International Journal of Fertility & Sterility
Year:2025 | Volume:19 | Issue:1|Papers Count:14

The fertility preservation (FP) is a paramount concern for oncology patients and should be regarded as an essentialcomponent of their overall cancer management strategy. The magnitude of this issue has been recognized in FPguidelines. The formulation and execution of harmonized guidelines and policies concerning the provision of FPservices, inclusive of therapeutic strategies and standardization of procedures, are crucial to surmount disagreementsregarding the delivery of these therapeutic services and avert delays in cancer treatment. The matter of FP andthe methodology for managing the treatment and follow-up of cancer patients should be documented as a componentof their management guideline, thereby providing patients with clear recommendations on fertility preservation.In this manuscript, we provide a succinct overview of existing international guidelines history and referencecomprehensive networks of FP services for oncology patients. Furthermore, we present the Royan Institute’sguideline specifically designed for preserving the fertility of female oncology patients.

Background: The effectiveness of changing the type of luteal phase support in patients with poor ovarian response(POR) remains unclear based on the available evidence. This study aimed to compare the effectiveness of variousluteal phase support (LPS) methods, including progesterone alone, human chorionic gonadotropin (hCG) alone,and the combination of progesterone with hCG, in these patients.Materials and Methods: In this randomized clinical trial, 375 patients diagnosed with POR based on the Bolognacriteria underwent intracytoplasmic sperm injection-embryo transfer (ET) cycles at the Royan Institute betweenNovember 2015 and June 2019. The patients were allocated randomly into three different LPS groups on the day ofoocyte pickup. In the first group, 1500 IU of hCG on the ET day, as well as 4 days after that were administrated intramuscularly.In the second group, the patients received 1500 IU of hCG IM on the ET day, as well as 3 and 6 daysafter the ET along with vaginal progesterone suppositories of 400 mg twice daily. For the third group, only vaginalsuppositories twice daily were administrated from the day of oocyte pick up until the pregnancy test day. The clinicalpregnancy, miscarriage and live birth rates were compared among groups using appropriate statistical tests.Results: The data analysis indicated that the three groups were comparable, and there were no significant differencesamong the groups in terms of implantation, clinical pregnancy, miscarriage, and live birth rates. The twinpregnancy rate in the hCG-only group was higher than in the other two groups, although this difference did notreach statistical significance (P=0.060).Conclusion: Similar pregnancy and live birth rates were observed among different LPS regimens. Interestingly,the use of two boluses of low-dose hCG (1500) was associated with a slight increase in multiple pregnancies. Wesuggest this effective method, which is easier and more patient-friendly (registration number: NCT02798653).

Background Given pregnant mothers' high frequency of vitamin D (25(OH)D) deficiency and the potential consequences for the health of the unborn child. Prenatal vitamin D administration raises maternal and baby 25(OH)D levels.Aims to assess the 25(OH)D supplementation effects on rate of clinical pregnancy and miscarriage in women with hyper androgenic polycystic ovarian disorder. Methods A prospective study was conducted on 200 patients with hyper androgenic polycystic ovarian disease, at outpatient infertility clinic, Menoufia University Hospital during from March 2021 till March 2022. The cases divided into group (A) included 100 women given a therapeutic dose of 25(OH)D supplements, while group (B) included 100 women didn't given 25(OH)D supplements. Results duration needed to reach follicle ≥18 mm was significantly higher among group B (16.74±2.57), compared with group A (13.40±2.12). While, midluteal progesterone was significantly higher among group A (19.63±2.12), compared with group B (17.74±2.36), (P<0.001). Our results indicate that women who have enough 25(OH)D are far more likely to get clinically pregnant than those who had deficiency of 25(OH)D.Conclusion More research is necessary to determine whether vitamin D supplementation can increase pregnancy rates in a simple and economical manner. In our study population, there was a significant prevalence of 25(OH)D deficit or insufficiency. Determining 25(OH)D status as part of a routine infertility assessment may therefore be advantageous.

