Journal of Reproduction & Infertility
Year:2009 | Volume:9 | Issue:4 (37)|Papers Count:13

Introduction: Polymorphisms of coagulation factor V gene are the most important suspected causes of thrombophilia in women with recurrent pregnancy losses (RPL). In this study the association between three polymorphisms of factor V (FV Leiden, FV A4070G & FV A5279G) and RPL are sought in Iranian women. Materials & Methods: In this case-control study, 100 female patients with at least two recurrent abortions were selected as the cases, and 100 healthy women with a history of two successful deliveries as the controls. Peripheral blood samples were collected and DNA was extracted. PCR-RFLP method was used for genotyping the samples. Results: Regarding the prevalence of FV Leiden mutation in the cases and the controls, 13% and 4% respectively, the chances for recurrent pregnancy losses were more than 3.5 times higher in individuals with this polymorphism (OR: 3.586, 95% CI: 1.127–11.412). The frequencies of FV A4070G and FV A5279G were 14% and 37% in the case and 4% and 7% in the control groups, respectively and the chances for RPL were higher in cases with these two polymorphisms. The proportion of cases with two or three mutations in the gene in comparison with the controls, showed a significant correlation between FV Leiden and FV A4070G polymorphisms. Statistical analysis of the simultaneous effects of the three polymorphisms for RPL showed that evaluation of FV A4070G and FV A5279G could help assess the chances of the three mutations for RPL. Conclusion: The three polymorphisms in coagulation V gene are accompanied with increased risks for RPL. Evaluation for the three polymorphisms is suggested in the work up of women with RPL.

Introduction: Loss of spermatogenesis following chemo or radiotherapy for the treatment of malignancies leads to the patient’s temporary or permanent infertility. Restoration of sperma-togenesis after malignancy treatments is the main target of recent studies. Therefore, this study was undertaken to evaluate role of follicular stimulating hormone (FSH) and estradiol in the regeneration of spermatogenesis in azoospermic mice.Materials and Methods: Busulfan, 30mg/kg, was used to induce azoospermia, in 20 male C57Bl/6 mice. Later on, the mice were divided into four groups of five animals. The animals on groups one to three received daily injections of FSH (7.5IU), estradiol benzoate (EB) (12.5mg) and simultaneous FSH and EB, respectively for ten days with no medication for the control group. On the 11th day, serum testosterone levels were measured. After sacrificing the animals, one testis of each mouse was fixed and processed for histopathological studies and the other was used for DNA flow cytometry to count haploid cells. Results: The highest increase in testosterone levels was seen with concomitant use of FSH and estradiol. The highest increases in haploid cells were seen in solitary use of estradiol and its concomitant use with FSH and resumption of spermatogenesis were observed histologically in these two kinds of administrations (p<0.001). Conclusion: FSH unlike estradiol did not restore spermatogenesis in azoospermic mice. Simultaneous use of FSH and estradiol had synergistic effects in the restoration of spermatogenesis in azoospermic mice. Therefore, the concomitant use of the two hormones may be considered for the restoration of spermatogenesis in men who have undergone treatments for malignancies.

Introduction: Reactive oxygen species (ROS) in the seminal fluid are derived from abnormal sperm, white blood cells or both. Oxidative stress will cause lipid peroxidation, decreased sperm motility and abnormalities in sperm fertilizing capacity. The aims of this study were to compare sperm parameters (Sperm count, motility and morphology) in infertile men with or without leukocytospermia and to measure both seminal total antioxidant capacity (TAC) and malon-dialdehyde (MDA) concentration.Materials and Methods: This case-control study included 110 male subjects referring to Kashan Infertility Center during 2007-2008. Regarding the World Health Organization criteria and following sperm analysis and seminal leukocyte counts, the cases were divided into two leukocytospermic and non-leukocytospermic groups and a third group composed of 45 men with normal test results were selected as the controls. Seminal plasma MDA and TAC levels were spectrophotometrically measured. Results: Upon semen analyses of 110 subjects, 45 individuals were classified as healthy, 30 as leukocytospermic and 35 as non-leukocytospermic; although there were <0.25×106 leukocytes in the semen of the latter group. Sperm motility (a+b) had a significant difference in the leukocytospermic individuals compared to non-leukocytospermic or healthy subjects (p<0.05 and p<0.001, respectively). MDA levels in the leukocytospermic group (178±18.48mmol/L) were higher than those of the non-leukocytospermic (2.7±1.73mmol/L) and the control group (0.4±0.14mmol/L). Additionally, TAC levels in the leukocytospermic group (636±75.58mmol/L) were significantly lower than the non-leukocytospermic (986±105.56mmol/L) or the controls (989±95.95mmol/L), (p<0.0001). Conclusions: High counts of leukocytes in the seminal fluid results in the increased production of ROS and their stable byproducts (MDA) in semen with subsequent depletion of its antioxidant capacity. Decreased TAC and increased MDA levels influence sperm parameters, especially its motility. Regarding the direct effects of sperm parameters on sperm fertilizing capacity, it is concluded that leukocytospermia may deleteriously influence male fertility.

