سال:1392 | دوره: | شماره: |تعداد مقالات:12

Background: Our information regarding immunity to toxoplasmosis among reproductive age women is indeterminate and there is significant variation between reported results; it is necessary to perform a Meta-analysis study on subjects to obtain required findings and develop preventive measures accordingly.Objective: Estimation level of immunity to toxoplasmosis in reproductive ages.Materials and Methods: All published papers in main national and international databases were systematically searched for some specific keywords to find the related studies up to 2012. We selected only original articles that either reported percentage of positive anti toxoplasma IgG or total anti toxoplasma antibody by using ELISA or IFAT method (provided that the titer ≥1.20 is considered positive for IFAT) in childbearing age women.Results: Studies involved a total of 13480 participants. The maximum and minimum reported prevalence rates of anti-toxoplasma IgG antibody using IFTA serological method were 21.8% and 54%; and using ELISA serological method were 23% and 64%, respectively. The overall estimation for prevalence of anti-toxoplasma IgG antibody using IFTA serological method was 34.5% (95% CI: 28.5-40.5); and using ELISA method was 37.6% (95% CI: 30.4-44.9). The overall estimation for prevalence of anti-toxoplasma total antibody was 39.9% (95% CI: 26.1-53.7).Conclusion: In Iran, screening of toxoplasma is not routinely performed yet, while the incidence of toxoplasmosis is too high to justify routine screening. Prenatal screening can help to identify mothers susceptible to infection. Screening for the presence of antibodies allows primary prevention of toxoplasmosis infection where eating habits and hygiene practices have clearly been identified as risk factors.

Background: Unexplained infertility is still a challenging issue as to its causes, appropriate management and treatment. Evidence implicates early embryopathy or implantation failure as likely causes.Objective: This study aims to investigate the effect of local endometrial injury on pregnancy rate in selected unexplained infertile patients.Materials and Methods: This was a randomized clinical trial conducted in Shiraz University Infertility Clinic of Ghadir Hospital. A total of 217 women with unexplained infertility aged 23-35 years old were randomly divided into two study groups through block randomization. After superovulation by clomiphene-citrate and gonadotropins and when the dominant follicles reached 18-20 mm, patients were randomly assigned to undergo endometrial local injury at posterior uterine wall by piplle endometrial sampling (n=114) or mock pipette biopsy (n=103) during pre-ovulatory days (when spontaneous urinary LH surge was detected). Then all the patients were instructed to follow a regularly timed intercourse.Results: The pregnancy rate was significantly higher in the endometrial injury group compared to the control group [17.114 (14.9%) vs. 6.103 (5.8%) (OR: 2.83 95% CI: 1.07-7.49, p=0.03]. The abortion rate was comparable between two groups (17.64% vs. 14.28%; p=0.701).Conclusion: Local mechanical injury of the endometrium can enhance the uterine receptivity and facilitates the embryo implantation. This simple, easy, and cost effective procedure is worth considering in selective unexplained infertility patients who implantation failure is the likely causes of infertility before complex treatments. This procedure may help reduce psychological tensions and high expenses imposed through such interventions.

Background: Chemical activation is the most frequently used method for artificial oocyte activation (AOA), results in high fertilization rates.Objective: This prospective, randomized, unblinded clinical study aimed to evaluate the efficiency of calcium ionophore on fertilization and pregnancy rate after intracytoplasmic sperm injection (ICSI) in infertile men suffer from teratoospermia.Materials and Methods: Thirty eight women with teratoospermic partner underwent ICSI with GnRH-antagonist protocol. A total of 313 metaphase II (MII) oocytes were randomly divided after ICSI into two groups: In the oocytes of the control group (n=145), routine ICSI was applied. Oocytes in the AOA group (n=168) immediately after ICSI, were cultured in culture medium supplemented with 5 mΜ calcium/100 mM calcium ionophore (A23187) for 5 minutes and then washed at least three times with MOPS solution. In both groups, the fertilization was evaluated 16-18 hours after ICSI.Results: The number of embryos obtained and fertilized oocytes were significantly different between two groups (p=0.04). There was no significant difference between the two studied groups regarding the fertilization and cleavage rate (95.33% vs. 89.56 %; and 84.4% vs. 87.74%; respectively, p=0.06). Implantation rate was higher in AOA group than in control group, but the difference was not significant. (17.64% vs. 7.4%, p=0.14). No significant differences were observed in chemical and clinical pregnancy rate between groups (47.1% vs. 16.7%, p=0.07; and 41.2% vs. 16.7%; p=0.14, respectively).Conclusion: Oocyte activation with calcium ionophore may improve ICSI outcomes in infertile men suffer from teratoospermia. Although, we found no significant difference in the implantation and pregnancy rate between the two groups of patients. Further study with more cases can provide greater value.

