International Journal of Reproductive BioMedicine
Year:2005 | Volume:3 | Issue:2|Papers Count:8

Ovarian hyperstimulation syndrome (OHSS) is a unique iatrogenic complication of controlled ovarian stimulation (COH)/in vitro fertilization (IVF) in reproductive endocrinology occurring during the luteal phase or early pregnancy. It can have a serious impact on the patient’s health. With the expansion of the assisted reproductive techniques (ART) from 1978, the incidence of OHSS is increasing worldwide.OHSS is characterized by gastrointestinal symptoms, ovarian enlargement, fluid shift to the third space, and hemoconcentration. Severe cases are associated with thromboembolic phenomena, respiratory distress, liver dysfunction and renal failure. OHSS is more common among women who are young, thin and have PCOS or multiple allergies. Vascular endothelial growth factor (VEGF) and other cytokines are pivotal in the pathogenesis of OHSS. In the prevention of any disease, it should be emphasized that the possibility of primary prevention depends on two main requirements, first, the etiology of the disease and predisposing factors; and second, it must be feasible to avoid or manipulate such factors as paint of a prevention strategy. This strategy for preventing OHSS and its severity have included prediction of women at risk; the first step in prevention is identification of patients at risk by the recognition of risk factors. As this is not always possible, there are several ways of avoiding developing of the syndrome. The stimulation phase has to be carefully monitored (regular ultrasound and estradiol measurements), and further interventions need to be implemented if signs of hyper-response are present. The aim of this systemic review of the literature is to answer this question: “can we prevent severe OHSS”. Canceling the cycle, modification of method to trigger ovulation administration of      macromolecules, coasting approach, timed unilateral or bilateral aspiration of one or two ovaries performed before or after hCG administration, In vitro maturation (IVM), elective cryopreservation of all embryos, and laser or electrocautery of one or both ovaries, have been showed to be associated with a reduced risk of OHSS by some research groups. The effect of combined method should be assessed. Finally, apart from canceling, none of these approaches was totally efficient, although most of the above-mentioned methods decrease the incidence in patients at high risk of OHSS, but overall “prevention is the ideal treatment of OHSS”.      

Background: Retinoids have been suggested to play a role in oogenesis and oocyte survival. Objective: In the present study the effects of retinol palmitate were investigated on differential follicular counts in response to superovulation as well as follicle quality after vitrification of ovaries. Materials and Methods: Ten, 4 week old female BALB/c mice were randomly assigned to either paraffin (n=5) or retinol palmitate (n=5) administration. Vitamin A administered animals received (i.p.) 250 IU retinol palmitate, dissolved in 0.1 ml of paraffin oil on days one and ten followed by superovulation with 10 IU PMSG. Paraffin administered mice were only treated with 0.1 ml of paraffin oil. The collected left ovaries from both paraffin and vitamin A administered groups were considered as non-vitrified and the collected right ovaries from both treated groups underwent vitrification. Ovaries in the vitrified group were frozen sequentially by placing into two vitrification solutions {VS1: 10% ethylene glycol (EG), 10% DMSO in holding medium (TCM-199 + 20% FBS: HM) and VS2: 20% EG, 20% DMSO in HM}. After warming, recovered ovaries as well as non-vitrified ovaries were serially sectioned and examined histopathologically. Results: The proportion of antral follicles in the non-vitrified ovaries from vitamin A administered mice was statistically higher than the non-vitrified ovaries from paraffin administered group (29.4% vs. 15.6%, respectively; p<0.001). No difference due to retinol palmitate injection was observed for the rate of small follicles between the two non-vitrified groups. The percentage of damaged follicles did not show any significant differences between the two vitrified groups (76% vs. 79%). Conclusions: Our results demonstrate that administration of retinol palmitate may improve the response to superovulation through the shift of follicular growth towards antral follicle development. However, no positive effect of retinol palmitate in the quality of follicles is probable when ovaries are vitrified.    

