Luteal Research Articles

P-708 melatonin alleviates circadian rhythm disruption-induced enhanced luteinizing hormone pulsatility and ovarian dysfunction in vivo and in vitro

Abstract Study question Is melatonin deficiency a reversible cause of abnormal pattern of luteinizing hormone (LH) pulsatility and ovarian dysfunction caused by circadian rhythm disruption (CRD)? Summary answer Melatonin could rescue the augmented LH pulsatility and reproductive abnormalities caused by CRD. What is known already Melatonin, mainly synthesized and released by pineal gland, engages in regulating circadian rhythms. When circadian rhythms are disrupted, the nocturnal productions of melatonin are suppressed. Evidence suggests that circadian rhythm disruption (CRD) is associated with reproductive dysfunctions, while melatonin plays a vital role for female reproduction as a free radical scavenger and a neuroendocrine regulator. The gonadotrophin-releasing hormone (GnRH) drives pulsatile luteinizing hormone (LH) secretion, which is also essential for fertility. Study design, size, duration We used 90 CBA/CaJ mice to establish the chronic jet-lag model in which mice were exposed to an 8 hr time shift every 3 days. After 8 weeks of jet-lag induction, some of the mice were given melatonin treatment for 4 weeks. Furthermore, we used a perfusion system in vitro to mimic the process of CRD-induce high-frequency GnRH pulses stimulation of LβT2 gonadotrope cells. Participants/materials, setting, methods Repetitive tail-tip blood collection was used to evaluate the pattern of LH pulsatility. Blood plasma samples were collected from 4 mice at 4-hour intervals to measure levels of melatonin. Follicular development was evaluated by ovarian histology. Reproductive hormones was detected by ELISA. Immunohistochemistry and western blot were used to detect the expression of melatonin receptor 1A (MT1). The LβT2 cells were exposed to pulsatile GnRH at high pulse frequencies to mimic augmented pulsatile GnRH stimulation. Main results and the role of chance CRD mice exhibited reproductive-endocrine dysfunction, including irregular estrous cycles, reduced number of corpus lutea (CL), and decreased levels of estradiol and progesterone. Additionally, CRD enhanced the frequency and amplitude of LH pulsatility and pituitary LH beta-subunit expression. Melatonin administration alleviated these CRD-induced reproductive abnormalities and reversed the augmented LH pulsatility. The expression of MT1 decreased in the anterior pituitaries of CRD mice but increased after melatonin treatment, indicating the essential role of MT1 in melatonin’s reversal of CRD-induced enhanced LH pulsatility. Limitations, reasons for caution Further research is needed to validate the applicability and safety of these findings in humans. Wider implications of the findings The results suggest that melatonin may be a beneficial option for patients with reproductive-endocrine abnormalities, particularly those with circadian rhythm disruption. Trial registration number 82101719

P-678 Cabergoline has inhibitory effects on FSH-induced cell differentiation and estrogen secretion in a primary culture system of rat ovarian granulosa cells

Abstract Study question How does cabergoline have effects on cell differentiation and hormone secretion induced by FSH stimulation in ovarian granulosa cells? Summary answer Cabergoline suppresses LH receptor expression and Estradiol (E2) secretion in primary cultures of rat ovarian granulosa cells by inhibiting cAMP production induced by FSH stimulation. What is known already Cabergoline is a dopamine receptor 2 agonist that has been used to treat hyperprolactinemia and, more recently, to prevent ovarian hyperstimulation syndrome. Although it has been previously reported that cabergoline suppresses E2 and Progesterone secretion induced by FSH stimulation in a primary culture system of rat ovarian granulosa cells, but the effect on LH receptor expression has not been investigated. It has also been reported that the activation of dopamine receptor 2 suppresses VEGF secretion and reduces the incidence of early-onset OHSS by inhibiting the VEGF/VEGFR2 pathway in research using human luteinized granulosa cells. Study design, size, duration We used a primary culture system of ovarian granulosa cells obtained from immature female rats treated with diethylstilbestrol to examine the effect of cabergoline addition on the changes in ovarian granulosa cells induced by FSH stimulation. Participants/materials, setting, methods FSH and cabergoline were added alone or co-added to a primary culture system of rat ovarian granulosa cells, and the changes induced by them were measured and compared. (1) mRNA expression of Lhcgr, Cyp19a1, and Fshr by RT-qPCR (2) E2 concentration in the culture medium (3) Measurement of hCG binding on the cell surface (4) cAMP concentration Main results and the role of chance Co-addition of cabergoline suppressed each of the changes induced by FSH stimulation as follows. (1) The mRNA expression levels of Lhcgr, Cyp19a1, and Fshr decreased in a concentration-dependent manner (0.01-10 µM) of co-added cabergoline compared to FSH alone. In the 10 µM of co-added cabergoline group, they decreased to 14%, 9%, and 49% of FSH alone, respectively. (2) E2 concentration in the culture media also decreased in a concentration-dependent manner (1-10 µM) of co-added cabergoline compared to FSH alone. In the 10 µM of co-added cabergoline group, it decreased to 49% of FSH alone. (3) The amount of hCG binding on the cell surface also decreased in a concentration-dependent manner (0.1-10 µM) of co-added cabergoline compared to FSH alone. In the 10 µM of co-added cabergoline group, it decreased to 7% of FSH alone. (4) FSH-stimulated cAMP production decreased in a concentration-dependent manner (0.01-1µM) of co-added cabergoline compared to FSH alone. In the 1µM of co-added cabergoline group, it decreased to 50% of FSH alone. These results suggest that cabergoline suppresses LH receptor and aromatase expression and E2 production by inhibiting cAMP production induced by FSH stimulation. Limitations, reasons for caution Since this is an in vitro experiment using a rat primary culture system, the results of this research cannot be considered directly applicable to humans. Wider implications of the findings Our findings imply that cabergoline administration during the follicular phase may inhibit ovarian granulosa cell differentiation and estrogen secretion. In women taking relatively high doses of cabergoline, attention may need to be paid regarding the effects of cabergoline on follicular development and estrogen secretion. Trial registration number not applicable