Background: T-shaped uterus is a subclass of dysmorphic uteri according to the European Society of Human Reproductionand Embryology (ESHRE) classification. A T-shaped uterus might be related to poor reproductive outcomesor pregnancy complications. We aim to compare the success rates of in vitro fertilization (IVF) between individualswith a normal uterus and those with a T-shaped uterus identified through Hysterosalpingography.Materials and Methods: A retrospective cohort study was done in Royan Institute, Iran, in April 2020-April 2021.In line with the criteria for inclusion and exclusion, 468 cases were selected. Inclusion criteria were as follow: womenof 20-45 years old, primary infertility, no repeated implantation failure (RIF), embryo quality “grade A” or “grade B”(freeze), and no consumption of smoking or alcohol. Patients with uterine fibroid, polyp, metabolic disorders, previousuterine surgery were excluded. Based on the hysterosalpingography (HSG) images, the patients were categorizedas: “T-shaped uterus” or “normal uterus”. IVF outcomes including positive or negative chemical pregnancy wereentered into SPSS software. Using the Chi-square test, the success rate of IVF in those groups was compared.Results: Of 468 cases, 91 cases had T-shaped uterus and 377 cases had normal uterus. The mean age of patients was34 ± 3. The frequency of positive chemical pregnancy in the T-shaped uterus group was 42.9%, but 48% in the normaluterus group. The distribution of positive clinical pregnancy was 34.06% in the T-shaped uterus group and 46.1% inthe normal uterus group. The distribution of failed pregnancies was 20.5% in women with T-shaped uteri and 19.8%in the normal uterus group (P=0.867). There was no significant difference observed between the two groups.Conclusion: The success rate of IVF and pregnancy outcomes of patients in the T-shape and normal groups were notfound to be statistically significantly different.

Background: Reproductive dysfunctions of polycystic ovary syndrome (PCOS) and blood anti-mullerian hormone(AMH) concentration are significantly influenced by the dietary advanced glycation end products (AGEs). The interplaybetween AGEs and their soluble form of receptor, might exert a protective role on the follicular environment andaffect AMH concentration. This study investigated the relationship between soluble receptor for advanced glycationend-products (sRAGE) levels in follicular fluid (FF) and serum AMH levels in PCOS and non-PCOS women.Materials and Methods: Among 43 women of reproductive age who participated in this case-control study 26 non-PCOS women were assigned to the control group, while 17 participants were diagnosed with PCOS and allocatedto the case group. Prior to the in vitro fertilization (IVF) procedure, fluid samples were collected and levels of FFsRAGEs and serum AMH were recorded through the use of commercially available ELISA kits.Results: Correlation analysis, without age adjusting, revealed a statistically considerable and positive associationbetween FF sRAGE and serum AMH concentration in PCOS women (P=0.012, r=0.596). Moreover, after age stratification,the same pattern was observed in some age groups; in PCOS women aged 40 years or older (r=1, P<0.001), aswell as those younger than 30 years (r=0.922, P=0.003), correlation analysis demonstrated a significant and positiverelationship between FF sRAGE and serum AMH levels.Conclusion: The association between sRAGE and AMH in women with PCOS is primarily affected by their age,whereas non-PCOS women showed no relationship. The results show that the levels of these receptors (sRAGE)show their specific effects in young women and women over 40 years old and not in middle age and target the ovarianreserve. It seems to act as a defensive shield in older women and increase fertility in young women.

Background: Unexplained recurrent miscarriage (RM) is still an unsolved reproductive health problem. Inheritedthrombophilias have been one of the causes. Mutation in genes encoding coagulation proteins, including prothrombin(PT G20210A) and methylenetetrahydrofolate reductase (MTHFR) genes, increase tendency for venous thromboembolism.This study aimed to evaluate association between polymorphisms in prothrombine and MTHFR genes withRM. We also evaluated association between protein C (PC), protein S (PS), antithrombin III (ATIII), and homocystienewith RM.Materials and Methods: We conducted a case-control study on women with history of miscarriages and healthycontrols. Genetic analysis was done using (TaqMan) polymerase chain reaction (PCR) technique and the othertests were performed to check general health indications and thrombophilia markers.Results: In this study, 195 RM group (group I) participants and 90 healthy controls (group II), PC, PS, ATIII deficiencyand Hyperhomocysteinemia were in 7.2, 65.6, 9.2, 10.8% of group I respectively, but was 1.1, 7.8, 2.2, 2.2% of groupII. PT G20210A showed two in group I were A/G, no A/G in group II, and no AA carrier in the either group. G allelewas observed in 99.5% of the group I and 100% of the group II, while A allele was detected in 0.5% of group I. MTHFRC677T gene showed C/T mutation in 33.3% of group I and 32.2% of group II, while T/T mutation was detected in 12.8%of group I and 8.9% of the group II. C allele was found in 70.5% of group I and 75% of group II, while T allele was foundin 29.5% of group I and 25% of group II (P=0.269).Conclusion: PT G20210A and MTHFR C677T gene mutations are not correlated with RM in the Egyptian population.However, Egyptian women with RM are strongly associated with hyperhomocysteinemia, PC, PS, and ATIII deficiencies(registration number: NCT03209063).

