International Journal of Reproductive BioMedicine
Year:2020 | Volume:18 | Issue:1|Papers Count:9

Background: Cumulus cells, as oocyte nurse cells, provide a suitable microenvironment with growth factors and cellular interactions required for oocyte maturation. Thus, these cells may serve as a natural niche for in vitro studies of female germ cell development. Cumulus cells may help attain a better understanding of the causes of infertility in women and eventually improve the outcomes of cases that respond poorly to standard infertility treatment. Objective: The aim of this study was to isolate, culture, and investigate the biological characteristics of human cumulus cells. Materials and Methods: In this experimental study, cumulus cells were isolated, cultured, and characterized using reverse transcription-polymerase chain reaction analyses of specific genes including FOXL2, CYP19A1, FSHR, AMHR, and LHR. The presence of vimentin, a structural protein, was examined via immunofluorescent staining. Moreover, levels of anti-mullerian hormone (AMH) and progesterone secretion by cumulus cells were measured with ELISA after 2, 4, 12, 24, and 48 hr of culture. Results: In adherent culture, human cumulus cells expressed specific genes and markers as well as secreted AMH and progesterone into the medium. Conclusion: Cumulus cells secrete AMH and progesterone in an adherent culture and might be applicable for in vitro maturation (IVM) and in vitro gametogenesis (IVG) studies.

Background: Preterm delivery is one of the main causes of infant death. Therefore, prediction of preterm delivery may eliminate a large number of prenatal complications. Objective: The present study aimed to understand if preterm delivery can be predicted by assessing maternal plasma fibronectin concentration. Materials and Methods: Serum samples from 105 pregnant women participating in this study were collected. The plasma fibronectin were measured at 24-28 wk of gestation and again at 32-36 wk of gestation. Unfortunately, only 65 of the 105 pregnant women, returned for the second sampling. The plasma fibronectin was analyzed using ELISA method and its concentration in term and preterm deliveries was compared. The delivery dates of all the women were also recorded. Results: Out of 105 pregnant women, 28 delivered preterm (26. 7%). The Plasma fibronectin concentrations in women with preterm delivery were higher than in those who delivered at term (p = 0. 001). Accordingly, Plasma fibronectin concentrations were significantly higher in the second serum samples (p = 0. 01). Plasma fibronectin concentrations was also higher in obese women and in those suffering from preeclampsia (p = 0. 12) and gestational diabetes (p = 0. 81). Conclusion: Plasma fibronectin concentrations test could be used as an optional screening test for preterm delivery at 28 to 34 wk of gestation in pregnant women who prefer to avoid vaginal sampling.

Background: The human amniotic membrane (HAM) is a suitable and effective scaffold for cell culture and delivery, and adipose-derived stem cells (ADSCs) are an important source of stem cells for transplantation and chondrogenic differentiation. Objective: To assess the practicability of a cryopreserved HAM as a scaffold in cell proliferation and differentiation in vitro. Materials and Methods: In this experimental study, adipose tissue samples were harvested from the inguinal region of male patients aged 15-30 years. Flow cytometry was used to identify CD31, CD45, CD90, and CD105 markers in adipose stem cells. HAM was harvested from donor placenta after cesarean section, washed, trypsin-based decellularized trypsinized decellularized, and used as a scaffold via three methods: 1) ADSCs were differentiated into chondrocytes on cell culture flasks (monolayer method), and after 14 days of culture, the cells were transferred and cultured on both sides of the HAM; 2) ADSCs were cultured and differentiated directly on both sides of the HAM for 14 days (scaffold-mediated differentiation); and 3) chondrocytes were differentiated with micromass culture for 14 days, transferred on HAM, and tissue slides were histologically analyzed qualitatively. Results: Flow cytometry confirmed the presence of mesenchymal stem cells. Histological findings revealed that the cells adhered and grew well on the stromal layer of HAM. Among the three methods, scaffold-mediated differentiation of ADSCs showed the best results. Conclusion: ADSCs have excellent attachment, viability, and differentiation capacity in the stromal side of HAM. Additionally, the direct culture and differentiation of ADSCs on HAM is more suitable than the culture of differentiated cells on HAM.