Background: Despite its frequency, the polycystic ovary syndrome (PCOS) is still a difficult diagnosis in endocrinology, gynecology, and reproductive medicine. The Rotterdam consensus conference proposed to include the ultrasonographic follicle count as a new diagnostic criterion. Unfortunately, its assessment does not offer sufficient reliability worldwide.Objective: To explore the possible roles of altered circulating androgens and anti-mullerian hormone among PCOS women regarding their body mass index and their outcomes after IVF.Materials and Methods: In this cross sectional study, 195 women with PCO were included, they were divided according to their body mass index (BMI <27 kg/m2) as obese PCOS (n=91) and overweight PCOS (BMI ≥27 kg/m2) (n=104). Serum levels of androgens (dehydroepiandrosterone sulfate [DHEAS], testosterone and androstenedione [A4]), and anti-mullerian hormone (AMH) were assessed and compared with the endocrine profile and cycles outcomes.Results: AMH, A4, FSH, and TSH concentrations were significantly higher in obese than in overweight women (p˂0.001). Contrary, LH: FSH ratio values, E2, PRL and DAHE-S levels were significantly lower in obese than in overweight women (p˂0.0001). Total oocyte retrieved, mature and fertilized oocyte were significantly higher in obese than in overweight women. Among pregnant obese PCOS women both AMH and A4 were significantly increased and DAHE-S was significantly decreased compared to pregnant overweight PCOS women.Conclusion: Obese PCOS women have a higher chance of getting pregnant over those categorized as overweight PCOS. Also, androgens and AMH levels recommended to be considered in IVF attributes among obese and overweight PCOS women.

Background: There is growing concern that occupational, environmental and lifestyle factors adversely affect male reproductive health. Fumaria parviflora Lam. is being used traditionally in Persian folk medicine to cure various ailments and has been supposed to have fertility-enhancing properties.Objective: A dose-response study was designed to assess effects of F. parviflora ethanolic leaves extract on reproductive parameters in adult male Wistar rats.Materials and Methods: In this experimental study, healthy adult male rats were treated with 100, 200 and 400 mg/kg/day of F. parviflora leaves extract via gavage for 70 days. Blood samples were collected for determination of testosterone, LH and FSH serum levels. Reproductive organs weight, motility, morphology and density of epididymal sperm, seminiferous tubules diameter and germinal epithelium height were evaluated in each experimental group.Results: The body weight was not affected, while the weights of testis and epididymis were significantly enhanced in rats treated with 200 and 400 mg/kg/day F. parviflora extract. No significant changes were observed in seminal vesicle and ventral prostate weight between experiment groups. Significant increase was found in epididymal sperm density and percent of morphologically normal sperm in extract-treated rats. Serum testosterone levels were significantly higher in rats received 200 and 400 mg/kg/day.Conclusion: The results indicated that ethanolic extract of F. parviflora leaves have a potential to improve reproductive parameters and enhance male fertility.

Background: Pregnant women are sometimes exposed to ionizing radiation in radiology examinations for various reasons. In such cases, the radiation dose to the conceptus and subsequent risks should be estimated.Objective: The purpose of this study was the calculation and presentation of fetal dose and subsequent risks resulted from different X-ray examinations.Materials and Methods: An analytical simulation study was conducted and six common radiographies in different views and three types of special examinations were evaluated. The entrance skin exposure (ESE) was measured using a solid-state dosimeter. A Monte Carlo program was used in order to simulate different views of X-ray examinations and calculate the radiation doses received by the conceptus for every view of each examination. Then the risk of childhood cancer and small head size were calculated for different radiographies.Results: The fetal doses and consequence risks of the small head size and childhood cancer for the radiographs of chest, skull, and sinuses were negligible but the risks of childhood cancer and small head size due to radiographies of abdomen, lumbar spine, and pelvis areas were ponderable. Conclusion: Results of this study can be used for the pregnant women radiographies management.

