International Journal of Fertility & Sterility
Year:2016 | Volume:10 | Issue:2|Papers Count:18

The Society for Assisted Reproductive Technology (SART) method of embryo grading is unique, simple, and widely practiced, and its use has been mandatory for SART membership programs since 2010. Developed by SART in 2006, the current embryo grading system categories, "good, fair, and poor, " are limited because they do not describe the best 1-2 embryos in the interest of keeping pace with the shift in clinical practice to be more selective and to transfer fewer embryos. This inspired us to conduct a review on the SART embryo grading system.In this retrospective study, the literature on evaluation of human embryo quality in general, and the SART method of evaluation in particular, were reviewed for the period of 2000 to 2014. A multifaceted search pertaining to methods of embryo grading and transfer using a combination of relevant terms [embryo, mammalian, embryo transfer, grade, grading, morphology, biomarkers, SART, and in vitro fertilization (IVF)] was performed. The inclusion and exclusion in this review were dictated by the aim and scope of the study. Two investigators independently assessed the studies and extracted information. A total of 61 articles were reviewed.Very few studies have evaluated the efficacy of the SART embryo grading method. The present study suggests the necessity for revision of the current SART grading system. The system, as it is now, lacks criteria for describing the cohort specific best embryo and thus is of limited use in single embryo transfer. The study foresees heightened descriptive efficiency of the SART system by implementing the proposed changes.Strengths and weaknesses of the SART embryo grading were identified. Ideas for selecting the best cohort-specific embryo have been discussed, which may trigger methodological improvement in SART and other embryo grading systems.

Minimal stimulation in vitro fertilization (mini-IVF) consists of a gentle controlled ovarian stimulation that aims to produce a maximum of five to six oocytes. There is a misbelief that mini-IVF severely compromises pregnancy and live birth rates. An appraisal of the literature pertaining to studies on mini-IVF protocols was performed. The advantages of minimal stimulation protocols are reported here with a focus on the use of clomiphene citrate (CC), gonadotropin releasing hormone (GnRH) agonist trigger for oocyte maturation, and freeze-all embryo strategy. Literature review and the author’s own center data suggest that minimal ovarian stimulation protocols with GnRH agonist trigger and freeze-all embryo strategy along with single embryo transfer produce a reasonable clinical pregnancy and live birth rates in both good and poor responders. Additionally, mini-IVF offers numerous advantages such as: i. Reduction in cost and stress with fewer office visits, needle sticks, and ultrasounds, and ii. Reduction in the incidence of ovarian hyperstimulation syndrome (OHSS). Mini-IVF is re-emerging as a solution for some of the problems associated with conventional IVF, such as OHSS, cost, and patient discomfort.

To provide a comprehensive review of the published literature of patients with endometrial bone or osseous fragments with a view to critically examine the antecedent clinical presentation, investigations and prognosis after treatment.This systematic review of the literature includes full text articles of published case reports and cases series from the following computerized databases: PubMed, Ovid, and Medline between 1928 and 2013. We reviewed a total of 293 patients in 155 case reports and case series.The mean±SD age at presentation was 32.7±8.9. Approximately 88% of patients had at least one prior surgical uterine evacuation relating to pregnancy termination or loss at a median gestational age of 14 weeks (range of 4-41 weeks). The most common presenting symptom was infertility (56.2%). One hundred twenty-four (66.0%) of the 188 patients attempting pregnancy after treatment achieved pregnancy prior to article publication and the majority (82.3%) were spontaneous. Spontaneous miscarriage rate remains high (43%); however, most pregnancies ended in live-birth (55%).Bone fragments in the endometrium are most commonly found after pregnancy termination, present with infertility and/or irregular menses, and upon removal, patients rapidly conceive spontaneously.

