International Journal of Reproductive BioMedicine
Year:2007 | Volume:5 | Issue:3|Papers Count:10

Endometriosis is a common gynaecological disease that can cause severe pelvic pain such as dysmenorrhoea and dyspareunia, however the mechanisms by which pain is generated are not well understood. Nerve fibres in endometriotic plaques have been reported by several authors. We have recently demonstrated the presence of unmyelinated sensory nerve fibres (using the pan-neuronal marker PGP9.5) in the functional layer of endometrium in women with endometriosis and a significantly increased nerve fibre density in endometrium and myometrium in women with endometriosis compared with women without endometriosis. Sensory C nerve fibres were only detected in the functional layer of endometrium of women with endometriosis and never in women without endometriosis. This finding is so consistent that it may become an effective means of making the diagnosis of endometriosis. Nerve fibres expressing a range of neuronal markers and an over-expression of nerve growth factor (NGF) and nerve growth factor receptor (NGFRp75) were also demonstrated in peritoneal endometrial plaques in women with endometriosis. Effects of currently available medications for endometriosis on nerve fibres in eutopic endometrium in hormonally treated women have been also studied. This review will describe nerve fibres in eutopic endometrium and ectopic endometriotic plaques in women with endometriosis.

Background: Immune system disturbances have an important role in endometriosis which may lead to infertility. It seems that inflammatory cytokines specially tumor necrosis factor alpha (TNF-α) which were produced by activated macrophages have an important role in pathology of endometriosis. Based on this theory, anti TNF-α drugs like pentoxifylline (PX) are suggested as new drugs for Endometriosis. Objective: This experimental study has been done on female rats to determine the effect of PX on the endometrial implants and leukocytes in serum. Material and Methods: In proestrous phase, one horn of rat’s bicorn uterus was removed surgically and the endometrium was implanted to different places as follows: subcutaneous, peritoneum and near ovaries. After two months observation, female rats divided into two groups randomly. In treated group (n=10) PX (5mg/kg twice a day) and in control group (n=10), normal saline (same dose) were injected  ubcutaneously. Then, via second laparotomy and in the same phase of the cycles, the size of implants and the amount of leukocytes in serum were measured. Results: In treated group compared with control, the size of implants was decreased significantly in right subcutaneous (8.05mm vs 13.50mm) p<0.01, left subcutaneous (7.64 mm vs 14mm) p<0.01, right ovary (6.64 mm vs 15.22mm) p<0.001 and left ovary (7.18 mm vs 14.56 mm) p<0.005. In treated group, the total leukocyte count (5259.54 ± 178.78 vs 15833.33 ± 259.27) p<0.02 was decreased. The number of esterous cycle was similar in both groups.Conclusion: PX can reduce the size of endometrial implants as well as leukocyte count.

Background: Recent reports have suggested that ultrasound-guided embryo transfer (UG-ET) might improve pregnancy rates. Objective: To determine whether transabdominal UG-ET is a useful tool for increasing pregnancy and implantation rates in patients undergoing IVF or ICSI. Materials and Methods: A prospective randomized clinical trial was conducted in 180 patients in order to compare embryo transfer under abdominal ultrasound-guidance (n=90) with embryo transfer by clinical touch method (n=90). Results: The Clinical pregnancy rate was 21.1 % in the ultrasound-guided group and 15.5 % in the clinical touch group (p =0.3). The implantation rate in the ultrasound guided group was 11.1% while this was 7.2% in the clinical touch group (p =0.12). The percentage of difficult transfer was not significantly different in both groups, this was 8.9% in the ultrasound-guided group and 13.3% in the clinical touch group (p =0.47). Conclusions: Although the clinical pregnancy and implantation rate are higher in UGET group than the clinical touch group, but this difference was not statistically significant.

