Adrenergic and Cholinergic Uterine Innervation and the Impact on Reproduction in Aged Women

Abstract

: In recent years, the development of Assisted Reproductive Technique, the egg and embryo donation changed substantially the role of the uterus in recent years. It provided a higher chance for a pregnancy even in women over 45 years or post-menopause. In fact, the number of aged patients and in peri/post-menopause in pregnancy is nowadays increasing, but it increases obstetrical and neonatal related problems. The human uterus is richly innervated and modified especially during pregnancy and labor, and it is endowed with different sensory, parasympathetic, sympathetic and peptidergic neurofibers. They are differently distributed in uterine fundus, body and cervix, and they are mainly observed in the stroma and around arterial vessel walls in the myometrial and endometrial layers. Many neurotransmitters playing important roles in reproductive physiology are released after stimulation by adrenergic or cholinergic nerve fibers (the so called sympathetic/parasympathetic co-transmission). Immunohistochemical study demonstrated the localization and quantitative distribution of neurofibers in the fundus, the body and cervix of young women of childbearing age. : Adrenergic and cholinergic effects of the autonomous nervous system are the most implicated in the uterine functionality. In such aged women, the Adrenergic and AChE neurofibers distribution in the fundus, body and cervix is progressively reduced by increasing age. Adrenergic and AChE neurotransmitters were closely associated with the uterine arteries and myometrial smooth muscles, and they reduced markedly by ageing. The Adrenergic and AChE neurofibers decreasing has a dramatical and negative impact on uterine physiology, as the reduction of pregnancy chance and uterine growth, and the increase of abortion risk and prematurity.

The impact of cervical conization size with subsequent cervical length changes on preterm birth rates in asymptomatic singleton pregnancies

“…It seems that a combination of several factors such as larger CCS and shortened USCL at 16–18 weeks of gestation depending on prior parity history (nulliparous or parous) plays a crucial role in PTB rate in asymptomatic women with singleton pregnancies. This CCS impact on PTB rates might be related to a high concentration of neuropeptides, neurotransmitters, oxytocin, and other physiologically active substances in the cervical tissue and lower uterine segment rather than to that in tissues in the upper part of the uterus 63 , 64 . By its modification, the cervix plays an important role during pregnancy and delivery as does the part of the uterine body forming the lower uterine segment 65 , 66 .…”

Laparoscopic Intracapsular Myomectomy in Women 40 Years Old and Over with Symptomatic Uterine Fibroids. A Pilot Study

“…25 Moreover, there are significant ethical considerations and maternal and fetal complications related to pregnancy in women of advanced age, this risk can be mitigated by ensuring optimal preconceptional health status. 26 Some women of advanced age who, in the past, underwent ART with their own oocytes are now able to undergo a heterologous fertilization with oocytes of younger donors. Wang et al 23 recently affirmed that no cavitydistorting intramural fibroids would significantly reduce implantation rate, clinical pregnancy rate, and live birth rate and significantly increase the miscarriage rate after IVF treatment, but it would not significantly increase the ectopic pregnancy rate.…”

“…The use of ARTs, such as oocyte donation, is a valuable therapy for women of advanced maternal age and in such cases, the woman can carry a pregnancy with an almost similar risk profile to that of her younger counterparts. 26 The impact of myomectomy in symptomatic women over the age of 40 years who desire to conceive is poorly investigated in literature. Obed et al 27 performed 98 abdominal myomectomies in women aged 40 years and above, the mean age of the patients was 42.6 AE 2.9 years and 77 (78.6%) of them were nulliparous.…”

Dystocic Labor and Adrenergic and Noradrenergic Neurotransmitters: A Morphological Experimental Study

“…These components play an important role in smooth myocytes’ contractions, more present during labor [ 4 ]. The uterus is particularly rich in both adrenergic and cholinergic fibers and these neurotransmitters are involved in the functioning of these microscopic structures as uterine myocytes [ 5 ]. Moreover, adrenergic functions of the sympathetic system, mediated by Adrenaline (A) and Noradrenaline (N), are involved in the uterus functionality during labor.…”