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15 September 2018, Volume 37 Issue 5
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Perception and Attitudes of Parents towards Sex Education for Disabled Children TU Xiao-wen，HU Ta-jing，LOU Chao-hua，LIAN Qi-guo 2018, 37 (5):  357-359.  Abstract ( 1248 )   PDF (804KB) ( 8560 )   Objective：To explore the perception and attitudes of parents towards sexuality education (SE) for adolescents with disabilities. Methods：A total of 31 parents with the disabled children were in-depth interviewed in the urban area of Shanghai and Beijing, and the rural area of Shanxi province. Results：Urban parents had some concern about sexual and reproductive health (SRH) problems among disabled children. All of them supported SE for their disabled children, especially education about self-protection. However, they were more conservative in providing knowledge on reproduction and contraception, induced abortion and sexually transmitted diseases. Only about 1/3 (4/13) of urban parents had ever provided information about puberty development, health care and self-protection to their disabled children. Rural parents had less concern about their children′s SRH than urban parents. Although most rural parents (13/18) also supported SE for the disabled children, they didn′t know what should be provided. Therefore, few of them had practically given SE to their children. Almost all urban parents (12/13) and majority of rural parents (13/18) support school SE, and considered that school SE should be better than family-based education. However, they knew a little about the status of school SE, especially rural parents. Conclusions：Rural parents were more conservative in SE, less likely to provide sexual knowledge, for their disabled children. It is necessary to improve the understanding of SE, and the ability of family-based SE, for those parents with disabled children. Related Articles | Metrics

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Retrospective Analysis of the Outcomes of Frozen Embryo Transfer in 483 Cases ZHOU Yue-xi，WANG Li-qun，XIE Shou-zhen，ZHOU Rong，XIE Di，ZHAO Xiao-ling，XU Fan，ZHANG Juan 2018, 37 (5):  360-363.  Abstract ( 1227 )   PDF (884KB) ( 8589 )   Objective：To investigate the outcome and its influence factors of frozen embryo transfer (FET) cycles. Methods：A total of 483 FET cycles were retrospectively analyzed, in our Center from January to December in 2016. According to the pregnancy success or not, those cycles were divided into the pregnancy group (253 cycles) and the non-pregnancy group (230 cycles). The basic clinical data, pregnancy outcome and the influence factors between two groups were compared. Results：The mean age of the pregnancy group was significantly less than that of the non-pregnancy group, while the number of optimal embryo for FET in the pregnancy group was more (both P＜0.05). Logistic regression analysis showed that the influence factors of FET outcome included age (OR=0.715, 95%CI: 0.550-0.930, P=0.012), embryo quality (OR=1.780, 95%CI: 1.323-2.395, P=0.000) and type of embryo (OR=1.737, 95%CI: 1.076-2.805, P=0.024). Conclusions：Younger age, blastula transfer, optimal embryo transplantation were more conductive to the planting success rate and the clinical pregnancy rate of FET cycles. Related Articles | Metrics

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Expression of PTEN in the Placental and Embryonic Tissues from Patients undergoing in vitro Fertilization-Embryo Transfer ZHAO Liang，SUN Li-fang，ZHENG Xiu-li，LIU Jing-fang，ZHENG Rong，WANG Ying，YANG Rui，ZHANG Lei，YU Li，ZHANG Han 2018, 37 (5):  363-366.  Abstract ( 1274 )   PDF (855KB) ( 8562 )   Objective：To study the effect of in vitro fertilization-embryo transfer (IVF-ET) on the expression of the gene of phosphate and tension homology deleted on chromsome ten (PTEN) and its protein in the placenta villus and embryonic tissues. Methods：Eight cases undergoing IVF-ET and the ultrasound-guided embryo reduction (the IVF-ET group), and 10 cases of natural pregnancy undergoing abortion (the control group) were included in this study. The placental villus and embryonic tissue were collected. The expression of PTEN mRNA was measured by real-time qPCR. The distribution of PTEN protein in tissues was tested by immunohistochemistry. Results：PTEN protein was expressed in the cell membrane and cytoplasm of placental villus trophoblast cells and syncytiotrophoblast cells, and widely expressed in the different germ layers of early embryo. The expression of PTEN protein in the placental villus of the IVF-ET group was lower than that of the control group (t=2.325, P=0.027). However, there was no significant difference in the expression of PTEN protein in the tissues of early embryo between the two groups (P=0.288). The expression pattern of PTEN mRNA was just consistent with that of PTEN protein. Conclusions：The in vitro procedure of IVF-ET may decrease the expressions of PTEN gene and protein in placenta, however does not change the expression levels in the tissues of early embryo. It is necessary to explore the underlying meanings of the decreased PTEN expression in placenta related to IVF-ET. Related Articles | Metrics

