Journal of Reproduction & Infertility
Year:2019 | Volume:20 | Issue:3|Papers Count:11

Globally, more than 7 million live births now result from IVF cycles so that more than 6% of the European births and especially in Denmark about 10% of children are conceived through ART. Compliant with this increment, the infertility treatment using third-party and its success rate are increasing during the past decades. At present, more than 16% of the total IVF cycles, more than 20% of all live births result from oocytes, sperm, embryo donation and gestational carriers in US, so that the third-party IVF cycles are the main infertility treatment for aged couples and the success rate of ART cycles is 39. 7% in live birth for third-party compared to 29. 6% for autologous cycles (1). . . .

Background: For improving the evaluation of male infertility, many parameters were studied and reported in earlier literature. The aim of this study was to estimate the frequency of sperm aneuploidy and DNA fragmentation in infertile men and to assess the correlation between sperm aneuploidy and DNA fragmentation. Methods: In this study 100 infertile men were included, cases with azoospermia were 68%, oligospermia 18%, severe oligospermia 6%, and oligoasthenoteratospermia (OAT) 8%. Ten normozoospermic men who had two normal children were included as a control. The sperm aneuploidy test by Fluorescence In Situ Hybridization (FISH) and sperm DNA fragmentation index by TdT (Terminal deoxynucleotidyl transferase)-mediated dUTP nick end labelling (TUNEL) were carried out. To determine the aneuploidy status and DNA fragmentation index, frequency was used. The correlation between sperm aneuploidy and sperm DNA fragmentation along with age was assessed by using Spearman's correlation coefficient. The p<0. 05 was considered significant. Results: The age of 100 subjects ranged between 22-48 years (35. 5± 5. 1). Sperm aneuploidy frequency and DNA fragmentation rate were found to be higher in infertile men compared to control men (n=10). There was a significant relationship between age and sex chromosomal aneuploidy (p<0. 05) and significant difference between sperm aneuploidy and damaged DNA (p<0. 05). Conclusion: FISH and TUNEL assay results showed increased sperm aneuploidy frequency, and DNA fragmentation index in infertile men compared with the fertile men. There is significant relationship observed between sperm aneuploidy and DNA fragmentation. These two parameters are important and they must be investigated for clinical practice.

Background: The evaluation of embryo morphology is one of the most important parameters used to evaluate developmental timing, also providing an indication of chromosomal failure or degeneration. The first step in the evaluation of a fertilization event is determining the number and shape of the pronuclei (PN). Normally fertilized eggs possess two even PN. However, some embryos which develop from abnormally fertilized zygotes may be tri-pronuclear zygotes (3PN). Methods: Thirty embryos were collected from 12 women who underwent in vitro fertilization (IVF) at Dr. Cipto Mangunkusumo General Hospital in Jakarta, Indonesia. Embryos were cultured until the blastocyst stage on days 5-6. The blastomere biopsy was performed by piercing the zona pellucida with a laser under a microscope. Chromosomal numerical abnormalities were analyzed using Next Generation Sequencing (NGS). Results: Among the 30 embryos with 3PN zygotes, 33. 3% had a normal chromosomal array, with 22 pairs of autosomes and 2 pairs of sex chromosomes. While the rest of sample population detected as abnormal chromosome (66. 7%), with the highest percentage of abnormality was triploidy 43. 3%, followed by mosaicism 13. 4% and aneuploidy 10%. Conclusion: This was a preliminary study revealed not all morphologically 3PN embryos are genetically abnormal.

Background: Human follicular fluid (FF) is rich in hormones and antioxidants. Many components of FF differ in follicles of patients with polycystic ovary syndrome (PCOS). Regarding vitamin D effects on gene expression, 25(OH)D level of FF and its association with oxidative status and sex steroids dysregulation in PCOS group was evaluated and compared to controls of Non-obese healthy women. Methods: FF of 50 non-obese healthy women and 50 women with PCOS (18-36 years old) who were candidates for IVF/ICSI was aspirated on the oocyte retrieval day. Sex steroids and 25(OH)D levels were measured by ELISA. Reactive oxygen species (ROS) levels, total antioxidant capacity (TAC), and activities of superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) were assessed by chemiluminescence and spectrophotometric methods. Data were analyzed by unpaired t-test or Mann-Whitney test, and Pearson correlation coefficient. The p<0. 05 was considered statistically significant. Results: Estradiol, progesterone, 25(OH)D, TAC, and activities of SOD, GPx, and CAT in FF of women with PCOS were significantly lower, whilst their free and total testosterone and ROS levels were significantly higher than controls. There were significant positive correlations between FF levels of 25(OH)D with TAC, estradiol and progesterone concentrations, SOD, GPx, and CAT activities. Negative correlations were found between 25(OH)D with free and total testosterone, and ROS levels. Conclusion: Despite different hormonal and antioxidant levels in FF of normal and cystic follicles, the correlation between 25(OH)D levels with sex steroids and oxidative stress markers showed a possible role of 25(OH)D in regulating sex hormones secretion and enhancement of antioxidant defense.

