International Journal of Reproductive BioMedicine
Year:2013 | Volume:11 | Issue:4|Papers Count:12

Background: Careful evaluation of patients and proper treatment with right techniques are essential for successful outcome of assisted reproduction. To obtain satisfactory results, it is necessary to assess ovarian reserve before planning treatment.Objective: To evaluate anti-mullerian hormone as a predictor of fertility potential in terms of ovarian reserve and ovarian response reflected by antral follicles and mature oocyte counts in response to menotrophin stimulation in in vitro fertilization (IVF) women from Gaza Strip.Materials and Methods: This prospective cohort study consisted of 81 women (mean age 28.7 years) attending IVF at Al-Basma Fertility Center in Gaza City. Blood withdrawal for antimullerian hormone measurement was performed in all the patients and the number of oocytes and embryos were recorded.Results: The total number of retrieved oocytes was inversely associated with age (12.5±4.5, 11.0±5.4 and 6.9±4.7 at age £25, 26-35 and >35 years, respectively (F=4.793 and p=0.011). The ovarian response to Menotrophin (FSH 75IU, LH 75 IU) stimulation was better for younger age. There was a significant positive association between ovarian response in terms of total number of oocytes and antimullerian hormone levels. The maximum level of antimullerian hormone was observed in females who achieved positive pregnancies (4.5±2.5 ng/mL) followed by negative pregnancies (2.9±1.8 ng/mL) with significant differences (F=6.862 and p=0.002). Correlation coefficient revealed that the number of mature oocytes showed strong positive correlation with the antimullerian hormone levels (r=0.469, p=0.001).Conclusion: Anti-mullerian hormone can be used in IVF programs as a good predictor of ovarian reserve and ovarian response.

Background: Male infertility is affected by several factors. Lead is one of the heavy metals more bioavailable than usually modifies the sperm quality in humans.Objective: The aim of this study was to establish the role of lead in semen quality in environmentally exposed men.Materials and Methods: Semen and blood samples were obtained from two groups: the exposed group (EG=20) and the non-exposed group (NEG=27). Two semen aliquots were used, one to evaluate spermatic quality and the other for lead determination. Blood (PbB) and semen lead (PbS) determination was performed by atomic absorption spectrophotometry.Results: The PbB concentration was significantly greater in the EG, 10.10±0.97 mgdL-1 than in the NEG, 6.42±0.38 mgdL-1 (p<0.01), as well as the PbS concentration, with 3.28±0.35 and 1.76±0.14 mgdL-1 in the EG and NEG respectively (p=0.043). A significant correlation between PbS and PbB concentration in the EG was found (r=0.573, p=0.038). Overall, the spermatic quality was lower in the EG than in the NEG. Specifically, there were significant differences in the spermatic concentration [EG=43.98±6.26 and NEG=68.78±8.51X106 cellmL-1 (p<0.01)], motility [EG=49±7 and NEG=67±4% (p=0.029)], viability [EG=36.32±3.59 and NEG=72.12±1.91% (p<0.01)] and abnormal morphology [EG=67±18 and NEG=32±12% (p<0.01)]. In the immature germ cells (IGC) concentration differences were found only for A cells (EG=8.1±1.1x100 and NEG=3.2±1.9x100 spermatozoa) (p<0.01) and for Sab cells (EG=3.4±2.2x100 and NEG=1.1±1.0X100 spermatozoa) (p=0.041).Conclusion: These results suggest that chronic environmental exposure to low levels of lead adversely affect the spermatic quality.

