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Anmol Saini A Saini, Discipline of Reproduction and Development,School of Biomedicine, The University of Adelaide, Adelaide, Australia

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Nicole O McPherson N McPherson, Discipline of Reproduction and Development, School of Biomedicine, The University of Adelaide, Adelaide, Australia

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Mark Nottle M Nottle, Discipline of Reproduction and Development, School of Biomedicine, The University of Adelaide, Adelaide, Australia

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The present study determined whether adding granulocyte macrophage colony stimulating factor (GM-CSF) during in vitro oocyte maturation (IVM) could improve oocyte developmental competence by examining embryo development and implantation and birth rates following embryo transfer in mice. In an initial dose response experiment, we demonstrated that the addition of 2 and 10 ng/mL of GM-CSF during IVM increased cumulus expansion (P<0.05) but did not affect fertilisation rate compared with the control group. The addition of 10 ng/mL increased blastocyst rate (17.0%; P<0.05) and tended to increase the number of good quality blastocysts present at 96 h of culture (+19.4%; P=0.06) and increased blastocyst inner cell mass (+25.2%; P<0.001), trophectoderm (+29.9%; P<0.01), and total cell numbers (+28.6%; P<0.05). GM-CSF also reduced the incidence of DNA damage in blastocysts in the 10 ng/mL group (-16.2%) compared with the control group. These improvements translated into increases in implantation rate (+21.0%; P<0.05) and birth rate (+17.0%; P<0.05) following the transfer of vitrified blastocysts.GM-CSF treatment did not alter any fetal and placental parameters. Together these results suggest that the addition of GM-CSF during IVM may improve livestock in vitro embryo production and human IVM.

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Beril Yuksel Istanbul Sisli Memorial Hospital, Department of ART and Reproductive Genetics, Istanbul, Türkiye

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Gonul Ozer Istanbul Sisli Memorial Hospital, Department of ART and Reproductive Genetics, Istanbul, Türkiye

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Ipek Nur Balin Duzguner Istanbul Sisli Memorial Hospital, Department of ART and Reproductive Genetics, Istanbul, Türkiye

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Aysu Akca Istanbul Sisli Memorial Hospital, Department of ART and Reproductive Genetics, Istanbul, Türkiye

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Yesim Kumtepe Istanbul Sisli Memorial Hospital, Department of ART and Reproductive Genetics, Istanbul, Türkiye

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Hakan Yelke Istanbul Sisli Memorial Hospital, Department of ART and Reproductive Genetics, Istanbul, Türkiye

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Semra Kahraman Istanbul Sisli Memorial Hospital, Department of ART and Reproductive Genetics, Istanbul, Türkiye

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George Liperis Westmead Fertility Centre, Institute of Reproductive Medicine, University of Sydney, Westmead, NSW, Australia.

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Munevver Serdarogullari Department of Histology and Embryology, Faculty of Medicine, Cyprus International University, Northern Cyprus via Mersin 10, Türkiye

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First-trimester pregnancy losses are commonly attributed to chromosomal abnormalities. The causes of pregnancy loss following transfer of a euploid embryo are not fully elucidated. The aim of this study was to evaluate clinical and embryological parameters for pregnancy failure following the transfer of a single euploid embryo. Pregnancy outcomes of single euploid embryo transfers from a single centre between January 2017 and March 2020 were retrospectively evaluated. Several clinical and embryological parameters were evaluated in consideration to pregnancy outcomes; total pregnancy loss and live birth (LB). Endometrial preparation type, number of previous frozen embryo transfer cycles, history of recurrent pregnancy loss, higher body mass index, presence of endometriosis and/or adenomyosis and embryo quality were found to be significantly different between two groups. Morphokinetic parameter analysis of 523 euploid embryos using time-lapse imaging did not show any statistical differences between the two groups; however, a significantly higher rate of uneven blastomeres in the cleavage stage was observed in the total pregnancy loss group. Evaluation of clinical and embryological data can reveal possible factors associated with pregnancy loss that can facilitate improved patient consultation. Feasible interventions can potentially increase the chance of achieving an LB.