Background: The purpose of the study was to evaluate the role of clinical, metabolic, hormonal and ultrasound features of women with PCOS in predicting the response to clomiphene citrate in treatment of infertility. Methods: A prospective observational study was done over a period of one year. A total of 164 women with PCOS related infertility were enrolled. They were treated with an incremental dose of clomiphene citrate starting with 50 mg/day to a maximum of 150 mg over 3 cycles. The response was recorded as either presence or absence of ovulation. Multiple logistic regression was used to analyze various clinical, metabolic, hormonal and ultrasound features in these women. Sensitivity and specificity of each of these parameters in predicting non-responsiveness (failure to ovulate with 150 mg clomiphene) were calculated. Results: Ferriman-Gallwey score, androstenedione levels, HDL, and cholesterol were found to be the independent predictors of non-responsiveness to clomiphene citrate. The overall best predictor of non-responsiveness to clomiphene citrate is Ferriman-Gallwey score (FG). FG score, with a cut off value of 15, had 73. 9% sensitivity and 86. 8% specificity in predicting non-responsiveness to clomiphene. BMI was the best anthropometric predictor of the non-responsiveness to clomiphene. Fasting insulin was the best metabolic predictor of the non-responsiveness to clomiphene. AFC was the best ovarian reserve marker as the predictor of the non-responsiveness to clomiphene (cut-off value of 11. 75 with 73. 9% sensitivity and 73. 7% specificity). Conclusion: Ferriman-Gallwey score, androstenedione levels, and lipid profile are clinically useful parameters to predict which groups of PCOS women are unlikely to respond to clomiphene.

Background: Uterine leiomyomas are steroid hormone dependent myometrial neoplasms of female genital tract which appear after menarche and regress at menopause. The present study evaluated the role of ER-β gene polymorphisms (rs3020449 C/T, rs3020450 G/A, rs1271572 G/T, rs1256049 G/Aand rs4986938 G/A) in the etiology of disease. Methods: A total of 150 clinically, ultrasonographically evaluated uterine leiomyoma patients and an equal number of individuals as controls were considered for the present study. Genotype analysis was carried out by TETRA Primer Amplification Refractory Mutation System– PCR for promoter polymorphisms and PCR-RFLP method was done for exonic polymorphisms followed by agarose gel electrophoresis. The strength of the association of ER-β gene polymorphisms between controls and patients were measured by appropriate statistical methods. Results: An increased frequency of T/T genotype and T allele of rs3020449, AA genotype and A allele of rs3020450, T/T genotype and T allele of rs1271572, AA genotype and A allele of rs1256049 and A/A genotype and A allele of rs4986938 was observed in cases when compared with controls. Conclusion: The study indicates that the ER-β gene polymorphisms may act as a major genetic regulator in the etiology of uterine leiomyomas.

Background: There are limited data on the role of nutrient patterns in development of polycystic ovary syndrome (PCOS). The aim of the study is to document the relationship between nutrient patterns and PCOS. Methods: In this study, 281 incident PCOS women and 472 controls were interviewed through the endocrine clinics between February 2013 and March 2015 in Tehran, Iran. Usual dietary intakes were obtained using a validated semi-quantitative food frequency questionnaire. Factor analysis was conducted on the basis of 32 nutrients. Unconditional logistic regression was performed to ascertain odds ratios. The p<0. 05 was considered for significance level. Results: In principal component analysis two nutrient patterns emerged. Factor 1 had high loadings for riboflavin, niacin, pyridoxine, thiamin, magnesium, pantothenic acid, cobalamin, vitamin C, folate, vitamin D, total fiber, selenium, phosphorus, vitamin E, manganese, vitamin K, monounsaturated fatty acids, polyunsaturated fatty acids, potassium and vegetable protein. Factor 2 characterized by high loadings for carbohydrate, animal protein, fat, cholesterol, saturated fatty acid, sodium, biotin, copper, iron, fluoride, zinc, and calcium. After adjusting for potential confounders, the risk of PCOS was significantly higher in the highest tertile of factor 2 (OR: 2. 38, 95% CI: 1. 69-3. 21). Conversely, being in the highest tertile of factor 1 was associated with a lower risk of PCOS (OR: 0. 48, 95% CI: 0. 21-0. 82). Conclusion: Our results provide a possible new insight into the interactions between nutrient intakes and PCOS.