Background: Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine conditions that significantlyimpact the life quality of reproductive-aged women. In the Indian population, its prevalence varies from 3.7 to 22.5%depending on ethnicity and diagnostic criteria. Chronic inflammation plays a pivotal role in PCOS pathogenesis.The monocyte chemoattractant protein-1 (MCP-1) is an important chemotactic factor for inflammatory response ofmonocytes. Genetic variations in the MCP-1 gene may modulate MCP-1 expression. Although the association of theMCP-1 promoter polymorphism (-2518A/G) was extensively studied in different inflammatory conditions, there isonly one report in PCOS conditions. Since no study was reported from the Indian population, we aimed to explore theassociation of the MCP-1 -2518A/G polymorphism (rs1024611) with PCOS.Materials and Methods: In this case-control study, to analyse the distribution and association of rs1024611 with PCOS,polymerase chain reaction-fragment length polymorphism (PCR-RFLP) analysis was carried out in 202 patients whoexhibited PCOS from menarche onwards or with higher severity of symptoms and 122 age-matched controls.Results: In our study, no significant correlation was observed in rs1024611 polymorphism with PCOS patients incomparison with control. In addition to this, we found no significant difference in the genotype and allele frequenciesbetween obese and non-obese PCOS patients.Conclusion: Our finding suggests that the MCP-1 -2518 A/G polymorphism has not been associated with PCOSpredisposition.

Background: Over the past decade, numerous studies have been conducted to determine the role of homocysteineand methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms in the pathogenesis of polycystic ovary syndrome(PCOS), yet the results are inconsistent. The aim of the current study was to determine the association betweenhomocysteine levels (Hcy), MTHFR C677T and A1298C polymorphisms, and pregnancy outcomes in Georgianwomen with PCOS.Materials and Methods: This case-control study included 177 female participants, of which 96 women werediagnosed with PCOS, and 81 age-matched women were without PCOS. Participants were divided into fourgroups; group I: 59 PCOS patients with history of recurrent pregnancy loss (RPL), group II: 37 PCOS patientswith live birth in history and without RPL, group III: 39 women with RPL, without PCOS, group IV: controls,42 women with live birth in history, without RPL and PCOS. These groups were compared based on their serumHcy and the presence of two common single nucleotide polymorphisms (SNPs) in the MTHFR gene: C677T andA1298C.Results: The mean Hcy, frequency of hyperhomocysteinemia (Hhcy) and the prevalence of C677T and A1298Cpolymorphisms in MTHFR gene in PCOS patients were significantly higher than those without PCOS (P<0.05).Group I (PCOS with RPL) showed significantly elevated Hcy (13.7 ± 2.7) compared to group II (10.3 ± 2.6),group III (11.5 ± 2.3), and group IV (7.3 ± 2.2), P<0.001. In group I, the frequencies of the C677T-CT, A1298CACgenotypes, and the compound heterozygous of C677T-CT/A1298C-AC were significantly higher than in theother groups (P<0.05). The prevalence of MTHFR A1298C (CC) was significantly higher in group II (PCOSpatients with live birth) than in other comparison groups (P<0.05).Conclusion: The study reveals a significant correlation between hyperhomocysteinemia, MTHFR polymorphisms(C677T and A1298C), and PCOS, impacting pregnancy outcomes.

