Effect of the oxytocin receptor antagonist nolasiban on pregnancy rates in women undergoing embryo transfer following IVF: analysis of three randomised clinical trials.

STUDY QUESTION: Does a single oral dose of nolasiban 900 mg administered 4 h before embryo transfer (ET) increase pregnancy rates in women undergoing IVF? SUMMARY ANSWER: In an individual patient data (IPD) meta-analysis of three clinical trials, a single oral dose of nolasiban 900 mg was associated with an increased ongoing pregnancy rate of an absolute 5% (relative 15%). WHAT IS KNOWN ALREADY: Several clinical studies have shown that blocking activation of oxytocin receptors by an oxytocin receptor (OTR) antagonist has the potential to decrease uterine contractions, increase endometrial perfusion and enhance endometrial decidualisation and other parameters of endometrial receptivity. It has been hypothesised that antagonism of oxytocin receptors could improve the likelihood of successful embryo implantation and thus increase pregnancy and live birth rates following ET. STUDY DESIGN, SIZE, DURATION: This is an analysis of three randomised, double-blind, placebo-controlled trials, which randomised 1836 subjects between 2015 and 2019. We describe the results of a meta-analysis of individual participant data (IPD) from all three trials and the pre-specified analyses of each individual trial. PARTICIPANT/MATERIAL, SETTING, METHODS: Participants were patients undergoing ET following IVF/ICSI in 60 fertility centres in 11 European countries. Study subjects were below 38 years old and had no more than one previously failed cycle. They were randomised to a single oral dose of nolasiban 900 mg (n = 846) or placebo (n = 864). In IMPLANT 1, additional participants were also randomised to nolasiban 100 mg (n = 62) or 300 mg (n = 60). Fresh ET of one good quality embryo (except in IMPLANT 1 where transfer of two embryos was allowed) was performed on Day 3 or Day 5 after oocyte retrieval, approximately 4 h after receiving the study treatment. Serum hCG levels were collected at 14 days post oocyte retrieval (Week 2) and for women with a positive hCG result, ultrasound was performed at Week 6 post-ET (clinical pregnancy) and at Week 10 post-ET (ongoing pregnancy). Pregnant patients were followed for maternal (adverse events), obstetric (live birth, gestational age at delivery, type of delivery, incidence of twins) and neonatal (sex, weight, height, head circumference, Apgar scores, congenital anomalies, breast feeding, admission to intensive care and specific morbidities e.g. jaundice, respiratory distress syndrome) outcomes. MAIN RESULTS AND THE ROLE OF CHANCE: In an IPD meta-analysis of the clinical trials, a single oral dose of nolasiban 900 mg was associated with an absolute increase of 5.0% (95% CI 0.5, 9.6) in ongoing pregnancy rate and a corresponding increase of 4.4% (95% CI -0.10, 8.93) in live birth rate compared to placebo. Similar magnitude increases were observed for D3 or D5 transfers but were not significantly different from the placebo. Population pharmacokinetics (PK) demonstrated a correlation between higher exposures and pregnancy. LIMITATIONS, REASON FOR CAUTION: The meta-analysis was not a pre-specified analysis. While the individual trials did not show a consistent significant effect, they were not powered based on an absolute increase of 5% in ongoing pregnancy rate. Only a single dose of up to 900 mg nolasiban was administered in the clinical trials; higher doses or extended regimens have not been tested. Only fresh ET has been assessed in the clinical trials to date. WIDER IMPLICATIONS OF THE FINDINGS: The finding support the hypothesis that oxytocin receptor antagonism at the time of ET can increase pregnancy rates following IVF. The overall clinical and population PK data support future evaluation of higher doses and/or alternate regimens of nolasiban in women undergoing ET following IVF. STUDY FUNDING/COMPETING INTERESTS: The trials were designed, conducted and funded by ObsEva SA. A.H., O.P., E.G., E.L. are employees and stockholders of ObsEva SA. E.L. is a board member of ObsEva SA. G.G. reports honoraria and/or non-financial support from ObsEva, Merck, MSD, Ferring, Abbott, Gedeon-Richter, Theramex, Guerbet, Finox, Biosilu, Preglem and ReprodWissen GmbH. C.B. reports grants and honoraria from ObsEva, Ferring, Abbott, Gedeon Richter and MSD. P.P. reports consulting fees from ObsEva. H.T. reports grants and or fees from ObsEva, Research Fund of Flanders, Cook, MSD, Roche, Gedeon Richter, Abbott, Theramex and Ferring. H.V. reports grants from ObsEva and non-financial support from Ferring. P.T. is an employee of Cytel Inc., who provides statistical services to ObsEva. J.D. reports consulting fees and other payments from ObsEva and, Scientific Advisory Board membership of ObsEva. TRIAL REGISTRATION NUMBERS: ClinicalTrials.gov: NCT02310802, NCT03081208, NCT03758885. TRIAL REGISTRATION DATES: December 2014 (NCT02310802), March 2017 (NCT03081208), November 2018 (NCT03758885). FIRST PATIENT'S ENROLMENT: January 2015 (NCT02310802), March 2017 (NCT03081208), November 2018 (NCT03758885).