Introduction: Patients with PCOS have risk factors for cardiovascular diseases, especially elevated lipoproteins, high blood pressure or hyperinsulinaemia. Clinical evidence shows that hyperhomocysteinaemia may contribute to the development of cardiovascular diseases in PCOS patients. In this study we compared serum homocysteine levels in PCOS patients with healthy Iranian women.Materials and Methods: This case-control study was performed on 52 individuals with PCOS (Rotterdam 2003 criteria). The cases were compared to 104 healthy non-PCOS, 20 to 35-year-old female subjects with no history of diabetes or renal diseases. The cases had referred to the Gynecology and Infertility Clinic of Vali-e-Asr Hospital in Tehran. Blood samples were taken on the 2nd to the 5th day of menstrual cycle for the evaluation of homocysteine levels, folic acid, triglyceride, insulin and some other metabolic and endocrine parameters. Results: Serum levels of insulin and folate were significantly higher in PCOS patients (16.62±7.45mIU/ml and 7.48±4.37ng/ml) compared to the controls (12.04±4.23mIU/ml and 5.43±3.15ng/ml), (p<0.001). Serum triglyceride concentrations were significantly higher in PCOS patients (116.62±73.02mg/dl) compared to the healthy subjects (88.00±50.29mg/dl), (p=0.01). The mean value for homocysteine (±SD) was 12.21 (±4.55) and 13.68 (±4.37) mmol/L in PCOS and healthy women, respectively but no significant statistical differences were observed (p=0.057). Regression analyses depicted that homocysteine level was mostly under the influence of folate and FBS concentrations.Conclusion: There is an inverse correlation between homocysteine and serum folic acid levels in PCOS patients. Therefore, it seems that proper administration of folic acid can reduce homocysteine levels in patients with PCOS and help prevent the attributed cardiovascular risk factors associated with the disease.

Introduction: Cigarette smoking is a major public health hazard which may cause different diseases such as fertility disorders through numerous mechanisms. Smoking decreases sperm quality and its fertilizing capacity; it prevents growth of ovarian follicles and decreases female fertility. The objective of this study was to determine the prevalence of smoking in infertile couples referring to Avicenna Infertility Clinic.Materials and Methods: This cross-sectional study included 342 infertile couples referring to Avicenna Infertility Clinic during 2000-2008. The data were collected via interviews using WHO Fagerström test for nicotine dependence and questionnaires by the International Union against Tuberculosis and Lung Disease (IUATLD).Results: Out of 684 cases, 246 (36%) had cigarette smoking experiences, with more prevalence among men than women (59.4% of men vs. 12.6% of women), (p<0.01). The mean age for smoking initiation was 20.1±5.8 years. Totally, 141 subjects (20.6%) were cigarette smokers, with a significant prevalence among male subjects (37.7% of men vs. 3.5% of women), (p<0.01). The mean value for nicotine dependency (Fagerström test) among the smokers was 2.9±2.8; with high, average and low nicotine dependencies, 16.1%, 18.3% and 65.6% respectively.Conclusion: The prevalence of cigarette smoking among infertile couples in Tehran was about 14.4%; quite similar to that of the prevalence among the Iranian general population (12.5%).

