Nicola Tempest

Nicola Tempest
University of Liverpool | UoL · Institute of Translational Medicine

Doctor of Medicine

About

85
Publications
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Introduction
I am currently working as an Academic Clinical Lecturer at the University of Liverpool/ Liverpool Women`s Hospital. I am interested in the endometrial epithelium, stem cells, the histoarchitecture of the endometrium and the endometrium in implantation. Ongoing research projects include, alternative treatments for chronic pelvic pain, exercise and reproduction, proteins involved in implantation, 3D reconstruction, repurposing of drugs for endometriosis and the progression of endometriosis.

Publications

Publications (85)
Article
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Background An increased body mass index (BMI) can lead to subfertility; however, current literature fails to exclude the effect of other confounding medical conditions, raising questions regarding the direct link between increased BMI and fertility outcomes. Objectives To conduct a systematic review and meta-analysis to elucidate the effects of in...
Preprint
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Background Variability in glucose levels during pregnancy can adversely affect foetal development. A strong positive relationship between physical activity (PA) and glucose variability has been observed in pregnancy, which could inform strategies to improve gestational glycaemia. However, no study has previously measured objective PA and glucose va...
Article
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Rates of infertility are rising, and informed decision making is an essential part of reproductive life planning with the knowledge that ART success decreases dramatically while a woman’s age increases and that high costs can often be incurred during fertility treatment. We aimed to determine the current knowledge of infertility and its treatments...
Article
Study question Do uterine fibroids produce vasoactive factors that could affect vasculature and induce fibroid associated symptoms? Summary answer Ex vivo secretions from uterine fibroids induce a vasodilatory response in rat mesenteric arteries that is mediated via the opioid receptor pathway. What is known already Uterine fibroids (leiomyoma) a...
Article
Study question How much do the general population know regarding the menstrual cycle and conception? Summary answer There is a lack of basic knowledge regarding key menstrual cycle and conception facts which could lead to missed reproductive opportunities. What is known already Although the human menstrual cycle is a “normal” biological process,...
Article
Study question Will the transcriptional profile of SSEA-1+ endometrial epithelial cells (EECs) explain their functional role, which can be explored in an in vitro endometrial organoid model? Summary answer SSEA-1+ EECs demonstrate differentially expressed genes (DEGs) and associated functional pathways expected from a basal stem/progenitor cell (S...
Article
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STUDY QUESTION Does endometrial compaction (EC) help predict pregnancy outcomes in those undergoing ART? SUMMARY ANSWER EC is associated with a significantly higher clinical pregnancy rate (CPR) and ongoing pregnancy rate (OPR), but this does not translate to live birth rate (LBR). WHAT IS KNOWN ALREADY EC describes the progesterone-induced decre...
Article
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A significant number of pregnancies are lost in the first trimester and 1–2% are ectopic pregnancies (EPs). Early pregnancy loss in general can cause significant morbidity with bleeding or infection, while EPs are the leading cause of maternal mortality in the first trimester. Symptoms of pregnancy loss and EP are very similar (including pain and b...
Article
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Embryo implantation is vital for successful conception but remains to be fully understood. Trophoblast invasion is key for implantation, with anchorage and depth of placentation determined by its extent. There is a dearth of synchronous information regarding IVF, implantation site, and trophoblastic thickness (TT). Our aim was to determine whether...
Article
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Many women report embarrassment as the cause for their avoidance of routine gynaecological screening appointments. Methods of self-collection of bio samples would perhaps encourage women to participate in routine screening programs. The vaginal microbiome plays a key role in women’s health and reproductive function. Microbial disturbances can resul...
Article
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Most aspects of in-vitro fertilisation (IVF) have changed dramatically since introduction, but embryo transfer (ET) technique remains largely unaltered. We aimed to determine whether four-dimensional ultrasound guided embryo transfers (4D UGET) could improve pregnancy rates when compared with clinical touch technique (CTT). This was a single centre...
Article
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Study question Are self-collected vaginal tampons, as a biospecimen collection tool, comparable to current gold-standard methods in their efficacy, safety and acceptability? Summary answer Tampon efficacy for detection of gynaecological abnormalities was comparable to that of gold-standard methods in addition to being widely accepted with minimal...
Article
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Background Second-stage caesarean sections, of which there are around 34,000 per year in the UK, have greater maternal and perinatal morbidity than those in the first stage. The fetal head is often deeply impacted in the maternal pelvis, and extraction can be difficult. Numerous techniques are reported, but the superiority of one over another is co...
