Anandamide (N-arachidonoylethanolamine) is an endogenous ligand for both the brain-type (CB1-R) and spleen-type (CB2-R) cannabinoid receptors. This investigation demonstrates that the periimplantation mouse uterus contains the highest levels of anandamide (142-1345 pmol/μ mol lipid P; 1-7 μ g/g wet weight) yet discovered in a mammalian tissue. The levels fluctuate with the state of pregnancy; down-regulation of anandamide levels is associated with uterine receptivity, while up-regulation is correlated with uterine refractoriness to embryo implantation. Anandamide levels are highest during the nonreceptive phase in the pseudopregnant uterus and in the interimplantation sites, and lowest at the site of embryo implantation. The lower levels of uterine anandamide at the implantation sites may be a mechanism by which implanting embryos protect themselves from the detrimental effects of this endogenous ligand. We also observed a reduced rate of zona-hatching of blastocysts in vitro in the presence of anandamide, and inhibition of implantation by systemic administration of a synthetic cannabinoid agonist CP 55,940. These adverse effects were reversed by SR141716A, a specific CB1-R antagonist. Taken together, the results suggest that an aberrant synthesis of anandamide and/or expression of the cannabinoid receptors in the uterus/embryo may account for early pregnancy failure or female infertility.
Purpose: Our purpose was to determine the effects of endometriosis on implantation and pregnancy rates in ovum recipients. Methods: The medical records of 239 consecutive oocyte recipient patients who were treated between January 1, 1991, and June 30, 1995, were analyzed retrospectively. Recipients with endometriosis (group I; n=55) were compared to recipients without endometriosis (group II; n=184). Patients in group I had active endometriotic disease confirmed by laparoscopy and were subdivided into mild (Stages I and II; n=18) and moderate to severe (Stages III and IV; n=37) endometriosis. Results: No difference was found in recipient age, endometrial thickness, donor age, and embryos transferred. The pregnancy rates (28 versus 29%) and implantation rates (12 and 13%) were also comparable between group I and group II, as well as between patients with mild and patients with moderate to severe endometriosis. Conclusions: The presence of endometriosis in oocyte recipients does not lower implantation or pregnancy rates. We conclude that the adverse effect of endometriosis on reproductive outcome is not related to implantation but, in fact, is most likely an effect on oocyte or embryo quality.
Attempts to date to increase the rate of embryo implantation, for example by assisting embryo hatching from the zona pellucida, have failed. Recently, several studies have suggested the biostimulating effect of low power laser irradiation. The objective of this study was therefore to examine the potential of low power laser irradiation of the uterus to enhance embryo implantation rate in the rat. Rat potential of low power laser irradiation of the uterus to enhance embryo implantation rate in the rat. Rat blastocysts were flushed from the uterus on day 5 of gestation. They were transferred to the uteri of pseudopregnant recipients on day 4 or 5 of pseudopregnancy. One cornu of the recipient uterus was irradiated; the other was used as control. On day 5 of pregnancy, irradiation did not change implantation rate after 10 or 30 sec of irradiation while 120 sec. of irradiation significantly decreased embryonic implantation. On the other hand, on day 4 of pregnancy, 120 sec. of radiation allowed embryonic implantation to a level similar to that seen after synchronized transfer. Conclusion: He-Ne laser irradiation of the exposed rat uterus can attenuate embryo implantation rate.
