International Journal of Fertility & Sterility
Year:2018 | Volume:12 | Issue:2|Papers Count:15

Hypertensive disorders (HDs) as the most prevalent medical problem during pregnancy, predispose the patient to a lot of comorbidities and may even cause maternal or fetal death. The rate of infertility has been increasing in recent decades. So, we collected and summarized data about the co-existence of these two entities and found that HDs are somewhat more common in women receiving fertility treatments regardless of pathophysiologic correlation of infertility and hypertension or older age and chance of multiple pregnancies.

Background: Marital quality reflects the individual’s overall evaluation of marital relationship. The aim of study was examine the effect of cognitive behavioral counseling on marital quality among women.Materials and Methods: The experimental study was a randomized clinical trial with two groups, on 198 qualified women who referred to selected health care centers in Hamadan, Iran in 2016. The intervention participants attended four 90-minute sessions of cognitive behavioral counseling. Demographic information questionnaire and marital quality scale [Revised Dyadic Adjustment Scale (RDAS)] were completed by the two groups before and after the intervention. To perform the comparisons, t test, Chi-square test and Fisher’s test, Logistic Regression and covariance analysis were used. Covariance analysis or change analysis were employed. Statistical analysis was done using SPSS Software, version 21.0. The significance level was set at 5% (P<0.05).Results: According to the results of the present study, the mean age in the control group and the intervention group was 23.58±7.54 and 35.04±7.91 years old, respectively. Covariance analysis was utilized to examine the marital quality scores. In this analysis, after modification of the variables of age, marital quality score of agreement and satisfaction before the intervention, and income status, the total marital quality score experienced a significant change in all dimensions (P<0.05) and the mean scores increased remarkably. Moreover, according to the cut-off point of the dimensions, the scores of all dimensions increased remarkably and the proportion of individuals with high marital quality before and after the intervention changed significantly (P<0.05).Conclusion: Due to the role of sexual relations in stabilizing marriage, cognitive behavioral consultation was effective in improving marital quality especially after agreement and can be used in health care centers in order to improve the relationship between couples and reduce divorce rates (Registration number: IRCT201610209014N125).

Background: Abnormalities in birth weight and gestational age cause several adverse maternal and infant outcomes. Our study aims to determine the potential factors that affect birth weight and gestational age, and their association.Materials and Methods: We conducted this cross-sectional study of 4415 pregnant women in Tehran, Iran, from July 6-21, 2015. Joint multilevel multiple logistic regression was used in the analysis with demographic and obstetrical variables at the first level, and the hospitals at the second level.Results: We observed the following prevalence rates: preterm (5.5%), term (94%), and postterm (0.5%). Low birth weight (LBW) had a prevalence rate of 4.8%, whereas the prevalence rate for normal weight was 92.4, and 2.8% for macrosomia. Compared to term, older mother’s age [odds ratio (OR)=1.04, 95% confidence interval (CI): 1.02-1.07], preeclampsia (OR=4.14, 95% CI: 2.71-6.31), multiple pregnancy (OR=18.04, 95% CI: 9.75- 33.38), and use of assisted reproductive technology (ART) (OR=2.47, 95% CI: 1.64-33.73) were associated with preterm birth. Better socioeconomic status (SES) was responsible for decreased odds for postterm birth compared to term birth (OR=0.53, 95% CI: 0.37-0.74). Cases with higher maternal body mass index (BMI) were 1.02 times more likely for macrosomia (95% CI: 1.01-1.04), and male infant sex (OR=1.78, 95% CI: 1.21-2.60). LBW was related to multiparity (OR=0.59, 95% CI: 0.42-0.82), multiple pregnancy (OR=17.35, 95% CI: 9.73-30.94), and preeclampsia (OR=3.36, 95% CI: 2.15-5.24).Conclusion: Maternal age, SES, preeclampsia, multiple pregnancy, ART, higher maternal BMI, parity, and male infant sex were determined to be predictive variables for birth weight and gestational age after taking into consideration their association by using a joint multilevel multiple logistic regression model.

