Journal of Reproduction & Infertility
Year:2003 | Volume:4 | Issue:4 (16)|Papers Count:11

Male Infertility treatment has reached to prominent improvements in recent years by emergence of microinjection. In this method even with finding at least one spermatozoa, through Testicular Sperm Extraction (TESE), fertility would be possible. By, such facilities, the treatment of non Obstructive azoospermic men would be possible and finding of at least a few sperm from testis, was signified. In order to predict the probability of retrieving spermatozoa from testis, different study was performed. Immune system and its role in production of antisperm antibody was considered in this study. Sperm antigens which appear at puberty are unfamiliar for immune system and their encounter with immune system stimulate and produce antisperm antibody (ASA). So, this study evaluated the relationship between antisperm antibodies in serum and semen of infertile men with outcome of testicular sperm extraction. This study included 94, azoospermic men who needed diagnostic biopsy or TESE. ASA was detected by indirect MAR test for IgG and IgA and the correlation between level of ASA and success rate of TESE were evaluated by statistic tests. The results showed that in men with positive TESE, level of lgG was more than negative one. (rspearrman=0.360, p=0.000). In 40 men the result of MAR test was more Than 10% and sperm found in samples of 34 men. So in this study the positive predictive value of antisperm IgG was 85% and its negative predictive value was 52%. By having the level of IgG in MAR test equal or more than 40%, its positive predictive value would be 100%. It is worthy to note that negative ASA does not predict the absence of spermatogenesis. In other word, negative test has not predictive value. Generally our results showed that antisperm antibody in serum and semen of azoosperic infertile men has a good prognosis for finding testis spermatozo

In spite of advances in the filed of assisted reproductive techniques including in vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI), the pregnancy rate remained low. One of the major events in fertility is implantation process. Researchers believe that introduction of cervical bacteria into uterus during embryo transfer might have an inhibitory effect on implantation and thereby pregnancy rate. The reason for performing this study was the contradictory reports in this field and lack of regional information. In this cross-sectional study, endo-cervical samples from one hundred women who were undergoing intra-cytoplasmic sperm injection (ICSI) were prepared by using embryo transfer catheter tips. Catheters tips were transferred to selective culture media and after incubation in special conditions by using current bacteriological methods, bacteria in the samples were isolated and characterized. Implantation was confirmed by measurement of b- hCG in serum. Analysis of the results was carried out by chi-square. The overall implantation rate per transfer was 17%. Positive cultures in the successful and unsuccessful implantation groups were 29.4% and 49.4%, respectively. In other words, implantation rates in patients with and without cervical infection were 10.8% and 22.2%, respectively. Our study showed that, potentially pathogenic bacteria in endo-cervix of women with 1 unsuccessful implantation is more prevalent than those with successful implantation (p<0.05). Therefore, the results of this study imply the negative effects of cervical bacteria on the implantation process.

Insulin-like growth factor-I (IGF-I) is believed to be involved in the development of germ cells. IGF-I whose level is mainly controlled by concentration of growth hormone, induces cell proliferation and differentiation. Its action is mediated by Insulin-like growth factor binding-proteins (IGFBPs) and prostate-specific antigen (PSA). The aim of this case-control study was to evaluate serum and seminal plasma levels of IGF-I and PSA in idiopathic oligospermic and normospermic infertile males with simple random sampling. The case group was consisted of 29 infertile males with idiopathic oligospermia compared to 23 normospermic men with idiopathic infertility as control group. PSA and IGF-I were measured by immunoradiometric assay (IRMA).Comparison of sperm morphology, sperm count, serum and seminal plasma IGF-I and PSA between two groups were carried out using t-test. Sperm motility was compared between two groups by non-parametric Mann-Whitney test. Two-tailed test with α=0.05 was the level of statistically significance. Results showed that mean IGF-I level in seminal plasma of oligospermic group were significantly lower than normospermic group (p<0.01). But, there were no significant differences in serum IGF-I and serum and seminal plasma PSA levels between two groups. We concluded that IGF-I and PSA might be considered as a mitotic and differentiation factor in development of male germ cells.

Co-culture systems have important roles in maintenance of spermatogenicells and process of spermatogenesis. These systems are used for in Vitro maturation of germ cells and overcome on differentiation arrest of spermatogenic cells. FSH and Testosterone hormones are important in initiation and maintenance of spermatogenesis. Lack of these hormones causes spermatogenesis deficiency in vivo. In this study, the effects of both co-culture system with Vero cell and co-culture supplemented with rFSH and Testosterone were determined on maturation of round spermatids. Cell suspension was isolated from testis of NMRI male mice (8-12 weeks old) and divided into three parts. Suspensions in three groups include: control (culture on DMEM with 10% FBS), experimental 1 (culture on monolayer of Vero cell) and experimental 2 (culture on monolayer of Vero cell supplemented with rFSH and Testosterone), were cultured for 96-hours. The numbers of round, elongating and elongated spermatids, before and after of culture were recorded for 96-hr using light microscope. Survival rates of all kind of spermatids were evaluated using trypan blue test and the results of each group were compared statistically by repeated measure ANDV A test. The results of this study showed that in co-culture system on the first 24-hr, the number of round spermatid cells were reduced but elongating spermatid cells increased significantly (P<0.0001). In co-culture system supplemented with rFSH and Testosterone, the numbers of elongated and elongating spermatid cells increased significantly after 24 and 48 hours respectively (P<0.001) but after that the number of all kind of spermatid cells were reduced. Viability rates of all kinds of spermatid cells reduced during 96-hours culture and there were no significant differences. In conclusion, the results of this study confirms that round spermatid cells by using of co-culture system with and without hormones can progress into elongating over a short period (maximum 48 hours). Vero cell culture supplemented with rFSH and Testosterone can support in vitro maturation and viability of spermatogenic cells better than Vero cells without hormones.