Lay Abstract

Like natural pregnancies, not all pregnancies following fertility treatment go to term. The most common reason for these losses is that these embryos lack the genetic constitution compatible with live birth. Combined with fertility treatment, genetic tests can evaluate the genetic ability of embryos to go to term. Monitoring the outcome of pregnancies resulting from such embryos can help us identify whether and which conditions specific to treatment can lead to pregnancy loss. The analysis identified four parameters associated with embryo loss: Embryo quality and division patterns, existence of previous treatment and treatment type.

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Qian Feng Q Feng, Monash University, Clayton, Australia

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Nina Shigesi N Shigesi, Oxford, United Kingdom of Great Britain and Northern Ireland

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Jun Guan J Guan, Bejing, China

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Nilufer Rahmioglu N Rahmioglu, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland

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Mona Bafadhel M Bafadhel, King's College London, London, United Kingdom of Great Britain and Northern Ireland

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Kevin Paddon K Paddon, Oxford, United Kingdom of Great Britain and Northern Ireland

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Carol Hubbard C Hubbard, Oxford, United Kingdom of Great Britain and Northern Ireland

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Krina Zondervan K Zondervan, Women's Health, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland

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Christian Becker C Becker, Oxford, United Kingdom of Great Britain and Northern Ireland

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Karin Hellner K Hellner, University of Oxford, Oxford, OX1 2JD, United Kingdom of Great Britain and Northern Ireland

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Immunological dysregulation plays a fundamental role in the inflammatory aspects of endometriosis. Circulating blood leukocytes, one of the most abundant immune cell populations in the human body, have been shown diagnostic significance in some diseases. Nevertheless, the association between peripheral blood leukocyte counts and endometriosis remains unexplored to date.

We analysed two targeted study cohorts: a tertiary centre cohort (Endometriosis at Oxford University [ENDOX] study, 325 cases/177 controls) and a large-scale population study (UK Biobank [UKBB], 1537 cases/6331 controls). In both datasets, peripheral venous blood sample results were retrieved and counts of leukocyte subpopulations, including neutrophils, lymphocytes, monocytes, eosinophils and basophils analysed. Logistic regression models were used to investigate the association of leukocyte subtype alterations with endometriosis status, adjusting for confounding factors. We demonstrate that higher blood basophil level is associated with increased odds of endometriosis. This association was first discovered in the ENDOX cohort (basophils >0.04 x10^9/L: OR 1.65 [95%CI:1.06-2.57], P trend = 0.025) and replicated in the UKBB dataset (basophils >0.04 x10^9/L: OR 1.26 [95%CI:1.09-1.45], P trend = 0.001). Notably, women with basophil counts in the upper tercile had significantly increased odds of having stage III/IV endometriosis (ENDOX study: OR = 2.30, 95% CI [1.25 to 4.22], P trend = 0.007; UKBB study (OR = 1.40, 95% CI [1.07 to 1.85], P trend = 0.015). None of the other leukocyte subtypes showed an association. Our findings suggest an association between inflammatory responses and the pathogenesis of endometriosis; future studies are warranted to investigate whether the association is causal.

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Katja Hummitzsch K Hummitzsch, Robinson Research Institute, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, Australia

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Jasmine E Kelly J Kelly, The University of Adelaide, Adelaide, Australia

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Nicholas Hatzirodos N Hatzirodos, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, Australia

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Wendy M Bonner W Bonner, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, Australia

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Feng Tang F Tang, Robinson Research Institute, The University of Adelaide, Adelaide, Australia

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Hugh H Harris H Harris, Chemistry, The University of Adelaide Faculty Sciences Engineering and Technology, Adelaide, Australia

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Raymond Joseph Rodgers R Rodgers, Robinson Research Institute, The University of Adelaide, Adelaide, Australia