Background: Among the young generation, medical and law students’ attitude towards third party reproduction is very important because they will be directly involved in restricting or developing the programs that will support it in the future. The aim of this survey was to investigate attitude of law and medical students to oocyte donation and key aspects of this kind of third party.Materials and Methods: In analytical cross-sectional study, 345 medical and law students were randomly selected using stratified sampling. Data was collected using attitude toward donation- oocyte (ATOD-O) questionnaire. Responses were on a 5-point Likert scale. Data were analyzed according to established statistical approach by Heeren and D' Agostino.Results: The majority of the participants agreed with oocyte donation being the last choice for infertility treatment. There was a significant difference between medical students and law students regarding the acceptance of oocyte donation (3.23 vs.3.53, P=0.025). In addition, female participants were more tolerant on receiving donated oocytes from their sisters than male participants (3.01 vs.2.58, P=0.002) and finally, a higher number of the participants had a positive attitude towards anonymity of the donor and the recipient to one another (3.93 vs.3.86, P=0.580). The vast majority of female students believed that the oocyte recipient naturally likes that child (P<0.0001).Conclusion: In the current study, a great majority of law and medical students support oocyte donation as an alternative way of starting a family. There is an interest among female students in donating oocytes anonymously. The majority believed that the oocyte recipient family will like the donor oocyte child naturally.

Background: Many infertile couples experience psychological distress and suffer from impaired quality of life. Generally, when couples are dealing with uncontrolled events such as infertility, it is important to manage it well and to use the suitable coping style; so this can represent an example of attribution style. The purpose of this study is to investigate the quality of life, relationship beliefs and attribution style in infertile couples.Materials and Methods: This cross-sectional study consisted of 50 infertile couples, who were at least 18 years of age and could read and write in Persian. Participants provided demographic and general characteristics and completed the quality of life (SF-12), relationship belief inventory (RBI) and attribution style (ASQ) forms. Data was analyzed by the paired t test, Pearson correlation tests and multiple linear regression analysis, using SPSS version 22 statistical software.Results: Overall, 50 infertile couples participated in our study. The males had a significantly higher score for quality of life compared to the females (P=0.019). In RBI subscales except "Disagreement is Destructive" all others significantly higher in wives than husbands. All subscales of RBI had a negative correlation with the quality of life. The quality of life had a significant correlation with positive internal (r=0.213, P=0.033). The adjusted regression model showed that the quality of life for males was higher than in females (b=-3.098, P=0.024).Conclusion: The current data indicate that in infertile couples, the husbands have a higher quality of life in comparison to their wives. Also, all subscales of relationship beliefs have a negative correlation with the quality of life, but in attribution style, just internal attribution style for positive events is associated with the quality of life. In general, there is a correlation between relationship beliefs and the quality of life in infertile couples.

Background: Infertility is a major and problem influencing different aspects of couples life, especially those of women. Sexual dysfunction is the silent partner of infertility. This study aimed to identify the above-mentioned factors to make necessary decisions and perform efficient interventions to improve the sexual health of infertile women. This study investigated the factors influencing sexual dysfunction in infertile women in Mashhad, Iran.Materials and Methods: This cross-sectional study was conducted on 85 infertile women visiting governmental Infertility Clinic and Research Center in Mashhad, Iran. The convenience sampling method was used in this study. The research tools included a demographic and infertility information form, a sexual self-efficacy questionnaire based on Schwarzer’s General Self-Efficacy Scale, Female Sexual Function Index (FSFI), and Evaluation and Nurturing Relationship Issues, Communication, and Happiness (ENRICH) Marital Satisfaction Scale. The descriptive statistical tests and logistic regression method were used to analyze data.Results: The mean age of women was 31.18±5.56 years old. The majority of participants (36.7%) had higher educations, and 60% of them were housewives. Most of their husbands (49.4%) were self-employed. The mean period of infertility awareness was 6.02 ± 4.47 years, and the mean period of infertility treatment was 4.11±4.46 years. The following variables influenced the sexual function of infertile women: sexual self-efficacy, sexual satisfaction, marital satisfaction, the educational level of both wife and husband, income, satisfaction with spouse appearance, and the high costs of infertility treatment.Conclusion: The findings indicated that some factors such as sexual self-efficacy, marital satisfaction, sexual satisfaction, education, and cost of infertility treatment are associated with sexual function in infertile women.