Background: Infertility is a critical condition in women with polycystic ovary syndrome (PCOS), caused not only by anovulation but also by endometrial abnormality. Objective: This study aimed to evaluate and compare the hysteroscopic and histological findings of endometrial biopsies in infertile women with PCOS and normal endometrial thickness and women with unexplained infertility (UI). Materials and Methods: This cross-sectional study compared the initial hysteroscopy and endometrial histological findings of 70 infertile women with PCOS and normal endometrial thickness with those of 35 women with UI. The relationship between endometrial histology and clinical parameters such as including luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, testosterone, prolactin, fasting blood sugar, body mass index (BMI), and infertility duration was analyzed. Results: The mean age of women with PCOS was significantly lower than that of women with UI (27. 5 ± 4. 1 vs. 30 ± 4. 5 years, respectively) (p < 0. 001). The mean BMI was higher in women with PCOS than in women with UI (28. 7 ± 4. 4 vs. 25. 1 ± 3 kg/m2) (p < 0. 001). The hysteroscopic findings of all women with PCOS were normal, whereas 91. 4% of women with UI had normal hysteroscopic findings, 2. 9% had a polyp, and 5. 7% had endometrial thickening. The histological findings of women with PCOS revealed proliferative endometrium in 54. 3%, disordered proliferative endometrium in 17. 1%, secretory endometrium in 8. 6%, and endometrial polyp in 17. 1%, whereas these percentages in women with UI were 28. 6%, 0%, 54. 3%, and 20%, respectively. Conclusion: The hysteroscopic evaluation alone of infertile women might not detect all probable endometrial pathologies in women with PCOS.

Background: Oral progesterone is recommended as an alternative to gonadotropinreleasing hormone (GnRH) agonists and antagonists to prevent luteinizing hormone (LH) surge in assisted reproductive technology (ART) cycles. However, there are little data regarding its use. Objective: We aimed to compare the effect of oral Utrogestan and Cetrotide (a GnRH antagonist) on preventing LH surge in ART cycles. Materials and Methods: In this randomized clinical trial, 100 infertile women undergoing ART who received recombinant follicle-stimulating hormone (FSH) at 150-225 IU/day were randomly assigned to receive either Utrogestan 100 mg twice a day (case group) or GnRH antagonist protocol (control group) from cycle day 3 until the trigger day. Triggering was performed with 10, 000 IU hCG) when there were at least three mature follicles. Viable embryos were cryopreserved for transfer in the next cycle for both groups. The number of oocytes retrieved and transferred embryos were compared between groups. Results: The case group had significantly higher progesterone levels on triggering day, more follicles of >14 mm with higher maturity, and more oocytes retrieved with a higher rate of embryos transferred. A small increase in the pregnancy rate was observed in the case group, with no significant between-group differences. The most important result was the lack of premature LH surge in either group upon serum LH assessment on the triggering day. Conclusion: Utrogestan is an alternative treatment that could reduce the LH surge rate and increase the ART outcomes including the number of oocytes retrieved and transferred embryos compared with GnRH agonists and antagonists.

Background: The lack of knowledge from healthcare providers regarding fertility preservation will certainly affect the patient’ s knowledge, attitude, behavior, and also perspective. Obstetrics and Gynecology (OB/GYN) residents may most likely be the first line professionals to integrate fertility preservation technologies into their practice which plays an important task in giving an understanding of the relationship between age and fertility for patients. Objective: This study aims to assess OB/GYN resident knowledge and beliefs regarding age-related fertility decline, intentions, and religion aspect toward fertility preservation. Materials and Methods: A cross-sectional study was conducted on 92 Indonesian OB/GYN residents at the Cipto Mangunkusomo Hospital between November and December 2017. Data were collected using a questionnaire which had four sections, knowledge, attitude, intention, and religion aspect toward fertility preservation. Results: The majority of participants believed that an OB/GYN should encourage discussions about potential childbearing desires (96. 74%) and age-related fertility decline (94. 57%) with patients, of which 79. 34% believed that these discussions should be part of a woman’ s annual health examination. Cancer patients are likely to undergo oocyte cryopreservation than people who choose career as priority. From the religion aspect, fertility preservation options such as sperm, oocyte, embryo, and ovarian cortex cryopreservation were accepted by most residents with varied religions, while oocyte and sperm donor methods were unacceptable (48% and 57%, respectively) because of the belief that oocyte/sperm should only be given to legitimate partners, but many still do not know that oocyte and sperm donor were prohibited by all religions. Conclusion: Age-related fertility decline and frozen egg storage should be discussed during annual woman wellness examinations by OB/GYN specialists.