Background: Intrauterine growth retardation (IUGR) contributes significantly to fetal morbidity and mortality, but its etiology is unknown in most cases.Objective: The aim of this study was to examine the association between inherited thrombophilia and IUGR.Materials and Methods: A case-control study was performed in a tertiary referral center (Afzalipour Hospital) over 2-years period (2010-2011). Cases (n=25) were women who had pregnancies complicated by IUDR and control subjects (n=25) were women who had normal growth fetuses. All women were tested for inherited thrombophilia at least 4 weeks after delivery. Main outcome measure was prevalence of maternal thrombophlia. Genotyping for factor V Leiden, prothrombin gene (nucleotide G20210A), and MTHFR (C677T) mutation was performed by PCR technique. Protein C, S and antithrombin III activity were determined with a clotting assay (STA-Staclot, France).Results: The prevalence of hereditary thrombophilia was 68% (n=17) in IUGR group, and 32% (n=8) in control group (OR: 1.5, p=0.011, 95% CI: 1.3-14.8). The frequency of MTHFR (C677T) gene mutation (p=0.037; OR: 3.69) and protein S deficiency (p=0.034; OR: 5.41) was significantly increased in the group with IUGR compared with the control group. There was no significant difference between the two groups in prothrombin G20210A mutation (p=0.490) and protein C deficiency (p=0.609). A significant difference in the frequency of multiple thrombophilias was detected between the two groups (p=0.009).Conclusion: This study revealed that protein S deficiency and MTHFR gene mutation are more prevalent in pregnancies with IUGR.

Background: Spontaneous preterm labor is one of the common obstetrics problems causing several physical, psychological and economical outcomes. Although due to these outcomes and the efficacy of cares for decreasing them, preterm labor screening is cost-effective and it is still one of the challenging issues in obstetrics.Objective: In this study preterm labor screening by using cervical transvaginal sonography was evaluated.Materials and Methods: This observational cohort study was performed in Yazd, Iran. Samples were selected from pregnant women at gestational age of 21-24 weeks who had single live fetus and referred to the obstetrics clinics of two selected hospitals in Yazd. Gestational age was estimated based on the sonography of the first trimester and cervical length measured by transvaginal sonography. Data analysis was done by using t and x2 test as well as ANOVA. Statistical significant level was considered as p<0.05.Results: From 450 participants, 47 cases had preterm labor and 6 cases had positive funneling. Mean age of women with term labor was 26.09±4.13 years and that of women with preterm labor was 26.7±3.51 years (p=0.334). Duration of pregnancy and cervical length significantly differed between women with and without funneling (p=0.001). The sensitivity and specificity of screening based on cervical length of 25mm were 55.5% (50.9-60.1%) and 93.6% (91.2-96%) respectively.Conclusion: Based on the results of the present study, transvaginal ultrasound assessment of cervical length in low risk women has an acceptable reliability for screening of preterm labor.

Background: Sexually transmitted infections (STIs) are among the most common causes of illness in the world and have far-reaching health, economic and social consequences for many countries. Failure to diagnose and treat STIs at an early stage may result in serious complications and sequels.Objective: This study aimed to determine the prevalence of Chlamydia trachomatis infection in patients who remain symptomatic after completion of their first episode of treatment for STI.Materials and Methods: We conducted a cross-sectional study on 49 patients suffering from symptoms or signs of sexually transmitted infections despite their first complete anti STI treatment. Conducting physical exam and smear preparation from vaginal discharge, diagnosis was confirmed by Polymerase chain reaction (PCR) method on every patient’s first-voided urine sample.Results: Among the etiologic factors investigated in this study, Chlamydia was reported in 17 patients. Trichomoniasis, Candidiasis, Gonorrhea and nonspecific germs were next organisms with 11, 9, 6 and 6 patients, respectively. Sixteen specimens were PCR positive (32.65%), while 33 patients had negative PCR results (67.34%) for Chlamydia trachomatis.Conclusion: Gonorrheal infection was the most prevalent infection in patients with completed treatment (6.10), which must be remembered in patients follow ups, because this prevalence warrants empirical therapy for Gonorrheain similar clinical conditions. Chlamydia trachomatis was the responsible organism in approximately a quarter of patients (17.75) who despite their full compliance on anti-Chlamydial treatment still suffered from signs and symptoms of STI. This rate also recommends empirical therapy for Chlamydia trachomatis in the similar clinical signs and symptoms.

Abstract Background: Olive (Olea europea), from the Oleaceae family, is known as a phytoestrogen plant compound, containing Lignans and phenolic compounds. Some studies have shown phytoestrogens to have spermatogenesis-decreasing effects.Objective: The present study investigated the effects of a hydro-alcoholic extract of olive fruit on reproductive argons in male rats.Materials and Methods: The hydro-alcoholic olive (Olea europaea) extract was given orally to three experimental groups of rats in 50, 150, and 450 mg/kg in 48 days. The vehicle group was fed with normal saline and nothing was given to the control group (each group with 8 rats). After 49 days reproductive indicators i.e., sperm count, sperm motility, the weight of prostate, testis, epididymis, and seminal vesicle were measured.Results: The results showed a significant decrease in the weights of the left testicle, seminal vesicle, testosterone hormone, sperm count and sperm motility but there was no significant difference with regard to the weights of prostate and epididymis, and estradiol hormone.Conclusion: This study suggests that olive extract may have deleterious effects on fertility factors; therefore, after further studies, it may be used as a contraceptive in males.