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Reactive oxygen species (ROS) are a by-product of the activity of cytochrome P450 steroidogenic enzymes. Antioxidant enzymes protect against ROS damage. To identify if any particular antioxidant enzyme is used to protect against ROS produced by granulosa cells as follicles enlarge and produce oestradiol, we measured in the bovine granulosa cells the expression of two steroidogenic enzymes (CYP11A1, CYP19A1), important for progesterone and oestradiol production. We also measured expression of the members (FDXR, FDX, POR) of their electron transport chains (ETC). We measured antioxidant enzymes (GPXs 1-8, CAT, SODs 1 and 2, PRDXs 1-6, GSR, TXN, TXNRDs 1-3). Since selenium is an active component of GPXs, the selenium-uptake receptors (LRPs 2 and 8) were measured. Only the selenium-dependent GPX1 showed the same increase in expression as the steroidogenic enzymes did with increasing follicle size. GPX4 and PRDX2/6 decreased with follicle size, whereas SOD1/2, CAT, GSR, and TXNRD3 were lowest at the intermediate sizes. The other antioxidant enzymes were unchanged or expressed at low levels. The expression of the selenium-uptake receptor LRP8 also increased significantly with follicle size. Correlation analysis revealed statistically significant and strongly positive correlations of the steroidogenic enzymes and their ETCs with both GPX1 and LRP8. These results demonstrate a relationship between expression of genes involved in steroidogenesis and selenium-containing antioxidant defence mechanisms. They suggest that during the late stages of folliculogenesis, granulosa cells are dependent on sufficient expression of GPX1 and the selenium transporter LRP8 to counteract increasing ROS levels caused by the production of steroid hormones.

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Willem Ombelet The Walking Egg non-profit Organization, Genk, Belgium
Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Diepenbeek, Belgium

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Federica Lopes School of Medicine, University of Dundee, Dundee, United Kingdom

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Infertility affects millions worldwide, with significant medical, financial, and emotional challenges, particularly in low- and middle-income countries (LMICs). Cultural, religious, financial, and gender-related barriers hinder access to treatment, exacerbating social and economic consequences, especially for women. Despite its prevalence, infertility often remains overlooked due to competing health priorities. However, global initiatives recognise infertility as a reproductive health concern, advocating for universal access to high-quality fertility care. In LMICs, limited resources and infrastructure impede access to treatment, prompting people to turn to alternative, often ineffective, non-biomedical solutions. Addressing these challenges requires implementing affordable fertility care services tailored to local contexts, supported by political commitment and community engagement. Emerging technologies offer promising solutions, but comprehensive education and training programs are essential for their effective implementation. By integrating fertility care into broader health policies and fostering partnerships, we can ensure equitable access to infertility treatment and support reproductive health worldwide.

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Mary Ann Ottinger M Ottinger, Biology and Biochemistry , University of Houston College of Natural Sciences and Mathematics, Houston, 77204-5008, United States

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Shailaja Mani S Mani, Molecular & Cellular Biology and Neuroscience, Baylor College of Medicine, Houston, United States

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Sonja Krüger S Krüger, Ezemvelo KZN Wildlife, Pietermaritzburg, South Africa

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Brent Coverdale B Coverdale, Scientific Services, Ezemvelo KZN Wildlife, Pietermaritzburg, South Africa

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Sandi Willows-Munro S Willows-Munro, University of KwaZulu-Natal, Pietermaritzburg, South Africa

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Leigh Combrink L Combrink, School of Natural Resources and the Environment, University of Arizona, Tucson, United States

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Microbiomes have emerged as a key component essential for maintaining the health of an organism. Additionally, the roles of microbiomes are multifaceted, some unique to specific body areas and organs while others, particularly the gut microbiome, having broader effects on the entire organism. Comparative literature is emerging that compares microbiomes across mammals and birds. Domestic poultry have been the most extensively studied relative to their role in production agriculture. These data have provided a great deal of information about the effects of diet and nutritional requirements relative to the gut microbiome, productivity, and resilience to diseases. Conversely, limited such research has been conducted on wild birds, despite them inhabiting a broad array of ecological niches and environments, providing a rich diversity in their adaptations to different habitats. Migratory birds and raptors are of particular interest. Migratory birds encounter a range of ecosystems and provide a link between allopatric populations. Raptors occupy high positions in the food chain, with potential exposure to biomagnification of environmental contaminants and pathogens. This review overviews our current understanding of the structure and function of avian microbiomes as related to avian health and reproduction in domestic and wild birds, highlighting knowledge gaps in need of further investigation for more effective conservation of rapidly declining avian populations.