O-310 PARP inhibitors have no toxic effect on follicle reserve, mitotic and steroidogenic function of granulosa cells in human ovary

Abstract Study question Do the PARP inhibitors have gonadotoxic effects on human ovary? Summary answer No. The PARP inhibitor drugs Olaparib and Niraparib do not appear to have any toxic effects on the human ovary. What is known already The Poly (ADP-ribose) polymerase (PARP) family has many essential functions in cellular processes, including the regulation of transcription, apoptosis, and the DNA damage response. PARP has Poly (ADP-ribose) activity, which facilitates the recruitment of other repair proteins to promote the repair of DNA single-strand breaks when DNA damage occurs. PARP inhibitors are approved for the treatment of BRCA1/2 mutated breast and ovarian cancers. No data is available regarding the gonadotoxic potentials, if any, of these drugs on the human ovary. We aimed to address this issue in the current study. Study design, size, duration A clinical translational research study that utilizes ex-vivo and in-vitro experimental models on human ovarian cortical samples, primary luteinized non-mitotic granulosa cells, and immortalized human granulosa cells. Participants/materials, setting, methods Ovarian cortical samples were obtained from young women undergoing laparoscopic surgery for benign ovarian cysts (n = 5). Human non-mitotic luteinized granulosa cells (HLGCs) obtained from 10 IVF patients during the oocyte retrieval procedure and immortalized mitotic non-luteinized granulosa cell line (HGrC1), and immortalized granulosa cell tumor cell line (COV434) were used for the experiments. Cell/tissue culture, confocal imaging, flow cytometry, immunoblotting, cell viability/proliferation and hormone assays were applied. Main results and the role of chance Treatment of ovarian tissue samples and granulosa cells with PARP inhibitors at five different therapeutic concentrations (1, 5, 10, 20, and 40 µM/mL) up to 96 hours in culture resulted in resulted in the cleavage of PARP, validating in vitro activity of the drugs. The primordial follicle reserve and steroidogenic activity of the tissue samples remained stable at the end of culture period. Similar results were obtained in the granulosa cells, which retained their viability and steroidogenic functions after exposure to the PARP inhibitors. Real-time impedance-based cell proliferation assay with xCelligence system revealed that granulosa cells continued to proliferate normally and reached log phase in the presence of PARP inhibitors without any discernible cytotoxic effect. In immunoblot analysis, the expression of steroidogenic enzymes (StAR, aromatase, 3B-HSD and 17B-HSD) was comparable to control cells and cleaved caspase-3 expression was absent in the granulosa cells exposed to PARP inhibitors. Limitations, reasons for caution Caution should be exercised before extrapolating our data because these findings were obtained in ex-vivo and in-vitro models. They need to be confirmed using in-vivo experimental models such as human ovarian tissue xenografting in nude mice. Wider implications of the findings This study provides the first reassuring molecular evidence that PARP inhibitor drugs do not appear to have a significant gonadotoxic effect on human ovary. Trial registration number not applicable

P-585 Vaginal progesterone associated with oral dydrogesterone versus vaginal progesterone for luteal support in letrozole-hcg cycles for thawed embryo transfer: a non-inferiority prospective cohort study

Abstract Study question Does micronized vaginal progesterone (MVP) associated with oral dydrogesterone (DYG) an alternative for luteal support in Letrozole-hcg cycles for thawed embryo transfer? Summary answer The association of MVP and DYG is a non-inferior alternative to only MVP for luteal support in thawed embryo transfer in Letrozole-hcg cycles. What is known already Endometrial preparation is essential for thawed embryo transfer. Several protocols involving different luteal support with progesterones are available. Moreover, the presence of corpus luteum decreases the obstetrical morbidity mainly linked to hypertensive disorders. Letrozole-hcg administration is a good alternative for frozen embryo transfer (FET). However, the literature lacks information about the comparison among the different protocols for luteal support in Letrozole-hcg cycles. Dydrogesterone is an oral progesterone with some unique characteristics which could be utilized with some advantage for luteal support, including oral administration and some immunological activity. Study design, size, duration This is a prospective non-inferiority cohort study performed at an infertility clinic including patients performing the first FET cycle during 2023. Reproductive outcomes were compared between patients receiving 600 mg (3x200 mg) of MPV or 40 mg of DYG plus 400 mg of MVP after Letrozole-hcg administration. Participants/materials, setting, methods All patients (aged 23-39 years) undergoing their first FET cycle during 2023 were included in this study (n = 169), divided into two groups: MVP+DYG (n = 54) or MVP (n = 115) for luteal support after Letrozole-hcg. Letrozole was administered for 5 days (2,5 mg/bid) and hcg was done when a dominant follicle reached 18 mm with a follicular endometrium measuring at least 7 mm. Main results and the role of chance Both groups were equivalent in terms of age, infertility aetiology, BMI and AMH (P > 0.05). Moreover, the proportion of cleavage or blastocyst stage was also similar between both groups (57% blastocyst transfer for MVP+DYG and 50% blastocyst transfer for MVP group, P > 0.05). The number of transferred embryos was (mean ±SD) 1.6±0.5 for both groups, P > 0.05. Furthermore, the number of top-quality embryos (cleavage stage or blastocyst) was also similar, P > 0.05. Moreover, clinical pregnancy (> 12 weeks) was 42% in MVP+DYG group versus 31% in the MVP group (-0.22-1.27, P = 0.156) and the early pregnancy loss per positive hcg test did not differ (18% for MVP+DGY and 22% for MVP, P = 0.687). In addition, we performed a multivariable analysis controlling possible confounders for clinical pregnancy: BMI, age, AMH, embryo quality, infertility aetiology and embryo stage during the transfer, and only age (0.86; 95%CI -0.229 to -0.064, P = 0.001) was related to clinical pregnancy. Limitations, reasons for caution The main limitation is the cohort design of our study, with an inherent risk of bias (selection bias). Moreover, we calculated this study to achieve the power for a non-inferiority comparison, not superiority comparison. Wider implications of the findings This is the first study comparing MVP+DYG to only MVP in patients submitted to FET using the Letrozole-hcg protocol. We demonstrated in this non-inferiority study the usefulness of adding DYG. Moreover, our results were promising showing a trend towards better pregnancy rates after MVP+DYG. Trial registration number not applicable