Background: The increasing number of cesarean section is a great concern in many countries. In Iran cesarean section rate has been steadily rising from 35% in 2000 to 40% in 2005. Preferences for cesarean are often associated with some factors.Objective: To investigate factors associated with preference for cesarean delivery, with special emphasis on pregnant women’s preferences in first pregnancy in Neyshabur (Northeast of Iran).Materials and Methods: In this cross-sectional study, written questionnaires were completed via face to face interview with 797 pregnant women in first pregnancy. Socio-demographic data, preference toward mode of delivery and factors associated with it were assessed by applying questionnaire. Univariate and multivariate analysis were performed to identify the independent variables associated with preference for cesarean delivery.Results: In this study observed that 18.6% of pregnant women preferred caesarean delivery in first pregnancy. The mean age of pregnant women that they preferred cesarean delivery was upper than pregnant women that they preferred vaginal delivery and this difference was statistically significant (p=0.006). There was a statistically significant relation between preference for cesarean delivery and the following variables: educational level (p<0.001), gestational age (p=0.003) spouse’s age of pregnant women (p=0.001), physician’s advice (p<0.001), and fear of delivery (p<0.001).Conclusion: The results of this study show that the majority of pregnant women do not prefer caesarean delivery to vaginal delivery. Nevertheless the preference rate for cesarean delivery exceeded 15% that suggested by WHO and most important factors in pregnant women prefer cesarean deliveries are fear of delivery and physician’s advice.

Background: Controlled ovarian stimulation combined with intra uterine insemination (IUI) is a convenient treatment of infertility with a success rate of 11%. The clinical observation and pattern of progesterone secretion in this method is suggestive of luteal phase defect and postulated as an implicating factor of treatment failure.Objective: To investigate the efficacy of luteal phase support with intravaginal cyclogest in women undergoing controlled ovarian stimulation combined with intrauterine insemination.Materials and Methods: In this single-blinded clinical trial, 196 consecutively seen women eligible for the study protocol, were randomized to receive either intravaginal progesterone (cyclogest pessary, Actavis) or no medication in luteal phase. Blood samples were collected and serum progesterone level in 7th and 11th day of the cycle, biochemical and clinical pregnancy and luteal phase duration were compared in case and control groups.Results: The mean age in case and control group was 28 and 27.9 years, respectively and the most frequent cause of infertility was unexplained. Additionally, ovulatory dysfunction was the most common cause of female infertility in both groups. Based on these variables, there was no statistically significant difference between the two groups. Mean serum progesterone level in the case group were 48.34 and 34.24 nmol/day on day 7 and 11 after insemination, respectively and both values were significantly higher than the control group. There was no difference between the two groups in terms of biochemical and clinical pregnancy. Luteal phase duration in the case group was significantly longer than the control group.Conclusion: Luteal phase support by Cyclogest pessary increases progesterone level and prolongs the luteal phase, but does not affect success rate of IUI cycles in terms of achieving pregnancy.

Background: The infertility is an important health problem, affecting about 15% of couples. The important role of genetic factors in pathogenesis of infertility is now increasingly recognized. The value of karyotyping women in the routine work-out of couples referred for sterility has long been recommended.Objective: The aim of this study was to define the frequency of all chromosomal aberrations among women which referred to our department due to infertility during the 21-year period.Materials and Methods: In this 21-year retrospective study, for the first time, we investigated 896 women which referred to our department due to infertility during 1986 to 2006. For chromosome analysis, heparinized peripheral blood samples were cultured, harvested and banded according to standard methods.Results: Out of 896 patients, 710 patients (79.24%) had a normal karyotype, and 186 patients (20.76%) showed abnormal karyotype. Among the abnormal ones 48 patients (25.81%) showed Turner's syndrome (45,X), and 45 patients (24.19%) were sex reversal with 46,XY karyotype. The rest of 93 patients (50%) revealed a wide range of chromosome abnormalities.Conclusion: Our results emphasized the importance of the standard cytogenetic methods in assessing the genetic characteristics of infertile females, which allows detecting a variety of somatic chromosome abnormalities, because some of these may interfere with the success of reproduction.