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Landon K Eldridge L Eldridge, Department of Animal Science, Texas A&M University, College Station, United States

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Dallas Soffa D Soffa, Texas A&M University, College Station, 77843, United States

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Kyle J Hickman-Brown K Hickman-Brown, Department of Animal Science, Texas A&M University, College Station, United States

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Brooke E McAnally B McAnally, Department of Animal Science, Texas A&M University, College Station, United States

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Molly S Smith M Smith, Department of Animal Science, Texas A&M University, College Station, United States

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Jeffrey G Wiegert J Wiegert, Department of Animal Science, Texas A&M University, College Station, United States

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Rebecca K Poole R Poole, Department of Animal Science, Texas A&M University, College Station, 77843, United States

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The pioneer microbiome is the initial colonization and establishment of microorganisms within the neonate. The objective of this project was to quantify maternal and environmental contributions to the piglet's pioneer microbiome. Sterile swabs were used to collect samples from the gilt’s rectum, the farrowing crate before and after gilts were moved in, the gilt’s birth canal during farrowing, and the piglet’s rectum on days 0 (prior to suckling), 3, and 10 post-farrowing and at weaning (21.6 ± 1.0 days post-farrowing). During farrowing, colostrum was collected from each gilt from a representative sample of teats into a single sterile collection cup. Bacterial DNA extraction and sequencing targeted the V4 hypervariable region of the 16S rRNA gene. The relative abundance of Lactobacillus in the piglet microbiome was lower on day 3 compared to day 0, 10, and at weaning (P < 0.05). For alpha diversity, piglet samples exhibited distinct clustering for bacterial richness by day (P < 0.01). Multiple regression analyses indicated that the birth canal explained 51.6% of the variation observed in the piglet day 0 microbiome (P < 0.0001) and 6.5% of the variation in the piglet day 10 microbiome (P = 0.013). The day 10 microbiome explained 58.6% of the variation observed in the piglet microbiome at weaning (P < 0.0001). Bacterial communities of the farrowing crate and colostrum did not impact the piglet microbiome for any day (P > 0.10). Results indicate that the piglet pioneer microbiome is largely influenced by the microbiome of the birth canal.

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R de Koning Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
Nederlandse Endometriose Kliniek, Reinier de Graaf Gasthuis, Delft, The Netherlands

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A E P Cantineau Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands

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K van der Tuuk Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands

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B De Bie Endometriosis Foundation of the Netherlands (Endometriose Stichting), Sittard, The Netherlands

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H Groen Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands

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M E van den Akker-van Marle Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands

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A W Nap Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands

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J W M Maas Department of Gynaecology and Grow-school of Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands

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F W Jansen Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands

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A R H Twijnstra Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands

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M D Blikkendaal Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
Nederlandse Endometriose Kliniek, Reinier de Graaf Gasthuis, Delft, The Netherlands

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Currently, the optimal treatment to increase the chance of pregnancy and live births in patients with colorectal endometriosis and subfertility is unknown. Evidence suggests that that both surgery and in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) are effective in improving the live birth rate (LBR) among these women. However, the available evidence is of low quality, reports highly heterogeneous results, lacks direct comparison between both treatment options, and does not assess whether a combination strategy results in a higher LBR compared to IVF/ICSI-only treatment. Additionally, the optimal timing of surgery within the treatment trajectory remains unclear. The primary objective of the TOSCA study is to assess the effectiveness of surgical treatment (potentially combined with IVF/ICSI) compared to IVF-/ICSI-only treatment to increase the chance of an ongoing pregnancy resulting in a live birth in patients with colorectal endometriosis and subfertility, measured by cumulative LBR. Secondary objectives are to assess and compare quality of life and cost-effectiveness in both groups. Patients will be followed for 40 months after inclusion or until live birth. The TOSCA study is expected to be completed in 6 years.

