Journal of Reproduction & Infertility
Year:2019 | Volume:20 | Issue:4|Papers Count:9

This month, newspapers and websites released the news referring to the birth of twin girls by the world's oldest mother. A 74-year-old Indian woman and an 82-year-old Indian man, who have been married for 57 years were treated after 30 years of postmenopause. She became pregnant using donated eggs at an infertility clinic in Guntur, India. This treatment resulted in delivery of twin girls (1)...

Although fertility preservation is a growing topic in the management of oncological diseases, different benign gynecological pathologies are able to compromise the ovarian reserve due to mechanisms related to the pathology itself or secondary to the performed treatments. Endometriosis, benign ovarian tumors, adnexal torsion, familiarity and genetic syndromes are all benign conditions that can compromise the ovarian reserve. Endometriosis and particularly endometriomas provide a direct damage to ovarian reserve, with different mechanisms, and an indirect damage related to surgery. Similarly, benign ovarian tumors can provide a detrimental effect on ovarian reserve for the surgical treatment, especially for bilateral or recurrent tumors, and in case of secondary adnexal torsion with late diagnosis. Different fertility preservation options are available and should be considered particularly in cases with bilateral or recurrent pathology and/or surgery. In general, the identification of patients at risk of early ovarian failure, for benign gynecological disease or based on known genetic causes or familiarity, is of paramount importance in order to apply fertility preservation techniques before the complete depletion of ovarian reserve.

Background: According to several laboratory protocols and specific conditions, in vitro fertilization (IVF) dishes with culture media can be prepared 24 hr in advance compared to routine protocols. However, it is not clear if this procedure can affect embryological outcomes. Methods: A nested case-control study was done in a cohort of couples undergoing IVF at the Infertility Unit of the ASST Lariana from August 2016 to July 2018. Cases were patients undergoing ovum pick up after a laboratory day off. Controls were patients undergoing ovum pick up after working days from Monday to Thursday. Culture media for oocyte culture and insemination were prepared about 42 and 18 hr before oocyte retrieval for cases and controls, respectively. Cases and controls were matched with a 1: 2 ratio (for age, inseminated oocytes, length of stimulation). The "Good-Quality-Index" (GQI) was the main outcome to be compared between the two groups and was defined as good quality transferred or cryopreserved embryos on day 2 or 3+number of good quality blastocysts/inseminated oocytes. Results: A total of 76 cases and 152 matched controls were enrolled. The median GQI was equal to 33. 0% (IQR: 20. 0-50. 0%) and 33. 0% (IQR: 25. 0-50. 0%), in cases and controls, respectively (p=0. 40). Study groups and GQI were not significantly correlated (correlation coefficient r=0. 047, p=0. 48). Main embryological parameters and cumulative pregnancy rates were similar between the two groups. Conclusion: Our data support the vision that culture media can be prepared 24 hr in advance compared to routine protocols without affecting embryological outcomes.

Background: Luteinizing hormone receptor gene shows four nonsynonymous polymorphisms within the exons. Three of these polymorphisms, i. e. rs4539842 (an insertion of 6bp CTGCAG at nucleotide position 54), rs12470652 (c. 827A>G/p. Asn 291Ser), and rs2293275(c. 935G>A/p. Ser312Asn) have been studied more frequently. Beside other hormones, LH and FSH have an important role in production of competent oocyte and female fertility. Therefore, the objective of the current study was to investigate the prevalence of exons 1(rs4539842) and 10(rs12470652, rs2293275) polymorphisms of the LHCGR gene and its relationship with successful IVF in Iranian infertile women. Methods: SNPs in exons 1 and 10 were analyzed in 100 women of two equally sized groups of IVF failure and IVF success women using genomic DNA. For polymorphisms in exon 10, PCR and direct sequencing were used and for the polymorphism in exon 1, RFLP technique was used. The RFLP technique is confirmed by sequencing. Results: Our results showed significant difference in allelic frequency of SNP rs2293275 among IVF successful and IVF failure groups (p=0. 001). For this variation, AA genotype (A allele) was shown to have protective effect against IVF failure (p=0. 03 and OR=0. 04), while GG genotype (G allele) was a susceptive genotype to IVF failure (p=0. 003 and OR=3. 88). Allelic frequency of SNP rs4539842 also showed significant difference between the two groups (p=0. 0025). For this SNP, subjects with no 6bp insertion (homozygote deletion genotype) were susceptible to failure in IVF (p=0. 009 and OR=2. 93). Conclusion: It has been revealed that two common SNPs (rs4539842 and rs2293275) in the LHCGR gene are associated with the outcome of IVF in Iranian infertile women. Thus, these two SNPs can be suggested to be used as predictors for IVF outcome in Iranian population.

Background: Failure to respond adequately to standard protocols and to recruit adequate follicles is called ‘ poor ovarian response’ . The relationships between metabolic alterations and NUCB2/Nesfatin-1 levels were explored in patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization/intracytoplasmic sperm injection. Methods: This case-control study involved 20 infertile women with PCOS and 20 control women diagnosed as poor ovarian responders stimulated with a GnRH antagonist. Blood samples were taken during ovum pick-up and follicular fluids (FF) were obtained from a dominant follicle from the subjects. Samples were analyzed by using ELISA. Statistical analysis was performed with SPSS version 20. Data are expressed as means ± standard deviation (SD). Results: Blood NUCB2/Nesfatin-1 levels in PCOS were significantly lower (p= 0. 011) while the NUCB2/Nesfatin-1 levels of FF in poor ovarian response (POR) were higher, but not statistically significant. Insulin, total testosterone, fasting glucose, homeostasis model assessment, and insulin resistance index in women with POR decreased when compared with PCOS. Blood NUCB2/Nesfatin-1 levels were significantly higher than FF NUCB2/Nesfatin-1 levels in both groups (p<0. 001). Moreover, a positive correlation was detected between blood NUCB2/Nesfatin-1 and testosterone (p=0. 602, r=0. 304), HOMA-IR (p=0. 252, r=0. 384), BMI (p=0. 880, r= 0. 44) in PCOS, but it was not significant. Conclusion: NUCB2/Nesfatin-1 levels might be important in follicular growth in PCOS subjects undergoing IVF/ICSI with an antagonist protocol and NUCB2/ Nesfatin-1 level could reliably help to predict poor ovarian response.

