject to the same rules as natural embryos.

本文从伦理学角度对人类胚胎的道德地位进行了反思,这是决定涉及胚胎的可允许行为 及其保护程度的关键因素。文章主张将胚胎研究期延长至受精后 28 天。它还指出,类似胚胎的综合结构 (ELS) 目前不应享有与天然胚胎相同的道德地位。但是,如果它们通过了相关测试,则应受到与自然胚胎相同规则的约束。
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引用次数: 0
CALR3 defects disrupt sperm-zona pellucida binding in humans: new insights into male factor fertilization failure and relevant clinical therapeutic approaches. CALR3缺陷会破坏人类精子与透明带的结合:男性因素受精失败的新见解及相关临床治疗方法。
IF 6 1区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-01 DOI: 10.1093/humrep/deae205
Yang Gao, Rufeng Xue, Rui Guo, Fan Yang, Xuan Sha, Yuqian Li, Rong Hua, Guotong Li, Qunshan Shen, Kuokuo Li, Wenwen Liu, Yuping Xu, Ping Zhou, Zhaolian Wei, Zhiguo Zhang, Yunxia Cao, Xiaojin He, Huan Wu
<p><strong>Study question: </strong>Do biallelic deleterious variants of Calreticulin 3 (CALR3) cause fertilization failure (FF), resulting in male infertility in humans?</p><p><strong>Summary answer: </strong>Biallelic mutations in CALR3 were identified in two infertile men from unrelated families and were shown to cause FF associated with failed sperm-zona pellucida (ZP) binding.</p><p><strong>What is known already: </strong>In male mice, the Calr3-knockout has been reported to cause male infertility and FF. However, the mechanism behind this remains unclear in humans.</p><p><strong>Study design, size, duration: </strong>Sequencing studies were conducted in a research hospital on samples from Han Chinese families with primary infertility and sperm head deformations to identify the underlying genetic causes.</p><p><strong>Participants/materials, setting, methods: </strong>Data from two infertile probands characterized by sperm head deformation were collected through in silico analysis. Sperm cells from the probands were characterized using light and electron microscopy and used to verify the pathogenicity of genetic factors through functional assays. Subzonal insemination (SUZI) and IVF assays were performed to determine the exact pathogenesis of FF. ICSI were administered to overcome CALR3-affected male infertility.</p><p><strong>Main results and the role of chance: </strong>Novel biallelic deleterious mutations in CALR3 were identified in two infertile men from unrelated families. We found one homozygous frameshift CALR3 mutation (M1: c.17_27del, p.V6Gfs*34) and one compound heterozygous CALR3 mutation (M2: c.943A>G, p.N315D; M3: c.544T>C, p.Y182H). These mutations are rare in the general population and cause acrosomal ultrastructural defects in affected sperm. Furthermore, spermatozoa from patients harbouring the CALR3 mutations were unable to bind to the sperm-ZP or they disrupted gamete fusion or prevented oocyte activation. Molecular assays have revealed that CALR3 is crucial for the maturation of the ZP binding protein in humans. Notably, the successful fertilization via SUZI and ICSI attempts for two patients, as well as the normal expression of PLCζ in the mutant sperm, suggests that ICSI is an optimal treatment for CALR3-deficient FF.</p><p><strong>Limitations, reasons for caution: </strong>The results are based on sperm-related findings from two patients. Further studies are required to gain insight into the developmental stage and function of CALR3 in human testis.</p><p><strong>Wider implications of the findings: </strong>Our findings highlight the underlying risk of FF associated with sperm defects and provide a valuable reference for personalized genetic counselling and clinical treatment of these patients.</p><p><strong>Study funding/competing interest(s): </strong>This study was supported by the National Key R&D Program of China (2021YFC2700901), Hefei Comprehensive National Science Center Medical-Industrial Integration Medical
研究问题:Calreticulin 3(CALR3)的双拷贝致畸变体是否会导致受精失败(FF),从而导致人类男性不育?在两个无血缘关系家族的不育男性中发现了CALR3的双拷贝突变,结果表明这种突变会导致精子与透明带(ZP)结合失败,从而导致受精失败:据报道,在雄性小鼠中,Calr3基因敲除可导致雄性不育和FF。研究设计、规模和持续时间:研究设计、规模、持续时间:在一家研究型医院对原发性不育和精子头部畸形的汉族家庭样本进行测序研究,以确定潜在的遗传原因:通过硅学分析收集了两名精子头部畸形的不育症患者的数据。使用光镜和电子显微镜对这两名疑似患者的精子细胞进行鉴定,并通过功能测试验证遗传因素的致病性。为确定FF的确切致病机理,进行了亚区人工授精(SUZI)和体外受精(IVF)试验。为克服受CALR3影响的男性不育症,进行了卵胞浆内单精子显微注射(ICSI):在两个无血缘关系家族的不育男性中发现了CALR3的新型双重复致畸突变。我们发现了一个同卵框移CALR3突变(M1:c.17_27del,p.V6Gfs*34)和一个复合杂合CALR3突变(M2:c.943A>G,p.N315D;M3:c.544T>C,p.Y182H)。这些突变在普通人群中非常罕见,会导致受影响精子的顶体超微结构缺陷。此外,携带CALR3突变的患者精子无法与精子-ZP结合,或者会破坏配子融合或阻止卵母细胞活化。分子测定显示,CALR3 对人类 ZP 结合蛋白的成熟至关重要。值得注意的是,两名患者通过SUZI和ICSI尝试成功受精,以及突变精子中PLCζ的正常表达,表明ICSI是治疗CALR3缺陷FF的最佳方法:这些结果基于两名患者的精子相关研究结果。研究结果的广泛意义:我们的研究结果突显了FF的潜在风险:我们的研究结果凸显了与精子缺陷相关的FF潜在风险,为这些患者的个性化遗传咨询和临床治疗提供了有价值的参考:本研究得到了国家重点研发计划(2021YFC2700901)、合肥综合性国家科学中心医工结合医疗器械创新研究平台项目(4801001202)、国家自然科学基金(82201803、82371621、82271639)、安徽省教育厅基金(gxgwfx2022007)、安徽省教委自然科学研究重点项目(2023AH053287)和安徽省临床医学研究转化项目(202204295107020037)的支持。作者声明不存在利益冲突:N/A.
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Human reproduction
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