Background: There is limited evidence about the anti-diabetic effects of selenium supplementation in women with gestational diabetes mellitus (GDM). Objective: This study investigates the effects of selenium supplementation on glucose homeostasis in women with GDM. Materials and Methods: A total of 60 pregnant women with GDM were enrolled in this prospective randomized, double-blind, and placebo-controlled clinical trial. They were randomly assigned to take either 100μ g selenium supplements as tablet or a placebo daily for 12 wk since 24-28 wk of gestation. The primary outcomes were changes in the glucose homeostasis, including fasting plasma glucose, the 2-hr post prandial blood glucose, serum insulin level, glycosylated hemoglobin (Hb A1C), and the homeostasis model assessment of insulin resistance(HOMA_IR) at the initial period and 3 months after intervention. Results: The mean maternal age of the patients who took selenium supplements was 29. 19 ± 6. 16 (range 18-41) years. In the placebo group, the mean maternal age was 31 ± 4. 43 (range 24-39) years. Compared with the placebo group, fasting plasma glucose, 2-hr post-prandial blood glucose, glycosylated hemoglobin(Hb A1C), serum insulin level, and homeostasis model of assessment-estimated insulin resistance(HOMA_IR) were not significantly changed in the selenium group at the end of study (p = 0. 25, p = 0. 87, p = 0. 34, p = 0. 57, and p = 0. 31, respectively). Conclusion: The results of this trial suggest that supplementation with 100μ g of selenium does not modulate glucose homeostasis in women with GDM.

Background: There are concerns and diverse experiences related to infertility and childlessness. The lived experience of infertile people from various cultures needs to be explored. Objective: The aim of this qualitative study was to explore Iranian women experiences of their infertility. Materials and Methods: The data comprised interviews about fertility issues in the Persian language with eighteen women, aged 17-45 yr old, who agreed to be interviewed at the Mottahari Infertility Treatment Clinic, affiliated to the Urmia University of Medical Sciences about their fertility problems. They were approached by the researchers at the time of their first visit. The verbatim transcribed interviews were analyzed using deductive conventional content analysis. Results: The experiences of the informants were conceptualized into four major themes: 1) Shock (subthemes: Disbelief and Denial); 2) Reaction (subthemes: Distress, Guilt, Loss of self-esteem and Sexual reluctance); 3) Processing (subthemes: Internal processing, Avoidance, Marriage at risk, External processing, Stigma caused by the family and Stigma caused by the community) and 4) Reorientation (subthemes: Forgetting, Marriage to saving marriage and Sexual consent). Conclusion: Infertility can be a challenging condition. Considering that infertilityrelated issues affect Iranian women more contextual factors is necessary. So, culturally sensitive and gender specific protocols are suggested to provide suitable and about culturally sensitive and gender-specific protocols is a necessity in order to provide suitable care to infertile women.

Dear Editor: The field of assisted reproductive technologies (ARTs) is rapidly progressing with many new advances to help infertile or sub-fertile couples to conceive and finally give birth (1, 2). The application of ARTs has solved the problems associated with infertility in many couples and has improved the results of infertility treatment. More than 5 million children have been born through these technologies and about 40 million couples have benefited after ARTs worldwide (3). However, ARTs may be associated with complications in women and fetuses after taking prescribed drugs (4). The side effects of different medications cause concern in couples who try several times to conceive with ARTs.