Inhibition of steroid sulfatase decreases endometriosis in an in vivo murine model.

BACKGROUND: Steroid sulfatase (STS) is involved in estrogen biosynthesis and expressed in eutopic and ectopic endometrium of disease-free and endometriosis patients. The present study was designed to investigate its role in endometriosis development. METHODS: Human endometrial explants were cultured on inserts for 24 h to assess the effectiveness of an STS inhibitor (STS-I), estradiol-3-O-sulfamate (E2MATE), on STS activity in endometrial tissue. Endometriosis was induced in mice, and E2MATE (or vehicle alone) was given orally for 21 days. Plasma estradiol levels were measured, and STS activity was assessed in murine organs (uterus, liver and leukocytes) and in lesions. Lesion number, weight and size (morphometry) were quantified. Lesion STS and progesterone receptor (PR) expression, proliferation and apoptosis rates were determined by immunohistochemistry. RESULTS: In vitro, addition of 1 µM E2MATE to the culture medium resulted in decreased STS activity in endometrial explants (P < 0.001). Treatment of mice with E2MATE (1.0 and 0.5 mg/kg) did not modify plasma estradiol levels, but inhibited STS activity in murine uterus (P < 0.05), liver (P < 0.001) and leukocytes (P < 0.001), as well as in induced lesions (P < 0.05). E2MATE reduced lesion weight (P < 0.01) and size (P < 0.05), but had no impact on proliferation or apoptosis rates, nor STS protein expression. Stromal edema was observed in the uterus of animals treated with E2MATE, but not in the stroma of lesions. Increased PR expression was detected in endometriotic lesions (P < 0.001). CONCLUSIONS: E2MATE was shown to effectively inhibit STS activity in endometrial tissue in vitro. In vivo, E2MATE decreased endometriosis development without affecting systemic estradiol levels. Use of STS-I could therefore be of potential interest in endometriosis treatment.

Absence of aromatase protein and mRNA expression in endometriosis.

BACKGROUND: Aromatase has been reported to be involved in estrogen biosynthesis and expressed in eutopic and ectopic endometrium of endometriosis patients. The objective of the present study was to investigate its expression and localization in three distinct types of endometriosis. METHODS: Human peritoneal, ovarian and rectovaginal endometriotic lesions and matched eutopic endometrium were collected from patients during laparoscopy. Aromatase protein localization (immunohistochemistry, n = 63) and mRNA expression [quantitative polymerase chain reaction (Q-PCR), n = 64] were assessed. RESULTS: No aromatase protein was detected by immunohistochemistry in either the glandular or stromal compartment of endometriotic lesions or eutopic endometrium, while it was strong in placental syncytiotrophoblasts, granulosa and internal theca cells from pre-ovulatory follicles, and luteal cells from corpus luteum. By Q-PCR, low but discernible levels of aromatase expression were found in endometriomas, probably due to follicular expression. Transcripts for aromatase were barely detectable in only a few peritoneal and rectovaginal endometriotic lesions, and a few eutopic endometrium samples, probably due to contaminating surrounding tissues (adipose tissue, intact peritoneum). CONCLUSIONS: Unlike previous studies, we observed no aromatase protein in any of the endometriosis types, and barely detectable aromatase mRNA expression, suggesting that locally produced aromatase (within endometriotic lesions) may be less implicated in endometriosis development than previously postulated. Potential factors responsible for these discrepancies are discussed.

