International Journal of Fertility & Sterility
Year:2018 | Volume:12 | Issue:1|Papers Count:16

Background: The aim of the current study is to compare quinagolide with cabergoline in prevention of ovarian hyperstimulation syndrome (OHSS) among high risk women undergoing intracytoplasmic sperm injection (ICSI).Materials and Methods: This randomized clinical trial study was performed from March 2015 to February 2017. One hundred and twenty six women undergoing ICSI who were at high risk of developing OHSS (having over 20follicles of>12 mm), were randomized into two groups. The first group received cabergoline 0.5 mg and the second group received quinagolide 75 mg every day for 7 days commencing on the day of gonadotropin-releasing hormone (GnRH) agonist administration. Then OHSS symptoms as well as their severity were assessed according to standard definition, 3 and 6 days after GnRH agonist administration. Ascites were determined by trans-vaginal ultrasound. Other secondary points were the number of oocytes and the number of embryos and their quality. Quantitative and qualitative data were analyzed using Student’s t test, and Chi-square or fisher’s exact test, respectively. A P<0.05 was considered statistically significant.Results: The incidence of severe OHSS in the quinagolide-treated group was 3.1% while it was 15.8% in cabergolinetreated subjects (P<0.001). Ascites were less frequent after treatment with Quinagolide as compared to cabergoline(21.9 vs.61.9%, respectively) (P=0.0001). There was no significant statistical deferences between the two groups in terms of mean age, number of oocytes, metaphase I and metaphase II oocytes, and germinal vesicles. There wasa significant difference between cabergoline and quinagolide groups regarding the embryo number (P=0.037) with cabergoline-treated group showing a higher number of embryos. But, the number of good quality embryo in quinagolide-treated individuals was significantly higher than that of the cabergoline-treated group (P=0.001).Conclusion: Quinagolide seems to be more effective than Cabergoline in prevention of OHSS in high-risk patients undergoing ICSI (Registration number: IRCT2016053128187N1).

Background: Fertility loss is considered as a challenging experience. This study was conducted to compare the effectiveness of antidepressant medication and psychological intervention on depression symptoms in women with infertility and sexual dysfunctions (SD).Materials and Methods: This randomized, controlled clinical trial study was completed from December 2014 to June 2015 in Babol, Iran. Of the 485 participants, 93 were randomly assigned in a 1: 1: 1 ratio to psychosexual therapy (PST), bupropion extended-release (BUP ER) at a dose of 150 mg/d, and control (no intervention) groups. The Beck Depression Inventory (BDI) was completed at the beginning and end of the study. Duration of study was eight weeks. Statistical analyses were performed by using paired-test and analysis of covariance.Results: The mean depression score on the BDI was 22.35 ±8.70 in all participants. Mean BDI score decreased significantly in both treatment groups (PST: P<0.0001, BUP: P<0.002) from baseline to end of the study, whereas intra-individual changes in BDI score were not significant in the control group. The decrease in mean BDI score was greater with PST compared to BUP treatment (P<0.005) and the control group (P<0.0001). The PST group showed greater improvement in depression levels (severe to moderate, moderate to mild) in comparison with the two other groups (P<0.001). Drug treatment was well tolerated by the participants in the BUP group.Conclusion: PST can be a reliable alternative to BUP ER for relieving depression symptoms in an Iranian population of women with infertility and SD (Registration number: IRCT2015042721955N2).