Our purpose was to evaluate the early luteal phase of assisted reproductive cycles utilizing controlled ovarian hyperstimulation and to compare these results with those obtained in unstimulated cycles. We undertook a descriptive study analyzing luteal phase serum progesterone levels, endometrial histologic features, and endometrial surface ultrastructure by scanning electron microscopy of cycles utilizing controlled ovarian hyperstimulation. Study samples were obtained from 7 oocyte donors undergoing controlled ovarian hyperstimulation for the purpose of follicle aspiration in oocyte donation. Control (unstimulated) serum progesterone samples were obtained from 19 patients undergoing in vitro fertilization in unstimulated cycles. Prospective recipients of oocyte donation ( = 20) undergoing mock cycles of exogenous estradiol and progesterone acted as controls for the endometrial biopsies. Serum progesterone levels on the day of human chorionic gonadotropin administration were twofold higher in the study group than in the unstimulated group (1.1 ± 0.6 vs 0.5 ± 0.2 ng/ml, mean ± SD, < 0.01). On the day of follicle aspiration, progesterone levels were much higher in the study group (8.5 ± 2.2 vs 0.5 ± 0.1 ng/ml, < 0.001). Histologic dating of endometrial biopsies revealed that the study group was advanced by nearly 2 days as compared with the group having artificial cycles. Pinopods, ultrastructural markers of the implantation window, were present in only one of seven study cycles as compared with all of the four artificial cycles. The early luteal phase of cycles undergoing controlled ovarian hyperstimulation is characterized by markedly elevated serum progesterone levels during the periovulatory period, advanced endometrial histologic features, and an absence of endometrial pinopods at the time of embryo implantation. We speculate that these high levels of progesterone in the early luteal phase cause premature endometrial luteinization and a premature appearance of the implantation window, thus providing an explanation for the observed decrease in endometrial receptivity. (Am J Obstet Gynecol 1997;176:1262-9.)
We have reported that i.v. administration of splenocytes prepared from early pregnant mice promoted embryo implantation in pseudopregnant CD-1 (ICR) (closed colony) mice. In this study, the similar effects of splenocytes were confirmed using an inbred strain, BALB/c mice, and the mechanism was further investigated. Splenocytes were prepared from pregnancy day 4 (P4-spl) and dioestrus mice (Di-spl), and supernatant of P4-spl suspension (P4-sup) was used as controls. On pseudopregnancy day 2, splenocytes or supernatant were injected into caudal vein or endometrial stroma of the recipient mice, and blastocysts were transferred into the endometrial lumen. In both BALB/c and ICR strains, the implantation rates per recipient with i.v. and intraendometrial injection were significantly higher in P4-spl groups. Then, ICR mice were oophorectomized on pseudopregnancy day 3. After 3 day progesterone supplementation, blastocysts were transferred with i.v. injection of P4-spl and P4-sup, or s.c. oestradiol injection. Under progesterone supplementation, successful implantations were observed in the P4-spl- and oestradiol-treated groups, but not in P4-sup-treated group. Reverse transcriptase-polymerase chain reaction analysis revealed that messenger RNA expression of leukaemia inhibitory factor in the uterus was induced by P4-spl and oestradiol, but not by P4-sup. These findings showed that splenocytes of early pregnant mice promote embryo implantation by regulating endometrial differentiation.
This retrospective study of 1001 in-vitro fertilization (IVF) cycles included a consecutive series of single transfers (n = 341), dual transfers (n = 410) and triple transfers (n = 250) where all the transferred embryos in each cycle were of identical quality score and identical cleavage stage. In our 2 day culture system, transfer of 4-cell embryos resulted in a significantly higher implantation rate and pregnancy rate (23 and 49%) compared with 2-cell embryos (12 and 22%) and 3-cell embryos (7 and 15%). Furthermore, the transfer of 4-cell embryos resulted in a significantly higher pregnancy rate compared with embryos that had cleaved beyond the 4-cell stage (28%). The implantation rate (21%) and pregnancy rate (43%) after transfer of embryos of score 1.0 were significantly higher than after transfer of embryos of score 2.0 (14 and 32% respectively). Transferring embryos of score 2.1 resulted in significantly higher implantation rates (26%) and similar pregnancy rates compared with score 1.0. Transferring embryos of score 2.2-3.0 resulted in a significantly lower implantation rate (5%) and pregnancy rate (15%). A striking finding was that embryos of quality score 2.0 had a significantly lower implantation rate compared with embryos of quality score 1.0 and 2.1 and a significantly lower pregnancy rate compared to embryos of quality score 1.0. We also found a lower implantation rate and pregnancy rate when transferring 3-cell embryos. These findings may indicate periods of increased sensitivity to damage during the cell cycle. In conclusion, these results substantiate the idea of the superiority of 4-cell embryos and demonstrate that minor amounts of fragments in the embryo may not be of any importance. These findings may call for a shift when weighing the two main morphological components (quality score and cleavage stage) in the sense that reaching a 4-cell cleavage stage even with the presence of a minor amount of fragments should be preferred to a 2-cell embryo with no fragments.
