Infectious causes of reproductive loss in camelids

Reproductive losses in camelids are due to infertility, pregnancy loss, udder diseases and neonatal mortality caused by a variety of infectious diseases. Uterine infection and abortion represent the major complaint in camelid veterinary practice. The major infectious organisms in endometritis and metritis are E. coli and Streptococcus equi subspecies zooepidemicus. Abortion rates due to infectious diseases vary from 10% to more than 70% in some areas. Leptospirosis, toxoplasmosis and chlamydiosis have been diagnosed as the major causes of abortion in llamas and alpacas. In camels, brucellosis and trypanosomiasis represent the major causes of infectious abortion in the Middle East and Africa. Mastitis is rare in South American camelids. The prevalence of subclinical udder infection in camels can reach very high proportions in dairy camels. Udder infections are primarily due to Streptococcus agalactiae and Staphylococcus aureus. Neonatal mortality is primarily due to diarrhea following failure of passive transfer and exposure to E. coli, rotavirus, coronavirus, Coccidia and Salmonella. This paper reviews the etio-pathogenesis of these causes of reproductive losses, as well as the major risk factors and strategies to prevent their occurrence.     

Cytogenetics of recurrent pregnancy loss

The contribution of chromosomal abnormalities to recurrent pregnancy loss (RLP) is reviewed in the paper. Data from conventional cytogenetic analysis of the karyotype of parents and spontaneous abortions, as well as the results of molecular cytogenetic investigations and preimplantation genetic diagnostics, are discussed. Information about the significance of epigenetic impairments (abnormalities of imprinting and X-chromosome inactivation) for recurrent pregnancy loss is also considered. Cytogenetic analysis of products of conception enables ascertainment of the causes of embryonic death in a large proportion of families, more accurate estimation of the therapeutic efficiency of treatment and drugs (when women with abnormal embryos were excluded), and a statistically valid prognosis about the next pregnancy outcome.     

Dydrogesterone in threatened abortion: pregnancy outcome

OBJECTIVE: To determine whether therapy with dydrogesterone in threatened abortion during the first trimester of pregnancy will improve pregnancy outcome. DESIGN: Prospective open study. SUBJECTS: Pregnant women presenting to the obstetric and gynaecology clinic admitting center with vaginal bleeding before 13 weeks gestation were evaluated for entry into the study. Women were excluded if they had a history of recurrent miscarriage. METHOD: Eligible subjects were randomized to receive either dydrogesterone 40 mg stat dose followed by 10 mg twice a day for one week or conservative therapy. RESULTS: One hundred and 54 women were recruited. There was no statistically significant differences between the two groups with regard to pre-treatment status. The continuing pregnancy success rate was significantly (p=0.037) higher in women treated with dydrogesterone (95.9%) compared with women who received conservative treatment (86.3%). The odds ratio of the success rate between dydrogesterone treatment and non-treatment was 3.773 (95% confidence interval: 1.009-14.108). CONCLUSION: Corpus luteal support with dydrogesterone has been shown to reduce the incidence of pregnancy loss in threatened abortion during the first trimester in women without a history of recurrent abortion.     

Canine and feline pregnancy loss due to viral and non-infectious causes: a review

Among the causes for pregnancy loss, viruses and non-infectious factors are among the most important. In both dogs and cats, research and clinical evidence provide proof that there is an increasing incidence of pregnancy loss associated with infectious diseases like herpesvirus, as well as the presence of toxicants or chemicals in the animal's diet and environment. Endocrine causes must be taken into consideration when dealing with pregnancy loss. This review will cover the most recent knowledge regarding viral and non-infectious of pregnancy losses in the dog and cat.     

Genetic counseling in carriers of reciprocal translocations involving two autosomes

One of the main genetic causes involve in the pathogenesis of recurrent abortion is parental chromosomal abnormalities. The central concept in genetic counseling with such families is to estimate the probability of recurrence of unfavorable pregnancy outcomes. The main questions that consultants usually ask are: Why did this happen? What is the risk to be done again?Our cases were two families with repeated miscarriage. The pedigrees were drawn, the chromosomes of couples were studied, and estimation for recurrent risk was done. We tried to answer those two main questions and clear the results for them.Parental chromosome abnormalities were founded after karyotyping with GTG technique at 450 band resolution, revealing 46 chromosomes with balanced translocation of autosomes in one of the partner in both families. Recurrent risk was estimated as “high” for their future pregnancies in each family.Couples in which one partner is the carrier of such balanced translocation have increased risks of infertility, recurrent abortion, and delivery of chromosomally abnormal offspring. Genetic counseling of such couples, therefore, presents a unique challenge and should be considered in dealing with such families.     

