Endometrial cycle and infertility dr. rahul, physiology, sms mc jaipur e…

• Steroid receptors ERa, ERß, PR-A and PR-B are differentially expressed in normal and atrophic human endometrium I. Pain after endometrial biopsy Mylonas et al Histol Histopathol (2007) 22: 169-176 • These changes take place under the stimulatory action of estradiol, which stimulates the DNA-promoter enzyme, thymidylate synthetase.7,10,11 This, in turn, stimulates ribonucleic acid (RNA) polymerase activity,12 DNA synthesis, and mitosis. Cervical biopsy recovery Increased proliferation leads to a considerable thickening of the endometrial mucosa. • Under estrogenic influence, uterine glands begin to enlarge (Fig. Endometrial biopsy complications 3-2). Hysteroscopy endometrial biopsy The endometrium becomes more richly supplied with blood vessels, and water accumulates between cells in the tissues, a. Breast biopsy recovery time Thcondition known as edema. • Antigen KI-67 also known as Ki-67 or MKI67 is a protein that in humans is encoded by the MKI67 gene (antigen identified by monoclonal antibody Ki-67) Antigen KI-67 is a nuclear protein that is associated with and may be necessary for cellular proliferation. Endometrial biopsy ivf Furthermore it is associated with ribosomal RNAtranscription.[3] Inactivation of antigen KI-67 leads to inhibition of ribosomal RNA synthesis. Endometrial biopsy pain The Ki-67 protein (also known as MKI67) is a cellular marker for proliferation.[5]It is strictly associated with cell proliferation. Breast biopsy recovery During interphase, the Ki-67 antigencan be exclusively detected within the cell nucleus, whereas in mitosis most of the protein is relocated to the surface of the chromosomes. Endometrial biopsy results time frame Ki-67 protein is present during all active phases of the cell cycle (G1, S, G2, and mitosis), but is absent from resting cells (G0) • Nevertheless, expression of IGFs is also influenced by various hormones, including estrogens, adrenocorticotropic hormone, thyrotropin, luteinizing hormone, follicle-stimulating hormone (FSH), and human chorionic gonadotropin, as well as by other growth factors, such as platelet-derived growth factor (PDGF), epidermal growth factor (EGF), and fibroblast growth factor (FGF). Endometrial biopsy results interpretation Diet and nutrition affect circulating IGF-I levels, suggesting a possible impact on IGF-I production (7,8). Endometrial biopsy results IGF-I has both immediate and long-term effects on various cellular activities, and these effects are mediated mainly through IGF-IR (see next section). Bleeding after endometrial biopsy IGF-I exerts an acute anabolic action on protein and carbohydrate metabolism by increasing cellular uptake of amino acids and glucose and by stimulating glycogen and protein synthesis (11). IGF-I also has a long-term impact on cell proliferation, differentiation, and apoptosis (11). IGF-I is a potent mitogen for a wide variety of cells and exerts its mitogenic action by increasing DNA synthesis and by stimulating the expression of cyclin D1, which accelerates progression of the cell cycle from G1 to S phase (51,52).The mitogenic effect of IGF-I can be abolished by suppressing the expression of cyclin D1 (53). In addition to stimulating cell cycle progression, IGF-I also inhibits apoptosis. What is endometrial biopsy IGF-I is able to stimulate the expression of Bcl proteins and to suppress expression of Bax, which results in an increase in the relative amount of the Bcl/Bax heterodimer, thereby blocking initiation of the apoptotic pathway (54–56). Endometrial biopsy results how long Oxford Journals Medicine & Health JNCI J Natl Cancer InstVolume 92, Issue 18Pp. 1472-1489 • Th e average menstrual cycle length in adult women is 28 days, with a range of 25 to 35 days. What is an endometrial biopsy Th e interval fromovulation to the onset of menstruation is relatively constant, averaging 14 days in most women, and is dictated by the fixed lifespan of the corpus luteum. Biopsy endometrial In contrast, the interval from the onset of menses to ovulation (the follicular phase) is more variable and accounts for differences in cycle lengths among ovulating women. Skin biopsy results time Corpus luteum regress in 13 days Medical Physiology Principles of clinical medicine :Rodeney A Rhodes :4th ed: Lippincott:chap37/703 • The most biologically potent naturally occurring estrogen—17-estradiol—is secreted by granulosa cells of the dominant follicle and luteinized granulosa cells of the corpus luteum (williams23ed) • From From day 19, the vacuoles are only supra-nuclear and glycoproteinrich apocrine secretion from cytoplasm takes place, evidenced by protrusion and detachment of the apical part of the cells. • This period is also