Endocrine and paracrine factors related to pregnancy and infertility
Author: Hosseini Akram, Frida
Date: 2019-06-14
Location: Lecture Hall Aulan, plan 3, Danderyds sjukhus, Stockholm
Time: 13.00
Department: Inst för kliniska vetenskaper, Danderyds sjukhus / Dept of Clinical Sciences, Danderyd Hospital
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Thesis (2.153Mb)
Abstract
Unexplained infertility, one of the common gynecological disorders, affecting 10 to 15 % of women worldwide. Recurrent pregnancy loss affects approximately 1 to 3 % of pregnant women with an unknown etiology in 50 % of cases. Endocrine dysfunctions, including thyroid dysfunction, are one of the related factors to female reproductive disturbances. The aim of the thesis was to explore the importance of thyroid function and endometrial factors for implantation and pregnancy.
Three groups of pregnant women, one group with high risk (n = 88) was compared to a low-risk (n = 511) and a general screening group (n = 699) to study the incidence of subclinical hypothyroidism and hypothyroidism, defined as TSH < 2.5 mIU/L. Women with recurrent pregnancy loss, (n = 165), and controls, (n = 289), were included in genetic analysis and gene expression array of endometrium, (n = 4 and n = 5 respectively). Infertile women (n = 19) and fertile women were included to study thyroid-related proteins in endometrium (n = 28) and Fallopian tube (n = 13). Human embryos, (n= 36), were used to study the effect of thyroid hormone on embryo development.
Thyroid stimulating hormone (TSH), free thyroid hormone (fT4) and TPO antibodies (TPO-Ab) levels were analyzed by use of immunological methods. Genetic variations in the HABP2 gene was performed by use of TaqMan SNP Genotyping Assays. Gene expression array was used to study mRNA in endometrium of women with recurrent miscarriage at the time of implantation. Immunohistochemistry was used to analyze the presence and distribution of thyroid related proteins in endometrium. Additionally, influence of thyroid hormone (T4) on the early embryo development was analyzed.
Approximately 10 % of all pregnant women, regardless of risk, had elevated TSH levels. Furthermore, hypothyroid women on levothyroxine supplementation had in almost 50 % of cases inadequate treatment. There were no significant differences in the presence of polymorphism in HABP2 genes in comparison to fertile controls. In total, 124 genes were differently expressed in women with recurrent miscarriage mainly related to immunological processes, particularly shown by upregulation of IL8 in women with recurrent miscarriage. The infertile women showed lower protein staining of TRα1 and MCT8 in endometrium compared to the fertile women. Staining of thyroid related proteins was observed in all different parts of Fallopian tube. T4 supplementation showed improvement of blastocyst development in T4 added media.
In conclusion, general screening for thyroid dysfunction during first trimester of pregnancy is needed to find all women in need to LT4 supplementation. Inflammatory events, especially IL8, might offer a clue to recurrent pregnancy loss while variations in the HABP2 gene does not seem to be associated with recurrent miscarriage. The expression and distribution of thyroid-related factors in endometrium seem to be related to unexplained infertility. The presence of thyroid-related proteins in fallopian tube and the improvement of embryo development after T4 treatment suggest that a functional thyroid system is important form achievement of a normal pregnancy.
Three groups of pregnant women, one group with high risk (n = 88) was compared to a low-risk (n = 511) and a general screening group (n = 699) to study the incidence of subclinical hypothyroidism and hypothyroidism, defined as TSH < 2.5 mIU/L. Women with recurrent pregnancy loss, (n = 165), and controls, (n = 289), were included in genetic analysis and gene expression array of endometrium, (n = 4 and n = 5 respectively). Infertile women (n = 19) and fertile women were included to study thyroid-related proteins in endometrium (n = 28) and Fallopian tube (n = 13). Human embryos, (n= 36), were used to study the effect of thyroid hormone on embryo development.
Thyroid stimulating hormone (TSH), free thyroid hormone (fT4) and TPO antibodies (TPO-Ab) levels were analyzed by use of immunological methods. Genetic variations in the HABP2 gene was performed by use of TaqMan SNP Genotyping Assays. Gene expression array was used to study mRNA in endometrium of women with recurrent miscarriage at the time of implantation. Immunohistochemistry was used to analyze the presence and distribution of thyroid related proteins in endometrium. Additionally, influence of thyroid hormone (T4) on the early embryo development was analyzed.