Background: Mullerian disorders are present in 5-25% of infertile women. Myoma, polyp and endometrial adhesions are among other involved factors in infertility. Objective: The aim of this study was to determine the frequency distribution of pregnancy occurrence in infertile women after the diagnostic-surgical hysteroscopy on selected infertile cases including those with abnormal uterine. Materials and Methods: One hundred and fifteen women with at least 12 months infertility who had abnormal uterine cavity and patients who had at least 4 unsuccessful ART cycles with no confirmed diagnosis of uterine cavity problem, underwent diagnostic hysteroscopy and if required hysteroscopic surgery. Follow up sonography and HSG performed 2-3 months later and all subjects were followed for pregnancy occurrence for 12 months. Results: Mean age of subjects was 32.65 ± 6.2 years and mean of infertility duration was 8.33 ± 5.25 years. Based on the sonography and HSG performed prior to the hysteroscopy, respectively 69.6% and 41.8% of the subjects had abnormality. In 65.2% of the cases, hysteroscopy showed septum, myoma, endometrial adhesion and irregularity and all of them underwent hysteroscopic operation. Among the operated cases, in 27 cases pregnancy occurred during the first 6 postoperative months and in 2 cases during the second 6 postoperative months of whom one case was EP. Conclusion: There was no significant difference in the rate of pregnancy occurrence between those who had abnormal hysteroscopy and those who were normal (p= 0.63). This can show the variation of infertility causes and the fact that infertility is not just due to uterine problems. Therefore, the repetition of therapeutic measures and longer follow up of infertile cases are necessary.

Background: Matrigel (extracellular matrix) can improve the growth of many cell types in vitro. Objective: The aim of the present study was to determine the effect of Matrigel on the development of 2-4 cells human embryos in culture. Material and Methods: Surplus 2-4 cells human embryos, resulting from ICSI, were divided into two groups (control and test). Quality of embryos in both groups was morphologically similar. The test group (n=140) was cultured in Hams’ F10 supplemented with 10% human serum albumin and 150 μl liquid Matrigel. The control group (n=140) was cultured in the same medium devoid of Matrigel. Embryos were cultured for an additional 4 days and their morphology was assessed every 24 hours. Both groups were then statistically compared. Results: The percentage of the human embryos that reached the morula stage in the control and test groups were 79.2% and 80%, respectively (p>0.05). However, 36.4% of embryos reached the blastocyst stage in the test group as compared to 5.7% in the control group after 144 hours in culture. This difference was statically significant (p <0.01). In addition, culture of embryos on Matrigel and medium versus medium alone significantly improved in vitro hatching (25.7% versus 3.5%; p <0.01). Conclusion: Matrigel at low concentration enhances human blastocyst formation and hatching in vitro.

Background: The basis of spermatogenesis is the spermatogonial stem cells (SSCs). The concentration of SSCs is very small. However, a system that supports the proliferation and maintenance of SSCs in vitro could be used to preserve and expand SSCs numbers as well as increase success in transplantation. It is a new avenue to restore spermatogenesis in azoospermia subjects. Objective: Proliferation and enhancement of frozen-thawed SSCs numbers during in vitro culture. Materials and Methods: Both Sertoli and spermatogonial cells were isolated from adult mouse testes. Frozen-thawed spermatogonial cells were cultured in two groups: simple culture (Experimental 1) and co culture with Sertoli cells (Experimental 2). Also, Fresh cells were considered as control groups: simple culture (control1) and co culture with Sertoli cells (control 2).Assay of the spermatogonial-cell-derived colonies was carried out at the end of each week. Results: Results indicated that the viability rate of the frozen cells after thawing (68.4±10.2%) was influenced by cryopreservation procedure significantly (p ≤0.001). In addition, the number of the colonies and their diameters in the co-culture system with fresh cells (25.1±5.2 and 205.8±50 μm, respectively) were more than other groups and the differences were significant (p<0.001). Number of the colonies and their diameters in experimental 1(9.5±4.3 and 124±35.9 μm, respectively), experimental 2 (15.6±3.5 and 157.6±41.9μm, respectively) groups were better than control 1 group (3.1±2.2 and 87.5±30.6μm, respectively) and the differences were significant (p<0.001). Conclusion: We demonstrated that co-culture system with Sertoli cells can increase in vitro colony formation of adult fresh and frozen-thawed spermatogonial cells in mouse.