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Influencing Factors of the Successful Rate of AIH in Patients with PCOS: A Retrospective Analysis LIU Pan，GUO Li-na，ZHAO Min-ying，SUN Xiao-hui，LIN Hui-lan 2018, 37 (5):  367-371.  Abstract ( 1303 )   PDF (909KB) ( 8559 )   Objective：To study the factors influencing the success rate of artificial insemination of husband (AIH) in patients with polycystic ovary syndrome (PCOS). Methods: The clinical data of PCOS patients undergoing AIH between January 2013 and June 2017 were collected, including a total of 226 cycles of 150 cases. Those cycles were grouped according to age, body mass index (BMI), the timing of fertilization, storage time before treatment of semen, the number of mature follicles. The clinical pregnancy rate was compared among groups. Results: ①There was no significant difference in the pregnancy rate among three groups of ＜30 years, 30-35 years and 36-38 years (P＞0.05). ②There was significant difference in the pregnancy rate among three groups related to BMI (P＜0.05). The pregnancy rate in the BMI＜24 kg/m2 group was higher than that in the BMI 24-27 kg/m2 group, or that in the BMI ≥28 kg/m2 group (both P＜0.05). The pregnancy rate in the BMI 24-27 kg/m2 group was higher than that in the BMI ≥28 kg/m2 group (but P＞0.05). ③According to the timing of fertilization，the pregnancy rate of the group with two times of IUI before and after ovulation was significantly higher than that of another group with one time of IUI before ovulation (P＜0.05). ④According to the storage time before treatment of semen, the pregnancy rate in the 10-30 minutes group was higher than that in the ＞30 minutes group (P＜0.05). ⑤When there was one mature follicle, the pregnancy rate of the group with the total progressively motile sperm count (TPMC) 10×106～50×106 was significantly higher than that of the group with TPMC ＞50×106 (P＜0.05). When there were two mature follicles, there was no significant difference in the pregnancy rate between the above two groups (P＞0.05). Conclusions: The age has little influence on the pregnancy rate in those PCOS patients aged ＜39 years. PCOS patients with overweight and obese should be asked to lose weight before IUI treatment. The storage time before treatment of semen should be control within 10-30 minutes. TPMC can be properly adjusted according to the number of mature follicles. Two times of IUI can be arranged before and after ovulation with the informed consent, so as to increase the pregnancy rate. Related Articles | Metrics

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Evaluation of Distal Mucosa of Fallopian Tube by the Hysteroscopy CHEN Hang，HUANG Xiao-wu 2018, 37 (5):  372-376.  Abstract ( 1252 )   PDF (6383KB) ( 8753 )   Objective：To study the application of hysteroscopy in the evaluation of the distal mucosa of fallopian tube, and to analyze this feasibility hysteroscopy replacing falloposcopy in clinical practice. Methods：Clinical data of 174 fallopian tubes undergoing salpingectomy from January 2015 to February 2018 was collected. The mucosal status of fallopian tube was evaluated by the hysteroscopy replacing falloposcopy, before the salpingectomy. The pathological specimens of fallopian tube were then checked with microscope. According to the pathological standard, the fallopian tube was grouped as the normal group, the mild group, the moderate group and the severe group. The consistency between the pathological observation and the hysteroscopic evaluation was statistically analyzed. Results：The parameters of hysteroscopic evaluation on the mucosal lesions of distal tubal were included the sensitivity, specificity, positive predictive value, negative predictive value, false positive rate, false negative rate, total compliance rate, and the Kappa value being 98.2%, 91.5%, 84.6%, 99.1%, 8.5%, 1.8%, 93.7% and 0.861. Conclusions：Hysteroscopy, with a good diagnostic value and instead of falloposcopy, may be selectively used to evaluate the mucosal lesions of distal tubal with high sensitivity and specificity. Related Articles | Metrics