Background: The outcomes of fertility treatments are unpredictable, and levels of depressive symptoms increase inpatients during the waiting period of the result of intrauterine insemination (IUI) treatment. The aim of this study was to compare the effects of a positive reappraisal coping intervention (PRCI) and problem-solving skills training (PSS) on depression during the waiting period of the result of IUI Treatment.Materials and Methods: This randomized control clinical trial was done among 108 women undergoing IUI treatment. In the control group, the women received routine care. In the PRCI group, women attended two training sessions and were asked to complete coping thoughts cards and fill out daily monitoring forms during the waiting period. In the PSS group, PSS were taught over three sessions. The depression was measured by the beck depression inventory.Results: On the 10th day of the IUI waiting period, there were significant differences between the control group (21.42 ± 11.42) and the PSS group (12.52 ± 8.05) and PRCI groups (13.14 ± 9.7) (P<0.001), but no significant difference between the PRCI group and the PSS group.Conclusion: According to the results of this randomized control trial there is no difference between a PRCI and PSS on depression during the waiting period of the result of IUI treatment. This suggests that both interventions can be used to help infertile women combat depression during the waiting period of the result of fertility treatments (Registration number: IRCT2016020926490N1).

Background: The objective of this pilot study was to evaluate the feasibility of conducting a larger prospective cohort study, which will aim at determining the independent contribution of male and female lifestyle-related factors to assisted reproductive technology (ART) success. The study also examined whether couples seeking fertility treatments present lifestyle-related factors that may interfere with their reproductive health.Materials and Methods: This prospective pilot study was conducted in a fertility clinic between May 2015 and February 2016. Feasibility factors evaluated were recruitment rates, compliance with the protocol, retention rate and ART outcomes at six-month follow-up. Anthropometric profile and lifestyle habits of both partners were evaluated before the beginning of infertility treatments.Results: We approached 130 eligible infertile couples. Among them, 32 (25%) agreed to participate and 28 (88%) complied with the protocol. At six-month follow-up, seven couples (25%) did not start, or stop, infertility treatments and 13 couples (62%) achieved a clinical pregnancy. Among the 28 couples included in the analyses, 16% of the partners were obese and 23% had abdominal obesity. The majority of the subjects were still drinking alcohol (84%). Sixty-eight percent of women needed improvement in their diet (vs.95% of men, P=0.05) and none of them achieved the Canadian recommendations for physical activity (vs.33% of men, P=0.001). Moreover, 35% of the partners had a poor sleep quality. Overall, women presented a worse reproductive health profile than men, with 3.1 and 2.4 out of seven adverse factors, respectively (P=0.04).Conclusion: Conducting a large prospective cohort study in our fertility clinic will be feasible but recruitment and compliance with the protocol need to be improved. Many women and men seeking fertility treatments present unfavourable lifestyle-related factors that may explain, at least partially, their difficulties in conceiving.

Background: Women undergoing in vitro fertilization (IVF) cycles should successfully go through multiple points during the procedure (i.e., implantation, clinical pregnancy, no spontaneous abortion and delivery) to achieve live births. In this study, data from multiple cycles and multiple points during the IVF cycle are collected for each individual to model the effects of factors associated with success at different stages of IVF cycles in Iranian infertile women.Materials and Methods: This historical cohort study includes 996 assisted reproductive technology (ART) cycles of 511 infertile women. Covariates considered in this study were women’s age, type of cycle (fresh or frozen embryo transfer), number of embryos transferred and having polycystic ovarian syndrome during IVF cycles. Generalized estimating equations were used for calculation of odds ratio (OR) and 95% confidence intervals (95% CI) of success at different stages during IVF cycles. Cluster-weighted generalized estimating equations (CWGEE) was also fitted to handle informative cluster size.Results: After adjusting for potential confounders, it was seen that receiving frozen embryo transfer was associated with higher odds of success compared to receiving fresh embryo transfer (adj OR: 2.26, 95% CI: 1.66-3.07); however, cycles with fresh embryo transfer exhibited better results in clinical pregnancy compared to those receiving frozen embryo. Being in the age category of 38 to 40 was associated with lower odds of success compared to the reference category (<35) in CWGEE model (adj OR: 0.67, 95% CI: 0.45-1.00). The number of embryos transferred was positively associated with the odds of success in CWGEE (adj OR: 1.21, 95% CI: 1.03-1.42) as well as the GEE model.Conclusion: Receiving frozen embryo was positively associated with odds of success compared to cycles with fresh embryo. The number of embryos transferred and women’s age were significantly associated with odds of success.