Approximately 10 % of all pregnant women, regardless of risk, had elevated TSH levels. Furthermore, hypothyroid women on levothyroxine supplementation had in almost 50 % of cases inadequate treatment. There were no significant differences in the presence of polymorphism in HABP2 genes in comparison to fertile controls. In total, 124 genes were differently expressed in women with recurrent miscarriage mainly related to immunological processes, particularly shown by upregulation of IL8 in women with recurrent miscarriage. The infertile women showed lower protein staining of TRα1 and MCT8 in endometrium compared to the fertile women. Staining of thyroid related proteins was observed in all different parts of Fallopian tube. T4 supplementation showed improvement of blastocyst development in T4 added media.
In conclusion, general screening for thyroid dysfunction during first trimester of pregnancy is needed to find all women in need to LT4 supplementation. Inflammatory events, especially IL8, might offer a clue to recurrent pregnancy loss while variations in the HABP2 gene does not seem to be associated with recurrent miscarriage. The expression and distribution of thyroid-related factors in endometrium seem to be related to unexplained infertility. The presence of thyroid-related proteins in fallopian tube and the improvement of embryo development after T4 treatment suggest that a functional thyroid system is important form achievement of a normal pregnancy.
List of papers:
I. Frida Hosseini Akram, Bengt Johansson, Gunnar Möllerström, Britt-Marie Landgren, Anneli Stavreus-Evers, Lottie Skjöldebrand Sparre. Incidence of subclinical hypothyroidism and hypothyroidism in early pregnancy. Journal of Women's health. 2017, 26:1231-123.
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II. Frida Hosseini-Akram, Sally Haroun, Signe Altmäe, Lottie Skjöldebrand-Sparre, Helena Åkerud, Inger Sundström Poromaa, Britt-Marie Landgren, Anneli Stavreus-Evers. Hyaluronan-binding protein 2 (HABP2) gene variation in women with recurrent miscarriage. BMC Women's Health. 2018, 18:143.
Fulltext (DOI)
Pubmed
View record in Web of Science®
III. Frida Hosseini, Theodora Kunovac Kallak, Helena Åkerud, Britt-Marie Landgren, Lottie Skjöldebrand-Sparre, Anneli Stavreus-Evers. Endometrial gene expression in women with recurrent pregnancy loss reveals up-regulation of the IL8 pathway. [Submitted]
IV. Frida Hosseini Akram, Lottie Skjöldebrand-Sparre, Britt-Marie Landgren, Fatma Gulen Yaldir, Lusine Aghajanova, Kjell Wånggren, Anneli Stavreus-Evers. Elucidating the role of thyroid hormone receptors in endometrium, fallopian tubes and blastocysts in women with unexplained infertility and healthy fertile controls. [Manuscript]
I. Frida Hosseini Akram, Bengt Johansson, Gunnar Möllerström, Britt-Marie Landgren, Anneli Stavreus-Evers, Lottie Skjöldebrand Sparre. Incidence of subclinical hypothyroidism and hypothyroidism in early pregnancy. Journal of Women's health. 2017, 26:1231-123.
Fulltext (DOI)
Pubmed
View record in Web of Science®
II. Frida Hosseini-Akram, Sally Haroun, Signe Altmäe, Lottie Skjöldebrand-Sparre, Helena Åkerud, Inger Sundström Poromaa, Britt-Marie Landgren, Anneli Stavreus-Evers. Hyaluronan-binding protein 2 (HABP2) gene variation in women with recurrent miscarriage. BMC Women's Health. 2018, 18:143.
Fulltext (DOI)
Pubmed
View record in Web of Science®
III. Frida Hosseini, Theodora Kunovac Kallak, Helena Åkerud, Britt-Marie Landgren, Lottie Skjöldebrand-Sparre, Anneli Stavreus-Evers. Endometrial gene expression in women with recurrent pregnancy loss reveals up-regulation of the IL8 pathway. [Submitted]
IV. Frida Hosseini Akram, Lottie Skjöldebrand-Sparre, Britt-Marie Landgren, Fatma Gulen Yaldir, Lusine Aghajanova, Kjell Wånggren, Anneli Stavreus-Evers. Elucidating the role of thyroid hormone receptors in endometrium, fallopian tubes and blastocysts in women with unexplained infertility and healthy fertile controls. [Manuscript]
Institution: Karolinska Institutet
Supervisor: Skjöldebrand Sparre, Lottie
Co-supervisor: Landgren, Britt-Marie
Issue date: 2019-05-24
Rights:
Publication year: 2019
ISBN: 978-91-7831-502-4
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