超声在高危药流中的应用

目的 减少药物终止早期高危妊娠的并发症。方法 120例高危早孕,药物终止前后超声检查和随访。结果 一次性药流成功102例,占85％。不全流产或出血时间过长12例,占10％声像图表现：宫腔内见①小片状强回声②团块样中等回声③内膜粗糙④宫腔积液。失败6例,占5％,2例二周后,孕囊不规则,向宫口方向移,4例孕囊继续发育。结论 超声能动态观察子宫和宫内情况,为临床医师正确诊断及处理具极重要的指导意义。     

Hypoluteoidism in a bitch

Hypoluteoidism is characterized by insufficient secretion of progesterone by the corpora lutea during pregnancy. The resulting failure to maintain progesterone concentration above a critical level presumably could lead to fetal resorbtion as well as frank abortion. This report concerns a 2.5-year-old Bernese Mountain dog with a history of two previous pregnancies ending in abortion around Day 50 of pregnancy. The bitch was initially presented 2 days after mating. Physical and gynecological examination revealed no abnormalities. The infectious causes of abortion in the bitch, Brucella canis and herpesvirus, were excluded using serology. On Day 26 after mating, ultrasonography confirmed a pregnancy with at least four living fetuses. During the remaining part of the pregnancy repeated transabdominal ultrasonography and plasma progesterone measurements, using a RIA, were performed. On Day 42, ultrasonography revealed living fetuses but plasma progesterone concentration had decreased to 8.3 nmol/L, which is just above the threshold necessary to maintain a vital pregnancy. Oral treatment with 0.1mg medroxyprogesterone acetate (MPA) per kg body weight, once daily, was started and continued until Day 58 in order to prevent abortion due to progesterone deficiency. The endogenous plasma progesterone concentration decreased further, but pregnancy was maintained. On Day 59 a cesarean section was performed because of dystocia and four living and one dead pup were delivered. One puppy had severe facial malformations and was euthanised. The premature decrease in plasma progesterone concentration while ultrasonography demonstrated that the fetuses were still alive, and the maintenance of pregnancy during administration of MPA, strongly support the diagnosis of hypoluteoidism.     

Role of HLA-G and other immune mechanisms in pregnancy

Pregnancy loss (abortion) and pre-eclampsia represent the most common disorders in pregnant women. Besides infection, there are anatomical, endocrinological, genetic and immunological factors that can induce pregnancy disorders. Because the exact mechanisms of physiological pregnancy maintenance are still not clearly understood, the search for genes and proteins fulfilling this role is still in progress. One of the immune molecules that plays a beneficial role in pregnancy is the nonclassical HLA-G molecule. The molecule is mainly expressed on trophoblast cells in the foetal placenta and induces the immune tolerance of the foetus via its interaction with inhibitory receptors on maternal NK cells and CD8⁺ T lymphocytes. In relation to pregnancy disorders, associations between HLA-G polymorphism, HLA-G level and HLA-G function were described. Thus, the HLA-G molecule can be used as a new diagnostic marker and, potentially, for the future therapy of pregnancy disorders.     

Deconstructing Pregnancy: RU486, Seeing "Eggs," and the Ambiguity of Very Early Conceptions

This article deconstructs previous notions of pregnancy. Using empirical data from French women's experience with RU486 for medical abortion, I demonstrate that very early and unwanted conceptions have an ambiguous quality. I illustrate an understanding of pregnancy as a reproductive continuum: these women understand pregnancy to include a stage where "eggs," and not fetuses, are present. I discuss how the use of RU486 creates new ways of knowing about the fetus, and I compare an understanding of the fetus by women using RU486 with previous understandings from ultrasound images, in utero photography, and the imagination. I demonstrate that women's embodied knowledge can expand the parameters of fetal discourse. [RU486, fetal discourse, embodied knowledge, abortion, reproductive technology]     

Evidence of Selection against Complex Mitotic-Origin Aneuploidy during Preimplantation Development