P-626 Progesterone rescue is effective for clinical pregnancy outcome in women presenting low circulating progesterone levels at frozen embryo transfer day

Abstract Study question Is subcutaneous progesterone (prolutex® 25mg daily) addition effective for clinical pregnancy outcome in women presenting low progesterone(P4) levels at frozen embryo transfer(FET) day? Summary answer Subcutaneous progesterone rescue improved ongoing pregnancy rate and clinical pregnancy rate in women with low P4 results at FET day. What is known already FET has been increased, because preimplantation genetic testing for aneuploidies is performed widely, and FET presents a significantly low risk of ovarian hyperstimulation syndrome.In FET, there is no established optimal protocol for preparing endometrium, but hormonal replacement therapy (HRT) is widely used due to its convenient schedule adjustment. HRT protocol induce anovulation, functioning corpus luteum is lacking and exogenous progesterone administration is very important. Therefore, women showing low P4 levels around FET day have lower pregnancy rate. However, there are currently no data on the effectiveness of progesterone rescue. Study design, size, duration Primary outcomes from a randomized cohort retrospective study investigating subcutaneous progesterone (prolutex® 25mg) daily addition for whom had low P4 levels (<12ng/mL) at FET day. The study was conducted at one infertility center in Korea from January 2022 to December 2023 and pregnancy outcomes of FET transfers registered until Oct. 2023,. 194 patients fulfilled the inclusion criteria. Participants/materials, setting, methods One hundred ninety four women divided into two groups based on progesterone levels, with 12ng/ml as the threshold. Under 12ng/mL group were randomized to subgroup with and without addition of subcutaneous progesterone. In total 278 FET cycles, the effect of progesterone rescue on cumulative clinical pregnancy rate (CPR), Ongoing pregnancy rate (OPR) was reported as primary outcomes. Main results and the role of chance In total 278 cycles, there were 137 cycles with adequate serum P4 levels, while 141 cycles presented with low P4 levels in which randomly rescue subcutaneous progesterone administration added from next day of embryo transfer. When comparing the groups, there was no statistical difference in maternal age, BMI, smokers, duration of infertility, type of infertility, indication of in vitro fertilization(IVF), endometrial preparation method. In low P4 group, with and without subcutaneous progesterone addition subgroups included 51 and 90 cycles, retrospectively. CPR were 52.9% versus 35.6% (P = 0.044; chi-squared test) with a statistically significant higher rate of OPR in progesterone rescue group (45.1% versus 28.9%, p = 0.052). When comparing the group with adequate P4 levels and the group with low P4 levels without progesterone rescue, OPR were 18.2% versus 28.9% (p = 0.06, chi-squared test), CPR was significantly higher in low P4 levels group (23.4% versus 35.6%,p=0.046, chi-squared test). Adequate P4 level group had more IVF attempts (4.6 versus 2.2, p < 0.001, chi-squared test). There is tendency to use more luteal phase support medication with repeated attempt (serum P4 concentration on ET day 39.3 ng/mL versus 8.7 ng/mL, p < 0.001, t-test) Limitations, reasons for caution The main limitation of the study was retrospective, and had small sample size. A control group without progesterone rescue in low P4 levels did not receive any intervention. Wider implications of the findings The progesterone rescue for women presenting low P4 on FET day improved clinical outcome and excessively raising progesterone medication may have adverse effects. Therefore rather than using excessive progesterone administration from luteal support start day, progesterone rescue might be effective when low P4 levels presenting at FET day. Trial registration number not applicable

P-426 Comprehensive study of the endometrial early/mid secretory phase during natural cycles reveals conserved molecular dynamics involved in the window of implantation

Abstract Study question Is there a common transcriptomic signature in the endometrial early/mid secretory phase of healthy women in natural cycles? Summary answer We observed a conserved transcriptomic regulation of the endometrium around the window of implantation (WOI), consistent across donors, and not influenced by the biopsy procedure. What is known already Extensive research has been conducted on the gene expression changes that characterize the WOI, aiming to identify signals that indicate its onset. However, much of this work has utilized whole-transcriptome techniques and has involved IVF patients, who require luteal phase support. The few studies performed in natural cycles often relied on restricted methods, such as qPCR that examines only a few targets simultaneously. As such, an extensive transcriptomics study in volunteer donors in true natural cycles is lacking. This may provide deeper insights into the physiological changes during the WOI in young women driven by the endogenous effects of progesterone. Study design, size, duration 34 healthy donors were enrolled. Each donor provided one endometrial sample, on a day between LH + 2 and LH + 9 during their natural cycle. A minimum of two and a maximum of five donors were allocated to each day. Ovulation was detected via ecographic inspection and hormonal determination of LH/E2/P4. LH + 0 was established when the LH peak was detected (>2.8 times basal levels), together with a subsequenc decrease in E2 (-30%) and increase in P4 (>1.6ng/ml) Participants/materials, setting, methods When the biopsy was of sufficient size, we separated it in two parts and extracted RNA separately to assess concordance between different areas of the same biopsy. RNAseq libraries were prepared with NEBNextUltraII Directional RNA LibraryPrep and sequenced on a NovaSeq6000. Fastq files were aligned with STAR to GRCh38. Principal component analyses (PCA) were created with plotPCA, gene expression time course analysis was performed with DEseq2, and pseudotime analysis was performed using the slingshot package. Main results and the role of chance Of the 34 donors, we obtained good quality RNAseq data (minimum 20 million reads) from 41 samples, with 27 donors having one sample sequenced, while 2 independent samples from the same biopsy were obtained from 7 volunteers. Analysing same-biopsy concordance via PCA revealed a great degree of similarity between all the pairs, which clustered close to each other. Samples from different donors collected on the same day also showed a good clustering, apart from a single day LH + 4 sample. Pseudotime analysis revealed a distinct trajectory in transcriptomic profiles changing progressively from day LH + 2 to LH + 9. This analysis clearly delineated three phases: LH + 2 to LH + 5, LH + 6 to LH + 7, and LH + 8 to LH + 9. Accordingly, we categorized these into pre-receptive, receptive and post receptive groups, and conducted a time course experiment. We identified a total of 3,311 genes with varying expression across these three timepoints, primarily associated with progesterone signalling, metabolism and cell-to-cell communication. Based on their expression patterns, we isolated a subset of 538 genes which increased their expression during the receptive phase only. These genes could represent novel markers for a more in-depth characterization of the WOI. Limitations, reasons for caution The samples analysed are in bulk, and the genes identified could be expressed either in the stroma or in the epithelial compartment. These findings are not applicable to artificial cycles, as the absence of the corpus luteum and varying levels of exogenous progesterone administered may change the transcriptomic signatures. Wider implications of the findings Our study revealed good concordance of whole transcriptome profiles of donor’s endometria according to cycle progression. This may lead to the identification of novel markers involved in the regulation of the WOI that may not have been found in previous studies performed on artificial cycles. Trial registration number not applicable

