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Effect of insulin-like growth factor system on luteinising angiogenesis. 胰岛素样生长因子系统对黄体生成血管的影响。
Pub Date : 2023-03-01 DOI: 10.1530/RAF-22-0057
Chinwe U Nwachukwu, Robert S Robinson, Kathryn J Woad

Preovulatory follicle growth and the luteal transition requires intense angiogenesis. This enables progesterone production to increase sufficiently to support a pregnancy. Inadequate follicular or luteal vascularisation can lead to reduced ovarian function and thus compromise fertility. Insulin-like growth factor 1 (IGF1) and IGF2 regulate multiple ovarian processes and are key links between an animal's reproductive and metabolic status. This study investigated the role that the IGF system plays in regulating luteinising follicular endothelial cell (EC) networks and progesterone production in vitro. Bovine luteinising follicular angiogenesis cultures were treated with 1) LR3-IGF1 (10 or 100ng/ml) under basal and angiogenic-stimulated conditions or 2) IGF1 receptor inhibitor (picropodophyllin (PPP); 1µM) in the presence or absence of LR3-IGF1, IGF2, or combined LR3-IGF1+IGF2 (10ng/ml). EC networks were quantified by von Willebrand factor immunohistochemistry. Progesterone production was analysed by ELISA and cell proliferation was determined by MTT assay. LR3-IGF1 had limited effects on EC growth parameters, whilst PPP (p<0.001) markedly reduced EC growth parameters (by 60-70%). Cell proliferation was slightly increased (by 3-5%) by LR3-IGF1 (p<0.001). LR3-IGF1 had variable effects on progesterone production, whilst PPP reduced progesterone concentration (p<0.001) with or without LR3-IGF1 or IGF2 alone or in combination. IGF1 was detected in cell conditioned media and was increased by LH (50ng/ml) (p<0.001). In conclusion, exogenous IGF1 and IGF2 had minimal effects on luteinising follicular angiogenesis and progesterone production, but the inhibitory effect of the IGFR1 inhibitor (PPP) suggests that IGF1 receptor signalling is critical for the development of EC networks and progesterone production in luteinising follicular cells.

排卵前卵泡的生长和黄体过渡期需要大量的血管生成。这样才能使孕酮的分泌增加到足以支持怀孕的程度。卵泡或黄体血管生成不足会导致卵巢功能减退,从而影响生育能力。胰岛素样生长因子1(IGF1)和IGF2调节卵巢的多个过程,是动物生殖和代谢状态之间的关键环节。本研究调查了 IGF 系统在体外调节黄体化卵泡内皮细胞(EC)网络和孕酮分泌中的作用。在有或没有 LR3-IGF1、IGF2 或 LR3-IGF1+IGF2 组合(10ng/ml)的条件下,用 1) LR3-IGF1(10 或 100ng/ml)处理牛黄体化卵泡血管生成培养物,或用 2) IGF1 受体抑制剂(苦茶碱(PPP);1µM)处理牛黄体化卵泡血管生成培养物。通过 von Willebrand 因子免疫组化对心血管细胞网络进行量化。通过酶联免疫吸附分析了孕酮的产生情况,并通过 MTT 试验确定了细胞的增殖情况。LR3-IGF1 对心肌细胞生长参数的影响有限,而 PPP(p
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引用次数: 0
Serum anti-müllerian hormone (AMH) concentration during pregnancy: a longitudinal study. 孕期血清抗缪勒氏管激素(AMH)浓度:一项纵向研究。
Pub Date : 2023-03-01 DOI: 10.1530/RAF-22-0128
Sarah McCredie, Belinda An, Monika McShane, William Leigh Ledger, Christos Venetis