Background: Polycystic ovary syndrome (PCOS) is related to obesity and to major metabolic alterations including both insulin resistance and beta-cell dysfunction. Ghrelin was identified as the endogenous ligand for the growth hormone secretagogue (GHS) receptor. The actions of ghrelin are carried out through interaction with specific receptor, named GHS-R.Objective: In a case-control study, we compared the expression of ghrelin and GHS-Rs mRNA by Quantitative Real-time PCR method in studied groups in order to determine the role of ghrelin and GHS-Rs in pathogenesis of PCOS.Materials & Methods: Follicular fluid samples were obtained at oocyte collection from 22 patients undergoing IVF-ET as control and 11 patients were diagnosed as having PCOS. Total RNA was extracted from isolated follicular fluid cells and 2µg RNA was diluted and reverses transcribed using random primers and Superscript II. Specific primers for the ghrelin, GHS-R1a and GHS-R1b were designed. Samples were run in triplicate on an ABI Geneamp 5700 sequence detection system. They were subjected to 40 cycles of amplification under condition 92°C- 20s and 62°C-1min using 3µl diluted cDNA (1:7), 10µl 2X SYBR green, 3µl diluted cDNA. β-actin mRNA was assayed and then normalized to total RNA measurements for each sample. Results: Age, weight and resulting pregnancies did not vary between PCOS and non-PCOS patients, whereas the BMI and serum testosterone level of PCOS were significantly higher than non-PCOS patients. Quantitative real-time RT-PCR showed that mRNA for ghrelin and GHS-R 1b were detectable in follicular fluid cells from all patients. We failed to find mRNA for GHS-R 1a in any of follicular fluid cells. There were no significant difference in ghrelin and GHS-R1b mRNA expression levels between PCOS and non-PCOS groups. Conclusion: Our findings indicate that ghrelin and ghrelin receptors may not be considered risk factors for pathogenesis of PCOS.      

Background: In vitro maturation (IVM) of oocytes is a promising technique to reduce the costs and avert the side-effects of gonadotropin stimulation for in vitro fertilization (IVF). The pregnancy rates from oocytes matured in vitro are much lower than those of in vivo stimulation cycles, indicating that optimization of IVM remains a challenge. Objective: In this study, we investigated the effect of cumulus cells on maturation and fertilization rate of immature oocytes (Germinal vesicle). Materials and Methods: Germinal vesicle (GV) oocytes were recovered from 6-8 weeks old Balb C female mice 48hr after injection of 10 IU pregnant mare serum gonadotropin (PMSG). Collected oocytes were divided into two groups. Group A: GV oocytes without cumulus (denuded oocyte). Group B: GV oocytes with cumulus cells (cumulus-oocyte complex). The oocytes in both groups were cultured in TCM-199 medium in a humidified atmosphere of 5% CO2 in air at 37ºC. The maturation, fertilization and developmental rates were recorded after 24hr. Results: Maturation, fertilization and developmental rates in denuded oocytes (DO) were 65.1%, 68.02%, 78.63% respectively, and in cumulus-oocyte complex (COC) were 78.20%, 85.57% and 85.05%, respectively. The maturation, fertilization and developmental rates of COC were significantly higher than those of DO (p<0.05). Conclusion: The results show that cumulus cells have beneficial effects on maturation, fertilization and cleavage rates of mice oocytes.      

Background: In the field of mammalian embryo culture, the putative influence of autocrine/ paracrine factor(s), produce by the embryos itself, is under investigation. A smaller medium drop can prevent dilution of this factor(s). Objective: The objective of this study was to examine the effect of culture medium volume on in vitro development of mouse 2-cell embryos. Materials and Methods: The embryos were obtained from female NMRI mice. To evaluate the effect of medium volume, groups of 16-20 late 2-cell embryos were cultured in 2, 5, 10, 20, 50 and 100 µl of drops of Ham’s F10 medium for 72 h. Results: Development to blastocyst stage in 50 and 100 µl of drop were significantly higher than this in any other volume (p<0.001). Almost a similar pattern was also observed for hatched blastocyst formation. However, the total number of cells in blastocysts, developing in different volumes, were not significantly different. Conclusion: These results indicate that the optimal volumes of Ham’s F10 medium for mouse early embryo development are 50 to 100 µl. However, volumes as small as 2 µl can successfully support mouse 2-cell embryo development to blastocyst and hatching stages.      