Background: Infertility stress can have a devastating impact on the lives of couples and influence their physical and psychological health. The purpose of this study was to investigate the effects of group counseling on female stress and gender-role attitudes in infertile women. Methods: The present study is a randomized clinical trial conducted on 90 infertile women referred to Rooyesh Infertility Treatment Center in the city of Karaj, Iran. The convenience sampling method was used. Samples were divided into intervention and control groups through four-block random allocations. Accordingly, the intervention group received five-session group counselling and the control group only received routine care. Newton’ s fertility problem inventory (FPI) and gender role questionnaire (GRQ) were used for collecting data before, after, and one month after the intervention. The significance level was set at 0. 05. Results: The result showed a significant relationship between gender role attitude and stress in infertile women (p=0. 03) and indirect association between of them (r=0. 13). And also repeated measures test indicated that length of time had affected the total scores of infertility stress (p<0. 001) and gender role attitude scores (p= 0. 001) and there was a significant difference between the two groups in infertility stress scores (p<0. 001) and gender role attitude scores (p=0. 001). Conclusion: Group counseling can be used in stress reduction and also improved gender role attitude of infertile women.

Background: Infertility is considered an important phenomenon in couples’ life. In-fertility and its treatment process influence all aspects of the individual’ s life. This study aimed to explain the psycho-social process of social construction of infertility among Iranian infertile women. Methods: This was a qualitative study using a grounded theory approach. The study setting was the Vali-e-Asr Fertility Health Research Center and Avicenna Fertility clinic in Tehran. The sampling started purposefully and it was continued theoretical-ly. The data collection was performed by using 36 semi-structured interviews, obser-vation and field notes with 27 women who suffered from primary and secondary in-fertility having no living child. The method suggested by Strauss and Corbin was used for data analysis. Results: Results indicate that "Concerns over life instability" and "being judged by others" were the participants’ most important preoccupation. Attempts to stabilize life and get rid of being judged by others were key aspects of the social construction of infertility and the main strategies for resolving their preoccupation. This core con-cept explained the basic psychological-social process of infertility in relation to axial codes. Conclusion: The results of the study show that various interactive factors affect the social construction of infertility among infertile women who focus on the central concept of attempts to stabilize life and get rid of being judged by others. Therefore, in order to achieve this goal, infertile women should be empowered by effective cop-ing strategies.

Background: 46 XX male syndrome, a rare case of infertility was first reported by de la Chapelle in 1964. In newborn males, the incidence rate of the syndrome varies from 1/9000 to 1/20000. Here, a case of 46 XX male syndrome is reported with clinical, biochemical and genetic changes of the patient and normal masculine features. Case Presentation: A 29 year old male with infertility registered at the Sree Avittom Thirunal Hospital of Government Medical College, Thiruvananthapuram for fertility treatment. He was diagnosed with non obstructive azoospermia in repeated semen analysis. Chromosomal analysis on peripheral blood lymphocytes has revealed 46 XX male syndrome and the result was confirmed with Fluorescent In situ Hybridization (FISH). Real time polymerase chain reaction failed to detect genes on azoospermia factor regions, AZFa, AZFb and AZFc of Y chromosome, but detected SRY gene positivity. Masculine features of patient were normal except small sized testis, ejaculatory dysfunction and azoospermia. Conclusion: Appearance of the external genitalia will be generally normal in 46 XX with SRY positive males and generally difficult to identify before puberty because there will not be any significant clinical indication. The present case report demonstrates that mere physical or clinical examination may not disclose the genetic defects. Therefore, in addition to general examination, it is essential to perform genetic analysis on men with infertility.

it is widely known that mercury (Hg) is highly toxic to humans. Environmental Hg pollution still represents a huge health concern worldwide (1). Human industrial activities have led to raised levels of Hg in the air, soil, and fresh and sea waters, and to bioaccumulation along the food chain. Humans easily absorb Hg through fish consumption. Also, it is a major toxicant because it has adverse effects on human reproductive health (2). Mercury, particularly in its organic forms, methyl-Hg and ethyl-Hg, is toxic even when individuals are exposed to relatively low Hg levels (3).