Whole-chromosome imbalances affect over half of early human embryos and are the leading cause of pregnancy loss. While these errors frequently arise in oocyte meiosis, many such whole-chromosome abnormalities affecting cleavage-stage embryos are the result of chromosome missegregation occurring during the initial mitotic cell divisions. The first wave of zygotic genome activation at the 4–8 cell stage results in the arrest of a large proportion of embryos, the vast majority of which contain whole-chromosome abnormalities. Thus, the full spectrum of meiotic and mitotic errors can only be detected by sampling after the initial cell divisions, but prior to this selective filter. Here, we apply 24-chromosome preimplantation genetic screening (PGS) to 28,052 single-cell day-3 blastomere biopsies and 18,387 multi-cell day-5 trophectoderm biopsies from 6,366 in vitro fertilization (IVF) cycles. We precisely characterize the rates and patterns of whole-chromosome abnormalities at each developmental stage and distinguish errors of meiotic and mitotic origin without embryo disaggregation, based on informative chromosomal signatures. We show that mitotic errors frequently involve multiple chromosome losses that are not biased toward maternal or paternal homologs. This outcome is characteristic of spindle abnormalities and chaotic cell division detected in previous studies. In contrast to meiotic errors, our data also show that mitotic errors are not significantly associated with maternal age. PGS patients referred due to previous IVF failure had elevated rates of mitotic error, while patients referred due to recurrent pregnancy loss had elevated rates of meiotic error, controlling for maternal age. These results support the conclusion that mitotic error is the predominant mechanism contributing to pregnancy losses occurring prior to blastocyst formation. This high-resolution view of the full spectrum of whole-chromosome abnormalities affecting early embryos provides insight into the cytogenetic mechanisms underlying their formation and the consequences for human fertility.     

Manipulation of cytokine production profiles as a therapeutic approach for immunologic pregnancy loss

Pregnancy is not as successful as one might think; it can be compromised by several complications such as recurrent spontaneous miscarriage, pre-term delivery, pre-eclampsia etc. Much attention has been paid to the possibility of the maternal immune system mediating deleterious effects on pregnancy. Research conducted during the last two decades has shed much light on cell-mediated immunologic effectors that might underlie these pregnancy complications. Of particular interest are the effects that pro-inflammatory and anti-inflammatory cytokines have on the foetus and placenta, and thus on the success and failure of pregnancy. This review presents evidences that certain cytokine profiles are associated with recurrent miscarriage and pre-term delivery and discusses possible pathways of effector function of cytokines in pregnancy loss and the redirection of cytokine profiles from one that is antagonistic to pregnancy towards one that is conducive to the success of pregnancy. Among the promising agents for the modulation of the Th1/Th2 balance are progestogens like progesterone and dydrogesterone; this review also discusses recent evidence that progestogens are capable of modulating cytokine production patterns in pregnancy loss.     

High fertility does not cause spontaneous intrauterine fetal loss: the determinants of spontaneous fetal loss in Egypt

This study is concerned with a major, though relatively neglected, reproductive health issue: fetal loss. In particular, the determinants of spontaneous intrauterine mortality in Egypt are investigated with stress on the demographic determinants. To this end, a conceptual framework is developed. Using pregnancy history data from a national survey conducted in Egypt in 1995, the determinants of spontaneous intrauterine fetal deaths among currently married women aged 18-45 are examined using multiple logistic models. It is found that the probability of intrauterine fetal loss rises with maternal age. The apparent positive association of the risk with gravidity is shown to be an artifact, due to the heterogeneity among women with respect to the risk of pregnancy loss, the consequent selection process, and reproductive compensation behavior according to the "success/failure" stopping rule. Therefore, high fertility cannot be said to cause spontaneous fetal loss. Two other features of a woman's reproduction are of strong significance, namely, her pregnancy history and spacing among pregnancies. Once a woman suffers from spontaneous fetal loss, the probability of undergoing further pregnancy losses rises sharply. And the shorter the pregnancy interval, the higher the probability of pregnancy loss. Pregnancies conceived after long intervals are less likely to end in loss.     

High Fat Diet Induced Developmental Defects in the Mouse: Oocyte Meiotic Aneuploidy and Fetal Growth Retardation/Brain Defects

Background

Maternal obesity is associated with poor outcomes across the reproductive spectrum including infertility, increased time to pregnancy, early pregnancy loss, fetal loss, congenital abnormalities and neonatal conditions. Furthermore, the proportion of reproductive-aged woman that are obese in the population is increasing sharply. From current studies it is not clear if the origin of the reproductive complications is attributable to problems that arise in the oocyte or the uterine environment.

Methodology/Principal Findings

We examined the developmental basis of the reproductive phenotypes in obese animals by employing a high fat diet mouse model of obesity. We analyzed very early embryonic and fetal phenotypes, which can be parsed into three abnormal developmental processes that occur in obese mothers. The first is oocyte meiotic aneuploidy that then leads to early embryonic loss. The second is an abnormal process distinct from meiotic aneuploidy that also leads to early embryonic loss. The third is fetal growth retardation and brain developmental abnormalities, which based on embryo transfer experiments are not due to the obese uterine environment but instead must be from a defect that arises prior to the blastocyst stage.