Background: Chlamydia trachomatis (CT), the most common bacterial sexually transmitted infection (STI), leads to pelvic inflammatory disease, infertility and chronic pelvic pain in women as well as an increased risk of vertical transmission, conjunctivitis and pneumonitis in infants. It may also be a co-factor along with human papillomavirus (HPV) in cervical cancer progression. We aimed to determine the prevalence of CT genotypes in genital specimens of women from South Khorasan, Iran and to test the association between CT and cytology statistics.Materials and Methods: This was a cross-sectional study on 248 Pap smear samples from women who visited a gynecologist for routine Pap smear testing in South Khorasan province. Nested polymerase chain reaction (PCR) was used to test the residual fluids of Pap smears for CT-DNA after cytological examination. Direct sequencing, alignment and phylogenic analyses were performed on eight samples to identify their genotypes.Results: The mean age of patients was 37.54 ± 5.21 years. Most samples had a normal cytology (214 cases, 86.29%). Overall, 31 samples were positive for CT infection (12.5%) of which 20 (9.34%) were normal and 11 (32.35%) were abnormal, with the frequency difference being significant (P=0.022). The co-infection of CT/HPV in total was identified in 14 cases (5.6%). The results of sequencing eight samples out of the 31 CT positive samples revealed the detection of genotypes D and E, each with four cases.Conclusion: We show that a high prevalence of genital CT infection is present in women with both normal and abnormal cytology; however, the higher prevalence among women in the abnormal group may indicate its involvement in cervical neoplasia.

Background: Failure in the endometrial receptivity may account for a significant number of infertility cases including unexplained infertility in women. Reduction in the endometrial estrogen receptor-alpha (ER-a) expression during implantation may be a critical event that coincides with the expression of specific genes and the formation of a receptive endometrium. The aim of the present study was to assess the expression of ER-a in the mid-secretory phase in the endometrium of women with unexplained infertility.Materials and Methods: This case-control study was carried out on randomly selected fertile (n=10) and infertile (n=16) women whose source of infertility remained unexplained. We evaluated the expression of ER-a and glycodelin-A (GdA) through mRNA level measurement with real-time polymerase chain reaction (PCR) in the endometrium of fertile women and patients suffering from unexplained infertility and fertile women. Endometrial biopsies of each subject were collected during a single menstrual cycle 7 days after the peak of luteinizing hormone (LH+7).Results: Endometrial expression level of ER-a was significantly (P<0.05) higher in the patients with unexplained infertility compared to the control. Significantly (P<0.05) lower levels of GdA expression were seen in women with unexplained infertility. A statistically non-significant negative correlation was observed between ER-a and GdA mRNA expression.Conclusion: Our findings demonstrate that reduction in the endometrial GdA expression is associated with elevated expression of ER-a in mid-luteal phase. Disruption in the endometrial ER-a expression, which leads to defects in uterine receptivity, may contribute to unexplained infertility.

Background: An abnormality in pulse amplitude and frequency of gonadotropin releasing hormone (GnRH) secretion is the most characteristics of polycystic ovarian syndrome (PCOS). On the other hand, arginine-phenylalanine-amide (RFamide) -related peptide-3 (RFRP3) inhibits the secretion of GnRH in mammalian hypothalamus. The current study performed in order to investigate the expression of RFRP3 mRNA in the dorsomedial hypothalamic nucleus (DMH)after the induction of PCOS in a rat model of constant light exposure, and the possible role of parity on occurrence of PCOS.Materials and Methods: In the experimental study, female nulliparous (n=12) and primiparous (n=12) rats were randomly subdivided into control and PCOS subgroups (n=6). PCOS were induced by 90 days exposure to constant light. After 90 days, blood, brain, and ovaries were sampled. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone were evaluated. In addition, six adult female ovariectomized rats as a control of real-time polymerase chain reaction (PCR) tests were prepared and in the DMH of all rats, the relative mRNA expression of RFRP3 was assessed.Results: Histological evaluation of ovaries represented the polycystic features. In addition, serum concentrations of testosterone in the PCOS subgroups were more than the controls (P<0.05). Furthermore, the relative expression ofRFRP3 mRNA in PCOS subgroups was lower than the controls (P<0.05).Conclusion: Constant light model of the PCOS-induced rats decreased the gene expression of RFRP3 in the DMH that suggests the decrease of RFRP3 may reduce its inhibitory effect on GnRH during the PCOS pathogenesis. This effect was stronger in the nulliparous rats than the primiparous.