Background: Threatened miscarriage is a common complication in pregnancy that leads to adverse pregnancy outcomes such as preterm labor. This study aimed to compare the vaginal progesterone (Cyclogest) versus 17-alpha-hydroxyprogesterone caproate (Proluton) on preventing preterm labor in pregnant women with threatened abortion at less than 34 weeks’ gestational age.Materials and Methods: This balanced randomized, double-blind, single-center controlled clinical trial included 190 women with threatened abortion. They were then randomly allocated into Cyclogest (n=95) and 17-alpha-hydroxyprogesterone caproate (Proluton, n=95) groups. Interested outcome was preterm labor less than 34 weeks. The Pearson chi-square and Student’s t test were used to compare two groups. The data were analyzed by Stata software version 13.Results: The risks of preterm labor less than 34 weeks in Proluton and Cyclogest groups were 8.6 and 6.52%, respectively. There was no significant difference for risk of preterm labor less than 34 weeks [relative ratio (RR): 1.31, 95% confidence interval (CI): 0.47- 3.66, P=0.59] between two groups.Conclusion: Risk of preterm labor in the vaginal progesterone group and 17-alpha-hydroxyprogesterone caproate group in pregnant women with threatened abortion is the same (Registration Number: IRCT2014123120504N1).

Background: The measurement of follicular output rate (FORT) has been proposed as a good indicator for evaluating follicular response to the exogenous recombinant follicle-stimulating hormone (rFSH). This places FORT as a promising qualitative marker for ovarian function. The objective of the study was to determine FORT as a predictor of oocyte competence, embryo quality and clinical pregnancy after intracytoplasmic sperm injection (ICSI).Materials and Methods: This prospective study was carried out on a group of infertile females (n=282) at Islamabad Clinic Serving Infertile Couples, Islamabad, Pakistan, from June 2010 till August 2013. Down- regulated females were stimulated in injection gonadotropins and on ovulation induction day, pre-ovulatory follicle count (PFC) was determined using transvaginal ultrasound scan (TVUS), and FORT was determined as a ratio of PFC to antral follicle count (AFC) ×100. Group I consisted of females with a negative pregnancy test, while group II had a positive pregnancy test that was confirmed with the appearance of fetal cardiac activity. Linear regression analyses of categorical variables of clinical pregnancy along with other independent variables, including FORT, were performed using SPSS version 15.0.Results: Pregnancy occurred in 101/282 women who were tested, recording a clinical pregnancy rate of about 35.8%. FORT values were higher in group II as compared to group I females (P=0.0001). In multiple regression analysis, 97.7, 87.1, 78.2, and 83.4% variations were explained based on the number of retrieved oocytes per patients, number of metaphase II oocytes retrieved, number of fertilized oocytes, and number of cleaved embryos, respectively, indicating FORT as an independent predictor.Conclusion: FORT is a predictor of oocyte competence in terms of a number of retrieved, mature and fertilized oocytes. It also gives information about the number of cleaved embryos and clinical pregnancy rate.

Background: Mothers with a history of infertility may experience parenting difficulties and challenges. This study was conducted to investigate the role of residential early parenting services in increasing parenting confidence in mothers with a history of infertility.Materials and Methods: This was a retrospective chart review study using the quantitative data from the clients attending the Karitane Residential Units and Parenting Services (known as Karitane RUs) during 2013. Parenting confidence (using Karitane Parenting Confidence Scale-KPCS), depression, demographics, reproductive and medical history, as well as child’s information were assessed from a sample of 27 mothers who had a history of infertility and who attended the Karitane RUs for support and assistance. The data were analyzed using SPSS version 19.Results: More than half of the women (59.3%) reported a relatively low level of parenting confidence on the day of admission. The rate of low parenting confidence, however, dropped to 22.2% after receiving 4-5 days support and training in the Karitane RUs. The mean score of the KPCS increased from 36.9 ± 5.6 before the intervention to 41.1±3.4 after the intervention, indicating an improvement in the parenting confidence of the mothers after attending the Karitane RUs (P<0.0001). No statistically significant association was found between maternal low parenting confidence with parental demographics (including age, country of birth, and employment status), a history of help-seeking, symptoms of depression, as well as child’s information [including gender, age, siblings, diagnosis of gastroesophageal reflux disease (GORD) and use of medication].Conclusion: Having a child after a period of infertility can be a stressful experience for some mothers. This can result in low parenting confidence and affect parent-child attachment. Our findings emphasized on the role of the residential early parenting services in promoting the level of parenting confidence and highlighted the need for early recognition and referral of the mothers with a history of infertility to such centers.