A prospective longitudinal cohort study aimed to longitudinally examine the kinetics of Anti-müllerian hormone (AMH) during the first two trimesters of pregnancy. Pregnant women with stored 1st trimester serum samples were recruited at 24-28 weeks gestation during their gestational diabetes testing, where they provided an additional serum sample. The samples were analysed for AMH, oestradiol and progesterone concentrations. A decrease in serum AMH was observed in 40 out of 45 (88.9%) (95% CI 75.9% to 96.3%) of the participants in this study. The median serum AMH concentration was 10.9 pmol/L in the 1st trimester and 6.5 pmol/L during the 2nd trimester, with a significantly different distribution of the values between the 1st and the 2nd trimester AMH samples (p<0.001). The median percentage of AMH difference of -39.8%. This study demonstrated a significant decrease in serum AMH levels from the 1st to the 2nd trimester of pregnancy. The absolute decrease in AMH levels seems to be positively associated with 1st trimester AMH levels, whereas the percentage of AMH difference is not. Further studies are required to elucidate the potential physiological mechanisms of this finding.

一项前瞻性纵向队列研究旨在纵向检测妊娠头两个三个月抗缪勒氏管激素(AMH)的动力学。在妊娠 24-28 周进行妊娠糖尿病检测时,研究人员招募了储存有孕期前三个月血清样本的孕妇,并为她们提供了一份额外的血清样本。对样本进行了 AMH、雌二醇和孕酮浓度分析。在这项研究的 45 名参与者中,有 40 人(88.9%)(95% CI 75.9% 至 96.3%)的血清 AMH 出现下降。妊娠头三个月的血清 AMH 浓度中位数为 10.9 pmol/L,妊娠后三个月的血清 AMH 浓度中位数为 6.5 pmol/L,妊娠头三个月和妊娠后三个月 AMH 样本的数值分布有显著差异(P<0.05)。
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引用次数: 0
The ovaries of transgender men indicate effects of high dose testosterone on the primordial and early growing follicle pool. 变性男性的卵巢表明,大剂量睾酮对原始卵泡和早期生长卵泡池有影响。
Pub Date : 2023-03-01 DOI: 10.1530/RAF-22-0102
Emily Bailie, Mila Maidarti, Stuart Jack, Robert Hawthorn, Neale Watson, Evelyn Telfer, Richard A Anderson

Androgens are essential in normal ovarian function and follicle health but hyperandrogenism, as seen in polycystic ovary syndrome, is associated with disordered follicle development. There are few data on the effect of long-term exposure to high levels of testosterone as found in transgender men receiving gender-affirming endocrine therapy. In this study, we investigate the effect of testosterone on the development, morphological health and DNA damage and repair capacity of human ovarian follicles in vivo and their survival in vitro. Whole ovaries were obtained from transgender men (mean age: 27.6 ± 1.7 years; range 20-34 years, n = 8) at oophorectomy taking pre-operative testosterone therapy. This was compared to cortical biopsies from age-matched healthy women obtained at caesarean section (mean age: 31.8±1.5 years; range= 25-35 years, n=8). Cortical tissues were dissected into fragments and either immediately fixed for histological analysis or cultured for 6 days and subsequently fixed. Follicle classification and morphological health were evaluated from histological sections stained with H&E and expression of γH2AX as a marker of DNA damage by IHC. In uncultured tissue, testosterone exposure was associated with reduced follicle growth activation, poor follicle health and increased DNA damage. After 6 days of culture, there was enhanced follicle activation compared to control with further deterioration in morphological health and increased DNA damage. These data indicate that high circulating concentrations of testosterone have effects on the primordial and small-growing follicles of the ovary. These results may have implications for transgender men receiving gender-affirming therapy prior to considering pregnancy or fertility preservation measures.

