Journal of Reproduction & Infertility
Year:2017 | Volume:18 | Issue:4|Papers Count:9

The introduction of vitrification method for cryopreservation of gametes/embryo in assissted reproductive technology (ART) increased the efficacy of freez-thawing method esspecislly its post-thawing survival rate. This efficient method provides an excellent solution to postpone embryo transfer in natural cycles with adequate number and timing for main challenges of ART such as polycystic ovarian syndrome (PCOS), preimplantation genetics diagnosis/screening (PGD/PGS), advanced female age, low responders, repeated implantation failure (RIF), multiple pregnancy, third-party reproduction, etc (1).

Background: The objective of this study was determination of the changes in the reactive oxygen species (ROS) level, mitochondrial DNA (mtDNA) copy number and enzyme activity and transcription factor A (TFAM) gene expression in oocytes after vitrification.Methods: The oocytes at metaphase II (MII) stage (n=320) were collected from superovulated adult female mice (n=40). These oocytes were divided into vitrified and non-vitrified groups (n=160 in each group). After vitrification of oocytes, ROS level, mtDNA copy number; TFAM gene expression and mitochondrial enzymes activity (cytochrome C oxidase and succinate dehydrogenase) were assessed and compared with non-vitrified group. Visualization of the mitochondria was done using Mitotracker green staining under confocal microscope. Data were compared by independent T-test. Values of p<0.05 were considered as statistically significant.Results: The survival rate of oocytes after vitrification and warming was 96.05%.The intensity of cytochrome C oxidase activity, mtDNA copy number and TFAM gene expression in non-vitrified oocytes were significantly lower and the level of ROS was higher in vitrified oocytes in comparison with non-vitrified group (p<0.05). But the intensity of succinate dehydrogenase activity was not significantly different between the two groups. The pattern of mitochondrial distribution in two groups of study was similar but the intensity of Mitotracker green in non-vitrified oocytes was significantly higher than vitrified oocytes (p<0.05).Conclusion: This study showed that vitrification of mouse MII oocytes reduced the mtDNA copy number and mitochondrial cytochrome C oxidase activity by increasing ROS level, thus the subsequent embryo development may be affected.

Background: Having low-grade chronic inflammation such as elevated C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-a (TNF-a) plays a crucial role in polycystic ovary syndrome (PCOS). This study aimed at investigating the therapeutic effects of curcumin on IL-6, CRP and TNF-a and symptoms of polycystic ovary syndrome.Methods: In this research, 72 female adult Wistar rats were divided into control (n=12), PCOS (n=12) and curcumin-treated PCOS groups (n=48). PCOS was induced by injection of estradiol valerate (2mg/kg - one-step). PCOS rats were divided into control and experimental groups which received daily intraperitoneal injection of curcumin. After 60 days of syndrome induction, ovaries were collected for histological and immunohistochemical evaluations. Serum IL-6 and CRP was detected by the ELISA kit. Data were analyzed using In-Stat 3 via one-way analysis of variance (ANOVA) and p<0.05 was considered statistically significant.Results: Histological studies showed a significant reduction in thickness of theca layer and increase in the number of corpus luteum (CL) diameter in the curcumintreated group compared with the PCOS group; also inflammatory markers such as IL-6 and CRP significantly decreased in groups treated with curcumin compared with PCOS groups. Regarding immunohistochemical analysis, the expression of TNF-a in granulosa layer and follicular fluid of follicles and ovarian cysts in PCOS group was more than the control group's expression. However, expression of this factor in the ovaries treated with curcumin was decreased.Conclusion: This study showed that the anti-inflammatory and antioxidant effects of curcumin on PCOS may be due to its inhibitory effect on expression and levels of TNF-a, serum IL-6 and CRP.

Background: The purpose of this study was to evaluate the ability of poor ovarian response criteria to classify women presenting with infertility and oligomenorrhea as having "occult" premature ovarian insufficiency.Methods: This was a cross sectional study conducted at Aziz Medical Center, Karachi, Pakistan from 1st August 2015 to 31st July 2016. Women with infertility and oligomenorrhea were included. All eligible women underwent day 2 FSH level and an early follicular phase transvaginal ultrasound to assess the antral follicular count (AFC). All women then underwent the confirmatory test, of Anti- Mullerian Hormone (AMH) level. The main outcome measure was assignment to occult premature ovarian insufficiency (POI) after screening that used the criteria set out in fertility guideline for predicting the likely ovarian response to gonadotrophin stimulation. Another measure was to compare the sensitivity and specificity of the two index criteria, of FSH and AFC, relative to the emerging reference standard, of the AMH criterion.Results: The three criteria together classified 59 (34.91%) women as occult POI in those with oligomenorrhea. The sensitivity, specificity, negative predictive value and positive predictive value of FSH relative to AMH for these women were 77.8%, 95.7%, 90.2% and 89.4%, respectively whereas the same values of AFC relative to AMH were 92.6%, 99.1 %, 96.6% and 98%, respectively.Conclusion: Women with menstrual irregularity and infertility are at a higher risk for satisfying criteria of poor ovarian response irrespective of age. A policy incorporating these surrogate markers can be used to screen these women for occult premature ovarian insufficiency.