Post operative adhesion is the most common cause of small bowel obstruction, infertility and technical problem in later surgical procedure. According to some results on animals or human, non-closure parietal peritoneum have performed less adhesion. Since there are considerable controversies over closure or non-closure parietal peritoneum on amount of adhesion after cesarean section. 300 pregnant women were included in this study. The parietal peritoneum in 148 patients was closed and in 152 patients left opened. In their next cesarean section, which was at least 31- 34 months later, the amount of adhesion and hernia were evaluated and recorded. The results showed that there were no statistically significant difference between the two groups over age, weight, parity and pelvic infection but there was a significant difference between the interval of two successive surgeries and type of surgeries: elective or emergency (p<0.05). The adhesion evaluation of abdominal wall, fascia, peritoneum, omentum, bowel and bladder in non-closure and closure peritoneum patients were 38.5%- 98%, 8.1%- 53.3%, 18.9%- 7.4% ,72.4%- 2.7%, 18.4%- 31.1% and 94.1% respectively. The results showed a significant difference in the amount of adhesion between two groups (p<0.001). It was much lower in the non-closure group. The comparison of total score of adhesion with age, weight and parity in two groups were not statistically significant. Although the results of our study showed the open peritoneum is better than closed parietal peritoneum but we can not generalize for all abdominal surgery. Therefore more research would be necessary.

Infertility with an incidence of about 10- 1 5% is one of the community burdens that even threatens the continuity of the family life. Intrauterine insemination (IUI) is frequently used in the treatment of infertile couples with various causes of infertility. The difference pregnancy rates following a double IVI versus a single IVI has been reported. In this study we compared the effectiveness of double IVI before and after ovulation with a single IVI super ovulated cycles with clomiphene citrate. This was a prospective randomized controlled trial study. Our study was carried on 200 women with mild male factor without male factor infertility, and other female factor as an IVI candidate. They were stimulated with clomiphene 100 mg for 5 days plus HCG 10000 IV. On the day of HCG administration, patients were randomly divided into one of two groups; in group I, IVI was performed 36 hours after HCG injection and in group II, Double IVI was performed 18 and 42 hours after the HCG injection. Clinical pregnancy rates in both groups were compared per cycle. The demographic data for two groups were similar. Pregnancy rate of the first group was 14% versus 13% for the second group, so there was no statistical significance difference between two groups (double and single IVI) for the pregnancy rates in super ovulation cycles with clomiphene citrate. (P=0.834) The result of this study did not show benefit for double IVI over single IVI in clomiphene citrate/ HCG cycles. Regarding our Findings for future research in IVI candidate couple, using double IVI and comparing with single IVI especially with HMG/HCG super ovulation protocol and also infertile couple with male factor is suggested.

There is a risk of thromboembolic complications in patients with prosthetic heart valves, to reduce this risk, anticoagulant drugs should be used. Besides thromboembolic events in pregnant women with prosthetic heart valves, anticoagulants may cause embryopathy, abortion, C. V.A. and valve thrombosis in mothers with generally high mortality. So, this study was performed to determine the pregnancy outcome in patients with prosthetic heart valves in Shahid Rajaee Heart Hospital. Eighty women aged 12-45 years old who underwent heart valve replacement at this hospital between 1978 and 1998 were included in this study. In these patients who had warfarin therapy during the whole period of pregnancy, 144 pregnancy and 18 elective abortion was occurred. Mitral Valve Replacement (MVR) was performed in 58.7%, Aortic Valve Replacement (A VR) in 16.3% and MVR plus A VR in 25%. Generally, 89.68% of the pregnancies were without any complications for mothers, but 5.56% of them had complications such as C.Y.A., hypertention, edema, dyspnea and prosthetic valve malfunction. Mother death occurred in 4.76% of them. There were 38.09% normal birth with healthy baby, 50% abortion, 3.18% congenital deformities and 8.73% infant death following premature delivery, still birth and maternal death during pregnancy. Our findings showed that fetal and maternal complications in women with prosthetic heart valve using anticoagulant drugs were more common in comparison with the normal population and suggests the more clear and complete assesments in this respect. Although most pregnancy losses in women with prosthetic valve were due to warfarin use, in cases the dose of warfarin is less than 5mgiday, shifting to heparin is not recommended because a low dose of warfarin has low maternal and fetal risks.

Some pregnant women cravings for non-food substances with no nutritional value which is called pica such as dirt, clay, paint chips, chalk, ice, etc. Most frequently, pica occurs in children, persons with mental retardation and women during their pregnancies or while they are breast-feeding. Pica is considered to be a serious eating disorder, sometimes resulting in serious health problems such as lead poisoning, bowel blockage, and iron deficiency anemia. In a cross-sectional survey (with randomized multi stage sampling) the prevalence of pica was studied in 560 pregnant women who referred to health centers in Zahedan. Using a structured questionnaire, over a four-month period information were obtained from all mothers. The prevalence of pica among the subjects was 15.5%, in which 25.3% of them ate dirt, 60.9% ice, and others substances such as chalk, rosary praying clay, freezer frost, tea stuff and other non-food substances. Considering that pica is not limited to any culture, race, sex or socioeconomic background and also can result in dangerous and serious health problems, therefore needs to raise public awareness of the adverse effects of this practice is suggested.