Homologous regulation of gonadotropin-releasing hormone receptors in cultured pituitary cells.

Specific receptors for gonadotropin-releasing hormone (GnRH) in cultured rat pituitary cells were increased by subnanomolar concentrations of GnRH agonists and decreased by high concentrations of these peptides. The antagonist [D-Phe2, Pro3, D-Phe6]GnRH did not alter GnRH binding capacity and blocked the increase in sites induced by GnRH. These findings provide direct evidence for the homologous regulation of GnRH receptors by physiological concentrations of the hypothalamic peptide, an action that could mediate the cyclical and postcastration increases in GnRH receptors and responsiveness of the pituitary gonadotrophs.

Yeast mating pheromone activates mammalian gonadotrophs: evolutionary conservation of a reproductive hormone?

alpha-Factor, a tridecapeptide mating pheromone of yeast (Saccharomyces cerevisiae), has extensive sequence homology with the hypothalamic decapeptide gonadotropin-releasing hormone (GnRH). Both synthetic and natural preparations of alpha-mating factor were found to bind specifically to rat pituitary GnRH receptors and to stimulate the release of luteinizing hormone from cultured gonadotrophs. The ability of the yeast pheromone to reproduce the biological actions of GnRH in the mammalian pituitary gland indicates that the structural and functional properties of GnRH-related peptides may have been highly conserved during evolution.

Binding affinity and biological activity of gonadotropin releasing hormone agonists in isolated pituitary cells.

The relationships between binding affinity and the biological potency of eight GnRH agonist analogs were evaluated in isolated rat pituitary cells. For this purpose, binding affinity and biological activity were assayed under similar physiological conditions in medium 199, pH 7.4, and binding affinity was also measured under the standard conditions in hypotonic buffer at low temperature. Under physiological conditions, receptor binding affinity was consistently lower than when measured in the hypotonic Tris buffer usually employed for GnRH receptor studies. In the low temperature binding assay at 0 C, which provided a measure of the affinity constant without degradation, a difference of 20- to 30-fold was observed between native GnRH and its most potent analog, [D-Ser(t-Bu)6]des-Gly10-GnRH N-ethylamide. Modifications of the amino acid residues at both positions 6 and 10 of the decapeptide increased the binding affinity of GnRH analogs. When the receptor binding assay was performed at 37 C, the range of the apparent affinity constants was extended up to 60-fold. The affinity constants derived at 37 C were closely correlated with the biological potencies of the individual analogs measured in the same cell system. The effect of temperature on binding affinity was not significantly influenced by peptide metabolism, which was minor in the absence of horse serum from the incubation medium. At the pituitary level, the biological potency of the GnRH agonist analogs is predominantly determined by their higher receptor affinity, and reduced degradation is a less important aspect of the high biological activity of the superagonist analogs.

Inhibition of pituitary gonadotropin secretion by 4-aminopyrazolo(3,4-d) pyrimidine.

