Identification and characterization of RSIY-11, a novel seminal peptide derived from semenogelin-1, which acts as a neutral endopeptidase inhibitor modulating sperm motility.

PURPOSE: Based on prior reports demonstrating that neutral endopeptidase (NEP) inhibitors increase sperm motility, the goal of our studies was to identify endogenous seminal peptides that inhibit NEP and investigate their potential effect on sperm motility. METHODS: Peptidomic analysis was performed on human seminal fluid, identifying 22 novel peptides. One peptide, named RSIY-11, derived from semenogelin-1, was predicted through sequence analysis to be a substrate and/or potential inhibitor of NEP. Enzymatic analysis was conducted to determine the inhibitory constant (Ki) of RSIY-11 as an inhibitor of NEP. Total and progressive sperm motility was determined at baseline and 30 and 60 min following addition of RSIY-11 to seminal fluid in 59 patients undergoing an infertility workup at an urban medical center. Additionally, the effects of RSIY-11 on sperm motility were evaluated in 15 of the 59 patients that met criteria for asthenospermia. RESULTS: RSIY-11 was shown to act as a competitive inhibitor of NEP with a Ki of 18.4 ± 1.6 µM. Addition of RSIY-11 at concentrations of 0.75 µM, 7.5 µM, and 75 µM significantly increased sperm motility at all time points investigated, with increases of 6.1%, 6.9%, and 9.2% at 60 min, respectively. Additionally, within the subgroup of patients with asthenospermia, RSIY-11 at concentrations of 0.75 µM, 7.5 µM, and 75 µM significantly increased sperm motility at all time points investigated, with increases of 7.6%, 8.8%, and 10.6% at 60 min, respectively. CONCLUSIONS: RSIY-11 is a newly identified semenogelin-1-derived peptide present in seminal fluid. RSIY-11 acts as a potent competitive inhibitor of NEP, which when added to seminal fluid significantly increases sperm motility. RSIY-11 could play a potential role in the treatment for male factor infertility related to asthenospermia and improve intrauterine insemination outcomes.

Comparison of perinatal outcomes following frozen embryo transfer cycles using autologous versus donor oocytes in women 40 to 43 years old: analysis of SART CORS data.

OBJECTIVE: To study the differences in perinatal outcomes after frozen embryo transfer cycles using autologous or donor oocytes in women of advanced maternal age. DESIGN: Historical cohort study. SETTING: US national database from the Society of Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) from 2009 to 2013. PATIENT(S): Women at 40-43 years of age undergoing autologous frozen embryo transfers (a-FET) or donor oocyte frozen embryo transfers (d-FET) resulting in singleton pregnancies that were entered in the SART CORS database from 2009 to 2013. RESULTS: a-FET resulted in 4402 singleton live births whereas d-FET resulted in 2703 singleton live births. d-FET resulted in a higher risk of preterm births (< 37 weeks), with adjusted odds ratio (aOR) 1.33 (95% CI 1.02-1.75), but similar risk of small for gestational age (SGA), with aOR 1.75 (95% CI 0.85-3.7), when compared to a-FET. However, when only single blastocyst transfer cycles are considered, d-FET and a-FET showed no difference in preterm births or other adverse perinatal outcomes. CONCLUSIONS: Singletons resulting from d-FET are at increased risk for perinatal morbidity. However, the risk was diminished in single blastocyst transfer cycles. Our study supports the current American Society for Reproductive Medicine (ASRM) guidelines of transferring a single blastocyst in d-FET cycles.

Not all twins are monozygotic after elective single embryo transfer: analysis of 32,600 elective single embryo transfer cycles as reported to the Society for Assisted Reproductive Technology.

OBJECTIVE: To study the incidence and risk factors of multiple pregnancies after elective single ET. DESIGN: Historic cohort. SETTING: Not applicable. PATIENT(S): Women <35 years of age undergoing elective single ET entered in the SART CORS database from 2010 to 2013. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Rate of sex discordant pregnancies. Rate of same sex pregnancies and risk factors for both same sex and sex discordant pregnancies. RESULT(S): A total of 32,600 cycles were reported to SART CORS during this time period. There were 15,143 pregnancies from which 14,888 were singletons (98.3%), 23 sex discordant (0.15%) multiple pregnancies, 226 (1.5%) sex concordant multiple pregnancies, and 6 (0.01%) pregnancies without sex information. When Weinberg's differential rule was applied, the rate of dizygotic pregnancies was calculated to be 18%. Unexplained infertility was found to be the biggest risk factor for sex discordant multiple pregnancies (adjusted odds ratio 4.33, 95% confidence interval 1.4-13.1), followed by elevated body mass index (BMI). The only risk factor found for sex concordant pregnancies was undergoing a fresh transfer (adjusted odds ratio 1.4, 95% confidence interval 1.02-1.95). CONCLUSION(S): Elective single ET improves, but does not completely eliminate the risk of multiple pregnancies. Patients should be counseled that there might be up to a ∼2% risk of multiple pregnancies, of which up to 18% can be dizygotic. Patients with elevated BMI and unexplained fertility may be at higher risk for sex discordant multiple pregnancies and patients undergoing fresh cycles may be at higher risk for sex concordant multiple pregnancies.

Improving Interprofessional Consistency in Electronic Fetal Heart Rate Interpretation.

Objective To determine if mandatory online training in electronic fetal monitoring (EFM) improved agreement in documentation between obstetric care providers and nurses on labor and delivery. Methods Health care professionals working in obstetrics at our institution were required to complete a course on EFM interpretation. We performed a retrospective chart review of 701 charts including patients delivered before and after the introduction of the course to evaluate agreement among providers in their documentation of their interpretations of the EFM tracings. Results Agreement between provider and nurse documentation at the time of admission improved for variability and accelerations (variability: 91.1 vs. 98.3%, p < 0.001; and accelerations: 75.2 vs. 87.7%, p < 0.001). Similarly, agreement improved at the time of the last note prior to delivery for documentation of variability and accelerations (variability: 82.1 vs. 90.6%, p = 0.001; and accelerations: 56.7 vs. 68.6%, p = 0.0012). Agreement in interpretation of decelerations both at the time of admission and at the time of delivery increased (86.3 vs. 90.6%, p = 0.0787, and 56.7 vs. 61.1%, p = 0.2314, respectively) but was not significant. Conclusion An online EFM course can significantly improve consistency in multidisciplinary documentation of fetal heart rate tracing interpretation.