Background: In 1993, Muller developed the Prenatal Attachment Inventory (PAI) which has been used widely in many studies and translated into several languages. The current study aimed to translate the PAI into Persian, assess the underlying structure of the PAI, and the appropriateness of the one-factor solution proposed by Muller.Materials and Methods: In this cross-sectional study, we recruited a total of 322 primigravidae in their 27th to 34th gestational weeks that referred to private and governmental prenatal clinics in Tehran, Iran. All participants completed the Persian versions of the PAI and a demographic questionnaire. Participants were re-tested 2 weeks after the initial testing. The following psychometric properties of the PAI were investigated: construct validity by confirmatory factor analysis (CFA), internal consistency reliability with Cronbach’s alpha, and test-retest reliability according to the intraclass correlation coefficient (ICC).Results: The CFA results indicated that a single-factor model provided good fit to the data, which confirmed the original model by its developer. The Cronbach’s alpha coefficient for PAI was 0.856 and the test-retest reliability with ICC was 0.784. Considering the duration between marriage and pregnancy, women with low duration scored significantly higher than women with high duration on PAI (P=0.043).Conclusion: The Persian version of the PAI showed that one factor structure was adequate and could be used for measuring psychological affectionate attachment between Iranian mothers and their fetuses.

Background: Orexin is a hypothalamic orexigenic neuropeptide, which third cerebral injection of it mainly exerts inhibitory effects on reproductive functions. It increases significantly the Aromatase (Cyp19) gene expression in the hypothalamus of male rats. Aromatase is an enzyme which converts androgens to estradiol in the hypothalamus of rats. Prenatal or neonatal exposure of females to testosterone masculinizes the pattern of Cyp19 mRNA levels in adulthood. In the present study the effects of central injections of orexin-A on hypothalamic Cyp19 gene expression of adult female rats were investigated, while they had been androgenized on third day of postnatal life.Materials and Methods: In this experimental study, twenty female Wistar rats received subcutaneous injections of testosterone propionate (50 mg/100 ml) on their third day of postnatal life. Adult androgenized rats weighing 180-220 g, received either 3 ml saline or one of 2, 4 or 8 mg/3 ml concentration of orexin via third cerebral ventricle. Five non-androgenized rats, as control group, received intra cerebral ventricle (ICV) injection of 3 ml saline. The hypothalamuses were dissected out and mean Cyp19 mRNA levels were determined by semi-quantitative real time-polymerase chain reaction (PCR) method. Data were analyzed by unpaired t test and one-way ANOVA using SPSS software, version 16.Results: Mean relative Cyp19 mRNA level was significantly increased in the hypothalamus of androgenized compared to non-androgenized female rats. Central injections of 2, 4 or 8 mg/3 ml orexin decreased significantly the hypothalamic Cyp19 mRNA level of androgenized rats compared to androgenized-control groups.Conclusion: The results suggested that the orexin may exert inhibitory effects on the gene expression of Cyp19 in the hypothalamus of neonatal androgenized female rats in adulthood.

Background: Globozoospermia is a rare syndrome with an incidence of less than 0.1% among infertile men. Researchers have recently identified a large deletion, about 200 kbp, encompassing the whole length of DPY19L2 or mutations in SPATA16 and PICK1 genes associated with globozoospermia. The aim of this study was to analyze the DPY19L2 gene deletion using polymerase chain reaction technique for the exons 1, 4- 8, 11 and 22 as well as break point (BP) "a" in globozoospermic men.Materials and Methods: In this experimental study, genome samples were collected from 27 men with globozoospermia (cases) and 36 fertile individuals (controls), and genomic analysis was carried out on each sample.Results: Deletion of DPY19L2 gene accounted for 74% of individuals with globozoospermia. DPY19L2 gene deletion was considered as the molecular pathogenic factor for the onset of globozoospermia in infertile men. By quantitative real-time polymerase chain reaction (qPCR), we genotyped DPY19L2 deletion and identified carriers within the population.Conclusion: This technique may be considered as a method for family counseling and has the potential to be used as a pre-implantation genetic diagnosis, especially in ethnic community with high rate of consanguineous marriages.