The reduction of plasma testosterone (T) in male rats treated with 4-aminopyrazolo(3,4-d)pyrimidine (4-APP) has been recently shown to be associated with a fall in plasma LH, and appears to be secondary to this impairment of gonadotropin secretion rather than to the decrease in lipoprotein cholesterol caused by the adenine analog. The effects of 4-APP on pituitary function and the mechanism of the fall in gonadotropin secretion were analyzed in adult male rats treated ip with 5, 10, 25, and 50 mg 4-APP/kg BW for 3 days. Twenty four hours later, serum cholesterol levels were reduced by 68 +/- 5% (mean +/- SE) in animals treated with 5 mg 4-APP/kg BW and by up to 84 +/- 1% after higher doses. Basal levels of serum T were not affected by 5 mg/kg APP but were significantly reduced by higher doses (P less than 0.05). Serum T responses to human CG (100 IU) stimulation in APP-treated rats were reduced in absolute magnitude, but were enhanced in terms of percentage increase above baseline. The three highest doses of 4-APP reduced serum levels of LH (51-79%) and FSH (21-39%). However, serum gonadotropin responses to GnRH stimulation were augmented by 32 +/- 9% for LH and 27 +/- 12% for FSH after 4-APP treatment. Serum levels of TSH were significantly (P less than 0.05) reduced by 25 and 50 mg/kg 4-APP and serum PRL was lowered by only the higher dose. Serum GH was lowered and ACTH increased by 5 mg/kg 4-APP. The pituitary contents of LH, FSH, and TSH were unchanged after 4-APP treatment, but PRL and GH contents were slightly but significantly increased (P less than 0.05). Pituitary receptors for GnRH (88 +/- 14 fmol/mg protein) were reduced by in vivo treatment with 25 and 50 mg/kg 4-APP to 52 +/- 5 and 57 +/- 7 fmol/mg, but not by 10 mg/kg 4-APP. No change in pituitary GnRH receptor content was observed after 48-h exposure to 10(-7) or to 10(-5) M 4-APP in vitro. The medial hypothalamic GnRH content was unchanged by 4-APP treatment. The dissociated effects of 4-APP on serum cholesterol and T levels, and the maintenance of T responses to human CG, provide further evidence that testicular androgen biosynthesis is not solely dependent on circulating cholesterol. The greater sensitivity of pituitary gonadotropins to 4-APP inhibition is evidence for a selective action of this drug on pituitary hormone release in vivo. Although the hypothalamic content of GnRH was unaltered by 4-APP treatment, the decrease in pituitary GnRH receptors observed in vivo, together with the fall in circulating LH and FSH and retention of gonadotropin responses to GnRH stimulation, suggest that the primary effect of 4-APP is to inhibit GnRH synthesis and/or release from the hypothalamus.

Immunoreactive relaxin-like substance in human seminal plasma.

Large amounts of an immunoreactive relaxin-like peptide were demonstrated in human seminal plasma. The concentrations of this peptide were determined in seven healthy volunteers, and in twenty-eight non-selected male patients seeking advice for sterility. A wide range of immunoreactive relaxin concentrations was observed, varying between 1,240 pg and 73,000 pg of relaxin porcine equivalents per ml of seminal plasma. Given the very special assay medium of seminal plasma, particular attention was paid to the validity of the radioimmunoassay system when applied to this medium.

Effects of human recombinant luteinizing hormone and follicle-stimulating hormone in patients with acquired hypogonadotropic hypogonadism: study of Sertoli and Leydig cell secretions and interactions.

UNLABELLED: Experimental data suggest that FSH-stimulated Sertoli cells can enhance LH-induced Leydig cell testosterone (T) production. The function of Leydig and Sertoli cells can be selectively studied by using recombinant human LH (rhLH) and recombinant human FSH (rhFSH) in patients with complete gonadotropin deficiency. The aim of the present study was to assess the secretion of testicular T, estradiol (E2), and inhibin B and the physiological relevance of the Sertoli-Leydig cell interaction in man. For that purpose, six patients with acquired complete hypogonadotropic hypogonadism received the following treatments for three periods of 1 month in a random order: 1) rhLH, 900 IU/day sc; 2) rhFSH, 150 IU/day sc; and 3) combined rhLH/rhFSH treatments. Each treatment period was separated by a washout period of 15 days. Plasma LH, FSH, T, E2, and inhibin B were measured before and every 10 days during each treatment. During rhLH administration, mean plasma LH levels rose significantly from 0.4 +/- 0.2 IU/L to 11.7 +/- 1.2 IU/L (P < 0.01) and plasma FSH levels did not change. rhFSH administration induced a significant increase in plasma FSH levels (from 0.5 +/- 0.4 to 12.1 +/- 1.4 IU/L; P < 0.01), whereas mean plasma LH levels remained low. Mean plasma E2 levels were unchanged during rhFSH treatment, but they increased significantly during rhLH from 22 +/- 4 to 54 +/- 8 pmol/L (P < 0.01) and during rhLH plus rhFSH administration. rhFSH treatment induced a sustained elevation of mean plasma inhibin B levels from 58 +/- 13 to 175 +/- 25 pg/mL (P < 0.01), similar to the increase occurring during rhFSH plus rhLH administration. In contrast, mean plasma inhibin B levels did not increase during rhLH administration. Finally, a similar and significant increase in mean plasma T levels occurred during both rhLH and rhLH plus rhFSH treatment from 0.9 +/- 0.3 to 5.4 +/- 0.7 nmol/L (P < 0.01) and from 1.0 +/- 0.4 to 6.0 +/- 0.9 nmol/L (P < 0.01), respectively. In contrast, during rhFSH treatment mean plasma T levels remained unchanged when compared with baseline. IN CONCLUSION: 1) the increase of plasma E2 induced by rhLH and the absence of effect of rhFSH confirm that Leydig cells are the major site of testicular E2 production in man; 2) the secretion of inhibin B is increased by rhFSH and not by rhLH, and, thus, Sertoli cells seem to be the main source of inhibin B production; and 3) the increase of plasma T induced by rhLH is not enhanced by rhFSH. These results suggest that the stimulatory effect of FSH on Leydig cell steroidogenesis by a Sertoli cell paracrine factor does not seem to play a major physiologic role in man.

