Implantation In Women Research Articles

Laparoscopic artificial urinary sphincter implantation in women with stress urinary incontinence: update on 13years' experience in a single centre.

To update the outcomes and analyse the safety of laparoscopic implantation of an artificial urinary sphincter (AUS) in women with stress urinary incontinence (SUI) as a result of intrinsic sphincter deficiency (ISD). Seventy-four women with SUI caused by ISD underwent laparoscopic AUS implantation between 2005 and 2018 in our centre. Urodynamic assessment was required. The AUS was implanted using a transperitoneal laparoscopic approach to the Retzius space. The cuff was placed around the bladder neck between the peri-urethral fascia and the vagina. Postoperative functional outcomes were defined as success (total continence), improvement (>50% decrease in number of leakages or in number of pads used), or failure (<50% improvement, persistent or increased leaking). Data on peri-operative and long-term complications were also collected. The mean ± sd operating time was 119.7 ± 48.9min, with no conversion to laparotomy. With a mean ± sd (range) follow-up of 44.5 ± 40.5 (1-149) months, 78.3% of the women were totally continent and 18.6% reported improvement. One vaginal and one urethral perforation were the only intra-operative complications, both solved during surgery. Late complications included recurrent urinary tract infection (5.4%), acute urinary retention (6.8%), urethral (4%) and vaginal erosion (2.7%), and urgency urinary incontinence (2.7%). Reimplantation of AUS was performed in 13.5% of the women as a result of mechanical failure (n =9) and erosion (n = 1). Permanent removal was performed in 10.8%. To our knowledge, this is the largest series with the longest follow-up of women with urinary incontinence treated with laparoscopic AUS implantation, demonstrating its safety, feasibility and effectiveness, and showing a very positive impact on the quality of life of the women.

Six-Year Prospective Outcomes of Primary Breast Augmentation With Nano Surface Implants.

BackgroundMotiva Implants (Establishment Labs Holdings Inc.) are a novel family of silicone breast implants using cutting-edge technologies engineered to optimize aesthetic and safety outcomes.ObjectivesThe authors sought to prospectively evaluate the safety and effectiveness of SmoothSilk/SilkSurface Motiva Implants over long-term follow-up.MethodsSurgeons at a single plastic surgery center undertook a 10-year follow-up study of SmoothSilk/SilkSurface Motiva Implants in women who underwent primary breast augmentation. Safety was assessed through identification of complications on follow-up and through magnetic resonance imaging (MRI) in a representative sample. Effectiveness outcomes were assessed by surgeons and patients using Likert scales and a Quality of Life tool.ResultsThis article reports the 6-year safety and effectiveness outcomes. A total of 35 patients were implanted between September and December 2010, and 71.9% of implants were placed submuscularly using inframammary incision. During the 6-year follow-up, there were no occurrences of capsular contracture, rupture, double capsules, or late seroma. MRI evaluation identified no signs of implant-related complications. Three revision surgeries were performed, all for aesthetic reasons; there were no implant replacements for medical reasons. The level of satisfaction for both patients and surgeons was high at all follow-up visits. Patient quality-of-life scores increased following breast augmentation by an average of 0.89% at 72 months.ConclusionsThe results of this prospective long-term follow-up study demonstrate the excellent safety and effectiveness of SmoothSilk/SilkSurface Motiva Implants in primary breast augmentation through 6 years of follow-up.Level of Evidence: 4

Complications of using Gore-Tex in medialization laryngoplasty: case series and literature review.

