Exploring the heterogenous genetic origin of female subfertility.

Adyns Tiffany, 2023
It is estimated that one in six people of reproductive age worldwide experiences infertility. The World Health Organization (WHO) defines infertility as the inability to conceive or carry a pregnancy to term, after 12 months or more of regular unprotected sex. A part of these patients seeks assisted reproductive technology (ART), such as in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). A significant portion of individuals seeking ART treatment face the harsh reality of multiple failed ART cycles. Couples experiencing infertility undergo a thorough examination to find the cause of their problems. However, in 30% of these couples, no specific cause is identified. Therefore, the couple is labelled with ‘idiopathic infertility’. It is suspected that in nearly half of these couples, infertility problems are caused by altered genetics. This thesis explores various genetic causes related to female infertility by reviewing relevant literature on this topic. In some cases, the cause is a monogenic disorder. A mutation in the mother's DNA results in a disrupted function of specific proteins critical for the fertilisation process. To achieve successful fertilisation, numerous steps must proceed flawlessly, and even a single genetic glitch can halt the entire process. This thesis provides an in-depth discussion of multiple mutations in three different genes, with each gene causing an error in a different part of the fertilisation process. Furthermore, this research discusses two syndromic causes, namely the FMR1 premutation and polycystic ovary syndrome (PCOS). The FMR1 premutation is linked with a broad spectrum of health conditions such as menopause before the age of 40, mental disorders, and a high risk of bone injuries. These patients can present with a lower reserve of oocytes, resulting in menstrual cycle irregularities, hormone fluctuations, and lower fertility. PCOS patients present a combination of clinical patterns, including menstrual cycle irregularities, an elevated level of testosterone in the blood leading to acne and increased body hair growth, and altered ovarian morphology with multiple cysts. This thesis aims to find connections between the patients’ DNA and their clinical outcomes, highlighting the potential for individualised approach to patient care based on genetic understanding. Additionally, the focus is on the hereditary aspects of the already mentioned infertility causes. Studying the inheritance patterns of genetic causes could reduce the risk of passing fertility problems on to future generations. Finally, the research discusses new experimental techniques for patients with monogenic infertility causes and for PCOS patients. These promising techniques can be integrated into the ART cycle, increasing the number of successful ART cycles and helping more patients realise their dream of parenthood. However, these techniques require rigorous study and refinement to ensure their safety and efficacy. The research holds significant societal value for several reasons. First and foremost, it challenges the stigma surrounding infertility, particularly 'idiopathic infertility,' where the cause remains unknown. Many individuals and couples grappling with infertility are left with feelings of despair and confusion when their condition is labelled as 'unexplained.' By uncovering the genetic underpinnings of infertility, this research can provide answers, offering solace to those who have long been left in the dark. Furthermore, this knowledge enables the development of personalised treatment plans. When the cause is understood, medical professionals can tailor interventions to suit both the individual’s infertility problem and the known comorbidities associated with this cause. In an era of rapidly advancing reproductive technologies, understanding the inheritance patterns contributing to infertility is essential. These discoveries will enable us to decrease the risk of passing on fertility problems to future generations. In conclusion, this research opens doors to new possibilities, both in terms of understanding the causes of infertility and treatment options. It underscores the importance of continued research into experimental techniques, bringing hope to those longing for a child.

Promotor Björn Heindryckx
Opleiding Geneeskunde
Kernwoorden female infertility genotype-phenotype correlations inheritance treatment