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Stem cell science has the potential to impact human reproductive medicine significantly – cutting edge technologies allow the production and regeneration of viable gametes from human stem cells offering potential to preciously infertile patients. Written by leading experts in the field Stem Cells in Reproductive Medicine brings together chapters on the genetics and epigenetics of both the male and female gametes as well as advice on the production and regeneration of gene cells in men and women, trophoblasts and endometrium from human embryonic and adult stem cells. Although focussing mainly on the practical elements of the use of stem cells in reproductive medicine, the book also contains a section on new developments in stem cell research. The book is essential reading for reproductive medicine clinicians, gynecologists and embryologists who want to keep abreast of practical developments in this rapidly developing field.
This chapter addresses the controversies surrounding the impact and surgical management of hydrosalpinges and uterine leiomyoma on in vitro fertilization (IVF) cycle outcome. Evidence accumulated over the last 15 years suggests that either unilateral or bilateral hydrosalpinges may exert deleterious effects on IVF cycle outcome. Hydrosalpinx fluid may have a direct embryotoxic effect and may also inhibit fertilization. This deleterious effect may be mediated by the presence of inflammatory cytokines present within hydrosalpinx fluid. Several groups have reported that only large hydrosalpinges, visible on ultrasound, resulted in reduced implantation and pregnancy rates. The impact of uterine leiomyomata specifically on the outcome of assisted reproductive technologies has been evaluated with conflicting results. Evaluation of the uterine cavity by hysteroscopy or sonohysterography should be a routine part of the pre-cycle evaluation. The accuracy of routine ultrasound evaluation and hysterosalpingography is more limited.
Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of ovulation induction, which may cause serious impact on the patient's health, with 0.1-2 percent of the patients developing severe forms of the syndrome. Many substances involved in the regulation of vascular permeability (VP) have been implicated in causing OHSS. The use of low doses of dopamine may be useful in severe OHSS patients. The OHSS primary prevention is to reduce its incidence, being the most important step to identify patients at risk that will undergo in-vitro fertilization (IVF) treatment, using a softer stimulation protocol and giving these patients special attention and close monitoring than usual with frequent ultrasound and serum estradiol levels. Until recently, OHSS treatment was reduced to the management of its complications. New data as the vascular endothelial growth factor (VEGF) system studies are providing new insights for prevention and treatment of OHSS.
This chapter presents published data on the embryonic regulation of endometrial epithelial molecules such as chemokine receptors, the leptin system and the relaxin receptor LGR7. Chemokines and their receptors are divided into two families based on structural and genetic considerations. A specific molecular cross-talk between embryo and endometrium has been reported to take place during human implantation process. In human and rodents, two major forms of leptin receptors (OB-R) are expressed: the short form (OB-RS) and the long form (OB-RL). Relaxin is a peptide hormone produced by the corpus luteum during luteal phase of the menstrual cycle and during first trimester of pregnancy. It has been associated with a wide range of functions related to pregnancy, such as parturition and lactation. Advances in gene expression profiling facilitated by the development of DNA microarrays represent major progress in global gene expression analysis.
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