This study was performed to evaluate the incidence and contributing factors of complications associated with medialization laryngoplasty using Gore-Tex in patients with unilateral vocal fold paralysis. A retrospective chart review was conducted for all patients who underwent medialization laryngoplasty using Gore-Tex at Tohoku University Hospital between January 2014 and April 2018. A search of series and case reports in PubMed was performed to determine the incidence of complications following medialization laryngoplasty using Gore-Tex. Sixty-eight patient charts were reviewed. Two patients (2.9%) had complications (infection and extrusion into the airway) related to the Gore-Tex implant after surgery. In the 555 medialization laryngoplasty cases reported in both our current data and eight additional articles, there were 11 complications related to the Gore-Tex implant (2.0%). The most common event was extrusion into the lumen, which occurred in six cases (1.1%), followed by persistent inflammation with the granulation formation (0.5%). There were 12 cases of Gore-Tex extrusion (one male, six female, and five of unknown gender). The interval to onset ranged from 1month to 10years (median, 49months). Our findings serve as a reminder that complications can occur with Gore-Tex implants following medialization laryngoplasty in patients with unilateral vocal fold paralysis, even in the long-term. We suggest that the use of excessively large implants in women and occurrence of postoperative hematoma followed by infection are factors that may cause complications. Nevertheless, Gore-Tex has been proven to be a relatively safe and reliable material for medialization laryngoplasty.

Endometrial MIR-543 is down-regulated during the implantation window in women with endometriosis-related infertility

Differentially expressed microRNAs (miRNAs) have been shown to be associated with endometriosis-related infertility. The aim of this study was to investigate the expression of the most relevant miRNAs in the eutopic endometrial tissue during the window of implantation in women with endometriosis-related infertility. All the infertile patients (76 women with a regular menstrual cycle) received treatment between January 2014 and June 2016. The study group included 38 patients with endometriosis related-infertility (n=38, with 26 at the proliferative phase and 12 at the time of implantation window (mid-secretory phase)). The control group included 38 patients with tubal factors (n=38, with 24 at the proliferative phase and 14 at the time of implantation window). Human miRNA microarray and mRNA microarray were used to examine the expression levels of miRNA and mRNA, respectively (from 3 endometriosis patients and 3 control cases). Quantitative Real-time PCR (RT-qPCR) arrays were utilized to examine the expression levels of 6 selected miRNAs (from 35 endometriosis patients and 35 disease-free individuals). Five differentially expressed miRNAs (miR-142-5p, miR-146a-5p, miR-1281, miR-940 and miR-4634) were significantly upregulated, whereas miR-543 was significantly down-regulated in the eutopic endometrium during the window of implantation in patients with endometriosis. RT-qPCR results showed that miR-543 was significantly down-regulated in patients with endometriosis (p=0.002), especially down-regulated at the window of implantation phase (p= 0.012). The area under the receiver operator characteristics curve was 0.72 [95% confidence interval (CI):0.594-0.846] in discriminating endometriosis from controls. miR-543 is down-regulated in the eutopic endometrial tissue during the window of implantation in women with endometriosis. Dysregulated expression of miR-543 may affect embryo implantation by disturbing the endometrial receptivity, which results in the pathogenesis of endometriosis-related infertility.

Coagulation tests at trigger day in patients with Factor V Leiden Mutation to predict implantation failure

Objectives: The aim of this study was to assess the predictive value of coagulation tests at trigger day in patients with isolated factor V Leiden mutation who underwent intracytoplasmic sperm injection cycle (ICSI).Study Design: Ninety women with isolated factor V Leiden mutation underwent ICSI cycles with an indication of unexplained infertility. In all participants antagonist protocol was used for ovarian hyperstimulation and coagulation tests including activated partial thromboplastin time (APTT), partial thromboplastin time (PT), international normalized ratio (INR), serum fibrinogen and D-dimer levels at trigger day were determined to predict successful implantation. All the clinical parameters specific for the treatment and some patient characteristics were recorded for each participants.Results: There was no significant difference between groups with and without succesfull implantation in terms of age, body mass index, basal hormone levels (follicle stimulating hormone, estradiol, progesterone at day 3 and antimullerian hormone) (P &gt; 0.05). Estradiol and progestrone levels at trigger day were comparable between groups (P &gt; 0.05). Groups had similar endometrial thickness at embryo transfer day (P &gt; 0.05). Some ovarian stimulation characteristics including initial gonadotropin dose, number of follicles &gt; 17 mm, number of oocytes harvested and number of embryos were similar between groups (P &gt; 0.05). Although there was no significant difference between groups with regard to APTT and PT levels, INR level were significantly lower while D-dimer levels and fibrinogen were significantly higher in cases without implantation (P &lt; 0.05).Conclusion: D-dimer, fibrinogen and INR levels were significant predictors for successful implantation in women with isolated factor V Leiden who underwent ovulation hyperstimulation.