Background: The presence of different missense mutations in sheep breeds have shown that the bone morphogenetic protein receptor 1B (BMPR1B), bone morphogenetic protein 15 (BMP15) and growth differentiation factor 9 (GDF9)genes play a vital role in ovulation rate and prolificacy in ewes. Therefore, the present study aims to investigate BMPR1B, BMP15 and GDF9 gene mutations in prolific ewes of Iranian fat-tailed Lori-Bakhtiari sheep.Materials and Methods: In the present experimental study, genomic DNA was extracted from whole blood of 10prolific Lori-Bakhtiari ewes with at least two twinning records in the first four parities to identify point mutations of the BMPR1B, BMP15 and GDF9 genes, using DNA sequencing.Results: The results obtained from DNA sequencing showed a new synonymous mutation (g.66496G>A) in exon 8of the BMPR1B gene, without any amino acid change. Sequencing of the BMP15 gene revealed a deletion of 3 bp (g.656_658delTTC) in exon 1, leading to an amino acid deletion (p.Leu19del). Four single nucleotide polymorphisms (G1: g.2118G>A, G2: g.3451T>C, G3: g.3457A>G and G4: g.3701G>A), were detected in exons 1 and 2 of the GDF9gene, two of which caused amino acid substitutions (G1: p.87Arg>His and G4: p.241Glu>Lys). These amino acid alterations are proposed to have a benign impact on structure and function of the GDF9 polypeptide sequence.Conclusion: Three major prolificacy genes (BMPR1B, BMP15 and GDF9) were polymorphic in Lori-Bakhtiari sheep, although none of the major causative mutation was detected in this sheep type. Further studies using high throughput methods such as genome-wide association study (GWAS) and evaluation of other candidate genes are necessary in the future.

Background: Saffron (Crocus sativus L.) has been traditionally used as a spice for coloring and flavoring in some countries cuisine. One of the main components of saffron is Crocin. Recent research have shown that crocin has various pharmacological effects. The aim of this study was to assess the effects of crocin on the Pituitary-Gonadal axis and Kiss-1 gene expression in hypothalamus and ovarian tissue organization in female Wistar rats.Materials and Methods: In this experimental study, 18 adult female Wistar rats were randomly divided into three groups. Control group received normal saline and experimental groups received two different doses of crocin (100and 200 mg/kg) every two days for 30 days. After the treatment period, blood samples were obtained from the heart and centrifuged. Next, the serum levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), estrogen and progesterone hormones were measured by ELISA assay. The ovarian tissues were removed and fixed for histological investigation. The hypothalamic Kiss-1 gene expression was measured using real-time polymerase chain reaction (PCR). All data were analyzed using one-way ANOVA.Results: A significant reduction (P=0.038) in the number of atretic graafian follicles (0.5 ±0.31) was observed inrats treated with 200 mg/kg crocin. In addition, estrogen concentration in experimental groups (35.04±0.85 and36.18±0.69 in crocin 100 and 200 mg/kg groups, respectively) compared to control group (38.35±0.64) and progesterone concentration in rats treated with crocin 200 mg/kg (2.06 ± 0.07) compared to control group (2.16± 0.04), significantly decreased. Interestingly, relative expressions of Kiss-1 mRNA significantly decreased in experimental groups (0.00053±0.00051 and 0.0011±0.00066 in crocin 100 and 200 mg/kg groups, respectively) (P=0.000) compared to control group (1±0).Conclusion: Crocin, at hypothalamic level, reduces Kiss-1 gene expression and it can prevent follicular atresia and reduce serum levels of estrogen and progesterone.