Article
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Background: Preterm birth (PTB) is one of the main causes of neonatal deaths globally, with approximately 15 million infants are born preterm. Women from the Black, Asian, and Minority Ethnic (BAME) populations maybe at higher risk of PTB, therefore, the mental health impact on mothers experiencing a PTB is particularly important, within the BAME...
Article
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Optimisation of lifestyle factors such as smoking and alcohol are encouraged to improve fecundability rates in the fertility setting. Currently, routine fertility consultations do not involve counselling or imparting advice regarding habitual physical activity (PA) and/or structured exercise, despite data showing that vigorous PA can be associated...
Article
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Study question Are menstrual tampons an acceptable and comparable method to lower vaginal swabs (LVS) for analysing the vaginal microbiome in non-pregnant women? Summary answer Tampons capture a higher bacterial load, volunteers are familiar with them, thus are well-accepted, and can be efficiently frozen at -20 °C prior to analysis. What is know...
Article
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Study question Is the vaginal metabolome predictive of early pregnancy outcomes? Summary answer The vaginal metabolome is moderately predictive of live normally-sited pregnancies when compared to a pregnancy with an adverse outcome. What is known already Approximately 15% of all pregnancies are lost in the first trimester and a further 1-2% are e...
Article
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Recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL), collectively referred to as recurrent reproductive failure (RRF), are both challenging conditions with many unanswered questions relating to causes and management options. Both conditions are proposed to be related to an aberrant endometrial microenvironment, with different pr...
Preprint
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Background: Preterm birth (PTB) is one of the main causes of neonatal deaths globally, with approximately 15 million infants are born preterm. Therefore, the mental health (MH) impact experienced by mothers experiencing a PTB is important, especially within the Black, Asian and Minority Ethnic (BAME) populations. Aim The aims of the study were to...
Article
Objective (s): To understand current practice, expertise and training requirements for management of an impacted fetal head (IFH) at caesarean section (CS) in the UK, and whether a clinical trial of techniques to manage an IFH is acceptable. Study Design: Five hundred and thirty-eight online surveys were completed by obstetricians (n = 206), obstet...
Article
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Recurrent reproductive failure (RRF) encompasses recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL). These highly prevalent, distressing conditions have many unanswered questions regarding aetiology and management. Oestrogen-receptor beta (ERβ) is the predominant oestrogen-receptor expressed in vascular endothelium of endometri...
Article
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BACKGROUND Human endometrium remains a poorly understood tissue of the female reproductive tract. The superficial endometrial functionalis, the site of embryo implantation, is repeatedly shed with menstruation, and the stem cell-rich deeper basalis is postulated to be responsible for the regeneration of the functionalis. Two recent manuscripts have...
Article
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Endometriosis is a common, chronic inflammatory condition, thought to have a higher incidence in symptomatic women, yet, commonly associated symptoms do not always correlate with the presence or severity of disease and diagnosis requires surgery. We prospectively collected data and assessed symptomology and NMR spectroscopy-based metabolomics of 10...
Article
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Study question Which metabolites are associated with a viable intrauterine pregnancy (VIUP) when compared to other early pregnancy outcomes (failed intrauterine and ectopic pregnancies)? Summary answer Serum levels of four metabolites (phenylalanine, alanine, glutamate and glutamine) were significantly altered in VIUPs compared to other early preg...
Article
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Study question Do women with recurrent pregnancy loss (RPL) have an aberrant expression of oestrogen receptor-β(ERβ) and cell-fate markers during the window of implantation (WOI) endometrium? Summary answer Women with RPL are found to have significantly altered levels of ER βand Ki–67 in the WOI endometrium, possibly resulting in anti-proliferativ...
Article
Study question Does the use of 4D ultrasound to guide embryo transfers improve live birth rates in comparison to the clinical touch technique? Summary answer 4D ultrasound guided embryo transfers (4DUS) result in significantly higher live birth rates (LBR) in comparison to those performed using the clinical touch technique (CTT)(41%vs28%). What i...
Article
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Study question Do women with recurrent pregnancy loss (RPL) have an aberrant expression of oestrogen receptor-β (ERβ) and cell-fate markers during the window of implantation (WOI) endometrium? Summary answer Women with RPL are found to have significantly altered levels of ERβ and Ki-67 in the WOI endometrium, possibly resulting in anti-proliferati...
Article
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Study question Are women who report a previous surgical diagnosis of endometriosis more likely to have a diagnosis or symptoms suggestive of restless leg syndrome (RLS)? Summary answer: Women who reported a prior surgical diagnosis of endometriosis, have a significantly higher prevalence of prior formal diagnosis of RLS or symptoms suggestive of RL...