Calpain7 impairs embryo implantation by downregulating \u03b23-integrin expression via degradation of HOXA10

Endometriosis (ENDO) is a common gynecological disease that causes infertility in many women. Previous studies noted that the dysregulation of Homeo box A10 (HOXA10) in the endometrium of women with ENDO was involved in the failure of embryo implantation. However, the mechanism by which HOXA10 expression is reduced in women with ENDO is still poorly understood. Here we found that a member of the calcium (Ca2+)-dependent cysteine protease family calpain7 (CAPN7), negatively correlated with HOXA10, was highly expressed in the endometrium of infertile women with ENDO and was significantly downregulated during the window of embryo implantation in mice. Overexpression of CAPN7 in Ishikawa cells or in the uterus of mice inhibited embryo implantation in vitro and in vivo. In the current study, we identified a sequence rich in proline, glutamic acid, serine, and threonine (PEST sequence) that enhanced the Ca2+-dependent degradation of HOXA10 by CAPN7. Furthermore, the interaction between HOXA10 and CAPN7 repressed the transcriptional activity and protein stability of HOXA10. In contrast, the administration of the calpain inhibitor ALLN reversed the CAPN7-induced HOXA10 degradation. Moreover, truncation of the PEST motif in HOXA10 abolished its CAPN7-dependent proteolysis. These studies reveal a novel pattern of HOXA10 regulation via PEST sequence-mediated calpain proteolysis that was demonstrated to be reversed by a calpain inhibitor. Thus, the inhibition of CAPN7-induced HOXA10 degradation may represent a novel potential therapeutic method to improve impaired embryo implantation in women with ENDO.

Uterine natural killer cell progenitor populations predict successful implantation in women with endometriosis-associated infertility.

Uterine natural killer (uNK) cells play a critical role early in gestation. As we previously identified altered uNK cell development in endometriosis-associated infertility, we herein sought to characterize natural killer (NK) cell profiles in endometriosis that may predict embryo implantation. Study participants had a surgical diagnosis of endometriosis-associated infertility. Endometrial tissue and peripheral blood were obtained from 58 women. Thirty-three patients underwent artificial reproductive technology (IVF, ICSI, or IUI) within a mean of 9.5months of surgery. NK and hematopoietic progenitor cells from endometrium and blood were analyzed by flow cytometry. Successful implantation was defined as a positive pregnancy test. In successful implantation, populations of endometrial CD34+ hematopoietic stem cells were higher (3.97% vs 0.69%; P<.0004), and coexpression of NK cell marker CD56 was increased (81.1% vs 60.9%; P<.034) compared with patients who had failed implantation. In contrast, levels of blood NK progenitors were similar in both groups. Our study revealed that uterine NK progenitor cell populations are markedly different in patients with endometriosis who proceed to successful or failed embryo implantation and may define a novel predictor of implantation success. Our findings also highlight the fundamental differences inherent in NK cell repertoires between blood and uterine compartments.

Overexpression of Endometrial Estrogen Receptor-Alpha in The Window of Implantation in Women with Unexplained Infertility.

