Journal of Reproduction & Infertility
Year:2016 | Volume:17 | Issue:3|Papers Count:10

Human is usually sub-fertile in comparison to other mammals; in other words, reproduction process of other mammals is more effective than human. Chromosomal anomalies of early embryos are the major reason for the low fecundity of human per cycle. Most of embryos with major genetic defects may be implanted and it can be followed with stopping of early development and early embryo loss with no tangible evidence of pregnancy. In addition, several studies have shown that more than 70% of embryos from assisted reproductive technologies have genetic anomalies. These anomalies lead to implantation failure or early embryo loss following implantation in IVF cycles (1).According to the above evidence onin vitro produced embryos, different methods such as PGD and PGS were developed for choosing the best embryos without genetic defects. These methods are based on molecular techniques of Q-PCR, FISH, CGH and SNP microarray, NGS and many other advanced technologies. While several studies approved the efficiency of these techniques, they have different problems that put their effectiveness in doubt over time. For example, the FISH method on blastomers of day three embryos was the choice in the two past decades, but recent evidence revealed that it failed to provide reliable result of PGS on cleavage embryos.Therefore, it has been replaced by the newer techniques such as CGH microarray and SNP microarray over time. However, though the newer techniques have higher degree of accuracy, they always have their own limitations and deficiencies as well (2).Alternatively, the poor results of PDG and PGS on day three embryos lead to performing the embryo biopsy on blastocyst on day five after fertilization. Although the quantity and quality of biopsied cells are better than day three embryos, this area already raised issues such as suspicion about its limitations and deficiencies like epigenetic changes due to prolongedin vitro culture, self-correction potency for chromosomal anomalies of early embryo, different origins of biopsied cells from trophoectoderm against ICM and several other limitations.Furthermore, today in the scientific community and the media, application of the expensive technique of next generation of sequencing (NGS) is recommended for genetic screening of IVF embryos. Preliminary data using this technology reported the increase of ART outcomes up to %70-80. Based on these results, this technique may have high accuracy and reliability. However, its wide application in large portion of infertile couples, especially those with repeated IVF failure (RIF), repeated pregnancy loss (RPL) and the patients older than 40 years requires further investigation (3). Currently, application of this technique will impose huge cost on couples and if its accuracy and precision is in doubt, it may lead to loss of a large number of embryos that have the potential of implantation and live birth. In addition, the interpretation of the large volume of data from NGS is not very simple. Many of these findings may indicate normal variations or corrective potential of embryos may ameliorate most of them. So, as long as validation of the effectiveness of this technique or innovation of newer techniques with maximum sensitivity and specificity is required, care should be taken in prescribing these techniques to infertile couples.

Background: Using cellular phone has rapidly increased all over the world. Also, the concern on the possible health hazards of electromagnetic fields (EMF) induced from cell phones to reproduction has been growing in many countries. The aim of this study was to assess the consequences and effects of exposure to the cell phone radiation on the quality and survival rates of preimplantation embryos in mice. Methods: A total of 40 mice (20 females and 20 males), 6 weeks old and sexually mature BALB/c, were used for control and experimental groups. The ovary burses were removed and the zygotes were dissected in the morning after mating. Next, 2-cell embryos were divided into two groups of control (n=150) and experimental (n=150). EMF (900-1800 MHz) was used for four days in experimental group for 30 min/day in culture at 37oC in a CO2 incubator. The quality of embryos was recorded daily and the fluorescent staining was used for identification of viable blastocysts. All data were compared by Student’s t-test and Mann-Whitney test (p<0.05).Results: The rate of embryo survival to the blastocysts stage was similar in both groups. However, the percentage of dead embryos at the 2-cell stage was significantly higher in EMF-exposed group compared with controls (p=0.03). Also, the loss of cell viability significantly increased in experimental blastocysts (p=0.002).Conclusion: The normal embryonic development up to the blastocyst stage indicates that EMF-exposure commonly did not have adverse effect on embryo development in mice. But, it caused loss of blastocysts cell viability.

Background: Ammonium is produced in culture medium due to amino acids degradation and has adverse effect on in vitro culture of embryo. In the current study, the purpose was to evaluate the effects of ammuniom chloride (AC) on in vitro oocyte maturation rate and early embryo development in the sheep and its effect on the expression of Bcl-2.Methods: In vitro maturation (IVM) was performed in the presence of various concentrations (0, 29, 88,132,176 M/ml) of ammonium chloride (NH4CL) (AC). Meiotic maturation, embryonic development and expression of Bcl2 gene in Blastocyst cells were determined. The data were analyzed by one-way ANOVA and Tukey post HOC test, and values with p<0.05 were considered statistically significant.Results: The highest concentration (176 mM) of AC significantly decreased the rate of fully expanded cumulus cells 24 hr after IVM compared with the control group (p<0.05). Moreover, significantly lower rates of MII oocytes were found in the 176 mM AC group compared with the 29 mM AC group. The percentage of zygotes developing to blastocysts in 176 mM AC was lower than the other group. Also, supplementation of the oocyte maturation media with 176 mM AC decreased Bcl2 expression. Conclusion: Our results suggested that significant increase in IVM rate could be obtained with supplementation maturation medium with AC in a dose dependent manner. Increased AC concentration led to lower blastocyst rate under normal condition. However, regulation of pro-apoptotic (Bcl-2) gene did not change with different concentrations of AC supplementing.