Background: The aim of this study was to evaluate the non-genomic action of thyroxin on sperm kinetic and its probable use to improve sperm recovery after applying an enrichment method like "swim-up" in comparison with the available one, pentoxifylline.Materials and Methods: This is an experimental study. A total of 50 patients were recruited, followed by infertility consultation. Conventional sperm assays were performed according to World Health Organization criteria-2010 (WHO-2010). A Computer Aided Semen Analysis System was employed to assess kinetic parameters and concentrations. Number of the motile sperm recovered after preparation technique was calculated.Results: Addition of T4 (0.002 mg/ml) to semen samples increased hypermotility at 20 minutes (control: 14.18±5.1% vs.17.66±8.88%, P<0.03, data expressed as mean±SD) and remained unchanged after 40 minutes. Significant differences were found in the motile sperm recovered after swim-up (control: 8.93×106±9.52×06 vs.17.20×106±21.16×106, P<0.03), achieving all of the tested samples a desirable threshold value for artificial insemination outcome, while adding pentoxifylline increased the number of recovered sperm after swim-up in 60% of the studied cases. No synergism between two treatments could be determined.Conclusion: We propose a new physiological tool to artificially improve insemination. The discussion opens windows to investigate unknown pathways involved in sperm capacitation and gives innovative arguments to better understand infertility mechanisms.

Background: Metals can cause male infertility through affection of spermatogenesis and sperm quality. Strong evidences confirm that male infertility in metal-exposed humans is mediated via various mechanisms such as production of reactive oxygen species (ROS). Flavonoids have antioxidant and metal chelating properties which make them suitable candidates for neutralizing adverse effects of metals on semen quality. In the current study, we have evaluated the effects of five types of flavonoids (rutin, naringin, kaempferol, quercetin, and catechin) on recovery of sperm motility and prevention of membrane oxidative damage from aluminum chloride (AlCl3), cadmium chloride (CdCl2), and lead chloride (PbCl4).Materials and Methods: In this experimental study, motility and lipid peroxidation of metal-exposed sperm was investigated in the presence of different concentrations of five kinds of flavonoids. Malondialdehyde (MDA) production was assessed as a lipid peroxidation marker.Results: Aluminum chloride (AlCl3), cadmium chloride (CdCl2), and lead chloride (PbCl4) diminished sperm motility. Treatment of metal-exposed sperm with rutin, naringin, and kaempferol attenuated the negative effects of the metals on sperm motility. Quercetin and catechin decreased the motility of metal-exposed sperm.Conclusion: Based on the MDA production results, only AlCl3 significantly induced lipid peroxidation. Treatment with rutin, naringin, and kaempferol significantly decreased MDA production.

Background: Manipulating the dietary fatty acid (FA) content can alter FA profiles of reproductive tissues. Numerous researchers have evaluated the effect of fish oil (FO) supplementation on reproductive characteristics in domestic animals, but reliable information concerning dietary FO effects on semen quality and testosterone concentrations in dogs has not been reported. Therefore, this study evaluated the effects of dietary FO on semen quality and serum testosterone concentrations in dogs.Materials and Methods: In this cross-over experimental study, 5 male dogs consumed either a control diet or the same diet supplemented with 54 mg FO/kg metabolic body weight (BW) for 120 days. After the 120-day wash-out period, control (C) dogs received FO and FO-fed dogs consumed the control diet. In the first period, 2 dogs were allocated to the FO group and 3 to the C group. In the second period, 3 dogs were allocated to the FO group and 2 to the C group. Semen samples collected on days 0, 60, 90 and 120 were evaluated by standard methods. Day 120 semen samples were analyzed for FA profiles. Blood samples were collected on days 0, 30, 60, 90 and 120 to measure serum testosterone concentrations. Data were analyzed by analysis of variance with repeated measures using the Mixed Models procedure of SAS (version 9.0, SAS Institute Inc., Cary, NC, USA). Animals and period of time (first or second 120 days) were random variables; and treatment, time, and the treatment by time interaction were considered fixed effects.Results: FO supplementation increased the percentage of motile sperm (P=0.02), total sperm count (P<0.01), total sperm viability (P<0.01), and total morphologically normal sperm (P<0.01). Supplementation decreased the percentage of viable sperm (P=0.03) and serum testosterone concentration (P<0.01). FO supplementation also increased the percentage of arachidonic acid, eicosapentaenoic acid, (EPA) and total n-3 in semen samples (P£0.05).Conclusion: These results are consistent with the concept that long-term FO supplementation influences semen quality and testosterone concentrations in dogs by altering semen FA profiles.

