C.O. Perfetto

Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss

OBJECTIVE To evaluate the prevalence of chronic endometritis (CE) in women with recurrent pregnancy loss (RPL) and compare pregnancy outcomes in women with and without CE. DESIGN Case-control observational study. SETTING Academic fertility practice. PATIENT(S) Women with two or more pregnancy losses. INTERVENTION(S) Hematoxylin and eosin (H & E) staining was performed on all endometrial biopsies and plasma cells were identified by morphology. Immunohistochemical (IHC) staining for CD138 was later applied to all tissue samples. Charts were reviewed to evaluate the outcome of the next clinical intrauterine pregnancy. MAIN OUTCOME MEASURE(S) Miscarriage rate and live birth rate. RESULT(S) A total of 107 women met inclusion criteria. The use of CD138 IHC staining resulted in a significantly higher prevalence of CE compared with the use of H & E staining and morphological assessment alone (56% [60/107] vs. 13% [14/107]). The 51 women with untreated CE were compared with the 45 women without CE by CD138 staining. Among those women with a subsequent pregnancy, the live birth rate in the next clinical intrauterine pregnancy after endometrial evaluation was 67.6% (23/34) in women with untreated CE and 87.1% (27/31) in women without CE. Age, body mass index (BMI), results of RPL evaluation, and number of prior losses were not significantly different between the two groups. CONCLUSION(S) CD138 IHC staining of endometrial biopsies in women with RPL provides increased sensitivity when screening for CE compared with H & E staining and morphological assessment alone. Untreated CE may contribute to poor pregnancy outcomes and deserves further investigation in a larger cohort.

Expression of interleukin-22 in decidua of patients with early pregnancy and unexplained recurrent pregnancy loss.

PurposeResearchers have hypothesized that an imbalance of immune cells in the uterine decidua and a dysfunction in cytokines they produce may contribute to recurrent pregnancy loss (RPL). The objective of this study was to determine if IL-22, IL-23 and IL-17 are expressed abnormally in the decidua of patients with RPL compared to those women with a normal pregnancy. We also sought to confirm that uterine natural killer (uNK) cells are lower in the decidua of patients with RPL, as well as identify IL-22 expression by uNK cells.MethodsAfter meeting strict inclusion criteria, maternal decidua of nine patients with unexplained RPL and a confirmed euploid fetal loss, and 11 gestational age-matched patients undergoing elective pregnancy termination were included in our analysis. Quantitative real time-polymerase chain reaction (qRT-PCR) was performed to quantify RNA expression, Western blot was performed to quantify protein expression and immunohistochemistry (IHC) was performed to identify IL-22 and uNK cells.ResultsWe found that women with unexplained RPL and a euploid fetal loss had significantly less gene and protein expression of IL-22 in the decidua. Additionally, we found that IL-22 is primarily expressed by uNK cells in the decidua.ConclusionsIn conclusion, our results suggest that lower levels of IL-22 in the uterine decidua in patients with unexplained RPL may contribute to a disruption of decidual homeostasis and ultimately lead to early pregnancy loss.

Female Infertility and Fertility Preservation

Infertility is a common problem, affecting 10–15 % of couples. This chapter focuses on evaluating the female for factors that can lead to infertility. As outcomes for cancer survivors improve and the population ages, many patients may be interested in fertility preservation for medical or social reasons. Treatment options for these patients are outlined. Indications for embryo, oocyte, and ovarian tissue cryopreservation are discussed.

Success and Anticipated Pregnancy Outcomes for Oocyte and Embryo Donation

Almost three decades ago, oocyte and embryo donation became an option for women who had experienced unsuccessful fertility treatments or were not candidates for other assisted reproductive technologies. Women with surgical or natural menopause, diminished ovarian reserve, premature ovarian failure, recurrent pregnancy loss, poor ovarian response to stimulation, or carriers of an inheritable disorder were provided with a new option for fertility. Women that were previously considered sterile were now able to have successful pregnancy and childbirth.