Conclusions/Significance

Our results suggest that reproductive complications in obese females are, at least in part, from oocyte maternal effects. This conclusion is consistent with IVF studies where the increased pregnancy failure rate in obese women returns to the normal rate if donor oocytes are used instead of autologous oocytes. We postulate that preconceptional weight gain adversely affects pregnancy outcomes and fetal development. In light of our findings, preconceptional counseling may be indicated as the preferable, earlier target for intervention in obese women desiring pregnancy and healthy outcomes.     

L’utilisation du MSOME: expérience de six ans

Introduction

MSOME (Motile Sperm Organellar Morphology Examination) is a new method for real-time evaluation of sperm morphology under 6600x high magnification. ICSI modified procedure with sperm selected by MSOME is named IMSI (Intracytoplasmic Morphologically Selected sperm Injection). IMSI has been developed to improve ongoing pregnancy rate in couples with repeated implantation failure.

Material and methods

The study concern an observational cohort of 11535 ICSI performed with fresh ejaculated sperm in our ART lab between January 2004 and July 2009. Among them, 2509 were realized with IMSI. The primary outcome measures were cleavage rate per injected oocyte on day 2, clinical pregnancy and abortion rates. Comparisons were performed using Chi square² test and univariate analysis of variance.

Results

There were no significant difference between conventional ICSI and IMSI groups in term of cleavage and pregnancy rates. Couples with abnormal sperm (teratozoospermia, oligozoospermia and oligoteratozoospermia) and no previous ICSI failure, had a significantly higher clinical pregnancy with IMSI than with ICSI (34.4% vs. 27.1%, p = 0.02). Furthermore, pregnancies obtained in patients with teratozoospermia were associated with a lower abortion rate after IMSI than after ICSI, close to significance (12.6% vs. 19.6%, p = 0.08).

Conclusion

In cases of severe teratozoospermia, IMSI appears to improve pregnancy rate and pregnancy outcome.     

Correlation between preimplantation genetic diagnosis for chromosomal aneuploidies and the efficiency of establishing human ES cell lines

There are several sources from which human embryonic stem cell (hESC) lines can be generated: surplus embryos after in vitro fertilization procedures, one- and three-pronuclear zygotes, early arrested or highly fragmented embryos that have reached the blastocyst stage, or otherwise chromosomally or genetically abnormal embryos after preimplantation genetic diagnosis (PGD). We report on the efficiency of establishing hESC lines from blastocysts with proven meiotic or mitotic errors after sequential testing of both polar bodies and blastomere analysis on day 3. The success rate of establishing hESC lines originating from blastocysts carrying a meiotic error was as low as 2.4% and differed significantly from the success rate of establishing hESC lines originating from blastocysts with balanced meiotic errors (21.6%) or mitotic errors (after sequential testing (9.1%) and after blastomere testing alone (12.2%)). This suggests that it may be reasonable to apply sequential PGD prior to the initiation of hESC culture. Information about the karyotype may in the future help refine the methods and possibly improve the efficiency by which hESC lines are derived from embryos with prezygotic abnormalities. Additionally, it may in general prove very difficult to obtain abnormal hESC lines for scientific study from aneuploid PGD embryos, which will limit our ability to study the biological consequences of chromosomal abnormalities. Furthermore, the success rates for generating aneuploid cell lines originating from fertilized oocytes carrying a prezygotic nondisjunction error seem to mirror the miscarriage rates during pregnancy of embryos carrying such errors.     

Bacterial and protozoal causes of pregnancy loss in the bitch and queen

Several bacterial species have been implicated in canine and feline pregnancy loss. Brucella canis is one of the more important bacterial infectious agents that cause pregnancy loss in the bitch. Brucella has been documented in the queen but in general infectious abortion from bacteria and protozoal agents is uncommon in the species. Protozoal causes of pregnancy loss in the bitch and queen are less common than in other species. Etiology, clinical signs, diagnosis and treatment of bacterial and protozoal causes of pregnancy loss in the bitch and queen are reviewed. Veterinary practitioners should be aware that many of these organisms have zoonotic potential.     

Coping with fertility in Israel: A case study of culture clash

The concepts of culture-bound belief systems and explanatory models focused on reproduction and contraception are applied to a case of a married Jewish woman seeking to interrupt an unwanted pregnancy. Discrepancies between the lay belief system held by the woman, and the clinical belief system of the medical mediators of contraception and abortion, have created a situation where none of the alternatives at the woman's disposal seems correct: the options available for preventing pregnancy are unacceptable or inefficient; having a child is also not acceptable; and termination of unwanted pregnancy by abortion is ethically and morally wrong. The "no-win" situation results from medical ethnocentrism and failure to interpret the context of meanings and norms within which health decisions are constructed.     