Introduction: It is estimated that about 10-15% of couples suffer from infertility worldwide, which is believed to be one of the most important life crises resulting in psychological problems and emotional stresses. This study examines the prevalence of psychiatric disorders and types of personality in fertile and infertile women referring to Vali-e-Asr Reproductive Health Research Center.Materials and Methods: In this cross-sectional study, 150 infertile women from Vali-e-Asr Infertility Clinic and 150 fertile women from Imam Khomeini Hospital’s Gynecologic Clinic were selected. Research tools included Symptom Checklist-90-Revised (SCL-90-R), Eysenck Personality Questionnaire (EPQ) and a structured researcher-devised questionnaire. Results: Noticeably, 44% of the infertile and 28.7% of fertile women were suffering from psychiatric disorders. The highest scores among infertile women upon SCL-90-R assessment were for paranoid ideation and depression, interpersonal sensitivity and the lowest scores were for psychoticism and phobic anxiety. Interpersonal sensitivity, depression, phobic anxiety, paranoid ideation and psychoticism scales were significantly more prevalent in infertile than fertile women (p<0.05). Additionally, emotionally unstable personality disorder was more prevalent among infertile than fertile women, based on Eysenck Personality Questionnaire (p<0.001). Conclusion: The higher prevalence of psychiatric disorders in infertile women demands serious psychological support and attention by the medical team. Developing a rapid and reliable screening instrument for identifying patients at greater need for psychological support and the inclusion of counseling and supportive psychotherapy in the general therapeutic framework of infertility are of great importance. 

Introduction: Practicing surrogacy without proper consultations with the two concerned parties, may poses surrogate mothers to psychological and behavioral problems during pregnancy, delivery, and postpartum. This study aims to underline possible risks and problems faced by surrogate mothers and it tries to take care of them by persuading to hold decent preliminary consultations. Materials and Methods: This paper reviews the published literatures during 1987 - 2008, and it covers domestic resources as well as foreign ones and focuses mainly on legal and cultural issues surrounding surrogacy and surrogate motherhood. Results: The reviews showed that the physicians or the counselors should explain the ethical and legal issues and medical risks related to surrogacy, as well as disclose benefits from this act to both parties during counseling sessions. Possible referral of both parties for mental health consultation must be available before surrogacy process is started. The potential surrogate mothers should understand the importance of a written agreement consisting of terms, preconditions and possible future incidents. Conclusion: It seems that consultation and clarification of probable contingencies faced during the surrogacy process greatly help surrogate mothers experience the period with an altruistic feeling to help the intended couples. Organizing a consulting team composed of clinicians and health experts with various expertise is recommended to cover all dimensions of surrogacy including its medical, psychological, religious, legal, and social aspects.

Introduction: Placenta increta is an uncommon and life-threatening pregnancy complication. This disorder usually is presented with vaginal bleeding during difficult placental removal in the third trimester of pregnancy. However, the disorder may cause some other complications such as abortion at the first or second trimesters of pregnancy too, which make its diagnosis more difficult. This report discusses a case of hysterectomy due to placenta increta at the first trimester of pregnancy. Case Presentation: A 34-years old woman was admitted to Imam Reza Hospital in Mashad, with a history of severe vaginal bleeding. Evacuation curettage had been done due to incomplete abortion at her first admission in another hospital 18 days ago. She had a history of two previous cesarean sections too. Curettage was done to control the severe hemorrhage with a probable diagnosis of incomplete uterine evacuation. Since hemorrhage was not controllable, the patient was consulted for hysterectomy. Afterwards, the pathology report confined the diagnosis, reading “Lower uterine segment with placenta increta”.Conclusion: Women with a history of previous caesarean sections are at risk for abnormal placentation. The condition is prone to complications such as uncontrollable vaginal bleeding in the first trimester which might necessitate immediate hysterectomy because of the complications due to abnormal nature of placenta increta.

Introduction: Gonococcal infection is one of the most common bacterial infections, especially in developing countries, but limited information is available about its prevalence in fertile and infertile women in Iran. Therefore, this study was set up to determine the prevalence of the disease in the aforementioned populations in Tehran.Materials and Methods: In this cross-sectional study, 209 infertile women as the cases, and 170 pregnant women in the third trimester of pregnancy as the controls, were evaluated for signs and symptoms of gonococcal infection through interviews. A first-catch urine sample (15ml) was collected from each subject for the detection of Neisseria gonorrhea by PCR method. The data from questionnaires and molecular evaluation were statistically analyzed.Results: PCR testing on urine specimens of fertile and infertile women showed no Neisseria gonorrhea infections.Conclusion: Absence of Neisseria gonorrhea infection in infertile and pregnant women in Tehran could signify the success of health initiatives and preventive measures taken in Iran.