Trial registration number

The TOSCA trial is registered as ‘Cost-Effectiveness of Surgical Excision of Colorectal Endometriosis Compared to ART Treatment Trajectory (TOSCA)’ in the Clinical Trials Register (NCT No. NCT05677269, https://clinicaltrials.gov/ct2/show/NCT05677269)

Date of first patient enrolment

The first patient was included in February 2023.

Lay summary

Treating bowel endometriosis in people with fertility problems is difficult, and at the moment, there is no consensus on the best way to increase the chances of pregnancy. This makes it hard for gynaecologists to advise people when to have either IVF/ICSI or surgery, particularly in patients with fewer pain symptoms, as the benefits of surgery to enhance fertility have to be balanced against the potential risk of side effects. Surgery can improve fertility and pain symptoms, but it may delay people trying to conceive which means the reserve of eggs in the ovaries will reduce with time. IVF/ICSI also seems a viable option, but having the surgery first may increase the chances of conception (both naturally and/or after IVF/ICSI). The TOSCA study aims to determine whether surgery for bowel endometriosis leads to an increased birth rate and better patient reported outcome measures compared to IVF/ICSI alone.

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Maria Handzhiyska Department of Research, Nadezhda Women’s Health Hospital, Sofia, Bulgaria

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Rumiana Ganeva Department of Research, Nadezhda Women’s Health Hospital, Sofia, Bulgaria

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Dimitar Parvanov Department of Research, Nadezhda Women’s Health Hospital, Sofia, Bulgaria

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Margarita Ruseva Department of Research, Nadezhda Women’s Health Hospital, Sofia, Bulgaria

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Petar Eftimov Department of Cell and Developmental Biology, Faculty of Biology, SU St. Climent Ohridski, Sofia, Bulgaria

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Vilyana Georgieva Department of Andrology, Nadezhda Women’s Health Hospital, Sofia, Bulgaria

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Denitsa Velikova Department of Andrology, Nadezhda Women’s Health Hospital, Sofia, Bulgaria

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Georgi Stamenov Department of Obstetrics and Gynecology, Nadezhda Women’s Health Hospital, Sofia, Bulgaria

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The objective of this study was to compare the motility, morphology, and levels of DNA fragmentation of spermatozoa subjected to conventional swim-up or cumulus matrix (CM) sperm selection. Semen samples were collected from 60 normozoospermic men at a private hospital between December 2021 and March 2022. After liquefaction, semen samples were separated into two portions – one part was subjected to conventional swim-up preparation, and the remaining spermatozoa were subjected to CM selection. The CM was obtained by mechanical isolation from healthy donor oocytes. Semen analysis and evaluation of sperm were performed according to the WHO 6th Edition Laboratory Manual and Kruger’s strict criteria, respectively. Sperm DNA fragmentation (SDF, %) of the two preparations was evaluated using the Halosperm G2 detection Kit (Halotech, Madrid, Spain). Wilcoxon rank-sum test was used to compare the characteristics of spermatozoa obtained by the two preparations. Spermatozoa selected by CM showed significantly better rapidly progressive motility (43.5% vs 30.6%, respectively, P < 0.001), a higher percentage of morphologically normal forms (14.0% vs 9.0%, respectively, P < 0.05), and lower levels of SDF (26.0% vs 45.0%, P < 0.05) compared to those prepared by conventional swim-up. Moreover, the incidence of multiple sperm defects was considerably lower in the samples that underwent CM selection compared to those that did not (30.0% vs 49.0%, respectively, P < 0.05).The selection by CM significantly increases sperm motility and reduces morphologically abnormal spermatozoa and DNA fragmentation rates compared to the conventional swim-up preparation. The application of this selection technique may increase the chances of successful IVF outcomes.