A population model for the follicular growth in women treated with follicle stimulating hormone.

PURPOSE: To develop a pharmacodynamic model that can describe the time course of follicular growth and to investigate the influence, if any, of covariates on the parameters of the model. METHODS: A population pharmacodynamic analysis was performed on total follicular volume data obtained after in vitro fertilisation and embryo transfer with urinary or recombinant human follicle stimulating hormone (FSH) treatment. A growth model in which the increase in total follicular volume with time is a function of several possible components was chosen. RESULTS: In the final population pharmacodynamic model, increase in total follicular volume (TFV) was described by the equation: dTFV/dt = Emax.TFV/(TFV + TFV50) + constant, in which Emax, TFV50, and constant were 508 mm3/hr (interindividual variability 72%), 12,900 mm3 (66%), and 1.43 mm3/hr (91%), respectively. Growth was positively correlated to baseline estradiol levels, so that Emax and TFV50 changed 0.52% for every picomolar change from the median baseline estradiol value of 100 pmol/L. Growth was negatively correlated to pretreatment FSH levels, so that individuals with a median FSH (6.7 IU/L) were expected to have a fivefold higher total follicular volume at day 10 after the start of treatment, compared to individuals at the high end of the pretreatment FSH range (12 IU/L). No relationship between FSH concentration and follicular growth was found. The urinary versus recombinant origin of the drug did not influence the ovarian response. CONCLUSION: Women with high endogenous levels of FSH respond less to standard doses of exogenous FSH. Women with higher baseline levels of estradiol have larger expected follicular growth rates.

Compartmentalization of luteinizing hormone pools: dynamics of gonadotropin releasing hormone action in superfused pituitary cells.

Cultured rat anterior pituitary cells were continuously perfused with medium 199, and exposed to short (5 min), intermediate (30 min), or long (6 h) pulses of a maximally effective concentration of gonadotropin-releasing hormone (GnRH). Assay of the effluent by radioimmunoassay and interstitial-cell bioassay revealed a biphasic response to GnRH, and indicated that 3 pools of luteinizing hormone (LH) are present in the gonadotroph. A rapidly releasable peak of bioactive LH comprising about 2% of the total cellular LH was mobilized within 1 min of GnRH addition, lasted for 3-4 min, and was independent of the duration of stimulation. The second, larger pool of bioactive LH varied from 15 to 50% of the total LH as the duration of exposure to GnRH was increased from 5 min to 6 h. A third LH pool comprising up to 50% of the total LH could be mobilized by 50 mM potassium but not by continuous GnRH treatment, due to refractoriness of the cells to prolonged stimulation by the decapeptide. In contrast, repeated pulses of GnRH evoked a series of biphasic LH peaks with profiles similar to that observed during a single response to GnRH, indicating that continuous exposure to GnRH is necessary for densensitization. Release of LH from the perfused cells was calcium-dependent, and the bio-immuno ratio of the first and second pools of LH was similar. The in vitro secretion profile of cultured rat cells is comparable with the early and late phases of LH release observed in GnRH-infused man, but occurs much more rapidly, and demonstrates heterogeneity of the LH release process at the level of the gonadotroph. The superfusion technique provides a powerful tool to further investigate the bioactivity of GnRH and its analogs for use in fertility control.