Article
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Background Symptoms associated with menstruation and endometriosis are common amongst women of reproductive ages and the pathogenesis of these illnesses is postulated to be associated with aberrations in endometrial regeneration, immune response and in endometrial stem cell function. Highly active antiretroviral therapy (HAART) has been shown to en...
Article
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Background Gestational diabetes mellitus (GDM) is a common complication of pregnancy and is associated with an increased risk of mental health (MH) disorders including antenatal and postnatal depression (PND), anxiety and post-traumatic-stress-disorder (PTSD). We hypothesized GDM and MH disorders will disproportionately affect individuals from Blac...
Article
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Embryo transfer (ET) is one of the vital steps in the in vitro fertilisation (IVF) process, yet there is wide variation in ET technique throughout the UK, without a nationally approved standardised approach. The aim of this study was to gain contemporaneous information regarding the current clinical ET practice in the UK. Method: A 38-question el...
Conference Paper
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Design A scoping systematic review with a systematic methodology was used. Method A systematic methodology was developed using a number of key variables. These were used to develop MeSH terms of mental health (MH), BAME, pre-eclampsia and pre-eclampsia in ethnic minorities. The snow-ball method was used with each of the MeSH terms developed. These...
Conference Paper
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Objectives To identify the prevalence of the mental health (MH) sequelae of stillbirth in women amongst Black, Asian and Minority Ethnic (BAME) groups. Design A scoping systematic review was designed with a systematic methodology. This review is part of a wider systematic review and meta-analysis with a protocol published on PROSPERO2020 CRD420202...
Conference Paper
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Objective Determine the prevalence of mental health (MH) sequelae and gestational diabetes mellitus (GDM) amongst Black, Asian and Minority Ethnic (BAME). Design A systematic review protocol was developed and published on PROSPERO (CRD42020210863) as part of the evidence synthesis phase of the multimorbid ELEMI Project. Studies were identified thro...
Article
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To evaluate and holistically treat the mental health sequelae and potential psychiatric comorbidities associated with obstetric and gynaecological conditions, it is important to optimize patient care, ensure efficient use of limited resources and improve health-economic models. Artificial intelligence applications could assist in achieving the abov...
Article
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Recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL) are distressing conditions without effective treatments. The luminal epithelium (LE) is integral in determining receptivity of the endometrium, whereas functionalis glands and stroma aid in nurturing early embryo development. Calcium signalling pathways are known to be of vital...
Article
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Background Endometriosis and restless leg syndrome (RLS) are both chronic conditions that can negatively affect a woman’s quality of life. A higher prevalence of RLS is seen in women and particularly in those who are pregnant, suggesting a possible ovarian hormonal influence. Endometriosis is a common (affecting 1 in 10 women) estrogen driven gynec...
Article
(Abstracted from Acta Obstet Gynecol Scand 2020;99:537–545) A fetus in the occiput posterior (OP) or occiput transverse (OT) position at delivery increases the risk for cesarean delivery up to 6-fold and instrumental delivery by up to 4-fold. Although there are a number of methods to assist with the delivery of the fetus in these malpositions, limi...
Article
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Chronic pelvic pain (CPP) is one of the most common chronic pain problems experienced by women, with prevalence rates comparable to asthma and back pain. However, it is poorly understood and causative pathology is only seldom found. We aimed to establish prevalence of abnormal findings at diagnostic laparoscopy in young women with CPP after normal...
Article
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Endometriosis is a common, oestrogen driven chronic condition, where endometrium-like epithelial and stromal cells exist in ectopic sites. At present, no curative treatments are available and the existing evidence for disease progression is conflicting. The pathogenesis is still unknown and evidently complex, as mechanisms of initiation may depend...
Article
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Regular menstrual‐shedding and repair of the endometrial functionalis is unique to humans and higher‐order primates. The current consensus postulates endometrial glands to have a single‐tubular architecture, where multi‐potential stem cells reside in the blind‐ending glandular‐bases. Utilising fixed samples from patients, we have studied the three‐...
Article
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The human uterus consists of the inner endometrium, the myometrium, and the outer serosa. Knowledge of the function of the uterus in health and disease is relevant to reproduction, fertility, embryology, gynaecology, endocrinology, and oncology. Research performed on uterine biopsies is essential to further the current understanding of human uterin...
Chapter
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The human endometrium is the main target organ for the ovarian steroidal hormones. The pivotal role of sex hormones in the development, growth and maintenance of the normal physiological endometrium is well established. Aberrations in the endometrial hormonal milieu due to endogenous or exogenous factors influence endometrial carcinogenesis and can...
