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A log transformation was given to the relative gene expression values. Models are controlled by age and body mass index BMI. Correlation coefficient and p value refer to the association of gene expression in both, donors and PCOS. The clinical manifestations of PCOS differ widely from a patient to another, suggesting a multi-factorial origin, which remains still unknown [ 1 , 2 , 3 , 4 , 5 , 6 ]. The peptides kisspeptin and NKB play an essential role in the neuroendocrine control of reproductive function acting coordinately at the hypothalamic-pituitary-gonadal HPG axis [ 4 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 37 ].
With respect to kisspeptin, several evidences argue for a potential role of this peptide in the pathophysiology of PCOS. Second, PCOS is associated with metabolic symptoms, which include obesity and insulin resistance [ 1 , 2 , 3 , 4 , 5 ], and kisspeptin plays an important role in the metabolic regulation of fertility [ 4 , 37 , 38 , 39 , 40 ]. Thus, fasting, which inhibits the activity of the reproductive axis, is associated with diminished expression of hypothalamic Kiss1 mRNA in rats and central administration of kisspeptin reverses the fasting-induced inhibition of gonadotrophin secretion [ 37 ].
These and other evidences, such as the deregulation of hypothalamic Kiss expression in conditions of obesity [ 39 , 40 ], strongly suggest that kisspeptin neurons in the arcuate nucleus ARC serve as a link between metabolism and reproduction [ 4 , 37 , 38 , 39 , 40 ]. Third, and in reference to the ovarian symptoms, different experimental data have shown that kisspeptin may participate in ovarian follicular development, can trigger egg maturation, and could contribute to the regulation of ovulation in different mammalian species including humans [ 17 , 23 , 27 , 28 , 30 , 31 ].
The main symptoms of PCOS are produced at the level of the ovary and are largely dependent on GC dysfunction [ 1 , 2 , 3 , 5 , 6 , 7 , 8 ]. This suggests that, in healthy donors, the expression of KISS1R in CCs is strictly regulated during a short period of time around ovulation.
A similar event has been observed in rats where the expression of Kiss1 is dramatically increased preceding ovulation [ 42 , 43 ]. In comparison with kisspeptin, less is known about the role of NKB and NK3R in the regulation of human ovarian physiology. However, a recent report involving treatment of 13 healthy women with the NK3R antagonist MLE has shown that NKB regulates gonadotropin secretion, ovarian follicular growth, and the timing of ovulation in healthy women [ 33 ].
In the same line, a recent study by Qi et al. While the potential contribution of kisspeptin and NKB to this phenomenon is assumed to be mainly central, our current data open up the intriguing possibility that local deregulated expression of KISS1 and NKB systems in GCs might contribute also to the miscommunication between gonadal and central levels of the HPG axis that is characteristic of PCOS. Further, studies will help to determine the precise significance of this finding in the pathogenesis of PCOS.
The lower levels of kisspeptin and NKB in the ovary of PCOS women could contribute to the abnormal follicular development and defective ovulation which is observed in these patients. Polycystic ovary syndrome. Livadas S, Diamanti-Kandarakis E. Polycystic ovary syndrome: definitions, phenotypes and diagnostic approach. Front Horm Res. Polycystic ovarian syndrome: an updated overview. Front Physiol. Neuroendocrine control by kisspeptins: role in metabolic regulation of fertility.
Nat Rev Endocrinol. Jayasena CN, Franks S. The management of patients with polycystic ovary syndrome. Article PubMed Google Scholar. Reprod BioMed Online. Hum Reprod Update. Identification of reference genes for qRT-PCR in granulosa cells of healthy women and polycystic ovarian syndrome patients. Sci Rep. Li R, Albertini DF. The road to maturation: somatic cell interaction and self-organization of the mammalian oocyte. Nat Rev Mol Cell Biol.
The GPR54 gene as a regulator of puberty. N Engl J Med. A role for tachykinins in female mouse and rat reproductive function. Biol Reprod. Nat Genet. Colledge WH. Gen Comp Endocrinol. Comprehensive review on kisspeptin and its role in reproductive disorders. Endocrinol Metab. Interactions between neurokinin B and kisspeptin in mediating estrogen feedback in healthy women. J Clin Endocrinol Metab. Tachykinins and tachykinin receptors: effects in the genitourinary tract.
Life Sci. Page NM. Neurokinin B and pre-eclampsia: a decade of discovery. Reprod Biol Endocrinol. Lasaga M, Debeljuk L. Tachykinins and the hypothalamo-pituitary-gonadal axis: an update. Satake H, Kawada T. Overview of the primary structure, tissue distribution, and functions of tachykinins and their receptors. Curr Drug Targets. KiSS-1 in the mammalian ovary: distribution of kisspeptin in human and marmoset and alterations in KiSS-1 mRNA levels in a rat model of ovulatory dysfunction.
Am J Physiol Endocrinol Metab. Fertil Steril. Hum Reprod. Neurokinin B exerts direct effects on the ovary to stimulate estradiol production. Kisspeptin receptor haplo-insufficiency causes premature ovarian failure despite preserved gonadotropin secretion.
Bhattacharya M, Babwah AV. Kisspeptin: beyond the brain. Direct actions of kisspeptins on GnRH neurons permit attainment of fertility but are insufficient to fully preserve gonadotropic axis activity. Kisspeptin triggers egg maturation in women undergoing in vitro fertilization. J Clin Invest. Kisspeptin is involved in ovarian follicular development during aging in rats. J Endocrinol. Neurokinin B regulates gonadotropin secretion, ovarian follicle growth, and the timing of ovulation in healthy women.
Revised consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Google Scholar. Revised consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome PCOS. Patients returned to the study center for regularly scheduled clinic visits as required per the IVF protocol and at other specified time periods. Participants were allowed to use oral contraceptives before administration of the GnRHa, if this was standard practice at the center.