Why is oocyte aneuploidy increased with maternal aging?

One of the main causes of pregnancy failure and fetus abortion is oocyte aneuploidy, which is increased with maternal aging. Numerous possible causes of oocyte aneuploidy in aged women have been proposed, including cross-over formation defect, cohesin loss, spindle deformation, spindle assembly checkpoint malfunction, microtubule-kinetochore attachment failure, kinetochore mis-orientation, mitochondria dysfunction-induced increases in reactive oxygen species, protein over-acetylation, and DNA damage. However, it still needs to be answered if these aneuploidization factors have inherent relations, and how to prevent chromosome aneuploidy in aged oocytes. Epidemiologically, oocyte aneuploidy has been found to be weakly associated with higher homocysteine concentrations, obesity, ionizing radiation and even seasonality. In this review, we summarize the research progress and present an integrated view of oocyte aneuploidization.     

挥发性有机化合物(VOCs)对IVF实验室影响的研究进展

体外受精-胚胎移植技术已成为当今治疗不育症的主要手段,为取得令人满意的临床妊娠率,体外受精(IVF)实验室的空气质量控制成为生殖助孕工作者关注的重点。胚胎培养室的挥发性有机化合物(volatileorganiccompounds,VOCs)含量对配子-胚胎发育的影响至关重要,体外胚胎对VOCs的耐受能力差,其含量超过一定界限时则会对配子和胚胎造成影响。本文概述了IVF实验室VOCs的来源,VOCs的生殖毒性,VOCs的测定方法以及胚胎培养室内VOCs的控制途径等,旨在更严格的进行IVF实验室的空气质量控制,尽可能杜绝VOCs的污染,提高IVF的成功率。     

Single‐cell transcriptome analysis reveals defective decidua stromal niche attributes to recurrent spontaneous abortion

ObjectivesSuccessful pregnancy involves the homeostasis between maternal decidua and fetoplacental units, whose disruption contributes to compromised pregnancy outcomes, including recurrent spontaneous abortion (RSA). The role of cell heterogeneity of maternal decidua in RSA is yet to be illustrated.Materials and methodsA total of 66,078 single cells from decidua samples isolated from patients with RSA and healthy controls were analysed by unbiased single‐cell RNA sequencing (scRNA‐seq).ResultsOur scRNA‐seq results revealed that stromal cells are the most abundant cell type in decidua during early pregnancy. RSA samples are accompanied by aberrant decidualization and obviously obstructed communication between stromal cells and other cell types, such as abnormal activation of macrophages and NK cells. In addition, the over‐activated TNF superfamily member 12 (TNFSF12, TWEAK) and FASLG in RSA are closely related to stromal cell demise and pregnancy failure.ConclusionsOur research reveals that the cell composition and communications in normal and RSA decidua at early pregnancy and provides insightful information for the pathology of RSA and will pave the way for pregnancy loss prevention.

Recurrent spontaneous abortion (RSA), characterized by pregnancy loss before 20 weeks of gestation more than twice, is an intricated pregnancy complication with enigmatic underlying mechanism ascribes to its complex pathogenesis. The homeostasis between the developing foetus and maternal decidua is critical for pregnancy maintenance. By exploring the cell heterogeneity in normal and RSA decidua utilizing scRNA‐Seq, we unravel the discrepancies in cell composition and communications in these two distinct deciduae. Our investigations uncover that stromal cells are the most abundant cell populations in the decidua, with three different subpopulations at various decidualization stages and two fibroblasts. There are two separated trajectories of stromal cell decidualization marked by PLA2G2A and WNT4. As the most abundant cell population in the decidua, the stromal cells dominate the communications with other cell types, including endothelial cells, macrophages, uNK cells and perivascular cells. Compared with normal decidua, decidualized stromal cells are overtly decreased in RSA decidua with augmented macrophages. In addition, we present some previously unappreciated signaling pathways among different cells types in decidua and also depict the remarkably changed communications between normal and RSA decidual. The aberrant activated TWEAK and FASLG in RSA are considered to be potential reasons for stromal cells demise and pregnancy failure. Our research reveals the cell composition and communications in normal and RSA decidua at early pregnancy and provides insightful information for the pathology of RSA and will pave the way for pregnancy loss prevention.