P-693 Three-dimensional modeling of follicular microenvironment dynamics in the human adult ovary

Abstract Study question How does the ovarian microenvironment, involving neural fibers, vascular networks, and immune cells, interplay with follicular dynamics in the human adult ovary? Summary answer Neural fibers growing into the ovarian cortex and vascular network expansion were associated with primordial follicle activation and growth. Macrophages associated with antral follicular atresia. What is known already The ovarian follicles, responsible for preserving and supplying oocytes, play a crucial role in fertility, with their fate influenced by the ovarian microenvironment. However, the three-dimensional (3D), irregular, and dynamic structural changes of the ovarian microenvironment are difficult to interpret using two-dimensional analysis. 3D-imaging technologies have been developed to reveal intricate structural and functional relationships particularly in rodents, but these approaches have not been widely adopted for human ovarian research. Study design, size, duration Our study aims to explore the follicular microenvironment dynamics in the human adult ovary. In this work, we optimized whole-mount immunofluorescence using TUBB3, PODXL, PECAM1, ACTA2 and CD68, and conducted 3D imaging on intact adult ovarian tissue, offering a visualization of the 3D structures and dynamic changes within ovarian follicles, neural fibers, vascular networks, and immune cells in human adult ovary at the single-cell level. Participants/materials, setting, methods The human ovarian samples were collected from donors (N = 5) who underwent oophorectomy after testosterone treatment. Part of the intact ovary, including cortex and medulla, was fixed and used for whole-mount immunofluorescence using markers for neural fibers (TUBB3), blood vessels (PODXL, PECAM1, ACTA2), and immune cells (CD68). Subsequently, an enhanced iDiSCO method was employed for tissue clearance. Finally, 3D images were acquired using a lightsheet microscope, followed by image analysis and 3D reconstruction using Imaris software. Main results and the role of chance Our results showed that TUBB3-labeled nerve fibers predominantly distributed in the ovarian cortex, with few presented in the medullary region. Notably, their presence surrounding secondary and antral follicles was limited. We observed a rich distribution of PODXL-labeled capillaries surrounding primordial and primary follicles in the cortical layer of the adult ovary. As follicles progressed to the secondary stage, PECAM1-labeled vasculature contributed to the construction of a vascular network enveloping the secondary follicles and connecting extensively to larger-caliber arteries containing (ACTA2+) smooth muscle cells. In antral follicles, large larger-caliber arteries were also detected, maintaining proximity to the theca cell layer. Interestingly, in cases of follicular atresia, vascular invasion within the follicular cavity was observed. Additionally, clusters of CD68+ macrophages exhibited a scattered distribution around the follicles at various stages, with a significant accumulation in atretic small-antral follicles. Limitations, reasons for caution Our study was conducted on ovaries from a limited number of donors after gender-affirming surgery. Although we aimed to provide insights into the ovarian microenvironment, we were so far unable to obtain ovaries with large antral follicles, ovulatory follicles and the formation of the corpus luteum. Wider implications of the findings The views provided by 3D-image analysis of the human ovary will augment the current knowledge of the complex interactions between the follicles and the ovarian microenvironment. 3D ovarian mapping will also provide a roadmap for generating oocytes in vitro for fertility preservation and ovarian disease modelling. Trial registration number N/A.

P-435 Superiority of modified natural cycle vs hormonal replacement therapy in non-menopausal egg recipients of advanced maternal age: clinical outcomes from 1273 single blastocyst transfer cycles