Background: Malignant mixed germ cell tumors of ovary are rare aggressive cancers affecting young adolescent girls. The commonest combination reported in literature is dysgerminoma and endodermal sinus tumors but in our study the most common combination was immature teratoma and endodermal sinus tumor which is exteremely rare. Preservation of future fertility is a concern. Fertility sparing surgery followed by combination chemotherapy is the current treatment of choice but treatment must be individualized depending upon the nature of the tumor. Methods: A retrospective study on five patients with these tumors was conducted on patients at Guru Gobind Singh Medical College and Hospital (Punjab, India) between September 2009 to January 2018. Results: Median age of patients was 15. 6 years. Histopathological combination was immature teratoma and endodermal sinus tumor (n=3), endodermal sinus tumor and embryonal carcinoma (n=1), and mature and immature teratoma (n=1). Tumor markers AFP, beta HCG and LDH were raised in all except the patient with mature and immature teratoma. All patients underwent surgery followed by combination chemotherapy. Three patients developed metastasis within six months of treatment and died. In the remaining two, no reccurrence was reported till date. Conclusion: Malignant mixed germ cell tumors of ovary are extremely rare tumors and have poor prognosis. Fertility preservation is a concern as these patients are usually young adolescent girls but fertility sparing treatment must be individualized on the basis of tumor type, surgical staging, and availability of combination chemotherapy. Considering high recurrence rate and mortality, total hysterectomy with bilateral salpingo-oophorectomy with complete surgical staging followed by combination chemotherapy should be perfomed at advanced stage and aggressive tumor biology. Preservation of fertility must be held secondary.

Background: Pre-eclampsia (PE) is the most common pregnancy complication affecting 2-8% of all pregnancies. PE could lead to maternal and prenatal morbidity. Imbalanced cytokine network and altered levels of several inflammatory and antiinflammatory cytokines have been reported in PE. Because of scare information regarding the roles of IL-17 and IL-35 in PE, the current study aimed to investigate the serum level of these cytokines in a group of Iranian women suffering from PE. Methods: Serum samples were collected from 100 pre-eclamptic and 100 healthy pregnant women. Patients and controls were matched for age, ethnicity and body mass index. The level of IL-35 and IL-17 were evaluated by ELISA technique. T test and one-way ANOVA with Tukey Post-Hoc test were used for analysis and p<0. 05 were assumed significant. Results: The serum level of IL-35 was increased in pre-eclamptic subjects as compared with healthy pregnant women (p<0. 001). There was no significant difference in the serum level of IL-17 between pre-eclamptic and healthy pregnant women (p=0. 73). Moreover, the results of the present study also showed that the pregnant women with severe pre-eclampsia had higher level of IL-35 in their sera when compared to those with mild form of the disease (p<0. 001). In addition, the serum level of IL-35 was significantly elevated in women with higher proteinuria (p<0. 001). Conclusion: Based on the our results, it seems that elevated levels of IL-35 in sera of pre-eclamptic women might work as a marker to evaluate the severity of the preeclampsia.

Background: The purpose of the study was to evaluate the use of contingent prenatal screening for the detection of Down’ s syndrome and neural tube defects (NTDs) in west of Iran. Methods: A prospective study was conducted on 653 pregnant women referred to a medical diagnostic laboratory (Imam Reza Clinic, Kermanshah, Iran) for contingent prenatal screening tests between October 2016 to September 2017. Results: Among 651 women screened in the first trimester, 8 (1. 22%) pregnancies were screen-positive for Down’ s syndrome. In the second trimester, among 605 women, 25 (4. 13%) had a positive result and all of these women voluntarily underwent amniocentesis. Overall, five pregnancies were complicated with chromosomal abnormalities, including five cases of Down’ s syndrome. Conclusion: In a nutshell, the contingent prenatal screening tests were found to be useful for estimation of Down’ s syndrome as well as NTDs in both young and older mothers in west of Iran. These tests should be performed for pregnant women before an invasive test for Down’ s syndrome.

Background: The use of eculizumab during pregnancy has generally been discouraged. Published data on related studies provides conflicting information and establishing a benefit-risk relationship proves to be a complicated task. Miscarriage rates, concomitant medications, and the stages of pregnancy when eculizumab treatment was initiated varied among the patients included in the case series. The aim of this report is to discuss eculizumab use during pregnancy. Case Presentation: A case of a woman diagnosed with Paroxysmal Nocturnal Hemoglobinuria (PNH) and treated with eculizumab, who expressed desire for pregnancy is presented. Six months after her eculizumab treatment, the patient experienced spontaneous abortion in her first trimester. The direct relation between eculizumab and the miscarriage is not clear. Other factors may have influenced this case, thus demonstrating the difficulty of managing pregnancy in women with PNH. Conclusion: Controversy on eculizumab risk during pregnancy encourages further review on its use, highlighting the importance to assess each case individually.