Background: Methotrexate (MTX), as an anti-folate agent, is widely used in the treatment of rheumatic disorders and malignant tumors, however it damages reproductive system in mice. The aim of this research was to study the effects of ethyl pyruvate (EP) on embryo development and oxidative stress changes in the testis of mice treated with MTX.Materials and Methods: In this experimental study, thirty-two adult male Naval Medical Research Institute mice, with average weight of 26±2 g, were divided into four groups. The first group (control) received distilled water (0.1 ml/mice/day), while the second group was intraperitoneally (IP) treated with 20 mg/kg MTX once per week. The third group was IP treated with 40 mg/kg/day EP, and the fourth group was IP treated with both 20 mg/kg MTX and 40 mg/kg/day EP for 30 days. At the end of treatment fertilization rate and embryonic development were evaluated. Differences between these groups were assessed by ANOVA using the SPSS software package for Windows with a Tukey-Kramer multiple post-hoc comparison test.Results: MTX treatment caused significant (P<0.05) increase in malondialdehyde (MDA) and reduced catalase (CAT), as well as leading to in vitro fertilization (IVF) and embryonic development. The improved effects of EP on the IVF were determined by the reduced level of MDA (index of oxidative stress) and significant increased level of CAT (a key antioxidant). We observed significant increase in fertilization rate and embryonic development in the treated group with both MTX and EP.Conclusion: It is suggested that EP can be useful in ameliorating testicular damages and embryotoxicity induced by MTX. These effects could be attributed to its antioxidant properties.

Background: Opioid consumption has been widely increasing across the globe; however, it can cause adverse effects on the body. Morphine, an opioid, can reduce sex hormones and fertility. Withania somnifera (WS) is a traditional herb used to improve sexual activities. This study strives to investigate the effect of WS on sex hormones and gonadotropins in addicted male rats.Materials and Methods: In this experimental study, forty-eight male National Maritime Research Institute (NMRI) rats were randomly divided into four groups: i. Control group, ii. WS-treated control group, iii. Addicted group, and iv. WS-treated addicted group. Water-soluble morphine was given to rats for 21 days to induce addiction, concurrently the treated groups (2 and 4) also received WS plant-mixed pelleted food (6.25%). At the end of the treatment, the sex hormone and gonadotropin levels of the rats’ sera were determined in all the groups.Results: Except for follicle-stimulating hormone (FSH), morphine reduced most of the gonadotropin and sex hormone levels. Whereas WS caused a considerable increase in the hormones in the treated addicted group, there was only a slight increase in the treated control group.Conclusion: WS increased sex hormones and gonadotropins-especially testosterone, estrogen, and luteinizing hormone-in the addicted male rats and even increased the progesterone level, a stimulant of most sex hormones in addicted male rats.