Background: Creation of artificial gametes may provide a universal solution for these patients with no gametes. Stem cell technology may provide a way to obtain fully functional gametes. Retinoic acid (RA) can initiate meiosis. Several studies have demonstrated that RA can promote sperm cells differentiation from mouse embryonic stem cells (mESCs) and other cells from human embryonic stem cells (hESCs).Objective: We sought to determine whether RA could promote differentiation of germ cells from hESCs.Materials and Methods: hESCs were differentiated as embryoid bodies (EBs) in suspension with all-trans RA (atRA) or without atRA for 0, 1, 3, 5 and 7 days, and then the expression of VASA, SCP3, GDF9 and TEKT1 were compared by real-time PCR. The statistical differences were evaluated by one way ANOVA.Results: The expression of germ cell-specific markers including the gonocyte marker VASA, the meiotic marker SCP3, and post meiotic markers, GDF9 and TEKT1, all increased in the presence and absence of RA as EB differentiation progressed. In addition, the expression of these markers increased an average of 9.3, 6.9, 7.2 and 11.8 fold respectively in the presence of RA, compared to the absence of RA, over 5 days differentiation.Conclusion: Our results indicate that hESCs may have the potential to differentiate to primordial germ cells (PGCs) and early gametes. RA can improve germ cells differentiation from hESCs.

Background: Luteal phase support is mandatory in assisted reproductive technologies (ART) for optimizing outcome, so the luteal phase is supported with either progesterone, addition of estradiol to progesterone, hCG or gonadotropin releasing hormone (GnRH) agonists. Supplementation of luteal phase with progesterone is prescribed for women undergoing routine IVF treatment.Objective: To compare oral dydrogestrone with vaginal progesterone for luteal-phase support in IVF.Materials and Methods: We performed this prospective, randomized trial in a tertiary infertility care unit in Taleghani Hospital, Tehran, Iran. In total 80 Women with a history of male factor infertility undergoing controlled ovarian stimulation for IVF treatment (fresh cycle) randomly were divided in two groups (group A or oral dydrogesterone group and group B or vaginal progesterone group). The inclusion criteria were the use of GnRH analogue down-regulation and age less than 40 years old with regular menstrual cycles. All women were euthyroid and normoprolactinemic. Group A (n=40) received 10 mg dydrogesterone QID (40mg daily) and group B (n=40) received 400 mg suppository vaginal progesterone (cyclogest) twice per day (800 mg daily).Results: Clinical pregnancy rate in cyclogest group was higher than dydrogesterone group but the difference was not significant (p=0.52), furthermore the miscarriage rate in two group was the same. The difference between two groups regarding antral follicle, embryo number, luteal-phase duration, endometrial thickness, oocyte number and metaphase-II was not significant (p>0.05).Conclusion: The results showed that oral dydrogesterone is as effective as vaginal progesterone for luteal-phase support in women undergoing IVF.

Background: It has been suggested that malfunction of immune system may causes testicular cancer. Recently, our understanding of innate immune system has been expanded, by discovery of “Toll-Like Receptors” (TLRs). Some studies have shown that polymorphisms of TLR2 and 4 may affect on the risk of cancer. Also, the role of TLRs 3 and 9 have been shown in apoptosis and metastasis of cancer cells in animal models.Objective: Little information is available about the influence of innate immunity on testicular malignancy. Therefore, expression of TLRs 2, 3, 4 and 9 as main components of innate immunity has been investigated in this study.Materials and Methods: In this case control study, TLRs gene expression was examined by RT-PCR in normal testis and testicular cancer tissues. Real time quantitative PCR (Q-PCR) analysis was used to compare the relative expression of TLRs between the samples.Results: mRNAs of TLR 2, 3, 4 and 9 were expressed in all normal and cancer samples. Q-PCR reveals that cancer samples had stronger expression of these genes compared with normal ones.Conclusion: It seems that the different TLRs expression in testicular cancer cells may contribute to extensive signaling pathways involved in carcinogenesis.