雄激素对卵巢的正常功能和卵泡健康至关重要,但多囊卵巢综合症中出现的雄激素过多与卵泡发育紊乱有关。关于变性男性长期暴露于高水平睾酮的影响(如接受性别确认内分泌治疗的变性男性)的数据很少。在这项研究中,我们调查了睾酮对人类卵泡体内发育、形态健康、DNA损伤和修复能力以及体外存活的影响。我们从接受卵巢切除术并在术前接受睾酮治疗的变性男性(平均年龄:27.6 ± 1.7 岁;20-34 岁不等,n = 8)身上获取了整个卵巢。这与年龄匹配的健康女性在剖腹产时获得的皮质活检组织(平均年龄:31.8±1.5 岁;范围= 25-35 岁,n=8)进行了比较。将皮质组织切成碎片,立即固定进行组织学分析,或培养 6 天后再固定。用 H&E 染色的组织切片评估卵泡分类和形态健康状况,并用 IHC 评估 DNA 损伤标记物 γH2AX 的表达。在未培养的组织中,睾酮暴露与卵泡生长激活减少、卵泡健康不良和DNA损伤增加有关。培养 6 天后,与对照组相比,卵泡激活增强,形态健康进一步恶化,DNA 损伤增加。这些数据表明,高浓度的循环睾酮会对卵巢的原始卵泡和小生长卵泡产生影响。这些结果可能会对变性男性在考虑怀孕或采取生育保护措施之前接受性别确认治疗产生影响。
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引用次数: 0
Array Comparative Genomic Hybridization Analysis of Products of Conception in Recurrent Pregnancy Loss for specific anomalies detected by USG. 阵列比较基因组杂交分析复发性妊娠丢失的受精卵对USG检测到的特定异常。
Pub Date : 2023-03-01 DOI: 10.1530/RAF-22-0092
Kinjal Gajjar, Alpesh Patel, Bhikhabhai Patel, Shiva Chettiar, Devendrasinh Jhala

To evaluate the proportion of chromosomal abnormalities in recurrent pregnancy loss (RPL) assisted by array comparative genomic hybridization (aCGH) bright out with higher detection rate, more accuracy, and less sample failure as compared with conventional cytogenetic analysis. In this study, product of conception samples with abnormal USG findings of the fetus and clinical history of RPL were first processed for karyotyping and Fluorescence In Situ Hybridization analysis. Normal results given by Karyotype and FISH samples with major anomalies detected by Ultrasound with RPL were divided into six groups and aCGH was performed to detect the gain or loss and copy number variations (CNVs) of a particular gene present in chromosomal segments. Among a total of 300 POC samples, 100 abnormal samples were identified either by karyotype (n=70) or by FISH (n=30). From the remaining 200 samples, 5 showed the presence of maternal cell contamination excluded. aCGH analysis revealed (n=195) that 74 (38%) samples with copy number variations (CNVs) and two samples with variants of unknown clinical significance (VOUS) were clinically associated with the clinical findings and 121(62%) samples showed no change in CNVs. The most frequent CNVs were loss of chromosome regions at 2q33.1, 7q11.21, 15q11.1, 16p11.2, Xp22.33, and Yp11.32. CNVs at arr[GRCh37]7p22.3,p21.2(830852-15124702)×1,7q34q36.3(141464180_158909738)×3, 14.2Mbp deletion of 7p22.3p21.2 (SUN1 gene) and 17.4Mbp duplication of 7q34q36.3 (KCNH2, CNTNAP2, and SHH genes) in one sample, CNVs at arr[GRCh37]8p22.2q22.3 (86326349_105509986)×1, 2.48Mbp deletion of 8p22.2q22.3 (GRHL1 gene) were found in another sample.