Background: Survival of the semi-allograft fetus during pregnancy opens a new area for the immunological based causes of recurrent spontaneous abortion (RSA). Cytotoxic T lymphocyte-associated antigen 4 (CTLA4) is a negative regulator of the T-cell activation, which may modulate peripheral self-tolerance of the allogeneic fetus.The present study aimed to investigate the+49 A/GCTLA4 genetic polymorphism and predisposition to RSA.Methods: The total participants were 120 women with at least two miscarriages and 120 healthy post-menopausal women as the control group. The+49 A/G polymorphism was genotyped using PCR-RFLP method. Required demographic information was collected through filling out a questionnaire. The obtained data were fed into SPSS software version 16.Results: The results showed a significant association between the minor alleles (G) with the decreased risk of the RSA. The frequency of the G allele in controls and patients was 25% and 12%, respectively. A GG genotype in the co-dominance model (OR: 0.25, 95%CI: 0.09-0.66) and in the dominant model for allele G (GG+AGvs.AA) (OR: 0.84, 95%CI: 0.8-0.87) showed significant association with RSA by imposing the protective role. The frequency of miscarriage is significantly (p=0.04) higher among the relatives of RSA women (33.3%) in comparison with the women in the control group (21.7%).Conclusion: It can be concluded that+49G allele may act as a dominant allele and reduce the risk of RSA. Family history of miscarriage increased the risk of RSA among women.

Background: Oxidative stress affects women fertility and influences on the sperm quality by alterating activities of cholinesterases, a molecular marker of stressrelated infertility. The aim of the present study was to investigate the role of acetylcholinesterase (AChE), butyrylcholinesterase (BuChE) activities and phenotypes in patients with unexplained infertility (idiopathic). It’s possible association with inflammation marker C-reactive protein (CRP) and other oxidative stress markers, i.e.before and after intra uterine insemination (IUI).Methods: In this study, blood samples of 60 patients with unexplained infertility were collected the day before and 24hr after IUI (between 8 AM and 9 AM after the overnight fasting) and activities of BuChE, AChE, catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GpX) and serum levels of thiol proteins (TP), C-reactive protein (CRP), total antioxidant capacity (TAC) were measured.Statistical significance was assumed at p<0.05.Results: Before IUI, there was a significant (p=0.048) positive correlation between BuChE activity and plasma TAC and a significant difference in the CAT activity between various BuChE (UU and non-UU) phenotypes. However, after IUI, a significant negative correlation between the AChE activity and BuChE activity was found (p=0.045) and the level of RBC AChE activity was significantly reduced (382.4±163.19vs.586.7±384 IU/grHb, p=0.025). Meanwhile, after IUI, the activities of SOD (1568±847.5IU/grHb vs.1126±229.3, p=0.031) and CAT (310±53.4 IU/grHb vs.338±73, p=0.025) were increased.Conclusion: This study suggests that decline in cholinesterases activities may be responsible for stimulation of oxidative stress and inflammation and reduction in fertility rates by IUI.

Background: Microdose flare-up GnRH agonist and GnRH antagonist have become more popular in the management of poor ovarian responders (POR) in recent years; however, the optimal protocol for POR patients undergoingin vitro fertilization has still been a challenge.Methods: In this observational study design, two hundred forty four poor ovarian responders were retrospectively evaluated for their response to GnRH agonist protocol (group-1, n=135) or GnRH antagonist protocol (group-2, n=109). Clinical pregnancy rate was the primary end point and was compared between the groups. Student t-test, Mann Whitney U test andc2-test were used to compare the groups. The p<0.05 was considered to show a statistically significant result.Results: The mean total gonadotropin doses were 3814±891 IU in group 1 and 3539±877IU in group 2 (p=0.02). The number of metaphase-II oocytes (3.6±2.4 vs. 2.8±1.9, p=0.005) and implantation rates (27.8%vs.18.8%, p=0.04) in group 1 and group 2, respectively were significantly different. The fertilization rate in group 1 and group 2 was 73%vs.68%, respectively (p=0.5) and clinical pregnancy rate was 19.8%vs.14.4%, respectively (p=0.13).Conclusion: The GnRH agonist microdose flare-up protocol has favorable outcomes with respect to the number of oocytes retrieved and implantation rate; nevertheless, the clinical pregnancy rate was found to be similar in comparison to GnRH antagonist protocol in poor ovarian responders. GnRH antagonist protocol appears to be promising with significantly lower gonadotropin requirement and lower treatment cost in poor ovarian responders.