Background: Chromosomal mosaicism, a phenomenon observed in a minority of embryos, showcases its prevalenceand inherent unpredictability, leading to variations in embryo mosaic rates across different centers. This research endeavorsto assess the prevalence of mosaicism and its characteristics within the scope of our preimplantation genetictesting-A (PGT-A) services in Indonesia. Specifically focusing on our center’s experience since 2020, this study aimsto elucidate mosaic rates among embryos in our care.Materials and Methods: In a retrospective approach, we collected secondary data sourced from our PGT-A outcomesdating back to 2020. A total of 196 embryos underwent analysis, their characteristics were documented and presenteddescriptively. Notably, the incidence of specific chromosome abnormalities was outlined. We assess a comparativeanalysis to investigate the relationship between mosaicism and its corresponding clinical characteristics.Results: In the analysis of 196 embryos, 106 (54.1%) displayed chromosomal anomalies spanning from low-levelmosaicism to whole chromosome aneuploidy. Low mosaicism was observed in 25 (12.8%) of the embryos, while highmosaicism was identified in 8 (4.1%) embryos. Notably, low-level mosaicism predominated in chromosome 9 (n=10,5.1%), whereas abnormality prevalence was highest in chromosome 21 (n=20, 10.2%). Statistical analysis revealedno significant disparity in mean maternal age among embryos with low-level mosaicism, high mosaicism, and normalchromosomes (33.88 vs. 35 vs. 33.26 years old, respectively). However, a statistically significant difference inmean maternal age (35.84 vs. 33.26 years) was observed between embryos with aneuploidy (monosomy or trisomy)and those with normal chromosomes. Furthermore, a significant difference in high mosaicism rates was detected inpatients with unexplained infertility (P<0.05).Conclusion: In contrast to the study conducted elsewhere, our center had a higher mosaicism rate. Chromosomes 9,8, and 6 were the most frequently affected. There was a significant difference in the high mosaicism rate for PGT-Arelatedunexplained infertility causes.

Background: The immunologic factors are the chief reason for recurrent pregnancy loss (RPL) and induction ofmaternal-fetal tolerance is the main treatment for this cause of RPL, but the effect of this method is uncertainly andneeds multiple doses and/or interventions. The aim of this study was to investigate whether a single administrationof transforming growth factor-β1 (TGF-β1) can improve the pregnancy outcomes of RPL mice and whether theimprovement is cause by TGF-β1 driving the expression of immune tolerance molecule indoleamine 2,3-dioxygenase(IDO).Materials and Methods: In this experimental study, 40 RPL model mice were equally divided into a control group,that received 0.01 M phosphate-buffered saline (PBS), and a treatment group, that received PBS containing 2, 20, and200 ng/ml TGF-β1 via tail vein injection. The mice were sacrificed at 13.5 days of pregnancy and the embryo resorptionrate was determined. The expression of IDO, TGF-β1, and TGF-β3 were detected in the placenta using westernblotting and immunohistochemistry techniques.Results: The expression of IDO was positively correlated with TGF-β1 in the placental tissue of RPL mice (r=0.591,P<0.001). In all treatment groups, the embryo resorption rates were significantly lower than the control group andthe expression of IDO in the placental tissue of all treatment groups was significantly higher than the control group.The expression of TGF-β1 increased gradually from, 2, 20 to 200 ng/ml in treatment groups, and the concentrationof exogenous TGF-β1 positively correlated with the expression of TGF-β1, in placental tissues in treatment groups(r=0.372, P=0.018).Conclusion: Exogenous TGF-β1 improves pregnancy outcomes in RPL mice, and the possible therapeutic mechanismis that exogenous TGF-β1 induces the persistent expression of endogenous TGF-β1 and IDO due to mutuallyinduced expression of the other. This experiment may provide a new direction and idea for the future treatment ofRPL patients.

Background: The utilization of decellularized extracellular matrix (dECM) derived from animal testis tissue hasdemonstrated potential as a component of tissue-specific scaffolds. Current research is mostly centered arounddECM as a natural resource for culturing testicular cells. This study aimed to assess firstly the comparison ofVoytik-Harbin (VH) and Frytes protocol in creating Ram’s dECM testis hydrogel and secondly the evaluation ofthe best protocol effect on in vitro spermatogenesis.Materials and Methods: In this experimental study, the six testes of mature rams were decellularized and the hydrogelproduction was performed by i. The Frytes protocol utilized a concentration of 1 mg/mL of pepsin, dissolvedin either 0.1 or 0.01 M HCl, and ii. The VH protocol was involved 10 mg of pepsin per 100 mg of ECM in 0.5 M ofacetic acid. Subsequently, mouse testicular cells were cultivated on collagen hydrogel as the control and the moreeffective testicular-derived hydrogel (TDH) to evaluate the early stages of in vitro spermatogenesis.Results: While the Freytes protocol produced a homogeneous pre-gel solution with both HCl concentrations; elevatingthe pH to 7.4 loosened the hydrogel and made gelation problematic. In contrast, the VH protocol solidifiedthe hydrogel and produced a strong hydrogel due to its gelation consistency. Furthermore, the prepared hydrogel byVH with 25 mg of dECM had a significantly higher priority in terms of rheology and structure (P<0.05). Followingmouse testicular cell culture, TDH and collagen hydrogel did not differ significantly in terms of cell survival ratesand the mRNA expression of early spermatogenesis genes.Conclusion: Using the VH protocol for producing ram TDH resulted in a firm hydrogel with a high frequency ofrepeat, which may be suited for testicular cell growth.