BackgroundFailure in the endometrial receptivity may account for a significant number of infertility cases including unexplained infertility in women. Reduction in the endometrial estrogen receptor-alpha (ER-α) expression during implantation may be a critical event that coincides with the expression of specific genes and the formation of a receptive endometrium. The aim of the present study was to assess the expression of ER-α in the mid-secretory phase in the endometrium of women with unexplained infertility.Materials and MethodsThis case-control study was carried out on randomly selected fertile (n=10) and infertile (n=16) women whose source of infertility remained unexplained. We evaluated the expression of ER-α and glycode-lin-A (GdA) through mRNA level measurement with real-time polymerase chain reaction (PCR) in the endometrium of fertile women and patients suffering from unexplained infertility and fertile women. Endometrial biopsies of each subject were collected during a single menstrual cycle 7 days after the peak of luteinizing hormone (LH+7).ResultsEndometrial expression level of ER-α was significantly (P<0.05) higher in the patients with unexplained infertility compared to the control. Significantly (P<0.05) lower levels of GdA expression were seen in women with unexplained infertility. A statistically non-significant negative correlation was observed between ER-α and GdA mRNA expression.ConclusionOur findings demonstrate that reduction in the endometrial GdA expression is associated with elevated expression of ER-α in mid-luteal phase. Disruption in the endometrial ER-α expression, which leads to defects in uterine receptivity, may contribute to unexplained infertility.

Expression of the mRNA of the inflammatory component of the immune response in the period of the expected window of implantation in women with recurrent pregnancy loss in the programs of assisted reproductive technologies

The aim of study. To reveal the peculiarities of mRNA expression of the inflammatory component genes of the immune response in the expected window of the implantation in women with RPL in ART programs.Material and methods. 240 patients with RPL in ART programs and 100 conditionally healthy fertile women in the control group with the presence in history of at least one childbirth in time and the absence of episodes of miscarriage were examined. The average age of the examined women of the main group was 29.80 ± 0.30 years, the control group – 30.09 ± 0.32 (p &gt;0.05). The average number of cases of involuntary termination of pregnancy after conduction of ART in main group was 3.24 ± 0.11, the average term of termination of pregnancy was 8.15 ± 0.65 weeks.All women had a paipel-biopsy of the endometrium during the expected implantation window. Samples were frozen at t = -70 °C. until the study. Reverse transcription -polymerase chain reaction was used to study mRNA expression of IL-1β, IL-2, IL-10, Foxp3, TLR9, IL-2Rα cytokine genes in endometrial biopsy obtained on the day of the implantation window.Results. It was found that the relative level of mRNA expression of IL-1β, IL-2, Foxp3, TLR9, IL-2Rα genes did not differ significantly in patients with RPL in the cycles of VRT and control group. A statistically significant decrease in mRNA expression of the IL-10 gene was noted.Conclusion. RPL in the treatment of infertile women in ART programs is associated with changes in the transcription profile of the endometrium during the intended implantation window and with a decrease in the expression level of the IL-10 gene mRNA.

Enhanced HOXA10 sumoylation inhibits embryo implantation in women with recurrent implantation failure

HOXA10 has emerged as an important molecular marker of endometrial receptivity. Recurrent implantation failure (RIF) after in vitro fertilization-embryo transplantation (IVF-ET) treatment is associated with impaired endometrial receptivity, but the exact underlying mechanism of this phenomenon remains elusive. Here we found that HOXA10 was modified by small ubiquitin like-modifier 1 (SUMO1) at the evolutionarily conserved lysine 164 residue. Sumoylation inhibited HOXA10 protein stability and transcriptional activity without affecting its subcellular localization. SUMO1-modified HOXA10 expression was decreased in estradiol- and progesterone-treated Ishikawa cells. Sumoylation inhibited the accelerant role of HOXA10 in BeWo spheroid and mouse embryo attachment to Ishikawa cells. Importantly, aberrantly high SUMO1-HOXA10 expression was detected in mid-secretory endometria of women with RIF compared with that of the control fertile women. Together, our results suggest that HOXA10 sumoylation impairs the process of embryo implantation in vitro and takes part in the development of RIF.

Adrenomedullin improves fertility and promotes pinopodes and cell junctions in the peri-implantation endometrium.