目的:评估阵列比较基因组杂交(aCGH)辅助染色体异常在复发性妊娠丢失(RPL)中的比例,与传统的细胞遗传学分析相比,该方法具有更高的检出率、更高的准确性和更少的样本失败率。在本研究中,首先对胎儿USG异常和RPL临床史的受孕样品进行核型分析和荧光原位杂交分析。将核型和FISH样本的正常结果与超声RPL检测的主要异常分为六组,并进行aCGH检测染色体片段中特定基因的增减和拷贝数变异(CNVs)。在总共300份POC样本中,通过核型(n=70)或FISH (n=30)鉴定出100份异常样本。在剩下的200个样本中,有5个显示排除了母体细胞污染的存在。aCGH分析显示(n=195) 74例(38%)拷贝数变异(CNVs)和2例临床意义未知变异(VOUS)与临床表现相关,121例(62%)拷贝数变异无变化。最常见的CNVs是2q33.1、7q11.21、15q11.1、16p11.2、Xp22.33和Yp11.32染色体区域的缺失。在一个样本中发现arr[GRCh37]7p22.3、p21.2(83082 -15124702)×1、7q34q36.3(141464180_158909738)×3位点的CNVs, 7p22.3p21.2 (SUN1基因)14.2Mbp的缺失和7q34q36.3(KCNH2、CNTNAP2和SHH基因)17.4Mbp的重复,在另一个样本中发现arr[GRCh37]8p22.2q22.3 (86326349_105509986)×1位点的CNVs, 8p22.2q22.3 (GRHL1基因)2.48Mbp的缺失。
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引用次数: 1
Disruption of CSF2RA in the bovine preimplantation embryo reduces development and affects embryonic gene expression in utero. 牛植入前胚胎中CSF2RA的破坏降低了发育并影响了子宫内胚胎基因的表达。
Pub Date : 2023-03-01 DOI: 10.1530/RAF-23-0001
Froylan Sosa, Kyungjun Uh, Jessica N Drum, Katy S Stoecklein, Kimberly M Davenport, M Sofia Ortega, Kiho Lee, Peter J Hansen

The hypothesis that CSF2 plays a role in the preimplantation development of the bovine embryo was tested by evaluating consequences of inactivation of CSF2RA (the functional receptor in the embryo) for development of embryos in utero. CRISPR/Cas9 was used to alter sequences on exon 5 and intron 5 of CSF2RA, Control embryos were injected with Cas9 mRNA only. Embryos > 16 cells at day 5 after insemination were transferred to synchronized recipient females in groups of 7 to 24. Embryos were flushed from the uterus two days later. The proportion of recovered embryos that developed to the blastocyst stage was lower for knockout embryos (39%) than for control embryos (63%). RNA sequencing of individual morulae and blastocysts indicated a total of 27 (morula) or 15 (blastocyst) differentially-expressed genes (false discovery rate <0.05). Gene set enrichment analysis indicated that the knockout affected genes playing roles in several functions including cell signaling and glycosylation. It was concluded that signaling through CSF2RA is not obligatory for development of the bovine preimplantation embryo to the blastocyst stage but that CSF2 signaling does enhance the likelihood that the embryo can become a blastocyst and result in specific changes in gene expression.

CSF2在牛胚胎植入前发育中发挥作用的假设是通过评估CSF2RA(胚胎中的功能受体)失活对子宫内胚胎发育的影响来测试的。CRISPR/Cas9用于改变CSF2RA外显子5和内含子5的序列,对照胚胎仅注射Cas9mRNA。受精后第5天>16个细胞的胚胎被转移到7至24组的同步受体雌性。两天后,胚胎被从子宫中冲洗出来。敲除胚胎发育到胚泡阶段的回收胚胎比例(39%)低于对照胚胎(63%)。单个桑椹胚和胚泡的RNA测序显示,共有27个(桑椹胚)或15个(胚泡)差异表达基因(错误发现率
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引用次数: 0
Does kisspeptin exert a local modulatory effect on bovine ovarian steroidogenesis? kisspeptin对牛卵巢类固醇生成有局部调节作用吗?
Pub Date : 2023-02-01 DOI: 10.1530/RAF-22-0088
Dareen Mattar, Warakorn Cheewasopit, Moafaq Samir, Philip G Knight