Progesterone was administered to support the luteal phase beginning on the day after oocyte retrieval. A large, randomized control trial previously demonstrated that there is no significant difference in pregnancy outcomes between 2 and 3 times daily dosing of PVI [ 21 ]. Embryo transfer occurred on day 3 or day 5 after insemination or intracytoplasmic sperm injection. Patients completed a survey to assess administration preferences of PVI and PIO at the start of their luteal phase support and at their final visit.
Responses to the survey assessed convenience and ease of use and other variables such as pain and discomfort associated with study drug administration. Assessment of safety and tolerability included documentation of AEs and serious AEs, results from clinical laboratory evaluations and electrocardiograms, measurements of vital signs, and findings from TVU.
As appropriate, one-way analysis of variance or the Wilcoxon rank sum test were used, to determine treatment group comparisons for continuous variables. Statistical analyses were performed using statistical software SAS version 9. The majority of women enrolled in the study were Caucasian, with Mean age was The number of women who received PVI or PIO for luteal phase support, underwent embryo transfer, and completed 10 weeks of luteal phase support are shown in Table 2.
PVI was administered twice daily in Conversely, a majority of patients and their partners described pain and anxiety, respectively, associated with PIO. In the PIO group, Of these, For those women in the PIO group, only In addition, There were no significant differences in the biochemical, clinical, and ongoing pregnancy rates for those patients in the PVI group compared with those rates for patients in the PIO group see Table 2.
Biochemical pregnancy rates were Clinical pregnancies occurred in The ongoing pregnancy rates were One or more AEs were reported during progesterone treatment by Most AEs were of mild or moderate intensity in both groups. Abdominal distension, lower abdominal pain, nausea, and ovarian hyperstimulation syndrome OHSS were the most common AEs reported in both groups. The IM and vaginal routes of administration are used almost exclusively in clinical practice when progesterone is given to patients for luteal phase support during ART [ 4 , 6 ].
Reports indicate that the vaginal and IM administration of progesterone results in comparable pregnancy outcomes [ 6 , 13 , 15 ]. Moreover, this analysis provides a comprehensive, prospective comparison of patient-reported convenience and ease of use, overall patient satisfaction, and tolerability for PVI compared to IM PIO from a population of women undergoing cycles of IVF. Despite the need to administer PVI either twice a day or 3 times a day, This is in contrast to patient response in the PIO group, where Only a few studies with progesterone for luteal phase support during cycles of IVF have attempted to assess patient treatment satisfaction and ease of use.
In a study by Schoolcraft et al. Data on patient satisfaction were obtained prospectively in these studies; however, the data collected were more limited in scope than the data collected in the current study. Results from this survey of patient satisfaction, convenience, ease of use, and tolerability provide a more comprehensive assessment of patient-reported satisfaction than analysis included in previous studies.
No significant difference in biochemical, clinical, or ongoing pregnancy rates were observed among the treatment groups. Pregnancy outcomes in this study were similar to those reported in previous studies comparing vaginal to IM administration of progesterone for luteal support in women of a similar age range [ 6 — 11 , 14 , 15 ]. Progesterone administered vaginally for luteal phase support has been shown to be well tolerated.
Breast tenderness, headache, abdominal pain, abdominal distension, nonspecific muscle spasms, and vaginal discharge have been associated with vaginal gel [ 23 ]. It can be difficult to clearly elucidate the true cause-effect relationship of AEs reported during a clinical study. Injection site irritation and redness have been reported frequently with administration of IM PIO [ 18 , 26 ]. The results of this comprehensive, prospective patient survey and other similar reports suggest that PVI provides an easy-to-use and convenient method for providing the necessary luteal phase support for IVF cycles without the pain and inconvenience of daily IM injections and with comparable pregnancy rates.
Check JH: Luteal phase support in assisted reproductive technology treatment: Focus on endometrin r progesterone vaginal insert. Ther Clin Risk Manag. Curr Opin in Obstet ynecol. Article Google Scholar. ASRM Practice Bulletin: Progesterone supplementation during the luteal phase and in early pregnancy in the treatment of infertility: an educational bulletin. Fertil Steril. Hum Reprod Update. Reprod Biomed Online. Zarutskie PW, Phillips JA: A meta-analysis of the route of administration of luteal phase support in assisted reproductive technology: vaginal versus intramuscular progesterone.
Fert Steril. Kahraman S, Karagozoglu SH, Karlikaya G: The efficiency of progesterone vaginal gel versus intramuscular progesterone for luteal phase supplementation in gonadotropin-releasing hormone antagonist cycles: a prospective clinical trial. Progesterone in oil in in vitro fertilization cycles.
Mitwally MF, Diamond MP, Abuzeid M: Vaginal micronized progesterone versus intramuscular progesterone for luteal support in women undergoing in vitro fertilization-embryo transfer. Intramuscular progesterone in oil for luteal phase support in in vitro fertilization: a large prospective trial. Yanushpolsky E, Hurwitz S, Greenberg L, Racowsky C, Hornstein M: Crinone vaginal gel is equally effective and better tolerated than intramuscular progesterone for luteal phase support in in vitro fertilization-embryo transfer cycles: a prospective randomized study.
Hum Reprod. Ferring Pharmaceuticals, Inc: Endometrin. Google Scholar. Watson Pharmaceuticals, Inc: Crinone. Ferring Pharmaceuticals, Inc: Menopur. American Regent, Inc: Progesterone. Download references. The authors wish to thank Ferring Pharmaceuticals, Inc, for support of this manuscript.
You can also search for this author in PubMed Google Scholar. Correspondence to Michael G Collins. MDS has no competing interests.
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