Background: Many adjuvant therapies are employed during IVF treatment in an attempt to improve outcomes. The objective of our study was to evaluate the impact of thirteen adjuvants (Intralipid, steroids, melatonin, coenzyme Q10, Filgrastim, testosterone, DHEA, growth hormone, antibiotics, hCG infusion, aspirin, enoxaparin/heparin and dopamine agonists) on the success of embryo transfers.Methods: This is a retrospective cohort study of all embryo transfers between January 2010 and April 2015 from a multi-site IVF clinic. To ensure data independence, random number was applied to each included transfer and used to pick an individual transfer for each patient (n=13, 372). Outcomes were clinical pregnancy, live birth and pregnancy loss. Univariate comparison with Chi square testing and logistic regression analysis were used. The level of significance was p<0.05.Results: Steroid use was significantly associated with both reduced clinical pregnancy loss (aOR 0.39, CI 0.19-0.76) and improved live birth rates (aOR 1.40, CI 1.11-1.77). While aspirin was associated with improved live birth rates (aOR 1.48, CI 1.08-2.02), melatonin was linked with reduced rates (aOR 0.66, CI 0.45-0.96).Analyses for all other adjuvant therapies did not reach statistical significance after logistic regression.Conclusion: Many of the interventions investigated in this study fail to significantly demonstrate any effects on the success of embryo transfers. Our analysis results show negative effects with the use of melatonin; however, use of aspirin or steroids demonstrated promising, potentially beneficial outcomes. Additional exploration is needed to guide evidence-based practice.

Background: Endometrium undergoes several changes in structure and cellular composition during pregnancy. Granulocyte Colony-stimulating Factor(GCS-F) is an important cytokine with critical role in embryo implantation and pregnancy. The aim of the present study was to evaluate the impact of intrauterine injection of G-CSF in patients who suffer from unexplained recurrent miscarriage (RM).Methods: In the present randomized clinical trial, a total of 68 patients were randomly allocated into two study groups including intrauterine G-CSF (n=23, 300mg) injection and control group (n=27, no G-CSF injection). Eighteen out of 68 patients were excluded from the final analysis due to different reasons. All patients were in Ovulation Induction (I/O) cycle. In G-CSF group, intrauterine injection of G-CSF was done twice in the cycle. All enrolled patients were under 40 years old and had at least two unexplained pregnancy losses. Pregnancy was evaluated by titer of bhCG, presence of gestational sac (implantation) and fetal heart rate (clinical pregnancy) was assessed by vaginal ultrasonography. Student’s T test and Mann-Whitney U were used for analysis. The p≤0.05 was determined as statistically significant.Results: No significant differences were observed between the two study groups when the rates of chemical pregnancy (26.1%vs.29.6%, p=0.781), implantation (26.1%vs.22.2%, p=0.750), clinical pregnancy (17.4% vs.11.1%, p=0.689) and abortion (33%vs.37.5%, p=0.296) were compared.Conclusion: In our study, no significant difference was observed between the two study groups when the rates of chemical pregnancy, implantation, clinical pregnancy and abortion were compared.

Background: Infertility as one of most concerning topics in childbearing age mothers needs better managements with less complications and IVF can be assumed as an efficient method. This study aimed to compare pregnancy outcomes in fresh and frozen embryos transferred in IVF cycles.Methods: In a retrospective study, 11201 patients underwent IVF cycles from 21st March 2013 to 20th March 2014 and they were categorized into two groups according to age, previous tubal disease and surgery, tubal ligation, and previous ectopic pregnancy variables. Clinical pregnancy, ectopic pregnancy, multiple pregnancy, spontaneous abortion and preterm labor rates were compared in both groups.Results: 11201 patients were categorized in two groups. Results of 4149 frozenthawed embryo transfer cycles showed 1281 clinical pregnancies (30.9%) and 7052 fresh embryo transfer cycles which led to 2085 clinical pregnancies (29.6%) without significant differences between groups (p=0.14). Ectopic pregnancy rates in frozen and fresh groups were 38 (3%) and 52 (2.5%), respectively (p=0.409). Spontaneous abortion rates in frozen and fresh groups were 8.4% and 9.4%, respectively (p=0.32).Preterm labor was seen in both frozen and fresh groups as 28.2% and 23.4%, respectively (p=0.002) and finally, multigestational pregnancy rate was 25.7% and 22.8% in frozen and fresh groups (p=0.06).Conclusion: According to this study, frozen and fresh embryo transfer cycles were not significantly different in clinical pregnancy, ectopic pregnancy, multigestational pregnancy rates, but preterm labor was dominant in frozen group, which should not be overlooked.

Background: Various placental and cord abnormalities have been known to adversely affect the obstetric outcome. Circumvallate placenta and Battledore insertion of the umbilical cord are both rare and known to be associated with poor obstetric outcome individually.Case Presentation: In this case report, the woman presented at 8 months of gestation with preeclampsia with IUFD to North Easter Indira Gandhi Regional Institute of Health and Medical Science Shillong on 22/7/16 and delivered a macerated fetus vaginally. After delivery, examination revealed both a circumvallate placenta and Battledore insertion of umbilical cord. This might have attributed to preeclampsia and ultimately IUFD in this case as she had no other identifiable cause for IUFD.Conclusion: If such placental and cord abnormalities are suspected or diagnosed antenatally by ultrasonography, the pregnancy should be regarded as high risk. Such woman would require more stringent follow up in the antenatal period and continuous intrapartum monitoring to avoid any catastrophe and to achieve a favorable maternal and fetal outcome.

Introduction: the techniques of assisted reproduction have admittedly unveiled the process of human oocyte fertilization and subsequent embryo- nic development. In specialized laboratories, male and female gametes are routinely handled and their immediate fusion product, the pronuclear stage, can nowadays be cultured up to the hatching blastocyst underin vitro conditions. Comprehensive overviews of the observed variable features of oocytes, zygotes, embryos and blastocysts have been provided elsewhere (1-4).