Background: Infertility is a common clinical problem. Psychological adjustment to infertility refers to changing the viewpoint and attitude of an infertile person toward infertility problems, treatments and possible outcomes. The present study aims to prepare a valid and reliable scale for assessing the psychological adjustment to infertility, by determining the cultural adaptation, validity and reliability of the Persian version of the Fertility Adjustment Scale.Materials and Methods: This is a cross-sectional study performed to localize and validate the Fertility Adjustment Scale, in which 40 infertile women and 40 healthy subjects (fertile or having children) were detected by a gynecologist and the subjects who completed the Fertility Adjustment Scale (FAS) questionnaire were recruited. This study had four steps: in the first step, the literature was reviewed, in the second step, the scale was translated, in the third step, the content and construct validity indicators were calculated, and in the fourth step, reliability of the scale was validated.Results: The mean (±SE and range) of fertility adjustment total scores in the infertile group and the control group were 43.2 (1.2 and 27-57) and 42.3 (1.5 and 18-57), respectively (P=0.623). The content validity was good according to Content Validity Index score (0.7-0.8). A two-component structure was extracted from factor analysis which approximately justifies 52.0% of the cumulative variations. A Cronbach’s alpha value of 0.68 showed moderate reliability.Conclusion: The results of this study revealed that the infertility adjustment scale is a useful tool for the analysis of psychological reactions towards infertility problems and evaluation of the consequences of treating this social-clinical problem.

Background: Health science and technology today is a rapidly growing field. Health is a multifaceted concept influenced by several factors, and health literacy is essential to deal properly with the current situation. In this study, the association between health literacy and sexual function and sexual satisfaction were investigated in 2016.Materials and Methods: This descriptive and correlational study was conducted on 193 couples in the Royan Institute, Tehran. Data collection instruments were three standard questionnaires which included the Test of Functional Health Literacy, the Female Sexual Function Index (FSFI) and the International Index of Erectile Function, and the Iranian version of the Sexual Satisfaction Scale. The data were analyzed using SPSS-v23 software at a significance level of 0.05.Results: Marginal health literacy, 49.7% among men and 44.1% among women, was more common than adequate or inadequate health literacy. Erectile function for the majority of men was appropriate (53.3%), compared to 16.6% who had perfect function and 30.1% for whom function was less than appropriate. The majority of women (57.0%) had sexual dysfunction. One hundred and three (53.3%) men had appropriate sexual function and 57% of women had normal sexual function. The greater proportion of men (50.8%) and women (46.1%) had good, rather than very good or less than good, sexual satisfaction. The results of chi-square tests indicated that greater health literacy was associated with higher levels of sexual function and sexual satisfaction among men and women. However, application of the Cramer’s V test indicates that the strength of these associations is moderate to weak.Conclusion: Health literacy was marginal among most couples and its adverse impacts on sexual function and sexual satisfaction were confirmed. Accordingly, it is recommended that plans be developed to promote health literacy among infertile couples.

Background: The main objective of this survey was to determine the difference between primary and secondary infertility in Morocco and the associated factors among women, who are referred to public and private health centers in Morocco.Materials and Methods: In this cross-sectional study, 619 infertile women referring to public and private health centers in Marrakech-Safi region, were selected by simple random sampling method. This study was conducted between 1 October 2013 and 31 December 2015. Socio-economic status, demographic characteristics, couple’s age, nutritional status and other data related to both male and female reproductive organs were collected by a questionnaire. Logistic regression was used to identify the associated factors to infertility. Statistical significance was set at 0.05.Results: The rates of primary and secondary infertility were 67.37, and 32.63%, respectively. Multivariate analysis identified a model with three significant predictive factors of secondary infertility: duration of marriage [odds ratio (OR)=12.263: 2.289-65.685], socio-economic status (OR=3.83: 1.011-14.70) and the ages of women (OR=1.268: 1.038-1.549).Conclusion: The causes of primary and secondary infertility were not always a woman’s problem, but both man and woman contribute to infertility. Multiple regression analysis showed that women’s age, duration of marriage, and socio-economic status are predictive variables that decrease the chance of fertility among women with secondary infertility.