Article
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Introduction: Malposition complicates 2-13% of births at delivery leading to increased obstetric interventions (cesarean section and instrumental delivery) and higher rates of adverse fetal and maternal outcomes. Limited data are available regarding the likely rates of obstetric intervention and subsequent neonatal and maternal outcomes of births...
Conference Paper
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Abstract Introduction: The human endometrium has a remarkable capacity to regenerate the superficial functionalis and is organised into functionally distinct layers, which are known to respond differently to the same ovarian hormones. Endometrial epithelial cells (EEC’s) are the defining cell type of the endometrium, and we have previously shown th...
Article
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The human endometrium is a highly regenerative organ undergoing over 400 cycles of shedding and regeneration over a woman’s lifetime. Menstrual shedding and the subsequent repair of the functional layer of the endometrium is a process unique to humans and higher-order primates. This massive regenerative capacity is thought to have a stem cell basis...
Article
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Study question: Is human endometrial leucine-rich repeat-containing G-protein-coupled receptor 5 (LGR5) gene expression limited to the postulated epithelial stem cell niche, stratum basalis glands, and is it hormonally regulated? Summary answer: LGR5 expressing cells are not limited to the postulated stem cell niche but LGR5 expression is hormon...
Conference Paper
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INTRODUCTION: Persistent malposition is associated with a longer 2nd stage of labour, postpartum haemorrhage, 3rd and 4th degree perineal lacerations, and increased neonatal morbidity compared with correcting the malposition and delivery in occiput anterior (OA) position. Determining the likely success rate at the initial assessment of a malpositio...
Conference Paper
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INTRODUCTION: Obstetricians with skills in rotational operative vaginal deliveries reduce the need for emergency caesarean sections in the 2nd stage of labour (pEMCS). The current UK training core curriculum only assesses competence in rotational ventouse (RV). A recent national survey recognised management of fetal malposition as a training priori...
Conference Paper
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Introduction Fetal head malposition in the second stage of labour is a significant risk factor for adverse maternal and neonatal outcomes. Rotational vaginal delivery is one of the most skilled, high risk obstetric procedures. Cochrane recently concluded no evidence from randomised trials to guide decision making to attempt instrumental delivery ve...
Article
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Objective To evaluate the neonatal and maternal outcomes associated with successful operative vaginal births assisted by manual rotation. Design Prospective and retrospective observational study. Setting Delivery suite in a tertiary referral teaching hospital in England. Population A cohort of 2,426 consecutive operative births, in the second st...
Article
Despite HIFU being a fertility sparing, outpatient procedure reported to be safe and effective in treating patients with fibroids for 15 years (Wang et al. Zhonghua Chao Sheng Ying Xiang Xue Za Zhi 2002; 11:161-63); approved by the FDA in America in 2004; and seen to have similar cost-effectiveness as all other uterine preserving treatments; it is...
Article
Endometrial cancer (EC) is the commonest gynaecological cancer in the Western World with an alarmingly increasing incidence related to longevity and obesity. Ovarian hormones regulate normal human endometrial cell proliferation, regeneration and function therefore are implicated in endometrial carcinogenesis directly or via influencing other hormon...
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STUDY QUESTION How does regulation of telomerase activity (TA) in human endometrial epithelial cells (EEC) by ovarian hormones impact on telomere lengths (TL) and cell proliferation?
Article
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Key content Second stage caesarean section ( CS ) is associated with greater maternal and neonatal morbidity and second stage CS rates are rising. Malposition of the fetal head is the most common indication for CS in the second stage of labour. Rotational vaginal deliveries are high risk obstetric procedures requiring advanced operator expertise an...
Article
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This article reviews recent significant contributions to the literature concerning advanced operative obstetric procedures used for rotational vaginal deliveries and their alternative, primary caesarean section. Rising caesarean section rates are a global concern. Caesarean section in the second stage of labour is associated with high rates of mate...
Article
Objective To compare the outcomes of operative cephalic births by Kielland forceps (KF), rotational ventouse (RV), or primary emergency caesarean section (pEMCS) for malposition in the second stage of labour in modern practise. Design Retrospective observational study. Population Data were included from 1291 consecutive full-term, singleton cephali...
Article
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Endometriosis is a common, chronic inflammatory disease defined by the presence of extrauterine endometrial tissue. The aetiology of endometriosis is complex and multifactorial, where several not fully confirmed theories describe its pathogenesis. This review examines existing theories on the initiation and propagation of different types of endomet...
Article
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Can the basal epithelial compartment of the human endometrium be defined by specific markers? Human endometrial epithelial cells from the basalis express nuclear SOX9 and the cell-surface marker SSEA-1, with some cells expressing nuclear β-catenin. In vitro, primary endometrial epithelial cells enriched for SSEA-1+ show some features expected of th...