Short-term utilization of a gonadotropin-releasing hormone agonist (buserelin) for induction of ovulation in an in vitro fertilization program.

Benefits of the short-term utilization of a gonadotropin-releasing hormone (GnRH) agonist (Buserelin, Hoechst, AG, Frankfurt am Mein, FRG) for induction of ovulation in an in vitro fertilization program (IVF) program were assessed. Eighteen patients underwent consecutively an induction of ovulation by clomiphene citrate (CC) and human menopausal gonadotropin (hMG), then by hMG alone, and finally by Buserelin and hMG. The switchover from CC and hMG to hMG alone significantly increased the number of aspirated follicles and the oocyte recovery rate. The addition of Buserelin prevented the outcome of spontaneous luteinizing hormone (LH) surges. It reduced the preovulatory luteinization and increased the number of recovered oocytes as well as the number of embryos available for transfer. A 33% clinical pregnancy rate per ovum pick-up was achieved with the Buserelin-hMG treatment.

Two chemically and immunologically distinct forms of luteinizing hormone-releasing hormone are differentially expressed in frog neural tissues.

Immunoreactive luteinizing hormone-releasing hormone (IR-LRF) has been measured in several neural tissues of the frog Rana catesbeiana and characterized by bioassay, chromatography and immunological analysis. Frog brain contains the mammalian form of LRF (mLRF), whereas, sympathetic ganglia and adrenal glands contain a form of LRF (pLRF) chromatographically and immunologically similar to the IR-LRF found in the central nervous systems of several piscine species. Frog retina contains both mLRF and pLRF, in a ratio of about 1:2. The two forms of LRF are apparently equipotent in their ability to release LH from rat gonadotrophs in vitro. Immunological analysis of the pLRF found in the frog nervous system suggests that it is a decapeptide, like mLRF, with one or more amino acid substitutions in the mLRF molecule.

Screening of conditions for rapid freezing of human oocytes: preliminary study toward their cryopreservation.

One hundred and twenty-one freshly-collected human oocytes and 839 unfertilized human oocytes after insemination were cryopreserved by vitrification. The cryoprotectants used were dimethylsulfoxide (DMSO) and sucrose. Vital staining and morphological criteria were used to assess injuries to cells. Variation of the time exposure to DMSO and sucrose, and cryoprotectants concentrations, followed by extraction-dilution in sucrose without freezing made it possible to study chemical toxicities. Variation of cryoprotectant concentrations followed by immersion in liquid nitrogen, thawing, extraction, and dilution made it possible to choose optimal conditions for vitrification. The sucrose concentration upon extraction after freezing and thawing which was lower than that during soaking enhanced the oocyte survival rate as did the choice of duration and temperature of soaking. No parthenogenetical activation of these unfertilized ovum was observed. This study indicates that with a certain combination of DMSO and sucrose concentrations up to 80% of morphologically intact human oocytes can be recovered after rapid freezing and thawing.

Ovulation instantaneously modifies women's peritoneal fluid characteristics: a demonstration from an in vitro fertilization program.

Concentrations of P and E2 were measured in serum and PF obtained from 34 laparoscopies performed in 18 patients for oocyte retrieval in an in vitro fertilization program. Samples from group A (28 patients who had not ovulated at laparoscopy) and group B (6 patients who had ovulated very shortly before laparoscopy) were compared. No difference was observed in serum steroid levels between the two groups; however, group B showed a 100-times increase in E2 concentration and a 200-times increase in P concentration measured in the PF. In conclusion, we can postulate that this sudden and large increase in PF steroids after ovulation is initially solely dependent on the mechanic rupture of the follicle and not on its luteinization.

Recombinant human follicle-stimulating hormone treatment leads to normal follicular growth, estradiol secretion, and pregnancy in a World Health Organization group II anovulatory woman.

A first case of successful induction of ovulation with recombinant human FSH administered subcutaneously to a WHO group II anovulatory patient is reported. Using a chronic low-dose protocol, recombinant human FSH, a preparation with no LH activity, led to a clear and even supraphysiological increase of inhibin and E2 and the development of four follicles among which one was dominant. The treatment cycle resulted in an ongoing pregnancy.