Background: The aim of present study was to clarify the role of the peroxisome proliferator-activated receptor (PPAR) g Pro12Ala and C161T polymorphisms in the pathogenesis of polycystic ovary syndrome (PCOS) and their influence on lipid and lipoprotein profiles of patients.Materials and Methods: The present cross-sectional study consisted of 50 women with PCOS, who referred to the Kermanshah University of Medical Sciences Clinic between April and October 2015, and 233 unrelated age-matched healthy women from the same region (West Iran). The PPARg Pro12Ala and PPARg C161T polymorphisms were genotyped using the polymerase chain reaction-restriction fragment length polymorphism method. Fasting blood sugar (FBS), serum triglycerides (TG), cholesterol, low density lipoprotein- cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C) and estradiol levels were measured.Results: The serum level of estradiol was significantly lower in PCOS patients compared to healthy women. The PPARg Pro12Ala (CG) genotype increased the risk of PCOS 2.96-fold. The frequency of the PPARg T allele (at C161T) was 21% in patients and 17.2% in controls with no significant difference (P=0.52). In all studied individuals, the PPARg CG genotype was associated with significantly higher levels of TG. However, significantly lower levels of total cholesterol and LDL-C were observed in PPARg TT individuals compared with those with the CC genotype. Within the PCOS group, the PPARg CG genotype was significantly associated with lower levels of estradiol compared with the CC genotype. Also, the CG genotype was significantly associated with higher levels of TG when compared with the CC genotype.Conclusion: Our study shows that, unlike PPARg C161T, PPARg Pro12Ala is associated with the risk of PCOS. Also, we found that the lipid and lipoprotein profiles significantly vary based on PPARg Pro12Ala and C161T genotypes.

Background: Chlamydia trachomatis (CT) infection is the most common sexually transmitted disease in the world that can persist and also ascend in the genital tract. This intracellular and silent infection is related to some adverse pregnancy outcomes, such as miscarriage. The aims of this study were to explore the best CT screening tests using blood and vaginal samples and to investigate the correlation between CT infection and the incidence of miscarriage.Materials and Methods: This case-control study was done in October 2013 through June 2014, using purposive sampling from 157 female participants with or without a history of miscarriage. The samples were taken after each participant had signed a letter of consent and had completed a questionnaire. To achieve the objectives of this study, polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) tests were performed on vaginal swabs and blood samples, respectively.Results: PCR results showed a significantly higher CT infection rate in the miscarriage group compared to the control group (11.3 vs.0%, P=0.007). Anti-CT IgG and IgA antibodies were found in 4.2 and 2.1% of cases in the miscarriage group, and in 1.7 and 6.7% of cases in the control group, respectively (P>0.05). Despite lower humoral responses in this study, positive samples were detected only by one of the following techniques; PCR, ELISA IgA and ELISA IgG. It also should be noted that PCR worked best in terms of detection.Conclusion: Based on the obtained data, there is a strong association between molecular evidence of CT infection and miscarriage. A higher rate of CT detection in molecular tests compared to serological assays suggests that PCR could be used as the first-choice assay for detection of C. trachomatis. However, the importance of serological tests in detecting potential past CT infection or upper genital infection not amenable to sampling is undeniable.

Background: DNA methylation is one the epigenetic mechanisms, which is critically involved in gene expression. This phenomenon is mediated by DNA methyl-transferases and is affected by environmental stress, including in vitro maturation (IVM) of oocytes. Melatonin, as an antioxidant, may theoretically be involved in epigenetic regulation via reductions of reactive oxygen species. This study was performed to investigate DNA methylation and the possibility of goat oocyte development after treatment with different concentrations of melatonin.Materials and Methods: This experimental study was performed to investigate DNA methylation and the possibility of goat oocyte development after treatment with different concentrations of melatonin. For this purpose, oocytes with granulated cytoplasm were selected and co-cultured with at least two layers of cumulus cells in maturation medium with 10-6 M, 10-9 M, 10-12 M and 0-M (as control group) of melatonin. Nucleus status, glutathione content and developmental competence of the oocytes in each experimental group were assessed. Also, expression of genes associated with DNA methylation, including DNA methyltransferase 1 (DNMT1), DNA methyltransferase 3b (DNMT3b) and DNA methyltransferase 3a (DNMT3a) was evaluated by quantitative real time-polymerase chain reaction (RT-PCR).Results: According to our findings, the percentage of oocytes that reached the M-II stage significantly increased in the 10-12 M group (P<0.05). Also, a significant elevation of glutathione content was observed in melatonin-treated oocytes (P<0.05). Analysis of blastocyst formation revealed that developmental competence of the oocytes was higher than the control group (P<0.05). It was observed that melatonin treatment decreased expression levels of DNA methyltransferases (DNMTs) and global DNA methylation (P<0.05). In addition, the expression of melatonin receptor1A (MTNR1A) was detected in both cumulus and oocyte by RT-PCR.Conclusion: The results suggested that in goat model melatonin affects DNA methylation pattern, leading to an improvement in the developmental competence of the oocytes.