Kisspeptin, a hypothalamic neuropeptide encoded by the KISS1 gene, has a pivotal role in promoting GnRH secretion in mammals. Kisspeptin and its receptor (KISS1R) are also expressed in certain peripheral tissues including gonads, suggesting intra-gonadal roles. Such actions at the level of the bovine ovary have not been explored previously. The current aims were to determine whether KISS1 and its receptor (KISS1R) are expressed in the bovine ovary and whether kisspeptin or a kisspeptin antagonist can modulate ovarian steroid production by cultured ovarian cells. Granulosa (GC) and theca interna (TC) were collected from antral follicles (3-18 mm) categorized into five class sizes. Early, mid and regressing corpora lutea (CL) were also collected for RT-qPCR analysis of KISS1 and KISS1R expression. Bovine TC and GC cultured under both non-luteinizing (serum-free) and luteinizing (serum-supplemented) conditions were treated for 4 days with kisspeptin-10 (10-10-10-6M) or kisspeptin antagonist (p234; 10-10-10-6M), alone and in combination with either FSH (GC), LH (TC) or forskolin (luteinized GC/TC). Steroid secretion (GC: oestradiol, progesterone; TC: androstenedione, progesterone; luteinized GC/TC: progesterone) was measured by ELISA and viable cell number determined by neutral red uptake assay. KISS1 and KISS1R transcripts were detected in TC, GC and CL with significant differences between follicle categories and CL stages. However, neither kisspeptin-10 nor kisspeptin antagonist affected steroid secretion or viable cell number in any of the four ovarian cell culture models. As such, the hypothesis that kisspeptin has a direct intra-ovarian role to modulate follicular or luteal steroidogenesis, or cell proliferation/survival, is not supported.

Kisspeptin是一种由KISS1基因编码的下丘脑神经肽,在促进哺乳动物GnRH分泌方面起着关键作用。Kisspeptin 及其受体(KISS1R)也在包括性腺在内的某些外周组织中表达,表明其在性腺内发挥作用。此前尚未对牛卵巢水平的此类作用进行过研究。目前的目的是确定 KISS1 及其受体(KISS1R)是否在牛卵巢中表达,以及吻肽或吻肽拮抗剂是否能调节培养卵巢细胞产生的卵巢类固醇。从前庭卵泡(3-18 毫米)中收集颗粒细胞(GC)和间质细胞(TC),并将其分为五个等级。还收集了早期、中期和退行性黄体(CL),用于对 KISS1 和 KISS1R 的表达进行 RT-qPCR 分析。在非黄体化(无血清)和黄体化(补充血清)条件下培养的牛 TC 和 GC 单独或与 FSH(GC)、LH(TC)或福斯克林(黄体化 GC/TC)联合使用吻肽-10(10-10-6M)或吻肽拮抗剂(p234;10-10-6M)处理 4 天。类固醇分泌量(GC:雌二醇、黄体酮;TC:雄烯二酮、黄体酮;黄体化 GC/TC:黄体酮)通过酶联免疫吸附试验测定,存活细胞数通过中性红吸收试验测定。在TC、GC和CL中检测到了KISS1和KISS1R转录物,不同卵泡类别和CL阶段的KISS1和KISS1R转录物差异显著。然而,在四种卵巢细胞培养模型中,无论是吻肽-10还是吻肽拮抗剂都不会影响类固醇的分泌或存活细胞的数量。因此,Kisspeptin在卵巢内直接调节卵泡或黄体类固醇生成或细胞增殖/存活的假设未得到支持。
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引用次数: 0
Integrins and ligands, are correlated at pig placental interface during pregnancy? 整合素和配体,在怀孕期间与猪胎盘界面是否相关?
Pub Date : 2023-02-01 DOI: 10.1530/RAF-22-0079
Carolina Vélez, Mariángeles Clauzure, Delia Williamson, Mónica García, Mirta Koncurat, Claudio Barbeito

In the present work, we emphasize the studies about integrins and their receptors in pig placental interface at different times of gestation. Uterine placental interface (n=24) of 17-, 30-, 60- and 70-days gestation (dg) and non-pregnant uterus (n=4) of crossbred sows were used. The presence of αvβ3 and α5β1 integrins, and their ligands fibronectin (FN), and osteopontin (OPN) were detected by immunohistochemistry, and the immunolabelled area percentage (IAP) and the optical density (OD) were determined. The integrins and its ligands analyzed have presented peaks of expression in early and mid-gestation, both in IAP and the OD area decreasing at 70 dg. These temporal changes showed us that the molecules studied in this work participate in embryo/feto-maternal attachment, variably. Besides, we found a significant correlation both in the intensity and in the extension of immunostaining for trophoblastic FN and endometrial αvβ3, and trophoblastic OPN and endometrial α5β1, throughout the entire pig pregnancy. At late gestation, take place a notable placental remodelation with subsequent removal or renewal of folds at the uterine-placental interface that results in the loss of focal adhesions. The decrease of the expression of some integrins and their ligands in late gestation, particularly at 70 dg, would demonstrate that there would be other adhesion molecules and other ligands that could be participating in the establishment of the maternal-fetal interface.