Background: Oxidative aggression is a hallmark of varicocele and may depend on decreased reactive ability ofthe endogenous antioxidant system following heat stress. We aimed to investigate the underlying mechanisms.Therefore, the expression of the main enzyme proteins involved in the generation of endogenous antioxidant power,cystathionine beta-synthase (CBS), cystathionine gamma-lyase (CSE), heme oxygenase (HO-1), and also, some ofthe metabolites (methionine, homocysteine, taurine and vitamin B6) reporting on their activity was investigatedusing a surgical varicocele model in rats.Materials and Methods: In this experimental study, thirty male Wistar rats (7-8 weeks old, weighing 180-220 g)were divided into three groups: control, sham, and varicocele. We evaluated sperm parameters and functional tests,as well as the expression of CBS, CSE, and HO-1 proteins using Western blot analysis. Serum levels of methionine,homocysteine, and taurine were analyzed through high-performance liquid chromatography, while vitamin B6concentrations were measured using enzyme-linked immunosorbent assay. For group comparisons, we employedANOVA and the Tukey test, considering a P<0.05 as significant.Results: We observed a significant reduction in both sperm quality and functional parameters. Additionally, therewas a notable decrease in the expression of CBS, CSE, and HO-1 proteins, as well as circulating vitamin B6 levels,in the varicocele group compared to the control and sham groups (P<0.001).Conclusion: The results of this study suggest that one possible cause of increased oxidative stress in varicocelemay be the reduced expression of testicular enzymes involved in the production of endogenous antioxidants, whichare associated with the transsulfuration pathway. However, further studies are needed to confirm these findings.

Background: Diabetes mellitus (DM), one of the most pervasive and enduring metabolic diseases, has been demonstratedto adversely impact male fertility. Conversely, both exercise training and Chrysin have been identified aspotential interventions capable of mitigating the deleterious effects of diabetes on spermatogenesis. Thus, the currentstudy aims to explore the individual and combined influences of Chrysin supplementation and running exerciseon oxidative stress and germ cell apoptosis in the testicular tissue of diabetic adult rats.Materials and Methods: In this experimental study, the DM was induced by streptozotocin (STZ,50 mg/kg). Ratswere divided into control (received STZ solvent), DM-sole, Chrysin-sole (50 mg/kg, daily), moderate-intensityrunning exercise training (MIRET-sole, warm-up, 5 minutes at 30% of Smax1 (Maximum speed); Moderate intensityexercise, 60 minutes at 60% of Smax1, and recovery, 5 minutes to 30% of Smax1), DM+Chrysin, DM+MIRET,and DM+MIRET+Chrysin. Following 8 weeks, the histopathological changes (Johnson’s score, epithelial height,and tubular diameter), testicular malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase(GPX), and the mRNA levels of anti-apoptotic gene Bcl-2 and pro-apoptotic gene Bax was analyzed.Results: Chrysin solely and simultaneous with MIRET could remarkably (P=0.001) improve the DM-induced histopathologicaldamages, increase the testicular SOD and GPx levels, and decline the DM-increased MDA content.Moreover, our results showed that Chrysin solely and more simultaneously with MIRET could significantly (P=0.001)decrease the mRNA expression of Bax and improve the Bcl-2 expression and rebalance the Bax/Bcl-2 balance.Conclusion: Our findings showed that co-administration of Chrysin along with MIRET can significantly amelioratethe DM-induced histopathological, and biochemical impairments and reduce the pro-apoptotic impact of DMon testicular tissue.

Background: Despite remarkable advancements in the use of embryo donation, concerns havearisen regarding its potential effects on the psychological well-being of children conceivedthrough this assisted reproductive technology and their parent-child relationships.  Method: In a cross-sectional analytical study, the psychological adjustment of 31 children aged3 to 7 born through embryo donation was assessed and compared to 30 age-matched childrenfrom families who conceived naturally using the Strengths and Difficulties Questionnaire.Parenting styles within these families were also evaluated using the Baumrind Parenting StylesInventory through clinical interviews.  Results: Although 8 out of 31 children born through embryo donation (25.8%) and 3 out of 30children from natural conception families exhibited psychological maladjustment, this differencewas not statistically significant. Furthermore, parenting styles did not significantly differbetween the two groups.Conclusion: The absence of genetic parent-child relationships does not appear to be a dominantfactor influencing the psychological adjustment of children or parenting styles.