Implantation is a complex event demanding contributions from both embryo and endometrium. Despite advances in assisted reproduction, endometrial receptivity defects persist as a barrier to successful implantation in women with infertility. We previously demonstrated that maternal haploinsufficiency for the endocrine peptide adrenomedullin (AM) in mice confers a subfertility phenotype characterized by defective uterine receptivity and sparse epithelial pinopode coverage. The strong link between AM and implantation suggested the compelling hypothesis that administration of AM prior to implantation may improve fertility, protect against pregnancy complications, and ultimately lead to better maternal and fetal outcomes. Here, we demonstrate that intrauterine delivery of AM prior to blastocyst transfer improves the embryo implantation rate and spacing within the uterus. We then use genetic decrease-of-function and pharmacologic gain-of-function mouse models to identify potential mechanisms by which AM confers enhanced implantation success. In epithelium, we find that AM accelerates the kinetics of pinopode formation and water transport and that, in stroma, AM promotes connexin 43 expression, gap junction communication, and barrier integrity of the primary decidual zone. Ultimately, our findings advance our understanding of the contributions of AM to uterine receptivity and suggest potential broad use for AM as therapy to encourage healthy embryo implantation, for example, in combination with in vitro fertilization.

P3283Predictors of pacemaker implantation in women undergoing contemporary transcatheter aortic valve replacement: Results from the WIN-TAVI registry

P3283Predictors of pacemaker implantation in women undergoing contemporary transcatheter aortic valve replacement: Results from the WIN-TAVI registry

Transvaginal six-arm mesh OPUR in women with apical pelvic organ prolapse — analysis of short-term results, pelvic floor ultrasound evaluation

Analysis of feasibility, efficacy and short-term results after six-arm transvaginal mesh OPUR implantation in women with apical prolapse. The same surgeon operated all of 39 women using mesh OPUR. Preoperatively patients had a standardized interview and clinical examination. Intraoperative and postoperative complications were analyzed. Postoperative evaluation included standardized interview, clinical examination and standardized pelvic floor ultrasound performed with 2D transvaginal probe and 4D abdominal probe. There was no complication that needed operative intervention. Hematomas in 3 patients resolved spontaneously. Transient voiding difficulties which lasted less than 7 days were observed in 5 patients. No erosion was observed. Comparison of pre- and postoperative results in 34 women revealed that in all 3 compartments improvement in POP-Q scale was statistically significant (p < 0.0000). One patient with malposition and rolled up mesh needed re-operation. During PFS-TV in 94.1% of patients urethra was normobile or hypermobile. In all of the patients urethral end of the mesh was positioned far enough from the middle part of the urethra (ultrasound) to implant suburethral sling without risk of collision. Sexually active women did not inform of any important discomfort or pain during intercourse. It seems that six-arm OPUR mesh, if implanted under strict surgical rules, gives low risk of complications and high chance to successfully reduce POP symptoms in short term after the operation. It seems that OPUR mesh should not have negative influence on the results after anti-incontinence suburethral sling.

Correlation between three-dimensional power Doppler and morphometric measurement of endometrial vascularity at the time of embryo implantation in women with unexplained recurrent miscarriage

Power Doppler in combination with three-dimensional (3D-PD) ultrasonography has been used as a noninvasive tool to evaluate the vascularity. However, it is unclear whether 3D-PD can accurately reflect endometrial vascularization and replace the invasive endometrial biopsy. This study aims to investigate the correlation between 3D-PD and micro vessel morphometric measurement of endometrial vascularity. Twenty-five women with unexplained recurrent miscarriage were recruited for 3D-PD and endometrial biopsy on precisely day LH + 7. Immunohistochemistry using vWF was employed to identify micro vessels in endometrial biopsy specimens followed by the use of morphometric technique to measure the mean vessel diameter and volume fractions. The vascularization index (VI), flow index (FI) and vascularization flow index (VFI) assessed by 3D-PD were calculated for both the endometrial and sub-endometrial regions. There were no significant correlations between any of the ultrasonographic measurements (endometrial thickness, endometrial volume, endometrial VI/FI/VFI, sub-endometrial volume, sub-endometrial VI/FI/VFI) and morphometric features (number of micro vessel, mean diameter of micro vessel and volume fraction measurement of vessel). This study indicates that endometrial vascularity assessed by 3D-PD could not be used to reflect changes in micro vessels of the endometrium at the time of embryo implantation in women with unexplained recurrent miscarriage.

