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To determine if DNA methylation alterations exist in first trimester human placenta between conceptions utilizing fertility treatments and those that do not, and if so, if they are the result of underlying infertility or fertility treatments. We also assessed if significant alterations led to changes in gene expression.We compared DNA methylation of first trimester placenta from singleton pregnancies that resulted in live births from unassisted, non-IVF fertility treatment (NIFT), and IVF conceptions using the Infinium MethylationEPIC BeadChip array. Significant CpG sites were compared to corresponding RNA-seq analysis in similar cohorts to determine if methylation alterations lead to differences in gene expression.138 singleton pregnancies undergoing chorionic villus sampling resulting in a live birth were recruited for methylation analysis (56 unassisted, 38 NIFT, 44 IVF conceptions). RNA-seq data consisted of 141 subjects (74 unassisted, 33 NIFT, and 34 IVF) of which 116 overlap with the methylation cohort.IVF conceived pregnancy, or pregnancy conceived via non-IVF fertility treatment such as ovulation induction and/or intrauterine insemination.Significant methylation changes at CpG sites after adjustment for multiple comparisons. Secondary outcome is gene expression changes of significant CpG sites.Of the 741,145 probes analyzed in placenta, few were significant at Bonferroni0.05: 185 CpG sites (0.025%) significant in pregnancies conceived with fertility treatment (NIFT+IVF) vs unassisted conceptions; 28 in NIFT vs unassisted; 195 in IVF vs unassisted; and only 13 (0.0018%) significant in IVF vs NIFT conceptions. Of all significant CpG sites combined, 10% (35 total) were located in genes with suggestive gene expression changes (RNA-seq P0.05), but none were significant after adjustment for multiple comparisons (RNA-seq FDR0.05). None of the 13 differentially methylated probes in IVF vs NIFT placenta were located in genes with suggestive IVF vs NIFT gene expression differences.Underlying infertility is the most significant contributor to the minimal differences in first trimester placental methylation, and not the specific fertility treatment utilized, such as IVF.

Background Little is known about the long-term reproductive effects of pelvic infection when a levonorgestrel-releasing intrauterine device (LNG-IUD) is in situ. Society guidelines do not recommend removing an LNG-IUD during pelvic infection. Case A 37-year-old woman presented with primary infertility, and the only contributing factor was intrauterine adhesions in the shape of an IUD. She was known to previously have an LNG-IUD and was treated for asymptomatic chlamydia infection while the IUD was in place. After lysis of adhesions, she successfully conceived spontaneously. Conclusion Data on long-term reproductive effects of pelvic infection with an LNG-IUD in situ are not available, and there may be consequences affecting the intrauterine milieu requiring further studies and potential counseling.

Little is known about the long-term reproductive effects of pelvic infection when a levonorgestrel-releasing intrauterine device (LNG-IUD) is in situ. Society guidelines do not recommend removing an LNG-IUD during pelvic infection.A 37-year-old woman presented with primary infertility, and the only contributing factor was intrauterine adhesions in the shape of an IUD. She was known to previously have an LNG-IUD and was treated for asymptomatic chlamydia infection while the IUD was in place. After lysis of adhesions, she successfully conceived spontaneously.Data on long-term reproductive effects of pelvic infection with an LNG-IUD in situ are not available, and there may be consequences affecting the intrauterine milieu requiring further studies and potential counseling.

In vitro fertilization involving frozen embryo transfer and donor oocytes increases preeclampsia risk. These in vitro fertilization protocols typically yield pregnancies without a corpus luteum (CL), which secretes vasoactive hormones. We investigated whether in vitro fertilization pregnancies without a CL disrupt maternal circulatory adaptations and increase preeclampsia risk. Women with 0 (n=26), 1 (n=23), or >1 (n=22) CL were serially evaluated before, during, and after pregnancy. Because increasing arterial compliance is a major physiological adaptation in pregnancy, we assessed carotid-femoral pulse wave velocity and transit time. In a parallel prospective cohort study, obstetric outcomes for singleton livebirths achieved with autologous oocytes were compared between groups by CL number (n=683). The expected decline in carotid-femoral pulse wave velocity and rise in carotid-femoral transit time during the first trimester were attenuated in the 0-CL compared with combined single/multiple-CL cohorts, which were similar (group-time interaction: P =0.06 and 0.03, respectively). The blunted changes of carotid-femoral pulse wave velocity and carotid-femoral transit time from prepregnancy in the 0-CL cohort were most striking at 10 to 12 weeks of gestation ( P =0.01 and 0.006, respectively, versus 1 and >1 CL). Zero CL was predictive of preeclampsia (adjusted odds ratio, 2.73; 95% CI, 1.14–6.49) and preeclampsia with severe features (6.45; 95% CI, 1.94–25.09) compared with 1 CL. Programmed frozen embryo transfer cycles (0 CL) were associated with higher rates of preeclampsia (12.8% versus 3.9%; P =0.02) and preeclampsia with severe features (9.6% versus 0.8%; P =0.002) compared with modified natural frozen embryo transfer cycles (1 CL). In common in vitro fertilization protocols, absence of the CL perturbed the maternal circulation in early pregnancy and increased the incidence of preeclampsia.

The brain is the central controller of reproduction and the menstrual cycle. Reproductive endocrinologists spend their days treating patients with perturbations in reproduction as a result of pituitary diseases and manipulate pituitary hormones to enhance fertility and quality of life. Microscopic neuroanatomical images will allow a better understanding of how a tumor in the pituitary might affect vision, or a mass in the brain might cause amenorrhea. Clinical correlations that are taught every day become much clearer once the anatomical relationships are explored. The objective of this pictorial tour is to elucidate anatomical and clinical relationships while showcasing the neuroanatomy of reproduction.