在本研究中,我们重点研究了不同妊娠期猪胎盘界面的整合素及其受体。研究对象为妊娠 17、30、60 和 70 dg 的杂交母猪子宫胎盘界面(n=24)和非妊娠子宫(n=4)。采用免疫组织化学方法检测αvβ3和α5β1整合素及其配体纤维连接蛋白(FN)和骨生长因子(OPN)的存在,并测定免疫标记面积百分比(IAP)和光密度(OD)。所分析的整合素及其配体在妊娠早期和中期出现了表达高峰,在妊娠 70 dg 时,IAP 和 OD 面积均有所下降。这些时间上的变化向我们表明,这项工作中研究的分子参与了胚胎/胎儿与母体的附着,而且是可变的。此外,我们发现滋养层 FN 和子宫内膜 αvβ3、滋养层 OPN 和子宫内膜 α5β1的免疫染色的强度和范围在整个猪妊娠过程中都有显著的相关性。在妊娠晚期,胎盘会发生明显的重塑,随后子宫胎盘界面的褶皱会被去除或更新,从而导致局灶性粘连的消失。在妊娠晚期,特别是 70 dg 时,一些整合素及其配体的表达减少,这表明可能还有其他粘附分子和配体参与母胎界面的建立。
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引用次数: 0
Revealing the uterine blood vessel network via virtual pathology. 通过虚拟病理学揭示子宫血管网络。
Pub Date : 2023-02-01 DOI: 10.1530/RAF-22-0135
Tsafrir S Kolatt, Yoel Shufaro, Shlomo Mashiach, Bernard Czernobilsky, Sarit Aviel-Ronen, Liat Apel-Sarid, Mazal Dahan, Yuval Or

Background: The distribution of the blood vessel network at any point in time in any body tissue, may provide valuable information with regards to the tissue condition and its angiogenesis functionality. The blood vessel three-dimensional network of the endometrium goes through a process of change over a relatively short period of 4 weeks on average. It is well accepted that this angiogenesis is closely related to the success or failure of the implantation of the embryo Objective and rationale: Our study aims to present a method to follow the three-dimensional evolution of the superficial blood vessel distribution in the endometrium throughout the uterine cycle.

Method: This method utilizes differences in the observed broadband colors of the blood vessels in order to assess their depth coordinate below the endometrial tissue surface. We implemented the method using microscopic images of fresh, ex-vivo, endometrial samples of different cycle days to obtain the statistical evolution track of the superficial blood vessel population in both human and animal (swine) samples.

Outcomes: In human samples we observed a systematic and consistent trend in the BV diameter distribution at different tissue depths. We demonstrate that the magnitude of this trend evolves throughout the course of the female cycle.

Wider implications: This method has the potential to further our understanding of the mechanisms of angiogenesis in tissues other than the endometrium. We propose that this method may also contribute to more precise endometrial dating and may assist in more accurate determination of embryo transfer timing within IVF treatments.