859 - Artificial urinary sphincter (AMS800) implantation in women: Rare indications and acceptable complications rate

859 - Artificial urinary sphincter (AMS800) implantation in women: Rare indications and acceptable complications rate

861 - Artificial urinary sphincter implantation in women with stress urinary incontinence: Preliminary comparison of the robot-assisted and open approaches

861 - Artificial urinary sphincter implantation in women with stress urinary incontinence: Preliminary comparison of the robot-assisted and open approaches

Endometrial expression of β3 integrin, calcitonin and plexin-B1 in the window of implantation in women with unexplained infertility

Endometrial receptivity plays a key role in the establishment of successful implantation and its impairment may contribute to subfertility and limit the assisted reproduction techniques (ART) success. The aim of present study was to investigate endometrial receptivity in terms of β3 integrin, calcitonin and plexin-B1 expression in women with unexplained infertility. We evaluated expression of β3 integrin, calcitonin and plexin-B1 through mRNA level measurement with real-time RT-PCR, in the endometrium of 16 infertile women with unexplained infertility and 10 fertile women. Endometrial biopsies were collected during a single menstrual cycle on postovulatory day LH+7 in each subject. Significant differences regarding β3 integrin and calcitonin expression levels found between patients with unexplained infertility and the fertile women. Endometrial plexin-B1 expression levels showed no significant difference between fertile and infertile women. There were significant correlations between expression of β3 integrin with calcitonin and plexin-B1 in fertile and infertile women. Reduced in endometrial expression of β3 integrin and calcitonin alone or together may contribute to unexplained infertility and these genes could account as the potential molecular markers of infertility.

Inherited thrombophilia: a double-edged sword.

Inherited thrombophilia is a blood coagulation disorder that increases the risk for venous thromboembolism (VTE). During the last decades, the practice of testing has evolved from testing selected populations, leading to high perceived risks, to broad testing for various conditions that included VTE, arterial thrombosis, and pregnancy complications. Because results of such tests usually do not guide treatment decisions, not testing patients with VTE for inherited thrombophilia is on the "Choosing Wisely" list endorsed by multiple specialty societies, including ASH. Inherited thrombophilia can be regarded a double-edged sword, as despite the rationale not to test, it is still being performed frequently. Another way of seeing inherited thrombophilia as a double-edged sword lies in its 2-sided association with reproduction, both in men and in women. Current areas of research are whether women with inherited thrombophilia and pregnancy complications benefit from anticoagulant therapy with regard to improving the chance of a successful pregnancy. Potential effects of inherited thrombophilia, most notably factor V Leiden, on improved embryo implantation in women and sperm counts in men are intriguing, but are currently poorly understood.

Non-invasive prediction of implantation window in controlled hyperstimulation cycles: Can the time from the menstrual day at embryo transfer to expected menstrual cycle give a clue?

Objective:The aim of this study was to assess whether the time from the menstrual day at embryo transfer to expected menstrual cycle (TETEMC) is associated with the implantation in women with regular cycles or not.Materials and Methods:Forty women with successful implantation and forty women without implantation with regular cycles were randomly selected from prospectively collected database of assisted reproductive technology clinic of Zeynep Kamil Women And Children’s Health Training and Research Hospital. TETEMC was calculated for each case to assess relationship with the successful implantation.Results:Comparison of groups revealed significant differences with regard to TETEMC and the menstrual period (p<0.05).In ROC analyses both the TETEMC (AUC=0.824, p<0.001) and the menstrual period (AUC=0.797, p<0.001) were significant predictors for clinical pregnancy. Cut off value for the menstrual period was found to be 27.5 days with 82.6% sensitivity and 65% specificity. Cut off value for TETEMC was 11.5 days with 75% sensitivity and 63.2% specificity.Conclusion:Longer menstrual cycle and the TETEMC seem to be associated with the implantation failure.

OC26.04: Influence of adenomyosis on pregnancy outcome and first and second trimester markers of impaired implantation in women with endometriosis

OC26.04: Influence of adenomyosis on pregnancy outcome and first and second trimester markers of impaired implantation in women with endometriosis