Abstract Study question Is the modified natural cycle (mNC) better than hormonal replacement therapy (HRT) for endometrial preparation in non-menopausal egg recipients of advanced maternal age? Summary answer In women above 40 years, mNC shows better reproductive and obstetrical outcomes compared to hormonal replacement therapy, especially in the subgroup 45-50 years old. What is known already There is extensive evidence showing the superiority of mNC over HRT in terms of live birth rates, miscarriages, and even obstetric complications. Apparently, the presence of the corpus luteum plays a major role in endometrial receptivity and embryo implantation, probably allowing for better placentation. Nevertheless, there is a general belief that the ovulatory cycle of older women is not the best choice for endometrial preparation, although paradoxically they are the group of patients who could benefit most from the reduction of obstetric complications. An increase in cancellation rates for mNC is claimed, without consistent data available. Study design, size, duration Retrospective single-centre comparative clinical study, including 1273 endometrial preparation cycles for frozen single-blastocyst transfer between January 2020 and December 2022: 892 (70,2%) on HRT protocol and 381 (29,8%) on mNC protocol. The two groups were homogeneous for donor’s age (25,7 years HRT vs 25,3 years mNC), recipient’s age (42,2 years HRT vs 42,1 years mNC), severe male factor (6% HRT vs 5% mNC), and the need for a sperm donor (28% HRT vs 26% mNC). Participants/materials, setting, methods Among 1273 started non-menopausal recipient’s cycles, we compared cancellation rates between HRT and mNC due to either medical reasons (inadequate endometrium, bleeding, premature ovulation) or other issues (no embryo survival, COVID-19, etc). We studied the outcomes of the 1096 elective frozen single-blastocyst transfers performed, comparing HRT and mNC cycles for: pregnancy, clinical pregnancy, miscarriage, live birth and <35weeks preterm birth rates. We stratified the results by age and used Chi-square test to compare groups (p < 0,05). Main results and the role of chance The overall cancellation rate was 13.9%. No significant differences in cancellation for medical reasons were found between HRT (7%) and mNC (6.8%), p = 0.93. When we analyse results stratified by age, patients aged 39 or less (270 cycles: HRT 75.9%, mNC 24.1%) showed no statistically significant differences in pregnancy (58% vs 64.6%, p = 0.35), clinical pregnancy (50.7% vs 56.9%, p = 0.34), miscarriage (18.3% vs 18.9%, p = 0.93), and live birth rates (41.5% vs 46.2%, p = 0.5). In the 40-44 age group (494 cycles: HRT 64.2%, mNC 35.8%), no statistically significant differences were found between HRT and mNC in pregnancy (58.2% vs 61.5%, p = 0.47), clinical pregnancy (50.8% vs 51.1%, p = 0.96), and live birth rates (40.4% vs 45.8%, p = 0.25). The HRT group had a significantly higher miscarriage rate (21%) compared to mNC (10%), p = 0.03. For patients aged 45-50 years (332 cycles: HRT 72%, mNC 28%), no statistically significant differences were observed in pregnancy (56.5% vs 62.4%, p = 0.33) and miscarriage rates (24.3% vs 15.1%, p = 0.18). Clinical pregnancy (44.8% Vs 57%, p = 0.04) and live birth rates (33.9% vs 48.4%, p = 0.01) were significantly higher in the mNC group compared to HRT. No significant differences were found between HRT and mNC in preterm birth rates <35 weeks (3.6% vs 4.6%, p = 0.75). Limitations, reasons for caution This study is a single-centre retrospective comparative trial. Our homogeneity study included several confounding variables, however other bias such as severe uterine factor, embryo quality or repeated implantation failure cases were not taken into account. Wider implications of the findings Modified natural cycle should be encouraged as the first option for endometrial preparation in non-menopausal egg recipients of advanced maternal age, having shown superiority over hormonal replacement therapy in patients aged 45-50 years. Moreover, modified natural cycles are more patient friendly and cost-effective, with no increase in the cancellation rates. Trial registration number not applicable

P-672 Is there a sweet spot for follicular size and/or estradiol level for the initiation of micronized progesterone to optimize natural proliferative phase (NPP) cryo-cycle outcome?

Abstract Study question Is there an optimal follicular size and/or estradiol level for the initiation of micronized progesterone to optimize outcomes in NPP cycles potentially restricting scheduling flexibility? Summary answer All follicular sizes >12 mm and estradiol levels >120 pg./mL do not significantly correlate with ongoing pregnancy rates (OPR) or pregnancy loss (PL). What is known already Planning of a frozen embryo transfer (FET) is feasible within either a natural (NC) or artificial cycle (AC). While AC-FETs offer flexibility in planning, concerns have raised due to studies indicating a higher risk for obstetric complications. Conversely, NC-FETs show a protective effect against these complications but are usually less flexible in planning and ask for more monitoring. Recently, the natural proliferative phase (NPP) protocol was described, in which luteal phase support is initiated as soon as the endometrium reaches 7mm. NPP-FETs were associated with ongoing pregnancy rates comparable to AC- and NC-FETs. Study design, size, duration A retrospective single-centre study including a total of 300 consecutive single frozen embryo transfers (FET), performed at a tertiary fertility centre between March 2023 and December 2023. All cycles were single blastocyst transfer cycles retained from IVF/ICSI cycles with autologous oocytes. Participants/materials, setting, methods A total of 227 patients underwent one or more frozen embryo transfer cycles. Administration of MVP 800mg BID was initiated after fulfilling the following criteria: follicular size > 12mm, estradiol level ≥120ng/mL and endometrium thickness ≥7mm. Blastocyst transfers were scheduled on the fifth day of MVP administration. Serum progesterone (P4) levels were determined on the day of transfer. Associations between treatment outcome, patient and cycle characteristics were explored using generalized estimating equations analyses. Main results and the role of chance The follicular size and estradiol level on the day of MVP initiation was not significantly associated with pregnancy rate (PR), ongoing pregnancy rate (OPR) or pregnancy loss (PL) (p = 0.386 and p = 0.260; p = 0.830 and p = 0.467; p = 0.978 and p = 0.313 respectively). Mean number of visits needed prior to the initiation of the MVP for scheduling the embryo transfer was 2.4 (SD 1.3). PR, but not OPR, was significantly associated with both the duration of the follicular phase as well as the number of visits (p = 0.008 and p = 0.006 respectively). For 91.3 % (274/300) of patients, embryo transfer could be scheduled on a weekday. 49% (146/300) of patients had a positive hCG test after the fresh blastocyst transfer in the NPP cycle. Ongoing pregnancy rate was 35 % (104/300), whereas pregnancy loss (early clinical miscarriage and biochemical pregnancy) was 23% (33/146). The OPR was significantly related to the age of the patient (p = 0.029). Both the PR as the OPR were significantly related the blastocyst quality (p = 0.008 and 0.009 respectively). The incidence of pregnancy loss was only significantly associated with blastocyst quality (p = 0.027). Mean serum P4 level at day of transfer was 19.4 ng/ml (SD 6.1) with a P4 level above 10ng/ml in 97% of cycles. Limitations, reasons for caution The retrospective character is a limitation of this study as well as the absence of live birth rate as a clinical outcome variable. Wider implications of the findings Flexibility about the required follicular sizes and estradiol levels open the perspective for exploring more flexible planning criteria such as lower thresholds for endometrial thickness. Further studies are needed to investigate whether ovulation occurs with formation of functional corpora lutea to effectively protect against hypertensive disorders. Trial registration number ONZ-2024-0015