Background: The aim of this study was to investigate the effects of curcumin on epididymal sperm parameters in adult male Navel Medical Research Institute (NMRI) mice exposed to sodium arsenite.Materials and Methods: In this experimental study, we divided the animals into four groups: control, sodium arsenite (5 mg/kg), curcumin (100 mg/kg) and curcumin+sodium arsenite. Exposures were performed by intraperitoneal injections for a 5-week period. After the exposure period, we recorded the animals’ body and left testes weights. The left caudal epididymis was used to count the sperm number and analyze motility, viability, morphological abnormalities, acrosome reaction, DNA integrity, and histone-protamine replacement in the spermatozoa. One-way analysis of variance (ANOVA) followed by the Tukey’s test was used to assess the statistical significance of the data with SPSS 16.0. P<0.05 was considered significant.Results: Mice exposed to sodium arsenite showed a significant decrease in the number, motility, viability, normal sperm morphology and acrosome integrity of spermatozoa compared to the control group. In the curcumin+sodium arsenite group, curcumin significantly reversed these adverse effects to the point where they approximated the control. In addition, the application of curcumin alone had no significant difference in these parameters compared to the control and curcumin+sodium arsenite groups. However, we observed no significant differences in the body and the testis weight as well as the DNA integrity and histone-protamine replacement in the spermatozoa of the four groups.Conclusion: Curcumin compensated for the toxic effects of sodium arsenite on a number of sperm parameters in adult mice.

Background: Selection of sperm for intra-cytoplasmic sperm injection (ICSI) is usually considered as the ultimate technique to alleviate male-factor infertility. In routine ICSI, selection is based on morphology and viability which does not necessarily preclude the chance injection of DNA-damaged or apoptotic sperm into the oocyte. Sperm with high negative surface electrical charge, named "Zeta potential", are mature and more likely to have intact chromatin. In addition, X-bearing spermatozoa carry more negative charge. Therefore, we aimed to compare the clinical outcomes of Zeta procedure with routine sperm selection in infertile men candidate for ICSI.Materials and Methods: From a total of 203 ICSI cycles studied, 101 cycles were allocated to density gradient centrifugation (DGC) /Zeta group and the remaining 102 were included in the DGC group in this prospective study. Clinical outcomes were compared between the two groups. The ratios of X- and Y bearing sperm were assessed by fluorescence in situ hybridization (FISH) and quantitative polymerase chain reaction (qPCR) methods in 17 independent semen samples.Results: In the present double-blind randomized clinical trial, a significant increase in top quality embryos and pregnancy rate were observed in DGC/Zeta group compared to DGC group. Moreover, sex ratio (XY/XX) at birth significantly was lower in the DGC/Zeta group compared to DGC group despite similar ratio of X/Y bearings spermatozoa following Zeta selection.Conclusion: Zeta method not only improves the percentage of top embryo quality and pregnancy outcome but also alters the sex ratio compared to the conventional DGC method, despite no significant change in the ratio of X- and Y- bearing sperm population (Registration number: IRCT201108047223N1).

From December 2000 until 2010, the researchers at Royan Institute conducted a wide range of investigations on ovarian tissue cryopreservation with the intent to provide fertility preservation to cancer patients that were considered to be candidates for these services. In 2010, Royan Institute established the Royan Human Ovarian Tissue Bank as a subgroup of the Embryology Department. Since its inception, approximately 180 patients between the ages of 7- 47 years have undergone consultations. Ovarian samples were cryopreserved from 47 patients (age: 7-35 years) diagnosed with cervical adenocarcinoma (n=9); breast carcinoma (n=7), Ewing’s sarcoma (n=7), opposite side ovarian tumor (n=7), endometrial adenocarcinoma (n=4), malignant colon tumors (n=3), as well as Hodgkin’s lymphoma, major thalassemia and acute lymphoblastic leukemia (n=1-2 patients for each disease). Additionally, two patients requested ovarian tissue transplantation after completion of their treatments.

In in vitro fertilization (IVF) programme, the advantages of mild-stimulation have long been appreciated, while there was a called for more patient-friendly approach in ovarian stimulation around 20 years ago. However, the concept is yet to get wide-spread acceptance in the IVF community. The main impediment has been a lack of robust outcome data that can assure the success of mild-IVF at least as good as those of conventional IVF. The randomized controlled trials (RCTs) that compared sequential clomiphene citrate (CC) and low-dose gonadotropins (as mild/ minimal stimulation) with conventional long protocol were either small in sample size or heterogeneous in character. Nevertheless, recent meta-analyses and systematic reviews found no difference in pregnancy rates or live birth rates (LBRs) between sequential CC-gonadotropin protocol and conventional IVF.