Immunoreactive relaxin surge in the peritoneal fluid of women during the midluteal phase.

Relaxin was assayed in the peritoneal fluid (PF) of 176 women with normal ovulatory cycles. Validation of the assay in this fluid was carefully established. Relaxin was rarely detected before day 20 of the cycle. From days 21 to 24, all samples contained detectable concentrations of the peptide, ranging between 75 and 775 pg/ml. Apparition of relaxin in the PF was not directly related to the ovulatory follicular rupture. It was also delayed, compared with the postovulatory rise of plasma and peritoneal progesterone. Relaxin is thus present in the PF only during the period propitious to human embryo implantation.

Leukemia inhibitory factor in human reproduction.

OBJECTIVE: To describe the clinical findings, expressions, interactions, and clinical implications of leukemia inhibitory factor (LIF) in human reproduction. DESIGN: Review of published articles. SETTING: Clinical development unit of biotechnology company. INTERVENTION(S): None. RESULT(S): In the endometrium, LIF is expressed in a menstrual cycle-dependent manner, with the highest level occurring at the time of implantation. LIF is also detected in uterine flushing, and its level is significantly lower in women with unexplained infertility. Likewise, endometrial explants derived from women with unexplained infertility showed reduced levels of LIF secretion. Binding of LIF to LIF receptor and gp130 activates signal transduction pathways. LIF receptor is expressed in endometrium, oocytes, and blastocysts. Cytotrophoblasts cultured in the presence of LIF differentiate toward an anchoring extravillous phenotype. CONCLUSION(S): On the basis of reports gathered from animal and human studies, LIF appears to play an important role in implantation and in the establishment of pregnancy.

Use of a gonadotropin-releasing hormone agonist during ovarian stimulation leads to significant concentrations of peptide in follicular fluids.

The penetration of a gonadotropin-releasing hormone agonist (GnRH-a), Buserelin (Hoechst AG, Frankfurt, West Germany), into human follicular fluids (FF) was studied by means of a radioimmunoassay (RIA) and a bioassay. Acute nasal administration of a therapeutic dose of Buserelin (300 and 600 micrograms) before the ovum pickup for in vitro fertilization leads to significant concentrations of Buserelin in one-third of the FF. These concentrations ranged between 28 and 124 pg/ml, which represents 10% to 50% of the serum concentrations achieved in these patients. Follicular penetration of this agonist is time-dependent. Chronic administration during the follicular phase leads to low but significant concentrations of peptide 36 hours after the last inhalation. A very good correlation was observed between the RIA and the bioassay. This demonstrates the accuracy and the specificity of the RIA. In addition, it indicates that the Buserelin that reaches follicles is intact and is not the inactive product of degradation. Intranasal administration of Buserelin stopped 35 hours before ovum pickup appears to be an adequate way of minimizing the exposure of maturing oocytes to the GnRH-a.

Evaluation of a synthetic serum substitute to replace fetal cord serum for human oocyte fertilization and embryo growth in vitro.

A comparison was made between a serum substitute. UltroSer G (Gibco, Ghent, Belgium) (2%) (medium B) and 10% human fetal cord serum (medium A), as regards their ability to support 1-cell and 2-cell mice embryo development in vitro. Sixty percent and 56% of the 1-cell embryos reached the expanded blastocyst stage when cultured in media A and B, respectively. Eighty-four percent and 88% of 2-cell embryos reached the expanded blastocyst stage when cultured in media A and B, respectively. A prospective randomized study was then performed to evaluate this synthetic serum substitute in human in vitro fertilization. Among 141 ovum pick-up (OPU), oocytes retrieved in 74 cases were processed in medium A and oocytes retrieved in 67 others in medium B. In media A and B, the fertilization rate was 67% and 44.3% respectively, and the pregnancy rate/OPU 23% and 9%, respectively. The pregnancy rate/transfer was 28.8% and 12.2% respectively, and the implantation rate/transferred embryo 9.5% and 4.2%. In the human sperm survival assay, the vitality and residual motility after 24 hours of incubation were significantly lower in medium B. In conclusion, UltroSer G successfully sustained the development in vitro of mouse embyros. However in human, it reduced sperm survival, oocyte fertilization, and embryo viability.