Background: The "Sex-Reassignment Surgery" is a solution that besides behavioral therapy has been suggested to people suffering from gender identity disorders in recent years. In Iran, this trend has become more popular over the past years due to the inclination to reach to the goal rapidly with less effort and also the surgery has attracted many patients with the problem. Religious clerics have tried to determine the religious doctrines for this practice and as a result a group of them favor an absolute permission while others choose prohibition and some of them favor a middle path.The aim of this study was to determine the religious doctrines for Sex-Reassignment and legitimate treatment for GID.Methods: The research method was a library research based on which an investigation was done by analyzing the relevant books, articles and dissertations. Primary documents of Islamic sources (Quran and tradition) along with scientific, medical and psychological materials were used in this research.Results: In this study, the survey shows that none of the reasons have the power to deliver a definitive and religious ruling on this issue because the validity of its reasons is related to the reality of "Sex-Reassignment".Conclusion: The results demonstrate that Sex-Reassignment is prohibited and it is not authorized. In case of urgency for doing the surgery, the gender of the person should not be changed.

Background: The aim of the study was to assess the effect of four repeated ejaculations on the same day at two-hour intervals on conventional and functional semen parameters.Methods: Three healthy men (32±3.6 years) donated the first semen samples after 3-4 days of sexual abstinence followed by three subsequent samples on the same day at two-hour interval each. Semen samples were processed and analyzed according to the World Health Organization (WHO) 2010 guidelines. Furthermore, intracellular reactive oxygen (ROS) production, sperm DNA fragmentation and mitochondrial function were evaluated by flow cytometry.Results: An overall decreasing trend was noted in the conventional semen parameters at second, third and fourth evaluations after two hours of abstinence in comparison to first evaluation after 3-4 days of abstinence. The statistical comparison of the conventional semen parameters at fourth evaluation after 2hr of abstinence revealed significant reduction (p<0.05) in the parameters of concentration, total sperm count and total motile sperm count at fourth evaluation. The functional parameter of intracellular ROS production showed a decreasing trend with each subsequent evaluation, the difference being significant (p<0.05) at fourth evaluation in comparison to first evaluation. An increasing trend was noted for DNA fragmentation index (DFI), although it remained within acceptable levels (<29%). The Dym high spermatozoa and the integrity of the plasma membrane remained stable throughout the evaluations.Conclusion: The findings of the present study indicate the potential use of additional semen samples with repeated ejaculations at short abstinence times in assisted reproduction procedures particularly from severe oligospermic men.

Background: Robertsonian translocations are structural chromosomal abnormalities caused by fusion of two acrocentric chromosomes. In carriers of such translocations, different modes of segregations would result in the formation of either balanced (alternate segregation mode) or unbalanced (adjacent 1, adjacent 2, and 3: 1 segregationmodes) gametes. In addition, there is an increased risk for imprinting disorders in their offspring. Although it has been estimated that 1/1000 healthy persons carry a Robertsonian translocation, homozygosity for this type of structural chromosomal abnormality has been reported rarely. Most of reported cases are phenotypically normal but experience adverse pregnancy outcomes.Case Presentation: In this paper, a report was made on a normal female with a history of 4 consecutive first trimester fetal losses and a normal son referred to Center for Comprehensive Genetics Services, Tehran, Iran, in summer 2015. Cytogenetic analyses of proband and her infant showed 44, XX, der (13; 14) (q10; q10) x2 and 45, XY, der (13; 14) (q10; q10), respectively. Parents of proband have been shown to have 45, XY, der (13q; 14q) and 45, XX, der (13q; 14q) karyotypes, respectively.Conclusion: The present report was in agreement with the few reports of homozygosity for Robertsonian translocation which demonstrated normal phenotypes for such persons and possibility of giving birth to phenotypically normal heterozygote carriers of Robertsonian translocations.

Background: McCune Albright syndrome is rare with an estimated prevalence of 1 in 100, 000 to 1 in 1, 000, 000 persons. The classical clinical triad consists of fibrous dysplasia of the bone, café-au-lait skin spots and precocious puberty. However, in rare cases, there may be primary hypogonadism and amenorrhea.Case Presentation: An eighteen-year-old female presented with amenorrhea. She had a short stature, round face, thick neck, and short fourth metacarpals and metatarsals.The secondary sexual characters were absent. Serum calcium, phosphorus and parathyroid concentrations were normal, but gonadotropin hormones were very low. Xray examination revealed short fourth and fifth metacarpals, short left metatarsal, and short fibula.Conclusion: These local bony abnormalities along with the biochemical findings helped us to diagnose this case as an unusual presentation of primary hypogonadism with features of McCune Albright’s syndrome where there was amenorrhea rather than preocious puberty.