Background: Oocyte cryopreservation is an essential part of the assisted reproductive technology (ART), which was recently introduced into clinical practice. This study aimed to evaluate the effects of two vitrification systems-Cryotop and Open Pulled Straw (OPS) -on mature oocytes gene expressions.Materials and Methods: In this experimental study, the survival rate of metaphase II (MII) mouse oocytes were assessed after cryopreservation by vitrification via i. OPS or ii. Cryotop. Then we compared the fertilization rate of oocytes produced via these two methods. In the second experiment, we determined the effects of the two vitrification methods on the expression of Hspa1a, mn-Sod, and b-actin genes in vitrified-warmed oocytes. Denuded MII oocytes were vitrified in two concentrations of vitrification solution (VS1 and VS2) by Cryotop and straw. We then compared the results using the two vitrification methods with fresh control oocytes.Results: mn-Sod expression increased in the vitrified-warmed group both in OPS and Cryotop compared with the controls. We only detected Hspa1a in VS1 and control groups using Cryotop. The survival rate of the oocytes was 91.2% (VS1) and 89.2% (VS2) in the Cryotop groups (P=0.902) and 85.5% (VS1) and 83.6% (VS2) in the OPS groups (P=0.905). There were no significant differences between the Cryotop and the OPS groups (P=0.927). The survival rate in the Cryotop or the OPS groups was, nevertheless, significantly lower than the control group (P<0.001). The fertilization rates of the oocytes were 39% (VS1) and 34% (VS2) in the Cryotop groups (P=0.902) and 29 % (VS1) and 19.7% (VS2) in the OPS groups (P=0.413). The fertilization rates were achieved without significant differences among the Cryotop and OPS groups (P=0.755).Conclusion: Our results indicated that Cryotop vitrification increases both cooling and warming rates, but both Cryotop and OPS techniques have the same effect on the mouse oocytes after vitrification.

Background: Many autocrine and paracrine elements that are produced within follicular niche have been the focus of much in vitro maturation (IVM) research. The present study was carried out to compare retinoic acid (RA) and basic fibroblast growth factor (bFGF) efficacy on IVM of mouse oocytes, and their further dual consumption to reach an optimal protocol.Materials and Methods: In this experimental study, germinal vesicle (GV) oocytes obtained from two-months-old NMRI mice were randomly divided into control, sham and three experimental groups. The basic culture medium was a-MEM supplemented with 10% fetal bovine serum (FBS), 50 mg/l streptomycin, 60 mg/l penicillin and 10 ng/ml epidermal growth factors. Each of the experimental groups received one of the following treatments: RA (2 mM), bFGF (20 ng/ml) or combination of RA and bFGF with the indicated concentrations. After 24 hours, capacitated spermatozoa were added to in vitro matured oocytes. Five hours later, the oocytes were cultured in fresh droplets of M2medium for 24 hours and assessed for cleavage to the two-cells stage.Results: As compared with the control group, the rate of maturation was significantly increased in the RA (P<0.001) and bFGF+RA (P<0.02) groups with 58 ± 10 and 57 ± 3.46, respectively. The rate of maturation was significant in the RA (P<0.02) and bFGF+RA (P<0.03) groups, in comparison with the bFGF group. The bFGF+RA group had higher rate (83 ± 1.52) of two-cells development, than control (33 ± 1, P<0.001).Conclusion: Our findings showed beneficial effects of 2 mM RA and 20 ng/ml bFGF combination on mouse oocyte IVM.