HISTOLOGICAL STRUCTURE AND FUNCTIONAL PROPERTIES OF THE TUNICA ALBUGINEA OF THE OVARY

Just below the surface epithelium of the ovary is the tunica albuginea, which is a tight irregular connective tissue structure that gives the tissue its white color and contains fibroblast cells. Tunica albuginea, which is more resistant to environmental factors, contains fewer cells and is rich in collagen fibers, is observed as the niche of preantral follicles. It has been observed that fibroblasts forming collagen fibers provide the development of follicles with the paracrine factors and cytokines they secrete and function as a nourishing cell layer. After the graaf follicle forms the corpus luteum, fibroblasts in the adjacent tunica albuginea proliferate and the thickness of this structure increases. The tunica albuginea undergoes frequent renewal due to the corpus luteum structures formed in rats. When the corpus luteum is formed, new capillaries and venules are formed in the adjacent tunica albuginea. This structure may be a suitable model for investigating the migration of cells from the bone marrow to the ovary via vessels. It can be suggested that mesenchymal cells and very small embryonic/epiblast-like stem cells (VSELs), which show pluripotent stem cell characteristics, may migrate from the bone marrow to the tunica albuginea through vascular structures and that the bone marrow may be the source of these cells, which have been previously shown to be present in the ovary. The aim of this review is to examine the effects of the tunica albuginea on the development of follicles and the dynamic structure of the ovary.

Metabolic adaptation to lactation of dairy cows in two contrasting facilities involving partial confinement plus grazing or total confinement

Context The increasing intensification of pasture-based systems has subjected the cows to different productive environments, which could affect physiological responses and, consequently, their productive performance. Aims The aim was to determine the effect of contrasting housing facilities (outdoor soil-bedded vs compost-bedded pack barn) used in partial confinement in pasture-based systems, on the metabolic adaptation during early lactation and its impact on productive and reproductive performance of autumn- and spring-calving dairy cows, having as a positive control a zero-grazing confined system in compost barn. Methods Multiparous Holstein dairy cows that calved in autumn (n = 36) and spring (n = 48) were distributed in the following three treatments from calving to 90 days in milk (DIM): outdoor soil-bedded–grazing (OD-GRZ), compost barn–grazing (CB-GRZ), compost barn–total mixed ration (CB-TMR). Milk production, total milksolids (TMS), body condition score, non-esterified fatty acids (NEFA), beta-hydroxybutyrate (BHB), cholesterol, insulin, insulin-like growth factor-1 (IGF-1), and the proportion of cows with corpus luteum were determined in repeated measurements. Key results In both calving seasons, milk production and TMS yields did not differ between OD-GRZ and CB-GRZ, but were greater in CB-TMR (P < 0.0001). In autumn, NEFA and BHB were not affected by treatments, but cholesterol increased faster in CB-TMR (P = 0.0500). In spring, NEFA and cholesterol concentrations were not affected by treatment, but BHB remained greater in OD-GRZ until 90 DIM than in the other treatments. IGF-1 and insulin did not differ between treatments in autumn, but in spring, IGF-1 was greater in CB-TMR (P < 0.0001). The proportion of cows with corpus luteum was not different between pasture-based treatments, but both were greater than CB-TMR up to 40 DIM in autumn (P = 0.0489) and during the entire study in spring CB-TMR (P = 0.0285). Conclusions Although no differences were found among housing facilities in partial confinement, except that in spring OD-GRZ cows had greater BHB concentrations, confined cows prioritised milk production instead of reproductive function, despite presenting better energy indicators than did pasture-based cows. Implications Outdoor housing combined with grazing can increase the risk of greater BHB concentrations, indicative of subclinical ketosis, under heat-stress conditions, when compared with indoor housing. Confined cows increased milk production but had a delay in the resumption of ovarian cyclicity, even having a better energy status than pasture-based cows.

Estrus response to estrus synchronization using prostaglandin nanoparticle in beef cattle in Majalengka regency

Abstract The study was conducted to determine the estrus response to the applying of prostaglandin nanoparticles (PNp) in two different estrous synchronization protocols. The estrus synchronization occurred in the Majalengka Regency in different years at the same location. The first study (study 1), estrus synchronization was carried out using a single PNp injection protocol, which was preceded by corpus luteum (CL) selection (21 cows). The second study (study 2), double PNp injections were carried out at day-0 and day-11 without prior CL selection (23 cows). The observation of estrus: onset of estrus and estrus quality (score 0-3) were observed 1-5 days after the PNp injection. Results of the study showed that 100% of the cattle were in estrus 2-3 days after the injection of PNp (study 1). The study 2, the estrus response appeared 2-3 days after the PNp injection: 17.35% showed an estrus response after the first PNp injection, 78.26% showed an estrus response at the second PNp injection, and 4.35% showed no estrus response. The pregnancy rate after estrus synchronization is 66.7% and 68.2% for studies 1 and 2. It can be concluded that there is a good response to estrus and pregnancy rate in the application of PNp in both single injections preceding CL selection and double injections with two periods of insemination. Both methods can be applied for estrus synchronization for more savings in PNp hormone administration. The application of that method depends on hormone availability and technician expertise in CL detection.