Background: It is estimated that about 50% of causes of recurrent pregnancy loss (RPL) cases remain unknown. Sperm factors are suggested to have probable role in cases with RPL. Objective: The goal was to determine the possible relationship between semen bacterial contaminations with unexplained RPL. Also, the correlation between number of bacterial colony and sperm chromatin condensation was examined.Materials and Methods: This study consisted of 30 fertile men (group A) and 30 infertile (group B) men with unknown RPL. Semen collection and analysis were done according to WHO manuals. Sperm count and motility were evaluated by Makler chamber. Eosin-Nigrosin and Papanicolaou staining methods were applied for viability and morphology assessment, respectively. The semen samples from both groups were cultured for aerobic bacteria. Aniline blue (AB) and toluidine blue (TB) staining methods were applied for evaluating sperm chromatin condensation.Results: The numbers of colonies were significantly higher in group B when compared to group A. Also, S. aureus and E. coli contaminations showed significant differences between two groups. Both AB+ and TB+ sperm cells showed significant increase in group B compared to group A. There was a significant negative correlation between colony number and progressive motility (p=0.01), and sperm viability (p=0.007). In addition, positive correlations were found between colony number and AB+ (p=0.001) and TB+ (p=0.004) as well.Conclusion: Bacterial contaminations in semen of men from RPL couples had significantly higher levels when compared to fertile controls. Presence of microorganisms in semen may be correlated with irregular sperm parameters and quality.

Background: Abdominal circumference (AC), biparietal diameters (BPD) and femoral length (FL) are now the main parameters used to obtain estimated fetal weight (EFW). Although the role of soft tissue parameters in determining fetal weight was proved but clinical attention to mid-thigh soft tissue thickness (STT) is limited. Objective: To find the impression of STT on birth weight (BW) and represent a new predictive formula.Materials and Methods: One hundred and fourteen normal singleton term (36-42w) pregnancies with delivery within 72 hours were randomly selected to participate in this prospective cohort study. Variables measured by ultrasonography before birth included: AC, BPD, FL and STT. The actual neonatal BW was also measured after birth. Linear regression model was used and R square and p-value were reported.Results: The mean (SD) of BW was 3406 (405) gr. R square was best fit for the model that STT was added to AC, BPD, FL (r2: 0.77). R square for the model using BPD, AC, FL and model using BPD, STT, FL was the same (r2: 0.7). Best fit formula was Log (BW)=2.461+0.003BPD+0.001AC+0.007STT+0.005FL. AC (R: 0.67, p<0.001), STT (R: 0.50, p<0.001), BPD (R: 0.59, p<0.001), FL (R: 0.66, p<0.001) were significantly correlated with birth weight. AC had also significant correlation with STT (p=0.001).Conclusion: This study showed adding STT to other variables in predictive models of fetal weight would provide a nice estimation (r2=0.77) and in cases that measuring AC is suboptimal STT may be a good replacement.

Background: No extensive studies were done that included the use of pentoxifylline or verify its effect on the outcome of ICSI in cases of mild and moderate asthenozoospermia.Objective: The aim of this study was to evaluate the effect of pentoxifylline used in preparation of semen samples which doesn't need motility enhancement prior to ICSI. Materials and Methods: The study was carried on 30 infertile patients where pentoxifylline was used for semen processing (group I), another 30 patients without pentoxifylline (group II) in addition to 60 infertile patients where crossing over of the semen sample was done further subdividing it into 2 subgroups in which the first half of the semen sample was incubated with pentoxifylline (group IIIA) and the second half of the sample without pentoxifylline (group IIIB).Results: The numbers of oocytes injected, numbers of oocytes fertilized, fertilization rate, the total numbers of embryos, numbers of good embryos and the numbers of embryos transferred of group IIIA were found significantly higher than that of Group IIIB (p=0.00). The overall 6 month pregnancy rate of group I was significantly higher than that of group II (73.3% vs. 60% respectively, p=0.04). The abortion rate of (Group I) and that of (Group II) was found non – significantly different (20% vs. 27.8% respectively, p=0.53).Conclusion: Pentoxifylline can be used as a useful compound for improving ICSI outcome in semen samples preparation prior to oocytes injection regardless of the state of sperm motility or the degree of asthenozoospermia.