Background: Recent studies have shown that vitamin D has an essential role in the reproductive system. In this study, we aimed to investigate the effect of vitamin D levels in patients undergoing ovulation induction (OI), and subsequent intrauterine insemination (IUI) procedure.Materials and Methods: One hundred and four infertile and one hundred and three fertile women were recruited in this cross-sectional study which was conducted in a tertiary level maternity hospital. Infertile patients were divided into pregnant and non-pregnant subgroups after treatment. Individual characteristics and 25-hydroxyvitamin D3 [25 (OH) D3] levels were compared between the groups.Results: The vast majority of our study population consisted of women who had vitamin D deficiency (96.6%). There was no statistically significant difference between infertile and fertile groups in terms of serum 25 (OH) D3 levels (P=0.512). Similarly, no significant difference was observed between the pregnant and non-pregnant subgroups of infertile patients regarding 25 (OH) D3 levels (P=0.267).Conclusion: There is no association between female infertility and serum vitamin D levels. Vitamin D does not predict pregnancy in infertile women undergoing OI with IUI. Further research which will provide a comparison between much more women who have deficient and sufficient 25 (OH) D3 levels is warranted.

Background: The main purpose of this study is to evaluate the effects of varicocelectomy on serum testosterone levels and semen quality in infertile men who suffer from varicocele.Materials and Methods: This prospective study enrolled 115 subjects with clinical varicocele grades II and III and 240 fertile men as the control group. Total volume of testosterone serum level (ng/dl) and semen quality were compared before and after microscopic varicocelectomy. We normalized testosterone serum levels for age, grade, and testis size basis. SPSS 20 software was used to analyze the data. All results of continuous variables were reported as mean±SD. Statistical significance was set at a P<0.05.Results: The mean ages of individuals who participated in the treatment (32.2±5.23) and control (32.8±5.27) groups were similar. There were similar mean values for adjusted testosterone levels between the varicocele (567±222 ng/ml) and control (583±263 ng/ml) groups. In the varicocele group, the adjusted testosterone levels insignificantly increased to 594±243 ng/ml. Among semen parameters, only mean sperm concentration significantly increased after varicocelectomy.Conclusion: Despite increases in sperm concentration, adjusted testosterone levels did not significantly improve after varicocelectomy.

Background: Y chromosome deletions (YCDs) in azoospermia factor (AZF) region are associated with abnormal spermatogenesis and may lead to azoospermia or severe oligozoospermia. Assisted reproductive technologies (ART) by intracytoplasmic sperm injection (ICSI) and testicular sperm extraction (TESE) are commonly required for infertility management of patients carrying YCDs. The aim of this study was to estimate the frequency of YCDs, to find the most frequent variant in infertile men candidate for ART and to compare YCD distribution with a control fertile group. The semen parameters, hormonal profiles and ART outcomes of the infertile group were studied.Materials and Methods: This case-control study consisted of 97 oligozoospermic or non-obstructive azoospermic (NOA) infertile men, who had undergone ART, as the case group and 100 fertile men as the control group. DNA samples were extracted from blood samples taken from all 197 participants and YCDs were identified by multiplex polymerase chain reaction (PCR) of eight known sequence-tagged sites. The chi-square test was used to compare the mean values of hormone and sperm parameters between the two groups. P<0.05 was considered statistically significant.Results: No YCD was detected in the control group. However, 20 out of 97 (20.6%) infertile men had a YCD. AZFc, AZFbc and AZFabc deletions were detected in 15 (75%), four (20%) and one (5%) YCD-positive patients. No fertilization or clinical pregnancy was seen following ICSI in this sub-group with YCD. The mean level of FSH was significantly higher in the group with YCD (28.45±22.2 vs.4.8±3.17 and 10.83±7.23 in YCD-negative patients with and without clinical pregnancy respectively).Conclusion: YCD is frequent among NOA men and YCD screening before ART and patient counseling is thus strongly recommended.