Narrow Results

Objective: The study was conducted to determine whether there were differences in COX-2 expression in endometrial women with PCOS compared to fertile women.

Methods: This study is a case-control study investigating the relationship between exposure (research factors) and disease, by comparing case group and control group based on their exposure status. The samples of this study were infertile polycystic ovary syndrome patients who were treated at the Sekar Fertility Clinic in Dr. Moewardi Hospital Surakarta, and fertile women seeking treatment at Dr. Moewardi Hospital Surakarta. The number of samples were 60 subjects consisting of 30 PCOS patients and 30 fertile women. The expression of COX-2 in endometrial biopsy LH + 5 until LH + 10 which meet the inclusion with Rotterdam criteria and exclusion criteria was checked by immunohistochemistry. The data was analyzed using the Mann-Whitney test.

Results: The mean COX-2 expression in PCOS (10.83 ± 5.35) in fertile women (37.00 ± 7.76), p = 0.005. Regression test of COX-2 by adjusting external variables (occupation, age, education, menstrual disorders, familial history, menstrual cycle, menarche, obesity, contraception history) shows also higher expression in PCOS patient with OR = -7.063; CI = 0.462–108.066; p = 0.160.

Conclusion: COX-2 expression in endometrium of women with PCOS is lower than it is in fertile women.

Decidual leukocytes make up approximately 30% of all decidual stromal cells in early pregnancy, of which 70% are uterine natural killer (uNK) cells. uNK cells are phenotypically distinct from peripheral blood NK cells, being CD56${}^{\text{bright}}$CD16${}^{-}$. A recent single-cell sequencing project of the decidua identified three subsets of uNK cells, but we are yet to determine how they differ functionally. Several roles for uNK cells in implantation are starting to emerge including biosensing of poor-quality embryos, killing of bacteria infected trophoblast, spiral artery remodeling, and regulation of trophoblast invasion. Altered numbers of uNK cells have been identified in several pathological conditions, but whether this is causative of the condition is currently unclear.

Background: Hormone replacement (HR)-frozen thawed embryo transfer (FET) is preferentially used in Japan. HR-FET needs supplementation of progesterone, but there are few data about the efficacy and safety of vaginal progesterone tablet. The aim of this study is to investigate the efficacy of vaginal progesterone tablet in HR-FET cycle in Japanese patients.

Methods: This study was multicenter, single arm, prospective study. Patients with infertility were administered 300 mg/day of vaginal progesterone tablet for luteal phase support in HR-FET cycle from 2015 to 2016.

Results: Main outcomes were available for 344 patients, of which 49 in the cleavage stage ET group and 295 in the blastocyst ET group. Ongoing pregnancy rate were 10.2% in cleavage stage ET group and 28.1% in blastocyst ET group. As for the secondary outcomes in the blastocyst ET group, embryo quality of blastocyst, the number of past ET, and maternal age were significantly associated with pregnancy rate at 2 weeks after progesterone administration. Mean serum progesterone level was 12.1 ± 5.3 ng/mL at the day of ET. There was no relationship between the serum progesterone level on ET day and either of pregnancy rates at 2, 4, and 6 weeks after progesterone administration.

Conclusions: The efficacy of monotherapy using 300 mg/day of vaginal progesterone tablet in HR-FET was shown and the serum progesterone level on ET day did not affect pregnancy rate. (UMIN000021983)

Attempts at assessing endometrial receptivity through its transcriptomic signature have unfortunately failed. On the contrary, RCTs have indicated that the period of receptivity is fairly wide, lasting 48–72 hours. Today, the ultimate challenge is to optimize hormonal preparation for frozen embryo transfers (FETs). Recent data have provided compelling evidence that vaginal progesterone provides insufficient plasma levels of progesterone in a large fraction of patients, which leads to lower live birth rates and increased risks of miscarriage. The most efficient option consists in delivering injectable progesterone, or opting for a combo approach associating vaginal and injectable progesterone.

Background: During hormone replacement therapy (HRT) to optimize endometrial growth for thawed-frozen embryo transfer (FET), patients normally undergo estrogen administration for 14 days (day 14 group). However, if optimal endometrial thickness is not achieved in 14 days, estrogen treatment is continued for seven more days at a higher dose (day 21 group). This study aimed to determine the effects of this extended estrogen administration regimen on pregnancy outcomes.

Methods: A retrospective analysis was performed using our patient database from November 2016 to March 2018. We analyzed 303 cycles of blastocyst-FET and compared patient background characteristics and pregnancy outcomes between day 14 and day 21 groups.

Results: In day 21 group, the pregnancy rate tended to be lower while the miscarriage rate and ectopic pregnancy rate were higher than those in day 14 group. However, the differences between the groups were not statistically significant.

Conclusions: Delayed endometrial growth resulted in poorer pregnancy outcomes in FET, but the differences were not statistically significant. Thus, it could be meaningful to add estrogen administration for 7 days to avoid the poor outcomes caused by a thin endometrium.

Background and Aims: PRP is a biological product defined as a portion of the plasma fraction of autologous blood with a platelet concentration above the baseline. PRP is one of the trends in regenerative medicine and also being used in reproductive medicine area, one of which is to treat thin endometrial problems by infused intrauterine. The goal of this treatment is to reach suitable endometrial thickness by enhancing proliferation of endometrial cells. A good and receptive endometrium is necessary to achieve successful embryo implantation, both in natural pregnancy and assisted reproductive technology. This study aimed to analyze the outcome of PRP treatment during 2022 in Yasmin IVF Clinic RSCM.

Method: This is a retrospective study which collected PRP service data during 2022 in Yasmin IVF Clinic RSCM. 76 subjects underwent PRP intrauterine infusion with thin endometrium indication ($<$6 mm). Subjects were then categorized into two groups, first only underwent PRP procedure once and another group underwent intrauterine PRP procedure two times. Subjects underwent intrauterine PRP procedure more than two times were excluded from this study. All data were then statistically analyzed.

Results: 76 subjects underwent intrauterine PRP infusion in Yasmin IVF Clinic RSCM during 2022. All subjects were diagnosed with thin endometrium ($<$6 mm). Only 23 subjects underwent one intrauterine PRP procedure based on endometrial thickness assessment. The rest of the subjects, 53 patients underwent intrauterine PRP infusion two times. After PRP infusion, the endometrium thickness in PRP group was 8.37 ±0.22 mm, which was significantly thicker than that in control group (6.05 ±0.23 mm) (P $<$0.05). However, implantation rate and clinical pregnancy rate in PRP group were not significantly higher than those in control group (28% vs 9%; 37% vs 20%; P $<$0.05; respectively).

Conclusion: Intrauterine PRP infusion seemed to be a good option in facing thin endometrium diagnosis. It is able to enhance endometrial thickness. However, the result of clinical pregnancy still needs to be improved.