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Influence of Different Parity on Serum Lipid during Pregnancy and Pregnant Outcome LUO Meng-meng，YIN Xiao-qian，HU Xiao-yue，GONG Miao，LIU Su-xin，HUO Yan 2018, 37 (5):  377-381.  Abstract ( 1271 )   PDF (893KB) ( 8546 )   Objective：To investigate the influence of parity on serum lipid during pregnancy and pregnant outcome. Methods：Totally, 1 669 women who delivered in Hebei General Hospital from September 2016 to December 2017 were recruited. Those women were divided into four groups based on the age and gestational age: the right-age and mid-pregnancy group (527 cases), the advanced-age and mid-pregnancy group (261 cases), the right-age and late-pregnancy group (in the late of pregnancy, 636 cases), the advanced-age and late-pregnancy group (in the late of pregnancy, 245 cases). Each group was divided into two subgroups: the primipara subgroup and the multipara subgroup according to the number of births. The levels of serum lipid, HDL-C/TC, LDL-C/TC and the LDL-C/HDL-C ratio were compared. Results：①The levels of TG, TC, VLDL-C in multipara women of the right-age and mid-pregnancy group were significantly increased (all P＜0.05), while the levels of TG, TC, HDL-C, LDL-C, VLDL-C and HDL-C/TC in multipara women of the advanced-age and mid-pregnancy group were mildly increased, only the significant difference in HDL-C level (P＜0.05), when compared with those primipara women. ②The levels of LDL-C, VLDL-C, LDL-C/TC and LDL-C/HDL-C in multipara women of the right-age and late-pregnancy group were significantly decreased, and the level of HDL-C/TC increased (all P＜0.05), while the levels of TG, TC, HDL-C, LDL-C, HDL-C/TC and LDL-C/HDL-C in multipara women of the advanced-age and late-pregnancy group were mildly decreased  (but P＞0.05) and the level of VLDL-C mildly increased (but P＞0.05), when compared with those primipara women. ③Compared with those primipara women, the multipara women of the right-age groups had lower incidences of premature rupture of membranes and fetal distress, while the multipara women of the advanced-age groups had lower incidences of hypertensive disorder complicating pregnancy (HDCP), gestational diabetes mellitus (GDM) and fetal distress (all P＜0.05). However, the incidences of premature and giant babies in those multipara women of the right-age groups were higher than those in the primipara women (both P＜0.05). ④The incidences of HDCP and GDM in both advanced-age groups were significantly higher than those in both right-age groups (all P＜0.05). Conclusions：Parity has a certain degree of effect on serum lipids, which could be related to pregnancy complications. Related Articles | Metrics

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Treatment in Patients with Unexplained Recurrent Spontaneous Abortion HU Jing-jing，WANG Chao，XIANG Hui-fen，WANG Ying，WU Rong，XU Xiao-feng，WEI Zhao-lian，CAO Yun-xia 2018, 37 (5):  382-384.  Abstract ( 1342 )   PDF (783KB) ( 8659 )   Objective：To investigate the clinical efficiency of aspirin, low molecular heparin, metacortandracin, and aspirin combined with low molecular heparin in patients with unexplained recurrent spontaneous abortion (URSA). Methods: A total of 1 013 women with URSA who accepted the artificial cycle freezing embryo transfer (FET) were enrolled from January 2014 to April 2018. 596 patients in the control group were not treated with the additional drugs besides the artificial cycle. 417 patients treated with the additional drugs from the menstruation end to the 12 weeks of pregnancy in the experimental group were divided into four subgroups (aspirin, low molecular heparin, metacortandracin and aspirin combined with low molecular heparin). F test and χ2 test were used to analyze the differences in the biochemical pregnancy rate, clinical pregnancy rate, early abortion rate and parturition rate. Results: There were significant differences in the biochemical pregnancy rate and early abortion rate between the control group and the experimental group (P＜0.05). The biochemical pregnancy rate of aspirin subgroup, low molecular heparin subgroup and aspirin combined with heparin subgroup were significantly higher than that in the control group (P＜0.05). The early abortion rate of aspirin subgroup and the aspirin combined with heparin subgroup were significantly lower than that in the control group (P＜0.05). However, there were no significant differences in the clinical pregnancy rate and parturition rate between the two groups, and among those subgroups (P＞0.05). Conclusions: For those patients with URSA undergoing FET, the additional anticoagulant drugs besides the artificial cycle may improve the pregnancy outcomes. The low molecular heparin is helpful for embryo implantation, while aspirin may effectively reduce the rate of early abortion. Therefore, the additional treatment with anticoagulant drugs is worth recommending for those patients with URSA undergoing FET. Related Articles | Metrics