背景:任何身体组织在任何时刻的血管网络分布情况,都可能提供有关组织状况及其血管生成功能的宝贵信息。子宫内膜的血管三维网络会在平均 4 周的较短时间内发生变化。人们普遍认为,血管生成与胚胎植入的成败密切相关:我们的研究旨在提出一种在整个子宫周期中跟踪子宫内膜表层血管分布三维演变的方法:方法:该方法利用观察到的血管宽带颜色差异来评估血管在子宫内膜组织表面下的深度坐标。我们利用不同周期天数的新鲜、体外子宫内膜样本的显微图像实施了该方法,以获得人类和动物(猪)样本表层血管群的统计演变轨迹:结果:在人类样本中,我们观察到不同组织深度的浅表血管直径分布呈系统一致的趋势。结果:在人类样本中,我们观察到不同组织深度的 BV 直径分布有一个系统且一致的趋势,我们证明了这一趋势的大小在整个雌性周期中都在演变:更广泛的意义:这种方法有可能进一步加深我们对子宫内膜以外组织血管生成机制的理解。我们认为这种方法还有助于更精确地确定子宫内膜的时间,并有助于更准确地确定试管婴儿治疗中的胚胎移植时间。
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引用次数: 0
Acknowledgement to reviewers 审稿人致谢
Pub Date : 2023-02-01 DOI: 10.1530/raf-4-a1
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引用次数: 0
Effect of growth hormone cotreatment in sub-fertile women ≥ 40 years: A Meta-analysis. 生长激素联合治疗对≥40 岁亚健康女性的影响:一项 Meta 分析。
Pub Date : 2023-02-01 DOI: 10.1530/RAF-22-0107
Mohamed Elkalyoubi, Larissa Schindler, Hena Zaheer

Treatment of sub-fertile women aged ≥ 40 years old (AMA) is challenging. Co-treatment with growth hormone (GH) is suggested to improve reproductive outcomes in poor responders. However, few studies, and with conflicting results, focused on women with AMA. A systematic review and meta-analysis of randomized controlled trials (RCTs) and comparative retrospective trials (CRTs) of GH cotreatment in AMA women undergoing in vitro fertilization or intracytoplasmic injection treatment using their autologous oocytes was performed. The search included studies published in English up to the end of 2021. The primary outcome was the clinical pregnancy rate per embryo transfer. Secondary outcomes were the number of mature and retrieved oocytes and the rate of live birth. 406 studies were found. The final analysis included three RCTs and four CRTs with 481 patients who used GH and 400 patients who did not. Clinical pregnancy and live birth rates were significantly higher in the GH cotreatment group compared to the placebo as well as the group without GH co-treatment, (OR 2.2; 95% CI 1.34 - 3.61 and OR 4.12; 95% CI 1.82 - 9.32, respectively). Intriguingly, the subgroup analysis showed that poor-responder patients did not benefit from co-treatment with GH. There were no statistically significant differences in the number of mature or retrieved oocytes. GH cotreatment in a subgroup of women with AMA improves clinical pregnancy and live birth per fresh embryo transfer. However, this conclusion must be taken with caution and further research is needed. The review is registered in PROSPERO database (CRD42021252618). www.crd.york.ac.uk/prospero/.

治疗年龄≥ 40 岁的亚健康女性(AMA)具有挑战性。有人建议,与生长激素(GH)联合治疗可改善反应不佳者的生殖结果。然而,针对 AMA 妇女的研究很少,而且结果相互矛盾。我们对使用自体卵母细胞进行体外受精或卵胞浆内注射治疗的 AMA 妇女的生长激素联合治疗的随机对照试验(RCT)和比较回顾性试验(CRT)进行了系统回顾和荟萃分析。检索包括截至 2021 年底发表的英文研究。主要结果是每次胚胎移植的临床妊娠率。次要结果是成熟和取出的卵母细胞数量以及活产率。共找到 406 项研究。最终分析包括三项 RCT 和四项 CRT,其中 481 名患者使用了 GH,400 名患者未使用。与安慰剂组和未使用 GH 联合治疗组相比,GH 联合治疗组的临床妊娠率和活产率明显更高(OR 2.2;95% CI 1.34 - 3.61 和 OR 4.12;95% CI 1.82 - 9.32)。耐人寻味的是,亚组分析表明,反应差的患者并不能从与 GH 的联合治疗中获益。在成熟卵母细胞数量或取回卵母细胞数量方面,没有统计学意义上的显著差异。对患有 AMA 的亚组妇女进行 GH 联合治疗可提高临床妊娠率和每次新鲜胚胎移植的活产率。但这一结论必须谨慎对待,还需要进一步研究。该综述已在 PROSPERO 数据库中注册(CRD42021252618)。www.crd.york.ac.uk/prospero/。
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Reproduction & Fertility
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