Background: Dietary antioxidants protect tissues and organs against insecticides/xenobiotic-induced damage. In the present study, we evaluated the results of exposure to synthetic pyrethroid insecticides, cypermethrin (Cyp) and deltamethrin (Del) and possible protective effects of curcumin and quercetin on reproductive systemin male Wistar rats.Materials and Methods: In this controlled experimental study, 42 male Wistar rats were randomly divided into 7groups of 6 animals. Group A served as control, group B was exposed to Cyp (2 mg/kg.bw), group C was exposedto Del (2 mg/kg.bw), group D was exposed to Cyp+Del (2 mg/kg.bw each), group E was exposed to Cyp+Del and treated with curcumin (100 mg/kg.bw), group F was exposed to Cyp+Del and treated with quercetin (100 mg/kg.bw) and group G was exposed to Cyp+Del and treated with quercetin+curcumin for 45 days.Results: Exposure to Cyp and Del caused decreases in reproductive organs weight, sperm count, sperm motility, level of sex hormones viz. testosterone (T), follicle stimulating hormone (FSH) and luteinizing hormone (LH), steroidogenic enzymes viz.3b-hydroxyl steroid dehydrogenase (3b-HSD) and 17b-HSD, non-enzymatic antioxidant glutathione (GSH) and enzymatic antioxidants viz. superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione-S-transferase (GST) and glutathione reductase (GR) activity and increases in sperm abnormalities and lipid peroxidation (LPO). The exposure also adversely affected the histo-achitecture of testes. Single and combined treatment with curcumin and quercetin significantly ameliorated Cyp and Del-induced damagein reproductive system.Conclusion: Curcumin and quercetin protected against Cyp and Del-induced reproductive system toxicity andoxidative damage in rats. The increases in activities of 3b-HSD and 17b-HSD with concomitant increases in testosterone were mainly responsible for ameliorating effects of curcumin and quercetin. Curcumin showed slightly better activity as compared to quercetin. The combination of both antioxidants offered more protection compared to each one alone.

Background: This study aimed to compare the effects of three commonly used varicocelectomy techniques namely, open retroperitoneal ligation (Palomo), open inguinal ligation (Ivanissevich) and laparoscopy, in Iranian infertile men.Materials and Methods: This retrospective study was conducted on 70 infertile men with palpable varicocele who underwent one of the varicocelectomy techniques namely, Palomo, Ivanissevich, or laparoscopy. Basic information about semen parameters were collected and registered prior to the surgery. Three months after the surgery, semen parameters and surgical complications were investigated in all patients.Results: The Palomo technique was significantly associated with fewer complications compared to other techniques (P=0.006). The means of sperm concentration, normal motility and normal morphology were significantly different among the three groups after surgery (P=0.025, 0.023 and 0.047, respectively); however, after adjustment for potential confounders, in addition to the baseline values of semen parameters, significant differences were observed only in sperm concentration among the groups (P=0.040).Conclusion: Varicocelectomy improved sperm parameters. The Ivanissevich technique was more effective in improving sperm concentration compared to the laparoscopic method. The lowest rates of complications were related to the Palomo technique.

Ovarian fibromas are the most common benign solid ovarian tumors, which are often difficult to diagnose preoperatively. Ovarian fibromas, especially in bilateral cases, may be cases of Gorlin-Goltz syndrome (GGS), a rare autosomal dominant disorder with predisposition to basal cell carcinomas (BCCs) and other various benign and malignant tumors. This case report describes a 25 year-old female with GGS, bilateral ovarian fibroma, endometriosis and septated uterus, which was referred to the Gynecology Clinic of Rasoul-e-Akram Hospital in October 2016. This patient had facial asymmetry due to recurrent odontogenic keratocysts. In young cases of ovarian fibromas as reported here, conservative surgical management can preserve ovarian function and fertility. These patients must be followed up by a multidisciplinary team and submitted to periodic tests.

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