associated with the secretion of a certain number of progesterone regulated proteins. Pipelle endometrial biopsy Immunohistochemical studies have located these proteins exclusively in the epithelial component. Endometrial biopsy procedure They are: progesterone-associated endometrial protein (PEP) (Joshi, 1983), insulin growth factor binding protein 2 (IGFBP2) or protein 14 or glycodelin (Waites et al, 1988a; Seppala and Tiitinen, 1995) (Figure 5), crystalloglobulin (Guild et al, 1997), the integrins (Lessey et al., 1995) and glycoproteins or type 1 mucins (Ravn et al., 1992; Serle et al., 1994; Aplin et al., 1996; Carson et al, 1998) which are secreted into the cytoplasm of the glands. Endometrial biopsy side effects The physiological role played by these various proteins is still not fully understood. Liver biopsy recovery time PP14 would seem to have an immunodepressive function, facilitating embryo implantation. Abnormal endometrial biopsy results The uterine flushings of patients who have had a miscarriage show reduced PP 14 secretion (Dalton et al., 1995). Endometrial biopsy recovery Retarded maturation is also observed very frequently in these patients. Endometrial biopsy video Mucin, on the other hand, particularly muc-1, has important functions at the luminal surface and plays a dominant role in maintaining a functionally non-receptive uterine surface with regard to blastocyst attachment. Pain after endometrial biopsy It may inhibit implantation at the maternal cell surface and it has been suggested that mucin deficiency • , estradiol stimulates the production of PGF2α, whereas progesterone stimulates the synthesis of both PGF2α and PGE2 in vitro.21 PGE2 presumably promotes capillary permeability and stromal edema via histamine, whereas vascular endothelial growth factor is a potent mitogen of endothelial cells. Cervical biopsy recovery Endometrial vascular proliferation at the implantation site is related to the blastocyst rather than to histamine or PGE2. Endometrial biopsy complications The blastocyst has a unique biologic property that is shared only with tumor cells producing the so-called angiogenesis factor, a substance capable of inducing growth of new capillaries.22 Receptors for human chorionic • They further demonstrated that such rapid angiogenesis is regulated, in part, through estrogen- and progesterone-regulated synthesis of VEGF (Ancelin and colleagues, 2002; Chennazhi and Nayak, 2009). Hysteroscopy endometrial biopsy This protein is secreted by stromal cells and glandular epithelium and stimulates endothelial cell proliferation and increases vascular permeability. Breast biopsy recovery time Thus, steroid hormone influences on growth and vasculature are directed to a large degree through the local production of growth factors. • A fall in the synthesis and deterioration of type IV collagen due to increased activity of collagenase present in the decidual cells may be the cause of metabolic anomalies for the fetus and trigger miscarriage (see Fig. Endometrial biopsy ivf 54-12).. Endometrial biopsy pain Inflammatory cells accumulate around glands and blood vessels. Breast biopsy recovery Edema of the midzone of the endometrium distinguishes the compact area from the underlying zona spongiosa, where • Tenascins are extracellular matrix glycoproteins. Endometrial
biopsy results time frame They are abundant in the extracellular matrix of developing vertebrate embryos and they reappear around healing wounds • 2 Since the endometrial cavity is about 1-2 mm in width, the total endometrial thickness at the time of ovulation measures about 6 – 8 mm [ 3mm thickness of the endometrium on one side + 1mm of the endometrial cavity + 3mm of the endometrium on the other side = 7 mm (approx)] by ultrasound. Endometrial biopsy results interpretation This is called the “triple line” of endometrium and indicates a good estrogenisation and healthy growth of the endometrium. Endometrial biopsy results – See more at: http://www.gynaeonline.com/uterine_cycle.htm#sthash.dIPAetVY.dpuf. Bleeding after endometrial biopsy A triple-line endometrium reflects the separation of the stratum basalis and functionalis layers, and is also observed in the periovulatory period secondary to rising estradiollevels, and disappears after ovulation A PRETTY FEATHER. What is endometrial biopsy endometrial thickness and endometrial pattern are useful as prognostic parameters for successful pregnancy in in-vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET). • Oxygen tension theory: In a recent publication (Fertil Steril 2011;96:519-521), Dr. Endometrial biopsy results how long Robert Casper from the University of Toronto, Canada offers an interesting mechanism by which a thin lining results in lower implantation. What is an