The effect of exogenous melatonin administration before superovulation on embryo yield in Assaf ewes.

The aim of this study was to determine the effect of exogenous melatonin administration on transferable embryos by increasing total antioxidant status before superovulation in Assaf ewes. Selected ewes were randomly divided into two equal groups: melatonin (n = 9) and control (n = 9). In the melatonin group, a melatonin implant (18 mg melatonin, Regulin®, Ceva, Turkey) was placed under the skin of the ear 7 days prior to insertion of the progesterone-containing sponge. In the control group, a physiological saline solution was injected under the skin of the ear on the same day. The same superovulation protocol was used in both groups. In addition, blood samples for determination of Glutathione peroxidase, superoxide dismutase, total antioxidant status and total oxidant status concentrations were collected on five different days, including the day of melatonin implant placement (Day-7), vaginal sponge insertion (Day 0), vaginal sponge removal (Day 11), mating (Day 12-13) and uterine flushing (Day 19). Embryos were collected by laparotomy on the 7th day after mating. Uterine flushing taken into petri dishes were scanned under a stereomicroscope, and the quality and developmental stages of the embryos were recorded. In the study, total corpus luteum count and total cell count were found to be higher in the control group than in the melatonin group (p < .05). When the results were evaluated in terms of oxidative stress index, a negative correlation was found between the total number of corpus luteum, number of cells obtained, count of transferable embryos and number of Grade 1 embryos on Day 0. There was also a positive correlation oxidative stress index and the number of unfertilized oocytes on Day-7. As a result, exogenous melatonin administration prior to superovulation during the breeding season is thought to have a negative effect on embryo yield and quality. Therefore, the use of exogenous melatonin in MOET studies during the breeding season is recommended to be investigated in new studies.

Granulosa Cell-Layer Stiffening Prevents Escape of Mural Granulosa Cells from the Post-Ovulatory Follicle.

Ovulation is vital for successful reproduction. Following ovulation, cumulus cells and oocyte are released, while mural granulosa cells (mGCs) remain sequestered within the post-ovulatory follicle to form the corpus luteum. However, the mechanism underlying the confinement of mGCs has been a longstanding mystery. Here, in vitro and in vivo evidence is provided demonstrating that the stiffening of mGC-layer serves as an evolutionarily conserved mechanism that prevents mGCs from escaping the post-ovulatory follicles. The results from spatial transcriptome analysis and experiments reveal that focal adhesion assembly, triggered by the LH (hCG)-cAMP-PKA-CREB signaling cascade, is necessary for mGC-layer stiffening. Disrupting focal adhesion assembly through RNA interference results in stiffening failure, mGC escape, and the subsequent development of an abnormal corpus luteum characterized by decreased cell density or cavities. These findings introduce a novel concept of "mGC-layer stiffening", shedding light on the mechanism that prevents mGC escape from the post-ovulatory follicle.

Chemotherapy drug combinations induced maternal ovarian damage and long-term effect on fetal reproductive system in mice

With the postponement of female reproductive age and the higher incidence of cancer in young people, fertility preservation has become increasingly important in childbearing age. Chemotherapy during pregnancy is crucial for maternal cancer treatments and fetal outcomes. It is a need to further study ovarian damage caused by chemotherapy drug combinations and long-term effects on offspring development, and a detailed understanding of side effects of chemotherapy drugs.In this study, chemotherapy drug combinations significantly impacted on ovarian function, especially epirubicin/cyclophosphamide (EC) combination led to an unbalance in the development of the left and right ovary. Exposure to EC and cisplatin/paclitaxel (TP) increased the number of progenitor follicles while decreased the count of antral follicles and corpora luteum. As to the estrus cycle, EC exposure resulted in a longer estrus period and diestrus period, while TP exposure only extended the diestrus period. EC and TP affected steroid biosynthesis by reducing the expression of SF1 and P450arom.γ-H2AX was detected in both EC and TP exposure groups.As to the impact on the offspring from 4T1 tumor-bearing pregnant mice injected with EC, no significant difference was observed in the physical and neurological development compared to the control, but the ovarian weights, estrus cycles of the offspring were significantly different. Chemotherapy drug combinations exhibit ovarian toxicity, not only causing direct damage on the follicle cells but also disrupting steroid biosynthesis. The reproductive system of offspring from maternal tumor-bearing mice exposed to chemotherapy drugs was observed disorder, but the concrete mechanism still needs further exploration.

A rare bleeding disorder with severe haemorrhagic manifestation

Factor V is a major part of the coagulation system and maintains a balance in pro-coagulant and anticoagulant pathways. Any deficiency or mutation can lead to disequilibrium in coagulation. Factor V deficiency can be congenital or acquired. Congenital factor V deficiency (parahemophilia or Owren’s disease) is a rare autosomal recessive condition. We present a case of an adolescent unmarried girl presenting with an acute abdomen and deranged coagulation parameters. It was confirmed that the bilateral haemorrhagic ovarian cysts and hemoperitoneum were due to factor V deficiency. In her case, the bleeding was likely due to a ruptured corpus luteum during ovulation. She was successfully managed conservatively with red cells and fresh frozen plasma transfusions, tranexamic acid and combined oral contraceptive pills (COCP) with instructions to continue the use of COCP to prevent such bleeding manifestations.