Background: About 90% of the world’s contraceptive users are women. This gender-based usage has occurred due to the emphasis of family planning programs and contraception research. Condom, vasectomy and withdrawal are the only male contraception devices available with less assurance for men. For new male contraceptive to have an impact, they must be acceptable to both men and women, as well as effective. A hormonal method will likely come to the market within the next few years.  It is necessary to use biologically active botanical substances or fertility-regulating agents of plant origin which are ecofriendly. Objectives: The epididymis is a site which can be exploited for male contraception without undue side effects. It was therefore of interest to investigate the effect of biologically active botanical ecofriendly plants such as Azadirchta Indica (neem) seed alcoholic extract as an efficient and competent male contraceptive on male mouse epididymis. Materials and Methods: In this experimental case control study sixty adult healthy mice divided into two groups of 40 as the control and 20 as the treated group. The treated group was administered by Iranian Botanical Azadirachta Indica seed alcoholic extract, cultivated at Dashteh Moghan (Ardabil province). The seeds were extracted with ethanol then administered first 50 mg/kg body weight /day then 100 mg/kg body weight/day orally for 15 days, following WHO guide lines (MB-50). The target organ, epididymis parameters viz. sperm motility, sperm count fertility rate, Scanning Electron Microscopic (SEM) morphology of spermatozoa and ATPase activity of epididymis of the two groups were compared. Results: The 50 mg/kg body weight (BW)/day showed no significant change in epididymal sperm motility, as compare to the control. Therefore the dose was changed to 100 mg/kg BW/day for 15 days. The body and organ weights (epididymis) of the treated animals were not significantly changed as compare to control group (p>0.05). The treatment brought about a significant reduction in fertility rate when normal cycling female mice were mated with treated males (p<0.001). Decline in ATPase activity in caput and cauda epididymis was observed (p<0.001). SEM photographs showed spermatozoa with abnormal head and bent mid-piece region. Conclusion: Decrease in ATPase activity could be attributed to androgen dependent parameters. However, the fertility rate was also significantly reduced which can be due to the decrease in cauda epididymal sperm motility and their morphological abnormalities. Since the effect on epididymal sperm motility and morphology was manifested in short period of 15 days, it is evident that the extract has potential as an antifertility agent. As this extract do not cause change in the body and organ weight, it is likely that no effect occurred on electrolyte balance.    

Background: Knowledge of infertile couples about assisted reproductive technology is a fundamental parameter to optimize the infertility treatment and conduct it cooperatively. Objective: To evaluate knowledge and attitude of infertile couples about assisted reproductive technology we designed a descriptive cross-sectional study. Materials and Methods: 400 infertile patients were investigated by a self- administered structured questionnaire about demographic data, infertility history, and several relevant variables in an out patient infertility clinic of a university hospital. The main outcome measurements included scoring the answers in the questionnaire regarding knowledge, and grouping the answers regarding attitude. Resulted data were analyzed in relation to patient’s gender and treatment history, and educational, ethnic and religious groups. Results: Of 400 cases (251 women and 149 men) 167 patients (41.7%) were scaled to have good knowledge and 223 patients (55.7%) had a poor knowledge about ART. 74.6% of patients with advanced education and 30.3% of patients without advanced education were scaled to be good in knowledge. 45.6% of men, 43.4% of women and 64.8% of patients with a history of passing previous ART cycles had a good knowledge. The source of information was mentioned to be the ART centers in 73% of cases. 95% of patients disagreed to have sperm or ovum donation or to undergo surrogacy. 22% of all patients (27.5% of women versus 12.1% of men) agreed with embryo reduction. 94.5% of patients mentioned the ART expenses not to be affordable readily.  Conclusions: Less than half of patients presented to be knowledgeable about ART. Not a great portion of the patients agreed with sperm donation. ART expense is mentioned to be burdensome by nearly all of the patients.    

Background: Recent studies of uterine contractility in IVF-embryo transfer led us to consider an alternative,and possibly complementary, explanation for the high implantation rates of blastocysts. It has been demonstrated that myometrial contractile activity influences embryo implantation, possibly through mechanical displacement of embryos. Objective: The aim of this study was to examine the effect of nitroglycerine (NTG) treatment for priming the uterus on the pregnancy outcome of ICSI-ET programs. Materials and Methods: This study was a prospective, randomized, double-blinded placebo-controlled clinical trial. One hundred consecutive cycles of ICSI-ET on infertile couples were randomly divided into treatment and control groups. The treatment group (50 cycles) received an oral dose of 0.4 mg of NTG, and the control group (50 cycles) received a placebo, 15 minutes before fresh ET. An informed consent from was obtained form each patients. The main outcomes were implantation rate (IR) and pregnancy rate (PR). Results: The mean age of females in the control group and in the treatment group were 30.1±5.1 and 31±5.5 years respectively. Data showed that the mean duration of infertility was not significantly different between control and treatment groups (6.6±5.8 versus 7.8±5.1 years, respectively). The mean number of oocyte retrieval (metaphase II), 2pn, embryo cleaved, embryo transferred and PR weren't different between two Groups (p>0.05). Overall PR was 36%, it was 38% in treatment group and 34% in control group but there wasn’t statistically significant difference between two groups. (p>0.05) Conclusion: NTG didn't increase PR compared to placebo group. These results suggest that NTG treatment before ET isn't effective in the priming of a uterus.