Background: Fetal growth in diabetic pregnancies is a complex process and probably abnormalities in other metabolic pathways such as protein and lipid, as well as carbohydrate are responsible for delivering of macrosomic newborn.Objective: The purpose of this study was to investigate the association between fetal growth and different maternal metabolic parameters in women with gestational diabetes mellitus (GDM) in comparison to control group.Materials and Methods: This was a prospective cohort study conducted between March 2011 and May 2012, on 112 pregnant women with GDM and 159 healthy pregnant women. In order to determine of lipids or lipoproteins changes during pregnancy and to investigate any possible effects on fetal growth, lipid components, glucose and insulin levels were obtained in maternal serum three times in third trimester.Results: Maternal serum glucose, total cholesterol (TC), low and high density lipoprotein (LDL-c, HDL-c) levels did not show any significant difference between two groups. While insulin, homeostasis model assessment-insulin resistance (HOMA-IR) and triglyceride (TG) values were detected to be significantly higher in the GDM cases especially after 32 weeks of gestation (p<0.001). After adjustment for confounding variables, maternal hypertriglyceridemia remained as a significant risk factor for delivering large for gestational age (LGA) newborns (p=0.04); and according to spearman test the increase of TG level was correlated with increase of insulin resistance and HOMA-IR (p<0.001, CI: 0.312).Conclusion: Due to positive correlation of hypertriglyceridemia and hyperinsulinemia with newborn weight, it is possible to assume that elevated TGs levels in GDM cases is a reflection of variation in maternal insulin levels.

Abstract Background: It has been hypothesized that Y-q microdeletion can account for significant proportion of infertility in men. There are three nonoverlapping regions referred to as the “azoozpermia factors” AZFa, AZFb, and AZFc from proximal to distal part of Y-q. These have been defined as spermatogenesis loci, this region deletions have been shown to be involved in male azoospermic or severe oligoozospermic infertility.Objective: Evaluation the rate of Y-chromosome microdeletions in infertile men. Materials and Methods: In this case-control study, 25 azoospermic infertile men candidate for intracytoplasmic sperm injection (ICSI) were selected as case group. For control group, 25 normoozoospemric men were selected. All cases and controls had normal 46XY karyotype. DNA extraction and molecular analysis were done on blood samples. Multiplex-PCR method was done to identify the presence of microdeletion in AZFa, AZFb or AZFc loci. Eight STS primers that include two controls were selected to determine Y-chromosome microdeletions.Results: 20% (5.25) of all patients have at least one microdeletion in more than one region of AZF loci. Totally 17 microdeletions was observed, one case had deletions in three AZF regions, and 4 cases had deletions in two AZF regions. The rate of deletions was 42% (7.17) for AZFc, 35% (6.17) for AZFa and 23% (4.17) for AZFb.Conclusion: The molecular DNA analysis could help us to know the real cause of infertility and can give good information for good decision for example in men whit microdeletions who want to undertake ICSI procedure the deletions will be passed to their son.

Background: Cryptorchidism is a common malformation in neonates; surgery or medical treatments are applied during childhood. Untreated cryptorchid testes are in the risk of intratubular germ cell neoplasia (IGCN) and consequently invasive testicular tumors which could be shown by immunohistochemistry staining for placental like acid phosphatase (PLAP) marker.Objective: We designed this study to know the prevalence of IGCN in untreated cryptorchid testes of infertile men, in our infertility center as a refferal center.Materials and Methods: In this cross-sectional study we assessed H&E slides of testicular samples of 13 adult infertile patients with impalpable intra-abdominal testes seeking infertility treatment; then we stained them by PLAP marker. Results: Three (23.08%) samples were positive for PLAP marker means presence of IGCN in testis. One of them showed seminoma besides IGCN.Conclusion: According to the results of this study and the fact that there are adult untreated cryptorchid patients in our country yet, it is suggested to pay more attention in clinical examination, assessment and follow up of such patients for malignancy screening.