endometrial biopsy The uterine lining has two layers, a “functional” layer which gets shed with menstruation and a “basal” layer which persists. Biopsy endometrial The functional layer of the endometrium has plenty of small blood vessels (capillaries), in contrast to the larger spiral arteries in the basal layer. Skin biopsy results time With ovulation, there is constriction of the spiral arteries with reduced blood flow to the functional layer. Pipelle endometrial biopsy This results in reduced oxygen tension, which is good for embryo implantation. Endometrial biopsy procedure In the endometrium, when the thickness measured by ultrasound is <7 mm, it is the functional layer that is thin or absent, and the implanting embryo would be much closer to the spiral arteries and the higher vascularity and oxygen concentrations of the basal endometrium. Endometrial biopsy side effects The high oxygen concentrations near the basal layer could be detrimental compared with the usual low oxygen tension of the surface endometrium. Liver biopsy recovery time Interesting! • as some researchers found that measurement of endometrial thickness have no predictive value for pregnancy but others found increased chances of miscarriages related to thin and thick endometrium. Abnormal endometrial biopsy results However the main advantage of measuring endometrial thickness lies in its high negative predictive values in cases where there is minimal endometrial thickness • Robert G edwards the physiologist who developed the treatment was awarded the Nobel Prize in Physiology or Medicine in 2010 Adrina Iliescu held the record of oldest women to give birth using IVF and donated egg when she gave birth in 2004 at age of 66 • These culture media, like Earle, Ham's F10, Tyrode's T6 and Whitten's WM1 were based on different salts and were constructed to support the development of somatic cells and cell lines in culture.The Ham's Nutrient Mixtures were originally developed to support growth of several clones of Chinese hamster ovary (CHO) cells, as well as clones of HeLa and mouse L-cells. • Weissman et al16 found a significant lower implantation and pregnancy rate in patients when an endometrial thickness on the day of hCG administration was > 14 mm. Endometrial biopsy recovery Kupesic et al17 reported no pregnancies, if the endometrial thickness on the ET day was >15 mm and Schild et al18 found no pregnancies if the thickness on the day of oocyte retrieval (OR) was > 16 mm. Endometrial biopsy video Ultrasound Assessment of Endometrial Receptivity in in vitro Fertilization TreatmentErnest Hung Yu NG, Pak Chung HODonald School Journal of Ultrasound in Obstetrics and Gynecology, April-June 2010;4(2):179-188 • Hypoxia in the endometrium may play a beneficial role for implantation as the expression of vascular endothelial growth factor is upregulated by hypoxia52 and relatively low oxygen tension was present around the blastocyst during the time of implantation • Endometrial growth is thought to depend on uterine artery flow and endomertial development has great importance on in-vitro fertilization Nitric oxide relaxes vascular smooth muscles through c-GMP mediated pathway and NO Synthase isoforms have been identified in the uterus. Pain after endometrial biopsy Phosphodiesterase hydrolyse c AMP and c GMP. Cervical biopsy recovery Sildenafil citrate (viagra) a type 5 specific Phosphodiesterase inhibitor aguments the vasodilatory effects NO by preventing degradation of c GMP. Endometrial biopsy complications Pulsatile index was decreased in 7 days after sildenafil indicating increased blood flow Combination therapy of Sildenafil and oestradiol valerate improved blood flow and endometrial thickness in all patients as per above mentioned journal NTG have been successfully used in improving uterine blood flow and endometrial lining but with increased side effects like hypotension and headaches Study on effects of sildenafil (vaginal suppositories) in increasing uterine bleeding and endometrial thickness is in priliminay phase and needs more intensive studies • estrogen component of OCP stimulates uniform endometrial growth and promptly stops shedding, while the progesterone component stabilizes the endometrium by converting it into pseudodecidua. Hysteroscopy endometrial biopsy With increasing ET between 6–11 mm we used oral conjugated estrogen followed by progesterone to stabilize the estrogen stimulated endometrial growth.


Breast biopsy recovery time The mechanism of action of conjugated estrogen is similar to intravenous estrogen and acts by stimulating clotting at the capillary level. Endometrial biopsy ivf ET more than 11 mm we used megestrol acetate, which is a powerful antiestrogen known to prevent and reverse endometrial hyperplasia.