Phytochemicals-based investigation of Rubia cordifolia pharmacological potential against letrozole-induced polycystic ovarian syndrome in female adult rats: In vitro, in vivo and mechanistic approach

Polycystic Ovarian Syndrome (PCOS) is a metabolic, reproductive, and endocrine disorder affecting women of fertile age. This study aimed to formulate a phytochemicals-based standardized aqueous ethanolic extract of Rubia cordifolia (SERC) to explore its pharmacological potential in PCOS-induced female rats and elucidate its mechanism. HPLC analysis revealed the presence of phytochemicals such as chlorogenic acid, p-coumaric acid, gallic acid, and kaempferol. Thirty female adult rats were divided into two groups for induction of PCOS (5 female rats in the normal control group + 25 female rats in the disease-induced group). PCOS was induced by administering letrozole (1 mg/kg p.o.) for 6 weeks. After PCOS induction, animals of the disease-induced group were divided into five groups: one group used as disease control (PCOS) group, one group on metformin (20 mg/kg), and three groups on SERC (200, 400, and 600 mg/kg). Histopathological analysis showed that PCOS induction reduced corpus luteum and developing follicles and increased cystic follicles. In comparison, SERC treatment improved ovulation with more primary and developing follicles. SERC reduced the serum insulin, LH surge, and testosterone levels while improving the FSH, estrogen, and progesterone serum levels. SERC significantly improved the oxidation status of the liver and normalized the lipid profile and liver function markers. In conclusion, SERC treated PCOS, and the suggested mechanism might be the restoration of aromatase activity and background inflammatory status improvement in ovaries.

Ultrasound Imaging and Ovarian Follicles Growth of Mares at Nirwana Equestrian Club

Mares in the estrus cycle by the form of reproductive determine the precision of ovulating time so that efficient to the appropriate time of artificial insemination for breeding. The determination requires supporting medical equipment such as Ultrasonography during the ovulation. This research was conducted to know the ovarian follicle imaging of mares during estrus with Ultrasonography that helps through presume ovulation and the appropriate time to proceed with artificial insemination. This observation was conducted at Nirwana Equestrian Club Semarang, from October until December 2023. The sampling is collected by purposive sampling method where the sample is specifically the mares while in their estrus symptom. The collected data and information are processed descriptively using laboratory equipment such as Ultrasonography. The observation collected the mares physical estrus symptoms such as urination, vulvar pulsination, and vaginal fluid discharge. Significant development was observed from the initial follicle size of 5.34 cm to 5.61 cm in one of the samples with the examination interval within 18 hours before the occurrence of the corpus luteum. The results were proved by 9 samples of mares that had been measured with ultrasound during their estrus, and undergoing pregnancy by one attempt of artificial insemination. The optimum time for artificial insemination for mare is during ovulation where the effective precision is supported by ultrasonography.

In mares resistant to endometrial infection, periovulatory treatment with ecbolic drugs does not influence uterine clearance or luteal development

We aimed to determine associations between experimentally impaired uterine clearance or treatment with ecbolic drugs on luteal development in estrous mares after insemination. In a crossover design, eight mares were treated with saline (CON), clenbuterol (CLEN), oxytocin (OXY) and carbetocin (CARB) from the day of first insemination until 2 days after ovulation. Between treatments, the mares rested for one cycle. Estrous mares were examined for the presence of free intrauterine fluid by transrectal ultrasound. Endometrial swabs for cytology and bacteriology were collected on days 1 and 14. Blood samples were collected daily before AI until day 14 after ovulation for determination of progesterone and PGF2α metabolites (PGFM). Differences between treatments were compared by a general linear model for repeated measures (SPSS 29). One mare was excluded because of a uterine infection in the control cycle. In all other mares, only minor amounts of free intrauterine fluid were present after insemination and decreased over time (P<0.05) with no treatment x time interaction. There was no effect of treatment on polymorphonucleated cells (PMN) in endometrial cytology after ovulation or PGFM secretion. Progesterone release from day 1–14 as well as pregnancy rate and conceptus size on day 14 was not influenced by treatment. In conclusion, treatment with clenbuterol does not impair uterine clearance in estrous mares resistant to endometritis. Repeated injection of the oxytocin analogue carbetocin during the early postovulatory period is not detrimental to corpus luteum function and can be recommended to enhance uterine clearance.

Effects of β-carotene supplementation and age on the oxidative status, production and reproductive performance of grazing ewes

Context There is some evidence that physiological stages such as breeding, pregnancy, parturition and lactation may trigger oxidative stress. It has also been observed in several species, including sheep, that age affects their vulnerability to oxidative stress. Aims This study investigated the effects of supplemental β-carotene and age on the oxidative status of grazing ewes around breeding, pregnancy, parturition and early lactation as well as on their production and reproduction performance. Methods Hundred and four ewes were divided into two broad age groups (young = 1–3 years, and old = 4–6 years). Within age groups, ewes of similar age were randomly assigned to four treatment groups (A1, A2, A3, C) by using a completely randomised block design. The young (n = 13) and old (n = 13) sheep in Groups A1, A2 and A3 were daily drenched with 100 mg, 75 mg and 50 mg β-carotene respectively. Group C was unsupplemented (Control). Supplementation lasted 28 days before oestrus synchronisation; 14 days during oestrus synchronisation (CIDR) and hand-mating; 18 days post-hand-mating; 30 days before lambing; and 15 days after lambing. All animals were grazed on Kikuyu grass (Pennisetum clandestinum). Six ewes from each group (total = 24) were sampled for blood to measure oxidative and hormonal status during the experiment. Key results Supplemental β-carotene at ≥75 mg/day may act as a pro-oxidant in ruminants under oxidatively stressed conditions such as parturition. Age did not affect the ewes’ oxidative status. The supplemental β-carotene did not affect bodyweight, oestrus parameters, corpus luteum size, conception rate and litter size. Except for a tendency of lambs from supplemented ewes to have heavier weight at 15 days old (P = 0.080), age group and supplemental β-carotene did not affect the lamb mortality rate or weight at birth or 15 days old. Older ewes showed earlier and longer duration of oestrus than did younger ewes. Conclusions Supplementation of grazing ewes with β-carotene should not be ≥75 mg/day, especially at parturition period, because it may work as a pro-oxidant. The older ewes seem to have earlier oestrus with a longer duration than do the younger ones. Implications Caution is urged when administering high doses of β-carotene to ewes during the peri-parturient period.