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Exploratory Treatment of Mitochondrial Disease by Mitochondrial Replacement Techniques LI Tian-jie，YU Yang 2018, 37 (5):  388-392.  Abstract ( 1329 )   PDF (806KB) ( 8565 )   Mitochondrial disease is a kind of genetic disease caused by the mutation in mitochondria genome. There is not a cure method for it. Recently, the nuclear transfer techniques including germinal vesicle transfer, spindle transfer, polar body transfer and pronuclear transfer provide a new hope for the treatment of mitochondrial disease. The germinal vesicle transfer requires the in vitro maturation of oocytes which may affect the development potential of oocytes. The spindle transfer may be at the high risk of damaging spindle since the spindle assembly is sensitive to mechanical stimulus and chromosomes are not enclosed within a nuclear membrane at this stage. As for the polar body transfer, the long-term side-effect is not clear since this technique steps over the natural selection. Pronuclear transfer, with the advantage of easy operation and sufficient research evidences, has the potential of clinical transformation in a short time，although there is still a ethical concern in the cytoplasmic donor from the zygote discarding itself genetic material. This paper reviews the possible application of four kinds of mitochondrial replacement techniques in the treatment of mitochondrial diseases. Related Articles | Metrics

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F-BOX Proteins in Reproduction JIN Yi-mei，SUN Si-man，YAN Shu-ling，LI Mo 2018, 37 (5):  393-396.  Abstract ( 1385 )   PDF (820KB) ( 8569 )   Since the expressions of functional proteins are not significantly regulated at the transcriptional level in oocytes, the post-translational modification such as ubiquitin proteasome system (UPS) may play an important role. F-BOX as a core member of UPS is responsible for the specific recognition of substrates, in which F-BOX participates in the ubiquitination and degradation of targeted proteins. F-BOX is widely present in germ cell and embryo, however, study on its substrates is limited. F-BOX participates in oocyte and embryo development, and oocyte-to-embryo transition (OET) by affecting the ubiquitination of those key proteins related to epithelial-mesenchymal transition (EMT), signal transduction, cell proliferation and apoptosis. Additionally, F-BOX is able to regulate the levels of estrogen and progestin. We reviewed the biological roles of F-BOX in UPS, oocyte and embryo development, OET and the regulation for estrogen and progestin, in order that F-BOX will be studied as a new target of reproductive health and fertility. Related Articles | Metrics

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Effects of Polyamine on Reproduction: Aspects of Reproductive Biology HU Meng-ting，CUI Yu-gui 2018, 37 (5):  397-400.  Abstract ( 1633 )   PDF (787KB) ( 8574 )   The polyamines are a group of ubiquitous polycationic compounds, including spermine, spermidine and putrescine. Mammals synthesize polyamines de novo from amino acids or intake these compounds from food. These compounds participate in the regulation of oxidative stress by eliminating the excess reactive oxygen species (ROS). The polyamines are essential to reproduction and embryo/fetal development. Studies indicate that the polyamines are regulators of cell growth and gene expression, and both mitosis and meiosis. In male reproduction, the polyamines are correlated with spermatogenesis and sperm motility. In female mammals, the polyamines are involved in follicle development and ovulation, and steroidogenesis in the ovary. The additional polyamines can effectively reduce the rate of oocyte aneuploidy and improve the embryonic development in in vitro maturation (IVM). Furthermore，the absence of polyamines can lead to the arrest of embryogenesis. The polyamines are also involved in placental development and material exchange between mother and fetal. This article reviews the biological functions of polyamines and their effects on gametogenesis and placental development. Related Articles | Metrics