Lay summary

There are various techniques for selecting high-quality sperm with better shape, mobility, and DNA quality. However, the success of assisted reproduction techniques remains relatively unchanged. In this study, we describe an innovative method that uses the ingredients of a natural coat surrounding the egg (cumulus matrix) to enhance sperm selection procedures. Using this cumulus matrix as a barrier through which sperm cells pass, we mimic natural sperm–egg interactions and are able to select sperm with better characteristics compared to conventional methods. This new sperm selection procedure could lead to increased assisted reproduction success rates.

Open access
Caitriona Brennan Department of Pediatrics, University of California San Diego, La Jolla, California, USA
Division of Biological Sciences, University of California San Diego, La Jolla, California, USA

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Kristina Chan Department of Pediatrics, University of California San Diego, La Jolla, California, USA
Department of Bioengineering, University of California, San Diego, La Jolla, California, USA

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Tanya Kumar Medical Scientist Training Program, University of California San Diego, La Jolla, California, USA

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Erica Maissy Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, California, USA

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Linda Brubaker Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California, USA

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Marisol I Dothard Department of Pediatrics, University of California San Diego, La Jolla, California, USA
Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, California, USA

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Jack A Gilbert Department of Pediatrics, University of California San Diego, La Jolla, California, USA
Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA

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Katharine E Gilbert Department of Pediatrics, University of California San Diego, La Jolla, California, USA

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Amanda L Lewis Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California, USA

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Varykina G Thackray Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California, USA
Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA

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Amir Zarrinpar Department of Bioengineering, University of California, San Diego, La Jolla, California, USA
Medical Scientist Training Program, University of California San Diego, La Jolla, California, USA
Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California, USA
Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA
Jennifer Moreno Department of Veterans Affairs Medical Center, La Jolla, California, USA
Institute of Diabetes and Metabolic Health, University of California San Diego, La Jolla, California, USA

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Rob Knight Department of Pediatrics, University of California San Diego, La Jolla, California, USA
Department of Bioengineering, University of California, San Diego, La Jolla, California, USA
Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA
Department of Computer Science and Engineering, University of California, San Diego, La Jolla, California, USA
Halıcıoğlu Data Science Institute, University of California San Diego, La Jolla, California, USA

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Graphical abstract

Abstract

Although numerous studies have demonstrated the impact of microbiome manipulation on human health, research on the microbiome’s influence on female health remains relatively limited despite substantial disease burden. In light of this, we present a selected review of clinical trials and preclinical studies targeting both the vaginal and gut microbiomes for the prevention or treatment of various gynecologic conditions. Specifically, we explore studies that leverage microbiota transplants, probiotics, prebiotics, diet modifications, and engineered microbial strains. A healthy vaginal microbiome for females of reproductive age consists of lactic acid-producing bacteria predominantly of the Lactobacillus genus, which serves as a protective barrier against pathogens and maintains a balanced ecosystem. The gut microbiota’s production of short-chain fatty acids, metabolism of primary bile acids, and modulation of sex steroid levels have significant implications for the interplay between host and microbes throughout the body, ultimately impacting reproductive health. By harnessing interventions that modulate both the vaginal and gut microbiomes, it becomes possible to not only maintain homeostasis but also mitigate pathological conditions. While the field is still working toward making broad clinical recommendations, the current studies demonstrate that manipulating the microbiome holds great potential for addressing diverse gynecologic conditions.

Lay summary

Manipulating the microbiome has recently entered popular culture, with various diets thought to aid the microbes that live within us. These microbes live in different locations of our body and accordingly help us digest food, modulate our immune system, and influence reproductive health. The role of the microbes living in and influencing the female reproductive tract remains understudied despite known roles in common conditions such as vulvovaginal candidiasis (affecting 75% of females in their lifetime), bacterial vaginosis (25% of females in their lifetime), cervical HPV infection (80% of females in their lifetime), endometriosis (6–10% of females of reproductive age), and polycystic ovary syndrome (10–12% of females of reproductive age). Here, we review four different approaches used to manipulate the female reproductive tract and gastrointestinal system microbiomes: microbiota transplants, probiotics, prebiotics, and dietary interventions, and the use of engineered microbial strains. In doing so, we aim to stimulate discussion on new ways to understand and treat female reproductive health conditions.

Open access