Background: Phospholipids are distributed asymmetrically between inner and outer leaflets of the plasma membrane of live cells. Early during apoptosis, this asymmetry is disrupted and phosphatidylserine becomes exposed on the outside surface of the plasma membrane. There is little information about the effects of vitrification on apoptosis. Objective: The aim of the present study was to evaluate the effect of vitrification on apoptosis of subfertile and fertile men. Materials and Methods: In this study, semen samples were collected from subfertile (n=20) and fertile men (n=10) after 48h abstinence of intercourse. After semen analysis according to WHO criterias, each semen sample was divided into two portions. First portion was assessed by Annexin V-flous staining kit for showing apoptosis in subfertile and fertile men and second portion was assessed after vitrification-thawing. Results were analyzed by Paired t-test and Independent t-test. Results: After vitrification-thawing, mean percentage of apoptotic spermatozoa has increased 6 and 3 times in subfertile and fertile men respectively. This difference is significant. Conclusion: Vitrification-thawing could disrupted membrane asymmetry and caused apoptosis. Therefore, it will cause reduction of functional spermatozoa in access of Assisted Reproduction Technologies (ART).

Background: There is mounting evidence for HPV involvement in cervical cancer Human Papilloma Virus DNA is detected by hybridization techniques in 75 – 100% of patients with condylomas, precancerous cervical dysplasia, and invasive carcinoma. Objective: The aim of this study was investigating factors that may contribute to falsenegative colposcopic biopsy results in positive high-risk HPV DNA results. Material and Methods: Patients positive for high-risk human papillomavirus (HPV) DNA with negative cervical histopathologic findings were examined between January 2004 and August 2006. Results: Patients with atypical squamous cells of undetermined significance (ASC) in Papanicolaou smears, with positive HPV DNA results, but negative cervical histopathologic findings accounted for 4.5% of all ASC smears submitted for HPV DNA testing. We found 4% of the cases had focal HPV infection or mild dysplasia. When serial sectioning of the biopsy material were examined, we found that 29% had clinically significant lesions: HPV infection or cervical intraepithelial neoplasia CIN 1, 18%; CIN II/III, 8%; and dysplasia, not otherwise specified (which we can not categorize into any group), 3%. Of the remaining patients, follow-up revealed squamous abnormalities in 25%. About 5% of patients with positive HPV DNA results had a negative follow-up biopsy result. "False-negative" biopsies accounted for one third of cases. Conclusion: In almost one third of cases, clinically significant lesions were found when additional levels were examined.

Background: Sodium arsenite and/ or vasectomy may cause variation in sex hormones which affect pathophysiology of reproductive organs. Objective: The aim was to investigate the morphological changes in structure of testis and hormonal imbalance in bilateral Vasectomised rats treated with sodium arsenite. Materials and Methods: Four groups of rats: bilateral vasectomy + sodium arsenite, bilateral vasectomy, sham operated + sodium arsenite and sham operated only were considered, and 8 mg/kg/ day of sodium arsenite was given for 8 weeks to the rats. The total volume of testis, volume of interstitial tissue, volume of seminiferous tubules, diameter of seminiferous tubules and germinal epithelium thickness were evaluated using stereological methods. Hormones were also measured and the results were analyzed using one way ANOVA. Results: A significant reduction of total volume of testis (p<0.01), mean volume of seminiferous tubules (p<0.002) as well as germinal epithelium thickness (p<0.05) in both vasectomy + sodium arsenite and vasectomy rats was seen compared to sham operated only. In addition a significant reduction of  estosterone was observed in vasectomy + sodium arsenite group when compared to the other groups (p<0.001). LH level decreased significantly in vasectomy + sodium arsenite when compared to sham operated ones (p<0.05). Conclusion: Vasectomy and treatment with sodium arsenite affect the structure of testis with respect to its volume, volume of seminiferous tubules and thickness of germinal epithelium, which may be due to variation of LH and testosterone level in the rats.

Background: Inversion of the uterus is very uncommon. Patients may present with pelvic pain, vaginal discharge, or hemodynamic shock. Case: We report a case of 35 years old women (virgin) who was admitted with profuse vaginal bleeding and cramps of uterus. In the vaginal examination at litothomy position a mass of 5×8 cm in size was protruded from the vagina. At first myomectomy was performed and after that laparotomy with total abdominal hysterectomy was done. Conclusion: Early diagnosis, immediate treatment of shock, and replacement are essential in uterine inversion.