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Safety of Ovulation Induction in Infertile Patients after Fertility-Sapring Surgery for Ovarian Malignant Tumors ZHU Yue-meng，LI Gui-ling 2018, 37 (5):  401-404.  Abstract ( 1301 )   PDF (816KB) ( 8548 )   With the development of fertility-sparing surgery (FSS) for ovarian malignant tumors in recent years, the safety, long-term prognosis and fertility of FSS have also been paid more and more attention. FSS treatment for early epithelial ovarian cancer does not increase the recurrence rate and mortality. FSS can be performed for malignant germ cell tumors regardless of tumor staging. The pregnancy rate after FSS was different, most of the patients could be able to conceive naturally. However, a few patients after FSS may need the assisted reproductive technology (ART). It is a common concern of both doctors and patients whether ovulation induction can lead to the recurrence of ovarian tumors. The FSS for the ovarian cancer at early stage and the ovarian borderline tumor is safe and feasible, and the effect of adjuvant chemotherapy on ovarian function after operation is reversible. There is no evidence at present that the ovulation induction will increase the postoperative recurrence rate or cause other malignant tumor. We discussed the safety of ovulation induction in those patients after FSS in this review. Related Articles | Metrics

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Advances in miRNAs and Etiology of Polycystic Ovary Syndrome JIANG Yan，YANG Xiao-kui 2018, 37 (5):  405-408.  Abstract ( 1243 )   PDF (844KB) ( 8579 )   Polycystic ovary syndrome (PCOS) is one of the most common reproductive endocrine disorders. The main features of PCOS include hyperandrogenism, chronic anovulation, polycystic ovaries and insulin resistance. MicroRNAs (miRNAs) are a family of small-molecule, single-stranded, non-coding RNAs, which regulate the expressions of target genes at the posttranscriptional level. MiRNAs can influence follicular development, ovulation and atresia by regulating ovarian granulosa cell proliferation and apoptosis. MiRNAs also cause the endocrine disorder by disturbing the androgen synthesis, and induce insulin resistance through regulating glucose metabolism and insulin sensitivity. It is concluded that miRNAs participate in the pathogenesis of PCOS. In this article, the research progress of miRNAs in etiology of PCOS was reviewed. Related Articles | Metrics

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Aquaporins and Polycystic Ovary Syndrome: A Review HUANG Shi-ya，WEN Qi-dan，LI Juan，MA Hong-xia 2018, 37 (5):  409-413.  Abstract ( 1326 )   PDF (933KB) ( 8642 )   Aquaporins (AQPs), a group of transmembrane proteins, have 13 types of aquaporins (AQP0-AQP12) expressed in mammalian reproductive system. They can be divided into three subfamilies, including water channel subfamily, water-glycerol channel subfamily and super aqua channel subfamily. AQPs can transport water through the cell membrane, while the AQPs of water-glycerol channel subfamily can also transport neutral molecules such as glycerol. The expressions of at least three AQPs (AQP7, AQP8, AQP9) are abnormal in women with polycystic ovary syndrome (PCOS), which may affect folliculogenesis and follicular atresia, as well as adipose metabolism. AQP1-4 and AQP8-9 are closely related to the growth of follicles. The down-regulations of AQP7 and AQP9 are factors of adipose metabolism disorder in PCOS. This paper reviews the function of AQPs and AQPs expression related with PCOS, which may provide new therapeutic opportunities for PCOS. Related Articles | Metrics

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The Etiology of Polycystic Ovary Syndrome ZHAO Jia-wei，LI Xiao-ning，HUANG Yan-qing，WANG Ya-nan，DU Yao-wu 2018, 37 (5):  414-416.  Abstract ( 1266 )   PDF (762KB) ( 8555 )   Polycystic ovary syndrome (PCOS) is a syndrome characterized by multiple causes, complicated pathogenesis and clinical manifestations. It is a reproductive endocrine disorder characterized by hyperandrogensim, persistent anovulation and ovarian polycystic changes. It is generally believed that PCOS is a polygenic genetic disease caused by the interaction of multiple microgenes and environmental factors. In addition, some drugs, such as antiepileptics, have more effects on the pathogenesis of PCOS. The intrauterine environment before birth and the external environment after birth also play a role in the pathogenesis of PCOS. Moreover，the disorder of hypothalamic-pituitary-ovarian axis caused by mental and psychological factors may also lead to the pathogenesis of PCOS. The research progress of the etiolog of PCOS is briefly discussed in this review. Related Articles | Metrics