Cyclooxygenase (COX) is the rate-limiting enzyme in the synthesis of prostaglandins (PGs) and exists in two isoforms, COX-1 and COX-2. In spite of long-standing speculation, definitive roles of PGs in various events of early pregnancy remain elusive. We demonstrate herein that the targeted disruption of COX-2, but not COX-1, in mice produces multiple failures in female reproductive processes that include ovulation, fertilization, implantation, and decidualization. Using multiple approaches, we conclude that these defects are the direct result of target organ-specific COX-2 deficiency but are not the result of deficiency of pituitary gonadotropins or ovarian steroid hormones, or reduced responsiveness of the target organs to their respective hormones.
Objective: To verify the percentage of chromosomally abnormal preimplantation embryos in patients with a poor prognosis and possibly to increase the chance of implantation by selecting chromosomally normal embryos. Design: A prospective, randomized, controlled study. Setting: In vitro fertilization program at the Reproductive Medicine Unit of the Societa Italiana Studi Medicina della Riproduzione, Bologna, Italy. Patient(s): In a total of 28 stimulated cycles, the maternal age was ≤38 years and/or the patient had ≤3 previous IVF failures, factors that indicated a poor prognosis. After consent, 11 patients underwent preimplantation genetic diagnosis for aneuploidy, whereas 17 controls underwent assisted zona hatching. Intervention(s): Simultaneous analysis of chromosomes X, Y, 13, 18, and 21 in a blastomere biopsied from day-3 embryos. Chromosomal analysis was performed with fluorescence in situ hybridization. Assisted zona hatching was performed on day-3 embryos from the control-group patients. Main Outcome Measure(s): Embryo morphology, results of fluorescence in situ hybridization, clinical pregnancies, and implantation. Result(s): In the study group, a total of 61 embryos were analyzed by fluorescence in situ hybridization, and 55% were chromosomally abnormal. Embryo transfer with at least one normal embryo was performed in 10 cycles. Four clinical pregnancies resulted, with a 28.0% implantation rate. In the control group, 41 embryos were transferred in 17 cycles after the assisted zona hatching procedure, yielding four clinical pregnancies and an 11.9% implantation rate. Conclusion(s): Infertile patients classified as having a poor prognosis have a high percentage of chromosomally abnormal embryos. The advantage of selecting and transferring embryos with normal fluorescence in situ hybridization results has an immediate impact on implantation.
Objective: To review the available information regarding the role of integrins in reproductive physiology and to discuss their potential clinical implications. Design: Studies that specifically relate to the expression and modulation of integrins in fertilization, embryogenesis, and implantation were identified through the literature and Medline searches. Result(s): Integrins are a class of adhesion molecules that participate in cell-to-cell and cell-to-substratum interactions and are present on essentially all human cells. All mammalian eggs express integrins at their surface, and the integrin α β serves as a sperm receptor that mediates sperm-egg binding. In addition, certain integrin moieties appear to be regulated within the cycling endometrium. Specifically, the expression of β integrins in the early proliferative phase is restricted to the glandular epithelium, whereas stromal cells also express β integrins in the midsecretory phase. The expression of β integrins increases at the time of implantation and remains elevated in the decidua during early pregnancy. A disruption of integrin expression is associated with certain types of infertility in women. The apical surface of the mural trophectoderm does indeed possess functional integrins, and trophoblast interactions with extracellular matrix proteins largely depend on the integrin family of adhesion receptors. Conclusion(s): Integrins play particularly important roles in both fertilization and embryogenesis, including the process of implantation.