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Confusion in Diagnosis and Treatment of Cervical Insufficiency GUO Yun-lei，WANG Yong-qing 2018, 37 (5):  417-421.  Abstract ( 1236 )   PDF (840KB) ( 8564 )   The cervical insufficiency as an important component of preterm birth syndrome is one of the main causes of miscarriage and premature birth. The diagnosis of cervical insufficiency mainly includes the medical history, the clinical manifestation of this pregnancy, ultrasound Doppler and pre-pregnancy diagnosis test. Some high-risk factors may be helpful for the prediction of cervical insufficiency, including twin/multiple pregnancy, polycystic ovary syndrome, cervical conization and obesity. For those pregnant women with the high-risk factors, the length of the cervix should be monitored regularly during pregnancy. The cervical shortening should be found and treated in time, which is of great significance for reducing preterm birth rate and abortion rate, and improving pregnancy outcome. So far, there is no uniform standard for its diagnosis, and there are no reliable serological indicators for predicting cervical insufficiency. We discussed the etiology and diagnosis of cervical insufficiency, as well as the prediction of high-risk factors. Related Articles | Metrics

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Threatened Abortion at 24 to 28 Gestational Weeks ZHONG Yun，CHAI Li-qiang 2018, 37 (5):  422-425.  Abstract ( 1238 )   PDF (1136KB) ( 8577 )   The fetus at the gestation of 24 to 28 weeks is defined as a viable child. The rate of miscarriage at 24-28 gestational weeks in China was about 0.3% in 2011. The causes of threatened abortion occurring at 24-28 gestational weeks include fetal structure abnormalities, chromosomal abnormalities, abnormal uterine development, disorder of cervical function, infection, immunity and thrombosis, etc. Those pregnant women should undergo a systematic review of medical history, physical examination and ultrasonic examination. Since the etiology is closely related to infection, some new inflammatory factors are potential markers of premature birth and miscarriage, such as C-reactive protein, melatonin α and IL-6. In addition to the traditional methods of preventing uterine contractions, anti-infection, anti-coagulation, glucocorticoid and cervical ligation, new immunotherapy has also been reported. This paper reviews the research progress of threatened abortion occurring at 24-28 gestational weeks. Related Articles | Metrics

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DNA Methylation and Recurrent Spontaneous Abortion LI Zhi-fang，XIANG Hui-fen，CAO Yun-xia 2018, 37 (5):  426-429.  Abstract ( 1171 )   PDF (812KB) ( 8582 )   Recurrent spontaneous abortion (RSA) is a common pathological pregnancy, in which 50% of the etiology and pathogenesis are unknown. In recent years, the development of epigenetics, especially the study of DNA methylation, provides a new perspective for the pathogenesis of RSA. The study found that the defects of DNA methylation, methylational modification and the other epigenetic modification related to DNA methylation were associated with RSA. The abnormalities of DNA methylation in the imprinted genes, the placenta specific genes and sperm DNA may directly or indirectly affect the implantation, growth and development of embryo, involving in RSA. This review summarizes the research progress of DNA methylation in pathogenesis of RSA. Related Articles | Metrics

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Recurrent Spontaneous Abortion due to the Damaged Decidualization by p53 WANG Wei，ZHAO Xiao-xuan，GU Yue-ru，CHANG Zhuo，FENG Xiao-ling 2018, 37 (5):  430-434.  Abstract ( 1270 )   PDF (843KB) ( 8592 )   The etiology of recurrent spontaneous abortion (RSA) is very complex, and about 50% of cases are undefined. The repeated loss of the embryo caused by the damaged decidualization is a research hotspot. p53 mediates the deterioration of decidualization by participating in multiple signaling pathways, leading to recurrent abortion. The excessive activation of p53/p21 signaling pathway can interfere the expressions of those regulatory factors related to cell cycle which make the blockage of cell cycle, induce the decidualization, promote the apoptosis, and affect the embryonic implantation. In the E2/p53-leukemia inhibitory factor (LIF)-signal transduction and transcriptional activator factor 3 (STAT3) signaling pathway, p53 promotes the secretion of LIF by the endometrial gland during the implantation period under the synergistic effect of estrogen, and activates JAK/STAT signaling pathway, creating favorable conditions for embryonic implantation. Moreover, studies have shown that the functional abnormality of lncRNA involved in regulating p53 signaling pathway and the polymorphism of p53 pathway genes could affect the activity of p53, and decidualization and pregnancy outcome. The recent studies on p53 protein family and its pathways involved in decidualization were reviewed. Related Articles | Metrics